Lemmingmay4624

Studies evaluating role of BRCA mutations on the survival outcomes in breast cancer (BC) patients have given confounding results and hence, in this meta-analysis, we assessed the impact of BRCA mutations on survival in BC patients.

Studies comparing survival outcomes of BC patients having BRCA mutations against wildtype BRCA phenotype were retrieved from PubMed, EMBASE, and Cochrane Library. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCCS) were the outcomes. Hazard ratio (HR) with 95% confidence interval (CI) was used for analysis. Subgroup analysis was performed for survival based on triple negative breast cancer (TNBC) and follow-up durations. The meta-analysis was performed as per PRISMA guidelines.

Altogether, 30 articles with 35,972 patients (mean age 45.6years) were included. Patients with BRCA 1 mutation had significantly lower OS (HR [95% CI] 1.2 [1.08, 1.33]; P < 0.001), BRCA 2 mutation had significantly lower DFS (HR [95% CI] 1.35 [1.1, 1.67]; P = 0.0049) and BCSS (HR [95%CI] 1.46 [1.26, 1.7]; P < 0.0001), and TNBC patients with BRCA 1 mutation had significantly poor DFS (HR [95% CI] 1.65 [1.08, 2.54]; P = 0.0216). Based on follow-up duration, the OS in BRCA 1-mutated patients revealed significantly poorer outcomes in studies with ≤ 5years (HR 1.48) and > 5years (HR 1.14) of follow-up. In BRCA 2 -mutated patients, the OS was significantly poorer in studies with > 5years of follow-up (HR 1.39, P < 0.05).

BC patients with BRCA 1 or BRCA 2 mutations had poor survival outcomes and hence screening patients with BC for BRCA mutations might help in strategizing their treatment and improving their survival.

BC patients with BRCA 1 or BRCA 2 mutations had poor survival outcomes and hence screening patients with BC for BRCA mutations might help in strategizing their treatment and improving their survival.Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories "Weakness and Coping Strategies" and "Perspectives of Dyspraxia". "Weakness" included clumsiness, organisation and needing extra time. The participants focused on their "Coping Strategies" that included Ensuring safety, adapted learning preferences and external support. "Perspectives of Dyspraxia" included diagnosis, career choice, stigma, "normalisation" and the "difference view" or "medical deficit" view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a "difference view". They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.The purpose of this study was to evaluate the feasibility and module content of a brief online self-help program for concerned gamblers, i.e., gamblers who perceived a need to change their gambling habits, in the context of a gambling helpline. The program consisted of four modules based on Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT), covering motivation to change, logging gambling behaviors, planning and implementing gambling-free activities, and managing risk situations. Gambling expenditures were also logged in the program, and their development over time were analyzed as longitudinal data using marginalized two-part models. Out of 4655 gamblers recruited via the helpline's webpage, 92% completed content in at least one module, and 23% were active in all four modules. Attrition was in general high, with only 10% retention in the gambling log for longer than 14 days. Gambling expenditures decreased for those who logged them for a shorter time period, whereas it increased for those who logged expenditures for a longer time period. MRTX-1257 order This study shows that it is relatively easy to recruit participants to an online program for concerned gamblers in the context of a gambling helpline. However, since few users logged in to the program more than once, we suggest future online programs to have open modules with all content accessible at once.

Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea.

This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients' clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leadin.

Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry clinicaltrials.gov; Trial registration number NCT03717779; Date of registration October 24, 2018 'Retrospectively registered'; URL of trial registry record clinicaltrials.gov.

Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry clinicaltrials.gov; Trial registration number NCT03717779; Date of registration October 24, 2018 'Retrospectively registered'; URL of trial registry record clinicaltrials.gov.Spondyloarthritis (SpA) has been less well studied than rheumatoid arthritis in North Africa, due to a belief that it is rare and benign in certain populations. The main genetic trait of SpA is its association with human leukocyte antigen (HLA)-B27. The distribution of this allele largely explains the prevalence and severity of SpA. The prevalence of HLA-B27 in the general population of North Africa is estimated at about 4%, and rises to about 60% among people affected with SpA. Coxitis is one of the main features of North African SpA, but the response to treatment is comparable to the literature from the West. The major challenge in North Africa remains accessibility to specialized care and means of early diagnosis. Prevalent infections in North Africa do not seem to be a major obstacle to optimal treatment strategies.Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p  less then  0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.Every year healthcare organizations suffer from several issues, such as unapropriated workflow, thousands of deaths caused by medical errors, counterfeit drugs, and increasing costs. To offer better patient care and increase profit, hospitals could adopt solutions that help remedy these problems. Real-Time Location Systems have the potential to deal with many of these issues, as well as offering means for developing new and intelligent solutions. This kind of system enables tracking assets and people, allowing several improvements. Even though the benefits of such solutions are well known and desired by healthcare providers, their large scale adoption is still distant. In this article, we surveyed Real-Time Location Systems usage in hospitals. While developing this survey, we observed a need for organizing important aspects of healthcare-oriented Real-Time Location Systems. Therefore, we analyzed challenges regarding this topic and a taxonomy proposed. This survey offers researchers and developers ways to comprehend the challenges surrounding this area while proposing a classification of aspects that a Real-Time Location System for healthcare environments must assess for it to be successful.Identifying the signs and symptoms of pathogens, insects, and other biotic and abiotic agents provides valuable information about the absolute and relative impacts of different types of damage across the forest landscape. In the USA, damage collection protocols have been included in various forms since the initiation of state-level forest surveys in the early twentieth century; however, changes in the protocols over time have made it difficult for the data to be used to its full potential. This article outlines differences in protocols across inventory regions, changes in protocols over time, and limitations and utility of the data so that those interested in using the US national forest inventory database will better understand what data are available and how they have been and can be used.

Since the 1990's, afforestation programs in the páramo have been implemented to offset carbon emissions through carbon sequestration, mainly using pine plantations. However, several studies have indicated that after the establishment of pine plantations in grasslands, there is an alteration of carbon pools including a decrease of the soil organic carbon (SOC) pool. The aim of this study is to investigate the impact of the establishment of pine plantations on the carbon stocks in different altitudes of the páramo ecosystem of South Ecuador.

At seven locations within an elevational gradient from 2780 to 3760ma.s.l., we measured and compared carbon stocks of three types of land use natural grassland, grazed páramo, and Pinus patula Schlltdl. & Cham. plantation sites. For a more accurate estimation of pine tree carbon, we developed our own allometric equations. There were significant (p < 0.05) differences between the amounts of carbon stored in the carbon pools aboveground and belowground for the three types of land use.