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Sydney, Australia

Mobbs E.J.,University of Sydney | Mobbs G.A.,Westmead Hospital | Mobbs A.E.D.,Statistician
Acta Paediatrica, International Journal of Paediatrics | Year: 2016

Instinctive behaviours have evolved favouring the mother-infant dyad based on fundamental processes of neurological development, including oral tactile imprinting and latchment. Latchment is the first stage of emotional development based on the successful achievement of biological imprinting. The mechanisms underpinning imprinting are identified and the evolutionary benefits discussed. Conclusion It is proposed that the oral tactile imprint to the breast is a keystone for optimal latchment and breastfeeding, promoting evolutionary success. ©2015 The Authors. Acta Pædiatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Pædiatrica.

Cummings J.L.,Cleveland Clinic | Ihl R.,Heinrich Heine University Dusseldorf | Herrschaft H.,University of Cologne | Hoerr R.,Willmar Schwabe GmbH and Co. KG | Tribanek M.,Statistician
International Psychogeriatrics | Year: 2013

ABSTRACT Background: The Neuropsychiatric Inventory (NPI) is widely used to assess psychopathology in dementia. The scoring involves ratings of frequency and severity, as well as the calculation of a composite score. It was suggested recently that, due to lower variance, the frequency score might be more sensitive to detect treatment-related change and to discriminate active treatment from placebo than the composite score, particularly in milder forms of the disease. Methods: Based on data from three randomized controlled trials in patients with mild to moderate dementia, standardized changes were calculated for both frequency and composite scores for two strata of disease severity. The two strata were formed by dichotomizing the sample along the median score of the short cognitive performance test (SKT) battery. Results: Across all studies and for both severity strata, standardized changes in frequency scores were not consistently larger than those in composite scores and both scores discriminated active treatment from placebo at similar probabilities for type-1 error. Conclusion: Our findings do not support the notion that there is a difference between frequency score and composite score with respect to their sensitivity to treatment-related change. © International Psychogeriatric Association 2012.

Lucka T.C.,Charite - Medical University of Berlin | Pathirana D.,Charite - Medical University of Berlin | Sammain A.,Charite - Medical University of Berlin | Bachmann F.,Charite - Medical University of Berlin | And 6 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2012

Background Despite the chronicity of psoriasis, most systematic reviews focus on short-term treatment. Methods The systematic search strategy and results from the German Psoriasis Guidelines were adapted. To update the data a literature search in Medline, Embase and the Cochrane Library was conducted. The proportion of participants achieving ≤75% decrease in Psoriasis Area and Severity Index (PASI) as well as Dermatology Life Quality Index (DLQI) reduction at different time points were assessed. Trials were summarized with respect to time periods and study designs. Suitable trials were included in a meta-analysis. Particular attention was paid to statistical approaches of handling dropouts. Results A total of 33 articles including 27 trials totaling 6575 patients with active treatment were included in the systematic review. Seven randomized controlled trials were eligible for the meta-analysis. Over a 24 week treatment period infliximab [risk difference (RD) 78%, 95% confidence interval (CI) 72-83%] and ustekinumab 90 mg every 12 weeks (RD 77%, 95% CI 71-83%) were the most efficacious treatments. Adalimumab (RD: 60%, 95% CI 45-74%) showed results within the range of different etanercept dosages (etanercept 50 mg once weekly: RD 62%, 95% CI, 52-72%), (etanercept 25 mg twice weekly: RD 45%, 95% CI 34-56%), (etanercept 50 mg twice weekly: RD 56%, 95% CI 49-62%) and (etanercept 50 mg twice weekly until week 12, then 25 mg twice weekly: RD 50%, 95% CI 42-57%). After 24 weeks a decrease in efficacy for inflximab, adalimumab and etanercept was observed. Conclusions More sufficient data is required to draw reliable conclusions in extended long-term treatment and head-to-head comparisons are necessary. © 2012 European Academy of Dermatology and Venereology.

Cole E.,McMaster University | Hopman W.,Statistician | Kawakami J.,Queens University
Journal of the Canadian Urological Association | Year: 2011

Objectives: Wait times in Canada are increasingly being monitored as an indicator of quality health care delivery. We created a higher resolution picture of the wait experienced by urological surgery patients beginning with the initial referral. In doing so, we hoped to (a) identify potential bottlenecks and common delays at our centre, and (b) identify predictors of wait time. Methods: The charts of 322 patients undergoing surgery from November 2007 to March 2008 were reviewed and specific dates, patient factors and delays were recorded. The data were used to detail the patient's wait and to determine the patient factors which were predictive of wait time. Results: The mean time from decision to operate to the day of operation was 75.87 days for all patients. This number accounts for 53% of the wait time, while the time from referral to decision to operate is 47%. Predictors of a decreased wait time include cancer cases, younger age, urgency score, repeat patients and female gender in multivariate analysis. Delays were experienced by 16.8% of patients; most common delays were operating room cancellations/ time constraints, patients requiring further optimization and delays in referral (4.7%, 3.4% and 3.1%, respectively). Conclusions: The waiting process is complex; the actual waiting time that a patient must endure is much longer than the wait times traditionally recorded and reported by hospitals. As strategies are implemented to decrease wait times, it will become increasingly important to monitor the entire wait time from referral to operation and to ensure that changes are being made that truly decrease wait times and not simply shift where and when the patient waits. © 2011 Canadian Urological Association.

Murin J.,Comenius University | Naditch-BrUle L.,Sanofi S.A. | Brette S.,Statistician | Chiang C.-E.,Taipei Veterans General Hospital | And 3 more authors.
PLoS ONE | Year: 2014

Background: Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. Methods and Results: Data from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N = 4869) and nonpermanent atrial fibrillation (N = 5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score &≥2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N = 2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke. Conclusion: Permanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart failure, adequate rate control is an important target for improving the management of permanent atrial fibrillation patients. © 2014 Murin et al.

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