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1.
J Exp Clin Cancer Res ; 39(1): 177, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32873322

RESUMEN

BACKGROUND: A pronounced polarization of healthcare resources and workforce towards the prevention of the rapid spread of SARS-CoV-2 occurred at the expenses of the majority of chronic diseases and cancer, thus jeopardizing continuity of care and therapy outcomes. In this challenging and overwhelming scenario, our Institute confirmed its mission to provide expert cancer care. Here, we provide a report of strategic decisions made and of articulated measures developed to limit virus spreading while striving to make our hospital closer to patients. CONCLUSIONS: We hope our experience may serve as a resource to inform clinical care models in case of future epidemiological outbreaks.


Asunto(s)
Betacoronavirus/patogenicidad , Enfermedad Crónica/epidemiología , Infecciones por Coronavirus/epidemiología , Oncología Médica/tendencias , Neumonía Viral/epidemiología , Benchmarking , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/virología , Factores de Riesgo
3.
Medicine (Baltimore) ; 99(31): e21182, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32756096

RESUMEN

The implementation of electronic medical records (EMRs) has generally been thought to improve medical efficiency and safety, but consistent evidence of improved healthcare quality due to EMRs in population-based studies is lacking. We assessed the relationship between the degree of EMR adoption and patient outcomes.We performed an observational study using discharge data from Tri-service General Hospital from 2013 to 2018. The levels of EMR utilization were divided into no EMRs, partial EMRs and full EMRs. The primary healthcare quality indicators were inpatient mortality, readmission within 14 days, and 48-hour postoperative mortality. We performed a Cox proportional hazards regression analysis to evaluate the relationship between the EMR utilization level and healthcare quality.In total, 262,569 patients were included in this study. Compared with no EMRs, full EMR implementation led to lower inpatient mortality [adjusted hazard ratio (HR) 0.947, 95% confidence interval (CI): 0.897-0.999, P = ..049] and a lower risk of readmission within 14 days (adjusted HR 0.627, 95% CI: 0.577-0.681, P < .001). Full EMR implementation was associated was a lower risk of 48-hour postoperative mortality (adjusted HR 0.372, 95% CI: 0.208-0.665, P = .001) than no EMRs. Partial EMR implementation was associated with a higher risk of readmission within 14 days than no EMRs (HR 1.387, 95% CI: 1.298-1.485, P < .001).Full EMR adoption improves healthcare quality in medical institutions treating severely ill patients. A prospective study is needed to confirm this finding.


Asunto(s)
Benchmarking , Registros Electrónicos de Salud/normas , Alta del Paciente , Calidad de la Atención de Salud , Humanos , Modelos de Riesgos Proporcionales , Taiwán
5.
Environ Monit Assess ; 192(8): 531, 2020 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-32683502

RESUMEN

Aquatic invertebrates are excellent indicators of ecosystem quality; however, choosing a sampling method can be difficult. Each method and associated protocol has advantages and disadvantages, and finding the approach that minimizes biases yet fulfills management objectives is crucial. To test the effects of both sampling methods and sample handling-i.e., to composite samples or leave them as replicates-we collected aquatic invertebrates from the Niobrara River at Agate Fossil Beds National Monument, Nebraska, using three methods and two sample handling protocols. We compared aquatic invertebrate assemblages collected with a Hester-Dendy multi-plate sampler, Hess sampler, and a D-frame dipnet. We calculated six common bioassessment metrics from composite (combined) and replicate (separate) samples. Hess samples contained the highest taxonomic richness (capturing 77% of all taxa observed) and dipnet samples the least (47%). Hester-Dendy samples had the greatest proportion of Ephemeroptera, and Ephemeroptera, Plecoptera, and Trichoptera (EPT). Dipnet samples had the lowest evenness values. In terms of sample handling, composite samples had inflated richness, diversity, and evenness compared with replicate samples, but bioassessment metrics calculated from proportions or averages (i.e., Hilsenhoff's Biotic Index and the proportion of EPT taxa) did not differ between them. The proportion of invertebrate groups from composite samples were not statistically different among sampling methods, but several groups differed between replicate samples collected by different methods. Ultimately, we recommend collecting replicate samples with a Hess sampler when the goal of the study is to detect ecosystem change, among locations or differences in variables of interest.


Asunto(s)
Ecosistema , Ríos , Animales , Benchmarking , Monitoreo del Ambiente , Invertebrados , Nebraska
6.
Isr Med Assoc J ; 7(22): 375-379, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32692500

RESUMEN

BACKGROUND: Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta blockers (BBs). OBJECTIVES: To determine factors associated with attaining upper-range doses in patients with HFrEF. METHODS: We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines. RESULTS: The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titration program, 41% and 35% of patients achieved upper-range doses of ACE-Is/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-I/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P = 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI ≥ 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P = 0.031). CONCLUSIONS: Achieving upper-range doses of ACE-Is/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.


Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas de Receptores de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Anciano , Benchmarking , Índice de Masa Corporal , Diabetes Mellitus/epidemiología , Relación Dosis-Respuesta a Droga , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/efectos de los fármacos
9.
Ecotoxicol Environ Saf ; 202: 110889, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-32623235

RESUMEN

Coke oven emissions (COEs) can cause oxidative stress of the body, which in turn induces the occupational lung disease and also increases the risk of other diseases. COEs are the major occupational hazard factors for coke oven workers. The aim of the study is to explore the influences of COEs exposure on oxidative damage and estimate the benchmark dose (BMD) of COEs. A group of 542 workers exposed to COEs and 237 healthy controls from the same city were recruited in this study. The corresponding measuring kits were used to determine the plasma biomarkers of oxidative damage level. Generalized linear models and trend tests were used to analyze the relationship between COEs exposure and biomarkers. EPA Benchmark Dose Software was performed to calculate BMD and the lower confidence limit of the benchmark dose (BMDL) of COEs exposure. A significant association was observed between COEs exposure and oxidative damage with T-AOC as a biomarker. The BMD of COEs exposure were 2.83 mg/m3 and 1.39 mg/m3 for males and females, respectively, and the corresponding BMDL were 1.47 mg/m3 and 0.75 mg/m3, respectively. Our results suggested that the exposure level of COEs below the current national occupational exposure limits (OELs) would induce oxidative damage, and the OEL of COEs based on the T-AOC damage was suggested at 0.03 mg/m3 in this study.


Asunto(s)
Coque/toxicidad , Enfermedades Profesionales/metabolismo , Exposición Profesional/análisis , Estrés Oxidativo/fisiología , Adulto , Grupo de Ascendencia Continental Asiática , Benchmarking , Biomarcadores/metabolismo , Coque/análisis , Daño del ADN , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/estadística & datos numéricos , Hidrocarburos Policíclicos Aromáticos/análisis , Pirenos/análisis , Residuos
10.
Diagn Pathol ; 15(1): 73, 2020 Jun 09.
Artículo en Inglés | MEDLINE | ID: covidwho-591935

RESUMEN

In lung cancer patients infected with COVID-19, pathological features are not easy to distinguish. This report presents detailed histopathological findings in two non-neoplastic subjects whose out-of-hospital deaths were caused by COVID-19 infection. These 'pure' cases differ in the time of presentation of symptoms, the phase of lung anatomopathological patterns (acute lung injury versus diffuse alveolar damage) and the mechanism of death. The results provide a valid diagnostic benchmark for evaluating the evolution of COVID-19 pneumonia.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/patología , Neumonía Viral/diagnóstico , Neumonía Viral/patología , Adulto , Benchmarking , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico
11.
Toxicol Lett ; 331: 218-226, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-32562635

RESUMEN

INTRODUCTION: The benchmark dose (BMD) is a dose that produces a predetermined change in the response rate of an adverse effect. This approach is increasingly utilized to analyze quantitative dose-response relationships. To proof this concept, statistical analysis was compared with the BMD approach in order to rank the sensitivity as well as the toxicity and to describe the mode of action. METHODS: Bronchial (BEAS-2B) and alveolar epithelial cells (A549) were exposed to a wide concentration range (0.4-100 µg/mL) of five metal oxide nanoparticles (CeO2, CuO, TiO2, ZnO, ZrO2). Eight toxicity endpoints were determined representing integrity of lysosomal and cell membrane, oxidative stress level, glutathione based detoxification (glutathione S-transferase), oxidative metabolism (cytochrome P450), alteration of the mitochondrial membrane potential, alteration of phase II antioxidative enzyme (NAD(P)H:quinone oxidoreductase), and de novo DNA synthesis. RESULTS: Based on the BMD calculated for the most sensitive test, the toxicity decreased in the following order: ZnO > CuO > TiO2>ZrO2>CeO2 in BEAS-2B. Both statistical evaluation methods revealed a higher sensitivity of BEAS-2B cells. The BMD-derived mode of action for CuO confirmed the existing hypotheses and provided insights into less known mechanisms. CONCLUSION: The findings proofed that BMD analysis is an effective tool to evaluate different aspects of risk assessment.


Asunto(s)
Células Epiteliales Alveolares/efectos de los fármacos , Bronquios/efectos de los fármacos , Pulmón/efectos de los fármacos , Nanopartículas del Metal/toxicidad , Células A549 , Benchmarking , Bronquios/citología , Relación Dosis-Respuesta a Droga , Determinación de Punto Final , Humanos , Pulmón/citología , Óxidos , Medición de Riesgo
13.
Stud Health Technol Inform ; 271: 232-239, 2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32578568

RESUMEN

BACKGROUND: Processing of free text written medical texts involves many difficulties arising from typographical errors, synonyms, and abbreviations occurring in the texts. METHODS: In this study, the applicability of the most common string similarity measures were analyzed and compared for the keyword-based medical text search. RESULTS: The usefulness of the similarity measures was studied in a set of medical documents containing more than 20,000 echocardiography reports. Experimental results showed that the Jaro-Winkler dissimilarity measure is the most capable measure to explore the content of the medical texts.


Asunto(s)
Benchmarking , Documentación
14.
Nat Biotechnol ; 38(6): 747-755, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32518403

RESUMEN

Single-cell RNA sequencing (scRNA-seq) is the leading technique for characterizing the transcriptomes of individual cells in a sample. The latest protocols are scalable to thousands of cells and are being used to compile cell atlases of tissues, organs and organisms. However, the protocols differ substantially with respect to their RNA capture efficiency, bias, scale and costs, and their relative advantages for different applications are unclear. In the present study, we generated benchmark datasets to systematically evaluate protocols in terms of their power to comprehensively describe cell types and states. We performed a multicenter study comparing 13 commonly used scRNA-seq and single-nucleus RNA-seq protocols applied to a heterogeneous reference sample resource. Comparative analysis revealed marked differences in protocol performance. The protocols differed in library complexity and their ability to detect cell-type markers, impacting their predictive value and suitability for integration into reference cell atlases. These results provide guidance both for individual researchers and for consortium projects such as the Human Cell Atlas.


Asunto(s)
Análisis de Secuencia de ARN , Análisis de la Célula Individual , Animales , Benchmarking , Línea Celular , Bases de Datos Genéticas , Genómica/métodos , Genómica/normas , Humanos , Ratones , Análisis de Secuencia de ARN/métodos , Análisis de Secuencia de ARN/normas , Análisis de la Célula Individual/métodos , Análisis de la Célula Individual/normas
15.
Stud Health Technol Inform ; 270: 1387-1388, 2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-32570672

RESUMEN

This poster presents some preliminary findings of the OpenWHO.org platform's global use trends, in terms of the geographical distribution and occupational characteristics of its users. Assessment of user profiles is essential to measure the platform's impact, most notably related to the attainment of its core mission: the provision of life-saving knowledge worldwide. A quantitative study was conducted on the global metrics of OpenWHO's user statistics. Common user categories encompassed a wide range of professional bodies and occupations, both within public health and beyond, ranging from students and volunteers, to WHO staff, to members of international organizations and NGOs. Global tendencies in platform use confirm that that the mission of OpenWHO, to provide timely, up-to-date and easy-to-understand lifesaving knowledge to healthcare workers based in-country and responding to outbreaks at the front line, is being met.


Asunto(s)
Educación a Distancia , Socorristas , Benchmarking , Personal de Salud , Humanos , Estudiantes
16.
Ecotoxicol Environ Saf ; 201: 110763, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32505759

RESUMEN

We aim to assess the risks of renal dysfunction and osteoporosis that is attributed to the seawater acidification caused cadmium (Cd) level increase in human consumed shellfish. A physiology-based pharmacokinetic model was used to estimate Cd concentrations in urine and blood among shellfish-only consumers and among the general population. We used the benchmark dose (BMD) method to determine the threshold limits of Cd in urine for renal dysfunction and in blood for osteoporosis for assessing the human health risk. Our results revealed that seawater acidification could increase the Cd accumulation in shellfish by 10-13% compared to the situations under current pH levels. Under the lower seawater pH level, the daily intake of Cd could increase by 21%-67% among shellfish-only consumers, and by 13%-17% among the general population. Our findings indicated that seawater acidification would lead to a marginal increase in Cd intake among humans in shellfish-only consumers. The results of BMDs of urinary Cd showed that the threshold limits for renal dysfunction at 5% were 3.00 µg g-1 in males and 12.35 µg g-1 in females. For osteoporosis, the estimated BMDs of blood Cd were 7.95 µg L-1 in males and 1.23 µg L-1 in females. These results of the risk of Cd intake showed that the consumption of Cd-contaminated shellfish in the general population is largely unaffected by changes in seawater pH levels. Notably, the potential impact of seawater acidification on renal dysfunction for males in shellfish-only consumers face a 14% increase of risk.


Asunto(s)
Cadmio/normas , Exposición Dietética/estadística & datos numéricos , Contaminantes Químicos del Agua/normas , Benchmarking , Cadmio/sangre , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Alimentos Marinos , Agua de Mar/química , Mariscos
17.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(3): 492-499, 2020 Jun 18.
Artículo en Chino | MEDLINE | ID: mdl-32541983

RESUMEN

OBJECTIVE: To assess the associations of different monitoring metrics for short-term exposure to ambient ozone (O3) with pulmonary function and airway inflammation in healthy young adults. METHODS: A total of 97 healthy young college students were recruited and followed in a panel study conducted from December 2017 to June 2018. Each participant underwent 3 follow-up visits, and lung function and fractional exhaled nitric oxide (FeNO) were measured at each visit. Ambient air pollutant concentrations were obtained from the environment monitoring station of Beijing closest to the participant residences, and meteorological data were collected from China Meteorological Data Service Center. Linear mixed-effect models were applied to assess the associations between different monitoring metrics for ambient O3 short-term exposure with pulmonary function or airway inflammation in the healthy young adults. RESULTS: During the study period, the P50 (P25, P75) values for ambient O3 concentration expressed as daily 1-hour maximum (O3-1 h max), daily maximum 8-hour average (O3-8 h max) and 24-hour average (O3-24 h avg) were 102.5 (76.8, 163.0) µg/m3, 91.1 (68.3, 154.3) µg/m3 and 61.6 (36.9, 81.7) µg/m3, respectively. The different monitoring metrics for short-term exposure to ambient O3 were significantly associated with reduced forced expiratory volume in the first second (FEV1) and increased FeNO. An interquartile range (IQR) increase in 6-d moving average of O3-1 h max (IQR=71.5 µg/m3) was associated with a 6.2% (95%CI: -11.8%, -0.5%) decrease in FEV1 and a 63.3% (95%CI: 13.8%, 134.3%) increase in FeNO. An IQR increase in 7-d moving average of O3-8 h max (IQR=62.0 µg/m3) was associated with a 6.2% (95%CI: -11.6%, -0.7%) decrease in FEV1and a 75.5% (95%CI: 19.3%, 158.0%) increase in FeNO. An IQR increase in 5-d moving average of O3-24 h avg (IQR=32.9 µg/m3) was associated with a 3.7% (95%CI: -7.1%, -0.2%) decrease in FEV1and a 25.3% (95%CI: 3.6%, 51.6%) increase in FeNO. There was no significant association between the three monitoring metrics for O3 exposure and peak expiratory flow (PEF). CONCLUSION: Short-term exposure to ambient O3 was associated with decreased lung function and increased airway inflammation among the healthy young adults, and daily 1-hour maximum was more sensitively to the respiratory effects of O3.


Asunto(s)
Contaminación del Aire , Contaminantes Atmosféricos , Benchmarking , China , Exposición a Riesgos Ambientales , Humanos , Inflamación , Ozono , Material Particulado , Adulto Joven
18.
Artículo en Inglés | MEDLINE | ID: mdl-32521811

RESUMEN

COVID-19 painfully demonstrates how little resilience our societies have to novel viruses. Societies, decision makers, and scientists lack (1) a comprehensive understanding of the complexity of viral outbreaks and their impact on society; (2) intervention portfolios; and (3) a global crisis and resilience policy, all of which are required to develop appropriate measures and to improve societal resilience. We highlight COVID-19 immunity as one key benchmark in preparation for the next wave of the pandemic. Specifically, using network scenarios, we demonstrate the substantial advantage of reintegrating health care workers with acquired COVID-19 immunity in epidemic hotspots, which would not only enable their safe contribution to the health care system but also drastically contain further spread.


Asunto(s)
Betacoronavirus/inmunología , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/inmunología , Pandemias/prevención & control , Neumonía Viral/inmunología , Benchmarking , Infecciones por Coronavirus/prevención & control , Necesidades y Demandas de Servicios de Salud , Humanos , Infectología , Neumonía Viral/prevención & control
19.
Medicine (Baltimore) ; 99(24): e20385, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541458

RESUMEN

Template matching is a proposed approach for hospital benchmarking, which measures performance based on matching a subset of comparable patient hospitalizations from each hospital. We assessed the ability to create the required matched samples and thus the feasibility of template matching to benchmark hospital performance in a diverse healthcare system.Nationwide Veterans Affairs (VA) hospitals, 2017.Observational cohort study.We used administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017. A standardized template of 300 hospitalizations was selected, and then 300 hospitalizations were matched to the template from each hospital.There was substantial case-mix variation across VA hospitals, which persisted after excluding small hospitals, hospitals with primarily psychiatric admissions, and hospitalizations for rare diagnoses. Median age ranged from 57 to 75 years across hospitals; percent surgical admissions ranged from 0.0% to 21.0%; percent of admissions through the emergency department, 0.1% to 98.7%; and percent Hispanic patients, 0.2% to 93.3%. Characteristics for which there was substantial variation across hospitals could not be balanced with any matching algorithm tested. Although most other variables could be balanced, we were unable to identify a matching algorithm that balanced more than ∼20 variables simultaneously.We were unable to identify a template matching approach that could balance hospitals on all measured characteristics potentially important to benchmarking. Given the magnitude of case-mix variation across VA hospitals, a single template is likely not feasible for general hospital benchmarking.


Asunto(s)
Benchmarking/métodos , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales de Veteranos/estadística & datos numéricos , Anciano , Algoritmos , Benchmarking/normas , Estudios de Cohortes , Grupos Diagnósticos Relacionados/tendencias , Servicio de Urgencia en Hospital/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Hispanoamericanos/estadística & datos numéricos , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Evaluación de Resultado en la Atención de Salud/métodos , Calidad de la Atención de Salud/estadística & datos numéricos , Servicio de Cirugía en Hospital/estadística & datos numéricos , Estados Unidos/epidemiología , United States Department of Veterans Affairs/organización & administración
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