56 research outputs found
Outcome of unreconstructed chronic critical leg ischaemia
Objective:To assess the outcome of unreconstructed chronic critical leg ischaemia with a special reference to the definition of CLI.Design and Setting:A retrospective study with 1 year follow-up in an academic referral centre (Fourth Department of Surgery, Helsinki University Central Hospital).Material:105 consecutive unreconstructed patients with 136 critically ischaemic legs as defined by the European Consensus Document on Chronic Critical Leg Ischaemia.Main outcome measures:Major amputations and mortality.Results:81% of the 136 critically ischaemic legs survived 1 month, 70% three months and 54% one year. Of the 105 patients 93%, 77% and 46% were alive at 1, 3 and 12 months, respectively, whereas survival of patients with nonamputated leg was only 71%, 56% and 28%. Patients with bilateral CLI had a worse prognosis in terms of survival and leg salvage. The leg outcome was not worsened by the presence of diabetes nor by the distal extent of arterial changes.Conclusion:Although the selection of the present material is likely to cause some bias, unreconstructed CLI seemed to predict a very poor outcome in terms of survival and limb salvage
Amerikanische Sozialpolitik zwischen starkem Markt und starkem Staat
Dieser Aufsatz nimmt schlaglichtartig einige Schlüsselaspekte der Sozialpolitik-Entwicklung in den USA in den Blick und fragt an diesen Beispielen nach der Realität und den Erscheinungsformen von staatlicher Aktivität in der Sozialpolitik und ihrem möglichen Bedeutungsgewinn oder Bedeutungsverlust. Der Schwerpunkt der Aufmerksamkeit liegt dabei auf den Sozialhilfeprogrammen, weil in ihnen der starke Staat am virulentesten Thema öffentlicher und sozialwissenschaftlicher Debatten geworden ist. Im Licht dieser Beobachtungen werden danach einige wichtige empirische und theoretische Annäherungen an das Thema staatliche vs. privatwirtschaftliche Organisationsformen der Daseinsvorsorge in international vergleichenden Gegenwartsanalysen betrachtet. Es wird deutlich, dass die durchgängig "wirtschaftsliberale" Klassifizierung der USA im Kontrast zu den europäischen Ländern richtig sein mag, dass man mit ihr aber wichtige Aspekte US-amerikanischer Staatlichkeit - und hier vor allem die ausgeprägte Präsenz staatlicher Gebote und Vorschriften im Leben der Sozialleistungsempfänger - nur schlecht in den Griff bekommt. Das abschließende Fazit fragt nach den Implikationen für empirische Konzepte zur Erforschung von Markt und Staat in der heutigen Sozialpolitik.This paper takes key elements of the United States' welfare system as examples for analyzing manifestations of "activist government" in the country’s social policy processes. It asks whether we can observe growing or declining significance of the state in shaping welfare and redistribution. The focus of attention is on social assistance programs, because state intervention is most salient and most pervasive in this policy area. In light of observations in the social assistance field important theoretical and empirical approaches to the question of public or private organization of social protection, as they exist in internationally comparative studies of welfare state development, will be assessed. Classifying the United States solely as an instance of the liberal welfare regime, it turns out, may have some merit when ascertaining the contrasts between European and American cases. However, it is not well-suited for identifying important aspects of the state’s role in social policy. In particular, it fails to highlight the strong interventionist presence of state rules and regulations in the lives of social assistance recipients. In closing the paper interrogates implications for the development of more suitable concepts for the study of state intervention and market coordination in today’s social policy
Prognostic Value of Tc-99m-HMDP Scintigraphy in Elderly Patients With Chronic Heart Failure
Background This study evaluated the prevalence and prognostic significance of cardiac transthyretin amyloidosis (ATTR) diagnosed using Tc-99m- hydroxymethylene-diphosphonate (Tc-99m-HMDP) scintigraphy in an elderly heart failure population. Methods This retrospective study included 335 patients aged >70 years with heart failure and who underwent Tc-99m-HMDP scintigraphy due to non-cardiac reasons in three imaging centres in Finland (Kymenlaakso Central Hospital, Jorvi Central Hospital, and Meilahti University Hospital). A Perugini grade >= 2 and heart-to-contralateral ratio (H/CL) of >= 1.30 were considered positive for cardiac ATTR. The overall and cardiovascular mortality were obtained from the national statistical service (Statistics Finland). Results There were 234 deaths, of which 70 were classified as being due to cardiovascular causes during a median follow-up of 1 (1-3) year. Transthyretin amyloidosis was diagnosed in 22 patients (6.6%) using visual analysis and 17 patients using the H/CL ratio (5.1%). Patients with ATTR were older (85 +/- 5 vs 80 +/- 5 yrs; p=0.002) and had higher N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels (1,451 [813-3,799] vs 6,192 [2,030-8,833] ng/L; p=0.02). Age, bone metastases, and glomerular filtration rate were independent predictors of overall mortality in multivariable analysis. Age, glomerular filtration rate, >= grade 2 visual cardiac uptake, and H/CL ratio were independent predictors of cardiovascular mortality. Conclusions Cardiac uptake suggestive of ATTR was found in 5% of elderly patients with chronic heart failure. The presence of cardiac uptake on bone scintigraphy did not convey independent prognostic value on overall mortality but was independently associated with cardiovascular mortality.Peer reviewe
Prognostic significance of incidental suspected transthyretin amyloidosis on routine bone scintigraphy
Background Transthyretin amyloidosis (ATTR) is an occasional incidental finding on bone scintigraphy. We studied its prognostic impact in elderly patients. Methods The study population consisted of 2000 patients aged over 70 years who underwent bone scintigraphies with clinical indications in three nuclear medicine departments (Kymenlaakso, Jorvi and Meilahti hospitals) in Finland. All studies were performed using (99m)Technetium labeled hydroxymethylene diphosphonate (HMDP). ATTR was suspected in patients with >= grade 2 Perugini grade uptake (grade 0-3). Heart-to-contralateral ratio (H/CL) of >= 1.30 was considered positive for ATTR. The overall and cardiovascular mortality were obtained from the Finnish National Statistical Service. Results There were a total of 1014 deaths (51%) and 177 cardiovascular deaths (9%) during median follow-up of 4 +/- 2 years. ATTR was suspected in 69 patients (3.6%) of which 54 (2.7%) had grade 2 and 15 (.8%) had grade 3 uptake and in 47 patients (2.4%) by H/CL ratio. In multivariate analyses age, bone metastasis, H/CL ratio and grade 3 uptake were independent predictors of overall and cardiovascular mortality. Grade 2 uptake was a predictor of cardiovascular mortality. Conclusions A suspected ATTR as an incidental finding on bone scintigraphy predicts elevated overall and cardiovascular mortality in elderly patients.Peer reviewe
Convolutional neural networks for detection of transthyretin amyloidosis in 2D scintigraphy images
Background Transthyretin amyloidosis (ATTR) is a progressive disease which can be diagnosed non-invasively using bone avid [Tc-99m]-labeled radiotracers. Thus, ATTR is also an occasional incidental finding on bone scintigraphy. In this study, we trained convolutional neural networks (CNN) to automatically detect and classify ATTR from scintigraphy images. The study population consisted of 1334 patients who underwent [Tc-99m]-labeled hydroxymethylene diphosphonate (HMDP) scintigraphy and were visually graded using Perugini grades (grades 0-3). A total of 47 patients had visual grade >= 2 which was considered positive for ATTR. Two custom-made CNN architectures were trained to discriminate between the four Perugini grades of cardiac uptake. The classification performance was compared to four state-of-the-art CNN models. Results Our CNN models performed better than, or equally well as, the state-of-the-art models in detection and classification of cardiac uptake. Both models achieved area under the curve (AUC) >= 0.85 in the four-class Perugini grade classification. Accuracy was good in detection of negative vs. positive ATTR patients (grade = 2, AUC > 0.88) and high-grade cardiac uptake vs. other patients (grade < 3 vs. grade 3, AUC = 0.94). Maximum activation maps demonstrated that the automated deep learning models were focused on detecting the myocardium and not extracardiac features. Conclusion Automated convolutional neural networks can accurately detect and classify different grades of cardiac uptake on bone scintigraphy. The CNN models are focused on clinically relevant image features. Automated screening of bone scintigraphy images using CNN could improve the early diagnosis of ATTR.Peer reviewe
Sydämen kaikututkimuksia avoterveydenhuollossa?
Vertaisarvioitu. English summary• Sydämen kaikututkimus on tärkeä diagnostinen työkalu sydänsairauksien selvittelyssä. • Hyvinkään, Espoon ja Kauniaisten terveyskeskuslääkärit voivat tilata näitä tutkimuksia ostopalveluna Hyvinkään ja Jorvin sairaaloista. • Uusi tai aiemmin tutkimaton systolinen sivuääni oli selvästi yleisin läheteaihe, kun käytiin läpi sata peräkkäistä sydämen kaikututkimusta, jotka oli tehty perusterveydenhuollon lähetteellä. • Hento systolinen sivuääni ilman muita sydänsairauden löydöksiä tai oireita ei edellytä kaikututkimusta, mutta diastolinen sivuääni kannattaa aina tutkia
Extensive Skeletal Muscle Cell Mitochondriopathy Distinguishes Critical Limb Ischemia Patients from Claudicants
Comparison of reprojected bone SPECT/CT and planar bone scintigraphy for the detection of bone metastases in breast and prostate cancer
Objective The aim of this study was to compare reprojected bone SPECT/CT (RBS) against planar bone scintigraphy (BS) in the detection of bone metastases in breast and prostate cancer patients. Methods Twenty-six breast and 105 prostate cancer patients with high risk for bone metastases underwent Tc-99m-HMDP BS and whole-body SPECT/CT, 1.5-T whole-body diffusion-weighted MRI and F-18-NaF or F-18-PSMA-1007 PET/CT within two prospective clinical trials (NCT01339780 and NCT03537391). Consensus reading of all imaging modalities and follow-up data were used to define the reference standard diagnosis. The SPECT/CT data were reprojected into anterior and posterior views to produce RBS images. Both BS and RBS images were independently double read by two pairs of experienced nuclear medicine physicians. The findings were validated against the reference standard diagnosis and compared between BS and RBS on the patient, region and lesion levels. Results All metastatic patients detected by BS were also detected by RBS. In addition, three metastatic patients were missed by BS but detected by RBS. The average patient-level sensitivity of two readers for metastases was 75% for BS and 87% for RBS, and the corresponding specificity was 79% for BS and 39% for RBS. The average region-level sensitivity of two readers was 64% for BS and 69% for RBS, and the corresponding specificity was 96% for BS and 87% for RBS. Conclusion Whole-body bone SPECT/CT can be reprojected into more familiar anterior and posterior planar images with excellent sensitivity for bone metastases, making additional acquisition of planar BS unnecessary.Peer reviewe
What characteristics of funding, provision and regulation are associated with effective social investment in ECEC in England, France and Germany?
Early childhood education and care (ECEC) is seen as a crucial element of the social investment state. Whilst the extent of social investment in ECEC depends on financial expenditure, its effectiveness depends on certain conditions being met, namely affordable, high quality provision being available. We explore policy development and the role played by government in the funding, provision and regulation of ECEC in England, France and Germany and then compare them in terms of availability, affordability and quality. We argue that for children aged three and over, social investment can be deemed to be broadly effective in France and Germany, but in England quality is compromised by low staff qualification levels in private childcare centres. For children under three, effective social investment is elusive in all countries although as a result of different conditions not being met. Our findings lead us to question the limitations of the concept of social investment in ECEC, particularly in marketised contexts
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