The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice : systematic review and economic evaluation

Funding The National Institute for Health Research Health Technology Assessment programme.Peer reviewedPublisher PD

Program Evaluation Intensive: Practical Training in Selecting Measures and Data Collection Methods to Obtain Useful Outcome Data

Do you need help determining appropriate measures and feasible data collection methods for program evaluations within integrated primary care? In this 3-hour preconference workshop, leaders from CFHA’s Research & Evaluation Committee and Families, Systems, & Health journal will provide practical training in conducting rigorous program evaluations. This workshop will help you identify appropriate measures to answer your key questions as well as data collection methods that balance quality and feasibility. This workshop is designed for those who are planning, conducting, or revising a program evaluation, as attendees will apply the material to their own personal projects within interactive small groups

An unusual case of myopic shift post acquired brain injury

Background Ocular and visual problems are frequent consequences of an acquired brain injury (ABI). The literature suggests that many patients demonstrate a myopic shift in refractive error after a traumatic brain injury (TBI), a form of an ABI. Three reported courses are suggested. Most commonly the myopia resolves under cycloplegic conditions, secondly the shift is transient, and least commonly the myopia increases over time. This case report, although not due to a TBI, is an example of the least common subgroup. Case Report The patient, a 63 year-old male, presented with a history (15 months prior to initial evaluation) of an excised right frontal temporal lobe tumour. The history included dexamethasone 4mg QD pre- and post-surgery which caused blood glucose levels to fluctuate between 5.72-22.2 mmol/l; a stroke occured postsurgery causing hemiparesis on his left side; and shunt surgery to decrease swelling to the area of excision and the optic nerves. Medications included: Cartia, lisinopril, Toprol XL, prednisone, Reglan, and Temodar. The patient was receiving chemotherapy to treat remnants of the tumour. His last eye exam in 2004 indicated a refractive error of -2.50-1.25X080 in his right eye and -3.000.75X080 in his left eye with visual acuity of 6/7.5 in both the right and left eye. He presented to our clinic with an aided visual acuity of 8/100 (6/110) in both the right and left eye and a left homonymous hemianopsia on finger counting fields. Cycloplegic retinoscopy revealed -6.003.00X090 in his right eye and -6.002.00X090 in his left eye. Dilated fundus exam showed mild swelling of both optic nerves. The patient reported blood glucose levels of 103-140. At a one-month follow-up, his best corrected visual acuity at a distance improved to 6/60 in both the right and left eye through the new prescription. His cycloplegic retinoscopy did not show any change in myopia or astigmatism and the disk edema was resolved.  Conclusion This case illustrates an unusual presentation of myopic shift post ABI. The patient’s condition continued to deteriorate eventually taking his life. It remains unclear whether the myopia and astigmatism continued to increase or remained stable. Although, the cause of this change is not fully understood and needs further investigation, providing appropriate optical correction did improve the patient’s quality-of-life

Comparison of placental growth factor and fetal flow Doppler ultrasonography to identify fetal adverse outcomes in women with hypertensive disorders of pregnancy: an observational study.

BACKGROUND: Hypertensive disorders of pregnancy and intrauterine growth restriction (IUGR) are leading causes of maternal and perinatal morbidity and mortality. Failure to detect intrauterine growth restriction in women at high risk has been highlighted as a significant avoidable cause of serious fetal outcome. In this observational study we compare fetal flow using Doppler ultrasonography with a new test for placental growth factor (PlGF) to predict fetal adverse events. METHODS: Eighty-nine women with hypertensive disorders of pregnancy (24 with chronic hypertension, 17 with gestational hypertension, 12 with HELLP syndrome, 19 with preeclampsia and 17 with superimposed preeclampsia) were enrolled. A single maternal blood sample to measure free PlGF (Alere Triage) taken before 35 weeks of pregnancy was compared to the last Doppler ultrasound measurement of fetal flow before delivery. PlGF was classified as normal (PlGF>/=100 pg/ml), low (12<PlGF<100) or very low (PlGF</=12 pg/ml). A positive test for abnormal fetal flow was defined as either signs of centralisation of the fetal circulation or diastolic block or reverse flow in the umbilical artery or descending aorta; this was a criterion for delivery. Fetal outcomes were intrauterine growth restriction and birth before 37 weeks of pregnancy. RESULTS: In total 61/89 women had a preterm birth and 22 infants had IUGR. Of those who delivered preterm, 20/20 women with abnormal fetal flow and 36/41 (87.8%) women with normal fetal flow had low or very low PlGF. Of those infants with IUGR, 22/22 had low or very low maternal PlGF and 10/22 had abnormal fetal flow. CONCLUSIONS: PlGF may provide useful information before 35th gestational week to identify fetuses requiring urgent delivery, and those at risk of later adverse outcomes not identified by fetal flow Doppler ultrasonography

A Novel Scoring Tool for Neonatal Persistent Pulmonary Hypertension

At birth, a decrease in pulmonary vascular resistance (PVR) is essential to facilitate pulmonary vascular perfusion as the infant establishes independent use of the lungs. • When PVR fails to decrease, hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) ensues. • A novel scoring tool was developed to characterize severity of HRF and PH in the setting of a critically ill newborn, accounting for level of hypoxemia and echocardiographic findings of PH.At birth, a decrease in pulmonary vascular resistance (PVR) is essential to facilitate pulmonary vascular perfusion as the infant establishes independent use of the lungs. • When PVR fails to decrease, hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) ensues. • A novel scoring tool was developed to characterize severity of HRF and PH in the setting of a critically ill newborn, accounting for level of hypoxemia and echocardiographic findings of PH

Der Einkaufswagen aus der Sicht von sechs Generationen

Da kein Abstract des Artikels vorhanden ist, finden Sie hier den Beginn des Artikels: Wenn es um den Einkaufswagen und seine Geschichte geht, können vor allem Texte gefunden werden, welche die Erfindung Goldmanns in den 1930er Jahren ausgiebig erläutern und die Einführung des Einkaufswagens in Amerika bis zu den 1950er beschreiben. Über die gesellschaftliche Bedeutung des Einkaufswagens findet sich indes kaum Forschungsliteratur, diese wären aber zentral, da Kulturen und Menschen durch die Objektbedeutung mitdefiniert werden. Nach Hans Peter Hahn ist die Wahrnehmung eines Objekts immer subjektiv und dabei spielen biografische Ereignisse eine Rolle. Deshalb – so die Ausgangsthese dieser Abhandlung – kann die Befragung von personenspezifischen Bedeutungsaspekten eines Objekts durch unterschiedliche Generationen und Lebenssituationen vielfältige Wahrnehmungsperspektiven hervorbringen. Das Ziel dieser Arbeit ist es, sich an die bisher kaum untersuchten Bedeutungen des Einkaufswagens in der Schweiz durch die Wahrnehmung von Personen aus sechs Generationen heranzutasten. Anhand der Analyse von Bedeutungszuschreibungen werden dabei auch die generationsübergreifenden Unterschiede und Gemeinsamkeiten dargelegt

When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function

Since the E/e’ ratio was first described in 1997 as a noninvasive surrogate marker of mean pulmonary capillary wedge pressure, it has gained a central role in diagnostic recommendations and a supremacy in clinical use that require critical reappraisal. We review technical factors, physiological influences, and pathophysiological processes that can complicate the interpretation of E/e’. The index has been validated in certain circumstances, but its use cannot be extrapolated to other situations—such as critically ill patients or children—in which it has either been shown not to work or it has not been well validated. Meta-analyses demonstrated that E/e’ is not useful for the diagnosis of HFpEF and that changes in E/e’ are uninformative during diastolic stress echocardiography. A similar ratio has been applied to estimate right heart filling pressure despite insufficient evidence. As a composite index, changes in E/e’ should only be interpreted with knowledge of changes in its components. Sometimes, e’ alone may be as informative. Using a scoring system for diastolic function that relies on E/e’, as recommended in consensus documents, leaves some patients unclassified and others in an intermediate category. Alternative methods for estimating left heart filling pressures may be more accurate, including the duration of retrograde pulmonary venous flow, or contractile deformation during atrial pump function. Using all measurements as continuous variables may demonstrate abnormal diastolic function that is missed by using the reductive index E/e’ alone. With developments in diagnostic methods and clinical decision support tools, this may become easier to implement