2,693 research outputs found

    Evaluation of strategies for reducing the burden of COPD in the UK using Bayesian methods

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    Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of all deaths and 1.7% of all hospital admissions in the UK. This thesis focuses on strategies to reduce COPD burden by targeting three aspects across the public healthcare system: prevention, emergency treatment, and long-term management. Analyses were performed in a Bayesian framework to exploit its flexibility in modelling uncertainty and the incorporation of prior knowledge. First, I assessed whether communication of personalised disease risk in primary care is an effective smoking cessation intervention, using cost-effectiveness and value of information analyses based on various data sources across the literature. The odds ratio for the effectiveness of communication of personalised disease risk was 1.48 (95%CrI:0.91-2.26). While I found a probability of cost-effectiveness of about 90%, further research up to a maximum of £27 million is justified to reduce the uncertainty around this estimate. Secondly, I assessed whether case ascertainment affects the detection of poorly performing hospital trusts in the treatment of acute exacerbation of COPD (AECOPD) in secondary care, using data from the National Asthma and COPD Audit Programme. Case ascertainment was associated with 30-day mortality (OR:1.74; 1.25-2.41) and adjusting for it impacted the findings, with 5 trusts becoming outliers and 2 trusts no longer classified as outliers. Finally, using general practice data from Clinical Practice Research Datalink, I assessed whether new guidelines suggesting triple therapy (long-acting beta-2 agonists, LABA + long-acting muscarinic antagonists, LAMA + inhaled corticosteroids, ICS) for the treatment of those with poorly-controlled COPD on LABA+LAMA dual therapy improves disease outcomes. Triple therapy was not associated with severe AECOPD (IRR:1.00; 0.93-1.07) or mortality (IRR:0.95; 0.86-1.06), but was associated with increased risk of pneumonia (IRR:1.19; 1.05-1.35). This thesis applied sophisticated Bayesian methods to increase understanding of how COPD burden could be reduced in different areas of the public healthcare system.Open Acces

    Proceedings - Wright State University Boonshoft School of Medicine Eighth Annual Medical Student Research Symposium: Celebrating Medical Student Scholarship

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    The student abstract booklet is a compilation of abstracts from students\u27 oral and poster presentations at Wright State University\u27s Eighth Annual Boonshoft School of Medicine Medical Student Research Symposium held on April 13, 2016.https://corescholar.libraries.wright.edu/ra_symp/1007/thumbnail.jp

    Metastização de tumores malignos para a cavidade oral: revisão sistemática de relatos e séries de casos clínicos

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    Introdução: A metastização de tumores malignos para a cavidade oral é um evento raro, que representa cerca de 1 a 8% de todos os tumores orais. Objetivos: Sintetizar a informação disponível publicada até à data, relativamente a tumores malignos com metastização para a cavidade oral, designadamente no que diz respeito a dados demográficos, local do tumor primário, localização da metástase na cavidade oral, manifestações orais e taxa de sobrevivência. Materiais e métodos: Foi realizada uma pesquisa eletrónica nas bases de dados Pubmed, Scopus e Google Scholar. Apenas foram incluídos relatos de caso ou séries de casos em que se realizou biópsia e exame anatomopatológico da lesão com confirmação de mestástate, e em que era referida qual a estrutura da cavidade oral afetada. Foi realizada a análise descritiva e uma curva Kaplan-Meier de análise da sobrevivência dos doentes. Resultados: Foram selecionados 273 artigos, perfazendo um total de 950 casos. A idade média foi de 57,11 anos. O sexo masculino foi mais afetado (57,5%). No sexo feminino, a origem mais comum foi a mama (29,8%), enquanto no sexo masculino foi o pulmão (24,8%). A metástase oral foi o primeiro sinal de doença tumoral disseminada em 30,4% dos casos. As estruturas ósseas foram mais afetadas (56,7%) do que os tecidos moles (37,9%), sendo a mandíbula a localização mais comum (45,5%), seguida da gengiva (19,9%). A manifestação clínica mais comum foi a presença de uma massa ou nódulo. Na presença de evidência radiográfica, uma lesão radiolúcida foi a imagem mais comum (60,6%). Ao fim de 3 anos a probabilidade de sobrevivência foi de 14,2% e ao fim de 5 anos foi de 10,7%. Conclusão: Apesar de ser um pouco comum, o médico dentista deverá estar atento à possibilidade da ocorrência de metástases para a cavidade oral. As lesões deverão ser biopsadas e analisadas, mesmo as que possam ter uma aparência clínica benigna, devido à possibilidade de doença metastática.Introduction: Metastasis of malignant tumors to the oral cavity is a rare event, representing about 1 to 8% of all oral tumors. Objectives: To summarize the available information published to date, regarding malignant tumors with metastasis to the oral cavity, in terms of demographics, primary site, oral site, clinical manifestations, and survival. Materials and methods: An electronic search was carried out in Pubmed, Scopus and Google Scholar databases. Only case reports or case series in which a biopsy and anatomopathological examination of the lesion were performed with confirmation of metastasis were included, and in which the affected oral site was mentioned. Descriptive analysis and a Kaplan-Meier survival curve were performed. Results: 273 articles were selected, for a total of 950 cases. The mean age was 57,11 years. Males were more affected (57.5%). In females, the most common primary site was the breast (29.8%), while in males it was the lung (24.8%). Oral metastasis was the first sign of disseminated tumor disease in 30.4% of cases. Jawbones were more affected (56.7%) than soft tissues (37.9%), with the mandible being the most affected site (45.5%), followed by the gengiva (19.9%). The most common clinical manifestation was a mass or nodule. In the presence of radiographic evidence, a radiolucent lesion was the most common image (60.6%). 3-year and 5-year survival rates were 14.2% and 10.7%. Conclusion: Despite being uncommon, the clinician should be aware of the possibility of metastases to the oral cavity. Lesions should be biopsied and analyzed, even those that may have a benign clinical appearance, due to the possibility of metastatic disease

    Metastização de tumores malignos para a cavidade oral: revisão sistemática de relatos e séries de casos clínicos

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    Introdução: A metastização de tumores malignos para a cavidade oral é um evento raro, que representa cerca de 1 a 8% de todos os tumores orais. Objetivos: Sintetizar a informação disponível publicada até à data, relativamente a tumores malignos com metastização para a cavidade oral, designadamente no que diz respeito a dados demográficos, local do tumor primário, localização da metástase na cavidade oral, manifestações orais e taxa de sobrevivência. Materiais e métodos: Foi realizada uma pesquisa eletrónica nas bases de dados Pubmed, Scopus e Google Scholar. Apenas foram incluídos relatos de caso ou séries de casos em que se realizou biópsia e exame anatomopatológico da lesão com confirmação de mestástate, e em que era referida qual a estrutura da cavidade oral afetada. Foi realizada a análise descritiva e uma curva Kaplan-Meier de análise da sobrevivência dos doentes. Resultados: Foram selecionados 273 artigos, perfazendo um total de 950 casos. A idade média foi de 57,11 anos. O sexo masculino foi mais afetado (57,5%). No sexo feminino, a origem mais comum foi a mama (29,8%), enquanto no sexo masculino foi o pulmão (24,8%). A metástase oral foi o primeiro sinal de doença tumoral disseminada em 30,4% dos casos. As estruturas ósseas foram mais afetadas (56,7%) do que os tecidos moles (37,9%), sendo a mandíbula a localização mais comum (45,5%), seguida da gengiva (19,9%). A manifestação clínica mais comum foi a presença de uma massa ou nódulo. Na presença de evidência radiográfica, uma lesão radiolúcida foi a imagem mais comum (60,6%). Ao fim de 3 anos a probabilidade de sobrevivência foi de 14,2% e ao fim de 5 anos foi de 10,7%. Conclusão: Apesar de ser um pouco comum, o médico dentista deverá estar atento à possibilidade da ocorrência de metástases para a cavidade oral. As lesões deverão ser biopsadas e analisadas, mesmo as que possam ter uma aparência clínica benigna, devido à possibilidade de doença metastática.Introduction: Metastasis of malignant tumors to the oral cavity is a rare event, representing about 1 to 8% of all oral tumors. Objectives: To summarize the available information published to date, regarding malignant tumors with metastasis to the oral cavity, in terms of demographics, primary site, oral site, clinical manifestations, and survival. Materials and methods: An electronic search was carried out in Pubmed, Scopus and Google Scholar databases. Only case reports or case series in which a biopsy and anatomopathological examination of the lesion were performed with confirmation of metastasis were included, and in which the affected oral site was mentioned. Descriptive analysis and a Kaplan-Meier survival curve were performed. Results: 273 articles were selected, for a total of 950 cases. The mean age was 57,11 years. Males were more affected (57.5%). In females, the most common primary site was the breast (29.8%), while in males it was the lung (24.8%). Oral metastasis was the first sign of disseminated tumor disease in 30.4% of cases. Jawbones were more affected (56.7%) than soft tissues (37.9%), with the mandible being the most affected site (45.5%), followed by the gengiva (19.9%). The most common clinical manifestation was a mass or nodule. In the presence of radiographic evidence, a radiolucent lesion was the most common image (60.6%). 3-year and 5-year survival rates were 14.2% and 10.7%. Conclusion: Despite being uncommon, the clinician should be aware of the possibility of metastases to the oral cavity. Lesions should be biopsied and analyzed, even those that may have a benign clinical appearance, due to the possibility of metastatic disease

    Interventional radiology in the elderly

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    Interventional radiological percutaneous procedures are becoming all the more important in the curative or palliative management of elderly frail patients with multiple underlying comorbidities. They may serve either as alternative primary minimally invasive therapies or adjuncts to traditional surgical treatments. The present report provides a concise review of the most important interventional radiological procedures with a special focus on the treatment of the primary debilitating pathologies of the elderly population. The authors elaborate on the scientific evidence and latest developments of thermoablation of solid organ malignancies, palliative stent placement for gastrointestinal tract cancer, airway stenting for tracheobronchial strictures, endovascular management of aortic and peripheral arterial vascular disease, and cement stabilization of osteoporotic vertebral fractures. The added benefits of high technical and clinical success coupled with lower procedural mortality and morbidity are highlighted
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