First clinical judgment by primary care physicians distinguishes well between nonorganic and organic causes of abdominal or chest pain

Objective: To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain. Design: Prospective observational study. Setting: General medical outpatient clinic in a university teaching hospital. Participants: One hundred ninety new, consecutive patients with a mean age of 44 years (SD=14 years, range 30-58 years) with a main complaint of abdominal or chest pain. Measurements and main results: The preliminary diagnosis, established on the basis of patient history and physical examination, was compared with a final diagnosis, obtained after workup at completion of the chart. A nonorganic cause was established in 66 (59%) of 112 patients with abdominal pain and in 65 (83%) of 78 with chest pain. The preliminary diagnosis of "nonorganic” versus "organic” causes was correct in 79% of patients with abdominal pain and in 88% of patients with chest pain. An "undoubted” preliminary diagnosis predicted a correct assessment in all patients with abdominal pain and in all but one patient with chest pain. Overall, only 4 patients (3%) were initially incorrectly diagnosed as having a nonorganic cause of pain rather than an organic cause. In addition, final nonorganic diagnosis (n=131) was compared with long-term follow-up by obtaining information from patients and, if necessary, from treating physicians. Follow-up information, obtained for 71% of these patients after a mean of 29 months (range 18-56 months) identified three other patients that had been misdiagnosed as having abdominal pain of nonorganic causes. Compared with follow-up, the diagnostic accuracy for nonorganic abdominal and chest pain at chart completion was 93% and 98%, respectively. Conclusions: A preliminary diagnosis of nonorganic versus organic abdominal or chest pain based on patient history and physical examination proved remarkably reliable. Accuracy was almost complete in patients with an "undoubted” preliminary diagnosis, suggesting that watchful waiting can be recommended in such case

How Does the Diversity of Divers Affect the Design of Citizen Science Projects?

Divers have widely participated in citizen science (CS) projects and are one of the main groups of marine citizen scientists. However, there is little knowledge about profiles of, and incentives for potential divers to join CS projects. To date, most studies have focused on the SCUBA diving industry; nevertheless, there is a diversity of divers, not all using SCUBA, who engage in different activities during their dives. Differences in diver profiles could affect their willingness and ability to contribute to CS. In this study, we compare the diving profile, interests, preferences and motivations to participate in CS of five diver types (artisanal fishermen, recreational divers, instructors, scientific divers, and others). All divers have strong interests in participating in CS projects, with no major differences among diver types. In general, they are interested in a wide variety of themes related to CS but they prefer simple sampling protocols. Divers are motivated to participate in CS to learn about the sea and contribute to science. Some important differences among diver types were found, with artisanal fishermen having significantly more dive experience than other diver types, but less free time during their dives and limited access to some communication channels and technologies. These characteristics make them ideal partners to contribute their local ecological knowledge (LEK) to local CS projects. In contrast, recreational divers have the least experience but most free time during their dives and good access to cameras and communications channels, making them suitable partners for large-scale CS projects that do not require a high level of species knowledge. Instructors and scientific divers are well-placed to coordinate and supervise CS activities. The results confirm that divers are not all alike and specific considerations have to be taken into account to improve the contribution of each diver type to CS. The findings provide essential information for the design of different types of CS projects. By considering the relevant incentives and opportunities for diverse diver groups, marine CS projects will make efficient gains in volunteer recruitment, retention, and collaborative generation of knowledge about the marine environment

Validation of the prognostic relevance of plasma C-reactive protein levels in soft-tissue sarcoma patients

Background: The concept of the involvement of systemic inflammation in cancer progression and metastases has gained attraction within the past decade. C-reactive protein (CRP), a non-specific blood-based marker of the systemic inflammatory response, has been associated with decreased survival in several cancer types. The aim of the present study was to validate the prognostic value of pre-operative plasma CRP levels on clinical outcome in a large cohort of soft-tissue sarcoma (STS) patients. Methods: Three hundred and four STS patients, operated between 1998 and 2010, were retrospectively evaluated. CRP levels and the impact on cancer-specific survival (CSS), disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan–Meier curves and univariate as well as multivariate Cox proportional models. Additionally, we developed a nomogram by supplementing the plasma CRP level to the well-established Kattan nomogram and evaluated the improvement of predictive accuracy of this novel nomogram by applying calibration and Harrell’s concordance index (c-index). Results: An elevated plasma CRP level was significantly associated with established prognostic factors, including age, tumour grade, size and depth (P<0.05). In multivariate analysis, increased CRP levels were significantly associated with a poor outcome for CSS (HR=2.05; 95% CI=1.13–3.74; P=0.019) and DFS (HR=1.88; 95% CI=1.07–3.34; P=0.029). The estimated c-index was 0.74 using the original Kattan nomogram and 0.77 when the plasma CRP level was added. Conclusion: An elevated pre-operative CRP level represents an independent prognostic factor that predicts poor prognosis and improves the predictive ability of the Kattan nomogram in STS patients. Our data suggest to further prospectively validate its potential utility for individual risk stratification and clinical management of STS patients

Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer

Background: The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Previous findings from small-scale studies revealed conflicting results about its independent prognostic significance with regard to different clinical end points in pancreatic cancer (PC) patients. Therefore, the aim of our study was the external validation of the prognostic significance of NLR in a large cohort of PC patients. Methods: Data from 371 consecutive PC patients, treated between 2004 and 2010 at a single centre, were evaluated retrospectively. The whole cohort was stratified into two groups according to the treatment modality. Group 1 comprised 261 patients with inoperable PC at diagnosis and group 2 comprised 110 patients with surgically resected PC. Cancer-specific survival (CSS) was assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of the NLR, the modified Glasgow prognostic score (mGPS) and the platelet-lymphocyte ratio univariate and multivariate Cox regression models were applied. Results: Multivariate analysis identified increased NLR as an independent prognostic factor for inoperable PC patients (hazard ratio (HR)=2.53, confidence interval (CI)=1.64–3.91, P<0.001) and surgically resected PC patients (HR=1.61, CI=1.02–2.53, P=0.039). In inoperable PC patients, the mGPS was associated with poor CSS only in univariate analysis (HR=1.44, CI=1.04–1.98). Conclusion: Risk prediction for cancer-related end points using NLR does add independent prognostic information to other well-established prognostic factors in patients with PC, regardless of the undergoing therapeutic modality. Thus, the NLR should be considered for future individual risk assessment in patients with PC