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opencc-zeroDec 2015View details →

Data from: Characteristics of patients with smear-negative pulmonary tuberculosis (TB) in a region with high TB and HIV prevalence

Introduction: Smear-negative pulmonary TB (SNPT) represents 30–60% of all pulmonary TB cases. The mortality of these patients can reach 25% in populations with high prevalence of HIV infection, and 10–20% of TB transmission at the population level are attributable to SNPT cases. Methods: We conducted a retrospective study to evaluate epidemiological, clinical, and radiological characteristics of patients with SNPT and to compare these with patients who were diagnosed as having smear-positive pulmonary TB (SPPT). All adult patients (≥ 18 years old) with a positive culture for Mycobacterium tuberculosis, and a diagnosis of pulmonary TB were included in the study. Results: 198 patients met the inclusion criteria (positive culture for Mycobacterium tuberculosis) and were included in the analysis. Of these patients, 69 (34.8%) were smear positive (SPPT) and 129 (65.2%) were smear negative (SNPT). In univariate analysis, cough, dyspnea, and hemoptysis were less frequent in SNPT patients in comparison with SPPT patients. In a multivariate model, having no cough and no radiographic pattern typical of TB were the characteristics independently associated with a diagnosis of SNPT. Conclusions: We found a very high prevalence of SNPT among patients with TB in a setting with high TB and HIV prevalence. The absence of cough in the presence of other symptoms suggestive of TB, and having no radiographic pattern typical of TB where independent predictors of SNPT.

Data from: Learning relevance models for patient cohort retrieval

OBJECTIVE We explored how judgements provided by physicians can be used to learn relevance models that enhance the quality of patient cohorts retrieved from Electronic Health Records (EHR) collections. METHODS A very large number of features were extracted from patient cohort descriptions as well as electronic health record collections. Specifically, we investigated retrieving (1) neurology-specific patient cohorts from the Temple University Hospital EEG Corpus as well as (2) the more general cohorts evaluated in the TREC Medical Records Track (TRECMed) from the de-identified hospital records provided by the University of Pittsburgh Medical Center. The features informed a Learning Relevance Model (LRM) that took advantage of relevance judgements provided by physicians. The LRM implements a pairwise learning-to-rank framework, which enables our learning patient cohort retrieval (L-PCR) system to learn from physicians' feedback. RESULTS AND DISCUSSION We evaluated the L-PCR system against state-of-the-art traditional patient cohort retrieval systems, and observed a 27% improvement when operating on EEGs and a 53% improvement when operating on TRECMed EHRs, showing the promise of the L-PCR system. We also performed extensive feature analyses to reveal the most effective strategies for representing cohort descriptions as queries, encoding EHRs, and measuring relevance. CONCLUSION The learning patient cohort retrieval system has significant promise for reliably retrieving patient cohorts from EHRs in multiple settings when trained with relevance judgments. When provided with additional cohort descriptions, the L-PCR will continue to learn, thus offering a potential solution to the performance barriers of current cohort retrieval systems.

Data from: Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study

Objectives: Approximately one in five stroke survivors suffer from difficulties with speech reception in noise, despite normal audiometry. These deficits are treatable with personal Frequency Modulated systems (FMs). This study aimed to evaluate long term benefits in speech reception in noise, after daily 10 week use of personal FMs, in non-aphasic stroke patients with auditory processing deficits. Design: This was a prospective non randomised controlled trial study. Patients were allocated to an intervention care group or standard care subjects group according to their willingness to use the intervention or not. Setting: Tertiary care setting. Participants: Nine non-aphasic subjects with ischemic stroke, normal/near normal audiometry, and auditory processing deficits and with reported difficulties understanding speech in background noise were recruited in the subacute stroke stage (3-12 months after stroke). Interventions: Four patients (intervention care subjects) used the FMs in their daily life over 10 weeks. Five patients (standard care subjects) received standard care. Primary outcome measures: All subjects were tested at baseline (visit 1) and 10 weeks later (visit 2) on a sentences in noise test with the FMs (aided) and without the FMs (unaided). Results: Speech reception thresholds showed clinically and statistically significant improvements in intervention but not in standard care subjects at 10 weeks in both aided and unaided conditions. Conclusions: 10 week use of FM systems by adult stroke patients may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes and require further investigation.

opencc-zeroNov 2019View details →

Data from: Outcomes of stroke patients treated with thrombolysis according to prestroke Rankin Scale scores

Background: It is common practice to withhold intravenous thrombolysis (IVT) for acute ischemic stroke in patients with preexisting disabilities. To test the hypothesis of an association of IVT and good clinical outcome also in patients with preexisting disabilities without an increase in mortality we analyzed data of 52,741 patients (15,317 treated with IVT) depending on prestroke Rankin Scale (pRS) score. Methods: We performed an observational study based on a consecutive stroke registry covering 10.8 million inhabitants. The outcome at discharge of stroke patients admitted in the time window of potential eligibility for IVT (<4.5h after stroke onset) was compared between patients treated and not treated with thrombolysis, stratified by pRS. Logistic regression analysis was used to estimate adjusted odds ratios (OR) along with 95% confidence intervals (CI) for favorable clinical outcome, defined as returning to the baseline pRS score or a score of 0 or 1 and mortality. Sensitivity analyses for subgroups of mildly and severely affected stroke patients were performed and influence of treatment duration was assessed. Results: Among included patients IVT rates were 32% for patients with pRS 0-1 and 20% for patients with pRS 2-5. IVT in patients with pRS of 0-4 was associated with a higher chance of returning to the baseline pRS (or a modified RS of 0/1), with ORs ranging between 1.42 (pRS 2; CI 1.16-1.73) and 1.73 (pRS 0; CI 1.61-1). The OR observed in patients with a pRS of 5 was 0.65 (CI 0.25-1.70). Observed associations remained consistent in sensitivity analyses. Subgroup analyses revealed no evidence of bias due to potential floor and ceiling effects. No evidence of elevated in-hospital mortality of patients treated with thrombolysis was observed. Conclusions: Our study suggests that IVT can be effective even in patients with severe preexisting disabilities, provided that they were not bedridden before stroke onset. Withholding IVT on the sole ground of prestroke disabilities may not be justified.

Data from: Characteristics of patients included and enrolled in studies on the prognostic value of serum biomarkers for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review

Objective: Mild traumatic brain injury (mTBI) has been insufficiently researched and its definition remains elusive. Investigators are confronted by heterogeneity in patients, mechanism of injury and outcomes. Findings are thus often limited in generalizability and clinical application. Serum protein biomarkers are increasingly assessed to enhance prognostication of outcomes but their translation into clinical practice has yet to be achieved. A systematic review was performed to describe the adult populations included and enrolled in studies that evaluated the prognostic value of protein biomarkers to predict post-concussion symptoms following a mTBI. Data sources: Searches of MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, PsycBITE, and PsycINFO up to October 2016. Data selection and extraction: Two reviewers independently screened for potentially eligible studies, extracted data and assessed the overall quality of evidence by outcome using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: A total of 23,298 citations were obtained from which 166 manuscripts were reviewed. Thirty-six cohort studies (2,812 patients) having enrolled between 7 and 311 patients (median 89) fulfilled our inclusion criteria. Most studies excluded patients based on advanced age (n=10 (28%)), neurologic disorders (n=20 (56%)), psychiatric disorders (n=17 (47%)), substance abuse disorders (n=13 (36%)) or previous TBI (n=10 (28%)). Twenty-one studies (58%) used at least two of these exclusion criteria. The pooled mean age of included patients was 39.3 (SD 4.6) years old (34 studies). The criteria used to define a mTBI were inconsistent. The most frequently reported outcome was post-concussion syndrome (PCS) using the Rivermead Post-Concussion Symptoms Questionnaire (n=18 (50%)) with follow-ups ranging from 7 days to 5 years after the mTBI. Conclusions: Most studies have recruited samples that are not representative and generalizable to the mTBI population. These exclusion criteria limit the potential use and translation of promising serum protein biomarkers to predict post-concussion symptoms.

opencc-zeroDec 2014View details →

Data from: Change in quality of life for patients with Irritable Bowel Syndrome following referral to a gastroenterologist: a cohort study

Background: Irritable bowel syndrome (IBS), a chronic functional condition, considerably reduces quality of life (QoL) and referral to gastroenterology is common. Until now, however, the impact of seeing a gastroenterologist for IBS on patients' QoL and utility has not been assessed. Methods: Patients referred with "probable IBS" to the Nottingham Treatment Centre between October 2012 and March 2014 were invited to complete a QoL questionnaire (EuroQol–5 Dimension) before their first appointment. Patients with confirmed IBS who completed this baseline assessment were sent follow-up questionnaires three and twelve months later. Global QoL and utility were measured at each time point and change from baseline calculated. Paired t-tests analysed the significance of any change. Results: Of 205 invited patients, 69 were eligible and recruited. Response at three and twelve months was 45% and 17% respectively. Median global QoL at baseline was 67.5 (Interquartile range [IQR] 50.0 to 80.0), with a mean increase of 3.25 (95% confidence interval [CI] -5.38 to 11.88) three months later and a mean decrease of -1.82 (95% CI -16.01 to 12.38) after one year. The median utility at baseline was 0.76 (IQR 0.69 to 0.80), with a mean increase of 0.06 (95%CI -0.01 to 0.14) at three months and no change, 0.00 (-0.16 to 0.16), after one year. Conclusion: Patients experienced a small but not statistically significant increase in QoL and utility three months after seeing a gastroenterologist for IBS, which was not maintained. Gastroenterology referral does not appear to appreciably improve Qol for most people with IBS.

opencc-zeroDec 2014View details →

Data from: Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital

Background: Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting. Objectives: The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI. Methods: We conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios. Results: The distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients. Conclusion: The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

opencc-zeroDec 2015View details →

Data from: Retinal capillary rarefaction in patients with type 2 diabetes mellitus

Purpose: In diabetes mellitus type 2, capillary rarefaction plays a pivotal role in the pathogenesis of end-organ damage. We investigated retinal capillary density in patients with early disease. Methods: This cross-sectional study compares retinal capillary rarefaction determined by intercapillary distance (ICD) and capillary area (CapA), measured non-invasively and in vivo by scanning laser Doppler flowmetry, in 73 patients with type 2 diabetes, 55 healthy controls and 134 individuals with hypertension stage 1 or 2. Results: In diabetic patients, ICD was greater (23.2±5.5 vs 20.2±4.2, p = 0.013) and CapA smaller (1592±595 vs 1821±652, p = 0.019) than in healthy controls after adjustment for differences in cardiovascular risk factors between the groups. Compared to hypertensive patients, diabetic individuals showed no difference in ICD (23.1±5.8, p = 0.781) and CapA (1556±649, p = 0.768). Conclusion: In the early stage of diabetes type 2, patients showed capillary rarefaction compared to healthy individuals.

opencc-zeroDec 2015View details →

Data from: Missed opportunities for earlier diagnosis of HIV in patients that presented with advanced HIV disease: a retrospective cohort study

OBJECTIVE: To quantify and characterize missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical center in Israel. MEASURES: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients RESULTS: Between 2010-2015, 356 patients were diagnosed with HIV, 118 (33.4 %) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 [95% CI 1.16-1.74]) and being heterosexual (OR=2.65 [95% CI 1.21-5.78]) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 month (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS: Missed opportunities to early diagnosis of HIV occur both in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to HIV late diagnosis. 'Strengths and limitations of this study' This study shows for the first time rate and reasons for missed opportunities to diagnose HIV in a low prevalence country like Israel. This study may shed light on the reasons why primary care physicians or specialists are missing to diagnose HIV earlier. Nonexistence of clear national guidelines for HIV testing and ignoring HIV clinically indicator diseases are major reasons for missed diagnosis of HIV. This study was carried out in one center and may not reflect the picture in the all country; Also, the total number of patients is low and this may limit generability of the study

Data from: Extent and cost of inappropriate use of tumour markers in patients with pulmonary disease: a multicentre retrospective study in Shanghai, China

Objectives: The currently implemented healthcare reform in China requires substantial capital investment. Although overtreatment results in serious waste, inappropriate laboratory use is widespread, and overuse of tumor markers (TMs) has attracted increasing attention. Design: Retrospective study. Setting: The respiratory, thoracic surgery, and oncology departments of three hospitals in Shanghai, from 2014 to 2015. Participants: Patients with chronic obstructive pulmonary disease (COPD) and primary bronchogenic lung cancer (PLC). Based on clinical guidelines and physician experience, the criteria of suitability of TM examinations were determined, and the number, cost, and proportion of inappropriate TM requests were analyzed. Results: The area under the receiver operating characteristic (ROC) curve for CEA+CYFRA211+SCC+NSE in COPD and PLC patients was 0.813, in accordance with the cost-effectiveness principle, indicating good clinical and health economics values. In the 2706 patients, 12,496–16,956 (58.27–79.06%) of TM requests were inappropriate. Furthermore, the involved expense was 650,200–1,014,156 yuan, accounting for 7.69–12.00% of examination expenses, and 1.35–2.11% of hospitalization costs. Conclusions: We found that the inappropriate use of TMs was widespread for patients with pulmonary disease. Clinicians should use TMs strictly according to the guidelines to effectively manage laboratory resources and control costs.

Data from: Difficult patient-doctor encounters in a Swiss university outpatient clinic: a cross-sectional study.

Introduction: Previous research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands. Aim: To measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents. Design and Setting: Cross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients. Method: We identified difficult doctor-patient encounters using the validated Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10), and characterized patients using the Patient's Vulnerability Grid, a validated questionnaire measuring 5 domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics. Participants: We analyzed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date. Outcome: One hundred and fifty-seven encounters (29,8%) were perceived as difficult. Results: After adjusting for differences among residents, all five domains of the Patient Vulnerability Grid were independently associated with a difficult encounter: frequent health care user; psychological comorbidity; health comorbidity; risky behaviors and a precarious social situation. Conclusion: Nearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents' perception of difficult patient encounters.

Data from: Effect of ultrasonography surveillance in patients with liver cancer: a population-based longitudinal study

Objective Liver cancer is a growing global public health problem. Ultrasonography is an imaging tool widely used for the early diagnosis of liver cancer. However, the effect of ultrasonography surveillance (US) on the survival of patients with liver cancer is unknown. Therefore, this study examined the association between survival and US frequency during the 2 years preceding patients' liver cancer diagnosis. Methods This population-based longitudinal study was conducted in Taiwan, a region with high liver cancer incidence, by using the National Health Insurance Research Database. We compared survival between patients who received US three times or more (≥3 group) and less than three times (<3 group) during the 2 years preceding their liver cancer diagnosis, and identified the predictors for the ≥3 group. Results This study enrolled 4621 patients with liver cancer who had died between 1997 and 2010. The median survival rate was higher in the ≥3 group (1.42 years) than in the <3 group (0.51 years). Five-year survival probability was also significantly higher in the ≥3 group (14.4%) than in the <3 group (7.7%). The multivariate logistic regression results showed that the three most common positive predictors for receiving three or more US sessions were indications of viral hepatitis, gallbladder diseases, and kidney–urinary–bladder diseases; the most common negative predictors for receiving three or more US sessions were male sex and indications of abdominal pain. Conclusion Patients with liver cancer who received US three times or more during the 2 years preceding their liver cancer diagnosis exhibited a higher 5-year survival probability.

Data from: Adherence to trained standards after a faculty development workshop on "Teaching With Simulated Patients"

Background: Nowadays, faculty development programs to improve teaching quality are considered to be very important by medical educators from all over the world. However, the assessment of the impact of such programs rarely exceeds tests of participants' knowledge gain or self-assessments of their teaching behavior. It remains unclear what exactly is expected of the attending faculty and how the transfer to practice may be measured more comprehensively and accurately. Method: This study evaluates how specific teaching standards were applied after a workshop (10 teaching units) focusing on teaching communication skills with simulated patients. Trained observers used a validated checklist to observe 60 teaching sessions (held by 60 different teachers) of a communication skills course integrating simulated patients. Additionally, we assessed the amount of time that had passed since their participation in the workshop and asked them to rate the importance of communication and social skills in medical education. Results: The observations showed that more than two thirds of teaching standards were met by at least 75% of teachers. Fulfillment of standards was significantly connected to teachers' rating of the importance of communication and social skills (tb=-.21, p=.03). In addition, the results suggest a slight decrease in the amount of fulfilled standards over time (r=-.14, p=.15). Conclusions: Teachers' adherence to basic teaching standards was already satisfying after a one-day workshop. More complex issues need to be re-addressed in further faculty development courses with a special focus on teachers' attitude towards teaching. In future, continuing evaluations of the transfer of knowledge and skills from faculty development courses into practice, preferably including pre-tests or control groups, are needed.

opencc-zeroDec 2012View details →

Data from: Randomised controlled trial of an education and support package for stroke patients and their carers

Objective: Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education. This study aimed to evaluate the effects of an education package which utilised both strategies on the knowledge, health and psychosocial outcomes of stroke patients and carers. Design: Multisite, randomised trial comparing usual care with an education and support package. Setting: Two acute stroke units. Participants: Patients and their carers (N=138) were randomised (control n=67, intervention n=71) of which data for 119 participants (control n=59, intervention n=60) were analysed. Intervention: The package consisted of a computer-generated, tailored written information booklet and verbal reinforcement provided prior to, and for 3 months following, discharge. Outcome measures: Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors. The primary outcome was stroke knowledge (score range: 0–25). Secondary outcomes were: self-efficacy (1–10), anxiety and depression (0–21), ratings of importance of information (1–10), feelings of being informed (1–10), satisfaction with information (1–10), caregiver burden (carers) (0–13) and quality of life (patients) (1–5). Results: Intervention group participants reported better: self-efficacy for accessing stroke information (adjusted mean difference (MD) of 1.0, 95% CI 0.3 to 1.7, p=0.004); feeling informed (MD 0.9, 95% CI 0.2 to 1.6, p=0.008); and satisfaction with medical (MD 2.0, 95% CI 1.1 to 2.8, p<0.001); practical (MD 1.1, 95% CI 0.3 to 1.9, p=0.008), services and benefits (MD 0.9, 95% CI 0.1 to 1.8, p=0.036) and secondary prevention information (MD 1.7, 95% CI 0.9 to 2.5, p<0.001). There was no significant effect on other outcomes. Conclusions: Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information, but other outcomes were not significantly affected. Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies.

Data from: Patients with primary biliary cholangitis and fatigue present with depressive symptoms and selected cognitive deficits, but with normal attention performance and brain structure

Background: In primary biliary cholangitis (PBC) fatigue is a major clinical challenge of unknown etiology. By demonstrating that fatigue in PBC is associated with an impaired cognitive performance, previous studies have pointed out the possibility of brain abnormalities underlying fatigue in PBC. Whether structural brain changes are present in PBC patients with fatigue, however, is unclear. To evaluate the role of structural brain abnormalities in PBC patients severely affected from fatigue we, therefore, performed a case-control cerebral magnetic resonance imaging (cMRI) study and correlated changes of white and grey brain matter with the cognitive and attention performance. Methods: 20 female patients with PBC and 20 female age-matched controls were examined in this study. The assessment of fatigue, psychological symptoms, cognitive and attention performance included clinical questionnaires, established cognition tests and a computerized test battery of attention performance. T1-weighted cMRI and diffusion tensor imaging (DTI) scans were acquired with a 3 Tesla scanner. Structural brain alterations were investigated with voxel-based morphometry (VBM) and DTI analyses. Results were correlated to the cognitive and attention performance. Results: Compared to healthy controls, PBC patients had significantly higher levels of fatigue and associated psychological symptoms. Except for an impairment of verbal fluency, no cognitive or attention deficits were found in the PBC cohort. The VBM and DTI analyses revealed neither major structural brain abnormalities in the PBC cohort nor correlations with the cognitive and attention performance. Conclusions: Despite the high burden of fatigue and selected cognitive deficits, the attention performance of PBC patients appears to be comparable to healthy people. As structural brain alterations do not seem to be present in PBC patients with fatigue, fatigue in PBC must be regarded as purely functional. Future studies should evaluate, whether functional brain changes underlie fatigue in PBC.

opencc-zeroDec 2018View details →

Data from: The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation

Background: Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA. Methods: The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation. Results: In total, 192 patients were included in the study. Median (25th – 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96-695) vs. 130 (49-346) pg/ml (p = 0.010), and in women it was 230 (125-480) vs. 230 (125-910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100-224) vs. 117 (83-179) pmol/l (p=0.120) and in women it was 139 (112-206) vs. 153 (93-249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7-33.9) vs. 25.8 (21.4-32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9-29.6) vs. 25.7 (21.7-34.6) ml/m2 (p =0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p=0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3-9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women. Conclusions: In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

Data from: Hypoglycemia Following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function

Background: Hypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or ≤40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia. Methods: We retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g glucose to treat hyperkalemia from December 1, 2013 to May 31, 2015 at our Department. Results: One hundred sixty four episodes of hyperkalemia were treated with insulin plus glucose and were eligible for analysis. Serum potassium levels dropped by 1.18 ± 1.01 mmol/l. Eleven treatments (6.1%) resulted in hypoglycemia and two (1.2%) in severe hypoglycemia. A lower pretreatment blood glucose tended to associate with a higher subsequent risk of hypoglycemia. Age, sex, renal function, an established diagnosis of diabetes or previous treatment were not associated with the development of this complication. We did not register any significant adverse events. Conclusion: Our intravenous regimen combining an infusion of insulin plus glucose effectively reduced serum potassium levels compared to previous studies and associated a low risk of symptomatic hypoglycemia and other complications.

opencc-zeroDec 2012View details →

Data from: Auditory threshold shifts after glycerol administration to patients with suspected Menière's disease: a retrospective analysis

Objectives: Nearly half a century ago, administration of glycerol was shown to temporarily improve the threshold of hearing in patients with suspected Menière's disease (glycerol test). Although a positive test result provides strong evidence of Menière's disease, the test has not gained widespread acceptance. A probable reason is that there is no consensus as to the definition of positive. Moreover, a negative test result is of little diagnostic value because Menière's disease cannot be excluded. By reanalyzing archived data, the authors sought to understand the test in light of signal detection theory. Moreover, they explored the possibility of estimating the probability of a positive test result from the pretest audiogram. Design: The study is based on audiograms from 347 patients (356 ears) who underwent a glycerol test to corroborate a suspected diagnosis of Menière's disease. Subsequent to an initial pure-tone audiogram, glycerol (1.2 mL/kg body weight) was orally administered; follow-up audiograms were obtained after 1, 2, 3, and 4 hr. Transcription of the audiograms into a computer-readable form made them available for automated reanalysis. Results: Averaged difference audiograms provided detailed insight into the frequency dependence and the temporal dynamics of the glycerol-induced threshold reduction. The strongest threshold reduction was observed 4 hr after glycerol intake, although nearly the same effect was already found after 3 hr. Strong overall threshold reductions were associated with a pronounced maximum at approximately 1000 Hz; weaker effects were associated with a plateau between 125 and 1000 Hz and a rapid decrease toward higher frequencies. To date, criteria suggested for a positive test result vastly differ in both sensitivity (with regard to the detection of a threshold reduction) and specificity (1 minus false-positive rate). Here, a criterion based on the aggregate threshold reduction in adjacent audiometric frequencies is suggested. This approach does not only seem to be more robust but also permits to freely adjust the false-positive rate. A positive test result is particularly likely when the mean low-frequency hearing loss is approximately 60 dB and the mean high-frequency hearing loss does not exceed 50 dB. Conclusion: If the pretest audiogram does not render a positive test result unlikely, a state-of-the-art implementation of the glycerol test is a competitive method for corroborating a suspected diagnosis of Menière's disease.

opencc-zeroDec 2014View details →

Data from: Inner conflict in patients receiving oral anti-cancer agents: a qualitative study

Objectives: To explore the experiences of patients receiving oral anticancer agents. Design: A qualitative study using semistructured interviews with a grounded theory approach. Setting: A university hospital in Japan. Participants :14 patients with gastric cancer who managed their cancer with oral anticancer agents. Results: Patients with cancer experienced inner conflict between rational belief and emotional resistance to taking medication due to confrontation with cancer, doubt regarding efficacy and concerns over potential harm attached to use of the agent. Although they perceived themselves as being adherent to medication, they reported partial non-adherent behaviours. The patients reassessed their lives through the experience of inner conflict and, ultimately, they recognised their role in medication therapy. Conclusions: Patients with cancer experienced inner conflict, in which considerable emotional resistance to taking their medication affected their occasional non-adherent behaviours. In patient-centred care, it is imperative that healthcare providers understand patients' inner conflict and inconsistency between their subjective view and behaviour to support patient adherence.