Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

A dynamic Bayesian network for diagnosing ventilator-associated pneumonia in ICU patients

Contains fulltext : 76095.pdf (publisher's version ) (Closed access)10 p

The impact of the multidisciplinary Endocarditis Team on the management of infective endocarditis

Background: In their latest guidelines for infective endocarditis (IE) (2015), the European Society of Cardiology (ESC) introduced the implementation of the Endocarditis Team (ET) to facilitate the management of IE. This study presents our experiences and the diagnostic and therapeutic impact of the ET on the management of IE. Methods: From 2016–2020, data of all patients with suspected IE referred to the ET were prospectively collected. The final diagnosis was defined by the ET as either rejected, possible or definite IE. Diagnostic impact was scored as any change in initial diagnosis, the frequency of additional diagnostic tests advised by the ET and any change in diagnosis after these tests. Therapeutic impact was scored as any change in antibiotic therapy or change from conservative to invasive therapy or vice versa. Results: A total of 321 patients (median age 67 [55–77] years, 71% male) were enrolled. The final diagnosis was rejected IE in 47 (15%), possible IE in 34 (11%) and definite IE in 240 (75%) patients. A change of initial diagnosis was seen in 53/321(17%) patients. Additional microbiological tests were advised in 69/321 (21%) patients, and additional imaging tests in 136/321 (42%) patients, which resulted in subsequent change in diagnosis in 23/321 (7%) patients. Any change in antibiotic treatment was advised in 135/321 (42%) patients, and change from initial conservative to additional surgical treatment in 15/321 (5%) patients. Conclusion: The ET had a clear impact on the therapeutic policy for patients with suspected IE and is useful in the management of this life-threatening disease. Broad implementation is warranted

A food-manufacturing manager’s experiences and perceptions of the implementation of an incentive scheme

Orientation: The field researcher, under the supervision of the co-authors Bussin and Schurink, sought to explore the experiences, views and perceptions of 10 managers about the incentive scheme that a South African food manufacturing company introduced. Research purpose: Identifying the contributors to negative feelings and demotivation, or conversely, excitement and motivation, will ultimately assist managers to implement an incentive scheme to motivate staff and improve performance. Motivation for the study: There is little research on how participants perceive incentive schemes and whether or not they motivate employees and improve overall performance. Research design, approach and method: The researcher used a modernistic qualitative research approach and, more specifically, a case study. Main findings: The participants in the research were unaware of the performance goals they needed to achieve. They felt that there was no link between their performance and their earnings. They felt that some objectives were demeaning and insulting, as was the payment they received. They felt that achieving their goals was outside their control and influence. Practical/managerial implications: Participants felt excited and motivated to perform when their managers presented the department’s overall goals to them and asked the participants to set their own goals based on the department’s objectives. Contribution/value-add: Although this study is explorative and descriptive, it suggests that it is how departments implement an incentive scheme, rather than merely having one, that will motivate or demotivate employees to perform