RESUMEN
BACKGROUND: Barrett's esophagus is strongly associated with esophageal adenocarcinoma. Considering costs and risks associated with invasive surveillance endoscopies better methods of risk stratification are required to assist decision-making and move toward more personalised tailoring of Barrett's surveillance. METHODS: A Bayesian network was created by synthesizing data from published studies analysing risk factors for developing adenocarcinoma in Barrett's oesophagus through a two-stage weighting process. RESULTS: Data was synthesized from 114 studies (n = 394,827) to create the Bayesian network, which was validated against a prospectively maintained institutional database (n = 571). Version 1 contained 10 variables (dysplasia, gender, age, Barrett's segment length, statin use, proton pump inhibitor use, BMI, smoking, aspirin and NSAID use) and achieved AUC of 0.61. Version 2 contained 4 variables with the strongest evidence of association with the development of adenocarcinoma in Barrett's (dysplasia, gender, age, Barrett's segment length) and achieved an AUC 0.90. CONCLUSION: This Bayesian network is unique in the way it utilizes published data to translate the existing empirical evidence surrounding the risk of developing adenocarcinoma in Barrett's esophagus to make personalized risk predictions. Further work is required but this tool marks a vital step towards delivering a more personalized approach to Barrett's surveillance.
Asunto(s)
Adenocarcinoma/diagnóstico , Esófago de Barrett/diagnóstico , Neoplasias Esofágicas/diagnóstico , Pronóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/etiología , Adenocarcinoma/patología , Adulto , Anciano , Esófago de Barrett/complicaciones , Esófago de Barrett/epidemiología , Esófago de Barrett/patología , Teorema de Bayes , Progresión de la Enfermedad , Endoscopía/métodos , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
The presence of a cerebrospinal fluid (CSF) shunt was previously considered a contra-indication to laparoscopic surgery, however, case reports appeared that describe laparoscopic surgery proceeding with no adverse outcomes in such patients. The majority of these reports relate to laparoscopic cholecystectomy. Here we present what we believe to be only the second report of a patient undergoing laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt. With this case we aim to add to the evidence that more major laparoscopic procedures can be performed safely in the presence of CSF shunts and with a brief review of the current evidence, have suggested appropriate monitoring and precautionary measures for approaching these procedures.
Asunto(s)
Derivaciones del Líquido Cefalorraquídeo , Laparoscopía , Peritoneo/cirugía , Médula Espinal/cirugía , Adulto , Femenino , Humanos , Vértebras LumbaresRESUMEN
BACKGROUND: Doctors are at an increased risk of suicide compared with the general population, and there is a current lack of formal education on suicide prevention for peers and colleagues. This educational project aimed to increase suicide awareness for medical students through simulation. METHODS: A simulation scenario was designed centred around a junior doctor (a qualified doctor who has not yet completed specialist postgraduate training) disclosing thoughts of suicide. The scenario and debriefing were designed using learning objectives and constructive alignment theory. Senior medical students participated in the scenario, which was followed by a facilitated debriefing and the provision of a framework for discussing suicide with a colleague. Quantitative and qualitative student feedback was collected and analysed. A simulation scenario was designed centred around a junior doctor colleague found distressed at work and disclosing thoughts of suicide RESULTS: A total of 35 students participated in the simulation over six sessions. Feedback indicated that students felt this subject was important and that the learning objectives had been achieved. DISCUSSION: This simulation scenario focusing on suicide awareness for senior medical students has provided opportunity for open discussion and reflection on the topic and has increased the awareness and understanding of suicidality in colleagues. This is one step in the direction of preventing further deaths by suicide in health professionals.
Asunto(s)
Educación Médica/métodos , Inhabilitación Médica/psicología , Prevención del Suicidio , Adulto , Femenino , Retroalimentación Formativa , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Simulación de Paciente , Estudiantes de Medicina/psicología , Adulto JovenRESUMEN
INTRODUCTION: Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road. METHODS: A convenience sample of consecutive EMRS missions covering a period of 18 months from May 2013 to January 2015 was taken. These missions were matched with the ambulance service information on geographical location of the incident. In order to assess the appropriateness of tasking, interventions undertaken on each mission were analysed and divided into two subcategories: 'critical care interventions' and 'advanced medical interventions'. A tasking was deemed appropriate if it included either category of intervention or if a patient was pronounced life extinct at the scene. RESULTS: A total of 1279 primary missions were undertaken during the study period. Of these, 493 primary missions met the inclusion criteria and generated complete location data. The median distance to scene was calculated as 5.6 miles for land responses and 34.2 miles for air responses. Overall, critical care interventions were performed on 17% (84/493) of patients. A further 21% (102/493) of patients had an advanced medical intervention. Including those patients for whom life was pronounced extinct on scene by the EMRS team, a total of 42% (206/493) taskings were appropriate. DISCUSSION: Overall, our data show a wide geographical spread of tasking for our service, which is in keeping with other suburban/rural models of prehospital care. Tasking accuracy is also comparable to the accuracy shown by other similar services.