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1.
Can J Diabetes ; 2020 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-32127297

RESUMO

OBJECTIVES: Both type 2 diabetes (T2DM) and dementia have multifactorial etiologies. Both are associated with aging and have well-recognized lifestyle, cardiovascular and psychosocial risk factors. However, uncertainty exists in the literature with regard to: 1) the potentially modifiable risk factors common to both dementia and T2DM, and 2) the risk of brain-related complications in those with established diabetes. In this study, we address this uncertainty and inform design of a survey questionnaire to assess knowledge about diabetes and brain health among at-risk groups. METHODS: This investigation consisted of a mixed-methods approach, including a Delphi consensus study preceded by a systematic literature review. The review was conducted using MEDLINE, EMBASE and Cochrane Library databases. A 2-round online Delphi study, informed by the review, invited international experts to rate their agreement with proposed risk factors and complications. RESULTS: Of 7,337 abstracts retrieved, 13 were included in the final review. Among 46 international experts invited to take part in the Delphi study, 14 (32%) responded. In the Delphi study, hypertension, obesity, physical inactivity and heavy alcohol consumption reached consensus as risk factors common to both T2DM and dementia. Proposed brain-related diabetes complications, depression and dementia were also identified. CONCLUSIONS: Results revealed expert consensus and literature review agreement on a number of common modifiable risk factors for T2DM and dementia, as well as agreement on brain-related complications of diabetes. A number of other proposed shared risk factors did not reach consensus agreement, suggesting a need for more high-quality studies to add to the evidence base.

2.
Ir J Med Sci ; 188(2): 625-631, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30019096

RESUMO

BACKGROUND: Physical activity represents a modifiable behaviour which may be associated with increased likelihood of experiencing positive mental health. AIMS: The aim of this study was to examine the association between self-rated physical activity and subjective indicators of both positive and negative mental health in an Irish adult population. METHODS: Based on data from a population-based, observational, cross-sectional study, participants were categorised using the International Physical Activity Questionnaire (IPAQ) into those who reported that they did and did not meet recommended physical activity requirements. Self-reported positive and negative mental health indicators were assessed using the Energy and Vitality Index (EVI) and the Mental Health Index-5 (MHI-5) from the SF-36 Health Survey Instrument, respectively. Binary logistic regression was used to identify variables independently associated with self-reported positive and negative mental health. RESULTS: A total of 7539 respondents were included in analysis. Overall, 32% reported that they met recommended minimal physical activity requirements. Self-reported positive and negative mental health were reported by 16 and 9% of respondents, respectively. Compared with those who reported meeting-recommended physical activity requirements, those performing no physical activity were three times less likely to report positive mental health (adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.28-0.55) and three times more likely to report negative mental health (OR 3.27, 95% CI 2.38-4.50). CONCLUSION: Compared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes.


Assuntos
Exercício/psicologia , Saúde Mental/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Irlanda , Masculino , Inquéritos e Questionários , Adulto Jovem
3.
Ir J Med Sci ; 188(2): 689-698, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30218291

RESUMO

BACKGROUND: Twelve randomised controlled trials (RCTs) comparing mechanical thrombectomy against traditional treatment options for patients experiencing acute ischaemic stroke (AIS) have been published. AIMS: To evaluate whether this technology is more effective and/or safer than traditional treatment options and to assess the potential for implementation of this technology as a treatment strategy for acute ischaemic stroke in Ireland. METHODS: RCTs published up to February 2017 were included. Meta-analysis was performed for two primary (mortality at 90 days, mRS at 90 days) and four secondary outcomes. Cumulative meta-analysis was used to investigate the point at which a consistent treatment effect was observed for outcomes that had a statistically significant pooled effect. RESULTS: Mechanical thrombectomy was associated with higher likelihood of being independent (mRS, p < 0.01; Barthel index, p < 0.01) at 90 days post-AIS (p < 0.001). Cumulative meta-analysis demonstrated a consistent treatment effect in favour of mechanical thrombectomy after each trial was added to the analysis. There was no evidence of a difference in mortality rates (p = 0.21) or rates of SICH (p = 0.71) between patients randomised to intervention and control arms. Although the intervention appears to be associated with higher rates of any cerebral haemorrhage (p < 0.01) and recurrent ischaemic stroke (p = 0.03), considerable uncertainty remains as to these treatment effects. CONCLUSIONS: The trials published most recently have acted as a 'watershed' for mechanical thrombectomy, and while there are significant caveats, the data suggests that mechanical thrombectomy needs to be factored into the planning and delivery of services for the management of patients with acute ischaemic stroke in Ireland.


Assuntos
Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Terapia Trombolítica/métodos , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia , Resultado do Tratamento
4.
Ir J Med Sci ; 188(3): 751-759, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30536140

RESUMO

PURPOSE: Although good evidence exists regarding the clinical effectiveness of mechanical thrombectomy for people with acute ischaemic stroke, cost-effectiveness should also be considered. The aim of this study was to systematically review the evidence of cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy in the management of acute ischaemic stroke. METHODS: The search was carried out in PubMed, EMBASE, Cochrane Library, and a grey literature search. Studies were included if they compared the costs and consequences of mechanical thrombectomy added to usual medical care compared to usual care alone for people with acute ischaemic stroke in the anterior and/or posterior region. Study quality was assessed using two appraisal tools tailored to economic evaluations. FINDINGS: Thirteen studies were identified including twelve cost-utility analyses and one cost-benefit analysis. Studies could be dichotomised into those that evaluated first-generation (n = 4) and second-generation (n = 9) mechanical thrombectomy devices. Six studies had low applicability, six had moderate applicability, and one had high applicability to other settings. All cost-utility studies reported incremental cost-effectiveness ratios that would be considered cost-effective under typical willingness-to-pay thresholds. CONCLUSIONS: If the outcomes of the trials underpinning the evidence of clinical effectiveness can be replicated, then mechanical thrombectomy is likely to be cost-effective by typical willingness-to-pay thresholds. This finding holds under the assumption that no investment is required to develop stroke centres to the standard required to provide a safe emergency endovascular service and that additional expenditure on timely patient transport is not required.


Assuntos
Isquemia Encefálica/economia , Isquemia Encefálica/terapia , Tratamento de Emergência/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Isquemia Encefálica/mortalidade , Análise Custo-Benefício , Humanos , Acidente Vascular Cerebral/mortalidade , Análise de Sobrevida , Resultado do Tratamento
5.
Resuscitation ; 126: 43-48, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29510194

RESUMO

AIM: The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. METHODS: A ten year prospective observational study involving a cohort of Irish general practices. SETTING: 521 general practice settings distributed throughout the Republic of Ireland, representing approximately one quarter of all practices and a third of Irish GPs. PARTICIPANTS: 534 patients suffering cardiac arrest in the community for whom resuscitation was attempted. INTERVENTIONS: Cardiac arrest with resuscitation attempted (CARA) in which a GP played a role. RESULTS: Over a ten year period almost half of participating practices reported one or more CARAs. A total of 534 CARAs were reported at a variety of locations; 161 (30%) had ROSC (return of spontaneous circulation) at some point, with outcome data available for 147/161; 90 patients survived to hospital discharge. Most survivors for whom follow up data are available were discharged home and were completely independent. The highest rate of survival was achieved when CARAs occurred at a GP practice premises (47.4%). CONCLUSIONS: Resuscitation following OHCA is a key task in general practice. Over time a significant number of GPs encounter OHCA, attempt resuscitation and achieve higher survival to hospital discharge rates than occur nationally among OHCAs in Ireland. We conclude that a defibrillator should be routinely available at all general practices and staff should have appropriate resuscitation skills.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Reanimação Cardiopulmonar/métodos , Desfibriladores/estatística & dados numéricos , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos
6.
Int J Drug Policy ; 52: 9-15, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29223761

RESUMO

BACKGROUND: Drug use for or during sex ('chemsex') among MSM has caused concern, because of the direct effects of the drugs themselves, and because of an increased risk of transmission of sexually transmitted infections (STIs). This study aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland's only MSM-specific sexual health clinic in Dublin over a six week period in 2016. METHODS: The questionnaire collected demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. RESULTS: The response rate was 90% (510/568). One in four (27%) reported engaging in chemsex within the previous 12 months. Half had taken ≥2 drugs on his last chemsex occasion. One in five (23%) reported that they/their partners had lost consciousness as a result of chemsex. Those engaging in chemsex were more likely to have had more sexual partners(p<0.001), more partners for anal intercourse (p<0.001) and to have had condomless anal intercourse(p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR 2.03, 95% CI 1.19-3.46, p=0.009). One in four (25%) reported that chemsex was impacting negatively on their lives and almost one third (31%) reported that they would like help or advice about chemsex. CONCLUSION: These results support international evidence of a chemsex culture among a subset of MSM. They will be used to develop an effective response which simultaneously addresses addiction and sexual ill-health among MSM who experience harm/seek help as a consequence of engagement in chemsex.


Assuntos
Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Prevalência , Parceiros Sexuais , Minorias Sexuais e de Gênero/estatística & dados numéricos , Inquéritos e Questionários , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
7.
Age Ageing ; 46(5): 865-869, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28531240

RESUMO

Background: there is growing consensus around the importance of population level approaches which seek to improve public knowledge and awareness of dementia. Aim: to assess knowledge of the relationship between dementia and ageing, and of the risk and protective factors associated with it, among the general public in Ireland. Design: cross-sectional survey. Participants selected using quota sampling based on Census data. Methods: the final sample of 1,217 respondents provided estimates of dementia knowledge in the Irish population. Logistic regression was used to assess the impact of potential predictor variables on knowledge of dementia. Results: a majority (52%) reported that they knew someone living with dementia. Just 39% were confident that they could tell the difference between the early signs of dementia and normal ageing. Less than half (46%) believed that there were things they could do to reduce their risk of developing dementia, and knowledge of risk and protective factors for dementia was very poor. Although significant differences were seen according to area of residence, social class and experience of dementia, even those groups with 'better' understanding demonstrated substantial knowledge deficits regarding risk and protective factors. Conclusions: the general public in Ireland are confused about the relationship between dementia and ageing, and knowledge of risk and protective factors for dementia is very poor. While not dissimilar to those reported internationally, the findings present a challenge to those tasked with promoting behaviour change and interventions to delay or prevent the onset of dementia.


Assuntos
Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Opinião Pública , Adolescente , Adulto , Fatores Etários , Conscientização , Cognição , Envelhecimento Cognitivo , Compreensão , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Demência/fisiopatologia , Demência/prevenção & controle , Feminino , Comportamentos Relacionados com a Saúde , Envelhecimento Saudável , Humanos , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Proteção , Fatores de Risco , Comportamento de Redução do Risco , Inquéritos e Questionários , Adulto Jovem
8.
Euro Surveill ; 21(27)2016 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-27416848

RESUMO

We report an outbreak of measles which started in April 2016 and which, by 13 June, has resulted in 22 confirmed and five probable measles cases occurring in four regions of Ireland. Genotype B3 was identified. We describe the identification, ongoing investigation and control measures being implemented. This outbreak occurs during a period of very low measles transmission in Ireland, with only one confirmed case (imported) notified in 2016 before this event.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Doenças Endêmicas/estatística & dados numéricos , Vacinação em Massa/estatística & dados numéricos , Sarampo/epidemiologia , Viagem , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Busca de Comunicante , Surtos de Doenças/prevenção & controle , Doenças Endêmicas/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Irlanda/epidemiologia , Masculino , Sarampo/diagnóstico , Sarampo/prevenção & controle , Vacina contra Sarampo/uso terapêutico , Vigilância da População , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
10.
Euro Surveill ; 20(40)2015.
Artigo em Inglês | MEDLINE | ID: mdl-26537764

RESUMO

In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/diagnóstico , Pessoas em Situação de Rua , Psicotrópicos/administração & dosagem , Pirrolidinas/administração & dosagem , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Estudos de Casos e Controles , Cromatografia Líquida de Alta Pressão , Drogas Desenhadas/administração & dosagem , Drogas Desenhadas/análise , Surtos de Doenças , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Psicotrópicos/urina , Pirrolidinas/urina , Fatores de Risco , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia
11.
PLoS One ; 10(7): e0133009, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26208117

RESUMO

The objective of this paper is to provide a detailed evaluation of type 2 diabetes mellitus research output from 1951-2012, using large-scale data analysis, bibliometric indicators and density-equalizing mapping. Data were retrieved from the Science Citation Index Expanded database, one of the seven curated databases within Web of Science. Using Boolean operators "OR", "AND" and "NOT", a search strategy was developed to estimate the total number of published items. Only studies with an English abstract were eligible. Type 1 diabetes and gestational diabetes items were excluded. Specific software developed for the database analysed the data. Information including titles, authors' affiliations and publication years were extracted from all files and exported to excel. Density-equalizing mapping was conducted as described by Groenberg-Kloft et al, 2008. A total of 24,783 items were published and cited 476,002 times. The greatest number of outputs were published in 2010 (n=2,139). The United States contributed 28.8% to the overall output, followed by the United Kingdom (8.2%) and Japan (7.7%). Bilateral cooperation was most common between the United States and United Kingdom (n=237). Harvard University produced 2% of all publications, followed by the University of California (1.1%). The leading journals were Diabetes, Diabetologia and Diabetes Care and they contributed 9.3%, 7.3% and 4.0% of the research yield, respectively. In conclusion, the volume of research is rising in parallel with the increasing global burden of disease due to type 2 diabetes mellitus. Bibliometrics analysis provides useful information to scientists and funding agencies involved in the development and implementation of research strategies to address global health issues.


Assuntos
Bibliometria , Diabetes Mellitus Tipo 2 , Pesquisa/estatística & dados numéricos , Diabetes Mellitus Tipo 2/história , História do Século XX , História do Século XXI , Humanos , Cooperação Internacional , Publicações/história , Publicações/estatística & dados numéricos , Pesquisa/história
12.
Head Neck ; 37(1): 64-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24288356

RESUMO

BACKGROUND: Sialocele and salivary fistula are common complications after parotidectomy. The purpose of the present study was to investigate whether extent of parotidectomy influences the incidence of these complications. METHODS: We conducted a prospective study of 66 consecutive parotidectomies. Cases undergoing skin or bone resection or flap reconstruction were excluded. Patients were divided into 2 groups based on extent of surgery: group 1 (extracapsular dissection or partial superficial parotidectomy); and group 2 (superficial parotidectomy or more extensive resection). The incidence of postoperative sialocele, salivary fistula, and facial weakness was studied. RESULTS: Eleven patients (16.7%) developed a sialocele, and 4 (6.1%) developed a salivary fistula. Group 1 had a significantly higher incidence of wound complications (p = .008), but a significantly lower incidence of facial weakness (p = .004). CONCLUSION: Less extensive parotid resection seems to be associated with a higher incidence of postoperative sialocele and salivary fistula, but is also associated with less postoperative facial nerve dysfunction.


Assuntos
Paralisia Facial/epidemiologia , Mucocele/epidemiologia , Doenças Parotídeas/cirurgia , Complicações Pós-Operatórias , Fístula das Glândulas Salivares/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Parotídeas/patologia , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
13.
Head Neck ; 36(6): 768-71, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23606557

RESUMO

BACKGROUND: There have been few reports of prophylactic thyroidectomy using the minimally invasive video-assisted thyroidectomy (MIVAT) approach in children with multiple endocrine neoplasia 2 (MEN2). METHODS: We conducted a retrospective review of a prospectively maintained database of patients who underwent MIVAT for total thyroidectomy. RESULTS: Six children underwent MIVAT; RET codon mutations identified were 634, 620, 611, and 918. Mean operative time was 93 minutes (range, 68-105 minutes). Five patients were discharged on the first postoperative day; however, 1 patient had a postoperative hematoma and was discharged 2 days postoperatively. There were no cases of laryngeal nerve palsy or postoperative hypoparathyroidism. High levels of satisfaction with postoperative cosmesis were reported. Calcitonin levels have been undetectable at follow-up thus far (mean follow-up, 42.8 months). CONCLUSION: Although our outcomes are similar to those reported using the traditional approach, it is important to note that MIVAT is essentially the same operation, just performed through a smaller incision, with resulting benefits in terms of pain, cosmesis and, perhaps, morbidity.


Assuntos
Neoplasia Endócrina Múltipla Tipo 2a/genética , Neoplasia Endócrina Múltipla Tipo 2a/cirurgia , Proteínas Proto-Oncogênicas c-ret/genética , Neoplasias da Glândula Tireoide/prevenção & controle , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Cirurgia Vídeoassistida , Biomarcadores/metabolismo , Criança , Pré-Escolar , Códon , Feminino , Seguimentos , Predisposição Genética para Doença , Hematoma/etiologia , Humanos , Masculino , Mutação , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/genética , Tireoidectomia/efeitos adversos , Resultado do Tratamento , Estados Unidos , Cirurgia Vídeoassistida/métodos
14.
J Pediatr Surg ; 48(3): 585-90, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23480917

RESUMO

BACKGROUND/PURPOSE: Staying abreast of the literature in a given speciality is difficult. The aim of this study is to analyze the publication patterns of the neonatal surgical literature over the last six decades. MATERIALS: A search strategy for the Web of Science database was designed using MeSH defined terms for 10 index neonatal surgical conditions, with output analyzed over two time-periods. RESULTS: There were 6215 and 6144 publications for periods 1 (1945-1994) and 2 (1995-2010), respectively. There were 24 and 546 articles published in 1945 and 2010, respectively. The mean citation counts of the top 50 publications are 228 and 156 for periods 1 and 2, respectively. There were 6 and 11 authors with two or more publications in the top 50 list in periods 1 and 2, respectively. Three of the pediatric surgery journals cumulatively have published 30.9% of the total articles. CONCLUSIONS: Publication patterns for neonatal surgical conditions have changed significantly over time. The majority of articles are published outside of pediatric surgical journals. Pediatric surgeons should not limit their reading to these journals.


Assuntos
Bibliometria , Neonatologia , Editoração/estatística & dados numéricos , Especialidades Cirúrgicas , Fatores de Tempo
15.
Int J Pediatr Otorhinolaryngol ; 77(5): 699-702, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23434200

RESUMO

OBJECTIVES: To assess Internet use and the influence of smartphones on health-information seeking by parents and carers of children with ENT conditions. METHODS: A paper-based questionnaire was circulated to parents attending otolaryngology services in both the out-patient and day-case settings at a tertiary referral centre. RESULTS: 79.5% of questionnaires were returned. 29.9% had consulted the Internet for ENT-related information. Factors associated with increased rates of ENT-related online activity included younger age, university education, and access to a smartphone (all p ≤ 0.001). 65.7% and 57.7% had found the information which they had found online to be understandable and helpful, respectively; however, just 25.5% felt that it had influenced the medical decisions they had made for their child. 50.3% had previously or intended to discuss information found online with their surgeon. 9.2% had searched online for information regarding their child's surgeon; 19.6% of these said that this had been a factor in choosing that particular surgeon. On ranking 8 information sources in terms of importance (scale 0-5), the ENT Surgeon ranked as most important (mean=4.63), whilst the Internet ranked lowest (3.10). 48.6% of respondents or their partners had an Internet-enabled smartphone; 45.2% said they would definitely use an iPhone app regarding their child's condition if one was available. 36.1% reported they would definitely use the Internet in the future. CONCLUSIONS: Whilst online sources must increasingly be considered in the dialogue with parents, it is clear that parents still rate the clinical team as most important for information gathering. Clinician-provided websites and smartphone applications may be the key to ensuring the provision of quality information into the future.


Assuntos
Telefone Celular/estatística & dados numéricos , Internet/estatística & dados numéricos , Otolaringologia/educação , Pais/educação , Educação de Pacientes como Assunto , Pediatria/educação , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Inquéritos e Questionários , Adulto Jovem
16.
J Surg Educ ; 69(5): 633-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22910162

RESUMO

BACKGROUND: Role models and mentors play an important part in attracting undergraduates into various medical specialties. However, little is known about the part played by role models and mentors in the context of surgery. The aim of this survey was to elucidate medical students' and surgical trainees' experiences of role models and to determine how mentoring works in practice. We also set out to identify traits associated with successful role models and mentors. METHODS: A questionnaire was distributed to senior undergraduate medical students in 1 medical school, and postgraduate surgical trainees (members of the Association of Surgeons in Training (ASIT) in the UK and Ireland. The survey included questions about the availability of mentors and role models and explored mentorship process. RESULTS: A total of 163 medical students and 216 surgical trainees completed the questionnaire. While most medical students did not have a mentor, 52% (n = 104) of trainees reported having a surgical mentor. In both cases, mentoring was ill-structured and informal. While most medical students expressed a preference for a formal mentoring program, only 38% of surgical trainees expressed a preference for a more formal approach. Experiences of negative surgical role models were a pervasive feature for both medical student and surgical trainee respondents. DISCUSSION: This survey highlights a lack of a deliberate approach to mentoring in surgery and the presence of an excess of negative role models. It is, therefore, time for surgeons to pay much more attention to their roles as professional exemplars and mentors.


Assuntos
Mentores , Especialidades Cirúrgicas/educação , Feminino , Humanos , Masculino , Papel (figurativo)
17.
Laryngoscope ; 122(9): 1967-73, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22648552

RESUMO

OBJECTIVES/HYPOTHESIS: To provide an in-depth evaluation of research yield in laryngeal cancer from 1945 to 2010, using large-scale data analysis, employment of bibliometric indicators of production and quality, and density equalizing mapping. STUDY DESIGN: Bibliometic analysis incorporating the Web of Science Database. METHODS: The search strategy employed was as follows; "TS = ((Laryngeal Neoplasm$) OR (Larynx Neoplasm$) OR (Larynx Cancer$) OR (Laryngeal Cancer$))." Author and journal data and cooperation networks were computed following analysis of combinations of countries and institutions that registered cooperation during the study period. Mapping was performed as described by Groneberg-Kloft in 2004. RESULTS: A total of 8,658 items relating to laryngeal cancer were published over the study period, accounting for 139,700 citations. The United States was the most prolific country, accounting for 28.83% (n = 2,496) of total output. Other prolific nations included Italy (n = 794) and Germany (n = 792). There were 973 items published as a consequence of international cooperation; this practice increased steadily over time and accounted for 15.58% (88 of 565) of output in 2010. There were 1,073 different journals publishing articles on laryngeal cancer, although the top 20 (1.8%) most prolific titles were together responsible for more than 43% of the total output; these were led by Laryngoscope (n = 368) and Head and Neck, Journal of the Scientific Specialties (n = 364). A total of 24,682 authors contributed to the literature on laryngeal cancer; the leading author by output was Alfio Ferlito (n = 120); Carlo La Vecchia recorded the highest h-index (h = 32). CONCLUSIONS: This work represents the first attempt to provide quantitative and qualitative analysis of laryngeal cancer research output, whilst in tandem identifying the key bibliometric benchmarks to which those involved in the production of that output might aspire.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Bases de Dados Bibliográficas , Neoplasias Laríngeas , Editoração/estatística & dados numéricos , Benchmarking , Estudos de Avaliação como Assunto , Feminino , Humanos , Irlanda , Masculino
18.
Oncol Rep ; 28(1): 365-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22552811

RESUMO

HER2/neu is associated with poorer clinical outcome in breast cancer. Expression patterns of co-localised cancer-associated genes at 17q12-21 were examined using RT-PCR. The study group consisted of a 96-patient cohort. Relative quantity of mRNA expression was calculated using the comparative cycle threshold method and Qbase software. Results were analysed to detect expression patterns among the genes, and to identify associations between expression levels and clinical data. Levels of HER2/neu correlated with those of GRB7 (r=0.551, p<0.001), RARA (r=0.391, p<0.001), RPL19 (r=0.549, p<0.001) and LASP1 (r=0.399, p<0.001). GRB7 was significantly inversely associated with improved DFS at 60 months (p=0.036). RARA levels were greater in HER2/neu-positive as opposed to HER2/neu-negative patients (p=0.021); levels were significantly higher in ER-positive patients, relative to those who were ER-negative (p=0.003). Levels of RPL19 were significantly higher in the HER2/neu-overexpressing (p=0.010) and luminal B subtypes (p=0.007). LASP1 levels were higher in those patients who had been classified clinically as HER2/neu-positive (p=0.004). This study reaffirms the correlation between HER2/neu and the co-localised LASP1 and GRB7; the latter target may hold additional significance in addition to being a surrogate marker for HER2/neu expression. The relationship identified between RARA and ER-positivity may herald an avenue for targeted therapy of these tumours.


Assuntos
Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Cromossomos Humanos Par 17/genética , Expressão Gênica , Receptor ErbB-2/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Proteínas do Citoesqueleto/genética , Proteínas do Citoesqueleto/metabolismo , Feminino , Proteína Adaptadora GRB7/genética , Proteína Adaptadora GRB7/metabolismo , Humanos , Estimativa de Kaplan-Meier , Proteínas com Domínio LIM/genética , Proteínas com Domínio LIM/metabolismo , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Receptor ErbB-2/genética , Proteínas Ribossômicas/genética , Proteínas Ribossômicas/metabolismo , Tubulina (Proteína)/genética , Tubulina (Proteína)/metabolismo
19.
Vasc Endovascular Surg ; 46(2): 157-62, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22308211

RESUMO

INTRODUCTION: To evaluate supraclavicular scalenectomy ± cervical rib excision for thoracic outlet syndrome (TOS), employing Disability of Arm, Shoulder, and Hand (DASH) scoring for functional assessment post-decompression. METHODS: A QuickDASH score was calculated for each patient using the algorithm: ([sum of responses/n] - 1) × 25, where n = number of completed responses. Nonparametric analysis was employed, with significance defined as P ≤ .05. RESULTS: Twenty-one patients were treated for TOS by the same surgeon; with 5 bilateral procedures (total = 26 procedures). Median DASH scores pre- and postoperatively were 68.5 and 36.0, respectively (P = .002). Just one reported worsening of symptoms postoperatively. Antecedent trauma and smoking were inversely associated with DASH score postoperatively (P = .005 and P = .005). Postoperative scores were less for patients with vascular symptoms (P = .011); scores did not change significantly for those with neurologic (P = .066) or mixed symptoms (P = .345). CONCLUSIONS: This study reconfirmed the value of supraclavicular approach for TOS, with the vast majority reporting subjective improvement.


Assuntos
Braço/inervação , Descompressão Cirúrgica/métodos , Avaliação da Deficiência , Mãos/inervação , Músculos do Pescoço/cirurgia , Procedimentos Ortopédicos , Ombro/inervação , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/cirurgia , Adolescente , Adulto , Algoritmos , Costela Cervical/cirurgia , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Osteotomia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento , Adulto Jovem
20.
Breast Cancer Res Treat ; 133(3): 831-41, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22147079

RESUMO

Molecular subtyping confirms that breast cancer comprises at least four genetically distinct entities based on the expression of specific genes including estrogen receptor (ER), progesterone receptor (PR), and HER2/neu receptor. The quantitative influence of subtype on ipsilateral locoregional recurrence (LRR) is unknown. The aim of this study was to systematically appraise the influence of breast cancer subtype on LRR following breast conserving therapy (BCT) and mastectomy. A comprehensive search for studies examining outcomes after BCT and/or mastectomy according to breast cancer subtype was performed using Medline and cross-referencing available data. Reviews of each study were conducted and data extracted to perform meta-analysis. Primary outcome was LRR related to breast cancer subtype. A total of 12,592 breast cancer patients who underwent either BCT (n = 7,174) or mastectomy (n = 5,418) were identified from 15 studies. Patients with luminal subtype tumors (ER/PR +ve) had a lower risk of LRR than both triple-negative (RR 0.38; 95% CI 0.23-0.61); and HER2/neu-overexpressing (RR 0.34; 95% CI 0.26-0.45) tumors following BCT. Luminal tumors were also less likely to develop LRR than HER2/neu-overexpressing (OR 0.69; 95% CI 0.54-0.89) or triple-negative tumors (OR 0.61; 95% CI 0.46-0.79) after mastectomy. HER2/neu-overexpressing tumors have increased risk of LRR compared to triple-negative tumors (RR 1.44; 95% CI 1.06-1.95) following BCT but there was no difference in LRR between HER2/neu-overexpressing and triple-negative tumors following mastectomy (RR 0.91; 95% CI 0.68-1.22). Luminal tumors exhibit the lowest rates of LRR. Patients with triple-negative and HER2/neu-overexpressing breast tumors are at increased risk of developing LRR following BCT or mastectomy. Breast cancer subtype should be taken into account when considering local control and identifies those at increased risk of LRR, who may benefit from more aggressive local treatment.


Assuntos
Neoplasias da Mama/classificação , Recidiva Local de Neoplasia , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Risco
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