808 research outputs found

    Paediatric meningitis and hearing loss in a developing country: exploring the current protocols regarding audiological management following miningitis

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    The purpose of this study was to establish audiology referral protocols for post meningitis paediatric populations in two academic hospitals in Gauteng, South Africa. Specific objectives of this study included determining if audiological assessment referrals were made following infection; determining the time of referral post meningitis diagnosis; establishing what audiological assessments were conducted on this population, as well as determining any correlations between signs and symptoms of meningitis and referrals for audiology assessments. Medical records of 47 children admitted to hospital with a diagnosis of meningitis between the ages of birth and 6 years were reviewed following a retrospective record review design. Data relevant to the current study were obtained from hospital records and this was captured in a data spreadsheet. Both descriptive and inferential statistics were implemented in analysis of the data. Inferential statistics in the form of logistic regression analysis was used to establish any significant factor that may predict referral for audiological assessment. The findings indicated that almost half (40%) of the cases were not referred for audiological services. Of those cases referred for assessment, 89% were referred as in-patients before hospital discharge, with minimal referrals occurring after discharge from hospital. Screening, rather than diagnostic audiology measures were conducted on a majority of the cases. Logistic regression analysis identified fever as the only predictor variable (

    Recommendations for the Health Examination Surveys in Europe

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    The Delivery System Design of a Community Mental Health Center and Provision of Quality: Cardiometabolic Screening for Persons with a Severe Mental Illness Prescribed Atypical Antipsychotic Medication

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    Background: Persons with a severe mental illness (SMI) prematurely lose up to 25 years of life when compared to the general population. This patient population has increased morbidity and mortality due to higher than normal rates of obesity, hypertension, diabetes, and cardiovascular disease. Treatment of SMI often includes the use of atypical antipsychotic (AA) medication which has been associated with the development of cardiometabolic illnesses. In response to the higher rates of co-morbid, chronic physical illness, monitoring guidelines for cardiometabolic illness have been published. Despite these guidelines, screening rates for cardiometabolic illness in this population remain low. Neither community mental health nor primary care systems address the physical health concerns of persons with a severe mental illness, thus widening the quality gap for this at risk, vulnerable population. The Chronic Care Model provides a systems framework for addressing the wide range of health needs for chronically ill populations and has successfully been used in improving the quality of care for persons with chronic physical health conditions. Few published studies have used the Chronic Care Model as a framework to guide improving the quality of care for persons with a SMI. Objective: The purpose of this study was to better understand how the delivery system design of a community mental health center affects quality outcomes for persons with a SMI treated on an AA medication that are at high risk for developing cardiometabolic illness. Methods: This cross-sectional study used baseline patient health data of persons with a SMI to analyze cardiometabolic screening rates, based on the American Diabetes Association (ADA), American Psychiatric Association (APA), Association of Clinical Endocrinologists, and North American Association for the Study of Obesity second generation antipsychotic monitoring guideline. The guideline included history of cardiovascular disease and biologic monitoring at baseline, 12 weeks, and both baseline and 12 weeks. This retrospective study used existing data from an electronic health record. A member of the clinic data team electronically extracted study demographic variables. All other study variables were manually extracted by the study investigator. The theoretical basis for this study was supported by the Care Model, an adapted version of the Chronic Care Model. Results: The study sample consisted of 190 patients. The mean patient age was 37.13 years with a SD ± 11.7 years and a range of 19 - 70 years. The majority of patients were men (58.4%) and most patients were single (90.5%). More than one-half of the patients (53.7%) represented a minority race, though most patients were not Hispanic (95.3%). Most patients were not currently employed (88.9%) and nearly one-half of the patients lived below the federal poverty guidelines (47.4%). Ninety percent of the patients were enrolled in the Medicare or State Medical Assistance program. More patients in the study were diagnosed with a mood disorder (72.1%) than a thought disorder (27.9%). Most patients (61.6%) did not schedule their baseline or followup visit, but rather “walked” into the clinic without prior notice. The average number of visits during the initial treatment phase was 3.7 ± 1.4 and more than one-third of patients had the same provider at baseline and follow-up (36.3%). No patients received all recommended screening measures per the ADA and APA monitoring guideline. Biological measures (excluding history of cardiovascular disease) were evaluated for ten patients at baseline, three patients at follow-up and one patient at both baseline and follow-up. At baseline, rates for each screening measure were as follows: weight or BMI (64.2%), blood pressure (62.1%), fasting plasma glucose or hemoglobin A1c (27.9%), fasting lipid profile (8.4%) and family or personal history of cardiovascular disease (34.7%). At followup, rates of each cardiometabolic screening measure were as follows: weight or BMI (63.2%), blood pressure (61.6%), fasting plasma glucose or hemoglobin A1c (13.2%), fasting lipid profile (9.5%). Summaries of the unadjusted (r) and adjusted (beta) associations between combined delivery system design candidate variables and each of the quality outcome variables at baseline revealed associations between being a current smoker (r = .15, p = .041), having a clinic primary care provider (r = .21, p = .003), being a walk-in at baseline (r = .14, p - .048), and the number of screening measures. At follow-up, no statistically significant associations were observed. Conclusion: Data suggest that the delivery system design of a community mental health center inadequately addresses screening for cardiometabolic symptoms of persons with SMI. Findings show that adherence to the full panel of ADA and APA recommended cardiometabolic screening measures for persons treated on an AA medication is abysmal. Even rates of common screening measures, such as blood pressure, are poor. The Care Model was a useful theoretical framework to guide the study. Results of the study indicate that SMI patients may interact with the health care system differently than patients with chronic medical conditions. It is feasible that the high rate of unscheduled visits, or “walk-in” visits and number of different providers caring for patients during the initial treatment phase contributes to poor quality care. Subsequent recommendations include developing an intervention study to evaluate quality outcomes using a) an integrated care delivery design specifically for SMI patients and b) expanding the Care Model components to include the health system organization, decision support, self-management support, and clinical information systems. It is critically important that care delivery systems for persons with SMI be integrated for optimal health outcomes

    Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer

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    Actividad antitumoral; Calidad de vida con cáncer; PARPActivitat antitumoral; Qualitat de vida amb càncer; PARPAntitumor activity; Quality of life with cancer; PARPBACKGROUND Patients with a germline BRCA1 or BRCA2 mutation make up a small subgroup of those with metastatic pancreatic cancer. The poly(adenosine diphosphate–ribose) polymerase (PARP) inhibitor olaparib has had antitumor activity in this population. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to evaluate the efficacy of olaparib as maintenance therapy in patients who had a germline BRCA1 or BRCA2 mutation and metastatic pancreatic cancer and disease that had not progressed during first-line platinum-based chemotherapy. Patients were randomly assigned, in a 3:2 ratio, to receive maintenance olaparib tablets (300 mg twice daily) or placebo. The primary end point was progression-free survival, which was assessed by blinded independent central review. RESULTS Of the 3315 patients who underwent screening, 154 underwent randomization and were assigned to a trial intervention (92 to receive olaparib and 62 to receive placebo). The median progression-free survival was significantly longer in the olaparib group than in the placebo group (7.4 months vs. 3.8 months; hazard ratio for disease progression or death, 0.53; 95% confidence interval [CI], 0.35 to 0.82; P=0.004). An interim analysis of overall survival, at a data maturity of 46%, showed no difference between the olaparib and placebo groups (median, 18.9 months vs. 18.1 months; hazard ratio for death, 0.91; 95% CI, 0.56 to 1.46; P=0.68). There was no significant between-group difference in health-related quality of life, as indicated by the overall change from baseline in the global quality-of-life score (on a 100-point scale, with higher scores indicating better quality of life) based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (between-group difference, −2.47 points; 95% CI, −7.27 to 2.33). The incidence of grade 3 or higher adverse events was 40% in the olaparib group and 23% in the placebo group (between-group difference, 16 percentage points; 95% CI, −0.02 to 31); 5% and 2% of the patients, respectively, discontinued the trial intervention because of an adverse event. CONCLUSIONS Among patients with a germline BRCA mutation and metastatic pancreatic cancer, progression-free survival was longer with maintenance olaparib than with placebo.Supported by AstraZeneca (as part of an alliance between AstraZeneca and Merck Sharp & Dohme, a subsidiary of Merck) and by a grant (P30-17 CA008748) from the National Institutes of Health National Cancer Institute Cancer Center

    PAEDIATRIC MENINGITIS AND HEARING LOSS IN A DEVELOPING COUNTRY: EXPLORING THE CURRENT PROTOCOLS REGARDING AUDIOLOGICAL MANAGEMENT FOLLOWING MENINGITIS

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    The purpose of this study was to establish audiology referral protocols for post meningitis paediatric populations in two academic hospitals in Gauteng, South Africa. Specific objectives of this study included determining if audiological assessment referrals were made following infection; determining the time of referral post meningitis diagnosis; establishing what audiological assessments were conducted on this population, as well as determining any correlations between signs and symptoms of meningitis and referrals for audiology assessments. Medical records of 47 children admitted to hospital with a diagnosis of meningitis between the ages of birth and 6 years were reviewed following a retrospective record review design. Data relevant to the current study were obtained from hospital records and this was captured in a data spreadsheet. Both descriptive and inferential statistics were implemented in analysis of the data. Inferential statistics in the form of logistic regression analysis was used to establish any significant factor that may predict referral for audiological assessment. The findings indicated that almost half (40%) of the cases were not referred for audiological services. Of those cases referred for assessment, 89% were referred as in-patients before hospital discharge, with minimal referrals occurring after discharge from hospital. Screening, rather than diagnostic audiology measures were conducted on a majority of the cases. Logistic regression analysis identified fever as the only predictor variable (

    Intelligent decision support systems for optimised diabetes

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    Computers now pervade the field of medicine extensively; one recent innovation is the development of intelligent decision support systems for inexperienced or non-specialist pbysicians, or in some cases for use by patients. In this thesis a critical review of computer systems in medicine, with special reference to decision support systems, is followed by a detailed description of the development and evaluation of two new, interacting, intelligent decision support systems in the domain of diabetes. Since the discovery of insulin in 1922, insulin replacement therapy for the treatment of diabetes mellitus bas evolved into a complex process; there are many different formulations of insulin and much more information about the factors which affect patient management (e.g. diet, exercise and progression of complications) are recognised. Physicians have to decide on the most appropriate anti-diabetic therapy to prescribe to their patients. Insulin-treated patients also have to monitor their blood glucose and decide how much insulin to inject and when to inject it. In order to help patients determine the most appropriate dose of insulin to take, a simple-to-use, hand-held decision support system has been developed. Algorithms for insulin adjustment have been elicited and combined with general rules of therapy to offer advice for every dose. The utility of the system has been evaluated by clinical trials and simulation studies. In order to aid physician management, a clinic-based decision support system has also been developed. The system provides wide-ranging advice on all aspects of diabetes care and advises an appropriate therapy regimen according to individual patient circumstances. Decisions advised by the pbysician-related system have been evaluated by a panel of expert physicians and the system has undergone informal primary evaluation within the clinic setting. An interesting aspect of both systems is their ability to provide advice even in cases where information is lacking or uncertain

    Toksin genotipizacija sojeva Clostridium perfringens izolovanih iz hrane za životinje i njihov značaj u etiologiji enterotoksemija domaćih životinja

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    Clostridium perfringens is a Gram-positive, endospore-forming, anaerobic rod, ubiquitous in nature. C. perfringens strains can produce about 17 toxins. Many of them can lead to miscellaneous diseases, among which the enteric ailment may be the most common and is of utmost importance. In the present work 34 strains of C. perfringens isolated from feed and one from a cow suspected to have died of clostridial infection were subjected to molecular analysis. In order to detect the genotypes, the following genes coding for toxins were targetted: cpa, cpb, cpb2, cpe, etx and iap. The multiplex PCR assay revealed that all C. perfringens isolates from animal feed were of type A and b2-toxinogenic type A strains, possessing only the cpa (n=21), or both the cpa and the cpb2 genes (n=13). The importance of C. perfringens toxins α and β-2 in the pathogenesis of enterotoxemia is discussed and the regulation on the detection of this bacteria in animal feed questioned. The use of PCR in practise could enable the toxin-genotyping of C. perfringens isolates and, thus, provide a real basis for the establishment of maximum acceptable limits of this bacteria in feed.Clostridium perfringens je Gram-pozitivna, anaerobna, sporulišuća, štapićasta bakterija, ubikvitarno rasprostranjena u prirodi. Kod različitih sojeva C. Perfringens, do danas, identifikovano je oko 17 vrsta toksina. C. perfringens je uzročni agens različitih oboljenja (sindroma), ali su crevne infekcije/intoksikacije najčešće i od najvećeg značaja za zdravlje farmski gajenih životinja. U ovom radu prikazujemo rezultate ispitivanja sojeva C. perfringens poreklom iz hrane za životinje (n=34) i jednog izolata iz organa krave uginule sa znacima enterotoksemije na prisustvo gena: cpa, cpb, cpb2, cpe, etx i iap primenom multipleks PCR tehnike. Svi sojevi C. perfringens izolovani iz hrane za životinje, identifikovani su kao tip A koji poseduje samo cpa gen (n=21) ili tip A koji produkuje b2-toksin, odnosno ima cpa i cpb2 gene (n=13). U radu diskutujemo o ulozi alfa (α) i beta-2 (β2) toksina u patogenezi enterotoksemija domaćih životinja, kao i aktuelnom zakonskom propisu po kojem ova vrsta bakterije ne sme biti prisutna u hrani za životinje. Primena PCR tehnike u svakodnevnoj praksi omogućila bi toksin-genotipizaciju sojeva C. perfringens, a time i realne osnove za uspostavljanje graničnih dozvoljenih vrednosti za ovu vrstu bakterije u hrani za životinje
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