The geothermal resource exploration generally requires a combined analysis of various geo-information datasets. In this framework the geospatial analysis as the weighted overlay, performed under GIS ...(Geographic Information Systems) environment, represent a strong tool to solve problems such as the site selection. This technique is applied on not homogeneous input data to perform an integrated analysis and producing favourability maps.
This work is based on the development of a new weighted overlay scheme, that combines favourable geological factors, which allow the identification of hydrothermal geothermal resources, and geological hazards (seismicity and volcanism), which can potentially limit the exploitation of a geothermal resource.
The technique was tested on Tuscany Region (Italy), where two geothermal fields, Larderello-Travale/Radicondoli and Monte Amiata, are in operation.
Results show that the most promising areas mostly coincide with the exploited geothermal fields. Moreover, new areas with a high geothermal favourability are identified.
Low-cost and rapid resource evaluation approaches like this could play a key role during the early stages of a geothermal exploration plan. Moreover, this methodology could be extensively used in other geothermal areas not only by the scientific community but also by stakeholders, as first concrete tool to explore a potential resource suitable for exploitation.
•GIS techniques to recognize potential areas suitable for geothermal exploitation.•The weighted overlay is a powerful tool in the first phase of an exploration program.•The proposed methodology could be used by both scientific community and stakeholders.
The use of aspirin to prevent cardiovascular disease events in patients without a history of cardiovascular disease is controversial.
To examine the benefits and harms of aspirin chemoprevention.
...MEDLINE (1966 to May 2001).
1) Randomized trials at least 1 year in duration that examined aspirin chemoprevention in patients without previously known cardiovascular disease and 2) systematic reviews, recent trials, and observational studies that examined rates of hemorrhagic strokes and gastrointestinal bleeding secondary to aspirin use.
One reviewer read and extracted data from each included article and constructed evidence tables. A second reviewer checked the accuracy of the data extraction. Discrepancies were resolved by consensus.
Meta-analysis was performed, and the quantitative results of the review were then used to model the consequences of treating patients with different levels of baseline risk for coronary heart disease. Five trials examined the effect of aspirin on cardiovascular events in patients with no previous cardiovascular disease. For patients similar to those enrolled in the trials, aspirin reduces the risk for the combined end point of nonfatal myocardial infarction and fatal coronary heart disease (summary odds ratio, 0.72 95% CI, 0.60 to 0.87). Aspirin increased the risk for hemorrhagic strokes (summary odds ratio, 1.4 CI, 0.9 to 2.0) and major gastrointestinal bleeding (summary odds ratio, 1.7 CI, 1.4 to 2.1). All-cause mortality (summary odds ratio, 0.93 CI, 0.84 to 1.02) was not significantly affected. For 1000 patients with a 5% risk for coronary heart disease events over 5 years, aspirin would prevent 6 to 20 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events. For patients with a risk of 1% over 5 years, aspirin would prevent 1 to 4 myocardial infarctions but would cause 0 to 2 hemorrhagic strokes and 2 to 4 major gastrointestinal bleeding events.
The net benefit of aspirin increases with increasing cardiovascular risk. In the decision to use aspirin chemoprevention, the patient's cardiovascular risk and relative utility for the different clinical outcomes prevented or caused by aspirin use must be considered.
Objectives
(i) To document the current state of the English, Scottish, Welsh, Northern Irish and Australian bowel cancer screening programmes, according to seven key characteristics, and (ii) to ...explore the policy trade-offs resulting from inadequate funding.
Setting
United Kingdom and Australia.
Methods
A comparative case study design using document and key informant interview analysis. Data were collated for each national jurisdiction on seven key programme characteristics: screening frequency, population coverage, quality of test, programme model, quality of follow-up, quality of colonoscopy and quality of data collection. A list of optimal features for each of the seven characteristics was compiled, based on the FOBT screening literature and our detailed examination of each programme.
Results
Each country made different implementation choices or trade-offs intended to conserve costs and/or manage limited and expensive resources. The overall outcome of these trade-offs was probable lower programme effectiveness as a result of compromises such as reduced screening frequency, restricted target age range, the use of less accurate tests, the deliberate setting of low programme positivity rates or increased inconvenience to participants from re-testing.
Conclusions
Insufficient funding has forced programme administrators to make trade-offs that may undermine the potential net population benefits achieved in randomized controlled trials. Such policy compromise contravenes the principle of evidence-based practice which is dependent on adequate funding being made available.
To assess the effectiveness of different colorectal cancer screening tests for adults at average risk.
Recent systematic reviews; Guide to Clinical Preventive Services, 2nd edition; and focused ...searches of MEDLINE from 1966 through September 2001. The authors also conducted hand searches, reviewed bibliographies, and consulted context experts to ensure completeness.
When available, the most recent high-quality systematic review was used to identify relevant articles. This review was then supplemented with a MEDLINE search for more recent articles.
One reviewer abstracted information from the final set of studies into evidence tables, and a second reviewer checked the tables for accuracy. Discrepancies were resolved by consensus.
For average-risk adults older than 50 years of age, evidence from multiple well-conducted randomized trials supported the effectiveness of fecal occult blood testing in reducing colorectal cancer incidence and mortality rates compared with no screening. Data from well-conducted case-control studies supported the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer incidence and mortality rates. A nonrandomized, controlled trial examining colorectal cancer mortality rates and randomized trials examining diagnostic yield supported the use of fecal occult blood testing plus sigmoidoscopy. The effectiveness of barium enema is unclear. Data are insufficient to support a definitive determination of the most effective screening strategy.
Colorectal cancer screening reduces death from colorectal cancer and can decrease the incidence of disease through removal of adenomatous polyps. Several available screening options seem to be effective, but the single best screening approach cannot be determined because data are insufficient.
Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 ...month before and after trial.
Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse.
Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%).
A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Review article: population screening for colorectal cancer NICHOLSON, F. B.; BARRO, J. L.; ATKIN, W. ...
Alimentary pharmacology & therapeutics,
December 2005, 2005-Dec, 2005-12-00, 20051201, Letnik:
22, Številka:
11‐12
Journal Article
Recenzirano
Odprti dostop
Summary
Colorectal cancer is a common cancer and common cause of death. The mortality rate from colorectal cancer can be reduced by identification and removal of cancer precursors, adenomas, or by ...detection of cancer at an earlier stage.
Pilot screening programmes have demonstrated decreased colorectal cancer mortality; as a result many countries are developing colorectal cancer screening programmes. The most common modalities being evaluated are faecal occult blood testing, flexible sigmoidoscopy and colonoscopy. Implementation of screening tests has been hampered by cost, invasiveness, availability of resources and patient acceptance. New technologies such at computed tomographic colonography and stool screening for molecular markers of neoplasia are in development as potential minimally invasive tools.
This review considers who should be screened, which test to use and how often to screen.
Aspirin and statins are both effective for primary prevention of coronary heart disease (CHD), but their combined use has not been well studied.
To perform a cost-utility analysis of the effects of ...aspirin therapy, statin therapy, combination therapy with both drugs, and no pharmacotherapy for the primary prevention of CHD events in men.
Markov model.
Published literature.
Middle-aged men without a history of cardiovascular disease at 6 levels of 10-year risk for CHD (2.5%, 5%, 7.5%, 10%, 15%, and 25%).
Lifetime.
Third-party payer.
Low-dose aspirin, a statin, both drugs as combination therapy, or no therapy.
Cost per quality-adjusted life-year gained.
For 45-year-old men who do not smoke, are not hypertensive, and have a 10-year risk for CHD of 7.5%, aspirin was more effective and less costly than no treatment. The addition of a statin to aspirin therapy produced an incremental cost-utility ratio of 56,200 dollars per quality-adjusted life-year gained compared with aspirin alone.
Excess risk for hemorrhagic stroke and gastrointestinal bleeding with aspirin, risk for CHD, the cost of statins, and the disutility of taking medication had important effects on the cost-utility ratios.
Several input parameters, particularly adverse event rates and utility values, are supported by limited empirical data. Results are applicable to middle-aged men only.
Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.
Drug Treatment of Hyperlipidemia in Women Walsh, Judith M. E; Pignone, Michael
JAMA : the journal of the American Medical Association,
05/2004, Letnik:
291, Številka:
18
Journal Article
Recenzirano
Odprti dostop
CONTEXT Several clinical trials have evaluated the effects of lipid-lowering
medications on coronary heart disease (CHD). Many of the trials have not included
enough women to allow sex-specific ...analyses or have not reported results in
women separately. OBJECTIVES To assess and synthesize the evidence regarding drug treatment of hyperlipidemia
for the prevention of CHD events in women and to conduct a meta-analysis of
the effect of drug treatment on mortality. DATA SOURCES We searched MEDLINE, the Cochrane Database, and the Database of Abstracts
of Reviews of Effectiveness for articles published from 1966 through December
2003. We reviewed reference lists of articles and consulted content experts. STUDY SELECTION AND DATA EXTRACTION Studies of outpatients that had a treatment duration of at least 1 year,
assessed the impact of lipid lowering on clinical outcomes, and reported results
by sex were included. Outcomes evaluated were total mortality, CHD mortality,
nonfatal myocardial infarction, revascularization, and total CHD events. Summary
estimates of the relative risks (RRs) with therapy were calculated using a
random-effects model for patients with and without a previous history of cardiovascular
disease. DATA SYNTHESIS Thirteen studies were included. Six trials included a total of 11 435
women without cardiovascular disease and assessed the effects of lipid-lowering
medications. Lipid lowering did not reduce total mortality (RR, 0.95; 95%
confidence interval CI, 0.62-1.46), CHD mortality (RR, 1.07; 95% CI, 0.47-2.40),
nonfatal myocardial infarction (RR, 0.61; 95% CI, 0.22-1.68), revascularization
(RR, 0.87; 95% CI, 0.33-2.31), or CHD events (RR, 0.87; 95% CI, 0.69-1.09).
However, some analyses were limited by too few CHD events in the available
trials. Eight trials included 8272 women with cardiovascular disease and assessed
the effects of lipid-lowering medications. Lipid lowering did not reduce total
mortality in women with cardiovascular disease (RR, 1.00; 95% CI, 0.77-1.29).
However, lipid lowering reduced CHD mortality (RR, 0.74; 95% CI, 0.55-1.00),
nonfatal myocardial infarction (RR, 0.71; 95% CI, 0.58-0.87), revascularization
(RR, 0.70; 95% CI, 0.55-0.89), and total CHD events (RR, 0.80; CI, 0.71-0.91). CONCLUSIONS For women without cardiovascular disease, lipid lowering does not affect
total or CHD mortality. Lipid lowering may reduce CHD events, but current
evidence is insufficient to determine this conclusively. For women with known
cardiovascular disease, treatment of hyperlipidemia is effective in reducing
CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization,
but it does not affect total mortality.
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