Przygotowanie jelita do kolonoskopii: Zalecenia Europejskiego Towarzystwa Endoskopii Przewodu Pokarmowego

 CEL: Niniejsze zalecania są oficjalnym stanowiskiem Europejskiego Towarzystwa Endoskopii Przewodu Pokarmowego (ESGE, European Society of Gastrointestinal Endoscopy) na temat wyboru sposobu przygotowania jelita do kolonoskopii.METODY: Zalecania opracowano na podstawie przeglądu literatury ukierunkowanego na dowody dotyczące przygotowania jelita do kolonoskopii. Siła zaleceń i jakość dowodów, na których je oparto zostały określone przy użyciu systemu GRADE (Grading of Recommendations Assessment, Development and Evaluation).WYNIKI: Najważniejsze zalecenia są następujące:1. ESGE zaleca w dniu poprzedzającym kolonoskopię dietę ubogoresztkową (słabe zalecenie, dowody umiarkowanej jakości);2. ESGE zaleca w rutynowym przygotowaniu do kolonoskopii 4 litry roztworu glikolu polietylenowego (PEG) w dwóch dawkach podzielonych lub, w przypadku kolonoskopii wykonywanej po południu, w jednorazowej dawce porannej. Alternatywą, szczególnie w przygotowaniu do kolonoskopii w warunkach ambulatoryjnych, może być podanie 2 l PEG z kwasem askorbinowym lub pikosiarczanu sodu z cytrynianem magnezu w dwóch dawkach podzielonych lub, w przypadku kolonoskopii wykonywanej po południu, w jednorazowej dawce porannej (silne zalecenie, dowody wysokiej jakości). Odstęp pomiędzy ostatnią dawką preparatu do przygotowania a kolonoskopią nie powinien przekraczać 4 godzin;3. ESGE radzi ze względów bezpieczeństwa nie używać rutynowo do przygotowania do kolonoskopii preparatów fosforanu sodu (silne zalecenie, dowody niskiej jakości).

Measuring the CMB primordial B-modes with Bolometric Interferometry

The Q&U Bolometric Interferometer for Cosmology (QL’BIC) is the first bolometric interferometer designed to measure the primordial B-mode polarization of the Cosmic Microwave Background (CMB). Bolometric interferometry is a novel technique that combines the sensitivity of bolometric detectors with the control of systematic effects that is typical of interferometry, both key features in the quest for the faint signal of the primordial B-modes. A unique feature is the so-called “spectral imaging”, i.e., the ability to recover the sky signal in several sub-bands within the physical band during data analysis. This feature provides an in-band spectral resolution of ∆v/v ~ 0.04 that is unattainable by a traditional imager. This is a key tool for controlling the Galactic foregrounds contamination. In this paper, we describe the principles of bolometric interferometry, the current status of the QU BIC experiment and future prospects

Atrial fibrillation: Prevalence after minimally invasive direct and standard coronary artery bypass

Background. This study identified and compared the prevalence of new-onset atrial fibrillation (AFIB) following standard coronary artery bypass grafting (SCABG) with cardiopulmonary bypass (CPB) and minimally invasive direct vision coronary artery bypass grafting (MIDCAB) without CPB. A further comparison was made between AFIB prevalence in SCABG and MIDCAB subjects with two or fewer bypasses. Methods. This is a retrospective, comparative survey. Patients with new-onset AFIB who underwent SCABG or MIDCAB alone were identified electronically using a triangulated method (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9 CM] code; clinical database word search; and pharmacy database drug search). Results. The total sample (n = 814; 94 MIDCAB, 720 SCABG) exhibited a trend toward lower AFIB prevalence in MIDCAB (23.4%) versus SCABG (33.1%) subjects (p = 0.059). AFIB prevalence in the SCABG subset with two or less vessel bypasses (n = 98; n = 18 single vessel, n = 80 double vessels) and MIDCAB subjects (n = 94; n = 90 single vessels, n = 4 double vessels) was almost identical (SCABG subset 24.5% versus MIDCAB 23.4%, p = 0.860). Slightly more than half (56.9%) of new-onset AFIB subjects were identified by ICD-9 CM codes, with the remainder by word search (37.7%) or procainamide query (5.4%). Conclusions. In this sample, the number of vessels bypassed seemed to have a greater influence on AFIB prevalence than the application of CPB or the surgical approach. Retrospective identification of AFIB cases by ICD-9 CM code grossly underestimated AFIB prevalence. © 2001 by The Society of Thoracic Surgeons

Empfehlungen für die Diagnostik und Therapie psychotischer Erkrankungen im Alter [Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly]

Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly Abstract. Psychotic disorders in the elderly cover a wide range of causes and manifestations. They often occur as part of a depression, dementia, substance abuse or delirium. While psychosis can occur with a first manifestation in advanced age, many patients with chronic psychotic disorders reach a high age. Many elderly individuals are also affected by cognitive impairment and somatic conditions, making a third-party history most relevant. The associated changes in life and the complexity of the individual situation needs to be integrated into the diagnosis and treatment. The presented recommendations have been developed under the lead of the Swiss Society of Old Age Psychiatry (SGAP) in collaboration with the Swiss Association of Nurses (SBK) and the subcommittees for gerontological and psychiatric nursing of the association of nursing science (VFP) as well as further professional societies. We aim to make current knowledge concerning diagnosis and treatment available to the interprofessional teams working in in- and outpatients' settings

Comparação de dados dos satélites Ikonos-II e Landsat/ETM+ no estudo de áreas cafeeiras Comparison between Ikonos-II and Landsat/ETM+ satellites data in the study of coffee areas

O objetivo deste trabalho foi avaliar o impacto do aumento da resolução espacial e radiométrica da imagem pancromática do Ikonos-II na identificação de plantios de café (Coffea arabica), em comparação com as imagens do Landsat/ETM+. A área de estudo está localizada no Município de Pedregulho, SP, onde foram selecionados 50 talhões com plantios de café, e foram levantados dados referentes à altura, idade, espaçamento e variedade de cada talhão. As imagens permitiram a identificação de talhões com características diferentes em campo, tendo-se destacado a imagem do Ikonos-II, que apresentou melhor desempenho. Para os talhões com características iguais em campo, as imagens analisadas não se mostraram eficientes, independentemente do satélite utilizado. As correções atmosféricas e radiométricas, na imagem do Ikonos-II, não proporcionaram ganho efetivo nas análises realizadas. A maioria dos talhões identificados na imagem do Ikonos-II pode ser localizada na imagem do Landsat/ETM+ (68%). A correlação significativa entre a banda 4 do Landsat/ETM+ e o canal pancromático do Ikonos-II indica uma forma de ligação entre as imagens dos dois satélites.<br>The objective of this work was to assess the impact of the better spatial and radiometric resolutions of the Ikonos-II panchromatic image, for the identification of coffee (Coffea arabica) planting areas, in comparison with a Landsat/ETM+ image. The area of study is situated in the city of Pedregulho, State of São Paulo, Brazil, where 50 coffee fields were selected. Information about plants features, like height, age, spacing and variety were collected. Images allowed the identification of coffee areas with different field features, and the calibrated Ikonos-II image showed the best results. Considering the areas with similar field features, images from both satellites were not efficient in the coffee identification. The atmospheric and radiometric corrections applied on the Ikonos-II image did not improve the analyses results. More than half of the identified areas in the Ikonos-II image could be found in the Landsat/ETM+ image (68%). The significant correlation between Landsat/ETM+ band 4 and Ikonos-II panchromatic channel shows a link between both satellite images

Análise da transição entre dias secos e chuvosos por meio da cadeia de Markov de terceira ordem Analysis of the transition between dry and wet days through third-order Markov chains

O objetivo deste trabalho foi verificar se as ocorrências de dias secos e chuvosos são condicionalmente dependentes da seqüência dos três dias secos e chuvosos anteriores, numa zona pluviometricamente homogênea, por meio da cadeia não-homogênea de Markov de terceira ordem. Os resultados mostraram que as probabilidades diárias de transição podem ser adequadamente estimadas, com base em dados agregados bimestralmente, seguidas de interpolação por meio de funções sinusoidais. Além disso, evidenciou-se que, naquela zona, as ocorrências diárias de chuva são condicionalmente dependentes da seqüência de dias secos e chuvosos nos três dias anteriores. A cadeia não-homogênea de Markov de terceira ordem é um importante instrumento para a análise da dependência entre as seqüências de dias secos e chuvosos em determinadas regiões.<br>The aim of this work was to verify if the occurrence of dry and wet days are conditionally dependent on the sequences of the dry and wet three preceding days, in a rainfall homogeneous area, using the nonhomogeneous third-order Markov chains. The results showed that daily transition probabilities can be properly estimated from two-month aggregate data, and then adjusted by means of sinusoidal functions. Besides, it was evidenced that everyday rain events in that area are conditionally dependent on the sequences of the dry and wet three days previous to occurrences. The third-order nonhomogeneous Markov chains are an important instrument for the analysis of the dependence between sequences of dry and wet days in certain areas

Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD : a Randomized, Controlled, Open-Label Trial

Objectives: This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure. Background: Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis. Methods: In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year. Results: At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p &lt; 0.001). Rates of normal ICA were 24.6% in the selective referral arm compared with 61.1% in the direct referral arm of the trial (p &lt; 0.001). Conclusions: In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198