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Relevant Impact (relevant + impact)
Selected AbstractsIntravascular lymphoma: a neoplasm of ,homeless' lymphocytes?HEMATOLOGICAL ONCOLOGY, Issue 3 2006Maurilio Ponzoni Abstract Intravascular lymphoma (IVL) is an extremely rare form of non-Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B-cell lineage. IVL is an aggressive and usually disseminated disease that predominantly affects elderly patients, resulting in poor PS, B-symptoms, anemia, and high lactate dehydrogenase serum level. The brain and skin are the most commonly involved sites; nodal disease is rare. Survival after conventional chemotherapy is disappointing, with a relevant impact of diagnostic delay and lethal complications. Notwithstanding these results, IVL limited to the skin (cutaneous variant) is a favorable presentation with distinctive clinical characteristics. Moreover, differences in clinical presentation with Eastern Countries IVL cases, mostly associated with hemophagocytic syndrome, do exist. Intensive combinations containing drugs with higher central nervous system bioavailability are needed in cases with brain involvement; the role of high-dose chemotherapy with autologous stem cell transplantation should be investigated in younger patients with unfavorable features. The present review will discuss the most recent acquisitions related either to diagnosis and immunophenotypic/biologic characteristics as well as clinical/therapeutic issues of IVL. Copyright © 2006 John Wiley & Sons, Ltd. [source] Impact of advanced exercise ECG analysis on cost of coronary artery disease managementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Riccardo Bigi PhD Abstract Background, Conventional analysis of exercise electrocardiogram (EX-ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX-ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD). Methods, A decision-tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity. Results, A clear trend in cost reduction was observed at improving EX-ECG specificity (about 8,8.5 million dollars, corresponding to a 5.6,7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9,13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8,12.5%). Conclusions, A proper improvement in EX-ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses. [source] Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's SexualityTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009Maurizio Serati MD ABSTRACT Introduction., Coital urinary incontinence is a frequently underreported symptom, with a relevant impact on women's sexuality and quality of life. Aim., This article will review the available evidence on incidence, pathophysiology, and treatment of coital urinary incontinence with the attempt to present the current state of the art. Methods., PubMed was searched for reports about coital urinary incontinence that were published from 1970 to 2008, and the most relevant articles were reviewed. Main Outcome Measures., Review on epidemiology, pathophysiology, diagnosis, and treatment of coital incontinence. Results., The incidence of coital incontinence in incontinent women has been reported to range between 10% and 27%. At present, some evidence suggests an association between urinary leakage at penetration and urodynamic stress (USI) incontinence as well as urinary leakage during orgasm and detrusor overactivity (DO). When treatment for these conditions are based upon urodynamic findings, pelvic floor muscle training, surgery, and pharmacotherapy show satisfactory cure rates. Conclusions., Coital urinary incontinence deserves much more attention in clinical practice: women should be specifically interviewed for this disturbance because it has a very negative impact on their sexuality. If a reliable urodynamic diagnosis is made, coital urinary incontinence at penetration can be cured in more than 80% of cases by surgery in the presence of USI. The form of coital incontinence during orgasm is curable by antimuscarinic treatment in about 60% of cases when associated with DO. Serati M, Salvatore S, Uccella S, Nappi RE, and Bolis P. Female urinary incontinence during intercourse: A review on an understudied problem for women's sexuality. J Sex Med 2009;6:40,48. [source] A review of potential methods of determining critical effect size for designing environmental monitoring programs,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2009Kelly R. Munkittrick Abstract The effective design of field studies requires that sample size requirements be estimated for important endpoints before conducting assessments. This a priori calculation of sample size requires initial estimates for the variability of the endpoints of interest, decisions regarding significance levels and the power desired, and identification of an effect size to be detected. Although many programs have called for use of critical effect sizes (CES) in the design of monitoring programs, few attempts have been made to define them. This paper reviews approaches that have been or could be used to set specific CES. The ideal method for setting CES would be to define the level of protection that prevents ecologically relevant impacts and to set a warning level of change that would be more sensitive than that CES level to provide a margin of safety; however, few examples of this approach being applied exist. Program-specific CES could be developed through the use of numbers based on regulatory or detection limits, a number defined through stakeholder negotiation, estimates of the ranges of reference data, or calculation from the distribution of data using frequency plots or multivariate techniques. The CES that have been defined often are consistent with a CES of approximately 25%, or two standard deviations, for many biological or ecological monitoring endpoints, and this value appears to be reasonable for use in a wide variety of monitoring programs and with a wide variety of endpoints. [source] Towards an integrated environmental assessment for wetland and catchment managementTHE GEOGRAPHICAL JOURNAL, Issue 2 2003R Kerry Turner This paper develops a decision support system for evaluation of wetland ecosystem management strategy and examines its, so far partial, application in a case study of an important complex coastal wetland known as the Norfolk and Suffolk Broads, in the east of England, UK. Most managed ecosystems are complex and often poorly understood hierarchically organized systems. Capturing the range of relevant impacts on natural and human systems under different management options will be a formidable challenge. Biodiversity has a hierarchical structure which ranges from the ecosystem and landscape level, through the community level and down to the population and genetic level. There is a need to develop methodologies for the practicable detection of ecosystem change, as well as the evaluation of different ecological functions. What is also required is a set of indicators (environmental, social and economic) which facilitate the detection of change in ecosystems suffering stress and shock and highlight possible drivers of the change process. A hierarchical classification of ecological indicators of sustainability would need to take into account existing interactions between different organization levels, from species to ecosystems. Effects of environmental stress are expressed in different ways at different levels of biological organization and effects at one level can be expected to impact other levels, often in unpredictable ways. The management strategy, evaluation methodologies and indicators adopted should also assess on sustainability grounds whether any given management option is supporting, or reducing, the diversity of functions which are providing stakeholders with the welfare benefits they require. [source] | ||||||||||