Non-concordance

OBJECTIVES: The Global Vascular Guidelines (GVG) recommend selecting an endovascular vs open-surgical approach to revascularization for chronic limb-threatening ischemia (CLTI), based on the Global Limb Anatomic Staging System (GLASS) and Wound, Ischemia, and Foot Infection (WIfI) classification systems. We assessed the utility of GVG-recommended strategies in predicting clinical outcomes. METHODS: We conducted a single-center, retrospective review of first-time lower-extremity revascularizations within a comprehensive limb-preservation program from 2010-2018...

It is understood that intervention for venous leg ulcer (VLU) management is more successful the sooner compression is applied, yet healing rates of VLUs are falling and recurrence rates increasing. This literature review seeks to explore the factors affecting patient concordance with compression therapy to manage VLU. Of the literature searched, 14 articles were identified and four themes of reasons for non-concordance emerged: education; pain/discomfort; physical limitations; and psychosocial issues. The reasons for non-concordance are vast and complex; district nurses must explore these reasons to help improve the alarming rates of non-concordance...

OBJECTIVES: In addition to an existing external assessment tool for the ICF-based assessment of the impairment of rehabilitation patients due to environmental and personal contextual factors, a self-assessment tool was developed and used for rehabilitation patients in a psychosomatic rehabilitation clinic. The aim was to compare the assessment of the impairment by contextual factors rated by the external assessment and by the rehabilitation patients on the other hand. Furthermore, the aim of the study was to obtain initial indications of the applicability of the newly designed self-evaluation instrument...

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder characterised by voluntary dietary restriction leading to severe undernutrition. Hypoglycaemia is mostly described through severe case reports and is always evaluated by fasting or post-meal blood glucose, showing nothing about hypoglycaemia's length or duration. The interest of continuous interstitial glucose monitoring (CGM), largely used in diabetes mellitus, has never been evaluated in AN patients. METHOD: Glycaemia cycles in AN patients were assessed using CGM over 5 days and then analysed according to food intake...

Central line-associated bloodstream infection (CLABSI) is among the most serious hospital acquired infections. Therefore, the rapid detection of the causative microorganism is of crucial importance to allow for the appropriate antimicrobial therapy. In the present study, we analyzed the clinical performance of the BioFire FilmArray Blood Culture Identification 2 (BCID2) panel in the identification of 33 microbial species and 10 antibiotic resistance genes in comparison to the VITEK-2 system. A total of 104 blood specimens were included...

Racial disparities in medicine have greatly harmed patients, particularly those of Black race. This review focuses on the persistent paucity of Black physicians in medicine, elucidating the common barriers impeding the Black academic physician workforce. Multiple studies over several decades have established that Black academic faculty members remain persistently underrepresented at all faculty ranks regardless of medical subspecialty at less than 4% overall, far below the 13% Black representation in the United States census...

OBJECTIVE: To determine if an ictal EEG recording as part of pre-surgical evaluation of children with a demarcated single unilateral MRI lesion is indispensable for surgical decision making, we investigated the relationship between interictal/ ictal EEG and seizure semiology with seizure-free outcome. METHODS: Data were obtained retrospectively from consecutive patients (≤ 18 years) undergoing epilepsy surgery with a single unilateral MRI lesion at our institution over a 6-year period...

BACKGROUND AND AIMS: Therapy and prognosis of pancreatic neuroendocrine tumors (PanNENs) are strictly related to Ki-67 index which defines tumor grading (G). The gold standard for the assessment of PanNENs' grading is endoscopic ultrasound-fine needle aspiration/biopsy (EUS-FNA/B). As data on diagnostic accuracy of EUS-FNA/B are heterogenous we aimed to analyze the variability in concordance between EUS (eG) and surgical grading (sG). METHODS: The MEDLINE, SCOPUS, and EMBASE databases were searched until November 2021 identifying studies reporting eG-sG concordance rate...

The mitochondrial serine protease High-temperature requirement A2 (HtrA2) is associated with various diseases including neurodegenerative disorders and cancer. Despite availability of structural details, the reports on HtrA2's mechanistic regulation that varies with the type of activation signals still remain non-concordant. To expound the role of regulatory PDZ (Postsynaptic density-95/Discs large/Zonula occludens-1) domains in multimodal activation of HtrA2, we generated heterotrimeric HtrA2 variants comprising different numbers of PDZs and/or active-site mutations...

OBJECTIVES: To integrate the glucose metabolism measured using [18 F]FDG PET/CT and anatomical features measured using MRI to forecast the post-surgical seizure outcomes of intractable temporal lobe epilepsy. METHODS: This retrospective study enrolled 63 patients with drug-resistant temporal lobe epilepsy. Z-transform of the patients' PET images based on comparison with a database of healthy controls, cortical thickness, and quantitative anisotropy (QA) of the diffusion spectrum imaging concordant/non-concordant with cortical resection was adopted to quantify their predictive values for the post-surgical seizure outcomes...

OBJECTIVE: To assess whether concordance with our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours. STUDY DESIGN: We conducted a retrospective review of 287 IOLs at a single urban, tertiary, academic medical center which took place before we created an evidence-based induction of labor (IOL) algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 or over with a singleton, cephalic pregnancy of 36 6/7 to 42 0/7 weeks' gestation were included...

As a predominately young, physically active, and generally healthy population, service members (SMs) with vestibular dysfunction (VD) following a TBI may not be accurately represented by the current civilian reference ranges on assessments of VD. This study enrolled SMs who were referred for vestibular rehabilitation following a mild/moderate TBI. The participants self-reported VD using the Activities-specific Balance Confidence (ABC) scale and the Dizziness Handicap Inventory (DHI) followed by evaluation of vestibular performance using computerized dynamic posturography sensory organizational test (CDP-SOT)...

There has been a large literature in the last two decades affirming adaptive DNA sequence evolution between species. The main lines of evidence are from (i) the McDonald-Kreitman (MK) test, which compares divergence and polymorphism data, and (ii) the phylogenetic analysis by maximum likelihood (PAML) test, which analyzes multispecies divergence data. Here, we apply these two tests concurrently to genomic data of Drosophila and Arabidopsis . To our surprise, the >100 genes identified by the two tests do not overlap beyond random expectation...

Little is known about the long-term association between high-risk human papillomavirus (hrHPV) test results in women participating in a hrHPV-based cervical cancer screening program. To address this question, we collected data of 2217 women who participated in the POBASCAM hrHPV-based screening trial (enrolment 1999/2002) and also attended the Dutch hrHPV-based screening program between January 2017 and March 2018. Among 143 women who tested hrHPV-positive in 1999/2002, 45 (31.5%) had ≥ CIN2 or hysterectomy before 2017 and 17 (11...

PURPOSE: To report the first experience of our multidisciplinary team with functional imaging using 11 C-methionine positron emission tomography-computed tomography (11 C-methionine PET-CT) co-registered with MRI (Met-PET/MRICR ) in clinical decision making and surgical planning of patients with difficult to treat prolactinoma. METHODS: In eighteen patients with prolactinoma, referred to our tertiary referral centre because of intolerance or resistance for dopamine agonists (DA), Met-PET/MRICR was used to aid decision-making regarding therapy...

AIMS: In heart failure (HF), anaerobic threshold (AT) may be indeterminable but its value held a relevant prognostic role. AT is evaluated joining three methods: V-slope, ventilatory equivalent, and end-tidal methods. The possible non-concordance between the V-slope (met AT) and the other two methods (vent AT) has been highlighted in healthy individuals and named double threshold (DT). METHODS AND RESULTS: We reanalysed 1075 cardiopulmonary exercise tests of HF patients recruited in the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score database...

BACKGROUND: Multidisciplinary team meetings formulate guideline-based individual treatment plans based on patient and disease characteristics and motivate reasons for deviation. Clinical decision trees could support multidisciplinary teams to adhere more accurately to guidelines. Every clinical decision tree is tailored to a specific decision moment in a care pathway and is composed of patient and disease characteristics leading to a guideline recommendation. OBJECTIVE: This study investigated (1) the concordance between multidisciplinary team and clinical decision tree recommendations and (2) the completeness of patient and disease characteristics available during multidisciplinary team meetings to apply clinical decision trees such that it results in a guideline recommendation...

INTRODUCTION: Besides the commonly described gray matter (GM) deficits, there is growing evidence of significant white matter (WM) alterations in patients with alcohol use disorder (AUD). WM changes can be assessed using volumetric and diffusive magnetic resonance imaging methods, such as voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). The aim of the present meta-analysis is to investigate the spatial convergence of the reported findings on WM alterations in AUD. METHODS: Systematic literature search on PubMed and further databases revealed 18 studies eligible for inclusion, entailing a total of 462 AUD patients and 416 healthy controls (up to January 18, 2021)...

PURPOSE: The prevalence of CYP21A2 gene variants and genotype-phenotype correlations are variable among populations. The aim of this study was to characterize CYP21A2 gene variants in adult patients with classical congenital adrenal hyperplasia (CCAH) from southern Poland and to analyze genotype-phenotype correlations. MATERIALS/METHODS: A total of 48 patients (30 women and 18 men) with CCAH were included in the study. Patients were divided into two clinical subgroups, namely, salt-wasting (SW) - 38 patients and simple virilizing (SV) - 10 patients...

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