Diagnostic Accuracy of Age and Alarm Symptoms for Upper GI Malignancy in Patients with Dyspepsia in a GI Clinic: A 7-Year Cross-Sectional Study

<div><h3>Objectives</h3><p>We investigated whether using demographic characteristics and alarm symptoms can accurately predict cancer in patients with dyspepsia in Iran, where upper GI cancers and <em>H. pylori</em> infection are common.</p> <h3>Methods</h3><p>All consecutive patients referred to a tertiary gastroenterology clinic in Tehran, Iran, from 2002 to 2009 were invited to participate in this study. Each patient completed a standard questionnaire and underwent upper gastrointestinal endoscopy. Alarm symptoms included in the questionnaire were weight loss, dysphagia, GI bleeding, and persistent vomiting. We used logistic regression models to estimate the diagnostic value of each variable in combination with other ones, and to develop a risk-prediction model.</p> <h3>Results</h3><p>A total of 2,847 patients with dyspepsia participated in this study, of whom 87 (3.1%) had upper GI malignancy. Patients reporting at least one of the alarm symptoms constituted 66.7% of cancer patients compared to 38.9% in patients without cancer (p<0.001). Esophageal or gastric cancers in patients with dyspepsia was associated with older age, being male, and symptoms of weight loss and vomiting. Each single predictor had low sensitivity and specificity. Using a combination of age, alarm symptoms, and smoking, we built a risk-prediction model that distinguished between high-risk and low-risk individuals with an area under the ROC curve of 0.85 and acceptable calibration.</p> <h3>Conclusions</h3><p>None of the predictors demonstrated high diagnostic accuracy. While our risk-prediction model had reasonable accuracy, some cancer cases would have remained undiagnosed. Therefore, where available, low cost endoscopy may be preferable for dyspeptic older patient or those with history of weight loss.</p> </div

Third World debt and natural resources conservation

Additional papers annexed : Proposal for forgiveness of official African debt; Multilateral development banks and the environment; Statement concerning the implementation of recommendations to promote improved environmental performance by the multilateral development banksRelated to DAP 87-4249 under which IDRC supported the WCED to acquire and duplicate original papers, submissions, tapes and transcripts, became the depository of all original archival materials and received the right to microfiche the collection for broader disseminatio

Designing Effective Video Teletraining Instruction: The Florida Teletraining Project

The Florida Teletraining Project was an evaluation study that sought to test the feasibility of providing various military courses to the Reserve Components using community college personnel. Delivery was via a two-way interactive system, TNET, one of the Army\u27s teletraining networks. Five courses were delivered and evaluated in the project. This article describes the course design requirements used to develop the interactive video courseware for the project. It also presents the results of the performance tests and reactions of the students and some of the instructional personnel to the instructional methods used in the courses. Results showed that all students passed the performance tests (consistent with the U.S. Army\u27s mastery requirements) and over 90% passed on the first attempt. Students and instructional personnel were positive about the strategies that were designed for the video teletraining courses. They rated the learning methods, including the interactivity provided, to be useful and effective

Wicking teaching aged care facilities program: Innovative Practice

This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students’ attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus