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1.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320996

RESUMEN

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Asunto(s)
Bases de Datos Factuales , Oftalmología/educación , Estudiantes de Medicina , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
2.
Nat Hum Behav ; 4(3): 317-325, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32015487

RESUMEN

Understanding how people rate their confidence is critical for the characterization of a wide range of perceptual, memory, motor and cognitive processes. To enable the continued exploration of these processes, we created a large database of confidence studies spanning a broad set of paradigms, participant populations and fields of study. The data from each study are structured in a common, easy-to-use format that can be easily imported and analysed using multiple software packages. Each dataset is accompanied by an explanation regarding the nature of the collected data. At the time of publication, the Confidence Database (which is available at https://osf.io/s46pr/) contained 145 datasets with data from more than 8,700 participants and almost 4 million trials. The database will remain open for new submissions indefinitely and is expected to continue to grow. Here we show the usefulness of this large collection of datasets in four different analyses that provide precise estimations of several foundational confidence-related effects.


Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Procesos Mentales/fisiología , Metacognición/fisiología , Psicometría , Análisis y Desempeño de Tareas , Adulto , Conducta de Elección/fisiología , Conjuntos de Datos como Asunto/estadística & datos numéricos , Humanos , Psicometría/instrumentación , Psicometría/estadística & datos numéricos , Tiempo de Reacción/fisiología
3.
Nat Commun ; 11(1): 926, 2020 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-32066737

RESUMEN

The field of epitranscriptomics continues to reveal how post-transcriptional modification of RNA affects a wide variety of biological phenomena. A pivotal challenge in this area is the identification of modified RNA residues within their sequence contexts. Mass spectrometry (MS) offers a comprehensive solution by using analogous approaches to shotgun proteomics. However, software support for the analysis of RNA MS data is inadequate at present and does not allow high-throughput processing. Existing software solutions lack the raw performance and statistical grounding to efficiently handle the numerous modifications found on RNA. We present a free and open-source database search engine for RNA MS data, called NucleicAcidSearchEngine (NASE), that addresses these shortcomings. We demonstrate the capability of NASE to reliably identify a wide range of modified RNA sequences in four original datasets of varying complexity. In human tRNA, we characterize over 20 different modification types simultaneously and find many cases of incomplete modification.


Asunto(s)
Epigenómica/métodos , Ensayos Analíticos de Alto Rendimiento/métodos , Procesamiento Postranscripcional del ARN/genética , Motor de Búsqueda , Espectrometría de Masas en Tándem/métodos , Secuencia de Bases/genética , Bases de Datos Factuales/estadística & datos numéricos , Conjuntos de Datos como Asunto , Humanos , Oligonucleótidos/química , Oligonucleótidos/genética , Oligonucleótidos/metabolismo , ARN de Transferencia/química , ARN de Transferencia/genética , ARN de Transferencia/metabolismo , Reproducibilidad de los Resultados
4.
Bone Joint J ; 102-B(2): 239-245, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009437

RESUMEN

AIMS: Anterior cruciate ligament (ACL) surgery in children and the adolescent population has increased steadily over recent years. We used a national database to look at trends in ACL reconstruction and rates of serious complications, growth disturbance, and revision surgery, over 20 years. METHODS: All hospital episodes for patients undergoing ACL reconstruction, under the age of 20 years, between 1 April 1997 and 31 March 2017, were extracted by procedure code from the national Hospital Episode Statistics (HES). Population standardized rates of intervention were determined by age group and year of treatment. Subsequent rates of serious complications including reoperation for infection, growth disturbance (osteotomy, epiphysiodesis), revision reconstruction, and/or contralateral ACL reconstruction rates were determined. RESULTS: Over the 20 year period, 16,125 ACL reconstructions were included. The mean age of patients was 16.9 years (SD 2.0; 27.1% female, n = 4,374/16,125). The majority of procedures were observed in the 15 to 19 years age group. The rate of ACL reconstruction increased 29-fold from 1997 to 1998, to 2016 to 2017. Within 90 days of ACL reconstruction, the rate of reoperation for infection was 0.31% (95% confidence interval (CI) 0.23 to 0.41, n = 50/16,125) and the rate of pulmonary embolism was 0.037% (95%.CI 0.014 to 0.081, n = 6/16,125). Of those with minimum five-year follow-up following ACL reconstruction (n = 7,585), 1.00% of patients subsequently underwent an osteotomy (95% CI 0.79 to 1.25, n = 76/7,585), 0.09% an epiphysiodesis (95% CI 0.04 to 0.19, n = 7/7,585), 7.46% revision ACL reconstruction (95% CI 6.88 to 8.08, n = 566/7,585), and 6.37% contralateral ACL reconstruction (95% CI 5.83 to 6.94, n = 483/7,585). CONCLUSION: Rates of paediatric and adolescent ACL reconstruction have increased 29-fold over the last 20 years. Despite the increasing rate in the younger population, the risk of serious complications, including further surgery for growth disturbance is very low. The results of our study provide a point of reference for shared decision making in the management of ACL injury in the paediatric and adolescent population. Cite this article: Bone Joint J 2020;102-B(2):239-245.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Adolescente , Lesiones del Ligamento Cruzado Anterior/epidemiología , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/estadística & datos numéricos , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Reoperación/estadística & datos numéricos , Reino Unido/epidemiología , Adulto Joven
5.
Ann R Coll Surg Engl ; 102(4): 308-311, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32081023

RESUMEN

INTRODUCTION: Survival for colorectal cancer is improved by earlier detection. Rapid assessment and diagnostic demand have created a surge in two-week rule referrals and have subsequently placed a greater burden on endoscopy services. Between 2009 and 2014, a mean of 709 patients annually were referred to Royal Surrey County Hospital with a detection rate of 53 cancers per year giving a positive predictive value for these patients of 7.5%. We aimed to assess what impact the 2015 changes in National Institute for Health and Care Excellence referral criteria had on local cancer detection rate and endoscopy services. METHODS: A prospectively maintained database of patients referred under the two-week rule pathway for April 2017-2018 was sub-analysed and the data cross-referenced with all diagnostic reports. FINDINGS: There were 1,414 referrals, which is double the number of previous years; 80.6% underwent endoscopy as primary investigation and 62 cancers were identified, 51 being of colorectal and anal origin (positive predictive value 3.6%). A total of 88 patients were diagnosed, with other significant colorectal disease defined as high-risk adenomas, colitis and benign ulcers. Overall, a total of 10.6% of our two-week rule patients had a significant finding.Since the 2015 referral criteria, despite a dramatic rise in two-week rule referrals, there has been no increase in cancer detection. It has placed significant pressure on diagnostic services. This highlights the need for a less invasive, cheaper yet sensitive test to rule out cancer such as faecal immunochemical testing that can enable clinicians to triage and reduce referral to endoscopy in symptomatic patients.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Vías Clínicas/normas , Detección Precoz del Cáncer/normas , Sangre Oculta , Triaje/normas , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Vías Clínicas/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Detección Precoz del Cáncer/métodos , Humanos , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Factores de Tiempo , Reino Unido/epidemiología
6.
Pediatrics ; 145(2)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31896548

RESUMEN

BACKGROUND AND OBJECTIVES: For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population. METHODS: In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status. RESULTS: Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P < .001] and 0.74 [P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening. CONCLUSIONS: Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Salud del Niño/estadística & datos numéricos , Trastornos Relacionados con Opioides , Cooperación del Paciente/estadística & datos numéricos , Efectos Tardíos de la Exposición Prenatal , Citas y Horarios , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Lactante , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente/etnología , Embarazo , Análisis de Regresión , Estudios Retrospectivos
7.
Ann R Coll Surg Engl ; 102(4): 271-276, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31918560

RESUMEN

INTRODUCTION: There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in delivery of general paediatric surgery in England and shows what is being performed where and by whom. MATERIALS AND METHODS: Using the Surgical Workload Outcome Database, we compared hospital-level data between 2009 and 2017. Inclusion criteria were children under 18 years admitted to NHS hospitals in England for elective general paediatric surgery. Data were analysed with an online statistical package performing paired t-tests. RESULTS: There was no real change in the overall number of elective general paediatric surgical marker cases, but the type mix has changed. The number of marker cases performed by adult surgeons fell by 34% (4699 vs 3090 p < 0.05). The number of marker cases performed by specialist paediatric surgeons increased by 21% (8184 vs 9862 p < 0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral (18% increase) centres. When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate. CONCLUSION: Best practice is to treat children close to home by staff with the right skills. This study shows significant shifts in the general paediatric surgical workload. It is important to monitor these trends for successful succession planning as well as configuration of services.


Asunto(s)
Procedimientos Quirúrgicos Electivos/tendencias , Hospitales Generales/tendencias , Hospitales Pediátricos/tendencias , Servicio de Cirugía en Hospital/tendencias , Carga de Trabajo/estadística & datos numéricos , Adolescente , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Inglaterra , Femenino , Planificación Hospitalaria/organización & administración , Hospitales Generales/estadística & datos numéricos , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Especialización/estadística & datos numéricos , Especialización/tendencias , Medicina Estatal/organización & administración , Medicina Estatal/estadística & datos numéricos , Medicina Estatal/tendencias , Cirujanos/estadística & datos numéricos , Cirujanos/tendencias , Servicio de Cirugía en Hospital/estadística & datos numéricos
8.
J Surg Res ; 246: 207-212, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31605947

RESUMEN

BACKGROUND: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. MATERIALS AND METHODS: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. RESULTS: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan-Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). CONCLUSIONS: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.


Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Corazón Auxiliar/efectos adversos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Listas de Espera/mortalidad
9.
J Surg Res ; 246: 145-152, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31580984

RESUMEN

BACKGROUND: Agreement regarding indications for vena cava filter (VCF) utilization in trauma patients has been in flux since the filter's introduction. As VCF technology and practice guidelines have evolved, the use of VCF in trauma patients has changed. This study examines variation in VCF placement among trauma centers. MATERIALS AND METHODS: A retrospective study was performed using data from the National Trauma Data Bank (2005-2014). Trauma centers were grouped according to whether they placed VCFs during the study period (VCF+/VCF-). A multivariable probit regression model was fit to predict the number of VCFs used among the VCF+ centers (the expected [E] number of VCF per center). The ratio of observed VCF placement (O) to expected VCFs (O:E) was computed and rank ordered to compare interfacility practice variation. RESULTS: In total, 65,482 VCFs were placed by 448 centers. Twenty centers (4.3%) placed no VCFs. The greatest predictors of VCF placement were deep vein thrombosis, spinal cord paralysis, and major procedure. The strongest negative predictor of VCF placement was admission during the year 2014. Among the VCF+ centers, O:E varied by nearly 500%. One hundred fifty centers had an O:E greater than one. One hundred sixty-nine centers had an O:E less than one. CONCLUSIONS: Substantial variation in practice is present in VCF placement. This variation cannot be explained only by the characteristics of the patients treated at these centers but could be also due to conflicting guidelines, changing evidence, decreasing reimbursement rates, or the culture of trauma centers.


Asunto(s)
Utilización de Equipos y Suministros/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Filtros de Vena Cava/estadística & datos numéricos , Heridas y Traumatismos/terapia , Adolescente , Adulto , Bases de Datos Factuales/estadística & datos numéricos , Utilización de Equipos y Suministros/economía , Utilización de Equipos y Suministros/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Mecanismo de Reembolso/normas , Mecanismo de Reembolso/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Centros Traumatológicos/economía , Centros Traumatológicos/normas , Filtros de Vena Cava/economía , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & control , Heridas y Traumatismos/complicaciones , Adulto Joven
10.
Br J Anaesth ; 124(2): 197-205, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31780140

RESUMEN

BACKGROUND: Medication-related adverse events (MRE) in anaesthesia care are frequent and require a deeper understanding if we are to prevent medication harm. METHODS: We searched for reported MRE from the Spanish Anaesthesia Incident Reporting System (SENSAR) database over a 10-yr period. SENSAR is a cross-national, multicentre system focused on perioperative and critical care. A descriptive analysis of independent variables, phase of medication process, type of MRE, and medication group involved, and their relationships with morbidity was conducted. RESULTS: A total of 1970 MRE were identified from 7072 reported incidents. Patient harm was reported in 31% of the MRE. The administration phase was more frequent (42%) and showed the highest harm rate (44%) compared with other medication process phases. The most frequent types of MRE were wrong treatment regimen and wrong medication (55% of cases). The medication groups most commonly reported were those that alter haemostasis (18%), vasoconstrictor agents (13%), and opioids (10%). Vasoconstrictor agents, benzodiazepines, and neuromuscular blocking agents were the medication groups involved in patient harm four-fold more, and opioids three-fold more, than medications that alter haemostasis. The 1970 incidents were investigated and led to implementation of 4223 local corrective patient safety and quality improvement measures. CONCLUSIONS: Patient harm in the perioperative setting from medications remains a major issue for patients, hospital leaders, and clinicians. We found patterns and specific causes that can be mitigated through proven systems solutions, and should be taken into consideration in designing sustainable solutions for safe perioperative care. CLINICAL TRIAL REGISTRATION: NCT03615898.


Asunto(s)
Anestesia/efectos adversos , Seguridad del Paciente/estadística & datos numéricos , Gestión de Riesgos/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Mejoramiento de la Calidad , Estudios Retrospectivos , España
11.
J Trauma Acute Care Surg ; 88(2): 219-229, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31804415

RESUMEN

BACKGROUND: We sought to examine patterns of readmission after nonoperative trauma, including rates of delayed operative intervention and mortality. METHODS: The Nationwide Readmissions Database (2013-2014) was queried for all adult trauma admissions and 30-day readmissions. Index admissions were classified as operative (OI) or nonoperative (NOI), and readmissions examined for major operative intervention (MOR). Multivariable regression modeling was used to evaluate risk for readmission requiring MOR and in-hospital mortality. RESULTS: Of 2,244,570 trauma admissions, there were 59,573 readmissions: 66% after NOI, and 35% after OI. Readmission rate was higher after NOI compared with OI (3.6% vs. 1.7% p < 0.001). Readmitted NOI patients were older, with a higher proportion of Injury Severity Score ≥15 and were readmitted earlier (NOI median 8 days vs. OI 11 days). Thirty-one percent of readmitted NOI patients required MOR and experienced higher overall mortality compared with OI patients with operative readmission (NOI 2.9% vs. OI 2%, p = 0.02). Intracranial hemorrhage was an independent risk factor for NOI readmission requiring MOR in both the overall (hazard ratio, 1.11; 95% confidence interval [CI], 1.01-1.22) and Injury Severity Score of 15 or greater cohorts (hazard ratio, 1.46; 95% CI, 1.24-1.7), with a predominance of nonspine neurosurgical procedures (20.3% and 55.1%, respectively). Operative readmission after NOI cost a median of $17,364 (interquartile range, US $11,481 to US $27,816) and carried a total annual cost of US $147 million (95% CI, US $141 million to $154 million). CONCLUSIONS: Nonoperative trauma patients have a higher readmission rate than operative index patients and nearly one third require operative intervention during readmission. Operative readmission carries a higher overall mortality rate in NOI patients and together accounts for nearly US $150 million in annual costs. LEVEL OF EVIDENCE: Epidemiological, level III.


Asunto(s)
Costos de Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Readmisión del Paciente/estadística & datos numéricos , Tiempo de Tratamiento/economía , Heridas y Traumatismos/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Estados Unidos , Heridas y Traumatismos/economía , Heridas y Traumatismos/mortalidad , Adulto Joven
12.
J Surg Res ; 246: 599-604, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31653413

RESUMEN

As more and more health systems have converted to the use of electronic health records, the amount of searchable and analyzable data is exploding. This includes not just provider or laboratory created data but also data collected by instruments, personal devices, and patients themselves, among others. This has led to more attention being paid to the analysis of these data to answer previously unaddressed questions. This is especially important given the number of therapies previously found to be beneficial in clinical trials that are currently being re-scrutinized. Because there are orders of magnitude more information contained in these data sets, a fundamentally different approach needs to be taken to their processing and analysis and the generation of knowledge. Health care and medicine are drivers of this phenomenon and will ultimately be the main beneficiaries. Concurrently, many different types of questions can now be asked using these data sets. Research groups have become increasingly active in mining large data sets, including nationwide health care databases, to learn about associations of medication use and various unrelated diseases such as cancer. Given the recent increase in research activity in this area, its promise to radically change clinical research, and the relative lack of widespread knowledge about its potential and advances, we surveyed the available literature to understand the strengths and limitations of these new tools. We also outline new databases and techniques that are available to researchers worldwide, with special focus on work pertaining to the broad and rapid monitoring of drug safety and secondary effects.


Asunto(s)
Macrodatos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Registros Electrónicos de Salud/estadística & datos numéricos , Neoplasias/inducido químicamente , Minería de Datos/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Conjuntos de Datos como Asunto , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Humanos , Neoplasias/epidemiología , Neoplasias/prevención & control , Medición de Riesgo/métodos
13.
J Surg Res ; 246: 395-402, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31629495

RESUMEN

BACKGROUND: Laparoscopic appendectomy is a preferred approach in children with appendicitis. Patient characteristics associated with open appendectomy are poorly characterized, although such information can help optimize the care. MATERIAL AND METHODS: To characterize the factors associated with open appendectomy, we performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified surgically managed appendicitis using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged 18 or younger. Factors associated with open appendectomy, 30-d readmission rate, and hospitalization length were assessed using logistic regression, Cox proportional hazards regression, and Poisson regression, respectively. RESULTS: Of 46,147 children with surgically managed appendicitis, 85.2% had laparoscopic appendectomy. Low-volume hospitals (odds ratio, OR: 3.01 [95% confidence interval, CI: 1.81-5.01]), rural hospitals (OR: 2.36 [95%CI: 1.63-3.40]), public insurance (OR: 1.19 [95%CI: 1.03-1.36]), lower-income neighborhood residence (OR: 1.40 [95%CI: 1.06-1.86]), younger age (OR: 5.00 [95%CI: 3.64-6.86] in <5 year-old), and abscess complicating appendicitis (OR: 1.91 [95%CI: 1.58-2.31]) were associated with open appendectomy. Laparoscopic appendectomy was associated with shorter hospitalization (incidence rate ratio: 0.77 [95%CI: 0.69-0.87]) and less readmission with wound infection, but not with 30-d readmission, or readmission with intraabdominal abscess. CONCLUSIONS: Along with clinical factors, non-clinical factors including appendicitis volume and rural/teaching status of the treating hospitals play a role in the choice of surgical approach. Awareness of the patient- and hospital-level factors associated with open appendectomy may allow for future resource distribution or improvement in access to care, resulting in population-level impact.


Asunto(s)
Absceso Abdominal/epidemiología , Apendicectomía/efectos adversos , Apendicitis/cirugía , Readmisión del Paciente/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Adolescente , Factores de Edad , Apendicectomía/métodos , Apendicitis/complicaciones , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Rurales/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía
14.
J Surg Res ; 246: 506-511, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31679799

RESUMEN

BACKGROUND: The studies that established historical rates of surgical infection after cholecystectomy predate the modern era of laparoscopy and routine prophylactic antibiotics. Newer studies have reported a much lower incidence of infections in "low-risk" elective, outpatient, laparoscopic cholecystectomies. We investigated the current rate of postoperative infections in these cases within a large, U.S. METHODS: We retrospectively reviewed elective laparoscopic cholecystectomies from the 2016-2017 American College of Surgeons National Surgical Quality Improvement Program database. Our primary outcome was postoperative surgical site infection; secondary was Clostridium difficile infection. Logistic models evaluated the associations of patient and operation characteristics with these outcomes. RESULTS: Surgical infection occurred in 1.0% of cases (293/30,579). Cdifficile infection occurred in 0.1% (31 cases). In our adjusted multivariable models, other/unknown race/ethnicity, diabetes, hypertension, smoking, American Society of Anesthesiologists >2, operative minutes, and wound class 4 were associated with a significantly higher odds of surgical infection; no covariates were significantly associated with Cdifficile infection. CONCLUSIONS: In the setting of modern U.S. surgical practice, the incidence of infection after elective laparoscopic cholecystectomy is very low, on par with clean cases. Our study identified several patient characteristics that were strongly associated with surgical infection. Many of these are not included as risk factors in current guidelines for antibiotic prophylaxis and may help to identify those at higher risk for this rare complication.


Asunto(s)
Profilaxis Antibiótica/normas , Colecistectomía Laparoscópica/efectos adversos , Infecciones por Clostridium/epidemiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Adulto , Antibacterianos/uso terapéutico , Infecciones por Clostridium/etiología , Infecciones por Clostridium/prevención & control , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Estados Unidos/epidemiología
15.
J Surg Res ; 246: 224-230, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31606512

RESUMEN

BACKGROUND: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma patients has been variable across the nation. The goal of this study was to assess PC utilization and intensity of care in older patients with severe TBI. We hypothesized that PC is underutilized despite its positive effects. MATERIALS AND METHODS: The National Inpatient Sample database (2009-2013) was queried for patients aged ≥55 y with International Classification of Diseases, Ninth Revision codes for TBI with loss of consciousness ≥24 h. Outcome measures included PC rate, in-hospital mortality, discharge disposition, length of stay (LOS), and intensity of care represented by craniotomy and or craniectomy, ventilator use, tracheostomy, and percutaneous endoscopic gastrostomy. RESULTS: Of 5733 patients, 78% died in hospital with a median LOS of 1 d, and 85% of the survivors were discharged to facilities. The overall PC rate was 35%. Almost 40% of deaths received PC, with nearly half within 48 h of admission. PC was used in 26% who had neurosurgical procedures, compared with 35% who were nonoperatively managed (P = 0.003). PC was associated with less intensity of care in the entire population. For survivors, those with PC had significantly shorter LOS, compared with those without PC. CONCLUSIONS: Despite high mortality, only one-third of older patients with severe TBI received PC. PC was associated with decreased use of life support and lower intensity of care. Significant efforts need to be made to bridge this quality gap and improve PC in this high-risk population.


Asunto(s)
Atención de Apoyo Vital Avanzado en Trauma/estadística & datos numéricos , Lesiones Traumáticas del Encéfalo/terapia , Cuidados Paliativos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Atención de Apoyo Vital Avanzado en Trauma/organización & administración , Atención de Apoyo Vital Avanzado en Trauma/tendencias , Factores de Edad , Anciano , Anciano de 80 o más Años , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/mortalidad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Mortalidad Hospitalaria , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/normas , Cuidados Paliativos/tendencias , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/estadística & datos numéricos , Mejoramiento de la Calidad/tendencias , Estudios Retrospectivos , Centros Traumatológicos/organización & administración , Centros Traumatológicos/tendencias , Estados Unidos
16.
J Surg Res ; 245: 64-71, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31401249

RESUMEN

BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.


Asunto(s)
Enfermedad de Graves/cirugía , Adhesión a Directriz/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , Tiroidectomía/normas , Adulto , Bases de Datos Factuales/estadística & datos numéricos , Endocrinología/normas , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Estudios Retrospectivos , Sociedades Médicas/normas , Tiroidectomía/efectos adversos , Estados Unidos/epidemiología , Adulto Joven
17.
Neural Netw ; 121: 276-293, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31586856

RESUMEN

Multi-output regression aims at mapping a multivariate input feature space to a multivariate output space. Currently, it is effective to extend the traditional support vector regression (SVR) mechanism to solve the multi-output case. However, some methods adopting a combination of single-output SVR models exhibit the severe drawback of not considering the possible correlations between outputs, and other multi-output SVRs show high computational complexity and are typically sensitive to parameters due to the influence of noise. To handle these problems, in this study, we determine the multi-output regression function through a pair of nonparallel up- and down-bound functions solved by two smaller-sized quadratic programming problems, which results in a fast learning speed. This method is named multi-output twin support vector regression (M-TSVR). Moreover, when the noise is heteroscedastic, based on our M-TSVR, we introduce a pair of multi-input/output nonparallel parameter insensitive up- and down-bound functions to evaluate a regression model named multi-output parameter-insensitive twin support vector regression (M-PITSVR). To handle the nonlinear case, we derive the kernelized extensions of M-TSVR and M-PITSVR. Finally, a series of comparative experiments with several other multi-output-based methods are performed on twelve multi-output datasets. The experimental results indicate that the proposed multi-output regressors yield fast learning speed as well as a better and more stable prediction performance.


Asunto(s)
Algoritmos , Bases de Datos Factuales/estadística & datos numéricos , Análisis Multivariante , Análisis de Regresión
18.
J Surg Res ; 245: 619-628, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31522035

RESUMEN

BACKGROUND: Gastric adenocarcinoma is a leading cause of cancer death worldwide and, in the United States, can present emergently with upper GI hemorrhage, obstruction, or perforation. No large studies have examined how urgent surgery affects patient outcomes. This study examines the outcomes of urgent versus elective surgery for gastric cancer. MATERIALS AND METHODS: Patients with gastric adenocarcinoma from the National Cancer Database from 2004 to 2015 were examined retrospectively. Patients with metastatic disease or incomplete data were excluded. Urgent surgery was defined as definitive surgery within 3 d of diagnosis. Univariate and multivariate analysis of patient factors, surgical outcomes, and oncologic data was performed. P-values <0.05 were statistically significant. RESULTS: Of 26,116 total patients, 2964 had urgent surgery and 23,468 had elective surgery. Urgent surgery patients were significantly older, were female, were nonwhite, had higher pathologic stage, and were treated at a low-volume center. Urgent surgery was associated with decreased quality lymph node harvest (odds ratio [OR] 0.68 95% confidence interval {CI} [0.62, 0.74]), increased positive surgical margin (OR 1.48, 95% CI [1.32, 1.65]), increased 30-d mortality (OR 1.38, 95% CI [1.16, 1.65]), increased 90-d mortality (OR 1.30, 95% CI [1.14, 1.49]), and decreased overall survival (hazard ratio 1.21, 95% CI [1.15, 1.27]). CONCLUSIONS: Urgent surgery for gastric cancer is associated with significantly worse outcomes than elective surgery. Stable patients requiring urgent surgical resection for gastric cancer may benefit from referral to a high-volume center for resection by an experienced surgeon. Patients undergoing urgent resection for gastric cancer should be referred to surgical and medical oncologists to ensure they receive appropriate adjuvant therapy and surveillance.


Asunto(s)
Adenocarcinoma/cirugía , Procedimientos Quirúrgicos Electivos/efectos adversos , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/mortalidad , Neoplasias Gástricas/cirugía , Adenocarcinoma/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Gastrectomía/métodos , Mortalidad Hospitalaria , Humanos , Escisión del Ganglio Linfático , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Análisis de Supervivencia , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
19.
Int J Radiat Oncol Biol Phys ; 106(1): 5-12, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31404580

RESUMEN

PURPOSE: In studies evaluating the benefit of adjuvant therapies, immortal time bias (ITB) can affect the results by incorrectly reporting a survival advantage. It does so by including all deceased patients who may have been planned to receive adjuvant therapy within the observation cohort. Given the increase in National Cancer Database (NCDB) analyses evaluating postoperative radiation therapy (PORT) as an adjuvant therapy, we sought to examine how often such studies accounted and adjusted for ITB. METHODS AND MATERIALS: A systematic review was undertaken to search MEDLINE and EMBASE from January 2014 until May 2019 for NCDB studies evaluating PORT. After appropriate exclusion criteria were applied, 60 peer-reviewed manuscripts in which PORT was compared with postoperative observation or maintenance therapy were reviewed. The manuscripts were reviewed to evaluate whether ITB was accounted for, the method with which it was adjusted for, impact factor, year of publication, and whether PORT was beneficial. RESULTS: Of the 60 publications reviewed, 23 studies (38.3%) did not include an adjustment for ITB. Most studies that did adjust for ITB employed a single landmark (LM) time (n = 31), 4 used a sequential landmark analyses, and 2 used a time-dependent Cox model. In 23 of 31 studies (74.2%) that did adjust for ITB via a single LM time, the rationale behind why the specified LM time was chosen was not clearly explained. There was no relationship between adjusting for ITB and year of publication (P = .074) or whether the study was published in a high-impact journal (P = .55). CONCLUSIONS: Studies assessing adjuvant radiation therapy by analyzing the NCDB are susceptible to ITB, which overestimates the effect size of adjuvant therapies and can provide misleading results. Adjusting for this bias is essential for accurate data representation and to better quantify the impact of adjuvant therapies such as PORT.


Asunto(s)
Sesgo , Bases de Datos Factuales/estadística & datos numéricos , Neoplasias/mortalidad , Neoplasias/radioterapia , Radioterapia Ayuvante/mortalidad , Humanos , Factor de Impacto de la Revista , Modelos Logísticos , Neoplasias/cirugía , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/mortalidad , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Factores de Tiempo , Espera Vigilante
20.
J Surg Res ; 245: 119-126, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31415933

RESUMEN

BACKGROUND: Data on outcomes after surgery for sigmoid volvulus is limited. The aim of this study was to develop a model to predict need for emergent surgery and mortality after resection for sigmoid volvulus. METHODS: The NSQIP database was queried from 2012 to 2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer's test for categorical variables and the Mann-Whitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes. RESULTS: 2086 patients met inclusion criteria. Factors associated with emergency surgery included female gender, relative hematocrit elevation, relative leukocytosis, acute kidney injury, preoperative sepsis, prior functional independence, and bleeding disorders. Laparoscopic resection and mechanical bowel preparation were more commonly used in the nonemergent setting. Patients having emergent resection were more likely to suffer from postoperative superficial surgical site infection, pneumonia, cardiac arrest, septic shock, myocardial infarction, and receive perioperative transfusion. No difference was seen in ileus, readmission or reoperation rates in the emergent and nonemergent groups. Factors predictive of postoperative mortality included increased age, systemic sepsis, and emergent surgery. Independence before illness, higher albumin levels, and lower BMI were shown to be protective. CONCLUSIONS: Emergent resection is independently associated with poor postoperative outcomes and mortality. Predictors of need for emergent resection and mortality identified in this study can be used to aid in shared decision-making for patients with sigmoid volvulus.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Vólvulo Intestinal/cirugía , Complicaciones Posoperatorias/mortalidad , Enfermedades del Sigmoide/cirugía , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Toma de Decisiones Conjunta , Tratamiento de Urgencia/estadística & datos numéricos , Femenino , Mortalidad Hospitalaria , Humanos , Vólvulo Intestinal/mortalidad , Masculino , Persona de Mediana Edad , Selección de Paciente , Periodo Perioperatorio , Complicaciones Posoperatorias/etiología , Medición de Riesgo/métodos , Factores Sexuales , Enfermedades del Sigmoide/mortalidad
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