Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Pasientforløp for eldre med kronisk sykdom: En oppsummering av kunnskap

Dette er en oppsummering av forsknings- og utviklingsarbeid som omhandler pasientforløp for eldre med kronisk sykdom i den kommunale helse- og omsorgstjenesten og mellom nivåene i helsetjenesten. Oppsummeringen inkluderer 121 forsknings- og utviklingspublikasjoner. I publikasjonene beskrives det norske helsevesenet som komplekst, fragmentert og under press. Dette utgjør en utfordring for helhetlige pasientforløp for eldre med kronisk sykdom, siden slike pasientforløp ofte har flere kritiske overganger. Kliniske retningslinjer utarbeidet for enkeltsykdommer, og fragmenterte og dårlig koordinerte tjenester trekkes også fram som utfordrende for pasienter som har flere kroniske sykdommer samtidig – såkalt multisykdom. Det pekes videre på svikt i informasjonsflyten ved overføringer mellom sykehus og kommune og på tydelige forskjeller i tilnærming og perspektiv mellom spesialist- og primærhelsetjenesten. I spesialisthelsetjenesten blir pasientens behov i hovedsak vurdert i et korttidsperspektiv og ut ifra en medisinsk, diagnoseorientert tilnærming. I primærhelsetjenesten blir pasientens behov i det vesentlige vurdert i et langsiktig perspektiv, med vekt på funksjonsnivå, mestring, livskvalitet og hjemmesituasjon. Ulike perspektiver på pasientenes omsorgsbehov gjenspeiles også i forståelsen av begrepet utskrivningsklar. Flere publikasjoner finner at samhandlingsreformen har ført til flere pasienter med økt behov for medisinsk behandling i kommunen og til flere reinnleggelser i sykehus. Det rapporteres om at sykehuset er for raske i utskrivningen og at mange pasienter ikke er ferdigbehandlet. Flere publikasjoner finner at det er for liten kompetanse i kommunen til å ta imot pasientene. Det pekes også på utfordringer relatert til knappe økonomiske ressurser i kommunene. Standardiserte pasientforløp og bruk av sjekklister beskrives som gode tiltak for å bedre overføringen fra sykehus og styrke oppfølgingen, mens bruk av IKT og pleie- og omsorgsmeldinger (PLO-meldinger) beskrives som tiltak som kan bidra til bedre informativ kontinuitet (relevant informasjon er tilgjengelig til enhver tid) i pasientforløpet. Ulike samarbeidsmodeller mellom sykehus og kommune kan bidra til kunnskapsoverføring og økt forståelse for pasientens situasjon. Dette kan videre gi bedre overganger og kontinuitet i pasientforløpet. Opprettelse av intermediære enheter og kommunale akutte døgnplasser (KAD) beskrives som sentrale og vellykkede tiltak for å bedre overgangen mellom sykehus og kommune, men det vises også blant annet til utfordringer i organiseringen av tilbudene. Eldre som er utskrevet fra sykehus til kommunen, vil ifølge litteraturen ha nytte av sammensatte og målrettede tiltak for å kunne forbedre overføringer på tvers av nivåer i helsevesenet

Multiple mtDNA deletions with features of MNGIE.

Item does not contain fulltextTwo sisters developed gastrointestinal malabsorption with pain and unsteady gait due to polyneuropathy at age 15. Both had ophthalmoplegia, neurogenic EMG, and COX-negative muscle fibers. One patient had low muscle complex I-IV activity, multiple mtDNA deletions, and depletion, but no thymidine phosphorylase (TP) or dNT-2 gene mutations. TP activity and brain MRI were normal. The condition resembles mitochondrial neurogastrointestinal encephalomyopathy, except for the absence of leukoencephalopathy, and is likely caused by a nuclear DNA mutation that disrupts intergenomic signaling

Classifier combination for in vivo magnetic resonance spectra of brain tumours

In this paper we present a multi-stage classifier for magnetic resonance spectra of human brain tumours which is being developed as part of a decision support system for radiologists. The basic idea is to decompose a complex classification scheme into a sequence of classifiers, each specialising in different classes of tumours and trying to reproduce part of the WHO classification hierarchy. Each stage uses a particular set of classification features, which are selected using a combination of classical statistical analysis, splitting performance and previous knowledge. Classifiers with different behaviour are combined using a simple voting scheme in order to extract different error patterns: LDA, decision trees and the k-NN classifier. A special label named "unknown¿ is used when the outcomes of the different classifiers disagree. Cascading is also used to incorporate class distances computed using LDA into decision trees. Both cascading and voting are effective tools to improve classification accuracy. Experiments also show that it is possible to extract useful information from the classification process itself in order to help users (clinicians and radiologists) to make more accurate predictions and reduce the number of possible classification mistakes

Quality assessment in in vivo NMR spectroscopy: IV. A multicentre trial of test objects and protocols for performance assessment in clinical NMR spectroscopy

A multicentre trial of test objects and protocols for performance assessment in single volume and slice selective magnetic resonance spectroscopy (MRS) was conducted by the European Community Concerted Action on MRI and MRS. The trial assessed phosphorus and proton localisation techniques implemented on commercially available MR systems at ten sites in Europe. At each site, a number of parameters devised by the Concerted Action were measured using prototype test objects. Some of these parameters related to the quality of localisation and others to the overall performance of the spectrometer. Results were obtained for the ISIS, DRESS, STEAM, and PRESS sequences with a range of acquisition parameters, allowing evaluation of the assessment methodology and comparison of the efficacy of various implementations of these localisation techniques. The results of this trial have been important in the development of the Concerted Action's final recommendations for MRS performance assessment, and demonstrate that such assessment provides valuable information in the comparison of spectroscopy data from different sites and in the development of new localisation sequences, and provides a means of quality assurance in MRS