Factors related to perceived needs of primary caregivers of patients with schizophrenia

[[abstract]]Background/Purpose: Schizophrenia is a chronic mental illness, and sufferers are usually dependent on family, primary caregivers in particular. The present study was designed to assess the perceived needs of caregivers so that adequate services can be provided for them in the community. Methods: A total of 177 primary caregivers were interviewed with the structured burden-and-need schedules to determine their perceived needs, and the related clinical and demographic factors. Four-teen perceived needs were identified and classified into different need clusters using the generalized association plots. A multiple regression of logistic model was adopted to explore the relationships between the related factors and perceived needs. Results: Four clusters of perceived needs were identified, which included assistant patient care (77.6%), access to relevant information (66.1%), societal support (68.2%), and burden release (27.2%). These needs were significantly related to number of admissions, duration of illness, relationship between caregiver and patient, and education level of the caregiver. Conclusion: Four clusters of caregivers' perceived needs were identified and found to be related to psychopathologic and demographic factors. These data are of value in designing appropriate community psychiatric programs to improve the quality of care and enhance the capacity of primary caregivers to care for patients

Cancer Biomarker Discovery: The Entropic Hallmark

Background: It is a commonly accepted belief that cancer cells modify their transcriptional state during the progression of the disease. We propose that the progression of cancer cells towards malignant phenotypes can be efficiently tracked using high-throughput technologies that follow the gradual changes observed in the gene expression profiles by employing Shannon's mathematical theory of communication. Methods based on Information Theory can then quantify the divergence of cancer cells' transcriptional profiles from those of normally appearing cells of the originating tissues. The relevance of the proposed methods can be evaluated using microarray datasets available in the public domain but the method is in principle applicable to other high-throughput methods. Methodology/Principal Findings: Using melanoma and prostate cancer datasets we illustrate how it is possible to employ Shannon Entropy and the Jensen-Shannon divergence to trace the transcriptional changes progression of the disease. We establish how the variations of these two measures correlate with established biomarkers of cancer progression. The Information Theory measures allow us to identify novel biomarkers for both progressive and relatively more sudden transcriptional changes leading to malignant phenotypes. At the same time, the methodology was able to validate a large number of genes and processes that seem to be implicated in the progression of melanoma and prostate cancer. Conclusions/Significance: We thus present a quantitative guiding rule, a new unifying hallmark of cancer: the cancer cell's transcriptome changes lead to measurable observed transitions of Normalized Shannon Entropy values (as measured by high-throughput technologies). At the same time, tumor cells increment their divergence from the normal tissue profile increasing their disorder via creation of states that we might not directly measure. This unifying hallmark allows, via the the Jensen-Shannon divergence, to identify the arrow of time of the processes from the gene expression profiles, and helps to map the phenotypical and molecular hallmarks of specific cancer subtypes. The deep mathematical basis of the approach allows us to suggest that this principle is, hopefully, of general applicability for other diseases

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Chest X-ray in right heart disease

© Springer International Publishing AG, part of Springer Nature 2018. Right heart pathology receives less attention from clinicians than left-sided heart disease, and knowledge of the importance of right heart, in particular right ventricle in disease development lags behind that of the left ventricle. In recent years, increasing evidence shows that right heart disease has significant impact on morbidity and mortality, thus highlighting the importance of recognizing right heart disease in clinical practice. Although ultrasound and computed tomography are the most commonly used diagnostic image techniques in the diagnosis of right heart disease, chest radiography still remains the first line technique in many applications. Despite non-specific findings in most of the situations, chest X-ray provides useful information for further diagnostic imaging tests of assessing right heart disease. This chapter provides an overview of applications of chest X-ray in the diagnosis of various right heart diseases