Risk prediction models for colorectal cancer (CRC) detection in symptomatic patients based on available biomarkers may improve CRC diagnosis. Our aim was to develop, compare with the NICE referral ...criteria and externally validate a CRC prediction model, COLONPREDICT, based on clinical and laboratory variables.
Methods
This prospective cross-sectional study included consecutive patients with gastrointestinal symptoms referred for colonoscopy between March 2012 and September 2013 in a derivation cohort and between March 2014 and March 2015 in a validation cohort. In the derivation cohort, we assessed symptoms and the NICE referral criteria, and determined levels of faecal haemoglobin and calprotectin, blood haemoglobin, and serum carcinoembryonic antigen before performing an anorectal examination and a colonoscopy. A multivariate logistic regression analysis was used to develop the model with diagnostic accuracy with CRC detection as the main outcome.
Results
We included 1572 patients in the derivation cohort and 1481 in the validation cohorts, with a 13.6 % and 9.1 % CRC prevalence respectively. The final prediction model included 11 variables: age (years) (odds ratio OR 1.04, 95 % confidence interval CI 1.02–1.06), male gender (OR 2.2, 95 % CI 1.5–3.4), faecal haemoglobin ≥20 μg/g (OR 17.0, 95 % CI 10.0–28.6), blood haemoglobin <10 g/dL (OR 4.8, 95 % CI 2.2–10.3), blood haemoglobin 10–12 g/dL (OR 1.8, 95 % CI 1.1–3.0), carcinoembryonic antigen ≥3 ng/mL (OR 4.5, 95 % CI 3.0–6.8), acetylsalicylic acid treatment (OR 0.4, 95 % CI 0.2–0.7), previous colonoscopy (OR 0.1, 95 % CI 0.06–0.2), rectal mass (OR 14.8, 95 % CI 5.3–41.0), benign anorectal lesion (OR 0.3, 95 % CI 0.2–0.4), rectal bleeding (OR 2.2, 95 % CI 1.4–3.4) and change in bowel habit (OR 1.7, 95 % CI 1.1–2.5). The area under the curve (AUC) was 0.92 (95 % CI 0.91–0.94), higher than the NICE referral criteria (AUC 0.59, 95 % CI 0.55–0.63; p < 0.001). On the basis of the thresholds with 90 % (5.6) and 99 % (3.5) sensitivity, we divided the derivation cohort into three risk groups for CRC detection: high (30.9 % of the cohort, positive predictive value PPV 40.7 %, 95 % CI 36.7–45.9 %), intermediate (29.5 %, PPV 4.4 %, 95 % CI 2.8–6.8 %) and low (39.5 %, PPV 0.2 %, 95 % CI 0.0–1.1 %). The discriminatory ability was equivalent in the validation cohort (AUC 0.92, 95 % CI 0.90–0.94; p = 0.7).
Conclusions
COLONPREDICT is a highly accurate prediction model for CRC detection
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. The inability or failure of many subjects to adhere to standard antibiotic regimens, which may last up to 10 ...days, results in suboptimal antibiotic treatment. Treatment with a single-dose antibiotic regimen may improve compliance with prescribed therapy. A novel microsphere formulation of azithromycin provides a single-dose regimen while maintaining tolerability.
To compare the efficacy and safety of a single 2.0-g dose of azithromycin microspheres to that of an extended-release formulation of clarithromycin (1.0 g/d for 7 days) for the treatment of adults with mild-to-moderate CAP.
A phase III, multinational, multicenter, randomized, double-blind, double-dummy study, comparing single-dose azithromycin microspheres to extended-release clarithromycin, both administered orally.
Subjects with mild-to-moderate CAP (Fine class I and II) were included. The primary end point was clinical response at the test-of-cure (TOC) visit (days 14 to 21) in the clinical per protocol (CPP) population. The bacteriologic response at the TOC visit was assessed in subjects with a baseline pathogen.
A total of 501 subjects were randomized, and 499 were treated. Clinical cure rates at the TOC visit in the CPP population were 92.6% (187 of 202 subjects) for azithromycin microspheres and 94.7% (198 of 209 subjects) for extended-release clarithromycin. Overall pathogen eradication rates were 91.8% (123 of 134 subjects) for azithromycin microspheres and 90.5% (153 of 169 subjects) for extended-release clarithromycin. Both agents were well tolerated. The incidence of treatment-related adverse events was 26.3% with azithromycin microspheres and 24.6% with extended-release clarithromycin. Most adverse events were mild to moderate in severity.
A single 2.0-g dose of azithromycin microspheres was as effective and well tolerated as a 7-day course of extended-release clarithromycin in the treatment of adults with mild-to-moderate CAP.
As práticas alimentares das crianças não são determinadas apenas pelas suas necessidades biológicas, mas também pela interação com o alimento, por fatores emocionais, socioeconômicos, culturais e ...pela interação com a própria mãe. Os objetivos deste estudo foram conhecer as representações sociais de mães de lactentes sobre a introdução de alimentos complementares, oportunos ou não e identificar os elementos que constituem o processo vivenciado por elas, para a escolha desses alimentos. Foram utilizados os pressupostos teóricos da Representação Social, propostos por Moscovici, os quais se ocupam em explicar um saber gerado na comunicação da vida cotidiana, com finalidade prática de orientar comportamentos e fixar sua posição em relação a um dado objeto. O modelo \"Pesando Riscos e Benefícios\" foi utilizado para dar suporte teórico ampliando a compreensão do processo de alimentação da criança. Os dados foram analisados, segundo a estratégia metodológica do Discurso do Sujeito Coletivo e foram coletados em um ambulatório de pediatria privado, em Jundiaí - SP, junto a 17 mães, após o seu consentimento esclarecido, por meio de entrevistas semi-estruturadas gravadas e transcritas na íntegra. Do material verbal coletado emergiram 13 discursos, organizados em três temas. O primeiro deles, \"Vivenciando o desmame\", foi composto por quatro discursos, tomando-se por base a fala de mães que desmamaram precocemente os filhos, os quais versaram sobre a vivência do desmame, as dificuldades enfrentadas para substituir o leite materno e sobre as representações maternas acerca do alimento e da introdução de alimentos complementares. O segundo tema, \"Tomando posição ante a alimentação da criança\" foi constituído por quatro discursos, os quais discutiram as necessidades das mães e os papéis da família e do médico no contexto da introdução de alimentos complementares. O último tema, \"Fazendo as escolhas alimentares propriamente ditas\", formado por cinco discursos, versaram sobre os elementos de escolha e as representações maternas acerca do alimento e da introdução de alimentos complementares. Concluiu-se que, com base em suas representações, experiências e crenças, as mães realizaram um movimento de avaliação, julgamento, interpretação e construção de indicadores por meio da observação de comportamento da criança, buscando valorá-los em termos simbólicos de risco ou benefício para si ou para o filho, a depender do contexto social em que a mãe e a criança estão inseridas. Tais achados permitiram demonstrar a expansão do modelo teórico \"Pesando Riscos e Benefícios\" para auxiliar a compreensão do significado não só da amamentação, como da introdução da alimentação complementar. Além disso, foi possível conhecer as representações deste grupo de mulheres, acerca do alimento e da introdução de alimentos complementares
The food practices of children are not determined only by their biological necessities, but also by their interaction with the food, for emotional, social, economic and cultural factors and by their interaction with their own mother. The objectives of this study were to know social representations of infants\' mothers about the introduction of complementary foods, propitious or not, and to identify in their experiences what are the reasons to chose those kind of foods. They were used the concepts of Social Representation by Moscovici which explain a knowledge that is generated by everyday life\'s communication and with the purpose to guide behaviors and to sustain them in front of an object. The model \"Thinking Risks and Benefits\" was used to give theoretical support and to increase the understanding of food process of a child. The data were analyzed according methodological strategies of Subjective Speech Collective and were collected from 17 mothers at a private pediatric ambulatory in Jundiaí, a São Paulo\'s city, after their consentment of semi-structured recorded interviews and all of them were transcribed word by word. From the verbal material collected emerged 13 speeches, organized in three themes. \"Living the Weaning Period\", the first one, is made by 4 speeches of mothers who weaned their children and talked about their experiences and their difficulties facing the replacement of breast milk and about motherhood representations of food and introduction of complementary foods. \"Taking Position in front of Child\'s Food Choices\", the second, is made by 4 speeches and debates mothers\' necessities and families and doctors roles in the context of introduction of complementary foods. \"Making the Food Choices Properly\", the last one, is made by 5 speeches that examines elements of choices and motherhood representations about food and the introduction of complementary foods. The conclusion is that based on their representations, experiences and believes, mothers analyse, judge, interpret and construct indicators from observation of children behavior and they search increase their worth in symbolic terms of risks and benefits to themselves or their children. It depends on which social context mother and child are insert. Theses findings allow to show an expansion of theoretical model \"Thinking Risks and Benefits\" to help the understating of meaning not only of breastfeed, but complementary food either. Besides that, it was possible to know the representations of theses groups of women about food and introduction of complementary foods
OBJETIVOS: Conhecer as representações de mães sobre a introdução de alimentos complementares e identificar os elementos que constituem o seu processo de escolha. MÉTODOS: Optamos pela pesquisa ...qualitativa, analisando os dados, das entrevistas de 17 mulheres, à luz dos pressupostos da Representação Social e do Modelo "Pesando Riscos e Benefícios". A estratégia metodológica foi o Discurso do Sujeito Coletivo. RESULTADOS: Emergiramos temas: "Vivenciando o desmame", "Tomando posição ante a alimentação da criança" e "Fazendo as escolhas alimentares propriamente ditas", que versaram sobre a vivência do desmame, os critérios de escolha e as representações maternas acerca da introdução e do alimento complementar. CONCLUSÃO: Com base em suas representações e experiências as mães realizam um movimento de julgamento, interpretação e construção de indicadores, observando o comportamento da criança e buscando, em seu ambiente e em sua visão de mundo, os elementos para tomada de decisão quanto à alimentação do filho.
OBJETIVOS: Conocer las representaciones de madres sobre la introducción de alimentos complementares e identificar los elementos que constituyen su proceso de escoja. MÉTODOS: Se ha optado por la pesquisa cualitativa, analizando los datos de las entrevistas de 17 mujeres, bajo los presupuestos de la Representación Social y del modelo"Pesando Riesgos y Beneficios". La estrategia metodológica ha sido el Discurso del Sujeto Colectivo. RESULTADOS: Han emergido los temas "Vivenciando el destete", " Tomando posición ante la alimentación del niño" y "Haciendo las escojas alimentares propiamente dichas", que han versado sobre la vivencia del destete, los criterios de escoja y las representaciones maternas sobre la introducción y del alimento complementar. CONCLUSIÓN: Las madres basadas en sus representaciones y experiencias realizan un movimiento de juzgamiento, interpretación y construcción de indicadores, observando el comportamiento del niño y buscando en su ambiente y en su visión de mundo para decidir sobre la alimentación de hijo.
OBJECTIVES: To know mother's representations about introduction of complementary foods and to identify the elements that form their process of choice. METHODS: We chose qualitative research, analyzing data from 17 interviews of women, according the theory of Social Representation and Model "Risks and Benefits". The methodological strategy was the Subjective Speech Collective. RESULTS: Three themes emerged. "Living the Weaning Period", "Taking Positions in front Child's Food Choices" and "Making the Food Choices Properly". They talking about the experiences during the weaning period, the standards of choice and the representations of mothers about introduction of complementary foods. CONCLUSION: Based in their representations and experiences, mothers judge, interpret and construct indicators from observation of child behaviors and search, in their environment and in theirs point of view, the elements to take a decision about their child food.
OBJETIVOS: Conhecer as representações de mães sobre a introdução de alimentos complementares e identificar os elementos que constituem o seu processo de escolha. MÉTODOS: Optamos pela pesquisa ...qualitativa, analisando os dados, das entrevistas de 17 mulheres, à luz dos pressupostos da Representação Social e do Modelo "Pesando Riscos e Benefícios". A estratégia metodológica foi o Discurso do Sujeito Coletivo. RESULTADOS: Emergiramos temas: "Vivenciando o desmame", "Tomando posição ante a alimentação da criança" e "Fazendo as escolhas alimentares propriamente ditas", que versaram sobre a vivência do desmame, os critérios de escolha e as representações maternas acerca da introdução e do alimento complementar. CONCLUSÃO: Com base em suas representações e experiências as mães realizam um movimento de julgamento, interpretação e construção de indicadores, observando o comportamento da criança e buscando, em seu ambiente e em sua visão de mundo, os elementos para tomada de decisão quanto à alimentação do filho.
The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology ...(Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.
O Programa Nacional de Telessaúde é uma ação do Ministério da Saúde, em parceria com o Ministério da Educação (MEC) e o Ministério da Ciência e Tecnologia (MCT), e tem como proposta a qualificação ...das equipes de saúde da família em todo país. Nessa perspectiva, o Núcleo São Paulo de Telessaúde desenvolveu a Teleamamentação, que tem como meta proporcionar aos profissionais da atenção primária informações sobre diversos aspectos da amamentação por diferentes profissionais da área da saúde. Este trabalho tem por objetivo relatar a experiência da Teleenfermagem na Teleamamentação do Programa Nacional de Telessaúde no Brasil no Núcleo São Paulo. Como metodologia de trabalho adotou-se a criação de um grupo multidisciplinar composto por pediatras, enfermeiras, fonoaudiólogas, nutricionistas e dentistas. Foram elaborados materiais didáticos multimídia inseridos na plataforma Cybertutor. Vislumbra-se a Teleamamentação como uma estratégia inovadora e promissora por permitir um impacto relevante na educação permanente de profissionais da saúde.
El Programa Nacional de Telesalud es una acción del Ministerio de Salud, en colaboración con el Ministerio de Educación (MEC) y el Ministerio de Ciencia y Tecnología (MCT), y tiene como propuesta capacitar a los equipos de salud de la familia en todo el país. Desde esta perspectiva, el Núcleo Sao Paulo de Telesalud desarrolló la tele lactancia, que tiene como meta proporcionar a los profesionales de atención primaria, informaciones sobre diversos aspectos de la lactancia materna, por diferentes profesionales del área de la salud. Este trabajo tiene por objetivo relatar la experiencia de la Teleenfermería en la tele lactancia del Programa Nacional de Telesalud en el Brasil, en el Núcleo Sao Paulo. La metodología de trabajo adoptada fue la creación de un grupo multidisciplinario compuesto por pediatras, enfermeras, fonoaudiólogas, nutricionistas y odontólogos. Fueron elaborados materiales didácticos multimedia incluidos en la plataforma Cybertutor. Se vislumbra la Tele lactancia como una estrategia innovadora y prometedora por permitir un impacto significativo en la educación continuada de los profesionales de la salud.
The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação – MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia – MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.
O Programa Nacional de Telessaúde é uma ação do Ministério da Saúde, em parceria com o Ministério da Educação (MEC) e o Ministério da Ciência e Tecnologia (MCT), e tem como proposta a qualificação ...das equipes de saúde da família em todo país. Nessa perspectiva, o Núcleo São Paulo de Telessaúde desenvolveu a Teleamamentação, que tem como meta proporcionar aos profissionais da atenção primária informações sobre diversos aspectos da amamentação por diferentes profissionais da área da saúde. Este trabalho tem por objetivo relatar a experiência da Teleenfermagem na Teleamamentação do Programa Nacional de Telessaúde no Brasil no Núcleo São Paulo. Como metodologia de trabalho adotou-se a criação de um grupo multidisciplinar composto por pediatras, enfermeiras, fonoaudiólogas, nutricionistas e dentistas. Foram elaborados materiais didáticos multimídia inseridos na plataforma Cybertutor. Vislumbra-se a Teleamamentação como uma estratégia inovadora e promissora por permitir um impacto relevante na educação permanente de profissionais da saúde.
In clinical practice, the diagnosis of alcohol-associated hepatitis (AH) is mostly based on non-invasive criteria, which were defined at a consensus conference by the National Institute on Alcohol ...Abuse and Alcoholism (NIAAA). These criteria were recently modified by adding C-reactive protein (CRP) and termed NIAAAm-CRP criteria, which showed superior diagnostic accuracy for presence of alcohol-associated steatohepatitis (ASH) on liver histology. The aim of our study was to validate the diagnostic accuracy of both original NIAAA criteria and NIAAAm-CRP criteria for presence of ASH on liver histology in an independent cohort.
Data from a large multinational cohort of 445 patients with alcohol-associated liver disease (ALD) that served to establish a novel grading and staging system of alcohol-associated liver disease were analyzed retrospectively. Diagnosis of ASH was based on presence of hepatocyte ballooning plus lobular neutrophil infiltration and established in virtual consensus meetings of multiple expert liver pathologists.
Complete data including CRP values were available in 346 patients. Overall diagnostic accuracy for prediction of ASH was 73% for NIAAA criteria and 77% for NIAAAm-CRP criteria. In a subgroup with suspected severe AH (MELD >20, n = 123), overall diagnostic accuracy for prediction of ASH was 69% for NIAAA criteria and 74% for NIAAAm-CRP criteria.
Our findings confirm recent data on suboptimal diagnostic accuracy of original NIAAA criteria and validate slightly better but still suboptimal performance of NIAAAm-CRP criteria for presence of ASH.
Alcohol-associated steatohepatitis (ASH) is diagnosed on liver histology but liver biopsy is not always feasible. Non-invasive diagnosis based on clinical findings has been proposed using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria and recently improved using NIAAAm-CRP criteria. Our findings validate slightly better but still suboptimal performance of NIAAAm-CRP criteria for the presence of histological ASH. Clinical trials of novel drugs should focus on histologically proven ASH.
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•Alcohol-associated steatohepatitis is defined by histology, but biopsy is not always feasible.•Non-invasive criteria for probable alcohol-associated hepatitis were proposed at a NIAAA consensus conference.•A recent study developed modified NIAAAm-CRP criteria with improved yet suboptimal accuracy.•In the present study we validate slightly superior but still suboptimal diagnostic accuracy of the new NIAAAm-CRP criteria.
The COVID-19 pandemic has challenged healthcare systems worldwide. In the Philippines, long-term care for patients with conditions identified through newborn screening (NBS) is coordinated through ...Newborn Screening Continuity Clinics (NBSCCs). These clinics are integral to achieving optimal outcomes by providing follow-up oversight and assistance for individuals identified through screening. Continuity of NBSCC care for NBS during the COVID-19 pandemic was both challenging and necessary and was accomplished through innovative strategies of dedicated personnel. Following the discontinuation of the community quarantine, a situation assessment survey was completed by each NBSCC to better understand the challenges encountered and their effect on patient care. Performance data from each NBSCC were reviewed both before and after an extended community quarantine (2018-2021) to evaluate the impact of NBSCC disaster contingency plans in overcoming the resultant challenges (transportation, supply chain, etc.). Thematic analysis of the survey showed three primary challenges: Operations, communications, and safety. In 2018 and 2019, successful patient contacts were 70.6% and 70.2%, respectively. During the pandemic, successful contacts were 74.9% in 2020 and 76.8% in 2021, demonstrating that the contact approaches taken by the NBSCCs were sufficient to maintain (and even improve) patient contacts. The number of unresponsive patients decreased during the pandemic likely due to decreased mobility and improved follow-up actions from the NBSCCs.
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