Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 307
Filtrar
1.
Arch Gynecol Obstet ; 309(2): 475-481, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-36735030

RESUMO

OBJECTIVES: The aim of the study is to assess obstetric and fetal outcomes of Jehovah's Witnesses (JWs) mothers in an inner city teaching hospital, as well as to examine the acceptance rates of various blood fractions and blood transfusion alternatives. METHODS: Case series to evaluate the maternal and fetal outcomes of JWs over a nine period between 2013 and 2021. RESULTS: There were 146 pregnancies extracted from our database, of which 10 were early pregnancy losses. Data from 136 deliveries > 24 weeks' gestation were assessed, with a mean maternal age and gestational age of 30.26 (± 5.4) years and 38.7 (± 5.3) weeks, respectively. 57% had normal vaginal deliveries, 8% had instrumental births and 35% had caesarean births. Mean estimated blood loss at caesarean was 575 (± 305.6) mls, while the overall mean estimated loss was 427.8 (± 299.8) mls. Cell salvage was performed in all caesarean sections but autologous transfusion was only necessary for 26%. Consultant presence was documented in 62% of caesarean births. The mean birthweight and 5-min Apgar scores were 3.31 (± 0.05) kg and 9.1 (± 0.09), respectively. There were no maternal deaths or admissions to the adult intensive care unit and the most serious complication was a uterine rupture following a trial of scar, after which the baby required cooling for hypoxic ischaemic encephalopathy. CONCLUSIONS: Pregnant JWs received obstetric care led by senior clinicians, with optimisation of haematinics, minimizing of blood loss at delivery and access to technology such as cell salvage.


Assuntos
Testemunhas de Jeová , Adulto , Feminino , Humanos , Gravidez , Transfusão de Sangue , Parto Obstétrico , Hospitais de Ensino , Londres
2.
Indian J Crit Care Med ; 28(8): 769-776, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39239182

RESUMO

Background: This study aims to assess the knowledge, perceptions, and utilization of point-of-care ultrasound (POCUS) among emergency physicians (EPs) in Saudi Arabia. Point-of-care ultrasound has emerged as a valuable tool in emergency medicine, providing real-time diagnostic information at the bedside. Understanding the current state of POCUS integration and the factors influencing its adoption is crucial for optimizing patient care in emergency settings. Materials and methods: A cross-sectional study was conducted across various hospitals in Saudi Arabia over six months. The study included 100 EPs, encompassing residents and specialists. Data were collected through an online self-administered questionnaire, exploring demographic factors, POCUS training, equipment availability, and physicians' perceptions. Statistical analyses were performed using SPSS version 28.0, including descriptive statistics and Chi-square tests. Results: The study revealed diverse demographic factors, with a majority of physicians working in regional emergency medical centers. While 84.0% of respondents had used an ultrasound device, varying levels of knowledge about POCUS were observed. Regional disparities and differences in training exposure were evident. The majority expressed positive perceptions of POCUS utility, with 67.0% recognizing its usefulness in primary care health centers. However, 31.0% only partially agreed on its daily practice utility, highlighting potential areas for intervention. Conclusion: This study provides a comprehensive assessment of POCUS awareness, knowledge, and perceptions among EPs in Saudi Arabia. The findings underscore the need for targeted educational initiatives, resource allocation, and regional considerations to enhance POCUS integration. Addressing perceived barriers and regional variations can contribute to the widespread adoption of POCUS, ultimately optimizing patient care in emergency settings. How to cite this article: Almulhim KN, Alabdulqader RA, Alghamd MK, Alqarni AA, Althikrallah FM, Alarfaj AA. Assessing Point-of-care Ultrasound Knowledge and Utilization among Emergency Physicians in Saudi Arabia: A Cross-sectional Survey. Indian J Crit Care Med 2024;28(8):769-776.

3.
Virol J ; 20(1): 188, 2023 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-37608372

RESUMO

BACKGROUND: Limited data exists on herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections in migrant populations. This study investigated HSV-1 and HSV-2 seroprevalences and associations among craft and manual workers (CMWs) in Qatar who constitute 60% of Qatar's population. METHODS: A national population-based cross-sectional seroprevalence survey was conducted on the CMW population, all men, between July 26 and September 9, 2020. 2,612 sera were tested for anti-HSV-1 IgG antibodies using HerpeSelect 1 ELISA IgG kits and for anti-HSV-2 IgG antibodies using HerpeSelect 2 ELISA IgG kits (Focus Diagnostics, USA). Univariable and multivariable logistic regression analyses were conducted to identify associations with HSV-1 and HSV-2 infections. RESULTS: Serological testing identified 2,171 sera as positive, 403 as negative, and 38 as equivocal for HSV-1 antibodies, and 300 sera as positive, 2,250 as negative, and 62 as equivocal for HSV-2 antibodies. HSV-1 and HSV-2 seroprevalences among CMWs were estimated at 84.2% (95% CI 82.8-85.6%) and 11.4% (95% CI 10.1-12.6%), respectively. HSV-1 infection was associated with nationality, educational attainment, and occupation. HSV-2 infection was associated with age, nationality, and educational attainment. CONCLUSIONS: Over 80% of CMWs are infected with HSV-1 and over 10% are infected with HSV-2. The findings highlight the need for sexual health programs to tackle sexually transmitted infections among the CMW population.


Assuntos
Herpes Simples , Herpesvirus Humano 1 , Migrantes , Masculino , Humanos , Catar/epidemiologia , Estudos Transversais , Estudos Soroepidemiológicos , Herpes Simples/epidemiologia , Herpesvirus Humano 2 , Anticorpos Antivirais , Imunoglobulina G
4.
MMWR Morb Mortal Wkly Rep ; 72(12): 313-316, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-36952279

RESUMO

U.S. clinical practice guidelines recommend directly observed therapy (DOT) as the standard of care for tuberculosis (TB) treatment (1). DOT, during which a health care worker observes a patient ingesting the TB medications, has typically been conducted in person. Video DOT (vDOT) uses video-enabled devices to facilitate remote interactions between patients and health care workers to promote medication adherence and clinical monitoring. Published systematic reviews, a published meta-analysis, and a literature search through 2022 demonstrate that vDOT is associated with a higher proportion of medication doses being observed and similar proportions of cases with treatment completion and microbiologic resolution when compared with in-person DOT (2-5). Based on this evidence, CDC has updated the recommendation for DOT during TB treatment to include vDOT as an equivalent alternative to in-person DOT. vDOT can assist health department TB programs meet the U.S. standard of care for patients undergoing TB treatment, while using resources efficiently.


Assuntos
Telemedicina , Tuberculose , Humanos , Estados Unidos , Terapia Diretamente Observada , Tuberculose/tratamento farmacológico , Antituberculosos/uso terapêutico , Adesão à Medicação
5.
Support Care Cancer ; 31(8): 461, 2023 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-37436477

RESUMO

OBJECTIVES: Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial. METHODS: Guided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes. RESULTS: We conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership "champions." CONCLUSIONS: Findings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology. TRIAL REGISTRATION: ClinicalTrials.gov #NCT02941614.


Assuntos
Neoplasias da Mama , Depressão , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Depressão/diagnóstico , Depressão/etiologia , Adaptação Psicológica , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Programas de Rastreamento , Guias de Prática Clínica como Assunto
6.
Intervirology ; 65(4): 224-229, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35134813

RESUMO

Several studies have reported serological cross-reactivity of the immune responses between SARS-CoV-2 and DENV. Most of the available studies are based on the point-of-care rapid testing kits. However, some rapid test kits have low specificity and can generate false positives. Hence, we aimed to investigate the potential serological cross-reactivity between SARS-CoV-2 and DENV-IgG antibodies using advanced assays including chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) test. A total of 90 DENV-IgG-ELISA-positive and 90 DENV-IgG-ELISA-negative prepandemic sera were tested for anti-SARS-CoV-2-IgG using the automated CL-900i CLIA assay. Furthermore, a total of 91 SARS-CoV-2-IgG-CLIA-positive and 91 SARS-CoV-2-IgG-CLIA-negative postpandemic sera were tested for anti-DENV-IgG using the NovaLisa ELISA kit. The DENV-IgG-positive sera resulted in five positives and 85 negatives for SARS-CoV-2-IgG. Similarly, the DENV-IgG-negative sera also resulted in 5 positives and 85 negatives for SARS-CoV-2-IgG. No statistically significant difference in specificity between the DENV-IgG-positive and DENV-IgG-negative sera was found (p value = 1.00). The SARS-CoV-2-IgG-positive sera displayed 43 positives, 47 negatives, and 1 equivocal for DENV-IgG, whereas the SARS-CoV-2-IgG-negative sera resulted in 50 positives, 40 negatives, and 1 equivocal for DENV-IgG. No statistically significant difference in the proportion that is DENV-IgG positive between the SARS-CoV-2-IgG-positive and SARS-CoV-2-IgG-negative sera (p value = 0.58). In conclusion, there is a low risk of serological cross-reactivity between the DENV and SARS-CoV-2-IgG antibodies when using advanced detection assays.


Assuntos
COVID-19 , Vírus da Dengue , Humanos , SARS-CoV-2 , COVID-19/diagnóstico , Anticorpos Antivirais , Imunoglobulina G , Ensaio de Imunoadsorção Enzimática/métodos , Sensibilidade e Especificidade
7.
J Pediatr Gastroenterol Nutr ; 75(2): e20-e24, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35666860

RESUMO

OBJECTIVE: The incidence of paediatric inflammatory bowel disease (IBD) has been increasing over 25 years; however, contemporary trends are not established and the impact of COVID-19 on case rates is unclear. METHODS: Data from Southampton Children's hospital prospective IBD database were retrieved for 2002-2021. Incidence rates were calculated based on referral area populations and temporal trends analysed. Disease prevalence for those aged <18 years was calculated for 2017-2021. Monoclonal prescriptions were reported. RESULTS: In total, 1150 patients were included (mean age at diagnosis 12.63 years, 40.5% female). An estimated 704 patients had Crohn's disease (61.2%), 385 had ulcerative colitis (33.5%), and 61 had IBD unclassified (5.3%). Overall IBD incidence increased, ß = 0.843, P = 3 × 10 -6 , driven by Crohn's disease, ß = 0.732, P = 0.00024 and ulcerative colitis, ß = 0.816, P = 0.000011. There was no change in IBDU incidence, ß = 0.230, P = 0.33. From 2002-2021, 51 patients were diagnosed <6 years of age, 160 patients aged 6 to <10 years and 939 patients aged 10 to <18 years of age. Increased incidence was observed in patients aged 10 to <18 years of age (ß = 0.888, P = 1.8 × 10 -7 ). There was no significant change in incidence of IBD in <6 years (ß = 0.124, P = 0.57), or 6 to <10 years (ß = 0.146, P = 0.54). IBD prevalence increased by an average of 1.71%/year from 2017 to 2021, ß = 0.979, P = 0.004. The number of new monoclonal prescriptions increased from 6 in 2007 to 111 in 2021. CONCLUSIONS: IBD incidence continues to increase in Southern England. Compounding prevalence and increased monoclonal usage has implications for service provision.


Assuntos
COVID-19 , Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Adolescente , Criança , Doença Crônica , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Prevalência , Estudos Prospectivos
8.
J Eur Acad Dermatol Venereol ; 36(8): 1246-1255, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35426183

RESUMO

BACKGROUND: Staging systems for cutaneous squamous cell carcinoma (cSCC) produce inconsistent risk stratification. OBJECTIVE: The aim of this study was to identify further prognostic parameters for better stratification. METHODS: We retrospectively analysed the prognostic significance of clinicopathologic parameters of 230 patients who underwent primary excision of invasive cSCC of the head and neck (n = 115) and non-head and non-neck (n = 115) locations. In addition to known high-risk features, we analysed tumour nest shape, invasion pattern, lymphoid response pattern and tumour budding. RESULTS: On multivariable analysis, lymphovascular invasion (LVI) and high tumour budding predicted worse disease-specific survival, and ulceration, LVI and high tumour budding predicted worse overall survival. Only ulceration was independently associated with risk of nodal metastasis. CONCLUSION: High tumour budding, LVI and ulceration are independently associated with poor outcome in cSCC and may be used to refine cSCC prognostic stratification, which is crucial to optimize clinical decision and to identify patients who are more likely to benefit from more aggressive interventions or clinical trials.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço
9.
JAMA ; 327(1): 41-49, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982119

RESUMO

Importance: Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective: To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants: A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions: Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures: The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results: All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance: Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration: ClinicalTrials.gov Identifier: NCT02941614.


Assuntos
Neoplasias da Mama/psicologia , Serviços de Saúde Comunitária , Depressão/diagnóstico , Programas de Rastreamento , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Humanos , Masculino , Oncologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto , Inquéritos e Questionários
10.
Educ Health (Abingdon) ; 34(3): 101-104, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35488656

RESUMO

Background: We analyze the University of British Columbia's Department of Political Science's first course on health, "Global Politics and Health," to determine whether one course could inform political science students to tackle health issues. The major concept was global public health is politics writ large, as determinants of health are rooted in economic and social power. Course objectives encouraged student agency in ameliorating population health status. Methods: We use three surveys, with qualitative and quantitative components, to assess interest and knowledge of public health issues, and determine whether student agency increased as the course progressed. Results: We confirmed that political science develops an excellent foundation for the analysis of issues related to global public health status. One course can stimulate curiosity in health issues. Unexpectedly, we discovered that students' greatest learning outcome integrated personal, interpersonal, and scholarly analyses of health issues. This provided an avenue for students outside of the health sciences to frame mental health, sexuality, and other stigmatized subjects within scholarly discourse. After the course, virtually all students had developed a sense of agency, hope, and tools to understand the roots of mental and physical health. Following case studies on various countries, students quickly grasped the significant impact of politics and economics on people's health. Discussion: We recommend that political science departments offer courses that focus on health for all alongside existing courses on healthcare systems' politics. Furthermore, departments of public health may benefit from including political science courses as core elements of their curriculum to assist graduates in navigating the highly politicized infrastructure of public health. Both disciplines stand to gain from this interdisciplinary opportunity-- in the service of better health for all.


Assuntos
Política , Saúde Pública , Currículo , Saúde Global , Humanos
11.
Br J Dermatol ; 180(2): 404-408, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29897634

RESUMO

Spitzoid neoplasms pose diagnostic difficulties because their morphology is not consistently predictive of their biological potential. Recent advances in the molecular characterization of these tumours provides a framework by which they can now begin to be categorized. In particular, spitzoid lesions with ALK rearrangement have been specifically associated with a characteristic plexiform growth pattern of intersecting fascicles of amelanotic spindled melanocytes. We report the case of an 87-year-old man with a 3-cm nodule on his mid-upper back comprised of an intradermal proliferation of fusiform amelanotic melanocytes arranged in intersecting fascicles with occasional peritumoral clefts. Immunohistochemical studies demonstrated diffuse, strong expression of SOX10 and S100 by the tumour cells and diffuse, weak-to-moderate cytoplasmic positivity for anaplastic lymphoma kinase (ALK), suggestive of ALK rearrangement. Fluorescence in situ hybridization revealed no ALK rearrangements but instead revealed at least three intact ALK signals in 36% of the tumour cells, confirming ALK copy number gain. To our knowledge, this is the first reported case of a plexiform spitzoid neoplasm exhibiting ALK copy number gain instead of ALK rearrangement. This case suggests that ALK copy number gain is a novel mechanism of ALK activation but with the same characteristic histopathological growth pattern seen among ALK-rearranged spitzoid neoplasms.


Assuntos
Quinase do Linfoma Anaplásico/genética , Variações do Número de Cópias de DNA , Nevo de Células Epitelioides e Fusiformes/genética , Neoplasias Cutâneas/genética , Idoso de 80 Anos ou mais , Dorso , Humanos , Hibridização in Situ Fluorescente , Masculino , Nevo de Células Epitelioides e Fusiformes/patologia , Pele/patologia , Neoplasias Cutâneas/patologia
12.
Support Care Cancer ; 27(5): 1737-1745, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30143893

RESUMO

PURPOSE: Limited understanding of factors affecting uptake and outcomes of different cancer survivorship care models hampers implementation of best practices. We conducted a formative evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model. METHODS: We identified clinical, operational, and patient stakeholders within Kaiser Permanente Southern California and conducted semi-structured interviews. Analyses were guided by the Consolidated Framework for Implementation Research (CFIR), an integrated framework from the field of implementation science. Deductive thematic categories were derived a priori from CFIR domains; thematic sub-categories were developed inductively. RESULTS: We interviewed 12 stakeholders; multiple themes were identified. Acceptability: oncologists and operational leaders perceived that the model was an acceptable solution to issues of capacity and efficiency with the potential to improve quality; however, several oncologists perceived negative consequences including "[loss of] the joy of medicine." Patients were less enthusiastic, fearing the introduction of "[someone] who doesn't know me." Feasibility: confidence was high that this model can succeed, although there was concern about finding the right PCP and investment in training and staff support. Culture/climate: numerous system-level facilitators were identified, including encouragement of innovation and familiarity with developing new models. CONCLUSIONS: Formative evaluation is a critical pre-implementation process. Acceptability and feasibility for this model were high among oncologists and operational leaders but patients were ambivalent. Keys to successful implementation include training and support of engaged PCPs and a patient transition plan introduced early in the care trajectory.


Assuntos
Atenção à Saúde/métodos , Ciência da Implementação , Modelos Organizacionais , Neoplasias/reabilitação , Atenção Primária à Saúde/métodos , California , Sobreviventes de Câncer , Atenção à Saúde/organização & administração , Estudos de Viabilidade , Pessoal de Saúde , Humanos , Percepção , Atenção Primária à Saúde/organização & administração
13.
Sensors (Basel) ; 19(20)2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31640246

RESUMO

This paper proposes a comprehensive study of indoor intruder tracking using visible light communication (VLC). A realistic indoor VLC channel was developed, taking into consideration reflections, shadowing, and ambient noise. The intruder was considered smart and aiming to escape tracking. This was modelled by adding noise and disturbance to the intruder's trajectory. We propose to extend the application of minimax filtering from state estimation in the radio frequency (RF) domain to intruder tracking using VLC. The performance of the proposed method was examined and compared with Kalman filter for both VLC and RF. The simulation results showed that the minimax filter provided marginally better tracking and was more robust to the adversary behavior of the intruder than Kalman filter, with less than 0.5 cm estimation error. In addition, minimax was significantly better than Kalman filter for RF tracking applications.

15.
J Pediatr Gastroenterol Nutr ; 64(3): 373-377, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27159210

RESUMO

BACKGROUND: The Pediatric Ulcerative Colitis Activity Index (PUCAI) is a noninvasive clinician-based index, which reflects disease severity in pediatric ulcerative colitis (UC) when no endoscopy is performed. Here, we aimed to explore signs and symptoms important to children with UC and their caregivers as the first stage of developing a patient-reported outcome (PRO) measure for pediatric UC (ie, the TUMMY-UC index) to supplement endoscopic assessment. METHODS: Concept elicitation qualitative interviews were performed with children who have UC and their caregivers in 6 centers. Items were rank-ordered by the interviewees according to the frequency of endorsement and importance, graded on a 1 to 5 scale. RESULTS: A total of 46 children (ages 12.5 ±â€Š3.3 years, range 7-18, 48% boys, 83% with pancolitis, 24% with moderate-severe disease) and 33 caregivers were interviewed (ie, 79 interviews). The following items were identified by the children, in decreasing order of weights: abdominal pain (importance × frequency weight 3.9), rectal bleeding (3.6), stool frequency (3.0), stool consistency (3.0), general well-being/fatigue (2.9), urgency (1.9), and nocturnal stools (1.6). Two other items were scored lower: lack of appetite (1.1) and weight loss (0.6). Children 13 to 18 years comprehended adult vocabulary, children 8 to 12 years comprehended simple vocabulary, and younger children had poor understanding in completing the questions. CONCLUSIONS: In this first stage of the TUMMY-UC development, items were generated and ranked by input from patients. These items are now being explored for optimal vocabulary and response options. The TUMMY-UC will supplement the PUCAI in clinical trial outcome assessment.


Assuntos
Colite Ulcerativa/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino
16.
Anim Genet ; 47(1): 3-11, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26490440

RESUMO

Genomic selection is becoming a standard tool in livestock breeding programs, particularly for traits that are hard to measure. Accuracy of genomic selection can be improved by increasing the quantity and quality of data and potentially by improving analytical methods. Adding genotypes and phenotypes from additional breeds or crosses often improves the accuracy of genomic predictions but requires specific methodology. A model was developed to incorporate breed composition estimated from genotypes into genomic selection models. This method was applied to age at puberty data in female beef cattle (as estimated from age at first observation of a corpus luteum) from a mix of Brahman and Tropical Composite beef cattle. In this dataset, the new model incorporating breed composition did not increase the accuracy of genomic selection. However, the breeding values exhibited slightly less bias (as assessed by deviation of regression of phenotype on genomic breeding values from the expected value of 1). Adding additional Brahman animals to the Tropical Composite analysis increased the accuracy of genomic predictions and did not affect the accuracy of the Brahman predictions.


Assuntos
Cruzamento , Bovinos/genética , Seleção Genética , Maturidade Sexual/genética , Adaptação Fisiológica , Animais , Feminino , Frequência do Gene , Genômica/métodos , Genótipo , Modelos Genéticos , Linhagem , Fenótipo
17.
Jt Comm J Qual Patient Saf ; 42(7): 303-10, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27301833

RESUMO

BACKGROUND: Despite colorectal cancer (CRC) screening and survival rates exceeding national averages in the United States, Kaiser Permanente Southern California (KPSC) aimed to identify system-level improvement opportunities to further reduce mortality from CRC. METHODS: To examine modifiable factors contributing to CRC mortality, a structured hybrid electronic/manual mor- tality review was used to examine 50 randomly selected cases among 524 individuals aged 25-75 years diagnosed with stage II, III, or IV CRC after July 2008 who subsequently died. Physicians conducted chart reviews using a standardized data extraction tool based on evidence-based best practices. RESULTS: Eighty-six percent (43) of the 50 decedents were initially diagnosed with stage III or IV CRC; two cases of appendiceal cancer were excluded. Thirty-one percent (15) of the remaining 48 cases presented with no history of screening; 15% (7) had documented iron deficiency anemia and abdominal pain or rectal bleeding; and 6% (3) had no follow-up colonoscopy after positive screening. Eleven (52%) of the 21 patients with initial stage II-III CRC received appropriate surveillance after curative surgery; 57% (12) developed metastases. Adjuvant chemotherapy was offered to 88% (14/16) of patients with stage III (node-positive) CRC; chemotherapy initiation was delayed in 6 patients. Missed opportunities for surgical oncology evaluation occurred among 61% (11/18) of patients with liver metastases at diagnosis. Failure to report clinically significant features on pathology occurred in 2 patients; they received appropriate treatment for other reasons. CONCLUSIONS: Improvement opportunities existed at multiple stages of care, including screening, evaluation of symp toms, timeliness of care, use of adjuvant chemotherapy, and surgical oncology practices.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Detecção Precoce de Câncer/estatística & dados numéricos , Adulto , Idoso , Quimioterapia Adjuvante , Neoplasias Colorretais/patologia , Prática Clínica Baseada em Evidências , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Qualidade da Assistência à Saúde/organização & administração , Fatores de Tempo , Estados Unidos
18.
Genet Mol Res ; 15(3)2016 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-27525951

RESUMO

Glycopentalone isolated from Glycosmis pentaphylla (family Rutaceae) has cytotoxic and apoptosis inducing effects in various human cancer cell lines; however, its mode of action is not known. Therefore, target fishing of glycopentalone using a combined approach of inverse docking and reverse pharmacophore mapping approach was used to identify potential targets of glycopentalone, and gain insight into its binding modes against the selected molecular targets, viz., CDK-2, CDK-6, Topoisomerase I, Bcl-2, VEGFR-2, Telomere:G-quadruplex and Topoisomerase II. These targets were chosen based on their key roles in the progression of cancer via regulation of cell cycle and DNA replication. Molecular docking analysis revealed that glycopentalone displayed binding energies ranging from -6.38 to -8.35 kcal/mol and inhibition constants ranging from 0.758 to 20.90 µM. Further, the binding affinities of glycopentalone to the targets were in the order: Telomere:G-quadruplex > VEGFR-2 > CDK-6 > CDK-2 > Topoisomerase II > Topoisomerase I > Bcl-2. Binding mode analysis revealed critical hydrogen bonds as well as hydrophobic interactions with the targets. The targets were validated by reverse pharmacophore mapping of glycopentalone against a set of 2241 known human target proteins which revealed CDK-2 and VEGFR-2 as the most favorable targets. The glycopentalone was well mapped to CDK-2 and VEGFR-2 which involve six pharmacophore features (two hydrophobic centers and four hydrogen bond acceptors) and nine pharmacophore features (five hydrophobic, two hydrogen bond acceptors and two hydrogen bond donors), respectively. The present computational approach may aid in rational identification of targets for small molecules against large set of candidate macromolecules before bioassays validation.


Assuntos
Antineoplásicos Fitogênicos/química , Propano/análogos & derivados , Pirróis/química , Sítios de Ligação , Quinase 2 Dependente de Ciclina/química , Quinase 6 Dependente de Ciclina/química , Humanos , Ligação de Hidrogênio , Interações Hidrofóbicas e Hidrofílicas , Simulação de Acoplamento Molecular , Propano/química , Ligação Proteica , Rutaceae/química , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/química
19.
Poult Sci ; 94(2): 169-71, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25589082

RESUMO

The aim of this study was to estimate genetic parameters for BW in meat quail at different ages. A total of 24,382 weight records from 3,652 quail, born between 2009 and 2011, were evaluated. Weekly BW was measured from hatch until 42 d of age. The genetic parameters were estimated by the restricted maximum likelihood method using a multivariate animal model. Heritability of BW ranged from 0.03 to 0.23. Genetic correlations were mainly high and positive. Selection for BW at 28 d of age yielded good indirect genetic progress in BW at 42 d of age.


Assuntos
Peso Corporal/genética , Codorniz/crescimento & desenvolvimento , Animais , Codorniz/fisiologia
20.
Genet Mol Res ; 13(2): 3981-90, 2014 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-24938609

RESUMO

This study investigated the in vitro anticancer activities of a total of 14 wild angiosperms collected in Saudi Arabia. The cytotoxic activity of each extract was assessed against human breast adenocarcinoma (MCF-7) cell lines by using the MTT assay. Among the plants screened, the potential cytotoxic activity exhibited by the extract of Lavandula dentata (Lamiaceae) was identified, and we analyzed its anticancer potential by testing antiproliferative and apoptotic activity. Our results clearly show that ethanolic extract of L. dentata exhibits promising cytotoxic activity with an IC50 value of 39 µg/mL. Analysis of cell morphological changes, DNA fragmentation and apoptosis (using an Annexin V assay) also confirmed the apoptotic effect of L. dentata extract, and thus, our data call for further investigations to determine the active chemical constituent(s) and their mechanisms of inducing apoptosis.


Assuntos
Adenocarcinoma/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Adenocarcinoma/patologia , Apoptose/efeitos dos fármacos , Neoplasias da Mama/patologia , Proliferação de Células , Fragmentação do DNA , Feminino , Humanos , Técnicas In Vitro , Células MCF-7 , Fitoterapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA