Barkermccall4309
Despite the increasing use of adjuvant bisphosphonates for early stage breast cancer (EBC), little is known about the patient experience with such treatments. A patient survey was performed to identify current prescribing practices, perceptions around the role of treatment, the impact of treatment on patients' quality of life, and future trial designs.
EBC patients who had either completed or were currently receiving adjuvant bisphosphonates were sent an anonymized survey. The survey collected information on patient and disease characteristics, bisphosphonate scheduling, compliance, and tolerance. Questions also assessed patient interest in trials of de-escalated bisphosphonate therapy.
A total of 255 patients were contacted, with 164 eligible respondents (eligible response rate 164/255, 64.3%). Median patient age was 52years (range 28 to 82years). The majority (111/163, 68.1%) were postmenopausal at the time of diagnosis, 23.3% (38/163) were premenopausal, and 7.4% (12/163) were perimenopausal. Most patients (78%) had received chemotherapy. Zoledronate was the most commonly used bisphosphonate (92%), with the majority receiving treatment every 6months for 3years (73%). While 66% (107/161) of respondents had experienced side effects with treatment, most had, or expected to, complete treatment (154/163, 94%). Provided there was no detriment in breast cancer outcomes, there was strong interest in future studies of de-escalating adjuvant bisphosphonate therapy.
While most patients tolerate their treatment, there is interest in performing trials of de-escalation of these agents.
While most patients tolerate their treatment, there is interest in performing trials of de-escalation of these agents.There is currently a gap in theory for point patterns that lie on the surface of objects, with researchers focusing on patterns that lie in a Euclidean space, typically planar and spatial data. Methodology for planar and spatial data thus relies on Euclidean geometry and is therefore inappropriate for analysis of point patterns observed in non-Euclidean spaces. Recently, there has been extensions to the analysis of point patterns on a sphere, however, many other shapes are left unexplored. This is in part due to the challenge of defining the notion of stationarity for a point process existing on such a space due to the lack of rotational and translational isometries. Here, we construct functional summary statistics for Poisson processes defined on convex shapes in three dimensions. Using the Mapping Theorem, a Poisson process can be transformed from any convex shape to a Poisson process on the unit sphere which has rotational symmetries that allow for functional summary statistics to be constructed. We present the first and second order properties of such summary statistics and demonstrate how they can be used to construct a test statistics to determine whether an observed pattern exhibits complete spatial randomness or spatial preference on the original convex space. click here We compare this test statistic with one constructed from an analogue L -function for inhomogeneous point processes on the sphere. A study of the Type I and II errors of our test statistics are explored through simulations on ellipsoids of varying dimensions.This study examines the direct and indirect impacts of climate change to the tourism sector on the islands of New Providence and adjacent Paradise Island in the Bahamas. The assessment was carried out by conducting a geospatial analysis of tourism establishments at risk using Geographic Information Systems (GIS). We combined the geospatial analysis with publicly available databases to assess the integrated climate-related impacts pertaining to a Small Island Developing State (SIDS) economy. Our study estimated that many tourism properties currently lie in a storm surge zone and the extent of properties at risk increases with a future scenario of a 1 m rise in sea level. While sea level rise (SLR) by itself only threatens a small number of properties, when combined with weak (Category 1), moderate (Category 3) and strong (Category 5) storms the resulting coastal flooding impacts 34%, 69%, and 83% of the tourism infrastructure (hotels and resorts), respectively. In addition to flooding, properties are also susceptible to coastal erosion with 28% of the total hotels and resorts on the two islands being situated within 0-50 m and 60% of the tourism infrastructure within 0-100 m of the coastline. Considering the economic importance of the sector, the potential impacts on the tourism infrastructure will cause significant losses in revenue and employment for the two islands. Furthermore, the majority of the tourism on these islands is beach-based and visitor expenditures will decline due to their vulnerability. These losses will have far-reaching social-economic consequences for the Bahamas. Our findings reveal a need for integrated coastal zone management that incorporates tourism management strategies with adaptation measures to deal with climate change.
Emergency urologic conditions are relatively common, albeit rarely life threatening, there is often a need for prompt and expedient management in order to avert severe or permanent morbidities. This study aimed to evaluate the spectrum of Urologic emergencies and interventions offered in a tertiary hospital in Nigeria.
We retrospectively reviewed the records of patients who were managed in our institution for emergency urologic conditions over a period of 6years (2011-2017). The data extracted included; the demographic information, diagnosis and the treatment offered. The data obtained were analyzed using SPSS version 20. Data were displayed using mean +/- standard deviation and percentages.
The records of a total of 681 patients were retrieved and they span across almost all ages with age range or 2-90years. Urinary retention was the commonest emergency seen, accounting for 51.7% of the patients. Testicular torsion was the next most common (10%), others are bilateral ureteric obstruction and priapism with 5.4% and 5.3% respectively. Suprapubic cystostomy (SPC) was the commonest operative procedure performed (37.6%). The age range for patients with urinary retention was 3-90years, though the peak incidence was in the 7th decade (37.3%). Patients with testicular torsion were young adults between the ages of 11 and 44years.
Urinary retention was the commonest urologic emergency followed by testicular torsion. Though urethral catheterization was successful in most patients urinary retention, making it the commonest procedure. SPC was the commonest emergency operative procedure performed. Other emergencies occurred sporadically.
Urinary retention was the commonest urologic emergency followed by testicular torsion. Though urethral catheterization was successful in most patients urinary retention, making it the commonest procedure. SPC was the commonest emergency operative procedure performed. Other emergencies occurred sporadically.
Endotracheal intubation by direct laryngoscopy is a mainstay of advanced airway management performed both in the prehospital environment and in the Emergency Department. Many factors may affect the quality of view during direct laryngoscopy, one of them being the visual acuity (VA) of the intubator under these demanding conditions. While some individual variation in VA is to be expected in younger populations, VA naturally deteriorates in older populations particularly beyond the age of 40years. This study aimed to describe VA in a younger (
=19) and an older (≥40years of age,
=20) cohort of intubators at baseline and during simulated adult laryngoscopy, and to compare VA between these two age cohorts.
A baseline near VA test was done using a Sloan Early Treatment Diabetic Retinopathy Study (EDTRS) near vision chart at 40cm under ambient indoor light. link2 Participants in both age cohorts were then requested to perform laryngoscopy using an airway simulator at 40cm viewing distance and again at a viewing distance.
Increased age was associated with a significant reduction in VA at baseline and during laryngoscopy, which can be partially compensated for by adjusting viewing distance. Although it is currently unknown to what extent this age-related reduction of VA might negatively affect time to place an endotracheal tube or success of placement under direct vision, older intubators should be aware of this effect and consider specialized corrective eyewear in order to maintain an adequate level of VA.
Increased age was associated with a significant reduction in VA at baseline and during laryngoscopy, which can be partially compensated for by adjusting viewing distance. Although it is currently unknown to what extent this age-related reduction of VA might negatively affect time to place an endotracheal tube or success of placement under direct vision, older intubators should be aware of this effect and consider specialized corrective eyewear in order to maintain an adequate level of VA.
Adverse events (AE) are a common occurrence in healthcare systems; however, the frequency of AEs occurring in South Africa and especially Emergency Departments (ED) is unknown. The aims of this study were to describe the frequency of AEs experienced by Healthcare providers (HCP) and the frequency of formal reporting thereafter over a 12-month period.
A cross sectional descriptive study was performed amongst HCPs at Helen Joseph Hospital and Chris Hani Baragwanath Academic Hospital EDs. The questionnaire incorporated ED relevant AEs using the South African National Procedural Manual for Patient Safety Incident Reporting and Learning.
The questionnaires from 51 doctors and 49 nurses were analysed. All HCPs experienced >10 AEs over 1year. Nurses were 21 times more likely than doctors to report >10 AEs (p<0.001). Twenty four percent of AEs experienced were deemed to be minor, very minor or not adverse.
There are low levels of formal AE reporting, especially amongst doctors, within Johannesburg Academic EM Departments despite large numbers of AEs experienced. There are multiple barriers, which influence these reporting practices. Improved reporting systems are needed to affect a change in the current environment.
There are low levels of formal AE reporting, especially amongst doctors, within Johannesburg Academic EM Departments despite large numbers of AEs experienced. There are multiple barriers, which influence these reporting practices. Improved reporting systems are needed to affect a change in the current environment.
Captopril is an important drug and is used to control hypertensive urgency world-wide. But there is very little data available regarding the evaluation of its outcomes in hypertensive urgency among African patients. This study aimed to evaluate the clinical outcomes of captopril use for hypertensive urgency at a selection of Sudanese emergency centres.
This was a cross-sectional study, conducted between 15 to 30 November 2015. A total of 50 patients, attending a selection of Khartoum State hospital emergency centres, with a clinical diagnosis of hypertensive urgency were approached by investigators for the study. Dose regimen, prognosis, and reduction in systolic and diastolic blood pressure were collected alongside a questionaire to patients regarding their care (compliance, etc.). Data were analysed using the Chi-square Test to compare the mean differences for various results. link3 Differences were considered to be significant at
<0.05.
Around two-thirds (60%) of participants were female, and 28% were non-compliant with treatment.
