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Ajaz M. Letter to the Editor: Which individual components of a colorectal surgery enhanced recovery program are associated with improved surgical outcomes? Surgery 2025; 180:108927. [PMID: 39613657 DOI: 10.1016/j.surg.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 10/11/2024] [Indexed: 12/01/2024]
Affiliation(s)
- Maryam Ajaz
- Al Nafees Medical College and Hospital, Isra University, Islamabad, Pakistan.
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Chauke TN, Khoza-Shangase K. Investigating Hearing Function in Paediatric Patients with Cancer in South Africa. Indian J Otolaryngol Head Neck Surg 2025; 77:1238-1247. [PMID: 40093441 PMCID: PMC11909360 DOI: 10.1007/s12070-024-05299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 12/23/2024] [Indexed: 03/19/2025] Open
Abstract
Paediatric cancer patients receiving platinum-based chemotherapy are at high risk of ototoxicity, often resulting in irreversible hearing loss. In South Africa, where healthcare resources are limited, routine audiological monitoring for this vulnerable population remains challenging, potentially leading to undiagnosed and untreated hearing impairments. To investigate hearing function in paediatric patients with cancer in South Africa. A descriptive, retrospective record review was conducted using patient data from two tertiary hospitals in Johannesburg: Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital. Audiological records for 47 paediatric cancer patients (ages 5-18) who had undergone baseline and follow-up hearing assessments were analysed. Descriptive and inferential statistics were used to examine hearing thresholds, tympanometry, and DPOAE results, with logistic regression assessing the association between cisplatin treatment and hearing loss. The study found that 36.2% of patients experienced high-frequency sensorineural hearing loss post-treatment, with significant threshold shifts at 4000-8000 Hz. Tympanometry indicated normal middle ear function in 87% of follow-up assessments, suggesting primarily cochlear damage. Logistic regression showed a significant association between cisplatin treatment and hearing loss, with an odds ratio of 3.18 (p = 0.003). DPOAE results further confirmed outer hair cell dysfunction, particularly in high frequencies, among patients who developed hearing loss. A substantial proportion of paediatric cancer patients in South Africa experience high-frequency hearing loss due to ototoxic treatments. These findings highlight the need for routine, standardized audiological monitoring protocols, particularly in resource-limited settings. Implementing early detection and management strategies can help mitigate the impact of hearing loss on language development, education, and quality of life in this vulnerable population.
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Affiliation(s)
- Tlangelani Nyeleti Chauke
- Department of Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Katijah Khoza-Shangase
- Department of Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Kumar R, Calvo N, Einstein G. Unexplored avenues: a narrative review of cognition and mood in postmenopausal African women with female genital circumcision/mutilation/cutting. Front Glob Womens Health 2025; 5:1409397. [PMID: 39850363 PMCID: PMC11754282 DOI: 10.3389/fgwh.2024.1409397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 11/19/2024] [Indexed: 01/25/2025] Open
Abstract
Recent ageing research has projected the lifespan and proportion of postmenopausal women living in low- and middle-income countries to substantially increase over the years, especially on the African continent. An important subgroup within the African postmenopausal population is those with female genital circumcision/mutilation/cutting (FGC). Practised across 31 African nations, FGC holds cultural significance as it is deemed essential to marriage and successful womanhood. Perhaps because of this, most FGC studies have primarily focused on women's reproductive functioning and their mood experiences. These studies also usually exclude postmenopausal women from their cohorts. Consequently, cognition and age-related cognitive decline and preservation remain understudied. Therefore, we investigated what is known about mood and cognition in local and immigrant postmenopausal African women with FGC. To do this, we carried out a narrative review searching PubMed, PsycInfo, and Google Scholar databases. Boolean combinations of keywords related to FGC, cognition, ageing, and mood were used, with a focus on cognition and ageing-related terms. Only studies published in English, those that recruited African women with FGC aged 50 years and older, and those that investigated cognitive and/or mood-related experiences were included. Ten studies were found; these included quantitative, qualitative, and case reports. The age range of cohorts across included studies was 13-90 years; women who were likely postmenopausal formed a minority within the cohorts (4.5%-25%). There were no studies assessing memory or cognition beyond those looking at FGC-related memories, which were vivid, especially if women had type III FGC (Pharaonic) or were older at the time of FGC. Although most of these women reported experiencing negative emotions concerning FGC, quantitative reports showed that only a minority of women experienced post-traumatic stress disorder, anxiety, or depression. Thus, there remains an urgent need to bring this understudied group into ageing and dementia research. Future research should adopt mixed-methods with culturally sensitive methodologies to investigate the lived experience of ageing as well as cognitive changes. A holistic understanding of ageing women from the Horn of Africa's experiences and needs will support an improvement in the quality of care delivered to this cohort in both local and immigrant contexts.
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Affiliation(s)
- Rohina Kumar
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Noelia Calvo
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Institute for Life Course & Aging, University of Toronto, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Rotman Research Institute, Baycrest Centre and University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Toronto, ON, Canada
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Collins BX, Bélisle-Pipon JC, Evans BJ, Ferryman K, Jiang X, Nebeker C, Novak L, Roberts K, Were M, Yin Z, Ravitsky V, Coco J, Hendricks-Sturrup R, Williams I, Clayton EW, Malin BA, Bridge2AI Ethics and Trustworthy AI Working Group. Addressing ethical issues in healthcare artificial intelligence using a lifecycle-informed process. JAMIA Open 2024; 7:ooae108. [PMID: 39553826 PMCID: PMC11565898 DOI: 10.1093/jamiaopen/ooae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 08/19/2024] [Accepted: 10/04/2024] [Indexed: 11/19/2024] Open
Abstract
Objectives Artificial intelligence (AI) proceeds through an iterative and evaluative process of development, use, and refinement which may be characterized as a lifecycle. Within this context, stakeholders can vary in their interests and perceptions of the ethical issues associated with this rapidly evolving technology in ways that can fail to identify and avert adverse outcomes. Identifying issues throughout the AI lifecycle in a systematic manner can facilitate better-informed ethical deliberation. Materials and Methods We analyzed existing lifecycles from within the current literature for ethical issues of AI in healthcare to identify themes, which we relied upon to create a lifecycle that consolidates these themes into a more comprehensive lifecycle. We then considered the potential benefits and harms of AI through this lifecycle to identify ethical questions that can arise at each step and to identify where conflicts and errors could arise in ethical analysis. We illustrated the approach in 3 case studies that highlight how different ethical dilemmas arise at different points in the lifecycle. Results Discussion and Conclusion Through case studies, we show how a systematic lifecycle-informed approach to the ethical analysis of AI enables mapping of the effects of AI onto different steps to guide deliberations on benefits and harms. The lifecycle-informed approach has broad applicability to different stakeholders and can facilitate communication on ethical issues for patients, healthcare professionals, research participants, and other stakeholders.
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Affiliation(s)
- Benjamin X Collins
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | | | - Barbara J Evans
- Levin College of Law, University of Florida, Gainesville, FL 32611, United States
- Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL 32611, United States
| | - Kadija Ferryman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Xiaoqian Jiang
- McWilliams School of Biomedical Informatics, UTHealth Houston, Houston, TX 77030, United States
| | - Camille Nebeker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA 92093, United States
| | - Laurie Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Kirk Roberts
- McWilliams School of Biomedical Informatics, UTHealth Houston, Houston, TX 77030, United States
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Zhijun Yin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
| | | | - Joseph Coco
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Rachele Hendricks-Sturrup
- National Alliance against Disparities in Patient Health, Woodbridge, VA 22191, United States
- Margolis Center for Health Policy, Duke University, Washington, DC 20004, United States
| | - Ishan Williams
- School of Nursing, University of Virginia, Charlottesville, VA 22903, United States
| | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Law School, Vanderbilt University, Nashville, TN 37203, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
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Grob A, Rohr J, Stumpo V, Vieli M, Ciobanu-Caraus O, Ricciardi L, Maldaner N, Raco A, Miscusi M, Perna A, Proietti L, Lofrese G, Dughiero M, Cultrera F, D'Andrea M, An SB, Ha Y, Amelot A, Bedia Cadelo J, Viñuela-Prieto JM, Gandía-González ML, Girod PP, Lener S, Kögl N, Abramovic A, Laux CJ, Farshad M, O'Riordan D, Loibl M, Galbusera F, Mannion AF, Scerrati A, De Bonis P, Molliqaj G, Tessitore E, Schröder ML, Stienen MN, Regli L, Serra C, Staartjes VE. Multicenter external validation of prediction models for clinical outcomes after spinal fusion for lumbar degenerative disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3534-3544. [PMID: 38987513 DOI: 10.1007/s00586-024-08395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/18/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Clinical prediction models (CPM), such as the SCOAP-CERTAIN tool, can be utilized to enhance decision-making for lumbar spinal fusion surgery by providing quantitative estimates of outcomes, aiding surgeons in assessing potential benefits and risks for each individual patient. External validation is crucial in CPM to assess generalizability beyond the initial dataset. This ensures performance in diverse populations, reliability and real-world applicability of the results. Therefore, we externally validated the tool for predictability of improvement in oswestry disability index (ODI), back and leg pain (BP, LP). METHODS Prospective and retrospective data from multicenter registry was obtained. As outcome measure minimum clinically important change was chosen for ODI with ≥ 15-point and ≥ 2-point reduction for numeric rating scales (NRS) for BP and LP 12 months after lumbar fusion for degenerative disease. We externally validate this tool by calculating discrimination and calibration metrics such as intercept, slope, Brier Score, expected/observed ratio, Hosmer-Lemeshow (HL), AUC, sensitivity and specificity. RESULTS We included 1115 patients, average age 60.8 ± 12.5 years. For 12-month ODI, area-under-the-curve (AUC) was 0.70, the calibration intercept and slope were 1.01 and 0.84, respectively. For NRS BP, AUC was 0.72, with calibration intercept of 0.97 and slope of 0.87. For NRS LP, AUC was 0.70, with calibration intercept of 0.04 and slope of 0.72. Sensitivity ranged from 0.63 to 0.96, while specificity ranged from 0.15 to 0.68. Lack of fit was found for all three models based on HL testing. CONCLUSIONS Utilizing data from a multinational registry, we externally validate the SCOAP-CERTAIN prediction tool. The model demonstrated fair discrimination and calibration of predicted probabilities, necessitating caution in applying it in clinical practice. We suggest that future CPMs focus on predicting longer-term prognosis for this patient population, emphasizing the significance of robust calibration and thorough reporting.
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Affiliation(s)
- Alexandra Grob
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Rohr
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vittorio Stumpo
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Moira Vieli
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olga Ciobanu-Caraus
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Ricciardi
- Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy
| | - Nicolai Maldaner
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonino Raco
- Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy
| | - Massimo Miscusi
- Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy
| | - Andrea Perna
- Department of Orthopedics, Foundation Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, Department of Neurosciences, "M.Bufalini" Hospital, Cesena, Italy
| | - Michele Dughiero
- Neurosurgery Division, Department of Neurosciences, "M.Bufalini" Hospital, Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, Department of Neurosciences, "M.Bufalini" Hospital, Cesena, Italy
| | - Marcello D'Andrea
- Neurosurgery Division, Department of Neurosciences, "M.Bufalini" Hospital, Cesena, Italy
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Severance Hospital, Yonsei University, Seoul, Korea
| | - Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
- Neurosurgical Spine Department, University Hospital of Tours, Tours, France
| | - Jorge Bedia Cadelo
- Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Pierre-Pascal Girod
- Department of Neurosurgery, Vienna Healthcare Network/ Municipial Hospital, Vienna, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph J Laux
- University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dave O'Riordan
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Anne F Mannion
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Alba Scerrati
- Department of Neurosurgery, University Hospital Sant'Anna, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, University Hospital Sant'Anna, Ferrara, Italy
| | - Granit Molliqaj
- Department of Neurosurgery, HUG Geneva University Hospital, Geneva, Switzerland
| | - Enrico Tessitore
- Department of Neurosurgery, HUG Geneva University Hospital, Geneva, Switzerland
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
| | - Martin N Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St. Gallen and Medical School of St.Gallen, St. Gallen, Switzerland
| | - Luca Regli
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Abas Z, Gashaw T, Jambo A, Edessa D. In-hospital mortality and its associated factors among hospitalized stroke patients at public hospitals of Eastern Ethiopia. BMC Cardiovasc Disord 2024; 24:456. [PMID: 39192236 PMCID: PMC11351025 DOI: 10.1186/s12872-024-04106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/08/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem. OBJECTIVE To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016-August 2022 G.C. METHODS A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association. RESULTS Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11-19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality. CONCLUSION In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored.
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Affiliation(s)
- Ziyad Abas
- Pharmacy Department, Hiwot Fana Comprehensive Specialized University Hospital, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Abera Jambo
- Clinical Pharmacy Department, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dumessa Edessa
- Clinical Pharmacy Department, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Moeed A, Larik MO, Fahim MAA, Rahman HAU, Najmi L, Changez MIK, Javed MM, Hasibuzzaman MA. Impact of non-alcoholic fatty liver disease on coronavirus disease 2019: A systematic review. World J Hepatol 2024; 16:1185-1198. [PMID: 39221098 PMCID: PMC11362910 DOI: 10.4254/wjh.v16.i8.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Many studies have revealed a link between non-alcoholic fatty liver disease (NAFLD) and coronavirus disease 2019 (COVID-19), making understanding the relationship between these two conditions an absolute requirement. AIM To provide a qualitative synthesis on the currently present data evaluating COVID-19 and NAFLD. METHODS This systematic review was conducted in accordance with the guidelines provided by preferred reporting items for systematic reviews and meta-analyses and the questionnaire utilized the population, intervention, comparison, and outcome framework. The search strategy was run on three separate databases, PubMed/MEDLINE, Scopus, and Cochrane Central, which were systematically searched from inception until March 2024 to select all relevant studies. In addition, ClinicalTrials.gov, Medrxiv.org, and Google Scholar were searched to identify grey literature. RESULTS After retrieval of 11 studies, a total of 39282 patients data were pooled. Mortality was found in 11.5% and 9.4% of people in NAFLD and non-NAFLD groups. In all, 23.2% of NAFLD patients and 22% of non-NAFLD admissions diagnosed with COVID-19 were admitted to the intensive care unit, with days of stay varying. Ventilatory support ranged from 5% to 40.5% in the NAFLD cohort and from 3.1% to 20% in the non-NAFLD cohort. The incidence of acute liver injury showed significance. Clinical improvement on days 7 and 14 between the two classifications was significant. Hospitalization stay ranged from 9.6 days to 18.8 days and 7.3 days to 16.4 days in the aforementioned cohorts respectively, with 73.3% and 76.3% of patients being discharged. Readmission rates varied. CONCLUSION Clinical outcomes except mortality consistently showed a worsening trend in patients with NAFLD and concomitant COVID-19. Further research in conducting prospective longitudinal studies is essential for a more powerful conclusion.
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Affiliation(s)
- Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
| | - Muhammad Omar Larik
- Department of Internal Medicine, Dow International Medical College, Karachi 74200, Sindh, Pakistan
| | - Muhammad Ahmed Ali Fahim
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
| | - Hafsah Alim Ur Rahman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
| | - Lubna Najmi
- Department of Internal Medicine, Ziauddin University, Karachi 75000, Sindh, Pakistan
| | - Mah I Kan Changez
- Department of Research, Yale University, New Haven 06520, CT, United States
| | - Muhammad Moiz Javed
- Department of Internal Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Md Al Hasibuzzaman
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
- Department of Medicine, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315211, Zhejiang Province, China.
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8
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Leonard JC, Harding M, Cook LJ, Leonard JR, Adelgais KM, Ahmad FA, Browne LR, Burger RK, Chaudhari PP, Corwin DJ, Glomb NW, Lee LK, Owusu-Ansah S, Riney LC, Rogers AJ, Rubalcava DM, Sapien RE, Szadkowski MA, Tzimenatos L, Ward CE, Yen K, Kuppermann N. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:482-490. [PMID: 38843852 PMCID: PMC11261431 DOI: 10.1016/s2352-4642(24)00104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. METHODS In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. FINDINGS Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. INTERPRETATION Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. FUNDING The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.
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Affiliation(s)
- Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Monica Harding
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lawrence J Cook
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeffrey R Leonard
- Department of Neurosurgery, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen M Adelgais
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Colorado Children's Hospital, Aurora, CO, USA
| | - Fahd A Ahmad
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Lorin R Browne
- Department of Pediatrics and Department of Emergency Medicine, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Rebecca K Burger
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniel J Corwin
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicolaus W Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, Benioff Children's Hospital, San Francisco, CA, USA
| | - Lois K Lee
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Sylvia Owusu-Ansah
- Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren C Riney
- Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexander J Rogers
- Department of Emergency Medicine and Department of Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI, USA
| | - Daniel M Rubalcava
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Matthew A Szadkowski
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Caleb E Ward
- Division of Emergency Medicine, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, USA
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Health Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
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9
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Wang H, Alanis N, Haygood L, Swoboda TK, Hoot N, Phillips D, Knowles H, Stinson SA, Mehta P, Sambamoorthi U. Using natural language processing in emergency medicine health service research: A systematic review and meta-analysis. Acad Emerg Med 2024; 31:696-706. [PMID: 38757352 PMCID: PMC11246236 DOI: 10.1111/acem.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Natural language processing (NLP) represents one of the adjunct technologies within artificial intelligence and machine learning, creating structure out of unstructured data. This study aims to assess the performance of employing NLP to identify and categorize unstructured data within the emergency medicine (EM) setting. METHODS We systematically searched publications related to EM research and NLP across databases including MEDLINE, Embase, Scopus, CENTRAL, and ProQuest Dissertations & Theses Global. Independent reviewers screened, reviewed, and evaluated article quality and bias. NLP usage was categorized into syndromic surveillance, radiologic interpretation, and identification of specific diseases/events/syndromes, with respective sensitivity analysis reported. Performance metrics for NLP usage were calculated and the overall area under the summary of receiver operating characteristic curve (SROC) was determined. RESULTS A total of 27 studies underwent meta-analysis. Findings indicated an overall mean sensitivity (recall) of 82%-87%, specificity of 95%, with the area under the SROC at 0.96 (95% CI 0.94-0.98). Optimal performance using NLP was observed in radiologic interpretation, demonstrating an overall mean sensitivity of 93% and specificity of 96%. CONCLUSIONS Our analysis revealed a generally favorable performance accuracy in using NLP within EM research, particularly in the realm of radiologic interpretation. Consequently, we advocate for the adoption of NLP-based research to augment EM health care management.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Naomi Alanis
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Laura Haygood
- Health Sciences Librarian for Public Health, Brown University, 69 Brown St., Providence, RI 02912
| | - Thomas K. Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, 657 N. Town Center Drive, Las Vegas, NV 89144
| | - Nathan Hoot
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Daniel Phillips
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Heidi Knowles
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Sara Ann Stinson
- Mary Couts Burnett Library, Burnett School of Medicine at Texas Christian University, 2800 S. University Dr., Fort Worth, TX 76109
| | - Prachi Mehta
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107
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10
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Wang H, Sun H, Fu Y, Cheng W, Jin C, Shi H, Luo Y, Xu X, Wang H. A comprehensive value-based method for new nuclear medical service pricing: with case study of radium [223 Ra] bone metastases treatment. BMC Health Serv Res 2024; 24:397. [PMID: 38553709 PMCID: PMC10981283 DOI: 10.1186/s12913-024-10777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
IMPORTANCE Innovative nuclear medicine services offer substantial clinical value to patients. However, these advancements often come with high costs. Traditional payment strategies do not incentivize medical institutes to provide new services nor determine the fair price for payers. A shift towards a value-based pricing strategy is imperative to address these challenges. Such a strategy would reconcile the cost of innovation with incentives, foster transparent allocation of healthcare resources, and expedite the accessibility of essential medical services. OBJECTIVE This study aims to develop and present a comprehensive, value-based pricing model for new nuclear medicine services, illustrated explicitly through a case study of the radium [223Ra] treatment for bone metastases. In constructing the pricing model, we have considered three primary value determinants: the cost of the new service, associated service risk, and the difficulty of the service provision. Our research can help healthcare leaders design an evidence-based Fee-For-Service (FFS) payment reference pricing with nuclear medicine services and price adjustments. DESIGN, SETTING AND PARTICIPANTS This multi-center study was conducted from March 2021 to February 2022 (including consultation meetings) and employed both qualitative and quantitative methodologies. We organized focus group consultations with physicians from nuclear medicine departments in Beijing, Chongqing, Guangzhou, and Shanghai to standardize the treatment process for radium [223Ra] bone metastases. We used a specially designed 'Radium Nuclide [223Ra] Bone Metastasis Data Collection Form' to gather nationwide resource consumption data to extract information from local databases. Four interviews with groups of experts were conducted to determine the add-up ratio, based on service risk and difficulty. The study organized consultation meeting with key stakeholders, including policymakers, service providers, clinical researchers, and health economists, to finalize the pricing equation and the pricing result of radium [223Ra] bone metastases service. MAIN OUTCOMES AND MEASURES We developed and detailed a pricing equation tailored for innovative services in the nuclear medicine department, illustrating its application through a step-by-step guide. A standardized service process was established to ensure consistency and accuracy. Adhering to best practice guidelines for health cost data analysis, we emphasized the importance of cross-validation of data, where validated data demonstrated less variation. However, it required a more advanced health information system to manage and analyze the data inputs effectively. RESULTS The standardized service of radium [223Ra] bone metastases includes: pre-injection assessment, treatment plan, administration, post-administration monitoring, waste disposal and monitoring. The average duration for each stage is 104 min, 39 min, 25 min, 72 min and 56 min. A standardized monetary value for medical consumables is 54.94 yuan ($7.6), and the standardised monetary value (medical consumables cost plus human input) is 763.68 yuan ($109.9). Applying an agreed value add-up ratio of 1.065, the standardized value is 810.19 yuan ($116.9). Feedback from a consultation meeting with policymakers and health economics researchers indicates a consensus that the pricing equation developed was reasonable and well-grounded. CONCLUSION This research is the first study in the field of nuclear medicine department pricing methodology. We introduce a comprehensive value-based nuclear medical service pricing method and use radium[223Ra] bone metastases treatment pricing in China as a case study. This study establishes a novel pricing framework and provides practical instructions on its implementation in a real-world healthcare setting.
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Affiliation(s)
- Haode Wang
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Hui Sun
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yuyan Fu
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
| | - Wendi Cheng
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
| | - Chunlin Jin
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Shanghai Medical College, Department of Nuclear Medicine, Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Yashuang Luo
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China
| | - Xinjie Xu
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Haiyin Wang
- Shanghai Health Development Research Center, (Shanghai Medical Information Center), Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People's Republic of China.
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11
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Arthur R, Mayberry RM, Odum S, Kempton LB. Can researchers trust ICD-10 coding of medical comorbidities in orthopaedic trauma patients? OTA Int 2024; 7:e307. [PMID: 38425488 PMCID: PMC10904096 DOI: 10.1097/oi9.0000000000000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/31/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024]
Abstract
Objectives The 10th revision of the International Classification of Diseases (ICD-10) coding system may prove useful to orthopaedic trauma researchers to identify and document populations based on comorbidities. However, its use for research first necessitates determination of its reliability. The purpose of this study was to assess the reliability of electronic medical record (EMR) ICD-10 coding of nonorthopaedic diagnoses in orthopaedic trauma patients relative to the gold standard of prospective data collection. Design Nonexperimental cross-sectional study. Setting Level 1 Trauma Center. Patients/Participants Two hundred sixty-three orthopaedic trauma patients from 2 prior prospective studies from September 2018 to April 2022. Intervention Prospectively collected data were compared with EMR ICD-10 code abstraction for components of the Charlson Comorbidity Index (CCI), obesity, alcohol abuse, and tobacco use (retrospective data). Main Outcome Measurements Percent agreement and Cohen's kappa reliability. Results Percent agreement ranged from 86.7% to 96.9% for all CCI diagnoses and was as low as 72.6% for the diagnosis "overweight." Only 2 diagnoses, diabetes without end-organ damage (kappa = 0.794) and AIDS (kappa = 0.798) demonstrated Cohen's kappa values to indicate substantial agreement. Conclusion EMR diagnostic coding for medical comorbidities in orthopaedic trauma patients demonstrated variable reliability. Researchers may be able to rely on EMR coding to identify patients with diabetes without complications or AIDS. Chart review may still be necessary to confirm diagnoses. Low prevalence of most comorbidities led to high percentage agreement with low reliability. Level of Evidence Level 1 diagnostic.
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Affiliation(s)
- Rodney Arthur
- University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC
| | - R. Miles Mayberry
- Wake Forest School of Medicine, Winston-Salem, NC
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC
| | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC
| | - Laurence B. Kempton
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC
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12
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Tan SI, Hoskin AK, Khatri A, Dave VP, Bhalerao S, Romero J, Agrawal R. Prognostic factors of open-globe injuries: A review. Indian J Ophthalmol 2023; 71:3587-3594. [PMID: 37991288 PMCID: PMC10788744 DOI: 10.4103/ijo.ijo_1496_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/07/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
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Affiliation(s)
- Sze Ing Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Annette K Hoskin
- Save Sight Institute, The University of Sydney, Australia
- Lions Eye Institute, The University of Western Australia, Australia
| | - Anadi Khatri
- Department of Ophthalmology, Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Opthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, USA
| | - Vivek P Dave
- Department of Ocular Immunology, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushank Bhalerao
- Shantilal Shanghvi Cornea Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Jose Romero
- Department of Ocular Trauma, Unidad Nacional de Oftalmologia de Guatemala, Guatemala, USA
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
- Duke‐NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Schoephoerster J, Roston S, Lunos S, Ramel SE, Anderson J, Georgieff MK, Ingolfsland EC. Identification of clinical factors associated with timing and duration of spontaneous regression of retinopathy of prematurity not requiring treatment. J Perinatol 2023; 43:702-708. [PMID: 36973383 DOI: 10.1038/s41372-023-01649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Identify clinical factors that delay or prolong spontaneous regression of retinopathy of prematurity (ROP). STUDY DESIGN Secondary analysis of three prospective studies with 76 infants with ROP not requiring treatment, born ≤30 weeks postmenstrual age (PMA) and ≤1500 grams. Outcomes were PMA at greatest severity of ROP (PMA MSROP), at which regression began, at time of complete vascularization (PMA CV), and regression duration. Pearson's correlation coefficients, t-tests, or analyses of variance were calculated. RESULTS Increased positive bacterial cultures, hyperglycemia, transfusion volume of platelets and red blood cells and severity of ROP were associated with later PMA MSROP. Positive bacterial cultures, maternal chorioamnionitis, and less iron deficiency were associated with later PMA CV and prolonged regression duration. Slower length gain was associated with later PMA CV. P < 0.05 for all. CONCLUSIONS Preterm infants with inflammatory exposures or linear growth impairment may require longer surveillance for ROP resolution and complete vascularization.
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Affiliation(s)
| | - Sydney Roston
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Sara E Ramel
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
| | - Jill Anderson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Michael K Georgieff
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
| | - Ellen C Ingolfsland
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA.
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14
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Jogiat U, Jimoh Z, Turner SR, Baracos V, Eurich D, Bédard ELR. Sarcopenia in Lung Cancer: A Narrative Review. Nutr Cancer 2023:1-14. [PMID: 37177914 DOI: 10.1080/01635581.2023.2212425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
It has been over 10 years since the relationship between sarcopenia and lung cancer was first explored. Since then, sarcopenia research has progressed substantially, and the prognostic value of this condition is becoming increasingly apparent. Prior systematic reviews and meta-analyses have established sarcopenia to be negatively associated with disease-free and overall-survival, as well as a major risk factor for post-operative complications. The bulk of the literature has explored sarcopenia in the resectable setting, with less emphasis placed on studies evaluating this condition in advanced disease. In this up-to-date review, an examination of the literature exploring the association between sarcopenia and long-term outcomes in advanced lung cancer is provided. We further explore the association between adverse events of medical therapy and the role of sarcopenia as a predictor of tumor response. Finally, the interventions on sarcopenia and cancer cachexia are reviewed, with an emphasis placed on prospective studies.
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Affiliation(s)
- Uzair Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
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15
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Wilson R, McFadden C, Rowbotham S. A meta-analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging. J Forensic Sci 2023; 68:731-742. [PMID: 36938845 DOI: 10.1111/1556-4029.15234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/21/2023]
Abstract
The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.
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Affiliation(s)
- Rachel Wilson
- School of Archaeology & Anthropology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Clare McFadden
- School of Archaeology & Anthropology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Samantha Rowbotham
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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16
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Hanrahan JG, Burford C, Nagappan P, Adegboyega G, Rajkumar S, Kolias A, Helmy A, Hutchinson PJ. Is dementia more likely following traumatic brain injury? A systematic review. J Neurol 2023; 270:3022-3051. [PMID: 36810827 DOI: 10.1007/s00415-023-11614-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI. OBJECTIVE To review the scope and quality of the existing literature investigating the relationship between TBI and dementia. METHODS We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool. RESULTS 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies. CONCLUSIONS Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration.
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Affiliation(s)
- John Gerrard Hanrahan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Burford
- Department of General Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, UK.
| | - Palani Nagappan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gideon Adegboyega
- Bart's and the London Medical School, Queen Mary University of London, London, UK
| | - Shivani Rajkumar
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Peter John Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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17
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Coombes FC, Strudwick K, Martin-Khan MG, Russell TG. A comparison of prospective observations and chart audits for measuring quality of care of musculoskeletal injuries in the emergency department. Australas Emerg Care 2022:S2588-994X(22)00071-9. [DOI: 10.1016/j.auec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
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Haynes S, Holloway S. A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting. Int Wound J 2021; 19:1232-1242. [PMID: 34753216 PMCID: PMC9284638 DOI: 10.1111/iwj.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well-being. Compression therapy is traditionally the "gold-standard" treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub-bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of "gold-standard" compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.
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Affiliation(s)
- Samantha Haynes
- Southampton Tissue Viability Team, Solent NHS Trust, Southampton, UK
| | - Samantha Holloway
- Centre for Medical Education, College of Biomedical and Life Sciences, Cardiff University School of Medicine, Cardiff, Wales, UK
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19
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Andersen CS, Thoft Jensen B, Nielsen Holck E, Kingo PS, Jensen JB. Prospective versus retrospective recordings of comorbidities and complications in bladder cancer patients undergoing radical cystectomy - a randomized controlled trial. Scand J Urol 2021; 56:6-11. [PMID: 34658306 DOI: 10.1080/21681805.2021.1987978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients undergoing radical cystectomy are predominantly elderly with many comorbidities and high risk of complications. Studies on comorbidity and complications following cancer surgery are often based on data collected retrospectively from records. However, prospective registration is often considered a more valid source of information. Therefore, it is relevant to investigate if the amount and severity of complications and comorbidities is valid when using retrospective registration compared to a more meticulous prospective registration. OBJECTIVE To investigate the difference in registered comorbidities and complications between prospective and retrospective data collection in patients with bladder cancer undergoing radical cystectomy. METHOD Seventy-three bladder cancer patients undergoing radical cystectomy were randomized to receive prospective or retrospective collection of data regarding comorbidities and complications. Data in the prospective arm was collected daily during hospitalization, 14-days after discharge and 90-days postoperatively. In the retrospective arm, medical records were reviewed retrospectively at 90-days. Comorbidities were compared using the Charlson Comorbidity Index (CCI) and complications were reported as overall, minor and major dependent on Clavien Dindo Classification (CDC). The primary endpoint was the difference in overall complication rate. RESULTS No statistically significant difference in CCI was observed with median [IQR] 2[0;3] and 1[0;2] (p = 0.21). No statistically significant difference was found regarding all, minor (CDC I-II) or major (CDC III-V) complications at all three time points. CONCLUSION No statistically significant difference in comorbidity and complications between retrospectively and prospectively collected data was observed. We find that retrospective collected data is reliable when strict reporting guidelines are used in this single-centre study.
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20
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Dosani A, Murthy P, Kassam S, Rai B, Lodha AK. Parental perception of neonatal transfers from level 3 to level 2 neonatal intensive care units in Calgary, Alberta: qualitative findings. BMC Health Serv Res 2021; 21:981. [PMID: 34535124 PMCID: PMC8449487 DOI: 10.1186/s12913-021-06967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Retro-transfers from level 3 to 2 NICUs in Alberta’s regionalization of neonatal care system are essential to ensure the proper utilization of level 3 NICUs for complex neonatal cases. Parents often experience distress that relates to the transfer of their neonates to another hospital. Limited information is available regarding parental perceptions of distress during transfers for neonates requiring care between NICUs in the current Canadian context. The objective of this study was to investigate: 1) what caused parents distress and could be changed about the transfer process and 2) the supports that were available to help ease parental distress during the transfer process. Methods Parents of singleton infants retro-transferred from level 3 to 2 NICUs in Calgary, Alberta between January 1, 2016, and December 31, 2017, were invited to participate in the study. Questionnaires were self-administered by one parent per family. A thematic deductive approach was employed by the researchers to analyze the qualitative data. Results Our response rate was 39.1% (n = 140). We found three themes for causes of parental distress and supports available to ease parental distress during the transfer, including communication between staff members and parents, details about the transfer process, and the care received throughout and shortly after the transfer process. Conclusion Parents should receive at least 24 h of notice, regular transfer updates, employ anticipatory preparation strategies, and foster more open communication between parents and health care professionals to help ensure parental satisfaction.
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Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Mount Royal University, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada. .,Cumming School of Medicine, University of Calgary, Y458, 4825 Mount Royal Gate S.W., Calgary, AB, T3E 6K6, Canada.
| | - Prashanth Murthy
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada
| | - Shafana Kassam
- Faculty of Arts and Science, University of Toronto, Toronto, Canada
| | - Baldeep Rai
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Abhay K Lodha
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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21
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Wei M, Bo F, Cao H, Zhou W, Shan W, Bai G. Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for malignant ovarian tumors: a systematic review and meta-analysis. Acta Radiol 2021; 62:966-978. [PMID: 32741199 DOI: 10.1177/0284185120944916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Accurate preoperative diagnosis of malignant ovarian tumors (MOTs) is particularly important for selecting the optimal treatment strategy and avoiding overtreatment. PURPOSE To evaluate the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for MOTs. MATERIAL AND METHODS A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science databases to find relevant original articles up to October 2019. The included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies on the diagnosis of MOTs with quantitative or semi-quantitative DCE-MRI were analyzed separately. The bivariate random-effects model was used to assess the diagnostic authenticity. Meta-regression analyses were performed to analyze the potential heterogeneity. RESULTS For semi-quantitative DCE-MRI, the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curves (AUC) were 85% (95% confidence interval [CI] 0.75-0.92), 85% (95% CI 0.77-0.91), 5.8 (95% CI 3.8-8.8), 0.17 (95% CI 0.10-0.30), 33 (95% CI 18-61), and 0.92 (95% CI 0.89-0.94), respectively. For quantitative DCE-MRI, the pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 88% (95% CI 0.65-0.96), 93% (95% CI 0.78-0.98), 12.3 (95% CI 3.4-43.9), 0.13 (95% CI 0.04-0.45), 91 (95% CI 10-857), and 0.96 (95% CI 0.94-0.98), respectively. CONCLUSION DCE-MRI has great diagnostic value for MOTs. Semi-quantitative DCE-MRI may be a relatively mature approach; however, quantitative DCE-MRI appears to be more promising than semi-quantitative DCE-MRI.
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Affiliation(s)
- Mingxiang Wei
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Fan Bo
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Hui Cao
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wei Zhou
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wenli Shan
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
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22
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Tang D, Yuan F, Ma X, Qu H, Li Y, Zhang W, Ma H, Liu H, Yang Y, Xu L, Gao Y, Zhan S. Incidence rates, risk factors, and outcomes of aspiration pneumonia after gastric endoscopic submucosal dissection: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1457-1469. [PMID: 33242356 DOI: 10.1111/jgh.15359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The risk and prognosis of aspiration pneumonia (AP) after endoscopic submucosal dissection (ESD) are inconsistent among studies. We aim to estimate the incidence, risk factors, and outcome of AP in patients after gastric ESD. METHODS PubMed, EMBASE, Cochrane Library, and Web of Knowledge were searched for relevant articles from inception until April 2020. Data involving the incidence, risk factors, and outcomes were extracted. Pooled incidence, odds ratios (ORs), or standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. RESULTS Forty records involving 48 674 subjects were finally included. The pooled incidence of AP after gastric ESD was 1.9% (95% CI, 1.2-2.7) via the double arcsine transformation method and 1.6% (1.1-2.5%) via the logit transformation method. Risk factors analyses revealed that old age (OR, 2.52; 95% CI, 1.99-3.18), comorbid pulmonary disease (2.49; 1.66-3.74), comorbid cerebrovascular disease (2.68; 1.05-6.85), remnant stomach (4.91; 1.83-13.14), sedation with propofol (2.51; 1.48-4.28), and long procedural duration (count data: 5.20, 1.25-21.7; measurement data: 1.01, 1.01-1.02) were related to the occurrence of AP. Patients with AP had a longer hospital stay (SMD, 0.56; 95% CI, 0.25-0.87) than those without AP. CONCLUSIONS About 1.9% (1.2-2.7%) of the patients who receive gastric ESD may develop AP, resulting in prolonged hospital stay. More attention should be paid in patients who are older; have comorbidities such as pulmonary diseases, cerebrovascular diseases, or gastric remnant; or require a long procedural duration or deep sedation with propofol.
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Affiliation(s)
- Dong Tang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Fuxiang Yuan
- Ophthalmologic Center, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Xiaoying Ma
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Haixia Qu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yuan Li
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Weiwei Zhang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Huan Ma
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Haiping Liu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yan Yang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Lin Xu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yuqiang Gao
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Shuhui Zhan
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
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Featherall J, Oak SR, Strnad GJ, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Spindler KP. Smartphone Data Capture Efficiently Augments Dictation for Knee Arthroscopic Surgery. J Am Acad Orthop Surg 2020; 28:e115-e124. [PMID: 31977610 PMCID: PMC6964865 DOI: 10.5435/jaaos-d-19-00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objectives of this study are (1) to develop a provider-friendly, evidence-based data capture system for lower-limb orthopaedic surgeries and (2) to assess the performance of the data capture system on the dimensions of agreement with operative note and implant log, consistency of data, and speed of provider input. METHODS A multidisciplinary team developed a database and user interfaces for Android and iOS operating systems. Branching logic and discrete fields were created to streamline provider data input. One hundred patients were randomly selected from the first four months of data collection (February to June 2015). Patients were limited to those undergoing anterior cruciate ligament reconstruction, meniscal repair, partial meniscectomy, or a combination of these procedures. Duplicate data on these 100 patients were collected through chart review. These two data sets were compared. Cohen's kappa statistic was used to assess agreement. RESULTS The database and smartphone data capture tool show almost perfect agreement (kappa > 0.81) for all data tested. In addition, data are more comprehensive with near-perfect provider completion (100% for all data tested). Furthermore, provider data entry is extremely efficient (median 151-second completion time). CONCLUSION A well-designed database and user-friendly interface have greater potential for research utility, clinical efficiency, and, thus, cost-effectiveness when compared with standard voice-dictated operative notes. Widespread utilization of such tools can accelerate the pace and improve the quality of orthopaedic clinical research. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joseph Featherall
- From the Cleveland Clinic Lerner College of Medicine (Mr. Featherall), the Department of Orthopaedic Surgery, Cleveland Clinic (Dr. Oak, Mr. Strnad, Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), and the Cleveland Clinic Sports Health Center, Cleveland Clinic (Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), Cleveland, OH
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24
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Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis. Neurocrit Care 2020; 32:272-285. [PMID: 31300956 PMCID: PMC7223912 DOI: 10.1007/s12028-019-00773-w] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ventilator-associated pneumonia (VAP) is one of the most severe complications in patients with traumatic brain injury (TBI) and is considered a risk factor for poor outcomes. However, the incidence of VAP among patients with TBI reported in studies varies widely. What is more, the risk factors and outcomes of VAP are controversial. This study estimates the incidence, risk factors, and outcomes of VAP in patients with TBI and provides evidence for prevention and treatment. PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched from the earliest records to May 2018. Data involving the incidence, risk factors, and outcomes were extracted for meta-analysis. The results showed that the incidence of VAP was 36% (95% confidence interval (CI) 31-41%); risk factors analyses showed that smoking [odds ratio (OR) 2.13; 95% CI 1.16-3.92], tracheostomy (OR 9.55; 95% CI 3.24-28.17), blood transfusion on admission (OR 2.54; 95% CI 1.24-5.18), barbiturate infusion (OR 3.52; 95% CI 1.68-7.40), injury severity score (OR 4.65; 95% CI 1.96-7.34), and head abbreviated injury scale (OR 2.99; 95% CI 1.66-5.37) were related to the occurrence of VAP. When patients developed VAP, mechanical ventilation time (OR 5.45; 95% CI 3.78-7.12), ICU length of stay (OR 6.85; 95% CI 4.90-8.79), and hospital length of stay (OR 10.92; 95% CI 9.12-12.72) were significantly increased. However, VAP was not associated with an increased risk of mortality (OR 1.28; 95% CI 0.74-2.21). VAP is common in patients with TBI. It is affected by a series of factors and has a poor prognosis.
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Affiliation(s)
- Yating Li
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Rm.212, No.107 Wenhua West Road, Jinan, 250012, Shandong Province, China
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Chenxia Liu
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Rm.212, No.107 Wenhua West Road, Jinan, 250012, Shandong Province, China
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Wei Xiao
- Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Tiantian Song
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Rm.212, No.107 Wenhua West Road, Jinan, 250012, Shandong Province, China
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Shuhui Wang
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Rm.212, No.107 Wenhua West Road, Jinan, 250012, Shandong Province, China.
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25
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van Baarle FEHP, van de Weerdt EK, Suurmond B, Müller MCA, Vlaar APJ, Biemond BJ. Bleeding assessment and bleeding severity in thrombocytopenic patients undergoing invasive procedures. Transfusion 2020; 60:637-649. [PMID: 32003910 PMCID: PMC7079124 DOI: 10.1111/trf.15670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Frank E H P van Baarle
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma K van de Weerdt
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bram Suurmond
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcella C A Müller
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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26
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Wang H, Zhang L, Zhang Z, Li Y, Luo Q, Yuan S, Yan F. Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials. Front Psychiatry 2020; 11:570362. [PMID: 33173517 PMCID: PMC7591683 DOI: 10.3389/fpsyt.2020.570362] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: The aim of this systematic review and meta-analysis of clinical trials was to investigate the effects of perioperative sleep disturbances on postoperative delirium (POD). Methods: Authors searched for studies (until May 12, 2020) reporting POD in patients with sleep disturbances following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: We identified 29 relevant trials including 55,907 patients. We divided these trials into three groups according to study design: Seven retrospective observational trials, 12 prospective observational trials, and 10 randomized controlled trials. The results demonstrated that perioperative sleep disturbances were significantly associated with POD occurrence in observational groups [retrospective: OR = 0.56, 95% CI: [0.33, 0.93], I 2 = 91%, p for effect = 0.03; prospective: OR = 0.27, 95% CI: [0.20, 0.36], I 2 = 25%, p for effect < 0.001], but not in the randomized controlled trial group [OR = 0.58, 95% CI: [0.34, 1.01], I 2 = 68%, p for effect = 0.05]. Publication bias was assessed using Egger's test. We used a one-by-one literature exclusion method to address high heterogeneity. Conclusions: Perioperative sleep disturbances were potential risk factors for POD in observational trials, but not in randomized controlled trials.
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Affiliation(s)
- Hongbai Wang
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Liang Zhang
- Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Zhe Zhang
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Yinan Li
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Qipeng Luo
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Su Yuan
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Fuxia Yan
- Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
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Abstract
INTRODUCTION The purpose of this study is to compare the utility and validity of the OrthoMiDaS (Orthopaedic Minimal Data Set) Episode of Care (OME) database with the current benchmark for recording procedural details, the operative note (OpNote), with regard to disease severity and risk factors for hip arthroscopy cases. METHODS A convenience sample of the first 100 hip arthroscopy cases for labral tears done at our institution between February and August 2015 were selected for this study. Surgeons recorded procedural details within OME after each case. An individual blinded to the OME data performed a chart review of the OpNote and/or implant log and recorded the information in a separate REDCap database. RESULTS OME demonstrated higher completion rates than the OpNote for important procedural details such as previous left and right hip surgery (P < 0.001), anchor type (P = 0.008), and labrum tear clockface variables (P < 0.001 for both). In addition, OME exhibited "near-perfect" agreement with the OpNote for several important procedural details such as surgical limb (Kappa = 1.000), suture configuration (Kappa = 0.982), repair type (Kappa = 0.947), tear clockface: from (Kappa = 0.949), and tear clockface: to (Kappa = 0.885). On average, surgeons took 117 seconds to complete data entry within OME. CONCLUSION The findings of this study validate the ability of OME to accurately and consistently capture important procedural details pertaining to arthroscopic hip surgery. Through the use of OME, high-quality standardized information can be captured and used to advance the field of hip arthroscopy by determining the clinically useful predictors of patient-reported outcome measures.
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Mohr J, Strnad GJ, Farrow L, Heinlein K, Hettrich CM, Jones MH, Miniaci A, Ricchetti E, Rosneck J, Schickendantz M, Saluan P, Vega JF, Spindler KP. A smart decision: smartphone use for operative data collection in arthroscopic shoulder instability surgery. J Am Med Inform Assoc 2019; 26:1030-1036. [PMID: 31188454 PMCID: PMC6748799 DOI: 10.1093/jamia/ocz074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study tested validity, accuracy, and efficiency of the Orthopaedic Minimal Data Set Episode of Care (OME) compared with traditional operative report in arthroscopic surgery for shoulder instability. As of November 2017, OME had successfully captured baseline data on 97% of 18 700 eligible cases. MATERIALS AND METHODS This study analyzes 100 cases entered into OME through smartphones by 12 surgeons at an institution from February to October 2015. A blinded reviewer extracted the same variables from operative report into a separate database. Completion rates and agreement were compared. They were assessed using raw percentages and McNemar's test (with continuity correction). Agreement between nominal variables was assessed by unweighted Cohen's kappa and a concordance correlation coefficient measured agreement between continuous variables. Efficiency was assessed by median time to complete. RESULTS Of 37 variables, OME demonstrated equal or higher completion rates for all but 1 and had significantly higher capture rates for 49% (n = 18; P < .05). Of 33 nominal variables, raw proportional agreement was ≥0.90 for 76% (n = 25). Raw proportional agreement was perfect for 15% (n = 5); no agreement statistic could be calculated due to a single variable in operative note and OME. Calculated agreement statistic was substantial or better (κ > 0.61) for 51% (n = 17) for the 33 nominal variables. All continuous variables assessed (n = 4) demonstrated poor agreement (concordance correlation coefficient <0.90). Median time for completing OME was 103.5 (interquartile range, 80.5-151) seconds. CONCLUSIONS The OME smartphone data capture system routinely captured more data than operative report and demonstrated acceptable agreement for nearly all nominal variables, yet took <2 minutes to complete on average.
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Affiliation(s)
- Jill Mohr
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gregory J Strnad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lutul Farrow
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kate Heinlein
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | | | - James Rosneck
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Sports Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jose F Vega
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. The role of physician associates in secondary care: the PA-SCER mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIncreasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.Objectives(1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.MethodsThis was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.ResultsThe surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57;p = 0.40). In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.LimitationsPAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team.ConclusionsPAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice.Future researchComparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners.Study registrationThe systematic review component of this study is registered as PROSPERO CRD42016032895.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Vari M Drennan
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Mary Halter
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Carly Wheeler
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sally Brearley
- Centre for Public Engagement, Joint Faculty of Kingston University and St George’s, University of London, London, UK
| | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jon Gabe
- Royal Holloway, University of London, Egham, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Phil Begg
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Bustamante-Munguira J, Herrera-Gómez F, Ruiz-Álvarez M, Figuerola-Tejerina A, Hernández-Aceituno A. A New Surgical Site Infection Risk Score: Infection Risk Index in Cardiac Surgery. J Clin Med 2019; 8:jcm8040480. [PMID: 30970636 PMCID: PMC6517895 DOI: 10.3390/jcm8040480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
Various scoring systems attempt to predict the risk of surgical site infection (SSI) after cardiac surgery, but their discrimination is limited. Our aim was to analyze all SSI risk factors in both coronary artery bypass graft (CABG) and valve replacement patients in order to create a new SSI risk score for such individuals. A priori prospective collected data on patients that underwent cardiac surgery (n = 2020) were analyzed following recommendations from the Reporting of studies Conducted using Observational Routinely collected health Data (RECORD) group. Study participants were divided into two periods: the training sample for defining the new tool (2010–2014, n = 1298), and the test sample for its validation (2015–2017, n = 722). In logistic regression, two preoperative variables were significantly associated with SSI (odds ratio (OR) and 95% confidence interval (CI)): diabetes, 3.3/2–5.7; and obesity, 4.5/2.2–9.3. The new score was constructed using a summation system for punctuation using integer numbers, that is, by assigning one point to the presence of either diabetes or obesity. The tool performed better in terms of assessing SSI risk in the test sample (area under the Receiver-Operating Characteristic curve (aROC) and 95% CI, 0.67/055–0.76) compared to the National Nosocomial Infections Surveillance (NNIS) risk index (0.61/0.50–0.71) and the Australian Clinical Risk Index (ACRI) (0.61/0.50–0.72). A new two-variable score to preoperative SSI risk stratification of cardiac surgery patients, named Infection Risk Index in Cardiac surgery (IRIC), which outperforms other classical scores, is now available to surgeons. Personalization of treatment for cardiac surgery patients is needed.
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Affiliation(s)
| | - Francisco Herrera-Gómez
- Anatomy and Radiology, Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid,47003 Valladolid, Spain.
- Nephrology, Hospital Virgen de la Concha, 49022 Zamora, Spain.
| | - Miguel Ruiz-Álvarez
- Prevention and Control of Infection, Hospital Universitario de La Princesa, 28006 Madrid, Spain.
| | | | - Ana Hernández-Aceituno
- Prevention and Control of Infection, Hospital Universitario de La Princesa, 28006 Madrid, Spain.
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Ciulla MM, Vivona P. Time arrow in published clinical studies/trials indexed in MEDLINE: a systematic analysis of retrospective vs. prospective study design, from 1960 to 2017. PeerJ 2019; 7:e6363. [PMID: 30723632 PMCID: PMC6360999 DOI: 10.7717/peerj.6363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/30/2018] [Indexed: 11/24/2022] Open
Abstract
Clinical studies/trials are experiments or observations on human subjects considered by the scientific community the most appropriate instrument to answer specific research questions on interventions on health outcomes. The time-line of the observations might be focused on a single time point or to follow time, backward or forward, in the so called, respectively, retrospective and prospective study design. Since the retrospective approach has been criticized for the possible sources of errors due to bias and confounding, we aimed this study to assess if there is a prevalence of retrospective vs. prospective design in the clinical studies/trials by querying MEDLINE. Our results on a sample of 1,438,872 studies/trials, (yrs 1960–2017), support a prevalence of retrospective, respectively 55% vs. 45%. To explain this result, a random sub-sample of studies where the country of origin was reported (n = 1,576) was categorized in high and low-income based onthe nominal Gross Domestic Product (GDP) and matched with the topic of the research. As expected, the absolute majority of studies/trials are carried on by high-income countries, respectively 86% vs. 14%; even if a slight prevalence of retrospective was recorded in both income groups, for the most part prospective studies are carried out by high-GDP countries, 85% vs. 15%. Finally, the differences in the design of the study are understandable when considering the topic of the research.
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Affiliation(s)
- Michele M Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Patrizia Vivona
- Cardiovascular Diseases Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Li B, Montbriand J, Eisenberg N, Roche-Nagle G, Tan KT, Byrne J. Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 57:98-108. [PMID: 30500629 DOI: 10.1016/j.avsg.2018.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/25/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The impact of aneurysm thrombus characteristics on type 2 endoleak rate following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is unclear. The purpose of this study is to determine the impact of pre-operative aneurysm thrombus volume and density on the incidence of type 2 endoleak following EVAR for infrarenal AAA. METHODS A retrospective analysis was completed on all patients who underwent standard EVAR at an academic medical institution between May 1, 2010 and June 1, 2016 with a minimum follow-up period of 12 months. The final analysis included 170 patients. Thrombus volume and density were determined by analyzing pre-operative computed tomography angiography (CTA) scans using the TeraRecon plaque analysis module. The number and diameter of patent infrarenal aortic branch vessels were also identified. Type 2 endoleak was diagnosed by post-operative CTA, duplex ultrasound, or angiography. RESULTS Over a median follow-up period of 29 months, 88 (51.8%) of 170 patients had a type 2 endoleak. The thrombus volume as a proportion of the infrarenal aorta volume was significantly lower in patients with type 2 endoleak (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.005-0.291, P = 0.002). The number of patent lumbar arteries was significantly greater in patients with type 2 endoleak (OR 1.45, 95% CI 1.16-1.56, P < 0.0005). Both variables independently predicted the incidence of type 2 endoleak in a multivariate analysis. Thrombus density was not related to the incidence of type 2 endoleak. CONCLUSIONS A lower ratio of thrombus volume/infrarenal aorta volume and a higher number of patent lumbar arteries were associated with an increased incidence of type 2 endoleak. A multivariate logistic regression model was generated to pre-operatively predict the risk of type 2 endoleak. This model can guide the stratification of patients for intensity of endoleak surveillance following EVAR and consideration of pre-operative treatment.
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Affiliation(s)
- Ben Li
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Janice Montbriand
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naomi Eisenberg
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Byrne
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
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van Zanden JE, Wagenaar S, Ter Maaten JM, Ter Maaten JC, Ligtenberg JJM. Pain score, desire for pain treatment and effect on pain satisfaction in the emergency department: a prospective, observational study. BMC Emerg Med 2018; 18:40. [PMID: 30409124 PMCID: PMC6225652 DOI: 10.1186/s12873-018-0189-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pain management in the Emergency Department has often been described as inadequate, despite proven benefits of pain treatment protocols. The aim of this study was to investigate the effectiveness of our current pain protocol on pain score and patient satisfaction whilst taking the patients’ wishes for analgesia into account. Methods We conducted a 10-day prospective observational study in the Emergency Department. Demographics, pain characteristics, Numeric Rating Scale pain scores and the desire for analgesics were noted upon arrival at the Emergency Department. A second Numeric Rating Scale pain score and the level of patient satisfaction were noted 75–90 min after receiving analgesics. Student T-tests, Mann-Whitney U tests and Kruskall-Wallis tests were used to compare outcomes between patients desiring vs. not desiring analgesics or patients receiving vs. not receiving analgesics. Univariate and multivariate logistic regression models were used to investigate associations between potential predictors and outcomes. Results In this study 334 patients in pain were enrolled, of which 43.7% desired analgesics. Initial pain score was the only significant predictive factor for desiring analgesia, and differed between patients desiring (7.01) and not desiring analgesics (5.14). Patients receiving analgesics (52.1%) had a greater decrease in pain score than patients who did not receive analgesics (2.41 vs. 0.94). Within the group that did not receive analgesics there was no difference in satisfaction score between patients desiring and not desiring analgesics (7.48 vs. 7.54). Patients receiving analgesics expressed a higher satisfaction score than patients not receiving analgesics (8.10 vs. 7.53). Conclusions This study pointed out that more than half of the patients in pain entering the Emergency Department did not desire analgesics. In patients receiving analgesics, our pain protocol has shown to adequately treat pain, leading to a higher satisfaction for emergency health-care at discharge. This study emphasizes the importance of questioning pain score and desire for analgesics to prevent incorrect conclusions of inadequate pain management, as described in previous studies.
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Affiliation(s)
- Judith E van Zanden
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Susanne Wagenaar
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jack J M Ligtenberg
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Minhas H, Welsher A, Turcotte M, Eventov M, Mason S, Nishijima DK, Versmée G, Li M, de Wit K. Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta-analysis of prospective studies. Br J Haematol 2018; 183:119-126. [DOI: 10.1111/bjh.15509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/11/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Hersimren Minhas
- Chicago Medical School, Rosalind Franklin University; North Chicago IL USA
| | - Arthur Welsher
- Michael G. DeGroote School of Medicine, McMaster University; Hamilton ON Canada
| | | | | | - Suzanne Mason
- CURE School of Health and Related Research; University of Sheffield; Sheffield UK
| | - Daniel K. Nishijima
- Department of Emergency Medicine; University of California, Davis School of Medicine; Sacramento CA USA
| | - Grégoire Versmée
- Department of Biomedical Informatics; Harvard Medical School; Boston MA USA
| | - Meirui Li
- Department of Anatomical Pathology; Western University; London ON Canada
| | - Kerstin de Wit
- Divisions of Emergency Medicine and Hematology; McMaster University; Hamilton ON Canada
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Nater A, Tetreault LA, Kopjar B, Arnold PM, Dekutoski MB, Finkelstein JA, Fisher CG, France JC, Gokaslan ZL, Rhines LD, Rose PS, Sahgal A, Schuster JM, Vaccaro AR, Fehlings MG. Predictive factors of survival in a surgical series of metastatic epidural spinal cord compression and complete external validation of 8 multivariate models of survival in a prospective North American multicenter study. Cancer 2018; 124:3536-3550. [PMID: 29975401 DOI: 10.1002/cncr.31585] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/30/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Anick Nater
- Department of Neurosurgery, Toronto Western Hospital, University Health Network; University of Toronto; Toronto Ontario Canada
| | - Lindsay A. Tetreault
- Department of Neurosurgery, Toronto Western Hospital, University Health Network; University of Toronto; Toronto Ontario Canada
- Graduate Entry Medicine; University College Cork; Cork Ireland
| | - Branko Kopjar
- Department of Health Services, University of Washington; Seattle Washington
| | - Paul M. Arnold
- Department of Neurosurgery, University of Kansas; Kansas City Kansas
| | - Mark B. Dekutoski
- Department of Orthopaedic Surgery, CORE Institute; Sun City West Arizona
| | - Joel A. Finkelstein
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center; Toronto Ontario Canada
| | - Charles G. Fisher
- Department of Orthopaedic Surgery, University of British Columbia; Vancouver British Columbia Canada
- Department of Orthopaedic Surgery, Vancouver Coastal Health; Vancouver British Columbia Canada
| | - John C. France
- Department of Orthopaedic Surgery, West Virginia University; Morgantown West Virginia
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University; Providence Rhode Island
| | - Laurence D. Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peter S. Rose
- Department of Orthopaedic Surgery, Mayo Clinic; Rochester Minnesota
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center; Toronto, Ontario Canada
| | - James M. Schuster
- Department of Neurosurgery, University of Pennsylvania; Philadelphia Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Thomas Jefferson University; Philadelphia Pennsylvania
| | - Michael G. Fehlings
- Department of Neurosurgery, Toronto Western Hospital, University Health Network; University of Toronto; Toronto Ontario Canada
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Mashoufi M, Ayatollahi H, Khorasani-Zavareh D. A Review of Data Quality Assessment in Emergency Medical Services. Open Med Inform J 2018; 12:19-32. [PMID: 29997708 PMCID: PMC5997849 DOI: 10.2174/1874431101812010019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/22/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services. METHODS The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study. RESULTS The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved. CONCLUSION In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users' perspectives can provide a broader picture of the reasons for poor quality data.
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Affiliation(s)
- Mehrnaz Mashoufi
- PhD Student of Health Information Management, School of Health Management and Information Sciences, Tehran Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abebe Y, Dida T, Yisma E, Silvestri DM. Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia. BMC Emerg Med 2018; 18:7. [PMID: 29433441 PMCID: PMC5810000 DOI: 10.1186/s12873-018-0158-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes. RESULTS Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity. CONCLUSIONS Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
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Affiliation(s)
- Yonas Abebe
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Dida
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Engida Yisma
- School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David M. Silvestri
- National Clinician Scholars Program and Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
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Pizzuti L, Marchetti P, Natoli C, Gamucci T, Santini D, Scinto AF, Iezzi L, Mentuccia L, D'Onofrio L, Botticelli A, Moscetti L, Sperati F, Botti C, Ferranti F, Buglioni S, Sanguineti G, Di Filippo S, di Lauro L, Sergi D, Catenaro T, Tomao S, Giordano A, Maugeri-Saccà M, Barba M, Vici P. Fasting glucose and body mass index as predictors of activity in breast cancer patients treated with everolimus-exemestane: The EverExt study. Sci Rep 2017; 7:10597. [PMID: 28878375 PMCID: PMC5587713 DOI: 10.1038/s41598-017-10061-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022] Open
Abstract
Evidence on everolimus in breast cancer has placed hyperglycemia among the most common high grade adverse events. Anthropometrics and biomarkers of glucose metabolism were investigated in a observational study of 102 postmenopausal, HR + HER2- metastatic breast cancer patients treated with everolimus-exemestane in first and subsequent lines. Best overall response (BR) and clinical benefit rate (CBR) were assessed across subgroups defined upon fasting glucose (FG) and body mass index (BMI). Survival was estimated by Kaplan-Meier method and log-rank test. Survival predictors were tested in Cox models. Median follow up was 12.4 months (1.0–41.0). The overall cohort showed increasing levels of FG and decreasing BMI (p < 0.001). Lower FG fasting glucose at BR was more commonly associated with C/PR or SD compared with PD (p < 0.001). We also observed a somewhat higher BMI associated with better response (p = 0.052). More patients in the lowest FG category achieved clinical benefit compared to the highest (p < 0.001), while no relevant differences emerged for BMI. Fasting glucose at re-assessment was also predictive of PFS (p = 0.037), as confirmed in models including BMI and line of therapy (p = 0.049). Treatment discontinuation was significantly associated with changes in FG (p = 0.014). Further research is warranted to corroborate these findings and clarify the underlying mechanisms.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit Policlinico Sant'Andrea, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. d'Annunzio University, Via dei Vestini, 66100, Chieti, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, SS Trinità Hospital, S.Marciano, 03039, Sora, Frosinone, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 200, 00128, Roma, Italy
| | - Angelo Fedele Scinto
- Medical Oncology, Ospedale San Giovanni Calibita Fatebenefratelli, ISOLA TIBERINA, Piazza In Piscinula 13 -, 00153, Roma, Italy
| | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. d'Annunzio University, Via dei Vestini, 66100, Chieti, Italy
| | - Lucia Mentuccia
- Medical Oncology Unit, SS Trinità Hospital, S.Marciano, 03039, Sora, Frosinone, Italy
| | - Loretta D'Onofrio
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 200, 00128, Roma, Italy
| | - Andrea Botticelli
- Medical Oncology Unit Policlinico Sant'Andrea, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Luca Moscetti
- Department of Oncology and Haematology, Azienda Ospedaliera Policlinico, Via del Pozzo 71, 41124, Modena, Italy
| | - Francesca Sperati
- Biostatistics Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Claudio Botti
- Department of Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Ferranti
- Department of Radiology, Regina Elena National Cancer Institue, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Simona Di Filippo
- Emergency Department, Santa Maria Goretti Hospital, Via Canova 3, 04100, Latina, Italy
| | - Luigi di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Teresa Catenaro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, La "Sapienza" University of Rome, Oncology Unit, Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana 1668, 04100, Latina, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, 1900 N, 12th Street, Temple University, Philadelphia, PA, USA
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. .,Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Kuberski T, Yourison I. Coccidioidomycosis A Cause of Sarcoidosis. Open Forum Infect Dis 2017; 4:ofw117. [PMID: 28717672 PMCID: PMC5502954 DOI: 10.1093/ofid/ofw117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/24/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sarcoidosis is a granulomatous disease of unknown etiology and coccidioidomycosis is a granulomatous fungal infection endemic to the southwestern United States. Clinical observations on patients with sarcoidosis and coccidioidomycosis simultaneously led to the hypothesis that sarcoidosis can be caused by the fungus Coccidioides. METHODS Two patients with sarcoidosis and coccidioidomycosis were studied, one prospectively (ie, a patient with sarcoidosis was predicted to develop coccidioidomycosis) and the other retrospectively (ie, a patient with coccidioidomycosis develops sarcoidosis). In addition, a literature review found 5 patients with these 2 diseases, and they were analyzed to establish an archived relationship between the 2 entities. In addition, polymerase chain reaction (PCR) testing for Coccidioides deoxyribonucleic acid (DNA) was performed on tissue from 15 Arizona patients diagnosed with sarcoidosis. RESULTS Patient 1 was diagnosed with sarcoid in Arizona and followed prospectively. There was no evidence for coccidioidomycosis at diagnosis. This patient was observed for 8 years before he was documented to have disseminated coccidioidomycosis. Patient 2 was retrospectively studied. He was diagnosed with disseminated coccidioidomycosis, but after 3 years, while on antifungal therapy, he developed respiratory failure. A lung biopsy was consistent with sarcoidosis with no evidence of Coccidioides; cultures, histopathology, and serology were all negative. Paradoxically, PCR testing for Coccidioides DNA on tissue taken at the time of the sarcoidosis diagnosis were all negative, including Patient 2 who had proven coccidioidomycosis. CONCLUSIONS The 2 study patients and 5 case reports from the literature support the hypothesis that Coccidioides can cause sarcoidosis in Arizona. There are similar reports in the literature that Histoplasma can be associated with sarcoidosis. Based on these observations, we propose that sarcoidosis can be caused by endemic fungi in different areas of the United States, coccidioidomycosis in the Southwest and histoplasmosis in the Midwest.
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Affiliation(s)
| | - Isaac Yourison
- School of Medicine, University of Arizona School of Medicine-Phoenix, Phoenix, Arizona
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Ukai T, Shikata S, Nakayama T, Takemura YC. A comparison of the results of prospective and retrospective cohort studies in the field of digestive surgery. Surg Today 2017; 47:789-794. [PMID: 28205020 DOI: 10.1007/s00595-017-1479-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We compared the results of prospective and retrospective cohort studies in the field of digestive surgery to clarify whether the results of prospective cohort studies were more similar to those of randomized controlled trials (RCTs). METHODS We conducted a secondary analysis of the results to compare the results of RCTs with those of cohort studies in meta-analyses of 18 digestive surgical topics. The data from the prospective and retrospective cohort studies were combined. The summary estimates of each design were compared with those of RCTs. We used the Z score to investigate discrepancies. RESULTS Twenty-nine outcomes of 11 topics were investigated in 289 cohort studies (prospective, n = 69; retrospective, n = 220). These were compared with the outcomes of 123 RCTs. In comparison to retrospective studies, the summary estimates of the prospective cohort studies were more similar to those of the RCTs [19/29 (prospective) vs. 10/29 (retrospective), P = 0.035). Five of the 29 outcomes of prospective studies and 6 of 29 outcomes of retrospective studies (P = 0.99) showed significant discrepancies in comparison to RCTs. CONCLUSIONS In the digestive surgical field, the results of prospective cohort studies tended to be more similar to those of RCTs than retrospective studies; however, there were no significant discrepancies between the two types of cohort study.
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Affiliation(s)
- Tomohiko Ukai
- Department of Community Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 515-3133, Japan
| | - Satoru Shikata
- Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yousuke C Takemura
- Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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41
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Ricketts D, Rogers RA, Roper T, Ge X. Recognising and dealing with complications in orthopaedic surgery. Ann R Coll Surg Engl 2016; 99:185-188. [PMID: 27917668 DOI: 10.1308/rcsann.2016.0364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Orthopaedic surgeons need information about the complications they are likely to encounter. The literature on complications is difficult to interpret owing to a lack of agreed definitions, problems with collecting accurate data and with data interpretation. We suggest a role for the Royal College of Surgeons and specialist societies in collecting and interpreting complications data.
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Affiliation(s)
- D Ricketts
- Brighton and Sussex University Hospitals NHS Trust , UK
| | - R A Rogers
- Brighton and Sussex University Hospitals NHS Trust , UK
| | - T Roper
- Brighton and Sussex NHS Library and Knowledge Service , UK
| | - X Ge
- People's Hospital of Rizhao , China
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Donin NM, Pantuck A, Klöpfer P, Bevan P, Fall B, Said J, Belldegrun AS, Chamie K. Body Mass Index and Survival in a Prospective Randomized Trial of Localized High-Risk Renal Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25:1326-32. [DOI: 10.1158/1055-9965.epi-16-0226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022] Open
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Kujawa-Myles S, Noel-Weiss J, Dunn S, Peterson WE, Cotterman KJ. Maternal intravenous fluids and postpartum breast changes: a pilot observational study. Int Breastfeed J 2015; 10:18. [PMID: 26113871 PMCID: PMC4480510 DOI: 10.1186/s13006-015-0043-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current breastfeeding initiation rate in Canada is approximately 87%. By one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. The aims of this pilot research study were to explore the relationship between intrapartum intravenous fluids given to mothers and postpartum breast swelling in the first 10 days postpartum and to determine if a larger study was warranted and feasible. METHODS A prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design was completed. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Daily data collection from admission into the study until postpartum day 10 took place. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema. RESULTS Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and more tender than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lactogenesis II. CONCLUSIONS The findings demonstrate that mothers in this pilot study who received intravenous fluids in labour and postpartum had higher levels of breast edema. These results suggest a larger study is warranted to more fully examine the effects of intravenous fluids on postpartum breast swelling.
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Affiliation(s)
- Sonya Kujawa-Myles
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Joy Noel-Weiss
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sandra Dunn
- Better Outcomes Registry & Network (BORN Ontario), Ottawa, Ontario Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
| | - Wendy E Peterson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
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Vellappally S, Gardens SJ, Al Kheraif AAA, Krishna M, Babu S, Hashem M, Jacob V, Anil S. The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents. BMC Oral Health 2014; 14:123. [PMID: 25273325 PMCID: PMC4190396 DOI: 10.1186/1472-6831-14-123] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the prevalence of malocclusion among 12-18-year-old disabled adolescents in Chennai, Tamil Nadu, India, by using the Dental Aesthetic Index (DAI) and to determine the association of malocclusion with dental caries. METHODS This cross-sectional study included 243 children with various mental disabilities with or without physical infirmities. The Dental Aesthetic Index (DAI) and the dentition status were recorded using the World Health Organization Oral Health Surveys - Basic Methods (1997) Pro-forma. The Decayed (D), Missing (M) and Filled (F) components of the DMF index were calculated using the Dentition Status and Treatment Need (DSTN). A Chi-square test, ANOVA, and t-test were used to derive inferential statistics. RESULTS The mean DAI score ± standard deviation was 39.0 ± 12.3. A total of 123 (50.6%) participants (74 males and 49 females) had DAI scores of 36 and above, which indicated a handicapping malocclusion requiring mandatory orthodontic treatment. Sixty-nine (28.4%) adolescents (36 males and 33 females) had DAI scores between 31 and 35, which indicated severe malocclusion, for which orthodontic intervention was desirable. Incisal segment crowding (84.8%) was the most common aspect of the malocclusion. The mean DMFT score was 4.36 ± 3.81, and 82.8% of the participants had a DMFT score > 0. There was no statistically significant correlation between the mean DAI and DMFT scores (r = 0.090, p = 0.15). Only 16 (6.6%) of the adolescents had minor or no anomaly not needing orthodontic treatment. CONCLUSIONS The prevalence of malocclusion and dental caries was found to be high. However, there was no positive correlation between the severity of malocclusion and dental caries among the surveyed disabled adolescents.
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Affiliation(s)
- Sajith Vellappally
- />Dental Health Department, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Post Box: 60169, Riyadh, 11433 Saudi Arabia
| | - Seby J Gardens
- />Department of Public Health Dentistry, Mahe Institute of Dental Sciences, Union Territory of Pondicherry, Pondicherry, India
| | - Abdul-Aziz Abdullah Al Kheraif
- />Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, 560013 Saudi Arabia
| | - Madhusudan Krishna
- />Krisha Devaraya College of Dental Sciences, Bangalore, 562157 Karnataka India
| | - Suresh Babu
- />Department of Public health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka India
| | - Mohamed Hashem
- />Dental Health Department, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, 11433 Saudi Arabia
| | - Vimal Jacob
- />Dental Caries Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sukumaran Anil
- />Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Post Box: 60169, Riyadh, 11545 India
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Buckley CM, Casey C, Bradley CP. Patientsmate: potentially a useful tool for documenting clinical performance. J Eval Clin Pract 2013; 19:1083. [PMID: 23387959 DOI: 10.1111/jep.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Cork, Ireland
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Tariq A, Georgiou A, Westbrook J. Medication incident reporting in residential aged care facilities: limitations and risks to residents' safety. BMC Geriatr 2012; 12:67. [PMID: 23122411 PMCID: PMC3547703 DOI: 10.1186/1471-2318-12-67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/04/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents' safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs' devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. METHODS The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. RESULTS The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. CONCLUSIONS This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.
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Affiliation(s)
- Amina Tariq
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, University of New South Wales, Kensington, Sydney, Australia
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Liddy C, Wiens M, Hogg W. Methods to achieve high interrater reliability in data collection from primary care medical records. Ann Fam Med 2011; 9:57-62. [PMID: 21242562 PMCID: PMC3022047 DOI: 10.1370/afm.1195] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We assessed interrater reliability (IRR) of chart abstractors within a randomized trial of cardiovascular care in primary care. We report our findings, and outline issues and provide recommendations related to determining sample size, frequency of verification, and minimum thresholds for 2 measures of IRR: the κ statistic and percent agreement. METHODS We designed a data quality monitoring procedure having 4 parts: use of standardized protocols and forms, extensive training, continuous monitoring of IRR, and a quality improvement feedback mechanism. Four abstractors checked a 5% sample of charts at 3 time points for a predefined set of indicators of the quality of care. We set our quality threshold for IRR at a κ of 0.75, a percent agreement of 95%, or both. RESULTS Abstractors reabstracted a sample of charts in 16 of 27 primary care practices, checking a total of 132 charts with 38 indicators per chart. The overall κ across all items was 0.91 (95% confidence interval, 0.90-0.92) and the overall percent agreement was 94.3%, signifying excellent agreement between abstractors. We gave feedback to the abstractors to highlight items that had a κ of less than 0.70 or a percent agreement less than 95%. No practice had to have its charts abstracted again because of poor quality. CONCLUSIONS A 5% sampling of charts for quality control using IRR analysis yielded κ and agreement levels that met or exceeded our quality thresholds. Using 3 time points during the chart audit phase allows for early quality control as well as ongoing quality monitoring. Our results can be used as a guide and benchmark for other medical chart review studies in primary care.
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Affiliation(s)
- Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Herdan A, Roth R, Grass D, Klimek M, Will S, Schauf B, Rossaint R, Heesen M. Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section. ACTA ACUST UNITED AC 2010; 8:121-127. [PMID: 21654900 PMCID: PMC3083505 DOI: 10.1007/s10397-010-0648-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/03/2010] [Indexed: 01/22/2023]
Abstract
Hypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of RCTs using the Consolidated Standards of Reporting Trials (CONSORT) statement since low quality can lend false credibility to a study and overestimate the effect of an intervention. We performed a systematic literature search in PubMed to identify relevant RCTs in a pre-CONSORT period (1990-1994) and a post-CONSORT period (2004-2008). A comparative evaluation was done between the two periods, and the trials were assessed for compliance with each of the 22 CONSORT items. A total of 37 RCTs was identified. The CONSORT score increased significantly (p < 0.05) from 66.7% (±12.5%) in the pre-CONSORT period to 87.4% (±6.9%) in the post-CONSORT period. A statistically significant improvement was found for eight items, including randomization, blinding and intention-to-treat analysis. The CONSORT score in the post-CONSORT era was fairly good, also in comparison to other medical fields. In the post-CONSORT era, reporting of important items improved, in particular in the domains that are crucial to avoid bias and to improve internal validity. Use of CONSORT should be encouraged in order to keep or even improve the reporting quality.
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Affiliation(s)
- A. Herdan
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - R. Roth
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - D. Grass
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - M. Klimek
- Department of Anesthesia, Erasmus Medical Center, Dr. Molewaterplein, 1101 Rotterdam, The Netherlands
| | - S. Will
- Department of Obstetrics, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - B. Schauf
- Department of Obstetrics, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
| | - R. Rossaint
- Department of Anesthesia, University Hospital of RWTH Aachen, Pauwelsstr. 50, 52074 Aachen, Germany
| | - M. Heesen
- Department of Anesthesia, Sozialstiftung Bamberg, Buger Str. 80, 96049 Bamberg, Germany
- Klinik für Anästhesie, Klinikum Bamberg, Buger Str.80, 96049 Bamberg, Germany
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Fathelrahman AI. Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. BMC Res Notes 2009; 2:183. [PMID: 19751526 PMCID: PMC2753346 DOI: 10.1186/1756-0500-2-183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 09/14/2009] [Indexed: 11/29/2022] Open
Abstract
Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k) and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed.
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Affiliation(s)
- Ahmed I Fathelrahman
- National Poison Center, Universiti Sains Malaysia, Minden, 11800 USM Pulau Pinang, Malaysia.
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50
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KHUÊ P, MALLET A, VEZIRIS N, JARLIER V, ROBERT J. Evaluation of data quality in a laboratory-based surveillance of M. tuberculosis drug resistance and impact on the prevalence of resistance: France, 2004. Epidemiol Infect 2008; 136:1172-8. [PMID: 18028573 PMCID: PMC2870927 DOI: 10.1017/s0950268807009867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2007] [Indexed: 11/05/2022] Open
Abstract
In France, surveillance of anti-tuberculosis drug resistance is performed by the Azay-Mycobacteria network, representing 30% of all culture-positive cases. We sought to validate administrative and clinical data gathered by the network in 2004 and to produce corrected resistance rates accounting for the observed misclassification. We reviewed a 10% sample of patients' records diagnosed in 2004 and measured the agreement between controlled data and data collected by the network by using the kappa (kappa) statistic. A re-sampling bootstrap-based method was used to investigate the impact of bias found on resistance rates. Most of data collected by the network, such as demographic data, and country of birth had an excellent agreement (kappa>0.8) with controlled data. The concordance was good (kappa>0.6) for HIV status and tuberculosis site. The only variable slightly discordant with controlled data was prior history of treatment (kappa=0.52). However, after correcting crude resistance rates for the observed misclassification, all estimated rates were within confidence intervals based on reported rates. This validation study is in favour of a good quality of data produced by the network, even though corrected rates are slightly different from observed rates. Therefore, data collected through the network may be used for policy making and tuberculosis programme evaluation. However, improvement in data collection regarding prior history of treatment should be considered.
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Affiliation(s)
- P. M. KHUÊ
- Université Pierre et Marie Curie, Paris 6, France
| | - A. MALLET
- Université Pierre et Marie Curie, Paris 6, Département de Biostatistiques et Information Médicale EA3974 – APHP Groupe Hospitalier Pitié-Salpêtrière France
| | - N. VEZIRIS
- Université Pierre et Marie Curie, Paris 6, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, APHP Groupe Hospitalier Pitié-Salpêtrière, France
| | - V. JARLIER
- Université Pierre et Marie Curie, Paris 6, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, APHP Groupe Hospitalier Pitié-Salpêtrière, France
| | - J. ROBERT
- Université Pierre et Marie Curie, Paris 6, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, APHP Groupe Hospitalier Pitié-Salpêtrière, France
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