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1.
J Card Surg ; 35(6): 1180-1185, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32531129

ABSTRACT

BACKGROUND: Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real-time imaging, with the goal of minimizing complications and ensuring appropriate cannula positioning. Nonetheless, the patients' critical and unstable conditions often require emergent initiation of ECMO and preclude the safe transport of the patient to a procedural suite. AIMS: Therefore, with the objective of avoiding delay with the initiation of therapy and reducing the hazard of transport, we implemented a protocol for bedside ECMO cannulation. MATHERIAL AND METHODS: A total of 89 patients required ECMO support at Hennepin County Medical Center between March 2015 and December 2019. Twenty-eight (31%) required veno-venous support and were all cannulated at the bedside. Overall survival was 71% with no morbidity or mortality related to the cannulation procedure. CONCLUSION: In the current pandemic, the strategy of veno-venous bedside cannulation may have additional benefits for the care of patients with refractory acute respiratory distress syndrome due to coronavirus-disease-2019, decreasing the risk of exposure of health care worker or other patients to the novel severe acute respiratory syndrome coronavirus-2 occurring during patient transport, preparation, or during disinfection of the procedural suite and the transportation pathway after ECMO cannulation.


Subject(s)
Catheterization/methods , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation/methods , Hospital Mortality , Pandemics/prevention & control , Pneumonia, Viral/therapy , Safety Management/methods , Betacoronavirus , Catheterization/statistics & numerical data , China , Cohort Studies , Coronavirus Infections/epidemiology , Critical Care/methods , Extracorporeal Membrane Oxygenation/statistics & numerical data , Female , Humans , Intensive Care Units , Male , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Patient Safety , Pneumonia, Viral/epidemiology , Point-of-Care Systems , Retrospective Studies , Risk Assessment , Survival Analysis
2.
Medicine (Baltimore) ; 99(21): e20257, 2020 May 22.
Article in English | MEDLINE | ID: mdl-32481303

ABSTRACT

BACKGROUND: Fibromyalgia (FM) is a common chronic pain condition that seriously affects the quality of patient lives. Its etiology, pathogenesis, and treatment still remain uncertain. Dietary supplements have been widely trialed for symptom relief for FM. The review aims to synthesize the previous literature publications to assess the impact of herbs and dietary supplements on FM patients. METHODS: We will conduct a literature search in the following databases PubMed, MEDLINE, EMBASE, Cochrane Library, Scopus, and Global Health from database inception to December 2019. Clinical studies published in the English language that used human participants and address the efficacy, safety, and acceptability of herbs and dietary supplements on individuals with FM will be included. The risk of bias and quality assessment of each trial will be evaluated. If trials are enough, a meta-analysis will be conducted using software RevMan5.3, Cochrane Collaboration. RESULT: Our review will be the first attempt to facilitate evidence-based management using herbs and dietary supplements to treat patients with FM. CONCLUSION: The findings may provide a framework for future research and clinic practice in FM management. PROSPERO REGISTRATION NUMBER: CRD42020149941.


Subject(s)
Dietary Supplements/adverse effects , Fibromyalgia/therapy , Plants, Medicinal/adverse effects , Chronic Disease , Evaluation Studies as Topic , Female , Fibromyalgia/epidemiology , Fibromyalgia/psychology , Humans , Male , Outcome Assessment, Health Care , Quality of Life , Randomized Controlled Trials as Topic , Safety
3.
Trials ; 21(1): 520, 2020 Jun 12.
Article in English | MEDLINE | ID: mdl-32532356

ABSTRACT

OBJECTIVES: To assess the safety and therapeutic effects of allogeneic human dental pulp stem cells (DPSCs) in treating severe pneumonia caused by COVID-19. TRIAL DESIGN: This is a single centre, two arm ratio 1:1, triple blinded, randomized, placebo-controlled, parallel group, clinical trial. PARTICIPANTS: Twenty serious COVID-19 cases will be enrolled in the trial from April 6th to December 31st 2020. INCLUSION CRITERIA: hospitalised patients at Renmin Hospital of Wuhan University satisfy all criteria as below: 1)Adults aged 18-65 years;2)Voluntarily participate in this clinical trial and sign the "informed consent form" or have consent from a legal representative.3)Diagnosed with severe pneumonia of COVID-19: nucleic acid test SARS-CoV-2 positive; respiratory distress (respiratory rate > 30 times / min); hypoxia (resting oxygen saturation < 93% or arterial partial pressure of oxygen / oxygen concentration < 300 mmHg).4)COVID-19 featured lung lesions in chest X-ray image. EXCLUSION CRITERIA: Patients will be excluded from the study if they meet any of the following criteria. 1.Patients have received other experimental treatment for COVID-19 within the last 30 days;2.Patients have severe liver condition (e.g., Child Pugh score >=C or AST> 5 times of the upper limit);3.Patients with severe renal insufficiency (estimated glomerular filtration rate <=30mL / min/1.73 m2) or patients receiving continuous renal replacement therapy, hemodialysis, peritoneal dialysis;4.Patients who are co-infected with HIV, hepatitis B, tuberculosis, influenza virus, adenovirus or other respiratory infection viruses;5.Female patients who have no sexual protection in the last 30 days prior to the screening assessment;6.Pregnant or lactating women or women using estrogen contraception;7.Patients who are planning to become pregnant during the study period or within 6 months after the end of the study period;8.Other conditions that the researchers consider not suitable for participating in this clinical trial. INTERVENTION AND COMPARATOR: There will be two study groups: experimental and control. Both will receive all necessary routine treatment for COVID-19. The experimental group will receive an intravenous injection of dental pulp stem cells suspension (3.0x107 human DPSCs in 30ml saline solution) on day 1, 4 and 7; The control group will receive an equal amount of saline (placebo) on the same days. Clinical and laboratory observations will be performed for analysis during a period of 28 days for each case since the commencement of the study. MAIN OUTCOMES: 1. Primary outcome The primary outcome is Time To Clinical Improvement (TTCI). By definition, TTCI is the time (days) it takes to downgrade two levels from the following six ordered grades [(grade 1) discharge to (grade 6) death] in the clinical state of admission to the start of study treatments (hDPSCs or placebo). Six grades of ordered variables: GradeDescriptionGrade 1:Discharged of patient;Grade 2:Hospitalized without oxygen supplement;Grade 3:Hospitalized, oxygen supplement is required, but NIV / HFNC is not required;Grade 4:Hospitalized in intensive care unit, and NIV / HFNC treatment is required;Grade 5:Hospitalized in intensive care unit, requiring ECMO and/or IMV;Grade 6:Death. ABBREVIATIONS: NIV, non-invasive mechanical ventilation; HFNC, high-flow nasal catheter; IMV, invasive mechanical ventilation. 2. Secondary outcomes 2.1 vital signs: heart rate, blood pressure (systolic blood pressure, diastolic blood pressure). During the screening period, hospitalization every day (additional time points of D1, D4, D7 30min before injection, 2h ± 30min, 24h ± 30min after the injection) and follow-up period D90 ± 3 days. 2.2 Laboratory examinations: during the screening period, 30 minutes before D1, D4, D7 infusion, 2h ± 30min, 24h ± 30min after the end of infusion, D10, D14, D28 during hospitalization or discharge day and follow-up period D90 ± 3 days. 2.3 Blood routine: white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, neutrophils, lymphocytes, monocytes, eosinophils Acidic granulocyte count, basophil count, red blood cell, hemoglobin, hematocrit, average volume of red blood cells, average red blood cell Hb content, average red blood cell Hb concentration, RDW standard deviation, RDW coefficient of variation, platelet count, platelet specific platelet average Volume, platelet distribution width,% of large platelets; 2.4 Liver and kidney function tests: alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, prealbumin, total protein, albumin, globulin, white / globule ratio , Total bilirubin, direct bilirubin, cholinesterase, urea, creatinine, total carbon dioxide, uric acid glucose, potassium, sodium, chlorine, calcium, corrected calcium, magnesium, phosphorus, calcium and phosphorus product, anion gap, penetration Pressure, total cholesterol, triacylglycerol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, lipoprotein a, creatine kinase, lactate dehydrogenase, estimated glomerular filtration rate. 2.5 Inflammation indicators: hypersensitive C-reactive protein, serum amyloid (SAA); 2.6 Infectious disease testing: Hepatitis B (HBsAg, HBsAb, HBeAg, HBeAb, HBcAb), Hepatitis C (Anti-HCV), AIDS (HIVcombin), syphilis (Anti-TP), cytomegalovirus CMV-IgM, cytomegalovirus CMV-IgG; only during the screening period and follow-up period D90 ± 3. 2.7 Immunological testing: Collect peripheral blood to detect the phenotype of T lymphocyte, B lymphocyte, natural killer cell, Macrophage and neutrophil by using flow cytometry. Collect peripheral blood to detect the gene profile of mononuclear cells by using single-cell analyses. Collect peripheral blood serum to detect various immunoglobulin changes: IgA, IgG, IgM, total IgE; Collect peripheral blood serum to explore the changes of cytokines, Th1 cytokines (IL-1 ß, IL-2, TNF-a, ITN-γ), Th2 cytokines (IL-4, IL-6, IL -10). 2.8 Pregnancy test: blood ß-HCG, female subjects before menopause are examined during the screening period and follow-up period D90 ± 3. 2.9 Urine routine: color, clarity, urine sugar, bilirubin, ketone bodies, specific gravity, pH, urobilinogen, nitrite, protein, occult blood, leukocyte enzymes, red blood cells, white blood cells, epithelial cells, non-squamous epithelial cells , Transparent cast, pathological cast, crystal, fungus; 2.10 Stool Routine: color, traits, white blood cells, red blood cells, fat globules, eggs of parasites, fungi, occult blood (chemical method), occult blood (immune method), transferrin (2h ± 30min after the injection and not detected after discharge). RANDOMIZATION: Block randomization method will be applied by computer to allocate the participants into experimental and control groups. The random ratio is 1:1. BLINDING (MASKING): Participants, outcomes assessors and investigators (including personnel in laboratory and imaging department who issue the sample report or image observations) will be blinded. Injections of cell suspension and saline will be coded in accordance with the patient's randomisation group. The blind strategy is kept by an investigator who does not deliver the medical care or assess primary outcome results. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Twenty participants will be randomized to the experimental and control groups (10 per group). TRIAL STATUS: Protocol version number, hDPSC-CoVID-2019-02-2020 Version 2.0, March 13, 2020. Patients screening commenced on 16th April and an estimated date of the recruitment of the final participants will be around end of July. . TRIAL REGISTRATION: Registration: World Health Organization Trial Registry: ChiCTR2000031319; March 27,2020. ClinicalTrials.gov Identifier: NCT04336254; April 7, 2020 Other Study ID Numbers: hDPSC-CoVID-2019-02-2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Subject(s)
Coronavirus Infections/therapy , Dental Pulp/cytology , Pneumonia, Viral/therapy , Randomized Controlled Trials as Topic , Stem Cell Transplantation/methods , Adolescent , Adult , Aged , Betacoronavirus , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Pandemics , Stem Cell Transplantation/adverse effects , Transplantation, Homologous , Young Adult
4.
Indian Heart J ; 72(2): 128-130, 2020.
Article in English | MEDLINE | ID: mdl-32534687

ABSTRACT

COVID-19 pandemic is creating havoc in the world. It is also spreading in India creating a massive healthcare problem. Few major hospitals were closed down because of the spread among healthcare personnel. Management of several commonly occurring diseases needed modifications to a lesser or greater extent because of this pandemic. Management of acute coronary syndrome (ACS) also requires certain modifications. In this opinion paper an attempt has been made to give an outline of ACS management in this changed scenario.


Subject(s)
Acute Coronary Syndrome/therapy , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Infection Control/organization & administration , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Disease Management , Female , Humans , India , Male , Pandemics/statistics & numerical data , Patient Care Team/organization & administration , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Risk Assessment , Severity of Illness Index , Survival Analysis
5.
Indian Heart J ; 72(2): 61-64, 2020.
Article in English | MEDLINE | ID: mdl-32534691

ABSTRACT

The huge impact of the COVID-19 pandemic on global healthcare systems has prompted search for novel tools to stem the tide. Attention has turned to the digital health community to provide possible health solutions in this time of unprecedented medical crisis to mitigate the impact of this pandemic. The paper shall focus on how digital solutions can impact healthcare during this pandemic.


Subject(s)
Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Public Health/trends , Telemedicine/organization & administration , Coronavirus Infections/prevention & control , Female , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Program Development , Program Evaluation
6.
Indian Heart J ; 72(2): 70-74, 2020.
Article in English | MEDLINE | ID: mdl-32534693

ABSTRACT

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.


Subject(s)
Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Myocardial Infarction/therapy , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Cardiology , Coronavirus Infections/epidemiology , Disease Management , Female , Humans , India , Male , Myocardial Infarction/diagnosis , Pandemics/statistics & numerical data , Patient Selection , Pneumonia, Viral/epidemiology , Societies, Medical/organization & administration , Treatment Outcome
7.
J Tradit Chin Med ; 40(3): 497-508, 2020 06.
Article in English | MEDLINE | ID: mdl-32506865

ABSTRACT

The TCM protocol in the Diagnosis and Treatment Protocol for corona virus disease 2019 (COVID-19) (Trial Version 7) has been updated from previous versions. The protocol was formulated under the direct leadership of the National Administration of Traditional Chinese Medicine, based on the experience of a panel of experts, supported by evidence from fever clinics and from the outcomes of emergency (EM) observation rooms and inpatients throughout China (especially in Wuhan, Hubei Province) in combination with the latest scientific research results and data. The present interpretation of the TCM protocol is based on an overall understanding of the revised content, and aims to guide and standardize its clinical application to provide a reference for clinicians.


Subject(s)
Betacoronavirus/drug effects , Coronavirus Infections , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional/methods , Pandemics , Pneumonia, Viral , China , Clinical Protocols , Humans , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Phytotherapy
8.
Langenbecks Arch Surg ; 405(3): 359-364, 2020 May.
Article in English | MEDLINE | ID: mdl-32385568

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeons have had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. PURPOSE: To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safely accommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergency surgery and oncological patients or jeopardizing the well-being of hospital staff. CONCLUSIONS: The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life while maintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards and operating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidently and successfully undertake their respective clinical duties.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Infection Control/methods , Outcome Assessment, Health Care , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Surgical Procedures, Operative/standards , Betacoronavirus , Coronavirus Infections/prevention & control , Female , Germany , Hospitals, University , Humans , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Care/standards , Patient Isolation , Pneumonia, Viral/prevention & control
9.
Isr Med Assoc J ; 22(5): 303-309, 2020 May.
Article in English | MEDLINE | ID: mdl-32378823

ABSTRACT

BACKGROUND: Survivors of acute myocardial infarction (AMI) are at increased risk for recurrent cardiac events and tend to use excessive healthcare services, thus resulting in increased costs. OBJECTIVES: To evaluate the disparities in healthcare resource utilization and costs throughout a decade following a non-fatal AMI according to sex and ethnicity groups in Israel. METHODS: A retrospective study included AMI patients hospitalized at Soroka University Medical Center during 2002-2012. Data were obtained from electronic medical records. Post-AMI annual length of hospital stay (LOS); number of visits to the emergency department (ED), primary care facilities, and outpatient consulting clinics; and costs were evaluated and compared according sex and ethnicity groups. RESULTS: A total of 7685 patients (mean age 65.3 ± 13.6 years) were analyzed: 56.8% Jewish males (JM), 26.6% Jewish females (JF), 12.4% Bedouin males (BM), and 4.2% Bedouin females (BF). During the up-to 10-years follow-up (median 5.8 years), adjusted odds ratios [AdjOR] for utilizations of hospital-associated services were highest among BF (1.628 for LOS; 1.629 for ED visits), whereas AdjOR for utilization of community services was lowest in BF (0.722 for primary clinic, 0.782 for ambulatory, and 0.827 for consultant visits), compared with JM. The total cost of BF was highest among the study groups (AdjOR = 1.589, P < 0.01). CONCLUSIONS: Long-term use of hospital-associated healthcare services and total costs were higher among Bedouins (especially BF), whereas utilization of ambulatory services was lower in these groups. Culturally and economically sensitive programs optimizing healthcare resources utilization and costs is warranted.


Subject(s)
Healthcare Disparities/statistics & numerical data , Myocardial Infarction/therapy , Patient Acceptance of Health Care/statistics & numerical data , Acute Disease , Adult , Aged , Arabs/statistics & numerical data , Female , Health Care Costs , Healthcare Disparities/economics , Humans , Israel , Jews/statistics & numerical data , Male , Middle Aged , Myocardial Infarction/economics , Outcome Assessment, Health Care , Retrospective Studies , Sex Factors
10.
BMJ ; 369: m1505, 2020 05 27.
Article in English | MEDLINE | ID: mdl-32461201

ABSTRACT

OBJECTIVE: To investigate the nature and extent of financial relationships between leaders of influential professional medical associations in the United States and pharmaceutical and device companies. DESIGN: Cross sectional study. SETTING: Professional associations for the 10 costliest disease areas in the US according to the US Agency for Healthcare Research and Quality. Financial data for association leadership, 2017-19, were obtained from the Open Payments database. POPULATION: 328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians. MAIN OUTCOME MEASURES: Proportion of leaders with financial ties to industry in the year of leadership, the four years before and the year after board membership, and the nature and extent of these financial relationships. RESULTS: 235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties. Total payments for 2017-19 leadership were almost $130m (£103m; €119m), with a median amount for each leader of $31 805 (interquartile range $1157 to $254 272). General payments, including those for consultancy and hospitality, were $24.8m and research payments were $104.6m-predominantly payments to academic institutions with association leaders named as principle investigators. Variation was great among the associations: median amounts varied from $212 for the American Psychiatric Association leaders to $518 000 for the American Society of Clinical Oncology. CONCLUSIONS: Financial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations. The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.


Subject(s)
Conflict of Interest/economics , Industry/economics , Physicians/economics , Societies, Scientific/economics , Consultants/statistics & numerical data , Cross-Sectional Studies , Drug Industry/economics , Equipment and Supplies/economics , Humans , Industry/ethics , Industry/organization & administration , Leadership , Outcome Assessment, Health Care , Physicians/ethics , Physicians/organization & administration , Societies, Scientific/organization & administration , Societies, Scientific/trends , United States/epidemiology , United States Agency for Healthcare Research and Quality/organization & administration
11.
Arthroscopy ; 36(5): 1308-1310, 2020 05.
Article in English | MEDLINE | ID: mdl-32370893

ABSTRACT

Proximal hamstring tendon injuries are uncommon injuries, and there are few high-quality studies of surgical procedures in the literature. Increasing standardization of outcome measures with the use of validated, injury-specific, patient-reported outcome measures will improve research in this area. This will allow better assessment of novel surgical techniques.


Subject(s)
Hamstring Muscles , Hamstring Tendons , Tendon Injuries , Humans , Outcome Assessment, Health Care , Rupture
12.
Medicine (Baltimore) ; 99(19): e19915, 2020 May.
Article in English | MEDLINE | ID: mdl-32384436

ABSTRACT

BACKGROUND: This study will assess the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) for patients with kidney stones (KS). METHODS: A comprehensive and systematic literature records search for studies will be conducted in MEDLINE, EMBASE, Cochrane Library, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these databases will be searched from inception to the present without language limitation. Cochrane risk of bias tool will be used to assess the methodological quality for all included studies. Statistical analysis is performed using RevMan 5.3 software. RESULTS: This study will provide synthesis of current evidence of ESWL for patients with KS through assessing primary outcomes of overall stone-free rate, and secondary outcomes of mean stone size (mm), pain intensity, urinary biochemical variables, mean hospital stay (day), quality of life, and adverse events. CONCLUSION: This study will provide recommendations for the effectiveness and safety of ESWL for patients with KS, which may help to guide clinician. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019157243.


Subject(s)
Extracorporeal Shockwave Therapy/methods , Kidney Calculi/therapy , Lithotripsy/methods , Humans , Meta-Analysis as Topic , Outcome Assessment, Health Care , Research Design , Systematic Reviews as Topic , Treatment Outcome
13.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Article in English | MEDLINE | ID: mdl-32384460

ABSTRACT

BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Osteoarthritis, Hip , Parkinson Disease/complications , Postoperative Complications , Recovery of Function , Reoperation , Aged , Arthroplasty, Replacement, Hip/methods , Case-Control Studies , Clinical Protocols , Female , Humans , Male , Middle Aged , Operative Time , Osteoarthritis, Hip/complications , Osteoarthritis, Hip/surgery , Outcome Assessment, Health Care , Patient Preference , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/surgery , Range of Motion, Articular , Reoperation/methods , Reoperation/statistics & numerical data
14.
Medicine (Baltimore) ; 99(20): e20161, 2020 May.
Article in English | MEDLINE | ID: mdl-32443332

ABSTRACT

INTRODUCTION: Psoriasis vulgaris (PV) is a chronic, painful, disfiguring, and disabling dermatological disease, which affects the physical and mental health of patients and impacts their quality of life. Current conventional systemic therapies can be costly, present risks of side effects, have limited efficacy and commonly recur following treatment cessation. Some Chinese herbal medicine therapies have shown therapeutic benefits for psoriasis vulgaris, including relieving symptoms and improving quality of life, and a potential of reducing relapse rate. However, explicit evidence has not yet been obtained. METHODS AND ANALYSIS: This is a pilot randomized controlled trial with the objective of investigating the effect of Jia Wei Liang Xue Xiao Feng San granules on relapse rate of recurrent PV and the correlation between Psoriasis area severity index (PASI) and key psoriasis-related cytokine changes and the number of cells. A total of 102 participants were recruited for this study, including 72 patients with recurrent PV, 15 healthy volunteers and 15 patients with psoriasis vulgaris who have recovered for more than 1 year. A total of 72 patients, with recurrent PV, will be randomized (1:1) to receive the oral Chinese herbal medicine Jia Wei Liang Xue Xiao Feng San or the oral Acitretin Capsule treatments for a period of 8 weeks. After this period, participants whose PASI scores improvement reached more than 75%, will undergo a 52-week follow-up phase.The primary outcome measures are as follows:The secondary study outcomes will include:This trial may provide a novel regimen for recurrent PV patients if the granules decrease recurrence rate without further adverse effects. ETHICS AND DISSEMINATION: The ethics approval was provided by the Sichuan Traditional Chinese medicine regional ethics review committee. The ethics approval number is 2018KL-055. The design and the results of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900022766).


Subject(s)
Heat Exhaustion/immunology , Hot Temperature/adverse effects , Immunity, Cellular/drug effects , Psoriasis/drug therapy , T-Lymphocytes, Helper-Inducer/immunology , Acitretin/administration & dosage , Acitretin/therapeutic use , Administration, Oral , Adolescent , Adult , Aged , Case-Control Studies , Cytokines/drug effects , Cytokines/metabolism , Drugs, Chinese Herbal/administration & dosage , Drugs, Chinese Herbal/therapeutic use , Female , Humans , Immunity, Cellular/physiology , Keratolytic Agents/administration & dosage , Keratolytic Agents/therapeutic use , Male , Middle Aged , Outcome Assessment, Health Care , Psoriasis/psychology , Quality of Life , Recurrence , Severity of Illness Index , Young Adult
16.
Lancet Psychiatry ; 7(6): 506-514, 2020 06.
Article in English | MEDLINE | ID: mdl-32445689

ABSTRACT

BACKGROUND: Cognitive bias modification (CBM) therapies, including attention bias modification, interpretation bias modification, or approach and avoidance training, are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We aimed to assess the relative effectiveness of various CBM interventions for anxious and depressive symptomatology. METHODS: For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane Central Register from database inception up until Feb 7, 2020. We included randomised controlled trials of CBM versus control conditions or other forms of CBM for adults aged 18 years and older with clinical or subclinical anxiety or depression measured with a diagnostic interview or a validated clinical scale. We excluded studies comparing CBM with a non-CBM active intervention. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depressive symptoms measured with validated clinical scales. We computed standardised mean differences (SMDs) with a restricted maximum likelihood random effects model. This study is registered with PROSPERO, CRD42018086113. FINDINGS: From 2125 records we selected 85 trials, 65 (n=3897) on anxiety and 20 (n=1116) on depression. In a well connected network of anxiety trials, interpretation bias modification outperformed waitlist (SMD -0·55, 95% CI -0·91 to -0·19) and sham training (SMD -0·30, -0·50 to -0·10) for the primary outcome. Attention bias modification showed benefits only in post-hoc sensitivity analyses excluding post-traumatic stress disorder trials. Prediction intervals for all findings were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Only four randomised controlled trials had low risk of bias on all six domains assessed. INTERPRETATION: CBM interventions showed consistent but small benefits; however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for interpretation bias modification for anxiety might be warranted, but insufficient evidence precludes conclusions for depression. FUNDING: Romanian Ministry of Research and Innovation, The National Council for Scientific Research-The Executive Agency for Higher Education, Research, Development and Innovation Funding.


Subject(s)
Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Depressive Disorder/therapy , Stress Disorders, Post-Traumatic/therapy , Adult , Anxiety Disorders/psychology , Bias , Case-Control Studies , Cognitive Behavioral Therapy/trends , Depressive Disorder/psychology , Humans , Network Meta-Analysis , Outcome Assessment, Health Care , Randomized Controlled Trials as Topic , Reproducibility of Results , Sensitivity and Specificity , Stress Disorders, Post-Traumatic/psychology
17.
Lancet ; 395(10235): 1506-1515, 2020 05 09.
Article in English | MEDLINE | ID: mdl-32334654

ABSTRACT

BACKGROUND: The timing of renal replacement therapy (RRT) for severe acute kidney injury is highly debated when no life-threatening complications are present. We assessed whether a strategy of delayed versus early RRT initiation affects 28-day survival in critically ill adults with severe acute kidney injury. METHODS: In this systematic review and individual patient data meta-analysis, we searched MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials for randomised trials published from April 1, 2008, to Dec 20, 2019, that compared delayed and early RRT initiation strategies in patients with severe acute kidney injury. Trials were eligible for inclusion if they included critically ill patients aged 18 years or older with acute kidney injury (defined as a Kidney Disease: Improving Global Outcomes [KDIGO] acute kidney injury stage 2 or 3, or, where KDIGO was unavailable, a renal Sequential Organ Failure Assessment score of 3 or higher). We contacted the principal investigator of each eligible trial to request individual patient data. From the included trials, any patients without acute kidney injury or who were not randomly allocated were not included in the individual patient data meta-analysis. The primary outcome was all-cause mortality at day 28 after randomisation. This study is registered with PROSPERO (CRD42019125025). FINDINGS: Among the 1031 studies identified, one study that met the eligibility criteria was excluded because the recruitment period was not recent enough, and ten (including 2143 patients) were included in the analysis. Individual patient data were available for nine studies (2083 patients), from which 1879 patients had severe acute kidney injury and were randomly allocated: 946 (50%) to the delayed RRT group and 933 (50%) to the early RRT group. 390 (42%) of 929 patients allocated to the delayed RRT group and who had available data did not receive RRT. The proportion of patients who died by day 28 did not significantly differ between the delayed RRT group (366 [44%] of 837) and the early RRT group (355 [43%] of 827; risk ratio 1·01 [95% CI 0·91 to 1·13], p=0·80), corresponding to an overall risk difference of 0·01 (95% CI -0·04 to 0·06). There was no heterogeneity across studies (I2=0%; τ2=0), and most studies had a low risk of bias. INTERPRETATION: The timing of RRT initiation does not affect survival in critically ill patients with severe acute kidney injury in the absence of urgent indications for RRT. Delaying RRT initiation, with close patient monitoring, might lead to a reduced use of RRT, thereby saving health resources. FUNDING: None.


Subject(s)
Acute Kidney Injury/therapy , Critical Illness/therapy , Renal Replacement Therapy/methods , Secondary Prevention/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Acute Kidney Injury/classification , Acute Kidney Injury/mortality , Adult , Aged , Aged, 80 and over , Critical Illness/mortality , Female , Humans , Male , Middle Aged , Mortality , Organ Dysfunction Scores , Outcome Assessment, Health Care , Randomized Controlled Trials as Topic , Severity of Illness Index , Survival Analysis , Time Factors
18.
J Am Acad Orthop Surg ; 28(11): 464-470, 2020 Jun 01.
Article in English | MEDLINE | ID: mdl-32287086

ABSTRACT

On March 14, 2020, the Surgeon General of the United States urged a widespread cessation of all elective surgery across the country. The suddenness of this mandate and the concomitant spread of the COVID-19 virus left many hospital systems, orthopaedic practices, and patients with notable anxiety and confusion as to the near, intermediate, and long-term future of our healthcare system. As with most businesses in the United States during this time, many orthopaedic practices have been emotionally and fiscally devastated because of this crisis. Furthermore, this pandemic is occurring at a time where small and midsized orthopaedic groups are already struggling to cover practice overhead and to maintain autonomy from larger health systems. It is anticipated that many groups will experience financial demise, leading to substantial global consolidation. Because the authors represent some of the larger musculoskeletal multispecialty groups in the country, we are uniquely positioned to provide a framework with recommendations to best weather the ensuing months. We think these recommendations will allow providers and their staff to return to an infrastructure that can adjust immediately to the pent-up healthcare demand that may occur after the COVID-19 pandemic. In this editorial, we address practice finances, staffing, telehealth, operational plans after the crisis, and ethical considerations.


Subject(s)
Betacoronavirus , Coronavirus Infections , Delivery of Health Care/organization & administration , Orthopedic Procedures/economics , Pandemics/prevention & control , Pneumonia, Viral , Practice Management, Medical/organization & administration , Cost-Benefit Analysis , Female , Health Care Costs , Humans , Male , Orthopedic Procedures/methods , Outcome Assessment, Health Care , United States
19.
Rev Lat Am Enfermagem ; 28: e3249, 2020.
Article in English, Portuguese, Spanish | MEDLINE | ID: mdl-32321040

ABSTRACT

OBJECTIVE: to analyze the psychometric properties of the adapted version of Bakas Caregiving Outcome Scale for Brazilian Portuguese. METHOD: this is a cross-sectional methodological study conducted with 151 informal caregivers of people with cerebral vascular accident sequelae enrolled in Family Health Units. To assess reliability, Cronbach's alpha was used. Construct validity was verified through exploratory factor analysis, confirmatory factor analysis and correlation with measures of instruments that evaluate correlated constructs. RESULTS: Cronbach's alpha for the total BCOS score was 0.89. Factor and exploratory analysis generated a one-factor structure, which was confirmed by confirmatory factor analysis. Construct validity was supported by the high positive correlations with Negative Affect (r = 0.51) and Negative Experience (r = 0.47) of the Well-being Scale and the Depression Anxiety and Stress Scale -21 (r = 0.53) and negative correlations with Positive Affect (r =-0.47) and Positive Experience (r = -0.17) of the Well-being scale. CONCLUSION: Bakas Caregiving Outcome Scale shows evidence of satisfactory reliability and validity in family caregivers of cerebral vascular accident survivors.


Subject(s)
Caregivers/psychology , Cross-Cultural Comparison , Stroke/therapy , Translating , Aged , Brazil , Cohort Studies , Cross-Sectional Studies , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Needs Assessment , Outcome Assessment, Health Care , Psychometrics , Reproducibility of Results
20.
Am Surg ; 86(3): 195-199, 2020 Mar 01.
Article in English | MEDLINE | ID: mdl-32223797

ABSTRACT

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion (P = 0.56). Statewide data similarly demonstrated no change (P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.


Subject(s)
Breast Neoplasms/diagnosis , Early Detection of Cancer/economics , Health Care Costs , Medicaid/economics , Outcome Assessment, Health Care , Adult , Aged , Breast Neoplasms/economics , Breast Neoplasms/mortality , Databases, Factual , Early Detection of Cancer/methods , Female , Humans , Insurance Coverage/statistics & numerical data , Medically Uninsured/statistics & numerical data , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Ohio , Patient Protection and Affordable Care Act , Prognosis , Retrospective Studies , Survival Analysis , United States
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