Conservation projects increasingly aim to deliver both environmental and social benefits. To monitor the success of these projects, it is important to pick indicators for which there is a reasonable expectation of change as a result of the project, and which resonate with project stakeholders. Results chains are widely used in conservation to describe the hypothesized pathways of causal linkages between conservation interventions and desired outcomes. We illustrate how, with limited additional information, results chains can be turned into fuzzy models of social-ecological systems, and how these models can be used to explore the predicted social and environmental impacts of conservation actions. These predictions can then be compared with the interests of stakeholders in order to identify good indicators of project success. We illustrate this approach by using it to select indicators for a water fund, an increasingly popular and multiobjective conservation strategy.
Introduction: The primary objective of this study was to determine the diagnostic accuracy and effect of an educational training on skin cancer course and dermoscopy use among primary care physicians in rural areas of Colombia. The secondary objective was to assess the diagnostic accuracy of skin cancer diagnosis and detection rate after 3 months of the initial training.
Methods: Twenty-one primary care physicians from 6 rural areas of Colombia participated in a 2-day skin cancer and dermoscopy training, followed by a day-long hands-on session on dermoscopy at a free skin cancer screening event. Pre- and post-tests were performed using clinical and dermoscopic images to evaluate the user’s ability to diagnose and differentiate benign and malignant neoplasms. In addition, participants’ levels of confidence were assessed.
Results: After the training, the sensitivity and specificity of characterizing skin lesions as benign or malignant or providing a specific diagnosis (ie, angioma, seborrheic keratosis, basal cell carcinoma, etc.) increased by 23.6% (62.9% to 86.5%; P < 0.0001) and 21% (54.7% to 75.7%; P < 0.0017), respectively. In addition, levels of confidence when diagnosing skin lesions changed from extremely low or low, to high or extremely high by 20.7% (38.3% to 59%) using dermoscopic images (odds ratio (OR) 3.22; 95% confidence interval (CI): 2.67-3.86; P < 0.0001). The secondary objective was not achieved due to loss of follow-up of the majority of participants.
Conclusion: Providers serving populations with limited healthcare access may benefit from education in diagnosing and differentiating skin cancer with the use of dermoscopy, which may ultimately improve patient care and reduce healthcare costs.
BackgroundRisk of choledocholithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step. The American Gastroenterology Society (ASGE) proposed a stratified predictor scale of choledocholithiasis. MethodsTo describe our experience managing patients with intermediate risk of choledocholithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. A retrospective observational study with a prospective database was conducted. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients had intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.77% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation > 6 mm OR: 14.65 (p 0.00). ConclusionsHigh variability in accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangio-resonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
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