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Ultrasound in Obstetrics & Gynecology :... Jun 2018To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE).
METHODS
MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random-effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver-operating characteristics (ROC) curves and obtain optimal cut-offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut-offs to obtain sensitivity and specificity values and generate summary ROC curves.
RESULTS
A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2-76.1%) and specificity (73.2%; 95% CI, 66.9-78.7%) for the prediction of early-onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61-0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6-61.0%), a similar specificity (73.2%; 95% CI, 66.9-78.7%) and a lower AUC (0.58; CI, 0.52-0.65) for the prediction of late-onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58-0.77) for early-onset PE and 0.57 (95% CI, 0.51-0.63) for late-onset disease.
CONCLUSIONS
Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a 'placental disorder'. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Female; Humans; Ophthalmic Artery; Pre-Eclampsia; Pregnancy; ROC Curve; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 29330892
DOI: 10.1002/uog.19002 -
Therapeutics and Clinical Risk... 2023For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study. (Review)
Review
OBJECTIVE
For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study.
METHODS
A systematic computer-based search was performed for relevant articles focusing on the ESR diagnosis of pediatric osteomyelitis in PubMed, Embase, and the Cochrane Library with an inclusion criteria: 1) the diagnostic utility of ESR for diagnosing osteomyelitis patients under the age of 18;2) two-by-two contingency tables can be obtained. Case reports, review papers, and animal experiments were excluded.
RESULTS
The diagnostic meta-analysis included 8 studies involving 348 children with osteomyelitis, all of whom were tested for ESR. Diagnostic meta-analysis revealed a sensitivity and specificity of 0.90, 95% confidence interval (CI) (0.86-0.93), and 0.50 (95% CI,0.47-0.54) for ESR in pediatric osteomyelitis diagnosis, respectively. The positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 1.38,(95% CI,1.08-1.78), 0.46, (95% CI,0.26-0.73), and 3.20, (95% CI,1.33-7.69), respectively. The area under the curve (AUC) was determined to be 0.80 based on the summary receiver operating characteristic curve (SROC).
CONCLUSION
The literature on the use of ESR in pediatric osteomyelitis diagnosis was thoroughly reviewed in this study. It was also found that ESR may be useful as a biomarker for pediatric osteomyelitis diagnosis. Due to its low specificity, it should be used in combination with other markers such as C-reactive protein, neutrophil percentage, and white blood cell count.
PubMed: 38089965
DOI: 10.2147/TCRM.S440996 -
Clinical Trials (London, England) Apr 2020Dose-escalation studies are essential in the early stages of developing novel treatments, when the aim is to find a safe dose for administration in humans. Despite their...
BACKGROUND/AIMS
Dose-escalation studies are essential in the early stages of developing novel treatments, when the aim is to find a safe dose for administration in humans. Despite their great importance, many dose-escalation studies use study designs based on heuristic algorithms with well-documented drawbacks. Bayesian decision procedures provide a design alternative that is conceptually simple and methodologically sound, but very rarely used in practice, at least in part due to their perceived statistical complexity. There are currently very few easily accessible software implementations that would facilitate their application.
METHODS
We have created MoDEsT, a free and easy-to-use web application for designing and conducting single-agent dose-escalation studies with a binary toxicity endpoint, where the objective is to estimate the maximum tolerated dose. MoDEsT uses a well-established Bayesian decision procedure based on logistic regression. The software has a user-friendly point-and-click interface, makes changes visible in real time, and automatically generates a range of graphs, tables, and reports. It is aimed at clinicians as well as statisticians with limited expertise in model-based dose-escalation designs, and does not require any statistical programming skills to evaluate the operating characteristics of, or implement, the Bayesian dose-escalation design.
RESULTS
MoDEsT comes in two parts: a 'Design' module to explore design options and simulate their operating characteristics, and a 'Conduct' module to guide the dose-finding process throughout the study. We illustrate the practical use of both modules with data from a real phase I study in terminal cancer.
CONCLUSION
Enabling both methodologists and clinicians to understand and apply model-based study designs with ease is a key factor towards their routine use in early-phase studies. We hope that MoDEsT will enable incorporation of Bayesian decision procedures for dose escalation at the earliest stage of clinical trial design, thus increasing their use in early-phase trials.
Topics: Algorithms; Antioxidants; Bayes Theorem; Clinical Trials, Phase I as Topic; Dose-Response Relationship, Drug; Humans; Logistic Models; Maximum Tolerated Dose; Neoplasms; Quercetin; Research Design; Software; User-Computer Interface
PubMed: 31856600
DOI: 10.1177/1740774519890146 -
HardwareX Sep 2023Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these...
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
PubMed: 37680492
DOI: 10.1016/j.ohx.2023.e00472 -
Frontiers in Surgery 2021The operating theater is recognized to involve a high frequency of occupational blood and body fluid contacts. This study aimed to visualize the production of blood...
The operating theater is recognized to involve a high frequency of occupational blood and body fluid contacts. This study aimed to visualize the production of blood and body fluid airborne particles by surgical procedures and to investigate risks of microbial contamination of the conjunctival membranes of surgical staff during orthopedic operations. Two physicians simulated total knee arthroplasty (TKA) and total hip arthroplasty (THA) in a bio-clean theater using model bones. The generation and behaviors of airborne particles were filmed using a fine particle visualization system, and numbers of airborne particles per 2.83 L of air were counted at the height of the operating and instrument tables. Each action was repeated five times, and particle counts were evaluated statistically. Numerous airborne particles were dispersed to higher and wider areas while "cutting bones in TKA" and "striking and driving the cup component on the pelvic bone in THA" compared to other surgical procedures. The highest particle counts were detected while "cutting bones in TKA" under unidirectional laminar air flow. These results provide a clearer image of the dispersion and distribution of airborne particles and identified higher-risk surgical procedures for microbial contamination of the conjunctival membranes. Surgical staff including surgeons, nurses, anesthesiologists, and visitors, should pay attention to and take measures against occupational infection particularly in high-risk surgical situations.
PubMed: 34881285
DOI: 10.3389/fsurg.2021.754785 -
Environmental Health Perspectives Dec 1978The current status of landfill disposal of hazardous wastes in the United States is indicated by presenting descriptions of six operating landfills. These landfills...
The current status of landfill disposal of hazardous wastes in the United States is indicated by presenting descriptions of six operating landfills. These landfills illustrate the variety of techniques that exist in landfill disposal of hazardous wastes. Although some landfills more effectively isolate hazardous waste than others, all landfills must deal with the following problems. Leachate from hazardous waste landfills is generally highly polluted. Most landfills attempt to contain leachate at the site and prevent its discharge to surface or groundwaters. To retain leachate within a disposal area, subsurface barriers of materials such as concrete, asphalt, butyl rubber, vinyl, and clay are used. It is difficult to assure that these materials can seal a landfill indefinitely. When a subsurface barrier fails, the leachate enters the groundwater in a concentrated, narrow band which may bypass monitoring wells. Once a subsurface barrier has failed, repairs are time-consuming and costly, since the waste above the repair site may have to be removed. The central problem in landfill disposal is leachate control. Recent emphasis has been on developing subsurface barriers to contain the wastes and any leachate. Future emphasis should also be on techniques for removing water from hazardous wastes before they are placed in landfills, and on methods for preventing contact of the wastes with water during and after disposal operations. When leachate is eliminated, the problems of monitoring, and subsurface barrier failure and repair can be addressed, and a waste can be effectively isolated.A surface seal landfill design is recommended for maintaining the dry state of solid hazardous wastes and for controlling leachate. Any impervious liner is utilized over the top of the landfill to prevent surface water from seeping into the waste. The surface barrier is also the site where monitoring and maintenance activities are focused. Barrier failure can be detected by visual inspections and any repairs can be made without disturbing the waste. The surface seal landfill does not employ a subsurface barrier. The surface seal landfill successfully addresses each of the four environmental problems listed above, provided that this landfill design is utilized for dry wastes only and is located at a site which provides protection from groundwater and temporary perched water tables.
Topics: Chemical Industry; Chromium; Environmental Pollution; Refuse Disposal; Soil; United States; Waste Disposal, Fluid
PubMed: 738247
DOI: 10.1289/ehp.7827309 -
Journal of Education and Health... 2023The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the...
BACKGROUND
The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the DREEM1 model is used. The present study was conducted to evaluate the clinical educational environment based on the DREEM model from the viewpoint of the OR2 students of the Lorestan University of Medical Sciences.
MATERIALS AND METHODS
The present descriptive-analytical cross-sectional study evaluated the viewpoint of 118 students of operation room (OR) technology using the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the hospitals affiliated with the Lorestan University of Medical Sciences during the second semester of 2020. The DREEM questionnaire has 50 statements and is divided into five sections, which are rated on a five-point Likert scale (0-4). The data were analyzed using frequency distribution tables, mean and standard deviation indices, Mann-Whitney and Kruskal-Wallis tests. Data analysis was conducted using IBM SPSS Statistics 22.0. IBM Corp.; 2013. and the level of significance was set at 0.05.
RESULTS
The total perception of the students of the clinical educational environment was good and excellent in 73.8% of the cases and of the subscales was also good (50.8%-63.2%). There was a significant relation between the total score of students' perception of the clinical educational environment and age ( = 5.618, < 0.001), semester (χ= 43.929, df = 3, < 0.001), internship hospital (χ= 12.948, df = 6, = 0.044) and also the mean score of the subscales ( < 0.001). As the GPA3 and interest in the major increased, the mean score of total perception and its subscales also increased except for perception from the educators ( < 0.05).
CONCLUSION
According to the results, the studied students had a positive perception of the clinical educational environment. It is recommended that the scientific foundation of the educators, the physical facilities of the operating rooms, and social communication should be strengthened to improve the care, treatment, and educational services. It will be useful to use the results to improve the accreditation level of medical centers.
PubMed: 37546016
DOI: 10.4103/jehp.jehp_1861_22 -
BMC Pregnancy and Childbirth Aug 2008Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert... (Review)
Review
BACKGROUND
Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews.
METHOD
We performed extensive search in MEDLINE (1951-2004), EMBASE (1974-2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 x 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios.
DISCUSSION
This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia.
Topics: Data Collection; Female; Humans; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Prenatal Diagnosis; Research; Research Design
PubMed: 18694494
DOI: 10.1186/1471-2393-8-38 -
Allergy & Rhinology (Providence, R.I.) Oct 2017Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated...
BACKGROUND
Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated otolaryngologic procedures. Key elements of an ergonomic operating environment include the height of operating tables and surgical chairs. Surgeons benefit from proper support and positioning to prevent musculoskeletal injuries and reduce occupational risk.
OBJECTIVE
The purpose of this study was to evaluate operating table and surgical seat heights, and determine whether adjustments can be made for various surgeon physiques.
METHODS
Operating tables and surgical seat dimensions were measured at local hospitals, and the information was complemented by an online search of other models.
RESULTS
Five unique operating tables and five unique surgical stools were identified, both in the local hospital and in a search on the Internet. Of available tables, the greatest range was 63.5-124.5 cm, which reaches above the maximum suggested working height of 76.2 cm. The surgical stool with the widest range was adjustable from heights of 50.8-72.4 cm. This combination of operative table and surgical stool provided the greatest range of heights.
CONCLUSION
Of the available tables and stools measured, the combination of surgical table with a range of 63.5-125.7 cm and surgical stool with a range of 50.8-72.4 cm provided the greatest versatility for diverse physician heights. In ergonomic terms, this combination may reduce physical fatigue and create a potentially safer working environment for seated surgeons.
PubMed: 29070277
DOI: 10.2500/ar.2017.8.0215 -
BJS Open Feb 2018Estimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors... (Review)
Review
BACKGROUND
Estimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.
METHODS
A meta-analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.
RESULTS
A total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19-9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.
CONCLUSION
None of the established criteria safely distinguishes malignant from non-malignant lesions.
PubMed: 29951625
DOI: 10.1002/bjs5.38