17 research outputs found

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

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    Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

    Urban systems of accumulation: half a century of Chilean neoliberal urban policies

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    We analyse a half-century of Chilean urban reforms to explain the introduction of a system of urban accumulation by dispossession of public resources and opportunities. Three stages have been conceptualised in the imposition of a neoliberal creative-destructive process: proto-neoliberalism, roll-back and roll-out periods. Empirical studies have traditionally analysed this process by examining a single urban policy's evolution over time. In this paper, we go beyond these types of studies by performing a systemic analysis of multiple urban policy reforms in Santiago, Chile. We use a genealogical thematic analysis to track changes in laws, government programmes and planning documents from between 1952 and 2014. Our analysis identifies different “urban systems of accumulation” by looking at the interplay of four urban policies: (1) urban planning deregulation; (2) social housing privatisation; (3) devolution of territorial taxes; and (4) decreased public service provision. Moreover, our multidimensional policy analysis in Santiago characterises a more radical, fourth expression in the creative destruction process of “accumulation by dismantling”. Consequently, we advocate for more multidimensional urban policy research that goes beyond a three-period analysis in order to gain a deeper understanding of contemporary neoliberal creative-destructive processes in variegated geographies
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