Background:
Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning.
Aim:
To determine whether ...screening for likely death within 12 months is more effective using screening tools or intuition.
Design:
Randomised controlled trial of screening tools (Surprise Question plus the Supportive and Palliative Care Indicators Tool for Surprise Question positive patients) to predict those at risk of death at 12 months compared with unguided intuition (clinical trials registry: ACTRN12613000266763).
Setting/participants:
Australian general practice. A total of 30 general practitioners (screening tool = 12, intuition = 18) screened all patients (n = 4365) aged ≥70 years seen at least once in the last 2 years.
Results:
There were 142 deaths (screening tool = 3.1%, intuition = 3.3%; p = 0.79). General practitioners identified more at risk of dying using Surprise Question (11.8%) than intuition (5.4%; p = 0.01), but no difference with Surprise Question positive then Supportive and Palliative Care Indicators Tool (5.1%; p = 0.87). Surprise Question positive predicted more deaths (53.2%, intuition = 33.7%; p = 0.001), but Surprise Question positive/Supportive and Palliative Care Indicators Tool predictions were similar (5.1%; p = 0.87 vs intuition). There was no difference in proportions correctly predicted to die (Surprise Question = 1.6%, intuition = 1.1%; p = 0.156 and Surprise Question positive/Supportive and Palliative Care Indicators Tool = 1.1%; p = 0.86 vs intuition). Screening tool had higher sensitivity and lower specificity than intuition, but no difference in positive or negative predictive value.
Conclusion:
Screening tool was better at predicting actual death than intuition, but with a higher false positive rate. Both were similarly effective at screening the whole cohort for death. Screening for possible death is not the best option for initiating end-of-life planning: recognising increased burden of illness might be a better trigger.
Capillary leak syndrome with tamponade Moynihan, Gerard V; Teo, Patrick CK; Lee, Frederick J ...
Anaesthesia and intensive care,
05/2019, Letnik:
47, Številka:
3
Journal Article
Recenzirano
Odprti dostop
A creatine kinase level of 60,000 units (U)/L (reference range 0–250 U/L) was attributed to severe muscle oedema and a resultant widespread compartment syndrome. Cases associated with both autoimmune ...diseases and drugs such as oxaliplatin have been described.2 The median age of patients diagnosed with CLS in one series was 55 years.1 CLS presents as recurrent episodes of shock and anasarca. The syndrome is characterised by three different stages; a flu-like prodrome, transient leakage of fluid and proteins at a capillary level, and finally resolution.1 The second stage is characterised by hypotension and oedema, and can mimic septic shock.3 Angioedema and anaphylaxis, which have plasma leakage as part of their pathophysiology, should also be considered in the differential diagnosis.4 Although CLS is a clinical diagnosis, a paraprotein may be present between attacks.1 Initial investigations will reveal intravascular hypovolaemia, haemoconcentration and hypoalbuminaemia.4,5 Proteinuria is absent.1 Fluid can accumulate in any organ or potential space, causing a range of complications: respiratory failure (from pulmonary oedema or pleural effusions), shock (from hypovolaemia or cardiac tamponade), mesenteric ischaemia (from severe oedema of the gut and hepatic congestion) and, as in this case, compartment syndrome and rhabdomyolysis (from muscle oedema).1 In the acute phase, IVIg is recommended to decrease mortality.6 The use of plasmapheresis has been described.1 Judicious fluid therapy in the early resuscitation period is important.
Background
This study was designed to compare post-irradiation sarcomas (PIS) and de novo sarcomas (DN) of the head and neck in terms of tumor characteristics, prognostic factors, and survival ...outcomes.
Methods
All (
N
= 83) head and neck sarcoma patients treated at National Cancer Centre, Singapore (Feb 2002–May 2011) were included: DN (
N
= 60; 72 %); PIS (
N
= 23; 28 %). Clinicopathologic features and outcomes of all patients and histologically matched pairs were compared. Prognostic factors were identified using univariate and multivariate analyses.
Results
Median age, gender, smoking status, and tumor size were not significantly different. Significant differences were seen in histology (most prevalent: PIS–sarcoma-NOS; DN–angiosarcoma) and tumor subsite (most prevalent: PIS–nasal cavity and sinuses; DN–skin). Median latency of PIS development was 16.7 years. PIS patients had shorter overall survival (OS) and disease-specific survival (DSS) compared with DN patients, most clearly seen on histologically matched pair analysis: 2-year OS (PIS: 54 %; DN: 83 %;
P
=
0.028). Multivariate analyses showed that age >50 years (hazard ratio (HR) = 3.68;
P
=
0.007), ever-smokers (HR = 2.79;
P
=
0.017), and larger tumor-size (cm) (HR = 1.12;
P
=
0.045) were associated with worse OS, and age at >50 years (HR = 2.77;
P
=
0.04) and ever-smokers (HR = 2.94;
P
=
0.021) were associated with worse DSS. When treated with curative intent, no significant survival difference was noted between DN and PIS patients.
Conclusions
In our cohort, PIS constituted 28 % of head and neck sarcomas. Poorer prognosis traditionally associated with PIS compared with DN was not seen amongst patients treated with curative intent.
Describes a system that is being used to segment gray matter from magnetic resonance imaging (MRI) and to create connected cortical representations for functional MRI visualization (fMRI). The method ...exploits knowledge of the anatomy of the cortex and incorporates structural constraints into the segmentation. First, the white matter and cerebral spinal fluid (CSF) regions in the MR volume are segmented using a novel techniques of posterior anisotropic diffusion. Then, the user selects the cortical white matter component of interest, and its structure is verified by checking for cavities and handles. After this, a connected representation of the gray matter is created by a constrained growing-out from the white matter boundary. Because the connectivity is computed, the segmentation can be used as input to several methods of visualizing the spatial pattern of cortical activity within gray matter. In the authors' case, the connected representation of gray matter is used to create a flattened representation of the cortex. Then, fMRI measurements are overlaid on the flattened representation, yielding a representation of the volumetric data within a single image. The software is freely available to the research community.
Aim
The survival benefit of using a non‐cross resistant second‐line chemotherapy in the third‐line setting in metastatic gastroesophageal cancer is unproven. We evaluated the utility of third‐line ...chemotherapy in patients treated at a single institution.
Methods
Between 2010 and 2014, efficacy and toxicity data of patients who received three or more lines of systemic therapies for metastatic gastroesophageal adenocarcinoma at the National Cancer Centre Singapore was retrospectively analyzed.
Results
Thirty‐two (6%) patients received three or more lines of chemotherapy. The median age and ECOG performance status were 59 years (36–82) and 1 (0–2), respectively. Majority of patients (88%) had tumor located in the stomach and 13 patients (41%) had diffuse histology or poorly cohesive or signet ring cells. Four (12%) patients had HER2‐positive disease. Prior therapy was platinum (100%), fluoropyrimidine (97%), taxane (63%), irinotecan (28%), anthracycline (13%) and ramucirumab (3%). Third‐line therapy consisted of 24 (75%) monotherapy, 6 (19%) doublet, 1 (3%) triplet chemotherapy and 1 (3%) clinical trial. Monotherapy irinotecan (44%) was most common, followed by docetaxel (19%) and paclitaxel (9%). Of 22 patients evaluable for response, there was 1 (5%) partial response, 9 (41%) stable disease. Median overall survival was 18.3 weeks (4.3–65.1). Of 30 patients evaluable for toxicities, 17 (57%) experienced at least one grade 3 or 4 toxicities.
Conclusion
The benefit of using non‐cross resistant second‐line regimens as third‐line chemotherapy was small with moderate toxicity. Newer agents such as nivolumab or TAS‐102 or clinical trial may be preferred.
An efficient method of computing the least-squares optimal basis functions to steer any function locally is presented. The method combines the Lie group-theoretic and the singular value decomposition ...approaches. Its efficiency is demonstrated with the design of basis functions to steer a Gabor function under the four-parameter linear transformation group.
This paper describes a general mathematical formulation for the problem of constructing steerable functions. The formulation is based on Lie group theory and is thus applicable to transformations ...which are Lie groups, such as, rotation, translation, scaling, and affine transformation. For one-parameter and Abelian multi-parameter Lie transformation groups, a canonical decomposition of all possible steerable functions, derived using the Jordan decomposition of matrices, is developed. It is shown that any steerable function under Lie transformation groups can be described using this decomposition. Finally, a catalog of steerable functions for several common multi-parameter image transformation groups is also provided.
This paper describes design and analysis of composite a leaf spring made of E-glass/epoxy reinforced polymer. The aim of this paper is to introduce a new design as well as to compare the stiffness, ...load capacity and weight reduction of composite material with that of steel leaf spring. A comparative study of steel and composite material with respect to weight and strength was carried out on ANSYS 16.2 under the same boundary conditions in order to obtain the maximum deflection and stress. It found that the maximum deflection and stress in steel are higher than E-glass/epoxy, which recorded lowest deflection and stress by 51.7% and 57.1%, respectively. E-Glass/epoxy composite material reduced the weight of leaf spring 67.7 % compared to steel leaf spring.
Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The present study reports on the sociodemographic ...features, gambling activity, comorbidity and legal problems in a sample of 150 pathological gamblers who sought treatment from the Community Addiction Management Programme (CAMP), Singapore over a 4-year period from 2002 to 2006.
Data were collected on 150 consecutive subjects who sought treatment at CAMP. Patients were administered a semi-structured interview to elicit demographic data, age of onset, family history, onset games and types of games ever played, largest debt incurred due to gambling, triggers, illegal activities and suicidal attempts by their counsellor. Patients were then assessed by the clinicians to establish the primary and comorbid diagnoses.
The mean age of the subjects was 42.5 standard deviation (SD) 10.2 years. The majority of them were males (87.3%) and of Chinese origin (97.3%). The most common comorbid disorders were mood disorders (n = 22, 14.7%), substance abuse (n = 11, 7.3%) and alcohol abuse or dependence (n = 7, 4.7%). Sixteen (10.7%) subjects had a history of suicidal attempts which had been precipitated by gambling-related issues.
Pathological gambling in our subjects appears to be associated with significant comorbidity and financial problems. These are the preliminary findings and further research is needed regarding the phenomenology, profile, course and response to treatment of pathological gambling disorders.
PDF
