scholarly journals Incidence, pathomorphism and outcomes of the bronchopulmonary dysplasia associated with microaspiration of gastric contents

2016 ◽  
Vol 71 (2) ◽  
pp. 128-140
Author(s):  
E. Y. Bryksina ◽  
V. S. Bryksin ◽  
A. V. Pochivalov
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Pulmonary Ventilation ◽  
Forecast Accuracy ◽  
Pepsin Activity ◽  
Gastric Contents ◽  
Neonatal Adaptation ◽  
Artificial Pulmonary Ventilation ◽  
Clinically Significant

Today the influence of the digestive tract functional violations followed by microaspiration of gastric contents (MAGC) on the incidence, features and outcomes of bronchopulmonary dysplasia BPD) remains little studied. Focusing on this aspect makes the research actual.Objective: determination of the nature of influence of MAGC on the progress and course of BPD.Methods: 373 newborns exposed to artificial pulmonary ventilation (APV) in the neonatal period were examined. In a tracheobronchial aspirate (TBA) the marker of MAGC – pepsin –was determined. Its activity was measured by extinction value with subsequent analysis of the incidence and nature of the course of bronchopulmonary dysplasia (BPD) in patients against MAGC and without it. During the three years follow-up period outcomes of BPD and features of combined pathology were established.Results: it was revealed that in children suffered from MAGC the incidence of BPD was higher and grew in proportion to the increase of pepsin activity in TBA and the reduction of gestational age. The extinction increase in TBA values was followed by the increase in duration of APV and the subsequent oxygen therapy, and also the severity of BPD clinical course. By the end of 3 years clinical recovery was detected in 55,2% of children suffering from BPD without MAGC whereas in patients with BPD against MAGC this outcome occured only in 0,9% of cases.Conclusion: MAGC is clinically significant for the etiology, pathogenesis and pathomorphism of BPD. The proposed method of early detection of MAGC and algorithm of complex therapy can reduce its severity and improve the forecast accuracy of neonatal adaptation. 

scholarly journals Microaneurysm Turnover in Mild Non-Proliferative Diabetic Retinopathy is Associated with Progression and Development of Vision-Threatening Complications: A 5-Year Longitudinal Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2142
Author(s):  
Ana Rita Santos ◽  
Luis Mendes ◽  
Maria Helena Madeira ◽  
Ines P. Marques ◽  
Diana Tavares ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Longitudinal Study ◽  
Predictive Biomarker ◽  
Fundus Photography ◽  
Prospective Longitudinal Study ◽  
Significant Difference ◽  
Clinically Significant ◽  
Prospective Longitudinal

Background: Analysis of retinal microaneurysm turnover (MAT) has been previously shown to contribute to the identification of eyes at risk of developing clinically significant complications associated with diabetic retinopathy (DR). We propose to further characterize MAT as a predictive biomarker of DR progression and development of vision-threatening complications. Methods: 212 individuals with type 2 diabetes (T2D; ETDRS grades 20 and 35) were evaluated annually in a 5-year prospective, longitudinal study, by color fundus photography and optical coherence tomography. Endpoints were diabetic macular edema (DME) or proliferative retinopathy (PDR). MAT analysis included determination of MA formation and disappearance rates, automatically assessed using the RetMarkerDR®. Retinopathy severity progression was evaluated using step increases in ETDRS severity levels. Results: Of the 212 individuals, 172 completed the 5-year follow-up study or developed an endpoint (n = 27). MAT calculated at 1 year showed a significant difference between groups of endpoint developments (p = 0.018), particularly MA disappearance rate (p = 0.007). MAT also showed a significant difference between eyes with different ETDRS severity progression in the 5-year period (p = 0.035). Conclusions: MAT is an indicator of the development of DME and/or PDR as well as of DR severity progression in T2D individuals with mild retinopathy.

Predicting change with the RBANS in a community dwelling elderly sample

2004 ◽  
Vol 10 (6) ◽  
pp. 828-834 ◽  
Author(s):  
KEVIN DUFF ◽  
MIKE R. SCHOENBERG ◽  
DOYLE PATTON ◽  
JAMES MOLD ◽  
JAMES G. SCOTT ◽  
...  
Keyword(s):  
Older Adults ◽  
Test Performance ◽  
Community Dwelling ◽  
Healthy Control ◽  
Neuropsychological Assessments ◽  
Clinically Significant ◽  
The Individual ◽  
Community Dwelling Older Adults

Repeated neuropsychological assessments are common with older adults, and the determination of clinically significant change across time is an important issue. Regression-based prediction formulas have been utilized with other patient and healthy control samples to predict follow-up test performance based on initial performance and demographic variables. Comparisons between predicted and observed follow-up performances can assist clinicians in determining the significance of change in the individual patient. In the current study, multiple regression-based prediction equations for the 5 Indexes and Total Score of the RBANS were developed for a sample of 223 community dwelling older adults. These algorithms were then validated on a separate elderly sample (N = 222). Minimal differences were present between observed and predicted follow-up scores in the validation sample, suggesting that the prediction formulas are clinically useful for practitioners who assess older adults. A case example is presented that illustrates how the algorithms can be used clinically. (JINS, 2004, 10, 828–834.)

Outpatient Management and Follow-Up of Bronchopulmonary Dysplasia

1984 ◽  
Vol 11 (1) ◽  
pp. 101-122 ◽  
Author(s):  
Beverly L. Koops ◽  
Steven H. Abman ◽  
Frank J. Accurso
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Outpatient Management

EVALUASI KESESUAIAN PELAKSANAAN PROBITY AUDIT PADA BPKP PUSAT DENGAN PEDOMAN PROBITY AUDIT PENGADAAN BARANG/JASA PEMERINTAH

INFO ARTHA ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 17-34
Author(s):  
Fadlil Usman
Keyword(s):  
Public Sector ◽  
Real Time ◽  
Procurement Process ◽  
Assessment Activity

Probity audit is an independence assessment activity to ensure the goods/services procurement processes have been implemented consistently appropriate with the principle of upholding integrity, uprightness, honesty and fulfill certain occur legislation aimed for improving the accountability for the use of public sector fund. Probity audit is done in real time simultaneously with the goods/services procurement process. This study aims to evaluate the suitability of the implementation of probity audit conducted by BPKP Headquarter as agency that initiated the implementation of probity audit in Indonesia compared with the Probity audit Guidelines for Procurement of Goods/Services as criteria. The results of this study indicate that the implementation of probity audit conducted by BPKP Headquarter has been implemented adequately, but there are activities that do not fit the criteria, especially in the activities of the determination of the scope of the audit, the preparation of working papers and the follow-up monitoring of the audit results. Probity audit merupakan kegiatan penilaian (independen) untuk memastikan bahwa proses pengadaan barang/jasa telah dilaksanakan secara konsisten sesuai dengan prinsip penegakan integritas, kebenaran, kejujuran dan memenuhi ketentuan perundangan yang berlaku yang bertujuan meningkatkan akuntabilitas penggunaan dana sektor publik. Probity audit dilakukan secara real time yaitu bersamaan dengan pelaksanaan pengadaan barang/jasa. Penelitian ini bertujuan untuk melakukan evaluasi kesesuaian pelaksanaan probity audit yang dilakukan oleh BPKP Pusat selaku instansi yang menginisiasi pelaksanaan probity audit di Indonesia dibandingkan dengan kriteria berupa Pedoman Probity audit Pengadaan Barang/Jasa Pemerintah. Hasil dari penelitian ini menunjukkan bahwa pelaksanaan probity audit yang dilakukan oleh BPKP Pusat sudah dilaksanakan secara memadai, namun masih terdapat hal yang belum sesuai dengan kriteria terutama dalam kegiatan penentuan ruang lingkup audit, penyusunan kertas kerja dan pemantauan terhadap tindak lanjut hasil audit.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

scholarly journals Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001372
Author(s):  
Sella Aarrestad Provan ◽  
Brigitte Michelsen ◽  
Joseph Sexton ◽  
Tillmann Uhlig ◽  
Hilde Berner Hammer
Keyword(s):  
Rheumatoid Arthritis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Logistic Regression Models ◽  
Patient Reported ◽  
Biologic Dmard ◽  
Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

Characterization of lung ultrasound imaging in preterm infants with bronchopulmonary dysplasia

2021 ◽  
pp. 1-13
Author(s):  
Ying-Hua Sun ◽  
Lin Yuan ◽  
Yang Du ◽  
Jian-Guo Zhou ◽  
Sam Bill Lin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Imaging Method ◽  
Chronic Lung Diseases ◽  
Pleural Line ◽  
Ultrasound Features

BACKGROUND: Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants. OBJECTIVE: To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD. METHODS: In this prospective cohort study, newborns of less than 37 weeks’ gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated. RESULTS: A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6–1.85) mm, which was thicker than that in the none-to-mild BPD infants (P <  0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P <  0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793–0.965) in sensitivity, 91.3% (95% CI: 0.797–0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544–0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in PPV, and 37.8% in sensitivity (95% CI: 0.251–0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211–0.478) in specificity. CONCLUSIONS: Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.

Squamous Cell Carcinoma of the External Ear: A Review of 75 Cases

1987 ◽  
Vol 97 (3) ◽  
pp. 308-312 ◽  
Author(s):  
William W. Shockley ◽  
Fred J. Stucker
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cancer Control ◽  
Surgical Excision ◽  
External Ear ◽  
Common Cancer ◽  
Node Metastases

Squamous cell carcinoma of the external ear can be a potentially lethal lesion. Although it is the most common cancer involving the pinna, the variables that have the greatest impact on prognosis are still in question. We reviewed 75 cases of squamous cell carcinoma of the external ear to determine patterns of occurrence and treatment failure. Forty patients had adequate follow-up for determination of cancer control rates. Local control was successful with initial treatment in 85% of the cases. The incidence of lymph node metastases was 10%, whereas distant metastasis occurred in only one patient (2.5%). This series differs from others in that most patients were unselected and most of the lesions treated were early (less than 1 cm). The significance of positive margins after surgical excision is also analyzed.

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