Abstract
Introduction
This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help ...women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice.
Aim
To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement.
Methods
A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation.
Results
Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing.
Discussion/Conclusion
Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.
References
1. Faculty of Sexual & Reproductive Healthcare (FSRH). Clinical Effectiveness Unit. FSRH Guidance – Progesterone-only pills. March 2015. Amended April 2019. Royal College of Obstetricians & Gynaecologists Website www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015 Accessed May 2022
2. Faculty of Sexual & Reproductive Healthcare (FSRH). UK Medical Eligibility Criteria (UKMEC) Summery sheets for contraceptive use. April 2016. Amended September 2019. Website www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets Accessed May 2022
Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable ...cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023–$28,800 US dollars (USD) in Japan to $14,513–$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards.
The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific ...region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study’s objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs. A systematic literature review (SLR) of Medline, PubMed, EMBASE, and Cochrane Library (2000–2017 inclusive) was performed using the following keywords: osteoporosis, fractures, liaison, and service. Inclusion criteria included the following: patients ≥ 50 years with osteoporosis-related fractures; randomized controlled trials or observational studies with control groups (prospective or retrospective), pre–post, cross-sectional and economic evaluation studies. Success of direct or indirect interventions was assessed based on patients’ understanding of risk, bone mineral density assessment, calcium intake, osteoporosis treatment, re-fracture rates, adherence, and mortality, in addition to cost-effectiveness. Overall, 5663 unique citations were identified and the SLR identified 159 publications, reporting 37 studies in Asia-Pacific. These studies revealed the unmet need for public health education, adequate funding, and staff resourcing, along with greater cooperation between departments and physicians. These actions can help to overcome therapeutic inertia with sufficient follow-up to ensure adherence to recommendations and compliance with treatment. The findings also emphasize the importance of primary care physicians continuing to prescribe treatment and ensure service remains convenient. These findings highlight the limited evidence supporting FLS across the Asia-Pacific region, emphasizing the unmet need for new programs and/or refinement of existing ones to improve outcomes. With the continued increase in burden of fractures in Asia-Pacific, establishment of new FLS and assessment of existing services are warranted to determine the impact of FLS for healthcare professionals, patients, family/caregivers, and society.
Naturally occurring G-quadruplex structural motifs, formed by guanine-rich nucleic acids, have been reported in telomeric, promoter and transcribed regions of mammalian genomes. G-quadruplex ...structures have received significant attention because of growing evidence for their role in important biological processes, human disease and as therapeutic targets. Lately, there has been much interest in the potential roles of RNA G-quadruplexes as cis-regulatory elements of post-transcriptional gene expression. Large-scale computational genomics studies on G-quadruplexes have difficulty validating their predictions without laborious testing in 'wet' labs. We have developed a bioinformatics tool, QGRS-H Predictor that can map and analyze conserved putative Quadruplex forming 'G'-Rich Sequences (QGRS) in mRNAs, ncRNAs and other nucleotide sequences, e.g. promoter, telomeric and gene flanking regions. Identifying conserved regulatory motifs helps validate computations and enhances accuracy of predictions. The QGRS-H Predictor is particularly useful for mapping homologous G-quadruplex forming sequences as cis-regulatory elements in the context of 5'- and 3'-untranslated regions, and CDS sections of aligned mRNA sequences. QGRS-H Predictor features highly interactive graphic representation of the data. It is a unique and user-friendly application that provides many options for defining and studying G-quadruplexes. The QGRS-H Predictor can be freely accessed at: http://quadruplex.ramapo.edu/qgrs/app/start.
Purpose We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period. Materials and Methods A retrospective chart analysis was ...performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher’s exact and chi-square tests. Results A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05). Conclusions The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.
Abstract Background With a decade earlier manifestation of coronary artery disease (CAD) and paucity of data characterizing coronary plaque with coronary computed tomography angiography (CTA) among ...CAD patients in India, the study aimed to analyze patient characteristics and coronary plaque burden and morphology in young Indian patients with CAD. Methods Serial coronary CTA was performed in 96 CAD patients. Among 60 patients ≤ 40 years, risk factor and coronary plaque analysis done using a 256- slice CT in 33 patients with acute coronary syndrome (ACS) was compared with 27 patients with chronic stable angina (CSA). Univariate and multivariate analysis was performed, for factors predicting ACS as an outcome among young CAD patients. In addition, quantitative and morphologic plaque characteristics were compared among those ≤ 40 years and > 40 years. Results Among 60 subjects ≤ 40 years of age, 77% had dyslipidemia, 70% high lipoprotein(a), 53.33% elevated hs-CRP and 73.33% raised homocysteine. hs-CRP (9.33 vs. 3.33, p value = 0.01) and serum triglycerides (178.67 vs. 141.42, p value = 0.03) were markedly raised in patients with ACS. Statistically significant number of patients in the ACS group had positive remodelling (ACS, 69.7% vs. CSA, 14.8%; p value < 0.001), low attenuation plaque (ACS, 63.6% vs. CSA, 11.1%; p value < 0.001), spotty calcification (ACS, 36.4% vs. CSA, 3.7%; p = 0.002) and non-calcified plaque (ACS, 69.7% vs. CSA, 11.1%; p < 0.001). On multivariate analysis, only lipoprotein (a) > 30 mg/dL and composite vulnerability score maintained a predictive value for ACS in patients ≤ 40 years. Statistically significant number of patients in the younger age group had higher mean total plaque volume (66.17 ± 41.31 mm3 vs. 44.94 ± 49.07 mm3 ; p = 0.03), remodelling index (1.5 ± 0.27 vs. 1.08 ± 0.38; p = 0.0001). Comparing culprit lesion characteristics of ACS patients in the two age groups, positive remodelling (95.8% vs. 70.5%, p = 0.02), spotty calcification (50% vs. 11.7%, p = 0.01) and non-calcified plaque (95.8% vs. 70.5%, p = 0.02) were significantly more frequent in patients ≤ 40 years. Conclusion ACS in young Indians is characterized by a higher prevalence of both conventional and newer risk factors. In addition, culprit lesions in young ACS patients are more frequently characterized by coronary plaques with high risk morphological features. This may have implications in terms of preventive strategies to identify this high-risk group.
G-quadruplex motifs in the RNA play significant roles in key cellular processes and human disease. While sequences capable of forming G-quadruplexes in the pre-mRNA are involved in regulation of ...polyadenylation and splicing events in mammalian transcripts, the G-quadruplex motifs in the UTRs may help regulate mRNA expression. GRSDB2 is a second-generation database containing information on the composition and distribution of putative Quadruplex-forming G-Rich Sequences (QGRS) mapped in ∼29 000 eukaryotic pre-mRNA sequences, many of which are alternatively processed. The data stored in the GRSDB2 is based on computational analysis of NCBI Entrez Gene entries with the help of an improved version of the QGRS Mapper program. The database allows complex queries with a wide variety of parameters, including Gene Ontology terms. The data is displayed in a variety of formats with several additional computational capabilities. We have also developed a new database, GRS_UTRdb, containing information on the composition and distribution patterns of putative QGRS in the 5′- and 3′-UTRs of eukaryotic mRNA sequences. The goal of these experiments has been to build freely accessible resources for exploring the role of G-quadruplex structure in regulation of gene expression at post-transcriptional level. The databases can be accessed at the G-Quadruplex Resource Site at: http://bioinformatics.ramapo.edu/GQRS/.
Occupation and cancer in Britain RUSHTON, L; BAGGA, S; HUTCHINGS, S. J ...
British journal of cancer,
04/2010, Letnik:
102, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Prioritising control measures for occupationally related cancers should be evidence based. We estimated the current burden of cancer in Britain attributable to past occupational exposures for ...International Agency for Research on Cancer (IARC) group 1 (established) and 2A (probable) carcinogens.
We calculated attributable fractions and numbers for cancer mortality and incidence using risk estimates from the literature and national data sources to estimate proportions exposed.
5.3% (8019) cancer deaths were attributable to occupation in 2005 (men, 8.2% (6362); women, 2.3% (1657)). Attributable incidence estimates are 13 679 (4.0%) cancer registrations (men, 10 063 (5.7%); women, 3616 (2.2%)). Occupational attributable fractions are over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma, larynx and stomach cancers. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100 or more registrations. Industries and occupations with high cancer registrations include construction, metal working, personal and household services, mining, land transport, printing/publishing, retail/hotels/restaurants, public administration/defence, farming and several manufacturing sectors. 56% of cancer registrations in men are attributable to work in the construction industry (mainly mesotheliomas, lung, stomach, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women are attributable to shift work (breast cancer).
This project is the first to quantify in detail the burden of cancer and mortality due to occupation specifically for Britain. It highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to carcinogenic agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Risk reduction strategies should focus on those workplaces where such exposures are still occurring.
Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of ...an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed. Information extracted from each article included key person coordinating the FLS (physician, nurse or other healthcare professional), setting (hospital vs community), intensity (single vs multiple), duration (long vs short term), fracture type and gender. A meta-analysis of randomised controlled trials was conducted based on the key person coordinating the FLS. Out of 7236 articles, 57 were considered to be high quality and identified for further analysis. The SLR identified several components which contributed to FLS success, including multidisciplinary involvement, driven by a dedicated case manager, regular assessment and follow-up, multifaceted interventions and patient education. Meta-analytic data confirm the effectiveness of an FLS following an osteoporotic fracture: approximate 27% increase in the likelihood of BMD testing and up to 21% increase in the likelihood of treatment initiation compared with usual care. The balance of evidence indicates that the multifaceted FLS and dedicated coordination are important success factors that contribute to effective FLS interventions which reduce fracture-related morbidity and mortality.
Autosomal dominant polycystic kidney disease, also known as ADPKD, is the most common hereditary kidney disease, affecting different age groups. ADPKD can eventually lead to end-stage renal disease. ...The etiology of ADPKD is genetic, resulting in the formation of cysts containing fluids on the kidneys. Patients with ADPKD present a range of symptoms following a decline in kidney function. Pain, stones, proteinuria and osteoporosis are few of the many symptoms, resulting from decreased kidney function. Tolvaptan, a selective V2 receptor antagonist, is the etiological treatment used for ADPKD. In this paper, we conducted a systematic review of the literature between 2011 and 2021 to gather data regarding the tolerability and efficacy of tolvaptan use in ADPKD. A total of 22 trials were reviewed. Tolvaptan efficacy in the trials was measured using changes in eGFR or changes in total kidney volume. Results showed that tolvaptan use in ADPKD was associated with a slower decline in kidney function and a decrease in total kidney volume. Side effects of this drug include polyuria, nocturia and polydipsia along with hepatotoxicity. The two biggest trials, TEMPO and REPRISE, change in eGFR from pre-treatment baseline to post-treatment was 1.3 mL/min/1.73 for REPRISE and 1 mL/min/1.73 for TEMPO 3:4. A mean decrease of 49% in total kidney volume from baseline to post-treatment was found in the TEMPO 3:4 study. Keywords: ADPKD, tolvaptan
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