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Medical Sciences	75%

Selected Abstracts

Reducing the duration of untreated first-episode psychosis , effects on baseline social functioning and quality of life

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2005
I. Melle
Objective:, Long duration of untreated psychosis (DUP) is associated with poorer outcome. The TIPS study demonstrated that DUP can be reduced through early detection (ED). As quality of life (QoL) is associated with DUP it is expected that reduction of DUP leads to better QoL. Method:, Consecutive first-episode patients with a DSM-IV diagnosis of non-organic, non-affective psychosis were included, 281 patients gave informed consent and 263 completed a full evaluation of QoL. Results:, There were no differences in subjective QoL between ED and No-ED groups attributable to reduction in DUP. There were significant bivariate differences in frequency of family and social contacts in favor of the ED group, but multivariate analyses indicated that these differences were based on differences in sample characteristics. Conclusion:, Deterioration in QoL may precede overt symptom formation. Focus on functional loss in ED educational campaigns may identify risk subjects earlier in the course of the disorder. [source]

Urinary tract cancer screening through analysis of urinary red blood cell volume distribution

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2000
Mamoru Wakui
Abstract Background: Hematuria is differentiated between glomerular and urinary tract origins on the basis of urinary red cell morphology. We used this distinction in a program of mass screening for urinary tract cancer to achieve cost-effective and safe hematuria screening. Methods: Of a total of 21 372 adults (mean age 52.3 years; range 20,79 years) participating in a health screening, 912 (4.3%) had a positive dipstick for hematuria and were enrolled in the present study. Urinary red cell volume distribution curves (RDC), the simplest method of assessing urinary red cell morphology, were calculated and subjects were divided into two groups based on their RDC patterns. Group I subjects had a normocytic or mixed pattern and they were immediately investigated for urinary tract malignancy because of the associated risk for urological disease. Group II subjects had a microcytic pattern and, therefore, were judged to be at a low risk of urologic malignancy and were followed up 3 years later without urologic investigations. Results: Among the 38 subjects in group I (4% of all dipstick-positive subjects), one case of bladder cancer was detected. In the remaining 37 patients, 15 cases of benign diseases were discovered. Group II was composed of 869 subjects (96%). The inquiry into their health status conducted 3 years later revealed that 831 (95.6%) were healthy and, of these, 13 had experienced gross hematuria during the period but urological malignancies were ruled out by their urologists, two (0.2%) had died of diseases other than urological cancer and 36 (4.1%) were lost to follow-up. With our method, total costs have been reduced by 93.8% against a conventional setting of a full evaluation for all cases of hematuria. Conclusions: Microcytic hematuria, accounting for 96% of asymptomatic microhematuria cases in the present study, was not associated with a risk for urinary tract malignancy. Compared with conventional hematuria screening with a complete work-up of all cases of hematuria, investigating only subjects with mixed or normocytic RDC patterns was safe and cost effective. [source]

Prevalence of laryngomalacia in children presenting with sleep-disordered breathing,,§¶

THE LARYNGOSCOPE, Issue 8 2010
Mahilravi Thevasagayam FRCS(Ed) FRCS (ORL-HNS)
Abstract Objective: To determine the prevalence of laryngomalacia among children presenting with symptoms of sleep-disordered breathing (SDB). Method: A retrospective observational study was conducted at a tertiary care paediatric hospital. All children presenting with SDB during a 55-month period were investigated using sleep nasopharyngoscopy (SNP). Patients who had laryngomalacia were identified. Patients who did not present primarily with SDB, or were not examined with SNP were excluded. Data for analysis was collected from a prospectively kept surgical database and medical records. This included patients' demographics, symptoms (including symptoms in infancy), diagnoses, SNP findings, overnight pulse oximetry findings, and treatment. Results: We identified 358 patients with documented primary diagnosis of SDB and who had undergone SNP. Fourteen of these also had a documented diagnosis of laryngomalacia, giving a prevalence rate of 3.9%. Three children were syndromic, and one had cerebral palsy in addition to SDB and laryngomalacia. Three children were obese, and three children had gastroesophageal reflux disease. Seven cases (50%) had symptoms of snoring and/or swallowing dysfunction and/or stridor in infancy. Twelve patients had adenotonsillar surgery. In eight cases symptoms resolved completely with adenotonsillar surgery only. In total, six patients had a supraglottoplasty. There were three failures to supraglottoplasty. Conclusion: The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms. Laryngoscope, 2010 [source]

How to Achieve Confidence in Drug Discovery and Development: Managing Risk (from a Reductionist to a Holistic Approach)

CHEMMEDCHEM, Issue 6 2009
Annette Bakker Dr.
Abstract Confidence in mechanism: Creating a more holistic understanding of disease pathophysiology and an early confidence in the mechanism under investigation could help facilitate the selection of not only the most appropriate targets but also the best mechanisms for disease intervention and how to select and optimise the best compounds. Drug target and candidate selection are two of the key decision points within the drug discovery process for which all companies use certain selection criteria to make decisions on which targets to accept into their discovery pipelines and which compounds will pass into development. These steps not only help define the overall productivity of every company but they are also decisions taken without full predictive knowledge of the risks that lie ahead or how best to manage them. In particular, the process of selecting new targets does not normally involve full evaluation of the risk(s) in the mechanism under investigation (the modulation of the target), which may result in an inability to fully connect in,vitro and animal model results to the disease (clinical) setting. The resulting poor progression statistics of many compounds in the clinic is at least partially the result of a lack of understanding of disease pathophysiology. Notably, the lack of efficacy is still a major reason for failure in the clinic.1 Creating a more holistic understanding of disease pathophysiology and an early confidence in the mechanism under investigation could help facilitate the selection of not only the most appropriate targets but also the best mechanisms for disease intervention and how to select and optimise the best compounds. [source]