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1.
Int J Clin Pharm ; 46(2): 529-535, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38151689

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants. AIM: To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting. METHOD: A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG (SLECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded SLECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner. RESULTS: Fifty-three of 112 care home residents participated. From 52 SLECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation. CONCLUSION: This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Projetos Piloto , Estudos Transversais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Eletrocardiografia , Palpação , Programas de Rastreamento/métodos
2.
Vet J ; 298-299: 106019, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37536451

RESUMO

Field tests and their association with laminitis have not been evaluated in large cohorts. The objectives of this study were to evaluate the performance of basal insulin (BI), the oral sugar test (OST) and the insulin tolerance test (ITT) to diagnose ID and investigate their association with laminitis. Insulin dysregulation status was determined in 146 ponies using BI (insulin concentration >20 µIU/mL), an OST (insulin concentration >65 µIU/mL at 60 or 90 min after oral administration of 0.45 mL/kg corn syrup) and an ITT (< 50% reduction in glucose concentration 30 min after intravenous administration of 0.1 IU/kg insulin). Laminitis was identified using modified-Obel scores. A Bayesian approach was used to define the characteristics of the tests and receiver operating characteristic curves were used to assess their association with laminitis. All tests were well tolerated and laminitis was diagnosed in 9% of ponies. Insulin dysregulation was diagnosed in 15% of ponies using BI, 38% using the OST and 54% using the ITT with 11% of ponies positive for all three tests. The sensitivities and specificities of BI, the OST and the ITT to diagnose ID were 0.52 (95% confidence interval [CI], 0.35-0.79) and 0.97 (95% CI, 0.91 - 1.00), 0.84 (95% CI, 0.70 - 0.94) and 0.60 (95% CI, 0.49 - 0.71), and 0.85 (95% CI, 0.68-0.96) and 0.88 (95% CI, 0.75 - 0.97), respectively. Only BI and the OST were associated with laminitis (P = 0.003 and 0.015, respectively).


Assuntos
Doenças do Pé , Doenças dos Cavalos , Cavalos , Animais , Insulina , Glicemia , Teste de Tolerância a Glucose/veterinária , Teorema de Bayes , Administração Intravenosa/veterinária , Doenças dos Cavalos/diagnóstico , Doenças do Pé/diagnóstico , Doenças do Pé/veterinária
3.
Vet J ; 296-297: 105995, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37207985

RESUMO

Plasma adrenocorticotropic hormone (ACTH) concentration is commonly measured to diagnose pituitary pars intermedia dysfunction (PPID). Several intrinsic and extrinsic factors affect ACTH concentrations, including breed. The objective of this study was to prospectively compare plasma ACTH concentrations among different breeds of mature horses and ponies. Three breed groups comprised Thoroughbred horses (n = 127), Shetland ponies (n = 131) and ponies of non-Shetland breeds (n = 141). Enrolled animals did not show any signs of illness, lameness or clinical signs consistent with PPID. Blood samples were collected 6 months apart, around the autumn equinox and spring equinox, and plasma concentrations of ACTH were measured by chemiluminescent immunoassay. Pairwise breed comparisons within each season were performed on log transformed data using the Tukey test. Estimated mean differences in ACTH concentrations were expressed as fold difference with 95 % confidence intervals (CI). Reference intervals for each breed group per season were calculated using non-parametric methods. In autumn, higher ACTH concentrations were found among non-Shetland pony breeds compared with Thoroughbreds (1.55 fold higher; 95 % CI, 1.35-1.77; P < 0.001), and in Shetland ponies compared with Thoroughbreds (2.67 fold higher; 95 % CI, 2.33-3.08; P < 0.001) and non-Shetland pony breeds (1.73 fold higher; 95 % CI, 1.51-1.98; P < 0.001). In spring, no differences were identified among breed groups (all P > 0.05). Reference intervals were similar among breed groups in spring, but upper limits for ACTH concentrations were markedly different between Thoroughbred horses and pony breeds in autumn. These findings emphasise that breed should be accounted for when determining and interpreting reference intervals for ACTH concentrations among healthy horses and ponies in autumn.


Assuntos
Doenças dos Cavalos , Doenças da Hipófise , Cavalos/genética , Animais , Doenças dos Cavalos/genética , Doenças da Hipófise/genética , Doenças da Hipófise/veterinária , Hormônio Adrenocorticotrópico , Estações do Ano , Marcha
4.
Clin Oncol (R Coll Radiol) ; 35(2): e110-e120, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36443138

RESUMO

Rectal cancer is a common cancer and shows an increased incidence with older age. Although the gold standard treatment is surgical excision, minimally invasive approaches are increasingly used and organ preservation is becoming a reasonable approach. The conservative treatment approach includes local excision, external beam radiotherapy and brachytherapy. However, these all carry a risk of side-effects. It is crucial to provide patients with information to quantify the improvement or detriment in quality of life with their cancer treatment. This can only be done with patient-reported outcome measures (PROMs) as tools within current and future trials. Colorectal cancer has numerous publications with specific PROMs. However, PROMs reporting in rectal cancer is more sparse; PROMs are generally extrapolated from colorectal cancer. Rectal PROMs trials hold small population samples and PROMs as an end point is scarce. We present a review of recent literature based on the PROMs reporting of quality of life for rectal cancer patients and introduce the CITRuS trial as an innovative feasibility study related to electronic PROMs data collection.


Assuntos
Braquiterapia , Neoplasias Retais , Humanos , Preservação de Órgãos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Reto , Ensaios Clínicos como Assunto
5.
Ann Entomol Soc Am ; 115(5): 378-386, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36105848

RESUMO

Ptelea trifoliata L., is a North American tree that supports insect communities through floral rewards. Our objectives were to determine the importance of insects as pollinators of P. trifoliata; describe the community of floral visiting insects of P. trifoliata in Iowa, where no such information was available; and to note insect preferences for male or female flowers. Over two years, inflorescences on 13 trees were covered with mesh bags before blooming and the amount of fruit produced was compared to uncovered inflorescences from the same trees. In one year, insects were collected from male and female trees with an insect vacuum every 3 h between 7 am and 7 pm from four sites in Iowa, USA between 30 May and 16 June 2020. In 2019 and 2020, almost no fruit set occurred from inflorescences covered with mesh bags while an average of 51.2 fruits formed on unbagged inflorescences (P < 0.0001), suggesting insects larger than the 600 µm pore diameters mesh were responsible for pollination of P. trifoliata. Insects from five orders, 49 families, and at least 109 species were collected. Most insects were Hymentoptera (48.3%) or Diptera (28.2%). Male flowers attracted 62.3% of all insects collected. Since most of the insects found visiting P. trifoliata were not bees, the floral rewards of the flowers may be a valuable resource for a wide variety of insects in the central United States.

6.
Aust Vet J ; 100(3): 107-113, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34859426

RESUMO

BACKGROUND: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT: An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION: These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.


Assuntos
Doenças dos Cavalos , Preparações Farmacêuticas , Animais , Antibacterianos/uso terapêutico , Nutrição Enteral/veterinária , Escherichia coli , Doenças dos Cavalos/tratamento farmacológico , Cavalos , Masculino , Fístula Bucoantral/complicações , Fístula Bucoantral/terapia , Fístula Bucoantral/veterinária
7.
Clin Oncol (R Coll Radiol) ; 33(9): 579-590, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34247890

RESUMO

The complex and varied motion of the cervix-uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.


Assuntos
Braquiterapia , Radioterapia Guiada por Imagem , Neoplasias do Colo do Útero , Feminino , Humanos , Imageamento por Ressonância Magnética , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Neoplasias do Colo do Útero/radioterapia
8.
Aust Vet J ; 99(9): 369-377, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34151420

RESUMO

BACKGROUND: Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management. OBJECTIVES: Investigate the effectiveness of amoxicillin-clavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns. MATERIALS AND METHODS: In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin-clavulanic acid (group A) or amoxicillin-clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups. RESULTS: Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin. CONCLUSION AND CLINICAL SIGNIFICANCE: Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio , Doenças do Cão , Animais , Cães , Combinação Amoxicilina e Clavulanato de Potássio/farmacologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Teorema de Bayes , Doenças do Cão/tratamento farmacológico , Farmacorresistência Bacteriana , Enrofloxacina/farmacologia , Testes de Sensibilidade Microbiana/veterinária , Staphylococcus
9.
Aust Vet J ; 98(8): 411-416, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32761617

RESUMO

OBJECTIVE: To assess the efficacy of an herbal spray combining various essential oils, with a claim of mast cell stabilisation, antipruritic, anti-inflammatory, and insect repellent effects on the clinical presentation of insect bite hypersensitivity (IBH) in horses. DESIGN: Double-blinded, placebo-controlled, randomised, cross-over clinical trial. METHODS: Twenty adult horses with clinical IBH were treated with a daily application of herbal spray or placebo for 28 days in a randomised, cross-over fashion, separated by a>28-day washout period. Horses were examined and scored prior to and after the completion of each treatment. Histopathology was performed on four horses. Owners kept daily diaries of observations. RESULTS: The herbal spray significantly reduced the severity of all assessed parameters (pruritus, excoriations, lichenification and alopecia; P < 0.05) compared with baseline values (pretreatment) and with placebo. Owners reported improvement of pruritus in 19/20 horses (95%) with complete resolution in 17 horses (85%) following treatment. Skin biopsies showed resolution of orthokeratosis in 4/4 horses, reduced thickness of the stratum spinosum in 2/4 horses and complete resolution of histopathological abnormalities in 1/4 horses after treatment, compared with either no change or deterioration of histopathologic lesions after placebo. No side effects were observed. CONCLUSIONS: The tested herbal spray may be an effective treatment for the management of equine IBH.


Assuntos
Ceratopogonidae , Doenças dos Cavalos , Hipersensibilidade/veterinária , Mordeduras e Picadas de Insetos/veterinária , Óleos Voláteis , Animais , Cavalos
10.
Clin Oncol (R Coll Radiol) ; 31(12): 834-843, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31331818

RESUMO

Checkpoint immunotherapy has revolutionised the way that melanoma is treated and has also shown significant effectiveness in lung, bladder, renal, and head and neck cancers. At the present time, trials of checkpoint immunotherapy in cervical cancer are at early phases, but there is very good rationale for pursuing this as a treatment option, especially as cervical cancer is a virally driven cancer and therefore should be recognised by the immune system as being foreign. This review explores the biomarkers for the selection of patients for immunotherapy in other cancers, such as programmed death ligand 1 (PD-L1) expression, tumour infiltrating lymphocytes and total mutational burden, and relates these biomarkers to cervical cancer. A PubMed search was carried out for publications published in English with the terms 'immunotherapy' OR 'cervical cancer' OR 'checkpoint blockade' OR 'tumour infiltrating lymphocytes' OR 'total mutational burden'. Articles that met these criteria and were available on PubMed before 8 October 2018 were included. The results showed that PD-L1 is positive in up to 90% of cervical cancers and that the total mutational burden is moderately high, with 5-6 mutations per megabase. In addition, the tumour microenvironment in cervical cancer has an impact on prognosis, with higher ratios of CD8+ tumour infiltrating lymphocytes to CD4+ T regulatory cells being associated with improved survival. Clinical studies to date have shown the response rate of cervical cancer to checkpoint immunotherapy to be in the region to 10-25%. Cervical cancer exhibits many of the features that have been shown to be correlated with response to checkpoint immunotherapy in other tumour sites. However, response rates to date are in the region of 10-25%. Therefore, combinations of immunotherapeutic agents or checkpoint inhibitors with radiotherapy may be required to maximise the therapeutic benefit of harnessing the host immune system to fight cancer.


Assuntos
Antígeno B7-H1/antagonistas & inibidores , Biomarcadores Tumorais/metabolismo , Imunoterapia/métodos , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/genética , Feminino , Humanos , Prognóstico
11.
Equine Vet J ; 51(4): 440-445, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30417404

RESUMO

BACKGROUND: Pituitary pars intermedia dysfunction (PPID) is a commonly described endocrine disorder in higher latitudes of the Northern hemisphere but the description of the disease at lower latitudes and in the Southern hemisphere is limited. OBJECTIVES: Document the clinical features of PPID at different Australian latitudes and climates, and investigate factors associated with survival, laminitis and insulin dysregulation (ID). STUDY DESIGN: Retrospective study of 274 equids from eight institutions across Australia. METHODS: A diagnosis of PPID was based on endogenous ACTH, overnight dexamethasone suppression test, thyrotropin-releasing hormone stimulation test or necropsy. Clinical and clinicopathologic characteristics of PPID and therapeutic responses were investigated. Laminitis was diagnosed by radiographic or histologic changes and ID was diagnosed based on endogenous insulin, an oral glucose test or a 2-step insulin-response test. RESULTS: Being a pony, having a higher body condition score and pergolide administration were associated with survival. The clinical presentation of PPID changed with latitude and climate, with anhidrosis and polyuria/polydipsia more commonly recognised at lower latitudes. Laminitis was diagnosed in 89.9% of cases and ID was present in 76.5% of cases in which they were investigated. MAIN LIMITATIONS: Despite the sample size, the lack of uniform testing at all locations (primary or referral cases) and the incompleteness of data sets limited the power of the statistical analyses. CONCLUSIONS: PPID can present with variable signs at different latitudes and climates, and ID should be investigated in equids diagnosed with PPID. Adequate body condition and administration of pergolide are fundamental in PPID management.


Assuntos
Doenças do Pé/veterinária , Casco e Garras/patologia , Doenças dos Cavalos/patologia , Inflamação/veterinária , Insulina/metabolismo , Doenças da Hipófise/veterinária , Animais , Austrália/epidemiologia , Feminino , Doenças do Pé/epidemiologia , Doenças do Pé/patologia , Doenças dos Cavalos/epidemiologia , Cavalos , Inflamação/epidemiologia , Inflamação/etiologia , Masculino , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/epidemiologia , Doenças da Hipófise/patologia , Adeno-Hipófise Parte Intermédia/patologia , Estudos Retrospectivos , Fatores de Risco
12.
Aust Vet J ; 96(7): 233-242, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29862508

RESUMO

The purpose of this article is to provide a review of the current knowledge and opinions about the epidemiology, clinical findings (including sequelae), diagnosis, treatment and monitoring of equine pituitary pars intermedia dysfunction, particularly in the Australian context. This information and the recommendations provided will assist practitioners in making informed decisions regarding the diagnosis and management of this disorder.


Assuntos
Doenças dos Cavalos , Doenças da Hipófise/veterinária , Adeno-Hipófise Parte Intermédia , Hormônio Adrenocorticotrópico/sangue , Animais , Austrália/epidemiologia , Agonistas de Dopamina/uso terapêutico , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/tratamento farmacológico , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/fisiopatologia , Cavalos , Nova Zelândia/epidemiologia , Pergolida/uso terapêutico , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/epidemiologia , Adeno-Hipófise Parte Intermédia/fisiopatologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Sociedades Científicas
13.
J Vet Pharmacol Ther ; 41(1): 92-97, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28503770

RESUMO

Nine horses received 20 mg/kg of intravenous (LEVIV ); 30 mg/kg of intragastric, crushed immediate release (LEVCIR ); and 30 mg/kg of intragastric, crushed extended release (LEVCER ) levetiracetam, in a three-way randomized crossover design. Crushed tablets were dissolved in water and administered by nasogastric tube. Serum samples were collected over 48 hr, and levetiracetam concentrations were determined by immunoassay. Mean ± SD peak concentrations for LEVCIR and LEVCER were 50.72 ± 10.60 and 53.58 ± 15.94 µg/ml, respectively. The y-intercept for IV administration was 64.54 ± 24.99 µg/ml. The terminal half-life was 6.38 ± 1.97, 7.07 ± 1.93 and 6.22 ± 1.35 hr for LEVCIR , LEVCER, and LEVIV , respectively. Volume of distribution at steady-state was 630 ± 73.4 ml/kg. Total body clearance after IV administration was 74.40 ± 19.20 ml kg-1  hr-1 . Bioavailability was 96 ± 10, and 98 ± 13% for LEVCIR and LEVCER , respectively. A single dose of Levetiracetam (LEV) was well tolerated. Based on this study, a recommended dosing regimen of intravenous or oral LEV of 32 mg/kg every 12 hr is likely to achieve and maintain plasma concentrations within the therapeutic range suggested for humans, with optimal kinetics throughout the dosing interval in healthy adult horses. Repeated dosing and pharmacodynamic studies are warranted.


Assuntos
Anticonvulsivantes/farmacocinética , Piracetam/análogos & derivados , Animais , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/sangue , Estudos Cross-Over , Preparações de Ação Retardada , Feminino , Cavalos , Injeções Intravenosas/veterinária , Intubação Gastrointestinal/veterinária , Levetiracetam , Masculino , Piracetam/administração & dosagem , Piracetam/sangue , Piracetam/farmacocinética
14.
Mon Not R Astron Soc ; 459(3): 2681-2689, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27279782

RESUMO

The eclipses of certain types of binary millisecond pulsars (i.e. 'black widows' and 'redbacks') are often studied using high-time-resolution, 'beamformed' radio observations. However, they may also be detected in images generated from interferometric data. As part of a larger imaging project to characterize the variable and transient sky at radio frequencies <200 MHz, we have blindly detected the redback system PSR J2215+5135 as a variable source of interest with the Low-Frequency Array (LOFAR). Using observations with cadences of two weeks - six months, we find preliminary evidence that the eclipse duration is frequency dependent (∝ν-0.4), such that the pulsar is eclipsed for longer at lower frequencies, in broad agreement with beamformed studies of other similar sources. Furthermore, the detection of the eclipses in imaging data suggests an eclipsing medium that absorbs the pulsed emission, rather than scattering it. Our study is also a demonstration of the prospects of finding pulsars in wide-field imaging surveys with the current generation of low-frequency radio telescopes.

15.
Mon Not R Astron Soc ; 459(3): 3161-3174, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27279785

RESUMO

We report on the results of a search for radio transients between 115 and 190 MHz with the LOw-Frequency ARray (LOFAR). Four fields have been monitored with cadences between 15 min and several months. A total of 151 images were obtained, giving a total survey area of 2275 deg2. We analysed our data using standard LOFAR tools and searched for radio transients using the LOFAR Transients Pipeline. No credible radio transient candidate has been detected; however, we are able to set upper limits on the surface density of radio transient sources at low radio frequencies. We also show that low-frequency radio surveys are more sensitive to steep-spectrum coherent transient sources than GHz radio surveys. We used two new statistical methods to determine the upper limits on the transient surface density. One is free of assumptions on the flux distribution of the sources, while the other assumes a power-law distribution in flux and sets more stringent constraints on the transient surface density. Both of these methods provide better constraints than the approach used in previous works. The best value for the upper limit we can set for the transient surface density, using the method assuming a power-law flux distribution, is 1.3 × 10-3 deg-2 for transients brighter than 0.3 Jy with a time-scale of 15 min, at a frequency of 150 MHz. We also calculated for the first time upper limits for the transient surface density for transients of different time-scales. We find that the results can differ by orders of magnitude from previously reported, simplified estimates.

16.
J Hum Nutr Diet ; 29(6): 697-703, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27230826

RESUMO

BACKGROUND: A standardised nutrition risk screening (NRS) programme with ongoing education is recommended for the successful implementation of NRS. This project aimed to develop and implement a standardised NRS and education process across the adult bed-based services of a large metropolitan health service and to achieve a 75% NRS compliance at 12 months post-implementation. METHODS: A working party of Monash Health (MH) dietitians and a nutrition technician revised an existing NRS medical record form consisting of the Malnutrition Universal Screening Tool and nutrition management guidelines. Nursing staff across six MH hospital sites were educated in the use of this revised form and there was a formalised implementation process. Support from Executive Management, nurse educators and the Nutrition Risk Committee ensured the incorporation of NRS into nursing practice. Compliance audits were conducted pre- and post-implementation. RESULTS: At 12 months post-implementation, organisation-wide NRS compliance reached 34.3%. For those wards that had pre-implementation NRS performed by nursing staff, compliance increased from 7.1% to 37.9% at 12 months (P < 0.001). The improved NRS form is now incorporated into standard nursing practice and NRS is embedded in the organisation's 'Point of Care Audit', which is reported 6-monthly to the Nutrition Risk Committee and site Quality and Safety Committees. CONCLUSIONS: NRS compliance improved at MH with strong governance support and formalised implementation; however, the overall compliance achieved appears to have been affected by the complexity and diversity of multiple healthcare sites. Ongoing education, regular auditing and establishment of NRS routines and ward practices is recommended to further improve compliance.


Assuntos
Implementação de Plano de Saúde , Desnutrição/diagnóstico , Programas de Rastreamento/normas , Avaliação Nutricional , Medição de Risco/normas , Adulto , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais/normas , Humanos , Vitória
17.
Equine Vet J ; 48(2): 176-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25421257

RESUMO

REASONS FOR PERFORMING STUDY: Critically ill foals often present to veterinary hospitals with impaired organ perfusion which can be demonstrated by increased blood L-lactate concentrations. As a compensatory mechanism to low blood pressure and electrolyte abnormalities, aldosterone and arginine vasopressin (AVP) are released to restore organ perfusion and function. Several studies have investigated the ability of blood L-lactate concentrations to predict severity of disease and outcome in critically ill human patients, adult horses and foals. However, information on the aldosterone and AVP response to hypoperfusion and its association with L-lactate concentrations in neonatal foals is limited. OBJECTIVES: To determine the association between clinical hypoperfusion and endocrine markers of reduced tissue perfusion in normo- and hypoperfused foals. STUDY DESIGN: Prospective, multicentre, cross-sectional observational study. METHODS: Blood samples were collected on admission from 72 clinically hypoperfused, 110 normoperfused (73 hospitalised and 37 healthy) foals of ≤4 days of age. Foals were considered clinically hypoperfused if they had L-lactate concentrations ≥2.5 mmol/l and one of the 3 following findings: heart rate >120 beats/min, packed cell volume (PCV) >0.44 l/l or azotaemia (increased creatinine and blood urea nitrogen [BUN]). Blood concentrations of aldosterone and AVP were determined by radioimmunoassays. RESULTS: Aldosterone, AVP, creatinine and BUN concentrations and heart rate, PCV and blood osmolality were higher in clinically hypoperfused compared with normoperfused foals (P<0.05). Risk of hypoperfusion increased with the presence of hypothermic extremities (OR = 5.26) and with each one unit increase in albumin concentrations (OR = 3.5) (P<0.05). The proposed admission L-lactate cut-off value above which nonsurvival could be reliably predicted in hospitalised foals was 10.6 mmol/l with 82% of sensitivity and 74% of specificity. CONCLUSIONS: Hyperaldosteronaemia and hypervasopressinaemia as well as hypothermic extremities and increased albumin concentrations are potent predictors of hypoperfusion in hospitalised foals.


Assuntos
Aldosterona/sangue , Arginina Vasopressina/sangue , Doenças dos Cavalos/sangue , Hipotensão/veterinária , Animais , Animais Recém-Nascidos , Biomarcadores , Estado Terminal , Estudos Transversais , Feminino , Doenças dos Cavalos/diagnóstico , Cavalos , Hipotensão/sangue , Hipotensão/diagnóstico , Masculino , Sepse/sangue , Sepse/veterinária
18.
J Nutr Health Aging ; 19(10): 1032-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26624216

RESUMO

OBJECTIVE: The prevalence of malnutrition in subacute inpatient settings has been reported to be 30-50%. While there are a number of nutrition evaluation tools which have been validated to diagnose malnutrition, the use of a validated nutrition evaluation tool to measure changes in nutritional status during an average length of stay for a subacute inpatient has not yet been tested. This study aims to determine the potential of the full MNA (full Mini Nutritional Assessment) and MNA (Mini Nutritional Assessment Short Form) scores to measure change in nutritional status over an average subacute inpatient stay (21 days). DESIGN: A prospective observational study. SETTING: The study was performed in three Rehabilitation and Geriatric Evaluation and Management (GEM) wards of the Kingston Centre, Monash Health, Melbourne, Australia. PARTICIPANTS: All patients ≥65 years admitted to these wards with an expected length of stay of at least 14 days were considered for inclusion in this study. MEASUREMENTS: Nutritional status was assessed on admission using the full MNA as part of usual dietetic care and patients were provided with nutrition intervention/diet therapy based on full MNA classification. Full MNA score (0-30), MNA score (0-14), anthropometry (weight and height) and nutritional biochemistry (serum albumin, transthyretin and C-reactive protein) were compared between admission and day 20.5 ± 2.4. RESULTS: Mean age (± SD) of 83 ± 7 years, n=114. For those patients diagnosed at risk of malnutrition or malnourished (n=103), there were significant increases in full MNA score (1.8 ± 2.4, p<0.001), MNA score (0.9 ± 1.7, p<0.001), weight (0.6 ± 2.5 kg, p=0.017) and serum albumin (1.4 ± 4.4 g/L, p=0.003) over the study period. All four of the full MNA domain sub-scores, also increased significantly in those patients diagnosed at risk of malnutrition or malnourished (n=103): anthropometric assessment (p<0.001), dietary assessment (p<0.001), general status assessment (p=0.019) and self-perceived health and nutrition states (p=0.033). CONCLUSION: Both the MNA and full MNA can be used to evaluate nutrition progress within the subacute inpatient setting over a three week time period, thereby providing clinicians with feedback on a patient's nutrition progress and assisting with ongoing care planning. Due to its ease of use and shorter time required to complete, the MNA may be the preferred nutrition evaluation tool in this setting.


Assuntos
Avaliação Geriátrica , Tempo de Internação , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Antropometria , Austrália , Pesos e Medidas Corporais , Proteína C-Reativa/metabolismo , Feminino , Humanos , Pacientes Internados , Masculino , Prevalência , Estudos Prospectivos , Albumina Sérica/análise
19.
Clin Oncol (R Coll Radiol) ; 27(6): 330-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25727645

RESUMO

AIMS: This audit provides a comprehensive overview of UK prostate brachytherapy practice in the year 2012, measured against existing standards, immediately before the introduction of new Royal College of Radiologists (RCR) guidelines. This audit allows comparison with European and North American brachytherapy practice and for the impact of the RCR 2012 guidelines to be assessed in the future. MATERIALS AND METHODS: A web-based data collection tool was developed by the RCR Clinical Audit Committee and sent to audit leads at all cancer centres in the UK. Standards were developed based on available guidelines in use at the start of 2012 covering case mix and dosimetry. Further questions were included to reflect areas of anticipated change with the implementation of the 2012 guidelines. Audit findings were compared with similar audits of practice in Europe, the USA and Latin America. RESULTS: Forty-nine of 59 cancer centres submitted data. Twenty-nine centres reported carrying out prostate brachytherapy; of these, 25 (86%) provided data regarding the number of implants, staffing, dosimetry, medication and anaesthesia and follow-up. Audit standards achieved excellent compliance in most areas, although were low in post-implant dosimetry and in post-implant scanning at 30 days. CONCLUSION: This audit provides a comprehensive picture of prostate brachytherapy in the UK in 2012. Patterns of care of prostate brachytherapy are similar to practice in the USA and Europe. The number of prostate brachytherapy implants carried out in the UK has grown significantly since a previous RCR audit in 2005 and it is important that centres maintain minimum numbers of cases to ensure that experience can be maintained and compliance to guidelines achieved.


Assuntos
Braquiterapia/normas , Auditoria Médica , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/radioterapia , Garantia da Qualidade dos Cuidados de Saúde , Humanos , Masculino , Radiologia , Radiometria , Dosagem Radioterapêutica , Fatores de Tempo , Reino Unido
20.
J Vet Intern Med ; 29(2): 636-43, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25818218

RESUMO

BACKGROUND: The route of Corynebacterium pseudotuberculosis infection in horses remains undetermined, but transmission by insects is suspected. OBJECTIVES: To investigate house flies (Musca domestica L.) as vectors of C. pseudotuberculosis transmission in horses. ANIMALS: Eight healthy, adult ponies. METHODS: Randomized, controlled, blinded prospective study. Ten wounds were created in the pectoral region where cages for flies were attached. Three ponies were directly inoculated with C. pseudotuberculosis. Four ponies were exposed for 24 hours to 20 hours C. pseudotuberculosis-inoculated flies. One negative control pony was exposed to noninoculated flies. Ponies were examined daily for swelling, heat, pain, and drainage at the inoculation site. Blood was collected weekly for CBC and biochemical analysis, and twice weekly for synergistic hemolysis inhibition titers. RESULTS: Clinical signs of local infection and positive cultures were observed in 7/7 exposed ponies and were absent in the negative control. In exposed ponies, peak serologic titers (1:512 to 1:2,048) were obtained between days 17 and 21. Seroconversion was not observed in the negative control. Neutrophil counts were higher in the positive and fly-exposed groups than in the negative control (P = .002 and P = .005) on day 3 postinoculation. Serum amyloid A concentrations were higher in the positive control than in the negative control and fly-exposed ponies on days 3 (P < .0001) and 7 (P = .0004 and P = .0001). No differences were detected for other biochemical variables. CONCLUSIONS AND CLINICAL IMPORTANCE: House flies can serve as mechanical vectors of C. pseudotuberculosis and can transmit the bacterium to ponies.


Assuntos
Infecções por Corynebacterium/veterinária , Corynebacterium pseudotuberculosis/fisiologia , Dípteros/microbiologia , Doenças dos Cavalos/transmissão , Insetos Vetores/microbiologia , Animais , Infecções por Corynebacterium/microbiologia , Infecções por Corynebacterium/transmissão , Doenças dos Cavalos/microbiologia , Cavalos , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/transmissão , Dermatopatias Bacterianas/veterinária
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