CT texture analysis can help differentiate between malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer

BACKGROUND: In patients with non-small-cell lung carcinoma NSCLC the lymph node staging in the mediastinum is important due to impact on management and prognosis. Computed tomography texture analysis (CTTA) is a postprocessing technique that can evaluate the heterogeneity of marked regions in images. PURPOSE: To evaluate if CTTA can differentiate between malignant and benign lymph nodes in a cohort of patients with suspected lung cancer. MATERIAL AND METHODS: With tissue sampling as reference standard, 46 lymph nodes from 29 patients were analyzed using CTTA. For each lymph node, CTTA was performed using a research software "TexRAD" by drawing a region of interest (ROI) on all available axial contrast-enhanced computed tomography (CT) slices covering the entire volume of the lymph node. Lymph node CTTA comprised image filtration-histogram analysis undertakes two stages: the first step comprised an application of a Laplacian of Gaussian filter to highlight fine to coarse textures within the ROI, followed by a quantification of textures via histogram analysis using mean gray-level intensity from the entire volume of the lymph nodes. RESULTS: CTTA demonstrated a statistically significant difference between the malignant and the benign lymph nodes (P = 0.001), and by binary logistic regression we obtained a sensitivity of 53% and specificity of 97% in the test population. The area under the receiver operating curve was 83.4% and reproducibility was excellent. CONCLUSION: CTTA may be helpful in differentiating between malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer, with a low intra-observer variance

Use of 18F-NaF PET in the staging of skeletal metastases of newly diagnosed, high-risk prostate cancer patients:a nationwide cohort study

OBJECTIVE: To determine whether preoperative staging of high-risk prostate cancer with (18)F-sodium-fluoride ((18)F-NaF) positron emission tomography (PET) reduces the risk of skeletal metastases. DESIGN: Nationwide, population-based cohort study using real-world data. SETTING: The study used national health registries, including all sites in Denmark from 2011 to 2018. PARTICIPANTS: Newly diagnosed high-risk prostate cancer patients who underwent radical prostatectomy from 2011 to 2018. Patients were stratified into two groups according to the preoperative imaging modality of either (18)F-NaF PET or bone scintigraphy. MAIN OUTCOME MEASURES: The risk of skeletal-related events (SREs) as a proxy for skeletal metastases following radical prostatectomy. The secondary endpoint was overall survival. RESULTS: Between 1 January 2011 and 31 December 2018, 4183 high-risk patients underwent radical prostatectomy. Of these patients, 807 (19.3%) underwent (18)F-NaF PET and 2161 (51.7%) underwent bone scintigraphy. The remaining 30% were examined by a different imaging method or did not undergo imaging. Using the inverse probability of treatment weighting to control potential confounding, the HR of experiencing an SRE for patients in the (18)F-NaF PET group versus the bone scintigraphy group was 1.15 (95% CI 0.86 to 1.54). The 3-year survival rates were 97.4% (95% CI 96.1 to 98.7) and 97.1% (95% CI 96.4 to 97.9) for patients receiving (18)F-NaF PET and bone scintigraphy, respectively. CONCLUSION: Patients with high-risk prostate cancer undergoing preoperative staging with (18)F-NaF PET did not display a lower risk of developing SREs after prostatectomy compared with patients undergoing bone scintigraphy. The survival rates were similar between the two groups

THE LINK BETWEEN STAKEHOLDER POWER AND VALUE CREATION IN CONSTRUCTION PROJECTS

ABSTRACT This paper presents a study on what effect stakeholder power has on value creation in construction projects. Fourteen main sources of power in organizations, described by Morgan, form the analytic framework. The ambition is to identify 1) how the distribution of power between the main stakeholders is, 2) which sources of power are most common in a construction project organization, 3) which effect the sources of power have on value creation in projects. The data is collected through semi-structured interviews. Experienced representatives from four main stakeholders in early phase of construction projects (owner, architect, design manager and project manager) were interviewed. The collected data through the interviews was coded, analyzed and linked to the literature study. The results reveals that 10 of 14 sources of power are identified as common sources of power in construction project organizations. Out of the ten, control of knowledge & information and formal authority are rated as the most influential sources of power. Apparently, all main stakeholders can possess these two sources. Rhetorical skills -which is not among the fourteen main sources described by Morgan -turn out to be an underrated and complex source of power. The LCI triangle model suggests that all project delivery systems have three basic domains whining which they operate i) organization, ii) the project´s "Operating system" and iii) the commercial terms binding the participants. These are equally important and should be aligned for the system to be coherent. Power is one of the main elements in organizational affairs that effect transparency and decision processes. There is a knowledge gap in how the power can affect the processes in project organization and which effects it can have on the projects´ overall value creation

Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics: nationwide study

Study question What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? Methods This was a nationwide cohort study based on linked administrative registry data from all hospitals in Denmark between 1997 and 2011. The study included patients aged 30 years and over admitted with a first myocardial infarction who survived at least 30 days after discharge. The association between PPIs and risk of gastrointestinal bleeding according to NSAID plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. Study answer and limitations The use of PPIs was independently associated with decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with NSAIDs. Of 82 955 post-myocardial infarction patients (mean age 67.4 years, 64% (n=53 070) men), all of whom were taking single or dual antithrombotic therapy, 42.5% (n=35 233) filled at least one prescription for NSAIDs and 45.5% (n=37 771) received PPIs. Over a mean follow-up of 5.1 years, 3229 gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0.95) regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. The main limitation of the study is its observational non-randomised design. The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot be avoided in post-myocardial infarction patients, physicians might prescribe a PPI as well. The study does not clarify whether PPIs might be safely omitted in specific subgroups of patients with a low risk of gastrointestinal bleeding. What this study adds In post-myocardial infarction patients, bleeding complications have been associated with both antithrombotic and NSAID treatment. Concurrent use of PPIs was independently associated with a decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and NSAID, regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. Funding, competing interests, data sharing AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation

Preoperative fasting: Instructions to patients and length of fasting – a prospective, descriptive survey

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Inngangur: Fasta sjúklinga er mikilvæg öryggisráðstöfun fyrir skurðað- gerð. Rannsóknir sýna þó að sjúklingar fasta mun lengur en leiðbeiningar kveða á um. Ástæður þess, þar með talinn þáttur sjúklingafræðslu, eru ekki kunnar. Tilgangur þessarar rannsóknar var að kanna hversu lengi sjúklingar fasta fyrir skurðaðgerð og hvaða leiðbeiningar þeir fengu varðandi föstu, þegar eitt ár var liðið frá innleiðingu nýrra leiðbeininga til starfsfólks og sjúklinga. Efniviður og aðferðir: Lýsandi rannsókn var gerð á Landspítala árið 2011. Gögnum var safnað úr sjúkraskrám og með spurningalista. Úrtakið náði yfir alla fullorðna sjúklinga sem gengust undir aðgerð í svæfingu eða slævingu á 5 daga tímabili. Niðurstöður: Þátttökuskilyrði uppfylltu 193 sjúklingar, þar af fóru 161 (83%) í valaðgerð. Útfylltir spurningalistar bárust frá 166 sjúklingum, eða 86% af þeim sem uppfylltu þátttökuskilyrði. Meðallengd föstu á mat var 13,6 (±3,0) klukkustundir og 8,8 (±4,5) klukkustundir á tæra drykki. Lið- lega fjórðungur sjúklinga (27%) fékk ráðleggingar um föstu í samræmi við leiðbeiningar og 45% var ráðlagt að fasta frá miðnætti. Upplýsingar voru veittar ýmist skriflega (18%), munnlega (37%) eða hvort tveggja (45%). Upplýsingar um tilgang föstu fengu 46% sjúklinga. Sjúklingar sem fóru í aðgerð að morgni föstuðu skemur en sjúklingar sem fóru í aðgerð eftir hádegi (p<0,05). Sjúklingar sem fengu bæði skriflegar og munnlegar upplýsingar föstuðu skemur á drykki en aðrir (p<0,001). Ályktanir: Skurðsjúklingar fasta mun lengur en nauðsynlegt er og fá mismunandi upplýsingar frá heilbrigðisstarfsfólki. Þörf er á að kanna frekar ástæðurnar fyrir þessu. Starfsfólk þarf að samræma starfshætti sína, virkja sjúklinga meira í eigin umönnun, veita samræmda og fullnægjandi sjúklingafræðslu og aðstoða sjúklinga við að stytta vökvaföstu eftir komu á sjúkrahúsiIntroduction: Fasting is an important safety precaution for patients before surgery but studies indicate that excessive fasting is common. Explanations for this, including patient education related factors, are not well known. The aim of this study was to explore how long patients fast before surgery and what instructions they received, one year after the introduction of new guidelines for patients and professionals. Material and methods: This descriptive study was undertaken in a national, 660-bed university hospital in 2011. Data was collected from patient records and with questionnaires. Included were adult surgical patients having anaesthesia during a 5day period. Results: The sample consisted of 193 patients: 83% were scheduled for elective surgery and 86% returned questionnaires. Average fasting time was 13,6 (±3.0) hours for solid food and 8,8 (±4.5) hours for clear fluids. A quarter (27%) had received instructions according to guidelines and 45% were instructed to fast from midnight. Information was either written (18%), verbal (37%) or both (45%) and 46% of patients received information on the importance of fasting. Patients scheduled for morning surgery fasted for a shorter time than afternoon patients (p<0.05). Patients who received both verbal and written information fasted shorter on clear fluids (p<0.001) than others. Conclusions: The fasting of surgical patients before their operation is unnecessarily long and they do not get uniform instructions. This warrants further exploration. There is a need for staff to coordinate instructional practices, to involve patients more in their own care with consistent information and comprehensive education and assist them in reducing fasting on clear fluids after hospital admission

Dronedarone in patients with congestive heart failure: insights from ATHENA

Dronedarone is a new multichannel blocking antiarrhythmic drug for treatment of atrial fibrillation (AF). In patients with recently decompensated congestive heart failure (CHF) and depressed LV function, the drug was associated with excess mortality compared with a placebo group. The present study aimed to analyse in detail the effects of dronedarone on mortality and morbidity in AF patients CHF. We performed a post hoc analysis of ATHENA, a large placebo-controlled outcome trial in 4628 patients with paroxysmal or persistent AF, to evaluate the relationship between clinical outcomes and dronedarone therapy in patients with stable CHF. The primary outcome was time to first cardiovascular (CV) hospitalization or death. There were 209 patients with NYHA class II/III CHF and a left ventricular ejection fraction &lt;0.40 at baseline (114 placebo, 95 dronedarone patients). A primary outcome event occurred in 59/114 placebo patients compared with 42/95 dronedarone patients [hazard ratio (HR) 0.78, 95% CI = 0.52-1.16]. Twenty of 114 placebo patients and 12/95 dronedarone patients died during the study (HR 0.71, 95% CI = 0.34-1.44). Fifty-four placebo and 42 dronedarone patients were hospitalized for an intermittent episode of NYHA class IV CHF (HR = 0.78, 95% CI = 0.52-1.17). In this post-hoc analysis of ATHENA patients with AF and stable CHF, dronedarone did not increase mortality and showed a reduction of CV hospitalization or death similar to the overall population. However, in the light of the ANtiarrhythmic trial with DROnedarone in Moderate to severe CHF Evaluating morbidity DecreAse study, dronedarone should be contraindicated in patients with NYHA class IV or unstable NYHA classes II and III CHF