Different strategies have been developed using Independent Component Analysis (ICA) to automatically de-noise fMRI data, either focusing on removing only certain components (e.g. motion-ICA-AROMA, ...Pruim et al., 2015a) or using more complex classifiers to remove multiple types of noise components (e.g. FIX, Salimi-Khorshidi et al., 2014 Griffanti et al., 2014). However, denoising data obtained in an acute setting might prove challenging: the presence of multiple noise sources may not allow focused strategies to clean the data enough and the heterogeneity in the data may be so great to critically undermine complex approaches. The purpose of this study was to explore what automated ICA based approach would better cope with these limitations when cleaning fMRI data obtained from acute stroke patients. The performance of a focused classifier (ICA-AROMA) and a complex classifier (FIX) approaches were compared using data obtained from twenty consecutive acute lacunar stroke patients using metrics determining RSN identification, RSN reproducibility, changes in the BOLD variance, differences in the estimation of functional connectivity and loss of temporal degrees of freedom. The use of generic-trained FIX resulted in misclassification of components and significant loss of signal (< 80%), and was not explored further. Both ICA-AROMA and patient-trained FIX based denoising approaches resulted in significantly improved RSN reproducibility (
< 0.001), localized reduction in BOLD variance consistent with noise removal, and significant changes in functional connectivity (
< 0.001). Patient-trained FIX resulted in higher RSN identifiability (
< 0.001) and wider changes both in the BOLD variance and in functional connectivity compared to ICA-AROMA. The success of ICA-AROMA suggests that by focusing on selected components the full automation can deliver meaningful data for analysis even in population with multiple sources of noise. However, the time invested to train FIX with appropriate patient data proved valuable, particularly in improving the signal-to-noise ratio.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background Palacky University Faculty of Medicine Centre for clinical practice guidelines is the independent academic centre focused on guidelines methodology. Objectives The aim of this study is to ...analyse methods of development, adaptation, implementation and evaluation of CPGs in the Czech and Slovak Republic from 2010 to 2013. Methods The database of all Czech and Slovak CPGs and specialty societies was developed in 2010 and updated on a regular basis. The analysis of methods of development was made. AGREE II instrument was used both in Czech and English version to evaluate quality of some CPGs. Results There are 112 Czech specialty societies and the national Reference Centre developing CPGs. 1331 CPGS were developed till 2013 in total with increase of 33% between 2010 and 2013. The number of adopted international CPGs has increased significantly. Majority of CPGs have not stated funding and conflicts of interest. In the Slovak Republic, there are 125 specialty societies and the Ministry of Health developing CPGs. 342 CPGs were developed till 2013. Majority of CPGs were developed by government. A few CPGs stated non-governmental funding, which is always a private company support. Discussion There has been increasing number of developed CPGs in both countries. Standardised high quality methods are not used systematically. High quality methodology was developed and used by Czech National Reference Centre. Implications for Guideline Developers/Users There should be high quality methods used for CPG development. The developing bodies should adopt methodology already exist in the Czech Republic.
Background High quality clinical practice guidelines in paediatrics (CPGP) should be developed with standard and rigour methods. There are specialty societies in the Czech Republic developing ...guidelines of variable quality using different methods of development, adaptation, implementation and evaluation Objectives The aim of this study was to analyse the methods of development, adaptation, dissemination, implementation and evaluation of Czech CPGP. Methods The database of all CPGP was developed in 2011 and updated on a regular basis. The three types of specialty societies were decided: 1. Paediatric and neonatology societies 2. Other specialty societies developing CPGP 3. Specialty societies developing guidelines with relevant recommendation for paediatric care. The search and analysis of open resources were made to find the information about guideline methodology. Questionnaire survey to get the missing information was made. Results There are 113 specialty medical societies in the Czech Republic. 31 societies developed 140 CPGS. 31% developed by paediatric and neonatology societies, 51% by other societies and 18% by societies developing CPGs with some paediatric recommendations. The questionnaire survey is ongoing. Discussion The methods of development CPGP in the Czech Republic is of low quality. There are no explicit strategies for dissemination, implementation and evaluation. Implications for Guideline Developers/Users The methods of guideline development need be standardised and should be of highest possible quality. There is already high quality methodology in the Czech Republic developed by National Reference Centre, which has been using by different specialty societies and could be used for CPGP.
Background The quality of guidelines has been variable. Evidence-based clinical practice guidelines should be of the highest possible quality, which has to be systematically evaluated. Obj TRiaDS, ...Research Methodology Group. Objectives We have evaluated quality of new set of CPGs developed by Czech neurological society between 2009 and 2011 using AGREE II instrument. Methods Six CPGs developed by Czech neurology society were assessed using AGREE II instrument by 4 independent assessors. Uncertainties and missing information were solved by the authors. Expert opinion on the evaluation process and outcomes were obtained. Results All evaluated CPGs were of high quality with average of 93.5% for total score domain. The CPGs had high scores in the Clarity and recommendations and Applicability (99.6%), Scope (99.0%), Rigour of development (97.6%) and Stakeholder involvement (97.1%). The lowest score was in Editorial independence (47.5%). Discussion The overall quality of neurology CPGs was high because of the methodology and support for developers was robust, systematic and standardised. Only the editorial independence scored low. The statement of conflict of interest is missing in all the CPGS as it is not a part of the methodology guidelines. Implications for Guideline Developers/Users High quality CPGs can be developed even in a small country with limited budget if the methods of development are well designed, implemented and evaluated.
Background Bioethical principles should be an integral part of all guidelines. Recently, there has been a movement towards ethical principles to be explicit in guidelines. They should be ...systematically evaluated. Objectives We have done a systematic review on ethical principles in guidelines and developed an instrument for evaluation of ethical principles in guidelines based on the AGREE II instrument. Methods The Questionnaire and User’s guide have been developed and tested. The questionnaire covers basic ethical principles, i.e. respect for autonomy, beneficence, non-maleficence and justice, as well as other very important issues such as health professional-patient relationship and inter-professional collaboration. The last question is whether a particular CPG contains examples of ethical dilemmas. New domain on equity was added. A pilot version of case reports for some domains was developed. The instrument will be disseminated, implemented, evaluated and updated if needed. Results Instrument for evaluation of ethical principles in guidelines. Discussion: Useful instrument for the evaluation of ethical principles in guidelines has been developing. Implications for Guideline Developers/Users The instrument can be used during guideline development process as well as during implementation and for evaluation of the quality.
Abstract only Introduction: Patients with large vessel occlusion stroke (LVO) benefit from thrombolysis before thrombectomy. Previous meta-analysis suggested superiority of tenecteplase over ...alteplase in achieving good clinical outcome at 3 months. Aim: We aimed to compare clinical outcomes after tenecteplase 0.25 mg/kg versus alteplase in patients with LVO. Methods: An experienced librarian searched PubMed and Scopus databases through July 13, 2022 for randomized controlled trials comparing tenecteplase with alteplase in patients with LVO. We included trials using 0.25 mg/kg tenecteplase dose, reporting blindly assessed pre-specified clinical outcomes at 3-4 months among patients with LVO. Two authors independently reviewed eligibility and extracted the data. We used RevMan 5.4 and random effect models with inverse variance weights to calculate odds ratios (OR) and 95% confidence intervals (CI). This systematic review is registered (CRD42022349414). Results: From 585 retrieved abstracts, 3 trials and 1 pooled secondary analysis involving 704 unique patients met the inclusion criteria. Among patients with LVO, tenecteplase 0.25mg/kg is not superior to alteplase in achieving good clinical outcome (defined as modified Rankin Scale mRS 0-2, OR 1.82 (95% CI 0.91-3.65, panel A); nor all-cause mortality, OR 0.75 (95% CI 0.49-1.13, panel B); while tenecteplase increases the odds of excellent outcome (mRS 0-1), OR 1.52 (95% CI 1.11-2.09, panel C), and odds of functional improvement (defined as a shift on the ordinal mRS), OR 1.54 (95% CI 1.07-2.20, panel D). High heterogeneity was present (I2 =70%) for the good clinical outcome. Conclusion: Tenecteplase is not superior over alteplase in achieving good clinical outcome. Tenecteplase, as compared to alteplase, increases the odds of functional improvement and excellent outcome. These findings support bridging tenecteplase in patients with LVO.
We examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association.
This prospective, multi-center, ...case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura.
After adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS.
Abdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
