Barrett's esophagus (BE) requires surveillance to identify potential neoplasia at an early stage. The standard surveillance regimen includes random 4-quadrant biopsies by Seattle protocol. Main ...limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding, and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations.
pCLE represents a real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1,000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patients. The main advantages would be real-time diagnosis and decision-making, greater diagnostic accuracy, and evaluation of larger area compared to random biopsies. Clinical pCLE studies in the esophagus show high diagnostic accuracy, and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key Messages: Despite promising results, its role in routine use in patients with BE remains questionable primarily due to lack of well-organized double-blind randomized trials.
Art is defined as the expression or application of the human creative skill and imagination, producing works to be appreciated primarily for their beauty or emotional power. "Ars medica" and "Ars ...musica" represent two concepts which have been mutually intertwined since the ancient times. Through history, many extraordinary physicians have shown talent towards making and performing music. Guided by the passion for medicine and music, since 2006 the students from the University of Rijeka, Faculty of Medicine have founded an informal group named "In honour of Asclepius and Orpheus" under the aegis of the Croatian Scientific Society for the History of Health Culture. The group organizes many musical activities such as concerts, musical recitals and events, among which are the most important - the traditional annual concert of Croatian medical students and the European Medical Students Orchestra and Choir project. Apart from Rijeka, they performed several times in Ljubljana, Zagreb, Pula, Karlovac, Krk, Opatija and Crikvenica. The members of this group plan their future work guided by the principles that motivate every physician-musician - art.
This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows:
To assess the diagnostic accuracy of abdominal ultrasound and alpha‐fetoprotein (AFP), alone or in ...combination, for the diagnosis of hepatocellular carcinoma (HCC) of any size and at any stage in people with chronic advanced liver disease, either in a surveillance programme or in a clinical setting.
Sustavni pregledni radovi se danas smatraju dijelom relevantne znanstvene i stručne literature koja postaje neizostavni dio svakodnevne medicinske prakse i važan element u donošenju odluka. Radi se o ...znanstvenom istraživanju koje temeljem sustavne i strogo definirane metodologije pretrage, odabira i analize dostupnih znanstvenih dokaza daje odgovor na točno definirano znanstveno pitanje. Cochrane kolaboracija je svjetska neprofitna organizacija čiji je cilj stvaranje kvalitetnih sustavnih preglednih radova kroz detaljnu, razrađenu i rigoroznu metodologiju. Kroz različite znanstvene grupe, autori publiciraju Cochrane sustavne preglede intervencija i dijagnostičkih testova koji se objavljuju u Cochrane bazi sustavnih preglednih članaka. Cochrane sustavni pregledni rad se razvija u nekoliko koraka: formulacija pitanja, odabir Cochrane skupine, registracija naslova, izrada i objava protokola, te izrada, objava i održavanje sustavnog preglednog rada. Ovim radom želimo prikazati metodologiju razvoja sustavnog pregleda u sklopu Cochrane kolaboracije kao općeniti uvid u kompleksnost njegove izrade.
Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association "Albert Einstein" and Eye Clinic "Dr B.Vojnikovid" Rijeka agreed a five-year project to ...study children's health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50-60 years ago, it was a very rare occurrence of some refractive errors in children.
Background
To determine the diagnostic accuracy of abdominal ultrasound (US) for the diagnosis of acute appendicitis (AA), in terms of sensitivity, specificity and post-test probabilities for ...positive and negative result.
Methods
A systematic search of MEDLINE, Embase, The Cochrane library and Science Citation Index Expanded from January 1994 to October 2014 was performed. Two authors independently evaluated studies for inclusion, extracted data and performed analyses. The reference standard for evaluation of final diagnosis was pathohistological report on tissue obtained at appendectomy. Summary sensitivity, specificity and post-test probability of AA after positive and negative result of US with corresponding 95% confidence intervals (CI) were calculated.
Results
Out of 3306 references identified through electronic searches, 17 reports met the inclusion criteria, with 2841 included participants. The summary sensitivity and specificity of US for diagnosis of AA were 69% (95% CI 59–78%) and 81% (95% CI 73–88%), respectively. At the median pretest probability of AA of 76.4%, the post-test probability for a positive and negative result of US was 92% (95% CI 88–95%) and 55% (95% CI 46–63%), respectively.
Conclusions
Abdominal ultrasound does not seem to have a role in the diagnostic pathway for diagnosis of AA in suspected patients. The summary sensitivity and specificity of US do not exceed that of physical examination. Patients that require additional diagnostic workup should be referred to more sensitive and specific diagnostic procedures, such as computed tomography.
Background
Hepatocellular carcinoma (HCC) occurs mostly in people with chronic liver disease and ranks sixth in terms of global instances of cancer, and fourth in terms of cancer deaths for men. ...Despite that abdominal ultrasound (US) is used as an initial test to exclude the presence of focal liver lesions and serum alpha‐foetoprotein (AFP) measurement may raise suspicion of HCC occurrence, further testing to confirm diagnosis as well as staging of HCC is required. Current guidelines recommend surveillance programme using US, with or without AFP, to detect HCC in high‐risk populations despite the lack of clear benefits on overall survival. Assessing the diagnostic accuracy of US and AFP may clarify whether the absence of benefit in surveillance programmes could be related to under‐diagnosis. Therefore, assessment of the accuracy of these two tests for diagnosing HCC in people with chronic liver disease, not included in surveillance programmes, is needed.
Objectives
Primary: the diagnostic accuracy of US and AFP, alone or in combination, for the diagnosis of HCC of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting.
Secondary: to assess the diagnostic accuracy of abdominal US and AFP, alone or in combination, for the diagnosis of resectable HCC; to compare the diagnostic accuracy of the individual tests versus the combination of both tests; to investigate sources of heterogeneity in the results.
Search methods
We searched the Cochrane Hepato‐Biliary Group Controlled Trials Register, the Cochrane Hepato‐Biliary Group Diagnostic‐Test‐Accuracy Studies Register, Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, until 5 June 2020. We applied no language or document‐type restrictions.
Selection criteria
Studies assessing the diagnostic accuracy of US and AFP, independently or in combination, for the diagnosis of HCC in adults with chronic liver disease, with cross‐sectional and case‐control designs, using one of the acceptable reference standards, such as pathology of the explanted liver, histology of resected or biopsied focal liver lesion, or typical characteristics on computed tomography, or magnetic resonance imaging, all with a six‐months follow‐up.
Data collection and analysis
We independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS‐2 checklist. We presented the results of sensitivity and specificity, using paired forest‐plots, and tabulated the results. We used a hierarchical meta‐analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double‐checked all data extractions and analyses.
Main results
We included 373 studies. The index‐test was AFP (326 studies, 144,570 participants); US (39 studies, 18,792 participants); and a combination of AFP and US (eight studies, 5454 participants).
We judged at high‐risk of bias all but one study. Most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time‐interval between the index test and the reference standard was rarely defined. Most studies with AFP had a case‐control design. We also had major concerns for the applicability due to the characteristics of the participants.
As the primary studies with AFP used different cut‐offs, we performed a meta‐analysis using the hierarchical‐summary‐receiver‐operating‐characteristic model, then we carried out two meta‐analyses including only studies reporting the most used cut‐offs: around 20 ng/mL or 200 ng/mL.
AFP cut‐off 20 ng/mL: for HCC (147 studies) sensitivity 60% (95% CI 58% to 62%), specificity 84% (95% CI 82% to 86%); for resectable HCC (six studies) sensitivity 65% (95% CI 62% to 68%), specificity 80% (95% CI 59% to 91%).
AFP cut‐off 200 ng/mL: for HCC (56 studies) sensitivity 36% (95% CI 31% to 41%), specificity 99% (95% CI 98% to 99%); for resectable HCC (two studies) one with sensitivity 4% (95% CI 0% to 19%), specificity 100% (95% CI 96% to 100%), and one with sensitivity 8% (95% CI 3% to 18%), specificity 100% (95% CI 97% to 100%).
US: for HCC (39 studies) sensitivity 72% (95% CI 63% to 79%), specificity 94% (95% CI 91% to 96%); for resectable HCC (seven studies) sensitivity 53% (95% CI 38% to 67%), specificity 96% (95% CI 94% to 97%).
Combination of AFP (cut‐off of 20 ng/mL) and US: for HCC (six studies) sensitivity 96% (95% CI 88% to 98%), specificity 85% (95% CI 73% to 93%); for resectable HCC (two studies) one with sensitivity 89% (95% CI 73% to 97%), specificity of 83% (95% CI 76% to 88%), and one with sensitivity 79% (95% CI 54% to 94%), specificity 87% (95% CI 79% to 94%).
The observed heterogeneity in the results remains mostly unexplained, and only in part referable to different cut‐offs or settings (surveillance programme compared to clinical series). The sensitivity analyses, excluding studies published as s, or with case‐control design, showed no variation in the results.
We compared the accuracy obtained from studies with AFP (cut‐off around 20 ng/mL) and US: a direct comparison in 11 studies (6674 participants) showed a higher sensitivity of US (81%, 95% CI 66% to 90%) versus AFP (64%, 95% CI 56% to 71%) with similar specificity: US 92% (95% CI 83% to 97%) versus AFP 89% (95% CI 79% to 94%). A direct comparison of six studies (5044 participants) showed a higher sensitivity (96%, 95% CI 88% to 98%) of the combination of AFP and US versus US (76%, 95% CI 56% to 89%) with similar specificity: AFP and US 85% (95% CI 73% to 92%) versus US 93% (95% CI 80% to 98%).
Authors' conclusions
In the clinical pathway for the diagnosis of HCC in adults, AFP and US, singularly or in combination, have the role of triage‐tests. We found that using AFP, with 20 ng/mL as a cut‐off, about 40% of HCC occurrences would be missed, and with US alone, more than a quarter. The combination of the two tests showed the highest sensitivity and less than 5% of HCC occurrences would be missed with about 15% of false‐positive results. The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results.
Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only ...very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Losinj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease (14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.
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