130 research outputs found
What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.
People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards
Ten-year evolution of a massive transfusion protocol in a level 1 trauma centre : have outcomes improved?
Background: We aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to lifeâthreatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre. Methods: A retrospective study of prospectively collected data was performed over a 14âyear period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a preâMTP group (2002â2006), an MTPâI group (2006â2010) and an MTPâII group (2010â2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused. Results: A total of 168 patients were included: 54 preâMTP patients were compared to 47 MTPâI and 67 MTPâII patients. In the MTPâII group, fewer units of PRBC and platelets were administered within the first 24âh: 17 versus 14 (P = 0.01) and 12 versus 8 (Pâ<â0.001), respectively. Less infections were noted in the MTPâI group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay. Conclusion: Introduction of an MTPâII in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of realâlife medical care in a level 1 civilian trauma centre
Spirometric changes in obstructive disease: after all, how much is significant?
OBJECTIVE: To establish the upper limits for changes in FEV1, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction. METHODS: One hundred and two adults with airflow obstruction (FEV1 = 62 ± 19% of predicted) were included in the study. All of the participants performed SVC and FVC maneuvers before and after the administration of placebo spray. The changes in FEV1, SVC, FVC, and IC were expressed as absolute values, percentage of change from baseline values, and percentage of predicted values, 95% CIs and 95th percentiles being calculated. Factor analysis was performed in order to determine how those changes clustered. RESULTS: Considering the 95% CIs and 95th percentiles and after rounding the values, we found that the upper limits for a significant response were as follows: FEV1 = 0.20 L, FVC = 0.20 L, SVC = 0.25 L, and IC = 0.30 L (expressed as absolute values); FEV1 = 12%, FVC = 7%, SVC = 10%, and IC = 15% (expressed as percentage of change from baseline values); and FEV1 = 7%, FVC = 6%, SVC = 7%, and IC = 12% (expressed as percentage of predicted values). CONCLUSIONS: In patients with airflow obstruction, IC varies more widely than do FVC and SVC. For IC, values greater than 0.30 L and 15% of change from the baseline value can be considered significant. For FVC, values greater than 0.20 L and 7% of change from the baseline value are significant. Alternatively, changes exceeding 0.20 L and 7% of the predicted value can be considered significant for FEV1 and FVC. On factor analysis, spirometric parameters clustered into three dimensions, expressing changes in flows, volumes, and dynamic hyperinflation.OBJETIVO: Estabelecer os limites superiores para mudanças em VEF1, capacidade vital lenta (CVL), CVF e capacidade inspiratĂłria (CI) apĂłs o uso de placebo em pacientes com obstrução ao fluxo aĂ©reo. MĂTODOS: Cento e dois adultos com obstrução ao fluxo aĂ©reo (VEF1 = 62 ± 19% do previsto) foram incluĂdos neste estudo. Todos os participantes realizaram manobras de CVL e CVF antes e depois do uso de spray de placebo. As mudanças em VEF1, CVL, CVF e CI foram expressas em valores absolutos, porcentagem de variação em relação aos valores basais e porcentagem dos valores previstos, e foram calculados os IC95% e os percentis 95. A anĂĄlise fatorial foi realizada a fim de determinar como essas alteraçÔes se agrupavam. RESULTADOS: Considerando os IC95% e percentis 95 e apĂłs o arredondamento dos valores, obtivemos os seguintes limites superiores para resposta significante: VEF1 = 0,20 L, CVF = 0,20 L, CVL = 0,25 L e CI = 0,30 L (em valores absolutos); VEF1 = 12%, CVF = 7%, CVL = 10% e CI = 15% (em porcentagem de variação em relação aos valores basais) e VEF1 = 7%, CVF = 6%, CVL = 7% e CI = 12% (em porcentagem dos valores previstos). CONCLUSĂES: Em pacientes com obstrução ao fluxo aĂ©reo, a CI apresenta maior variabilidade do que a CVF e a CVL. Para a CI, valores maiores que 0,30 L e 15% de variação em relação ao valor basal devem ser considerados significantes. Para CVF, valores maiores que 0,20L e 7% de variação em relação ao valor basal sĂŁo significantes. Alternativamente, alteraçÔes de mais de 0,20 L e 7% do previsto no VEF1 e na CVF devem ser consideradas significantes. Na anĂĄlise fatorial, os parĂąmetros espiromĂ©tricos se agruparam em trĂȘs dimensĂ”es, expressando mudanças no fluxo, volume e hiperinsuflação dinĂąmica.Universidade Federal do Rio Grande do NorteUniversidade Federal de SĂŁo Paulo (UNIFESP)Hospital do Servidor PĂșblico Estadual de SĂŁo PauloUNIFESPSciEL
Development and application of a differential method for reliable metabolome analysis in Escherichia coli
Resposta a broncodilatador na espirometria: que parùmetros e valores são clinicamente relevantes em doenças obstrutivas?
A computational framework for complex disease stratification from multiple large-scale datasets.
BACKGROUND: Multilevel data integration is becoming a major area of research in systems biology. Within this area, multi-'omics datasets on complex diseases are becoming more readily available and there is a need to set standards and good practices for integrated analysis of biological, clinical and environmental data. We present a framework to plan and generate single and multi-'omics signatures of disease states. METHODS: The framework is divided into four major steps: dataset subsetting, feature filtering, 'omics-based clustering and biomarker identification. RESULTS: We illustrate the usefulness of this framework by identifying potential patient clusters based on integrated multi-'omics signatures in a publicly available ovarian cystadenocarcinoma dataset. The analysis generated a higher number of stable and clinically relevant clusters than previously reported, and enabled the generation of predictive models of patient outcomes. CONCLUSIONS: This framework will help health researchers plan and perform multi-'omics big data analyses to generate hypotheses and make sense of their rich, diverse and ever growing datasets, to enable implementation of translational P4 medicine
Teaching old dogs new tricksâa personal perspective on a decade of efforts by a clinical ethics committee to promote awareness of medical ethics
To incorporate medical ethics into clinical practice, it must first be understood and valued by health care professionals. The recognition of this principle led to an expanding and continuing educational effort by the ethics committee of the Vancouver General Hospital. This paper reviews this venture, including some pitfalls and failures, as well as successes. Although we began with consultants, it quickly became apparent that education in medical ethics must reach all health care professionalsâand medical students as well. Our greatest successes came in the formative years of a medical career (ie, in medical school and residency training programmes), but other efforts were not wasted, particularly among nurses and other health care professionals. Although this is a personal review of the experience in one institution, the lessons learnt in Vancouver are applicable to the further development of medical ethics in the UK. Key Words: Medical ethics âą ethics committees âą continuing educatio
- âŠ