Medicine
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Clinical practice guidelines (CPGs) play an important role in health care. The guideline development process should be precise and rigorous to ensure that the results are reproducible and not vague. To determine the quality of guidelines, the Appraisal of Guidelines and Research and Evaluation (AGREE) instrument was developed and introduced. ⋯ Many other methodological disadvantages were identified. In the future, pancreatic cancer CPGs should base on the best available evidence rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision making in this field.
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Recent studies show that NOTCH3 is involved in the glioma development and it is also a prognostic factor for glioma patients. However, the gene polymorphism of NOTCH3 in gliomas prognosis remains unknown. A total of 266 patients were enrolled into this study. ⋯ We found that the 684G>A polymorphism affects the tumor NOTCH3 expression level and is closely associated with a higher tumor grade, poorer tumor differentiation, and karnofsky performance score in these glioma patients. More importantly, the 684G>A polymorphism is significantly associated with the prognosis of these patients regardless of their treatment manner. Our study indicates that the NOTCH3 gene 684G>A polymorphism may be used as a prognosis marker for gliomas.
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Acute care of stroke victims largely relies on the rapid identification and timely clinical and radiological assessment. We evaluated the effect of the number of patient companions on the efficiency of the diagnostic process in the emergency department (ED). Consecutive stroke patients admitted to the ED between August 2011 and October 2012 were evaluated. ⋯ It was found to be independently associated with shorter time to CT scanning adjusted for the stroke severity, sex, and speech disturbances (no companions as a reference group, relative risks 0.82, 0.73, and 0.70 for 1, 2, and ≥3 companions, respectively, all P < 0.001). Similarly, number of companions was associated with higher rates of stroke recognition by the triage nurse adjusted for covariates (odds ratios 2.11, 2.62, and 4.11, respectively, all P < 0.05). Our findings suggest that the family members and other companions could serve as facilitators of faster and more effective ED management of stroke patients, possibly improving their outcome.
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Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. ⋯ In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.
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Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. ⋯ ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.