The Waitemata District Health Board (Waitemata DHB) is a district health board with the focus on providing healthcare to people living in the area that used to be covered by North Shore city, Rodney District, and Waitakere City in New Zealand.
BACKGROUND:The number of people losing their independence is increasing as the population ages. Sarcopenia, low muscle strength and mass, and hand grip strength (HGS) are known to predict reduced independence in people in their seventies. This paper investigates these relationships in New Zealand octogenarians, including Indigenous Māori. METHODS:This study used data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), which recruited 421 Māori and 516 non-Māori in 2010-2011. The Nottingham Extended Activities of Daily Living (NEADL) scale measured independence. Participants were classified by ethnicity (Māori or non-Māori) and sex into high, medium or low independence trajectory groups based on their six annual NEADL scores using group-based trajectory modelling. The associations between HGS or probable sarcopenia (a binary measure of HGS) and independence trajectory group (high, medium, low) were tested separately by ethnicity and sex in multinomial logistic regression models. RESULTS:Hand grip strength was inversely associated with low (versus medium) independence trajectory among Māori women, non-Māori women and non-Māori men, adjusting for age, comorbidities and cognition (adjusted odds ratio, aOR, 0.84 (95% CI 0.72, 0.97), 0.86 (0.77, 0.96) and 0.90 (0.81, 0.99), respectively). Similar associations were seen for probable sarcopenia and independence trajectory among those three groups, but the effects did not reach statistical significance. CONCLUSIONS:Hand grip strength could be a valuable screening tool to assess independence trajectory in octogenarians, but further study is needed to clarify the effects of indigeneity and sex in this population.
Pelvic exenteration (PE) is a complex, potentially curative option for locally advanced or recurrent pelvic malignancies in which achieving an R0 margin is paramount. This clinical review provides a pragmatic, anatomy-driven framework to optimize preoperative assessment and multidisciplinary planning. Using a compartment-based schema-central, anterior, posterior, and lateral-the article maps tumor spread to structures that determine technical feasibility and functional outcomes. For each compartment, surgical implications and reporting "pearls and pitfalls" are summarized to ensure radiological interpretation directly informs surgical decision-making. Special attention is given to differentiating tumor infiltration from post-treatment fibrosis, particularly following chemoradiotherapy, where diffusion-weighted magnetic resonance imaging plays an important role in the attempt to differentiate residual disease from fibrosis and defining safe resection planes. The review outlines assessment of critical anatomical structures or variants that have implications for surgical planning or functional consequences for patients. In addition, reconstructive options and their imaging appearances are briefly discussed to aid postoperative assessment. Through detailed anatomical analysis and structured, compartment-based reporting, radiologists can enhance multidisciplinary communication, refine patient selection, anticipate morbidity, and ultimately increase the likelihood of achieving complete resection in pelvic exenteration.
OBJECTIVES:To determine the prevalence and predictive correlates of arthritis and joint damage in systemic lupus erythematosus (SLE) patients in the Asia-Pacific Lupus Collaboration (APLC) cohort, and to determine their impact on health-related quality of life (HRQoL). METHODS:SLE patient data (2013-2020) were collected from the prospective multinational APLC cohort. We defined arthritis according to the SLE Disease Assessment Index (SLEDAI-2K) definition of persistent arthritis as arthritis in ≥2 consecutive visits, and joint damage according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) definition (deforming or erosive arthritis). HRQoL was measured by Short Form Survey (SF36). Descriptive statistics, univariable and multivariable Cox hazard models, and Kaplan-Meier analyses were performed. RESULTS:During median 2.5 (1.0-5.1) years of follow-up, 803/4106 (19.6%) patients had arthritis at least once, and 18/3383 (0.53%) accrued joint damage. Patients with arthritis were more likely to be female, Caucasian, current smokers at enrolment, and less like to have tertiary education; they also had higher overall disease activity, and lower physical and mental HRQoL. Kaplan-Meier analysis demonstrated that joint damage was more likely in patients with arthritis. Persistent arthritis and longer follow-up were risk factors for joint damage accrual; being from high-income countries was protective. Patients with joint damage also had worse physical HRQoL. CONCLUSION:Arthritis in the APLC cohort was infrequent compared with other cohorts and was associated with smoking, higher overall disease activity, and damage accrual across multiple domains. Presence of arthritis significantly impacted physical and mental HRQoL. Joint damage was strongly predicted by persistent arthritis.
BACKGROUND:Natural language processing (NLP) was used to extract structured information from large numbers of radiology reports with the aim of showing the feasibility of this approach for system monitoring, conducting clinical research and improving practice. METHODS:In total, 220,000 consecutive radiology reports were processed using an NLP pipeline (Radiology Text Analysis, or RATA). The indications, modality, technique, anatomy and findings were mapped to SNOMED CT codes. A subset of 941 reports identified as CT-KUB was analysed to examine the pipeline's performance in detecting renal tract stones (RTS), compared with a manual reference standard. The Fisher exact and Cohen kappa tests were applied. RESULTS:Compared with the reference standard, RATA had accuracy 95%, sensitivity 94%, specificity 97%, positive predictive value 98% and negative predictive value 91%, with kappa statistic 0.9. Sub analysis showed that, of 366 females, 50% had negative RTS diagnoses, while only 32% of 566 males had negative RTS diagnoses (two-tailed p < 0.00001). CONCLUSION:The RATA pipeline has acceptable performance in extracting structured data from large numbers of radiology reports. Clinically relevant information such as variations in use can be uncovered.
