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The Cochrane Database of Systematic... Jul 2015Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and child including... (Review)
Review
BACKGROUND
Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and child including preterm birth and small-for-gestational-age babies. Interventions used to prevent RUTI in women who are pregnant can be pharmacological (antibiotics) or non-pharmacological (cranberry products, acupuncture, probiotics and behavioural modifications). So far little is known about the best way to prevent RUTI in pregnant women.
OBJECTIVES
To assess the effects of interventions for preventing RUTI in pregnant women.The primary maternal outcomes were RUTI before birth (variously defined) and preterm birth (before 37 weeks). The primary infant outcomes were small-for-gestational age and total mortality.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Published, unpublished and ongoing randomised controlled trials (RCTs), quasi-RCTs, clustered-randomised trials and abstracts of any intervention (pharmacological and non-pharmacological) for preventing RUTI during pregnancy (compared with another intervention, placebo or with usual care).
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
The review included one trial involving 200 women and was at moderate to high risk of bias.The trial compared a daily dose of nitrofurantoin and close surveillance (regular clinic visit, urine cultures and antibiotics when a positive culture was found) with close surveillance only. No significant differences were found for the primary outcomes: recurrent pyelonephritis (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.31 to 2.53; one study, 167 women), RUTI before birth (RR 0.30, 95% CI 0.06 to 1.38; one study, 167 women), and preterm birth (before 37 weeks) (RR 1.18, 95% CI 0.42 to 3.35; one study, 147 women). The overall quality of evidence for these outcomes as assessed using GRADE was very low. There were no significant differences between the two comparison groups for any of the following secondary outcomes, birthweight less than 2500 (g) (RR 2.03, 95% CI 0.53 to 7.80; one study, 147 infants), birthweight (mean difference (MD) -113.00, 95% CI -327.20 to 101.20; one study, 147 infants), five-minute Apgar score less than seven (RR 2.03, 95% CI 0.19 to 21.87; one study, 147 infants) and miscarriages (RR 3.11, 95% CI 0.33 to 29.29; one study, 167 women). The evidence for these secondary outcomes was also of very low quality. The incidence of asymptomatic bacteriuria (ASB) (at least 10(3) colonies per mL) (secondary outcome), only reported in women with a clinic attendance rate of more than 90% (RR 0.55, 95% CI 0.34 to 0.89; one study, 102 women), was significantly reduced in women who received nitrofurantoin and close surveillance. Data on total mortality and small-for-gestational-age babies were not reported.
AUTHORS' CONCLUSIONS
A daily dose of nitrofurantoin and close surveillance has not been shown to prevent RUTI compared with close surveillance alone. A significant reduction of ASB was found in women with a high clinic attendance rate and who received nitrofurantoin and close surveillance. There was limited reporting of both primary and secondary outcomes for both women and infants. No conclusions can be drawn regarding the optimal intervention to prevent RUTI in women who are pregnant. Randomised controlled trials comparing different pharmacological and non-pharmacological interventions are necessary to investigate potentially effective interventions to prevent RUTI in women who are pregnant.
Topics: Anti-Infective Agents, Urinary; Bacteriuria; Female; Humans; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Urinary Tract Infections; Watchful Waiting
PubMed: 26221993
DOI: 10.1002/14651858.CD009279.pub3 -
Philosophical Transactions. Series A,... Jul 2022One of the challenges of defining emergence is that one observer's prior knowledge may cause a phenomenon to present itself as emergent that to another observer appears...
One of the challenges of defining emergence is that one observer's prior knowledge may cause a phenomenon to present itself as emergent that to another observer appears reducible. By formalizing the act of observing as mutual perturbations between dynamical systems, we demonstrate that the emergence of algorithmic information does depend on the observer's formal knowledge, while being robust vis-a-vis other subjective factors, particularly: the choice of programming language and method of measurement; errors or distortions during the observation; and the informational cost of processing. This is called observer-dependent emergence (ODE). In addition, we demonstrate that the unbounded and rapid increase of emergent algorithmic information implies asymptotically observer-independent emergence (AOIE). Unlike ODE, AOIE is a type of emergence for which emergent phenomena will be considered emergent no matter what formal theory an observer might bring to bear. We demonstrate the existence of an evolutionary model that displays the diachronic variant of AOIE and a network model that displays the holistic variant of AOIE. Our results show that, restricted to the context of finite discrete deterministic dynamical systems, computable systems and irreducible information content measures, AOIE is the strongest form of emergence that formal theories can attain. This article is part of the theme issue 'Emergent phenomena in complex physical and socio-technical systems: from cells to societies'.
Topics: Biological Evolution; Knowledge
PubMed: 35599568
DOI: 10.1098/rsta.2020.0429 -
Canadian Family Physician Medecin de... Nov 1998To define qualitative research in terms of its philosophical roots, the questions it addresses, its methods and analyses, and the type of results it can offer. (Review)
Review
OBJECTIVE
To define qualitative research in terms of its philosophical roots, the questions it addresses, its methods and analyses, and the type of results it can offer.
DATA SOURCES
MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for the years January 1985 to April 1998. The search strategy consisted of "textword" terms that searched in the "title" field of both databases. Qualitative research and evaluation textbooks in health and the social sciences were also used.
QUALITY OF EVIDENCE
The information on qualitative research is based on the most recent and valid evidence from the health and social science fields.
MAIN MESSAGE
Qualitative research seeks to understand and interpret personal experience to explain social phenomena, including those related to health. It can address questions that quantitative research cannot, such as why people do not adhere to a treatment regimen or why a certain health care intervention is successful. It uses many methods of data collection, including participant observation, case studies, and interviews, and numerous approaches to data analysis that range from the quasistatistical to the intuitive and inductive.
CONCLUSIONS
Qualitative research, a form of research completely different from quantitative research, can provide important insights into health-related phenomena and can enrich further research inquiries.
Topics: Data Collection; Data Interpretation, Statistical; Focus Groups; Humans; Interviews as Topic; Logic; Observation; Philosophy, Medical; Reproducibility of Results; Research Design
PubMed: 9839063
DOI: No ID Found -
Asian Journal of Andrology 2015There are no agreed upon guidelines for placing patients on active surveillance (AS). Therefore, there are no absolute criteria for taking patients off AS and when to... (Review)
Review
There are no agreed upon guidelines for placing patients on active surveillance (AS). Therefore, there are no absolute criteria for taking patients off AS and when to recommend treatment. The criteria used to define progression are currently based on prostate specific antigen (PSA) kinetics, biopsy reclassification, and change in clinical stage. Multiple studies have evaluated predictors of progression such as PSA, PSA density (PSAD), prostate volume, core positivity, and visible lesion on multiparametric magnetic resonance imaging (mpMRI). Furthermore, published nomograms designed to predict indolent prostate cancer do not perform well when used to predict progression. Newer biomarkers have also not performed well to predict progression. These findings highlight that clinical and pathologic variables are not enough to identify patients that will progress while on AS. In the future, with the use of imaging, biomarkers, and gene expression assays, we should be better equipped to diagnose/stage prostate cancer and to distinguish between insignificant and significant disease.
Topics: Biomarkers, Tumor; Biopsy; Diffusion Magnetic Resonance Imaging; Disease Management; Disease Progression; Humans; Kallikreins; Magnetic Resonance Imaging; Male; Neoplasm Grading; Nomograms; Organ Size; Prostate-Specific Antigen; Prostatic Neoplasms; Watchful Waiting
PubMed: 26178391
DOI: 10.4103/1008-682X.151396 -
Scandinavian Journal of Work,... Jan 2010This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to... (Review)
Review
OBJECTIVES
This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to the needs of different users.
METHODS
We searched scientific databases and the internet for material from 1965 to September 2008. Methods were included if they were primarily based on the systematic observation of work, the observation target was the human body, and the method was clearly described in the literature. A systematic evaluation procedure was developed to assess concurrent and predictive validity, repeatability, and aspects related to utility. At least two evaluators independently carried out this evaluation.
RESULTS
We identified 30 eligible observational methods. Of these, 19 had been compared with some other method(s), varying from expert evaluation to data obtained from video recordings or through the use of technical instruments. Generally, the observations showed moderate to good agreement with the corresponding assessments made from video recordings; agreement was the best for large-scale body postures and work actions. Postures of wrist and hand as well as trunk rotation seemed to be more difficult to observe correctly. Intra- and inter-observer repeatability were reported for 7 and 17 methods, respectively, and were judged mostly to be good or moderate.
CONCLUSIONS
With training, observers can reach consistent results on clearly visible body postures and work activities. Many observational tools exist, but none evaluated in this study appeared to be generally superior. When selecting a method, users should define their needs and assess how results will influence decision-making.
Topics: Biomechanical Phenomena; Humans; Observation; Occupational Medicine; Posture; Risk Assessment; Task Performance and Analysis; Upper Extremity; Workload
PubMed: 19953213
DOI: 10.5271/sjweh.2876 -
The Canadian Journal of Urology Feb 2017There are numerous standard treatment options for men diagnosed with localized prostate cancer. Multidisciplinary consultation before decision-making is a consensus- and...
INTRODUCTION
There are numerous standard treatment options for men diagnosed with localized prostate cancer. Multidisciplinary consultation before decision-making is a consensus- and quality-based objective in Ontario. With the goals of working together more collaboratively and to provide higher quality information for patients at the time of decision-making, a prostate cancer community partnership consensus (PCPC) panel was formed among six partnering centers in the Greater Toronto Area.
MATERIALS AND METHODS
Five iterative meetings were held among 40 prostate cancer specialists (32 urologists and 8 radiation oncologists) who participate in multidisciplinary clinics. The meetings defined the goals of the partnership as well as the topics and questions the group would address together. Answers to these questions were developed by formal consensus: >= 75% of participants had to agree with wording based on secret ballots to achieve consensus.
RESULTS
All six groups wanted to participate to improve patient care/decision-making. Forty-one questions addressing 30 issues were derived from the literature and the group's collective experience. These issues were cross-tabbed against five management options: active surveillance, radical prostatectomy, low dose rate brachytherapy, high dose rate brachytherapy boost and external beam radiation. Answers common to all modalities were coalesced. Eighty-six issues were subjected to formal consensus. After three rounds of secret ballots, consensus was achieved for the answers to all issues.
CONCLUSIONS
A formal consensus-based partnership between urology and radiation oncology to support newly diagnosed prostate cancer patients was feasible and resulted in a patient information guide which may improve decision-making.
Topics: Brachytherapy; Decision Making; Humans; Interdisciplinary Communication; Male; Patient Education as Topic; Prostatic Neoplasms; Radiation Oncology; Urology; Watchful Waiting
PubMed: 28263130
DOI: No ID Found -
Annals of Surgery Apr 2023To assess the efficacy and safety of intentional watch and wait (W&W) and organ preservation surgery following neoadjuvant chemoradiotherapy plus consolidation CAPEOX in...
Intentional Watch and Wait or Organ Preservation Surgery Following Neoadjuvant Chemoradiotherapy Plus Consolidation CAPEOX for MRI-defined Low-risk Rectal Cancer: Findings From a Prospective Phase 2 Trial (PKUCH-R01 Trial, NCT02860234).
OBJECTIVE
To assess the efficacy and safety of intentional watch and wait (W&W) and organ preservation surgery following neoadjuvant chemoradiotherapy plus consolidation CAPEOX in magnetic resonance imaging (MRI)-defined low-risk rectal cancer.
BACKGROUND
Clinical T2/early T3 rectal cancers can achieve high yield pathological complete response (ypCR) rates after chemoradiotherapy; thus, an intentional W&W or organ preservation strategy for good clinical responders in these subgroups can be further tested.
METHODS
This prospective, single-arm, phase 2 trial enrolled patients with low-risk MRI prestaged rectal cancers, who concurrently received chemoradiation, followed by four 3-weekly cycles of CAPEOX regimen. Following reassessment, clinical complete response (cCR) or near-cCR patients underwent W&W/organ preservation surgery; the primary endpoint was a 3-year organ preservation rate.
RESULTS
Of the 64 participants, 58 completed treatment, with 6.4% and 33.9% grade 3 to 4 toxicities in the radiotherapy and consolidation CAPEOX phases, respectively, during a median 39.5-month follow-up. Initial cCR, and non-cCR occurred in 33, 13, and 18 patients, respectively. Of the 31 cCR and 7 near-cCR cases managed by W&W, local regrowth occurred in 7; of these, 6 received salvage surgery. The estimated 2-year local regrowth rates were 12.9% [95% confidence interval (CI): 1.1%-24.7%] in cCR and 42.9% (95% CI: 6.2%-79.6%) in near-cCR cases, respectively. Eight patients received local excision, including 2 with regrowth salvage. Lung metastases occurred in 3 patients and multiple metastasis occurred in 1 patient; no local recurrence occurred. The estimated 3-year organ preservation rate was 67.2% (95% CI: 55.6%-78.8%). The estimated 3-year cancer-specific survival, non-regrowth disease-free survival, and stoma-free survival were 96.6% (95% CI: 92.1%-100%), 92.2% (95% CI: 85.5%-98.9%), and 82.7% (95% CI: 73.5%-91.9%), respectively.
CONCLUSIONS
Chemoradiotherapy plus consolidation CAPEOX for MRI-defined low-risk rectal cancer can lead to high rates of organ preservation through intentional W&W or local excision. The oncologic safety of this strategy should be further tested.
Topics: Humans; Neoadjuvant Therapy; Organ Preservation; Prospective Studies; Rectal Neoplasms; Chemoradiotherapy; Magnetic Resonance Imaging; Watchful Waiting; Neoplasm Recurrence, Local; Treatment Outcome
PubMed: 35766394
DOI: 10.1097/SLA.0000000000005507 -
Ultrasound in Obstetrics & Gynecology :... Nov 2023To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management....
OBJECTIVES
To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes.
METHODS
We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date.
RESULTS
Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)).
CONCLUSION
FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Humans; Pregnancy Outcome; Cesarean Section; Pre-Eclampsia; Fetal Growth Retardation; Watchful Waiting; Metformin
PubMed: 37289938
DOI: 10.1002/uog.26282 -
European Urology Aug 2013Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS)... (Review)
Review
CONTEXT
Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS) strategies can lead to treatment delay, an increase in the interval between the diagnosis and treatment of prostate cancer (PCa).
OBJECTIVE
To review and summarise the current literature on the impact of treatment delay on PCa oncologic outcomes.
EVIDENCE ACQUISITION
A comprehensive search of PubMed and Embase databases until 30 September 2012 was performed. Studies comparing pathologic, biochemical recurrence (BCR), and mortality outcomes between patients receiving direct and delayed curative treatment were included. Studies presenting single-arm results following AS were excluded.
EVIDENCE SYNTHESIS
Seventeen studies were included: 13 on radical prostatectomy, 3 on radiation therapy, and 1 combined both. A total of 34 517 PCa patients receiving radical local therapy between 1981 and 2009 were described. Some studies included low-risk PCa only; others included a wider spectrum of disease. Four studies found a significant effect of treatment delay on outcomes in multivariate analysis. Two included low-risk patients only, but it was unknown whether AS was applied or repeat biopsy triggered active therapy during AS. The two other studies found a negative effect on BCR rates of 2.5-9 mo delay in higher risk patients (respectively defined as any with T ≥ 2b, prostate-specific antigen >10, Gleason score >6, >34-50% positive cores; or D'Amico intermediate risk-group). All studies were retrospective and nonrandomised. Reasons for delay were not always clear, and time-to-event analyses may be subject to bias.
CONCLUSIONS
Treatment delay of several months or even years does not appear to affect outcomes of men with low-risk PCa. Limited data suggest treatment delay may have an impact on men with non-low-risk PCa. Most AS protocols suggest a confirmatory biopsy to avoid delaying treatment in those who harbour higher risk disease that was initially misclassified.
Topics: Early Detection of Cancer; Humans; Male; Multivariate Analysis; Patient Selection; Predictive Value of Tests; Prostatectomy; Prostatic Neoplasms; Radiotherapy, Adjuvant; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; Watchful Waiting
PubMed: 23453419
DOI: 10.1016/j.eururo.2013.02.024 -
Physics of Life Reviews Mar 2018Is it possible to perceive others' mental states? Are mental states visible in others' behavior? In contrast to the traditional view that mental states are hidden and... (Review)
Review
Is it possible to perceive others' mental states? Are mental states visible in others' behavior? In contrast to the traditional view that mental states are hidden and not directly accessible to perception, in recent years a phenomenologically-motivated account of social cognition has emerged: direct social perception. However, despite numerous published articles that both defend and critique direct perception, researchers have made little progress in articulating the conditions under which direct perception of others' mental states is possible. This paper proposes an empirically anchored approach to the observability of others' mentality - not just in the weak sense of discussing relevant empirical evidence for and against the phenomenon of interest, but also, and more specifically, in the stronger sense of identifying an experimental strategy for measuring the observability of mental states and articulating the conditions under which mental states are observable. We conclude this article by reframing the problem of direct perception in terms of establishing a definable and measurable relationship between movement features and perceived mental states.
Topics: Cognition; Humans; Intention; Mental Processes; Perception
PubMed: 29066076
DOI: 10.1016/j.plrev.2017.10.002