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1.
Mar Pollut Bull ; 151: 110867, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32056647

RESUMO

We report the first large-scale investigation of microplastic contamination in beach sediments across Auckland, New Zealand's most populous region. Sediment samples were taken from the high tide and intertidal zones at 39 sites across estuary, harbour and ocean environments of the East and West Coasts. Microplastic contamination was present at the majority of beaches studied with a mean abundance of 459 particles.m-2 ranging from 0 to 2615 particles.m-2. High variability was observed between the sites, indicating the importance of small-scale factors on microplastic contamination. Samples from high and intertidal zones showed no significant difference in microplastic contamination (p = 0.225). The West Coast beaches exhibited higher microplastic contamination compared with East Coast beaches (p = 0.004). Microplastics were predominately fibres (88%), with lower proportions of fragments (8%) and films (4%). The majority of the microplastics analysed were regenerated cellulose (34%), polyethylene terephthalate (22%) and polyethylene (15%).


Assuntos
Monitoramento Ambiental , Microplásticos/análise , Poluentes Químicos da Água/análise , Sedimentos Geológicos , Nova Zelândia , Plásticos
2.
HPB (Oxford) ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32081540

RESUMO

BACKGROUND: In 2017, the WHO updated their 2010 classification of pancreatic neuroendocrine tumors, introducing a well-differentiated, highly proliferative grade 3 tumor, distinct from neuroendocrine carcinomas. The aim of this study was to investigate the clinical significance of this update in a large cohort of resected tumors. METHODS: Using a multicenter, international dataset of patients with pancreatic neuroendocrine lesions, patients were classified both according to the WHO 2010 and 2017 schema. Multivariable survival analyses were performed, and the models were evaluated for discrimination ability and goodness of fit. RESULTS: Excluding patients with a known germline MEN1 mutation and incomplete data, 544 patients were analyzed. The performance of the WHO 2010 and 2017 models was similar, however surgically resected grade 3 tumors behaved very similarly to neuroendocrine carcinomas. CONCLUSION: The addition of a grade 3 NET classification may be of limited utility in surgically resected patients, as these lesions have similar postoperative survival compared to carcinomas. While the addition may allow for a more granular evaluation of novel treatment strategies, surgical intervention for high grade tumors should be considered judiciously.

3.
J Orthod ; 47(1): 72-77, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31697179

RESUMO

INTRODUCTION: Retention is a crucial part of orthodontic treatment; however, patients often do not wear their retainers as advised. The British Orthodontic Society developed the 'Hold that Smile' campaign in 2017, to improve patient knowledge about retention. Information is provided in two formats: a cartoon and a conventional film. OBJECTIVE: To assess whether patients find the 'Hold that Smile' videos useful and whether they improved patients' intended retainer wear. The gold standard was that 90% of patients should intend to wear their retainers in the long term after watching the videos. DESIGN: National multicentre audit. SETTING: Nine units in the UK. METHODS: Patients aged ⩾ 10 years, in fixed appliances or retention, watched the retainer videos and then completed a questionnaire that was designed specifically for this audit. Each unit collected data for approximately 30 patients. RESULTS: Data were collected for 278 patients in total. The average age was 17.9 years; 64.4% of patients were female and 35.6% were male. Most patients (86.3%) watched both videos and, of these, 44.1% preferred the film, 31.3% preferred the cartoon and 24.6% had no preference. The majority of patients (81.3%) felt that the film provided them with new information, compared with a lower percentage (48.5%) for the cartoon. More patients said they would recommend the film (76.3%) compared with the cartoon (63.3%). Before watching the videos, 77.0% of patients felt they knew about long-term retainer wear and 74.3% of those intended to wear their retainers in the long term. After watching the videos, 96.4% of all patients thought they would now wear their retainers long term. CONCLUSION: After watching the videos, there was a notable increase in the number of patients planning to wear their retainers long term and the gold standard was met. Therefore, these videos may be beneficial in improving understanding and compliance with retention.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31752203

RESUMO

Home-based interventions targeting children's sedentary behaviours have had limited and inconsistent effectiveness, possibly due to a mismatch between the behaviours targeted, the behaviours actually performed, and health-risk messages parents need to initiate change. Between October 2017-February 2018, 540 parents completed an online survey indicating their own and their child's participation in 15 home-based sedentary behaviours (child mean age 11.1 ± 2.61 years, 52% male; parent mean age 40.7 ± 6.14, 93% female). Parents also indicated which home-based sedentary behaviours they and their child could reduce, and what health-risk messages would make them change their child's behaviours. The most prevalent sedentary behaviours among children (particularly older children) and parents were screen-based leisure-time activities, specifically TV/video/DVD use (67.5 and 62.5 min/day, respectively) and using a tablet/smart phone for leisure (53.6 and 80.8 min/day, respectively). Importantly, these were also perceived as the most feasible behaviours parents and children could reduce. Parents reported that the following messages would help them reduce their child's sedentary behaviour: sitting may increase the risk of poor mental health (85.2% of parents) and adversely impact future health as an adult (85.1%). These findings highlight feasible behavioural targets and intervention content for programs aiming to reduce sedentary behaviours in the home environment. Further research is needed to test these strategies.

5.
N Z Med J ; 132(1503): 83-92, 2019 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581185

RESUMO

Genomic analysis of tissues from rapid autopsy programmes has transformed our understanding of cancer. However, these programmes are not yet established in New Zealand. Our neuroendocrine tumour research group, NETwork!, received a request from a patient wishing to donate tumour tissues post-mortem. This viewpoint article summarises the ethical, logistical and social process undertaken to accept this patient's generous donation, and highlights the scientific and educational value of such a gift.


Assuntos
Pesquisa em Genética , Neoplasias/genética , Participação do Paciente , Variantes Farmacogenômicos , Manejo de Espécimes , Bancos de Tecidos , Protocolos Clínicos , Bases de Dados Genéticas , Heterogeneidade Genética , Humanos , Neoplasias/terapia , Nova Zelândia , Participação do Paciente/legislação & jurisprudência , Participação do Paciente/métodos , Manejo de Espécimes/ética , Manejo de Espécimes/métodos , Bancos de Tecidos/ética , Bancos de Tecidos/legislação & jurisprudência , Bancos de Tecidos/organização & administração
6.
J Clin Med ; 8(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547431

RESUMO

Quality performance indicators (QPIs) are used to monitor the delivery of cancer care. Neuroendocrine tumours (NETs) are a family of individually uncommon cancers that derive from neuroendocrine cells or their precursors, and can occur in most organs. There are currently no QPIs available for NETs and their heterogeneity makes QPI development difficult. CommNETs is a collaboration between NET clinicians, researchers and advocates in Canada, Australia and New Zealand. We created QPIs for NETs using a three-step consensus process. First, a multidisciplinary team used the nominal group technique to create candidates (n = 133) which were then curated into appropriateness statements (62 statements, 44 sub-statements). A two-stage modified RAND/UCLA Delphi consensus process was conducted: an online survey rated the statement appropriateness then the top-ranked statements (n = 20) were assessed in a face-to-face meeting. Finally, 10 QPIs met consensus criteria; documentation of primary site, proliferative index, differentiation, tumour board review, use of a structured pathology report, presence of distant metastasis, 5- and 10-year disease-free and overall survival. These NET QPIs will be trialed as a method to monitor and improve care for people with NETs and to facilitate international comparison.

7.
BMC Public Health ; 19(1): 1041, 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31376838

RESUMO

BACKGROUND: Adolescents engage in various combinations (typologies) of physical activity and sedentary behaviors, which impact their health and wellbeing in different ways. As such, there is a need to understand the factors that may inhibit or facilitate engagement in combinations of activity-related behaviors to help inform effective intervention strategies targeting those most in need. The aim of this study was to identify ecological correlates of adolescent physical activity and sedentary behavior typologies. METHODS: Cross-sectional study of 473 adolescents (15.0 ± 1.6 years, 41.4% boys) from 18 secondary schools in Melbourne, Australia. Intrapersonal, interpersonal and neighborhood-physical environmental factors were assessed via self-report surveys and Geographic Information Systems. Multinomial logistic regression models determined the relative risk ratio of membership of three homogenous activity-related behavior typologies based on the potential correlates. RESULTS: Higher levels of self-efficacy for physical activity, parental screen-time restriction rules, parental support for physical activity, sibling screen-time co-participation and perceptions of neighborhood pedestrian/traffic safety were associated with greater likelihood of adolescents being in the typology defined as highly active and low sedentary compared to the physically inactive, highly sedentary typology. Higher frequency of co-participation in screen-time with friends was associated with greater likelihood of adolescents being in the typology defined as moderately active, high screen-time compared to physically inactive, highly sedentary. CONCLUSIONS: A range of intrapersonal, interpersonal and environmental correlates appear to play a role in adolescent activity-related typology membership. The findings may inform public health interventions targeting unique adolescent subgroups most at risk of poor health outcomes based on their engagement in combinations of activity-related behaviors.


Assuntos
Comportamento do Adolescente , Fenômenos Ecológicos e Ambientais , Exercício Físico/psicologia , Adolescente , Austrália , Estudos Transversais , Feminino , Amigos/psicologia , Humanos , Masculino , Pais/psicologia , Características de Residência/estatística & dados numéricos , Tempo de Tela , Comportamento Sedentário , Autorrelato
8.
J Sci Med Sport ; 22(10): 1119-1124, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31277920

RESUMO

OBJECTIVES: This study examined the contribution of sports participation to overall moderate-to-vigorous physical activity (MVPA) among adolescents, and explored potential moderators. DESIGN: Cross-sectional observational study using survey and accelerometry data drawn from the NEighbourhood Activity in Youth (NEArbY) study. METHODS: Adolescents (n=358) were recruited from secondary schools in Melbourne, Australia. Average min/day in MVPA was assessed using accelerometry. Participants self-reported sports participation (number of teams, type, frequency, and months of participation). Regression models determined the percent variance in MVPA explained by the sport variables, adjusted for wear time, age and sex, and accounting for clustering at the school level. Additional analyses tested if age, sex, body mass index (BMI), and socioeconomic status (SES) moderated relationships between sport variables and MVPA. RESULTS: Participants (mean 15.3 years, 59% female) spent a mean (SD) of 68.6 (27.4) min/day in MVPA and 50% reported participating in any sport. Those who participated in sport did so 3.4 times/week on average and accumulated 7min/day of MVPA more than those who did no sport. For each additional sport participated in, on average, there were approximately 5 additional min/day of MVPA. The number and frequency of sports participation explained 3.2% and 3.8% of the variance in MVPA respectively. Participation in field hockey and gymnastics explained 2.2% and 3.6% of the variance in MVPA, respectively. There were no moderating effects. CONCLUSIONS: Sport appears to make a very small contribution to adolescents' average daily physical activity. Effectiveness of approaches to increasing youth population levels of physical activity via sports participation needs to be tested.


Assuntos
Exercício Físico , Esportes , Acelerometria , Adolescente , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
9.
Lancet Oncol ; 20(6): e327-e335, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31162106

RESUMO

Precision oncology guided by genomic research has an increasingly important role in the care of people with cancer. However, substantial inequities remain in cancer outcomes of Indigenous peoples, including Indigenous Maori in Aotearoa New Zealand (New Zealand). These inequities will be perpetuated unless deliberate steps are taken to include Indigenous peoples in all parts of cancer research-as research participants, in research leadership, and in research governance. This approach is especially important when there have been historical breaches of trust that have discouraged their participation in health research. This Personal View describes a precision oncology research roadmap for neuroendocrine tumour research, which seeks to reflect the values of New Zealand's Indigenous Maori people. This roadmap includes facilitating ongoing dialogue, Maori leadership, reciprocity, agreed kawa (guiding principles), tikanga (cultural protocols), and honest monitoring of what is and what is not being achieved. We challenge cancer researchers worldwide to generate locally appropriate roadmaps that honestly assess their practices to benefit Indigenous people internationally.

10.
J Orthod ; 46(3): 242-250, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31177898

RESUMO

OBJECTIVE: As the representative body for orthodontic specialists, the British Orthodontic Society (BOS) provides advice and guidance to professionals and patients on a variety of topics. The BOS receive frequent queries from professionals and patients and, where appropriate, provide advice and guidance. By reflecting on the types of queries received, it is hoped that general guidance can be developed and 'frequently asked questions' information established to improve knowledge in these particular areas. DESIGN: Retrospective assessment of queries raised to the BOS. SETTING: BOS headquarters, London. METHODS: All queries raised to the BOS by professionals and patients from January 2017 to October 2018 were collated and divided into those raised by dental professionals or by patients. Within each group, all queries were further subcategorised into different topic areas. For each of the main topics, guidance will be developed to improve clinician and patient knowledge in these areas. RESULTS: In the time period assessed, 422 queries were received to the BOS, 51.8% (n = 229) were from patients and 48.2% (n = 213) from professionals. Commissioning was the most common topic queried by professionals (34.3%), which included NHS contracts and tendering. Queries regarding associate matters (9.4%), specific clinical queries (9.4%) and BOS issues (8.9%) were also common topics raised by professionals. The most common topic queried by patients was the eligibility for NHS treatment (29.3%), followed by specific clinical queries (22.3%) and seeking recommendations for clinicians (10.5%). CONCLUSIONS: Overall, a large number of queries were received by the BOS. While some queries required specific information from the BOS, the majority of queries could be addressed through already published information and guidance. This project identifies the more common queries and provides clear guidance on where to find the appropriate advice.


Assuntos
Sociedades Odontológicas , Humanos , Londres , Estudos Retrospectivos
11.
J Orthod ; 46(2): 148-154, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056031

RESUMO

Facial feminisation surgery (FFS) aims to feminise the face by changing masculine facial features to feminine ones. It is commonly undertaken for transsexual individuals who are transitioning from male to female or for women who wish to further feminise their facial appearance. Assessment and treatment planning by a multidisciplinary team is essential for any patient considering FFS. Orthodontists have an important role within this team as patients may first present to an orthodontist expressing concerns about the appearance of their jaws. Therefore, it is important that orthodontists have a detailed understanding of FFS procedures, to enable good patient communication, thorough patient assessment and onwards referral where required. This article reviews the common FFS procedures, their indications, and the benefits and risks of each procedure and highlights the role of the orthodontist.


Assuntos
Ortodontistas , Cirurgiões , Face , Feminino , Feminização , Humanos , Masculino , Planejamento de Assistência ao Paciente
12.
Int J Behav Nutr Phys Act ; 16(1): 44, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31097036

RESUMO

BACKGROUND: Clusters of adolescents differentiated by patterns of physical activity and sedentary behavior (activity-related typologies) are common. Understanding both the characteristics of adolescents and modifiable correlates of these typologies, can help to develop interventions for those most at risk. This systematic review aimed to synthesize the socio-demographic characteristics and modifiable correlates of activity-related behavioral typologies among adolescents. METHODS: A systematic search of seven electronic databases was conducted to identify quantitative studies using person-oriented statistical approaches to identify activity-related behavioral typologies among 12-18 year-olds. This systematic review was registered in Prospero (registration number: CRD42016046879). RESULTS: Thirty-six studies met the inclusion criteria and were classified according to three sub-themes based on behaviors included in the typologies (1. physical activity and sedentary behavior only; 2. physical activity, sedentary behavior and risk-related behaviors; 3. physical activity, sedentary behavior and diet). Studies were mostly cross-sectional and relied on self-report measures. Methods were considerably heterogeneous, however results revealed some consistency in typologies within specific groups. For example, typologies characterized by unhealthy behavior patterns (e.g., characterized by physical inactivity, high sedentary behavior and poor diet or high risk-related behaviors) comprised more older adolescents. With the exception of socio-demographics (age, sex, body mass index and socio-economic status), very few correlates have been studied to date (mostly school-related behavioral factors and intrapersonal influences), with evidence largely from typologies comprised of physical activity, sedentary behavior and diet. CONCLUSIONS: More research is needed to assess a range of modifiable correlates associated with activity-related behavior typologies among adolescents. This will allow for more targeted interventions, to achieve long-lasting, positive behavior change in adolescent populations.


Assuntos
Comportamento do Adolescente/fisiologia , Exercício Físico/fisiologia , Comportamentos Relacionados com a Saúde/fisiologia , Adolescente , Criança , Humanos , Comportamento Sedentário
13.
Br Dent J ; 226(8): 600-604, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31028329

RESUMO

Introduction The use of apps has increased in recent years, especially in healthcare. Due to apps being largely unregulated, the quality and accuracy of the information provided can be variable.Aim To assess the availability of patient-focused oral hygiene apps and profile the characteristics of the most popular apps on Apple's 'App Store' and, on Android, 'Google Play'.Method Oral hygiene-related search terms were used to identify apps on these platforms. Detailed information for the 20 most popular apps for each search term was recorded.Results In total, 1,075 apps were identified with fewer apps available on the App Store than on Google Play. The 20 most popular apps for each search term focused on providing oral hygiene information, were free of charge and were developed after 2015. No apps contained information regarding whether they were approved by official organisations and if effectiveness or acceptability testing had been conducted. App ratings were variable and unrelated to the quality and accuracy of the information.Conclusion Due to a lack of professional regulation, there is a risk that patients may access inaccurate information via apps. Therefore, evaluation, validation, and quality assessment of healthcare apps is needed before recommending these to patients.


Assuntos
Aplicativos Móveis , Assistência à Saúde , Humanos , Higiene Bucal
14.
J Sci Med Sport ; 22(3): 319-323, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30190099

RESUMO

OBJECTIVES: To identify typologies of activity-related behaviours and demographic characteristics of these typologies among Australian adolescents. DESIGN: Cross-sectional study of 473 Secondary School students (41.4% boys, mean age 14.95±1.61 years) conducted in 2014-15. METHODS: Active travel to school, sport participation, leisure-time sedentary and demographic variables were self-reported in a survey. Duration of sedentary time and moderate-to-vigorous physical activity (mins/day) were accelerometer-derived. Latent class analysis (LCA) was conducted to identify typologies of activity-related health behaviours. One-way ANOVAs and chi-square tests were used to explore differences by demographic characteristics. RESULTS: Three typologies were identified: (1) "Physically inactive, highly sedentary" (44%); (2) "Moderately active, high screen-time" (42%); and (3) "Highly active, low sedentary" (14%). Differences between typologies were evident for age, sex, body mass index (BMI), cultural identity, employment status and socioeconomic position (SEP). Those in typology 3 (optimal behaviour pattern) tended to be younger, of higher SEP and lower BMI. CONCLUSIONS: This study found that older adolescents have less active, more sedentary profiles than younger adolescents. The findings support the need for targeted interventions to improve adolescent activity-related behaviour engagement.


Assuntos
Comportamento do Adolescente , Comportamentos Relacionados com a Saúde , Adolescente , Fatores Etários , Austrália , Índice de Massa Corporal , Estudos Transversais , Exercício Físico , Feminino , Humanos , Atividades de Lazer , Masculino , Comportamento Sedentário , Autorrelato , Classe Social
15.
Children (Basel) ; 6(1)2018 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-30583608

RESUMO

This study examined two-year changes in patterns of activity and associations with body mass index (BMI) and waist circumference (WC) among adolescents. Inclinometers (activPAL) assessed sitting, sitting bouts, standing, stepping, and breaks from sitting. ActiGraph-accelerometers assessed sedentary time (SED), light-intensity physical activity (LIPA, stratified as low- and high-LIPA), and moderate-to-vigorous physical activity (MVPA). Anthropometric measures were objectively assessed at baseline and self-reported at follow-up. Data from 324 and 67 participants were obtained at baseline and follow-up, respectively. Multilevel mixed-effects linear regression models examined changes over time, and associations between baseline values and BMI and WC at follow-up. There were significant increases in BMI (0.6 kg/m²) and durations of prolonged sitting (26.4 min/day) and SED (52 min/day), and significant decreases in stepping (-19 min/day), LIPA (-33 min/day), low-LIPA (-26 min/day), high-LIPA (-6.3 min/day), MVPA (-19 min/day), and the number of breaks/day (-8). High baseline sitting time was associated (p = 0.086) with higher BMI at follow-up. There were no significant associations between baseline sitting, prolonged sitting, LIPA, or MVPA with WC. Although changes in daily activity patterns were not in a favourable direction, there were no clear associations with BMI or WC. Research with larger sample sizes and more time points is needed.

16.
NPJ Genom Med ; 3: 18, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30062048

RESUMO

Pancreatic neuroendocrine tumors (pNETs) are uncommon cancers arising from pancreatic islet cells. Here we report the analysis of gene mutation, copy number, and RNA expression of 57 sporadic well-differentiated pNETs. pNET genomes are dominated by aneuploidy, leading to concordant changes in RNA expression at the level of whole chromosomes and chromosome segments. We observed two distinct patterns of somatic pNET aneuploidy that are associated with tumor pathology and patient prognosis. Approximately 26% of the patients in this series had pNETs with genomes characterized by recurrent loss of heterozygosity (LoH) of 10 specific chromosomes, accompanied by bi-allelic MEN1 inactivation and generally poor clinical outcome. Another ~40% of patients had pNETs that lacked this recurrent LoH pattern but had chromosome 11 LoH, bi-allelic MEN1 inactivation, and universally good clinical outcome. The somatic aneuploidy allowed pathogenic germline variants (e.g., ATM) to be expressed unopposed, with RNA expression patterns showing inactivation of downstream tumor suppressor pathways. No prognostic associations were found with tumor morphology, single gene mutation, or expression of RNAs reflecting the activity of immune, differentiation, proliferative or tumor suppressor pathways. In pNETs, single gene mutations appear to be less important than aneuploidy, with MEN1 the only statistically significant recurrently mutated driver gene. In addition, only one pNET in the series had clearly actionable single nucleotide variants (SNVs) (in PTEN and FLCN) confirmed by corroborating RNA expression changes. The two clinically relevant patterns of LoH described here define a novel oncogenic mechanism and a plausible route to genomic precision oncology for this tumor type.

18.
Med J Aust ; 207(5): 195-200, 2017 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-28987132

RESUMO

OBJECTIVE: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. DESIGN, SETTING AND PARTICIPANTS: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women's Hospital) during February 2011 - March 2014. 1366 prospectively recruited patients presenting to the ED with symptoms of suspected acute coronary syndrome (ACS) were stratified into groups at low, intermediate or high risk of an ACS. INTERVENTION: High risk patients were treated according to NHFA/CSANZ guidelines. Low and intermediate risk patients underwent troponin testing (sensitive assay) 0 and 2 hours after presentation. Intermediate risk patients underwent objective testing after the second troponin test; low risk patients were discharged without further objective testing. MAIN OUTCOME MEASURES: The primary outcome was an ACS within 30 days of presentation. Secondary outcomes were ED and hospital lengths of stay (LOS). RESULTS: The IMPACT protocol stratified 244 (17.9%) patients to low risk, 789 (57.7%) to intermediate risk, and 333 (24.4%) to high risk categories. The overall 30-day ACS rate was 6.6%, but there were no ACS events in the low risk group, and 14 (1.8%) in the intermediate risk group. The median hospital LOS was 5.1 hours (IQR, 4.2-5.6 h) for low risk and 7.7 hours (IQR, 6.1-21 h) for intermediate risk patients. CONCLUSIONS: The IMPACT protocol safely and efficiently allowed a large proportion of patients presenting to EDs with chest pain to undergo accelerated assessment for risk of an ACS. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000206921.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Medição da Dor/métodos , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Nova Zelândia , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Medição de Risco , Centros de Atenção Terciária , Resultado do Tratamento , Troponina/análise
19.
Am J Orthod Dentofacial Orthop ; 152(2): 154-160, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28760277

RESUMO

INTRODUCTION: Patient decision-making aids (PDAs) are instruments that facilitate shared decision making and enable patients to reach informed, individual decisions regarding health care. The objective of this study was to assess the efficacy of a PDA compared with traditional information provision for adolescent patients considering fixed appliance orthodontic treatment. METHODS: Before treatment, orthodontic patients were randomly allocated into 2 groups: the intervention group received the PDA and standard information regarding fixed appliances, and the control group received the standard information only. Decisional conflict was measured using the Decisional Conflict Scale, and the levels of decisional conflict were compared between the 2 groups. RESULTS: Seventy-two patients were recruited and randomized in a ratio of 1:1 to the PDA and control groups. Seventy-one patients completed the trial (control group, 36; PDA group, 35); this satisfied the sample size calculation. The median total Decisional Conflict Scale score in the PDA group was lower than in the control group (15.63 and 19.53, respectively). However, this difference was not statistically significant (difference between groups, 3.90; 95% confidence interval of the difference, -4.30 to 12.11). Sex, ethnicity, age, and the time point at which patients were recruited did not have significant effects on Decisional Conflict Scale scores. No harm was observed or reported for any participant in the study. CONCLUSIONS: The results of this study showed that the provision of a PDA to adolescents before they consented for fixed appliances did not significantly reduce decisional conflict. There may be a benefit in providing a PDA for some patients, but it is not yet possible to say how these patients could be identified. REGISTRATION: This trial was registered with the Harrow National Research Ethics Committee (reference 12/LO/0279). PROTOCOL: The protocol was not published before trial commencement.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Ortodontia/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Preferência do Paciente/psicologia
20.
Crit Pathw Cardiol ; 15(3): 121-5, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27465009

RESUMO

OBJECTIVE: Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history. METHODS: A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited. Data collection included self-reported patient history, electrocardiogram testing, and troponin I measurements. Independent assessment of risk factors and medical history was adjudicated by cardiologists. Diagnosis of acute coronary syndrome (ACS) at 30 days after presentation was assessed. Cohen's kappa measured patient-cardiologist agreement. Cardiologist adjudicated events were taken as true to assess accuracy. RESULTS: A total of 83 participants (10.7%) were diagnosed with ACS at 30 days after presentation. "Previous coronary artery bypass grafting" showed highest agreement (K = 1.00) between patient-reported and cardiologist-adjudicated events. Lowest agreement between patient-reported and cardiologist-adjudicated events was found for "prior ventricular dysrhythmia" (K = 0.33). Accuracy of reported "prior congestive heart failure" differed significantly between patients with and without diagnosed ACS at 30 days (92.8% and 97.5%, respectively). CONCLUSIONS: Accuracy of patient's recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Anamnese , Medidas de Resultados Relatados pelo Paciente , Síndrome Coronariana Aguda/complicações , Dor no Peito/etiologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco
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