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1.
Eur J Obstet Gynecol Reprod Biol ; 252: 206-212, 2020 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-32623252

RESUMO

OBJECTIVE: The aim of this meta-analysis is to review quality of life (QoL) in patients who underwent simple minimally invasive (MIS) hysterectomy compared to abdominal hysterectomy (AH) for benign conditions or endometrial cancer. METHODS: A literature search was performed of electronic databases including Cochrane, Medline, Pubmed, Pubmed Central, clinicaltrials.gov and Embase from study inception until December 2019. Search terms included "QoL", "minimally invasive surgery" "laparoscopic hysterectomy" "abdominal hysterectomy". The literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results were reported as mean differences or pooled odds ratios (OR) with 95 % confidence intervals (95 % CI). RESULTS: A total of 4988 citations were reviewed; 9 studies comprising 3116 patients were selected for the analysis. Publications reporting QoL in patients undergoing simple MIS hysterectomy compared to AH were included. 9 studies reporting 3 different QoL assessment tools were included: EuroQoL five dimensions visual analogue scale (EQ-5D-VAS), Functional Assessment of Cancer Therapy-General (FACT-G) and Short Form-36 (SF-36). For EQ-5D, patients in the MIS group had a significantly higher QoL compared to those in the AH group at 1 week (OR 9.82, 95 % CI 4.61-15.03, p = 0.0002) and 4 weeks (OR 4.83 95 % CI 0.71-8.95, p = 0.02) post-operatively. Similarly, for FACT-G, at 1 week and at 4 weeks post operatively, patients in the MIS group reported a significantly higher score compared to those in the AH group (1 week: OR 6.39, 95 % CI 3.16-9.61, p = 0.0001, 4 weeks: OR 6.33, 95 % CI 3.55-9.12, p = <0.00001). There was no difference in SF-36 scores at any time point between the groups. CONCLUSION: MIS hysterectomy is associated with improved QoL in the short term post-operative phase compared to AH both for benign disease and endometrial cancer.

2.
Gynecol Oncol ; 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32499070

RESUMO

BACKGROUND: Evidence on the incidence and risk factors for lower limb lymphedema (LLL) associated with endometrial cancer is limited. Our objective was to use data from a prospective, longitudinal gynecological cancer cohort study to determine LLL incidence up to 24 months post-diagnosis of endometrial cancer and to explore the relationship between personal and treatment-related factors and risk of developing LLL. METHODS: Women recently diagnosed with endometrial cancer (n = 235) were evaluated at regular intervals post-diagnosis (up to 3-monthly) using bioimpedance spectroscopy (BIS) and self-reported leg swelling (SRLS). RESULTS: Incidence of LLL at 24 months post-diagnosis was 33% and 45% according to BIS and SRLS, respectively. When analyses were restricted to obese women, incidence at 24 months post-diagnosis increased to 67% (BIS) and 54% (SRLS). Following adjusted analyses, higher body mass index was associated with higher odds of baseline lymphedema (BIS: OR 1.91, 95% CI 1.47-2.49, p < .01; SRLS: OR 1.06, 95% CI 1.00-1.12, p < .01) and LLL incidence by 24 months post-diagnosis (BIS: OR 1.29, 95% CI: 0.99-1.68, p = .055; SRLS: OR 1.06, 95% CI 1.02-1.11, p = .008). According to SRLS, presence of comorbidities was also associated with baseline lymphedema (OR: 1.43, 95% CI: 1.15-1.78, p = .001), and more extensive lymph node dissection (OR 1.06, 95% CI: 1.01-1.12, p = .026) and receipt of chemotherapy (OR: 2.65, 95% CI: 1.12-6.29, p = .027) were identified as risk factors for lymphedema incidence. CONCLUSIONS: These findings suggest that LLL following endometrial cancer is common, particularly in women with high body mass index, or comorbidities, and those requiring more extensive lymph node dissection or chemotherapy. Future studies should examine the potential of weight loss intervention as a strategy to reduce LLL incidence.

3.
J Clin Epidemiol ; 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569618

RESUMO

OBJECTIVE: Ensuring implementation fidelity of Patient Reported Outcome Measures (PROMs) in the complex clinical setting is remains exigent. We aimed to integrate the routine use of PROMs reports in day to day patient care, and assess the implementation outcomes using Statistical Process Control (SPC) methods. STUDY DESIGN AND SETTING: This prospective pilot study used an implementation science framework to integrate PROMs. SPC analysis was applied to track patient completion rates and staff acknowledgment rates over time. Daily observational data across clinical areas were collected to assess potential variations. RESULTS: Data were available from 324 patient encounters over 14 weeks. On average, 78% (52% to 100%) of eligible patients entering the clinic completed the PROMs; staff acknowledged 78% (50-100%) of these patient reports. Most patterns of fluctuation were inside the control frame. Dips in compliance relating to changes in clinic daily routine, including the introduction of the second randomised clinic, were quickly resolved with a structured response. CONCLUSIONS: Implementation of PROMs was feasible with reasonable patient completion and staff acknowledgement rates. Fidelity was vulnerable to barriers impacting the daily routine, or unusual events in the clinics, suggesting that greater standardization and integration into clinic processes may yet further improve compliance and consistency of reporting.

4.
Nat Med ; 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32572267

RESUMO

The rapid increase in telemedicine coupled with recent advances in diagnostic artificial intelligence (AI) create the imperative to consider the opportunities and risks of inserting AI-based support into new paradigms of care. Here we build on recent achievements in the accuracy of image-based AI for skin cancer diagnosis to address the effects of varied representations of AI-based support across different levels of clinical expertise and multiple clinical workflows. We find that good quality AI-based support of clinical decision-making improves diagnostic accuracy over that of either AI or physicians alone, and that the least experienced clinicians gain the most from AI-based support. We further find that AI-based multiclass probabilities outperformed content-based image retrieval (CBIR) representations of AI in the mobile technology environment, and AI-based support had utility in simulations of second opinions and of telemedicine triage. In addition to demonstrating the potential benefits associated with good quality AI in the hands of non-expert clinicians, we find that faulty AI can mislead the entire spectrum of clinicians, including experts. Lastly, we show that insights derived from AI class-activation maps can inform improvements in human diagnosis. Together, our approach and findings offer a framework for future studies across the spectrum of image-based diagnostics to improve human-computer collaboration in clinical practice.

5.
Australas J Dermatol ; 2020 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-32363572

RESUMO

Despite the potential of teledermatology to increase access to dermatology services and improve patient care, it is not widely practised in Australia. In an effort to increase uptake of teledermatology by Australian dermatologists and support best practice, guidelines for teledermatology for the Australian context have been developed by The University of Queensland's Centre for Online Health in collaboration with The Australasian College of Dermatologists' E-Health Committee. The guidelines are presented in two sections: 1. Guidelines and 2. Notes to support their application in practice, when feasible and appropriate. Content was last updated March 2020 and includes modalities of teledermatology; patient selection and consent; imaging; quality and safety; privacy and security; communication; and documentation and retention of clinical images. The guidelines educate dermatologists about the benefits and limitations of telehealth while articulating how to enhance patient care and reduce risk when practicing teledermatology.

6.
Int J Gynecol Cancer ; 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32381512

RESUMO

OBJECTIVES: This review examines how response rates to progestin treatment of low-grade endometrial cancer can be improved. In addition to providing a brief overview of the pathogenesis of low-grade endometrial cancer, we discuss limitations in the current classification of endometrial cancer and how stratification may be refined using molecular markers to reproducibly identify 'low-risk' cancers which may represent the best candidates for progestin therapy. We also discuss constraints in current approaches to progestin treatment of low-grade endometrial cancer and perform a systematic review of predictive biomarkers. METHODS: PubMed, ClinicalTrials.gov, and Cochrane Library were searched for studies reporting pre-treatment biomarkers associated with outcome in women with low-grade endometrial cancer or endometrial hyperplasia with an intact uterus who received progestin treatment. Studies of fewer than 50 women were excluded. The study protocol was registered in PROSPERO (ID 152374). A descriptive synthesis of pre-treatment predictive biomarkers reported in the included studies was conducted. RESULTS: Of 1908 records reviewed, 19 studies were included. Clinical features such as age or body mass index cannot predict progestin response. Lesions defined as 'low-risk' by FIGO criteria (stage 1A, grade 1) can respond well; however, the reproducibility and prognostic ability of the current histopathological classification system is suboptimal. Molecular markers can be reproducibly assessed, have been validated as prognostic biomarkers, and may inform patient selection for progestin treatment. DNA polymerase epsilon (POLE)-ultramutated tumors and a subset of p53 wild-type or DNA mismatch repair (MMR)-deficient tumors with 'low-risk' features (eg, progesterone and estrogen receptor-positive) may have improved response rates, though this needs to be validated. DISCUSSION: Molecular markers can identify cases which may be candidates for progestin treatment. More work is needed to validate these biomarkers and potentially identify new ones. Predictive biomarkers are anticipated to inform future research into progestin treatment of low-grade endometrial cancer and ultimately improve patient outcomes.

7.
Australas J Dermatol ; 61(2): e174-e183, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32232852

RESUMO

Despite the potential of teledermatology to increase access to dermatology services and improve patient care, it is not widely practised in Australia. In an effort to increase uptake of teledermatology, Australian-specific practice guidelines for teledermatology are being developed by the Australasian College of Dermatologist. This paper reports finding from literature reviews that were undertaken to inform the development of these guidelines. Results cover the following sections: Modalities of teledermatology; Patient selection and consent; Imaging; Quality and safety; Privacy and security; Communication; and Documentation and retention. The document educates providers about the benefits and limitations of telehealth while articulating how to enhance patient care and reduce risk when practicing teledermatology.

8.
Support Care Cancer ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32170440

RESUMO

BACKGROUND: The use of complementary and alternative medicines (CAM) has been reported to be frequent and increasing in the general population and among cancer survivors. Very few studies have investigated the use of CAM among long-term endometrial cancer survivors. To address this gap in evidence, this qualitative study aimed to understand the use of CAM and factors motivating the use among long-term survivors of endometrial cancer. METHODS: Semi-structured qualitative interviews were conducted with 17 women diagnosed with endometrial cancer 7-10 years previously, to understand their CAM use and its impact on their wellbeing. Thematic analysis was performed by two researchers to extract the most relevant quotes related to CAM products, practices, and practitioners. RESULTS: All 17 women interviewed used some type of CAM practices, practitioners, or products, specifically 94% concentrated on their diet, 88% focused on their exercise, 59% used a CAM product, 53% visited a CAM practitioner, and 18% used a CAM psychological approach. The main motivators for CAM use included to reduce physical and psychological symptoms, and to stop or reduce medications. Women reported a lack of lifestyle advice from their traditional medical healthcare team which they therefore tried to obtain from other sources. CONCLUSIONS: Our findings suggest CAM practices, practitioners, or products form an important part of women's healthcare options and are commonly used by long-term endometrial cancer survivors. Our data can be of importance to health care professionals and hospitals, as it reflects an unfulfilled need among cancer survivors that does not currently appear to be met by their traditional healthcare team.

9.
Aust N Z J Public Health ; 44(2): 111-115, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32190955

RESUMO

INTRODUCTION: A Melanoma Screening Summit was held in Brisbane, Australia, to review evidence regarding current approaches for early detection of melanomas and explore new opportunities. RESULTS: Formal population-based melanoma screening is not carried out in Australia, but there is evidence of considerable opportunistic screening as well as early detection. Biopsy rates are rising and most melanomas are now diagnosed when in situ. Based on evidence review and expert opinion, the Summit attendees concluded that there is currently insufficient information in terms of comparative benefits, harms and costs to support change from opportunistic to systematic screening. Assessment of gains in precision and cost-effectiveness of integrating total body imaging, artificial intelligence algorithms and genetic risk information is required, as well as better understanding of clinical and molecular features of thin fatal melanomas. CONCLUSIONS: Research is needed to understand how to further optimise early detection of melanoma in Australia. Integrating risk-based population stratification and more precise diagnostic tests is likely to improve the balance of benefits and harms of opportunistic screening, pending assessment of cost-effectiveness. Implications for public health: The Summit Group identified that the personal and financial costs to the community of detecting and treating melanoma are rising, and this may be mitigated by developing and implementing a more systematic process for diagnosing melanoma.


Assuntos
Detecção Precoce de Câncer , Programas de Rastreamento/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Austrália , Consenso , Detecção Precoce de Câncer/métodos , Política de Saúde , Humanos , Melanoma/prevenção & controle , Prática de Saúde Pública , Neoplasias Cutâneas/prevenção & controle
10.
Dermatology ; 236(2): 90-96, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32114570

RESUMO

BACKGROUND: Previous cross-sectional research indicates high acceptance of mobile teledermoscopy-enhanced skin self-examination (SSE) by consumers based on the technology acceptance model (TAM) domains: perceived usefulness, ease of use, compatibility, attitude and intention, subjective norms, facilitator, and trust. However, no study has assessed this outcome longitudinally among people who actually used the technology in their own homes. METHODS: Participants were living in Brisbane, Australia, aged 18 years or older, and at high risk of skin cancer. Participants randomly assigned to the intervention group (n = 98) completed a self-administered questionnaire on mobile teledermoscopy acceptance for skin cancer detection both before use and after performing mobile teledermoscopy-enhanced SSE in their homes. The survey included a 25-item scale assessing seven TAM domains. Item scores ranged from 5 (strongly agree) to 1 (strongly disagree). Participants also answered survey questions on satisfaction with use of teledermoscopy, and a 9-item "thoughts about melanoma" scale that measures cancer worry. RESULTS: Participants were 19-73 years old, had high skin cancer risk, blue or grey eyes (53.1%), fair or very fair skin (88.8%), and previous skin cancer treatments (61.2%). Participants were more accepting of mobile teledermoscopy at baseline: mean TAM score of 4.15 (SE 0.05); their level of acceptance decreased significantly after teledermoscopy use: mean score 3.94 (SE 0.05; p = 0.001). In linear regression analysis, the decrease in TAM scores was similar across demographic and skin cancer risk categories. Ninety-two percent (n = 90) of participants agreed that mobile teledermoscopy was easy to use. The mean score of the "thoughts about melanoma" scale did not change significantly from baseline to follow-up. CONCLUSION: Consumers had high TAM scores before they used mobile teledermoscopy within a randomised control trial. At the end of the intervention period, TAM scores decreased, although participants' average score still indicated "agreement" that mobile teledermoscopy was acceptable.

11.
Dermatology ; 236(2): 97-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126557

RESUMO

BACKGROUND: Mobile teledermoscopy is a rapidly advancing technology that promotes early detection and management of skin cancers. Whilst the use of teledermoscopy has proven to be effective and has a role in the detection of skin cancers, patients' attitudes towards the multiple ways in which this technology can be utilised has not been explored. METHODS: Data were obtained from a large randomised controlled trial comparing mobile teledermoscopy-enhanced skin self-examinations (SSEs) with naked-eye SSE. A semi-structured interview guide was developed by the investigators with questions focusing on people's previous skin screening behaviours and 2 of the major pathways which can be utilised in mobile teledermoscopy: (i) direct-to-consumer and (ii) doctor-to-doctor. All interviews were tape-recorded and transcribed verbatim. Thematic analysis was undertaken by 2 independent researchers. RESULTS: Twenty-eight participants were interviewed. Eighty-six percent of participants (n = 24/28) had previously had a clinical skin examination. Only 18% of participants (n = 5/28) visited the same doctor for each clinical skin examination. Five main themes were identified in the interviews that affected how people felt about the integration of mobile teledermoscopy into skin screening pathways: history of clinical skin examinations, continuity of the doctor-patient relationship, convenience of the direct-to-consumer teledermoscopy, expedited review enhancing the doctor-to-doctor setting and mobile teledermoscopy as a partner-assisted task. CONCLUSIONS: Overall mobile teledermoscopy was viewed positively for both direct-to-consumer and doctor-to-doctor interaction. Continuity of care in the doctor-patient relationship was not found to be a priority for clinical skin examination with most participants visiting several doctors throughout their clinical skin examination history.

13.
Int J Cancer ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32067220

RESUMO

There is little long-term follow-up information about how the number of melanoma deaths and case fatality vary over time according to the measured thickness of melanoma at diagnosis. This population-based longitudinal cohort study examines patterns and trends in case fatality among 44,531 people in Queensland (Australia) diagnosed with a single invasive melanoma (International Classification of Diseases for Oncology, third revision [ICD-O-3], C44, Morphology 872-879) between 1987 and 2011, including 11,883 diagnosed between 1987 and 1996, with up to 20 years follow-up (to December 2016). The 20-year case fatality increased by thickness, with the percentage of melanoma deaths within 20 years of diagnosis being up to 4.8% for melanomas with measured thickness <0.80 mm, 10.6% for tumors 0.8 to <1.0 mm and generally more than 30% for melanomas measuring 3 mm and more. For melanomas <1.0 mm, most deaths occurred between 5 and 20 years after diagnosis, whereas for thicker melanomas the reverse was true with most deaths occurring within the first 5 years. Five-year case fatality decreased over successive calendar time periods for melanomas <1.0 mm, but not for melanomas ≥1.0 mm. These findings demonstrate that the time course for fatal melanomas varies markedly according to tumor thickness at diagnosis. Improved understanding of the patient factors and characteristics of melanomas, in addition to tumor thickness, which increase the likelihood of progression, is needed to guide clinical diagnosis, communication with patients and ongoing surveillance pathways of patients with potentially fatal lesions.

14.
Telemed J E Health ; 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32058835

RESUMO

Background: Technological advances have given rise to virtual health care services, resulting in a shift in how traditional health care services are being delivered. Consumers are increasingly demanding efficient access to health care information and services irrespective of time and distance, which is further driving the digitization of health care. This digital economy has created new opportunities for innovative new business models to meet the needs of these new markets. This study explores several in-use business models of virtual health care service platforms that incorporate mobile teledermoscopy (MTD) technologies. By comparing the different building blocks of these commercial ventures, we provide insights on business model choices and discuss the elements that contribute to economically sustainable and viable service offerings incorporating MTD applications. Materials and Methods: We searched the literature on teledermatology, complemented by searches using Google and other mobile app store platforms, and identified seven commercial ventures using teledermoscopy. We analyzed the building blocks of each business model by using an adapted version of Ash Maurya's Lean Canvas and Alexander Osterwalder's Business Model Canvas. Results: We identified three business elements that support the viability, sustainability, and growth of online dermatology services: developing key partnerships, clinician involvement in the design and implementation process, and managing the medico-legal risks and liabilities that are relevant for each country. Conclusions: Leveraging mobile technologies to deliver virtual health care present new business opportunities for health care providers. A better understanding of the business features associated with existing commercial ventures may increase uptake and improve financial viability of MTD applications as a complementary tool to traditional patient care models.

15.
Dermatology ; 236(2): 81-89, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097934

RESUMO

BACKGROUND: Skin cancer places a substantial burden on the health system in Australia. The modernisation of skin cancer prevention interventions by using social media may enhance their contemporary reach and relevance, especially among the youth. This study aimed to analyse Twitter posts in Australia to establish a baseline of skin cancer and sun-related communication trends. METHODS: Tweets posted over the summer of 2018/2019 relating to relevant keywords and hashtags such as "slipslopslap" and "sunscreen" were analysed using quantitative and qualitative methods. The number of tweets, related communication patterns, and possible factors for sudden changes in tweet volume were studied. RESULTS: Results showed that Australians are using Twitter to communicate about their sun-related and skin cancer experiences and to share advice and information on this matter. Overall, Australians use Twitter more frequently to talk about sunscreen (number of tweets between December 2018 and February 2019 = 5,842) and/or skin cancer (n = 3,936), but not so often to communicate about other sun-protective behaviours (n = 1,972) or skin cancer prevention campaigns (n = 108). The number of tweets is greatly affected by the increase in temperature. Celebrities, non-health-related organisations with a high number of followers, and individuals sharing their own skin cancer experiences achieve a substantial number of likes and retweets and thus influence on Twitter regarding skin cancer-related communication. CONCLUSIONS: The results allow deeper understanding of important determinants for effective social media use for health promotion and public health messaging in the future. Linking tweets with temperature, sharing by celebrities or non-health-related organisations and individuals with a high following can all contribute to greater spread of skin cancer and sun-related messages.

16.
Dermatology ; 236(2): 75-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107345

RESUMO

BACKGROUND: The relationship between social media usage and the public's expressions of sunburn remains unexplored. This study is a content analysis of Twitter that was performed to identify the public's expressions, perceptions, and attitudes towards sunburn. METHODS: Qualitative content analysis was conducted on tweets by Australian Twitter users during January 2007 and January 2016. Out of 2,000 tweets available, in-depth content analysis of 200 random tweets was performed. RESULTS: Tweets in this study were categorised into 10 distinct themes, three of which were cognitive (fact based) and seven affective (emotional), while one was miscellaneous. Results reveal that tweets about sunburn overwhelmingly contained affective as opposed to cognitive components. In addition, the sentiments contained in the affective tweets were frequently positively (68.9%) rather than negatively valanced (31.1%). While humour was the most common theme (n = 68 tweets), many tweets also expressed a link between Australian national identity and sunburn (n = 25 tweets). CONCLUSION: Many of the tweets analysed contained positive affective sentiments such as joy, rather than worry or concern, suggesting an avenue for further health promotion research.

17.
BMJ Open ; 10(2): e034388, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32107270

RESUMO

OBJECTIVE: To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths. DESIGN: Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses. SETTING: Queensland, Australia. PARTICIPANTS: Men and women with a mean age 50 years modelled for 30 years. INTERVENTIONS: Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo. PRIMARY AND SECONDARY OUTCOMES: Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years. RESULTS: Per 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%). CONCLUSIONS: Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.

19.
Lymphat Res Biol ; 18(2): 101-109, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31486709

RESUMO

Background: This study aimed at testing whether arm-to-leg ratios of extracellular water (ECW) and ECW normalized to intracellular water (ICW), measured by bioimpedance spectroscopy (BIS), can accurately detect bilateral, lower-limb lymphedema, and whether accounting for sex, age, and body mass index (BMI) improves the diagnostic performance of cut-offs. Methods and Results: We conducted a dual-approach, case-control study consisting of cases of bilateral, lower-limb lymphedema and healthy controls who self-reported absence of lymphedema. The diagnostic performance using normative data-derived cut-offs (i.e., mean + 0.5 standard deviation [SD] to mean + 3 SD; n = 136, 66% controls) and receiver operating characteristic (ROC) curve-derived cut-offs (n = 746, 94% controls) was assessed. The impact of sex, age, and BMI was investigated by comparing stratified and nonstratified normative data-derived cut-offs, and ROC curves generated from adjusted and unadjusted logistic regression models. Arm-to-leg ratios of ECW between mean + 0.5 SD and mean + 1 SD showed fair to good sensitivity (0.73-0.84) and poor to good specificity (0.64 to 0.84). Arm-to-leg ratios of ECW/ICW failed to detect lymphedema (sensitivity <0.5). Stratification by sex, or by sex and age, yielded similar results to nonstratified cut-offs. Cut-offs derived from adjusted ROC curves showed both good sensitivity (0.83-0.89) and specificity (0.8-0.84). Conclusion: These findings represent new BIS criteria for diagnosing lower-limb lymphedema that do not rely on comparison to baseline measures or the presence of a nonaffected, contralateral limb.

20.
JMIR Res Protoc ; 8(11): e14579, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31769763

RESUMO

BACKGROUND: Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. OBJECTIVE: The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. RESULTS: This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. CONCLUSIONS: Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14579.

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