Brazilian Society of Cardiology - The Women's Letter Oliveira, Glaucia Maria Moraes de; Negri, Fátima Elizabeth Fonseca de Oliveira; Clausell, Nadine Oliveira ...
Arquivos brasileiros de cardiologia,
06/2019, Letnik:
112, Številka:
6
Journal Article
To determine the accuracy of various ultrasonographic (US) signs for assessment of the degree of liver fibrosis, with histologic results as reference standard.
Three hundred consecutive asymptomatic ...patients with at least 6 months of increased levels of aspartate aminotransferase and/or alanine aminotransferase underwent liver US and biopsy. The estimated pretest probability of severe fibrosis or cirrhosis was 35%. Three US parameters were investigated: liver surface nodularity, caudate lobe hypertrophy, and pattern of hepatic venous blood flow. US results were compared with histologic results obtained after liver biopsy, which constituted the reference standard for diagnosis of severe fibrosis or cirrhosis. The degree of fibrosis was graded according to METAVIR criteria, with stages 3 and 4 considered together. Data were analyzed with kappa and chi2 statistics. Sensitivity, specificity, positive and negative likelihood ratios, and posttest probability were calculated for each US sign.
In 107 (36%) patients with severe fibrosis (n = 34) or cirrhosis (n = 73), liver surface nodularity had the highest diagnostic accuracy, with specificity of 95% and positive and negative likelihood ratios 11.6 and 0.51, respectively. When liver surface nodularity was considered alone, posttest probability of severe fibrosis or cirrhosis increased from 35% to 86%. When caudate lobe hypertrophy and hepatic venous blood flow were also taken into account, posttest probability increased by only 2% (ie, to 88%).
US determination of liver surface nodularity is an accurate method for identifying the subset of asymptomatic patients with severe liver fibrosis or cirrhosis, which indicates a worse prognosis.
The Internet continues to be an important supplemental health information resource for an increasing number of U.S. adults, especially for those with a new or existing chronic condition. Here we ...examine how people use the Internet to learn about Type 2 diabetes and how health literacy (HL) influences this information-seeking behavior. We analyzed the searches of approximately 2 million people who queried for diabetes-related information on Microsoft's Bing search engine. The HL of searchers was imputed through a community-based HL score. Topics searched were categorized and subsequent websites were assessed for readability. Overall, diabetes information-seeking strategies via the Internet are similar among adults with limited and adequate HL skills. However, people with limited HL take a longer time to read pages that are quickly read by people with adequate HL and vice versa. Information seeking among the former is terminated prematurely, as is evident from a Hidden Markov Model of the search process. Our findings indicate that the reading level required to understand the majority of diabetes-related information is high. Especially on government websites, more than 80% of information requires a reading level corresponding to 7th grade or higher. Our results indicate that individuals with lower HL may disproportionately struggle with Internet searches and fail to get an equivalent benefit from this information resource compared to users with greater HL. Future interventions should target the quality and ease of navigation of health care websites and find ways to leverage other relevant professionals to encourage and promote successful information access on the Web.
Breakfast consumption can entail nutritional advantages positively affecting food choices. This study investigated the effect of minor changes in breakfast composition on the perceived attributes of ...foods, both at breakfast and at lunchtime. Four breakfasts were defined considering nutritional and perceptual factors. Three breakfasts varied just for a single cereal-based chocolate-containing food item, while a control breakfast mimicked fasting conditions. Breakfast perception was assessed before and after consumption. Subjects rated breakfast energy content on the basis of single items, while judged breakfast healthiness as a whole, suggesting that the combination of different ingredients can modify the perceived health value of foods. Additionally, 4 h after breakfast, a perceptual evaluation of lunch-related food images was performed, without differences among breakfasts. This study extends current knowledge on the relationship between subjective perceptual attributes and objective energy value and food composition, as well as on breakfast impact on food perception at lunchtime.
ABSTRACT This article reports a case of primary cardiac angiosarcoma and a brief review is provided. A 44-year-old male patient was suspected of having myxoma in the right atrium. The tumor, on ...pathology examination, was shown to be a cardiac angiosarcoma. In the postoperative period, the patient developed a cardiac tamponade, requiring reoperation and evolving to death. Angiosarcomas are malignant tumors characterized by a devastating clinical course. They have a predilection for the right atrium, occurring between the third and fifth decades of life, with a male preponderance. Because of its rarity, the ideal treatment has not been identified yet.
Colonoscopy workload for endoscopy services in Western countries is increasing markedly because of the implementation of faecal occult blood-based mass screening programmes against colorectal cancer ...(CRC). We therefore explored the possibility of using a combination of faecal tests to prioritize the access to colonoscopy with criteria other than symptoms and/or time of referral.
We tested a combination of faecal tests immunochemical faecal occult blood test (i-FOBT), M2-PK, calprotectin as markers for advanced neoplasia in a selected series of patients requiring colonoscopy for the suspicion of CRC. All the tests were performed in a 1-day stool sample of patients aged 50-80 years, without any dietary restriction, before colonoscopy.
A total of 280 patients' stool single samples were analysed. Forty-seven patients had CRC and 85 patients had one or more advanced adenoma(s) at colonoscopy/histology. CRCs were associated with a highly significant increase (P<0.001) in faecal tumour M2-PK (mean 24.2 kU/l), which correlated with Dukes' staging. For CRC detection, i-FOBT was the test with the highest specificity and positive predictive value (0.89 and 0.53), whereas M2-PK had the highest sensitivity and negative predictive value (0.87 and 0.96). Calprotectin showed performance similar to M2-PK in terms of sensitivity and negative predictive value (0.93), but had lower specificity (0.39). The best combination of tests to predict the risk of CRC in this series was i-FOBT+M2-PK, as in patients showing positivity to both markers, the risk of cancer was as high as 79%.
The combination of i-FOBT and M2-PK is a sensitive tool in clinical practice for the appropriate management of waiting lists for colonoscopy, as it allows the classification of patients into different degrees of priority for investigation, according to their foreseeable risk of CRC.
Abstract Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation ...training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range IQR 5-7; vs 7 (IQR 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance.
Objective: The aim of our study was to investigate which text-background (TB) color combinations improve legibility and pleasantness of texts either presented on a computer screen or projected on a ...wider surface. Background: Our work stems from the observation that multimedia presentations, even those by professionals in visual disciplines, are often spoiled by illegibility, which affects readability and the pleasantness of attending to such presentations. Methods: We investigated this problem through three experiments. Experiment 1 assessed the best TB color combinations in slides presented on a laptop. Experiment 2 verified the correlation between legibility and pleasantness for TB presentations. Experiment 3 investigated the legibility of a slide projected on a wide screen in different room lighting conditions. In all experiments participants expressed a rating score for stimulus legibility or pleasantness. Results: Experiments 1 and 3 showed that it is best to have a dark text on a light background for both displayed and projected texts. Experiment 2 showed that pleasantness is tightly correlated with legibility, though legibility depends on contrast between text and background. Conclusions: Our findings are not in complete agreement with the literature concerning legibility of text displayed on a computer screen, and they are in contrast with the common belief that for projection purposes it is best to have a light text on a dark background. Applications: Some practical rules on combining TB colors are given to enhance the legibility of presentations, especially important for the legibility of projected texts.
In 2005, the National Health Service recommended a population-based colorectal cancer (CRC) screening program using biennial fecal occult blood testing (FOBT), followed by total colonoscopy in ...positive patients. So far, no studies have been performed to evaluate the impact of a mass-screening CRC campaign on the health system services at the community level in Italy. We have therefore assessed the workload generated by the first two biennial rounds of screening program on the activity of hospital services involved in CRC diagnosis in the Lecco province.
Routine data from all hospital services of our province were collected on activity levels related to CRC diagnosis from January 2003 to December 2009. This time span covered the 2 years prior to, as well as the two biennial rounds of the CRC screening program. In particular, we focused on the volume of outpatient FOBTs and colonoscopies (both diagnostic and interventional) performed among subjects outside the screening program. Joinpoint models were used to test whether an apparent change in trend of examination over time was statistically significant in different age cohorts of the population (<50 years, 50-69 years, and ≥70 years).
The volume of "extra-screening" per-patient/FOBTs and colonoscopies increased significantly over the evaluated periods in all ages, until year 2008, when a steady trend was beginning; the AAPCs (average of the annual percent changes) values were 5.7, 3.1, and 8.4 for FOBT and 14.6, 13.4, and 16.7 for colonoscopy in the three age cohorts, respectively. However, the increase in both FOBT and colonoscopy demand was maximal in the cohort ≥70 years, where three statistically significant annual percent changes (APCs) were identified (in 2003-2005, 2005-2006, and 2006-2007 APCs were 12.3, 14.9, and 15.9 for FOBT, and 18.7, 36.8, and 25.4 for colonoscopy, respectively).
After the implementation of a FOBT-based mass-screening program for CRC, careful consideration must be given to the significant increase in the workload of hospital services involved in CRC diagnosis, outside the screening campaign. The extra-work mainly involves gastroenterologists performing colonoscopy, whose activity increased over the 5-year period by 118%, as well as laboratory services, where the demand of FOBTs rose by 40%. This phenomenon, mainly attributable to a profound change in the attitude toward CRC screening by those age cohorts outside the program, covers a time span of two full rounds of screening, whereupon a steady trend for colonoscopy is apparent.
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