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See detailBurden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old
Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A. et al

in Scandinavian Journal of Primary Health Care (2018)

Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in ... [more ▼]

Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. Design: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. Setting: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. Subjects: This study included 2543 GPs from 29 countries. Main outcome measures: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (!50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. Results: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00–4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12–4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56–1.98). Conclusions: GPs’ choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD [less ▲]

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See detailVariation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries
Streit, Sven; Verschoor, Marjolein; Rodondi, Nicolas et al

in BMC Geriatrics (2017)

Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent ... [more ▼]

Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision. Methods Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP. Results The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs’ decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48–0.59; ORs per country 0.11–1.78). Conclusions Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making. [less ▲]

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See detailGenerating Unit Tests with Structured System Interactions
Havrikov, Nikolas; Gambi, Alessio; Zeller, Andreas et al

in IEEE/ACM International Workshop on Automation of Software Test (AST) (2017)

There is a large body of work in the literature about automatic unit tests generation, and many successful results have been reported so far. However, current approaches target library classes, but not ... [more ▼]

There is a large body of work in the literature about automatic unit tests generation, and many successful results have been reported so far. However, current approaches target library classes, but not full applications. A major obstacle for testing full applications is that they interact with the environment. For example, they establish connections to remote servers. Thoroughly testing such applications requires tests that completely control the interactions between the application and its environment. Recent techniques based on mocking enable the generation of tests which include environment interactions; however, generating the right type of interactions is still an open problem. In this paper, we describe a novel approach which addresses this problem by enhancing search-based testing with complex test data generation. Experiments on an artificial system show that the proposed approach can generate effective unit tests. Compared with current techniques based on mocking, we generate more robust unit tests which achieve higher coverage and are, arguably, easier to read and understand. [less ▲]

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See detailSearch-based Security Testing of Web Applications
Thome, Julian UL; Gorla, Alessandra; Zeller, Andreas

in SBST 2014 Proceedings of the 7th International Workshop on Search-Based Software Testing (2014)

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