Intraclass correlation coefficients for cluster randomized trials in care pathways and usual care: hospital treatment for heart failure.

BACKGROUND: Cluster randomized trials are increasingly being used in healthcare evaluation to show the effectiveness of a specific intervention. Care pathways (CPs) are becoming a popular tool to improve the quality of health-care services provided to heart failure patients. In order to perform a well-designed cluster randomized trial to demonstrate the effectiveness of Usual care (UC) and CP in heart failure treatment, the intraclass correlation coefficient (ICC) should be available before conducting a trial to estimate the required sample size. This study reports ICCs for both demographical and outcome variables from cluster randomized trials of heart failure patients in UC and care pathways. METHODS: To calculate the degree of within-cluster dependence, the ICC and associated 95% confidence interval were calculated by a method based on analysis of variance. All analyses were performed in R software version 2.15.1. RESULTS: ICCs for baseline characteristics ranged from 0.025 to 0.058. The median value and interquartile range was 0.043 [0.026-0.052] for ICCs of baseline characteristics. Among baseline characteristics, the highest ICCs were found for admission by referral or admission from home (ICC = 0.058) and the disease severity at admission (ICC = 0.046). Corresponding ICCs for appropriateness of the stay, length of stay and hospitalization cost were 0.069, 0.063, and 0.001 in CP group and 0.203, 0.020, 0.046 for usual care, respectively. CONCLUSION: Reported values of ICCs from present care pathway trial and UC results for some common outcomes will be helpful for estimating sample size in future clustered randomized heart failure trials, in particular for the evaluation of care pathways

Multislice/multidetector-row computed tomography findings of a rare coronary anomaly: the first septal perforator branch originating from the left main coronary artery

Multislice/multidetector-row computed tomography (MDCT) is now widely used for noninvasive assessment of coronary arteries, and it may sometimes reveal coronary anomalies. Detection of such anomalies may be relevant both during follow-up and for planning cardiac or coronary surgical/interventional procedures. These anomalies may be missed unless carefully sought. In this paper, we present the MDCT images of a first septal perforator branch originating from the left main coronary artery, which represents an extremely rare coronary anomaly. To the bestof our knowledge, this is the first case in the literature where MDCT images are presented

Inheritance of photo-sensitivity in pigeonpea

Pigeonpea [Cajanus cajan (L.) Millsp.] is a short-day legume species and the late maturing genotypes are more photosensitive than early types. To generate information about the inheritance of photo-sensitivity, this study was conducted under natural and artificially extended (16 h) photo-periods using F1, F2 and BC1F1 generations. Under natural photo-period, F1 hybrids showed partial dominance of earliness; while in F2, a normal distribution that was skewed towards earliness was observed. In contrast under extended photo-period, the spread of F2 data was wide with discontinuities recorded at day 70, 82 and 103. Chisquare tests, when applied to F2 and BC1F1 data, suggested that three dominant genes (PS3, PS2 and PS1) controlled the expression of photo-sensitivity. These genes were found operating in a hierarchical order with PS2 and PS1 genes failing to express in the presence of PS3 gene. Similarly in the absence of PS3 gene, PS2 expressed but it masked the expression of PS1. Further, PS1 gene expressed only when both PS3 and PS2 were in recessive homozygous state. Hence, the proposed genetic model for photosensitivity in pigeonpea is PS3 > PS2 > PS1 and photoinsensitive genotype being a triple recessive (ps3ps3ps2 ps2ps1ps1)

Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases.

OBJECTIVE: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This article is based on a meeting report authored by 12 scientists studying atrial fibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials. METHODS: An advisory board panel was convened to confer on management strategies for challenging AF cases. The article is derived from a summary of case presentations and the collaborative discussions at the meeting. CONCLUSION: This expert consensus of cardiologists aimed to define management strategies for challenging cases with patients who underrepresented in pivotal trials using case examples from their routine practice. Although strong evidence is lacking, exploratory subgroup analysis of phase III pivotal trials partially informs the management of these patients. Clinical trials with higher external validity are needed to clarify areas of uncertainty. The lack of clear evidence about complex AF cases has pushed clinicians to manage patients based on clinical experience, including rare situations of off-label prescriptions

Managing organizational DSS development in small manufacturing enterprise

A number of Hong Kong manufacturing companies have moved their production to the People's Republic of China while retaining their supporting functions (such as marketing, distribution, etc.) in Hong Kong. As a consequence, their mode of operation has become more complex and demands better production planning and control (PPC). One solution is to use an information system in which all factory resources are integrated within a single framework for PPC. The main instrument of this strategy is an Organizational DSS (ODSS). This paper presents a case study of development and adoption of an ODSS in a small manufacturing enterprise. Analysis of the findings highlights the cultural as well as organizational underpinnings and the need for effective intervention before and throughout the computerization. The implementation strategies are described, with emphasis on prerequisite infrastructural developments, showing how they provide opportunities and constraints

АДАПТАЦИЯ МЕТОДОВ ЦИФРОВОЙ ОБРАБОТКИ СИГНАЛОВ К ЗАДАЧЕ АНАЛИЗА РЕЧИ ПРИ НЕВРОЛОГИЧЕСКИХ ПАТОЛОГИЯХ

The methodical and software for the speech signal analysis at neurological pathologies, in particular, bulbar violations, has been offered. The approach is based on the digital signal processing methods adapted to the problem of speech analysis in clinical medicine. The result is a program developed in MatLab that performs the calculating and plotting spectrogram, histogram, kepstrogramm, frequencies of the main tone for the recorded speech tests. Approbation of the method was performed on the basis of Republican research and clinical center of neurology and neurosurgery and showed the prospects of its use for the diagnosis of bulbar syndrome.Предложено методическое и программное обеспечение для анализа речевых сигналов при неврологических патологиях, в частности, бульбарных нарушениях. В основе подхода - методы цифровой обработки сигналов, адаптированные к задаче анализа речи в клинической медицине. Результат представляет собой программу, разработанную в среде MatLab, выполняющую расчет и построение спектрограммы, гистограммы, кепстрограммы, частоты основного тона для записанных речевых тестов. Апробация разработанного авторами метода, выполненная на базе РНПЦ неврологии и нейрохирургии Министерства здравоохранения Республики Беларусь, показала перспективность его использования для диагностики бульбарного синдрома

Adaptation of digital signal processing methods to the analysis of speech in neurological pathologies

Предложено методическое и программное обеспечение для анализа речевых сигналов при неврологических патологиях, в частности, бульбарных нарушениях. В основе подхода – методы цифровой обработки сигналов, адаптированные к задаче анализа речи в клинической медицине. Результат представляет собой программу, разработанную в среде MatLab, выполняющую расчет и построение спектрограммы, гистограммы, кепстрограммы, частоты основного тона для записанных речевых тестов. Апробация разработанного авторами метода, выполненная на базе РНПЦ неврологии и нейрохирургии Министерства здравоохранения Республики Беларусь, показала перспективность его использования для диагностики бульбарного синдрома. The methodical and software for the speech signal analysis at neurological pathologies, in particular, bulbar violations, has been offered. The approach is based on the digital signal processing methods adapted to the problem of speech analysis in clinical medicine. The result is a program developed in MatLab that performs the calculating and plotting spectrogram, histogram, kepstrogramm, frequencies of the main tone for the recorded speech tests. Approbation of the method was performed on the basis of Republican research and clinical center of neurology and neurosurgery and showed the prospects of its use for the diagnosis of bulbar syndrome