Central Oxygen Venous Saturation and Mortality in Patients Undergoing Coronary Artery Bypass Grafting.

Purpose: Central venous oxygen saturation (ScvO2) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO2 and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia. Patients and Methods: A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO2 <60% upon admission to the intensive care unit (ICU) following surgery. The major outcome was mortality rates after 30 days. Furthermore, exposure variables were measured at preoperative, intra-operative, and postoperative time points. Results: A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO2 <60% upon ICU admission compared with those with higher saturation levels (relative risk 4.2, 95% confidence interval: 2.4-7.2; p = 0.001). Values were adjusted using variables such as age (>75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (>60 min), and intra-operative inotrope use. The primary cause of death was cardiogenic shock (54.7%), followed by sepsis (25.0%) and postoperative bleeding (17.2%). Conclusion: The study identified an association between ScvO2 <60% and in-hospital mortality in patients undergoing CABG.

Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia.

BACKGROUND: The aim of this study was to determine the factors associated with in-hospital mortality after a coronary artery bypass (CABG) in a high-complexity clinic in the city of Santiago de Cali, Colombia. METHODS: A retrospective case-control analytical study was performed. Cases were defined as adult patients that had undergone CABG and died within 30 days of the surgery. Patients aged ≥18 years that had undergone isolated surgeries were included, i.e. procedures without other interventions combined. Patients were excluded from this study if: 1) they had missing data in their medical records; 2) they had previously been in a state of coma; or 3) they had previously undergone cardiac surgery other than a bypass procedure. Exposure variables were measured at three stages: preoperative, intraoperative, and postoperative. RESULTS: The study included 77 cases and 308 controls. The most common cause of death was cardiogenic shock (53.2%), followed by sepsis (27.3%). The multinomial logistic regression model revealed an association of in-hospital mortality with preoperative variables of age >75 years (odds ratio [OR] 2.5, 95% confidence interval [95% CI]: 1.1-5.8, P=0.032), low socioeconomic status (OR=2.3, 95% CI: 1.1-5.2, P=0.034), heart failure (HF) (OR=3.2, 95% CI: 1.5-7.0, P=0.002), unstable angina (OR=4.2, 95% CI: 1.9-9.0, P=0.000), acute myocardial infarction (AMI)≤7 days (OR=3.9, 95% CI: 1.1-13.7, P=0.037), chronic kidney insufficiency (CKI) (OR=2.9, 95% CI: 1.2-7.0, P=0.018), peripheral vascular disease (PVD) (OR=2.8, 95% CI: 1.2-6.8, P=0.019), and urgent/emergent surgery (OR=8.2, 95% CI: 2.0-34.5, P=0.004). Of the intraoperative variables, the model showed an association between the use of inotropic agents (OR=2.8, 95% CI: 1.3-6.4, P=0.011) and cardiogenic shock (OR=50.6, 95% CI: 7.5-339, P=0.000). CONCLUSIONS: This study identifies the factors during preoperative and intraoperative periods that are associated with in-hospital mortality in patients that have undergone CABG.

Aerobic Physical Exercise for Pain Intensity, Aerobic Capacity, and Quality of Life in Patients With Chronic Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Currently, chronic pain is a disabling condition that is difficult to manage, which generates a high burden on health systems. The objective is to determine the effects of aerobic physical exercise in adults with chronic pain. METHODS: A systematic review of searches in databases including MEDLINE, LILACS, ScienceDirect, PEDro, OTseeker, The Cochrane Library, EBSCO, and Google Scholar was conducted. The search process was carried out until July 31, 2020, and the study selection process was independently carried out through a criteria analysis for each phase. Outcome measures were chosen: aerobic capacity, physical function, quality of life, and pain. RESULTS: Twenty-seven studies were included in which aerobic exercise was considered as an option to treat chronic pain. These studies showed significant results compared with other treatment options in terms of pain measurements (-0.22 [-0.42 to -0.03]) and aerobic capacity. For quality of life, there were significant improvements in the physical function component over the mental health component evaluated with the short form health survey-36/12. CONCLUSION: Aerobic exercise is a nonpharmacological therapeutic option for treatment. Also, aerobic capacity and endurance improved when this type of exercise was prescribed, thus resulting in a substantial improvement in the quality of life of people suffering from chronic pain.

Safety of the 9-Valent Human Papillomavirus Vaccine.

BACKGROUND: The 9-valent human papillomavirus vaccine (9vHPV) was approved for females and males aged 9 to 26 years in 2014. We analyzed postlicensure surveillance reports to the Vaccine Adverse Event Reporting System (VAERS). METHODS: We searched VAERS data for US reports of adverse events (AEs) after 9vHPV from December 2014 through December 2017. We calculated reporting rates and conducted empirical Bayesian data mining to identify disproportional reporting. Physicians reviewed reports for selected prespecified conditions. RESULTS: VAERS received 7244 reports after 9vHPV: 31.2% among females, 21.6% among males, and for 47.2%, sex was not reported. Overall, 97.4% of reports were nonserious. Dizziness, syncope, headache, and injection site reactions were most commonly reported; the most commonly reported AEs were similar between females and males. Two reports of death after 9vHPV were verified; no information in autopsy reports or death certificates suggested a causal relationship with vaccination. Approximately 28 million 9vHPV doses were distributed during the study period; crude AE reporting rates were 259 reports per million 9vHPV doses distributed for all reports and 7 per million doses distributed for serious reports. Syncope (a known AE associated with human papillomavirus vaccination) and several types of vaccine administration errors (eg, administered at wrong age) exceeded the statistical threshold for empirical Bayesian data mining findings. CONCLUSIONS: No new or unexpected safety concerns or reporting patterns of 9vHPV with clinically important AEs were detected. The safety profile of 9vHPV is consistent with data from prelicensure trials and from postmarketing safety data of its predecessor, the quadrivalent human papillomavirus vaccine.

Emotions and decision rules in discrete choice experiments for valuing health care programmes for the elderly.

The evaluation of health care programmes is commonly approached with stated preference methods such as contingent valuation or discrete choice experiments. These methods provide useful information for policy decisions involving health regulations and infrastructures for health care. However, econometric modelling of these data usually relies on a number of maintained assumptions, such as the use of the compensatory or random utility maximization rule. On the other hand, health policy issues can raise emotional concerns among individuals, which might induce other types of choice behaviour. In this paper we consider potential deviations from the general compensatory rule, and how these deviations might be explained by the emotional state of the subject. We utilized a mixture econometric model which allows for various potential decisions rules within the sample, such as the complete ignorance, conjunctive rule and satisfactory rules. The results show that deviations from the full linear compensatory decision rule are predominant, but they are significantly less observed for those subjects with a medium emotional state about the issue of caring for the health state of the elderly. The implication is that the emotional impact of health policy issues should be taken into account when making assumptions of individual choice behaviour in health valuation methods.

Evaluating residents' preferences for remediation technologies: A choice experiment approach.

The choice of technologies used to remediate contaminated environments is increasingly made through engagement with a multitude of stakeholders including affected residents. Despite this, little is known about how residents perceive remediation technology applications. In this study a choice experiment is designed to explore ways of understanding and measuring residents' preferences for different remediation technologies approaches using a sample of 944 residents in New South Wales, Australia. Analysis reveals that the residents' acceptability of remediation technologies can be explained by both the efficacy of the technology in improving the environmental quality of the community, and the reputational value of the technology. In particular it is found that residents prefer Monitor Natural Attenuation and Bioremediation to other remediation technologies. In particular they are willing to pay an increase in yearly taxes of $44.60 and $41.15 respectively for implementing such technologies instead of alternative remediation technologies like Chemical remediation.

Post-licensure safety monitoring of quadrivalent human papillomavirus vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2009-2015.

BACKGROUND: The Food and Drug Administration (FDA) approved quadrivalent human papillomavirus vaccine (4vHPV) for use in females and males aged 9-26 years, since 2006 and 2009 respectively. We characterized reports to the Vaccine Adverse Event Reporting System (VAERS), a US spontaneous reporting system, in females and males who received 4vHPV vaccination. METHODS: We searched VAERS for US reports of adverse events (AEs) following 4vHPV from January 2009 through December 2015. Signs and symptoms were coded using Medical Dictionary for Regulatory Activities (MedDRA). We calculated reporting rates and conducted empirical Bayesian data mining to identify disproportional reports. Clinicians reviewed available information, including medical records, and reports of selected pre-specified conditions. FINDINGS: VAERS received 19,760 reports following 4vHPV; 60.2% in females, 17.2% in males, and in 22.6% sex was missing. Overall, 94.2% of reports were non-serious; dizziness, syncope and injection site reactions were commonly reported in both males and females. Headache, fatigue and nausea were commonly reported serious AEs. More than 60 million 4vHPV doses were distributed during the study period. Crude AE reporting rates were 327 reports per million 4vHPV doses distributed for all reports, and 19 per million for serious reports. Among 29 verified reports of death, there was no pattern of clustering of deaths by diagnosis, co-morbidities, age, or interval from vaccination to death. INTERPRETATION: No new or unexpected safety concerns or reporting patterns of 4vHPV with clinically important AEs were detected. Safety profile of 4vHPV is consistent with data from pre-licensure trials and postmarketing safety data.

The effect of medical experience on the economic evaluation of health policies. A discrete choice experiment.

In this paper we present results on the effect of medical experience on the economic evaluation of health policies utilizing the method of discrete choice experiments. Subjects in two split samples were asked about choice situations involving alternative profiles defined by the attributes of an innovative program for cervical cancer screening. The first sample was formed by expert medical practitioners who were familiar with the illness and its potential treatments. A second sample was formed by young undergraduate students in social sciences who were not familiar with the illness or with the potential benefits of screening programmes. The statistical comparison between both subsamples utilizes a robust method for discrete choice models which shows that there are no significant differences in the structural models and the parameter estimates. The main implication is that background medical information and familiarity with the process of illness might not have a relevant impact on the valuation of health policies with discrete choice experiments.

Economic evaluation of health effects with preference imprecision.

The estimation of economic benefits of health effects through direct methods, such as contingent valuation, presents the problem of preference imprecision. This paper deals with this problem by proposing an elicitation method that allows the subject to state an interval for willingness to pay, without inducing any specific amount as a response. The paper also analyzes the effects of the context where changes in health occur on the associated imprecision level and the estimates, by comparing a situation without context with another in which effects are due to atmospheric pollution. The econometric modelling develops a Bayesian estimation method for censored intervals, which models the existing uncertainty between the lower and upper limits derived from the elicitation process. Results prove that data dispersion is significantly higher for the non-contextual scenario, and increases for the most severe symptoms.

Willingness to pay for health risk reduction in the context of altruism.

This paper presents results on the valuation of health risks in the presence of altruism. The contingent valuation method is utilised in a split sample experiment for estimating the private and public values in reducing the risk of flu. Data modelling for the dichotomous choice method follows a Bayesian approach, which accounts for zero responses and is adequate for the comparison of small sample results. The results of the experiment suggest that altruism is a positive component in the value of reducing the probability of flu, which depends positively on the number of days involved, the health status and the personal income of the subject. The marginal value of risk is found to be a decreasing function of the reduction in the probability of becoming ill.