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1.
J Tradit Chin Med ; 40(3): 497-508, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32506865

RESUMEN

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.


Asunto(s)
Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus , Medicamentos Herbarios Chinos/uso terapéutico , Medicina China Tradicional/métodos , Pandemias , Neumonía Viral , China , Protocolos Clínicos , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Fitoterapia
2.
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
3.
Ann Rheum Dis ; 79(7): 943-950, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32321721

RESUMEN

OBJECTIVES: Remission in systemic lupus erythematosus (SLE) is defined through a combination of 'clinical SLE Disease Activity Index (cSLEDAI)=0', 'physician's global assessment (PGA) <0.5' and 'prednisone (PDN) ≤5 mg/day'. We investigated the performance of these items, alone or in combination, in defining remission and in predicting SLICC/ACR Damage Index. METHODS: We tested seven potential definitions of remission in SLE patients followed-up for ≥5 years: PDN ≤5 mg/day; PGA <0.5; cSLEDAI=0; PGA <0.5 plus PDN ≤5 mg/day; cSLEDAI=0 plus PGA <0.5; cSLEDAI=0 plus PDN ≤5 mg/day; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5. The effect of these definitions on damage was evaluated by Poisson regression analysis; the best performance was identified as the lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were calculated. RESULTS: We included 646 patients (mean±SD disease duration 9.2±6.9 years). At multivariate analysis, ≥2 consecutive year remission according to all definitions protected against damage (OR, 95% CI: PGA <0.5 0.631, 0.444 to 0.896; cSLEDAI=0 0.531, 0.371 to 0.759; PGA <0.5 plus PDN ≤5 mg/day 0.554, 0.381 to 0.805; cSLEDAI=0 plus PGA <0.5 0.574, 0.400 to 0.826; cSLEDAI=0 plus PDN ≤5 mg/day 0.543, 0.376 to 0.785; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5 0.532, 0.363 to 0.781, p<0.01 for all), except PDN ≤5 mg/day, which required four consecutive years (OR 0.534, 95% CI 0.325 to 0.877, p=0.013). Positive and negative predictive values were similar; however, cSLEDAI=0 showed the best performance (AIC 1082.90, BIC 1109.72, p<0.0001). Adding PGA <0.5 and/or PDN ≤5 mg/day to cSLEDAI=0 decreased remission duration (-1.8 and -1.5 year/patient, respectively) without increasing cSLEDAI=0 performance in predicting damage accrual. CONCLUSIONS: cSLEDAI=0 is the most attainable definition of remission, while displaying the best performance in predicting damage progression in the short-to-mid-term follow-up.


Asunto(s)
Lupus Eritematoso Sistémico/clasificación , Lupus Eritematoso Sistémico/tratamiento farmacológico , Evaluación de Resultado en la Atención de Salud/métodos , Índice de Severidad de la Enfermedad , Adulto , Antiinflamatorios/administración & dosificación , Teorema de Bayes , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prednisona/administración & dosificación , Análisis de Regresión , Inducción de Remisión
4.
Anticancer Res ; 40(4): 2199-2208, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234915

RESUMEN

BACKGROUND/AIM: To date, there is no clear understanding whether preoperative long-course chemoradiotherapy combined with surgery for rectal cancer is detrimental to anorectal function. The purpose of this study was to clarify the influence of preoperative chemoradiotherapy and surgery for middle and lower rectal cancer on postoperative anorectal function. PATIENTS AND METHODS: Data of 113 patients with middle or lower rectal cancer treated with preoperative chemoradiotherapy plus surgery or surgery alone between January 2013 and December 2016 were analyzed. A total of 84 and 29 patients underwent low anterior resection and intersphincteric resection, respectively. In patients with T3 or deeper and with any N stage cancer below peritoneal reflection, surgery plus lateral lymph node dissection or preoperative radiation (total: 50.4 Gy/28 fractions) to the pelvis with chemoradiotherapy plus surgery was treated. Anorectal function was assessed prior to treatment and 6 and 12 months postoperatively. Specifically, maximum resting pressure and maximum squeezing pressures were measured. The Wexner score was recorded prior to treatment and 12 months postoperatively. RESULTS: maximum resting pressure and maximum squeezing pressure decreased post-surgery in both groups. Maximum resting pressure and maximum squeezing pressure at 12 months and the Wexner score at 12 months post-surgery were comparable among patients treated with chemoradiotherapy plus surgery and those treated with surgery alone. CONCLUSION: Preoperative chemoradiotherapy did not clearly impair postoperative anorectal function in patients who underwent low anterior resection and intersphincteric resection.


Asunto(s)
Canal Anal/fisiopatología , Neoplasias del Recto/cirugía , Neoplasias del Recto/terapia , Recto/fisiopatología , Anciano , Canal Anal/patología , Canal Anal/cirugía , Quimioradioterapia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Periodo Preoperatorio , Recto/patología , Recto/cirugía
5.
Anticancer Res ; 40(4): 2209-2217, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234916

RESUMEN

AIM: To investigate potential association between administration of corticosteroids, antibiotics, probiotics, proton pump inhibitors, non-steroidal anti-inflammatory drugs (NSAID), statins and metformin and outcome in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. PATIENTS AND METHODS: A total of 224 patients with advanced NSCLC treated at nine comprehensive cancer centers were analyzed in this national retrospective study. Survival statistics were evaluated using Kaplan-Meier method and Cox analysis. RESULTS: Only corticosteroid use had a significant negative effect on the objective response rate. In the univariate analysis, there was no significant effect of the studied concomitant medications on the efficacy of nivolumab. In a subsequent multifactorial analysis, a possible positive effect of the concomitant use of NSAID at the initiation of nivolumab treatment was revealed. CONCLUSION: The results of the present retrospective exploratory analysis underscore the importance of knowing the exact type of concomitant medication, the route of administration, the dose of medication, and the region of the ongoing study. The present data indicated a significantly higher rate of progression in patients treated with corticosteroids and the possible positive effect of NSAID use at the initiation of nivolumab treatment.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Evaluación de Resultado en la Atención de Salud/métodos , Corticoesteroides/administración & dosificación , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Estimación de Kaplan-Meier , Masculino , Metformina/administración & dosificación , Persona de Mediana Edad , Nivolumab/administración & dosificación , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Probióticos/administración & dosificación , Modelos de Riesgos Proporcionales , Inhibidores de la Bomba de Protones/administración & dosificación , Estudios Retrospectivos
6.
Anticancer Res ; 40(4): 2257-2260, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234922

RESUMEN

BACKGROUND/AIM: For treatment personalization in elderly cancer patients, survival prognoses should be considered. We developed an instrument to estimate survival of elderly patients with brain metastasis from gynecological cancer. PATIENTS AND METHODS: In 15 patients, whole-brain radiotherapy regimen, tumor site, age, Karnofsky performance score (KPS), number of brain metastases, extra-cerebral metastases and interval from diagnosis of gynecological cancer until radiotherapy were retrospectively evaluated for survival. Characteristics found significant on multivariate analysis were used for the instrument. RESULTS: In the multivariate analysis, KPS ≥70% (hazard ratio=3.71, p=0.0499) and an interval ≥28 months (hazard ratio=3.71, p=0.030) were significantly associated with better survival. Based on these characteristics, patients received 0 (n=6), 1 (n=3) or 2 points (n=6). Six-month survival rates of the groups 0-1 and 2 points were 0% and 50%, respectively (p=0.007). CONCLUSION: This instrument helps estimating survival in elderly patients with brain metastases from gynecological cancer and contributes to personalization of their treatment.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Irradiación Craneana/métodos , Anciano , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Femenino , Humanos , Estimación de Kaplan-Meier , Estado de Ejecución de Karnofsky , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Neoplasias Ováricas/patología , Estudios Retrospectivos , Tasa de Supervivencia
7.
Anticancer Res ; 40(4): 2331-2336, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234934

RESUMEN

BACKGROUND/AIM: To assess the perioperative outcomes of cholecystectomy in cytoreductive procedures for epithelial ovarian cancer (EOC). PATIENTS AND METHODS: Prospectively collected perioperative data of patients that underwent cytoreduction for advanced EOC, between 2014 and 2018, were analysed. Patients were divided in two groups on the basis of whether cholecystectomy was performed. RESULTS: A total of 144 patients with stage IIIC/IV EOC were included. Cholecystectomy was performed in 22 (15.3%) patients. Those who underwent cholecystectomy more likely required diaphragmatic peritonectomy, splenectomy, lesser omentectomy, excision of disease from the porta hepatis and liver's capsule (p<0.001). There was no difference in the cytoreductive outcomes (complete or optimal) and the rate of grade 3-5 complications between the two groups (p=0.10 & p=0.06, respectively). No direct complications related to cholecystectomy were observed. CONCLUSION: A significant percentage of patients with advanced EOC require cholecystectomy. Gynecologic oncologists should embrace the opportunity to develop advanced surgical skills including cholecystectomy.


Asunto(s)
Carcinoma Epitelial de Ovario/cirugía , Colecistectomía/métodos , Procedimientos Quirúrgicos de Citorreducción/métodos , Anciano , Carcinoma Epitelial de Ovario/patología , Diafragma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Periodo Perioperatorio
8.
BMC Psychiatry ; 20(1): 51, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32028913

RESUMEN

BACKGROUND: Supporting personal recovery in people with mental health difficulties is central to mental health services. This study aimed to develop the Japanese version of INSPIRE and Brief INSPIRE measure of staff support for personal recovery and to evaluate its reliability and validity. METHODS: A questionnaire survey was conducted from October to December 2015. The authors asked users to participate in the survey of 14 community mental health services in the Kanto region of Japan. The service users completed self-administered questionnaires that include the Japanese version of INSPIRE, the Recovery Assessment Scale, the Client Satisfaction Questionnaire, the patient version of the Scale to Assess Therapeutic Relationship in Community Mental Health care and the Short Form Health Survey. Internal consistency was assessed using Cronbach's alpha coefficient, and test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. Convergent validity was examined by assessing correlation with other scales. Factor validity was evaluated by exploratory factor analysis (EFA) with generalized least-squares mean and oblimin rotation. In addition, confirmatory factor analysis was used to check the fitness of the factor structure models derived from the EFA. RESULTS: A total of 195 out of 212 users gave written informed consent and participated in the study. Data from 190 respondents were analyzed (response rate 89.6%). INSPIRE, Brief INSPIRE, and the subscales all showed Cronbach's alpha coefficient over 0.78. ICC and weighted kappa derived more than 0.92 for subscales and Brief INSPIRE. These numerical values indicated good reliability. The convergent validity of Brief INSPIRE and the subscales was significantly positively correlated with the other scales. Different from the previous study, the factor structure was extracted using EFA. Both factor structures were checked by CFA, but the degree of fitness index was not good in either. Therefore, the factor analysis did not show goodness of fit. CONCLUSIONS: This study found the Japanese version of INSPIRE and Brief INSPIRE to be reliable and valid for use among community mental health service users in Japan.


Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Trastornos Mentales/rehabilitación , Evaluación de Resultado en la Atención de Salud/métodos , Psicometría , Autoimagen , Adulto , Femenino , Humanos , Japón , Masculino , Salud Mental , Psicometría/métodos , Psicometría/normas , Reproducibilidad de los Resultados , Traducciones
9.
BMJ ; 368: m160, 2020 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-32071114

RESUMEN

OBJECTIVES: To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage. DESIGN: Systematic review. DATA SOURCES: Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level. RESULTS: Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use. CONCLUSIONS: 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017074211.


Asunto(s)
Indicadores de Salud , Multimorbilidad , Sesgo , Servicios de Salud Comunitaria , Medicina Basada en la Evidencia/métodos , Humanos , Trastornos Mentales/epidemiología , Evaluación de Resultado en la Atención de Salud/métodos , Calidad de Vida , Reproducibilidad de los Resultados , Medición de Riesgo/métodos
10.
Plast Reconstr Surg ; 145(3): 746-754, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32097319

RESUMEN

Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.


Asunto(s)
Artritis Reumatoide/cirugía , Artroplastia/efectos adversos , Prótesis Articulares/efectos adversos , Evaluación de Resultado en la Atención de Salud/normas , Proyectos de Investigación/normas , Artritis Reumatoide/epidemiología , Artroplastia/instrumentación , Artroplastia/normas , Sesgo , Toma de Decisiones Clínicas , Ensayos Clínicos como Asunto/normas , Medicina Basada en la Evidencia/normas , Estudios de Seguimiento , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Selección de Paciente , Estudios Prospectivos , Siliconas/efectos adversos
11.
Am J Occup Ther ; 74(1): 7401185030p1-7401185030p18, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078508

RESUMEN

IMPORTANCE: Low vision affects many older adults and is expected to significantly increase over the next several decades. It has a significant impact on all aspects of daily life, including the reading required for participation in occupations. OBJECTIVE: To determine the effectiveness of interventions within the scope of occupational therapy to improve reading required for the performance of occupations by older adults with low vision. DATA SOURCES: We conducted a systematic review of literature published in the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker databases from 2010 through 2016. The references of retrieved articles were also hand searched. STUDY SELECTION AND DATA COLLECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to abstract and assess data quality and validity. This review followed the established methodology of the American Occupational Therapy Association Evidence-Based Practice Project. FINDINGS: Sixteen articles met the inclusion criteria and were categorized into three themes: (1) technology, (2) visual skills training, and (3) multicomponent interventions. Moderate evidence supports stand-based electronic magnification and eccentric viewing training to improve reading outcomes. Strong evidence supports multicomponent interventions. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners working with older adults with low vision are strongly encouraged to integrate stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services into routine care. Further research with larger sample sizes and functional reading outcome measures is needed. WHAT THIS ARTICLE ADDS: This review provides additional support for the use of select occupational therapy interventions (stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services) to support the reading required for occupational performance for older adults with low vision. The findings provide guidance to occupational therapy practitioners for selection and implementation of evidence-based interventions for reading.


Asunto(s)
Terapia Ocupacional , Baja Visión , Anciano , Práctica Clínica Basada en la Evidencia , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Lectura
12.
BMC Geriatr ; 20(1): 30, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996158

RESUMEN

BACKGROUND: Ambulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age. We evaluated the effectiveness of AGR compared to usual care on progression of nursing care levels, nursing home admissions, hospital admissions, incident fractures, mortality rate and total cost of care during a one-year follow-up period. METHODS: Analyses were based on claims data from the health insurance company AOK Nordost. Propensity Score matching was used to match 4 controls to each person receiving the AGR intervention. RESULTS: A total of 632 AGR participants and 2528 matched controls were included. The standardized mean difference of matching variables between cases and controls was small (mean: + 1.4%; range: - 4.4/3.9%). In AGR patients, the progression of nursing care levels (+ 2.2%, 95%CI: - 0.9 /5.3), nursing home admissions (+ 1.7%, 95%CI: - 0.1/3.5), hospital admissions (+ 1.1%, 95%CI: - 3.2/5.4), incident fractures (+ 11.1%, 95%CI: 7.3/15) and mortality rate (+ 1.2%, p = 0.20) showed a less favourable course compared to controls. The average total cost per AGR participant was lower than in the control group (- 353€, 95%CI: - 989€/282€), not including costs for AGR. CONCLUSIONS: Analysis based on claims data showed no clinical benefit from AGR intervention regarding the investigated outcomes. The slightly worse outcomes may reflect limitations in matching based on claims data, which may have insufficiently reflected morbidity and psychosocial factors. It is possible that the intervention group had poorer health status at baseline compared to the control group. TRIAL REGISTRATION: German Clinical Trials Register DRKS00008926, registered 29.07.2015.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Evaluación Geriátrica/métodos , Servicios de Salud para Ancianos/normas , Formulario de Reclamación de Seguro/normas , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/tendencias , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Servicios de Salud para Ancianos/tendencias , Humanos , Formulario de Reclamación de Seguro/tendencias , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/normas , Evaluación de Resultado en la Atención de Salud/tendencias , Resultado del Tratamiento
13.
BMC Health Serv Res ; 20(1): 23, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915001

RESUMEN

BACKGROUND: The science of measuring and reporting on the performance of healthcare systems is rapidly evolving. In the past decade, across many jurisdictions, organisations tasked with monitoring progress towards reform targets have broadened their purview to take a more system-functioning approach. Their aim is to bring clarity to performance assessment, using relevant and robust concepts - and avoiding reductionist measures - to build a whole-of-system view of performance. Existing performance frameworks are not fully aligned with these developments. METHODS: An eight stage process to develop a conceptual framework incorporated literature review, mapping, categorisation, integration, synthesis and validation of performance constructs that have been used by organisations and researchers in order to assess, reflect and report on healthcare performance. RESULTS: A total of 19 performance frameworks were identified and included in the review. Existing frameworks mostly adopted either a logic model (inputs, outputs and outcomes), a functional, or a goal-achievement approach. The mapping process identified 110 performance terms and concepts. These were integrated, synthesised and resynthesised to produce a framework that features 12 derived constructs reflecting combinations of patients' needs and expectations; healthcare resources and structures; receipt and experience of healthcare services; healthcare processes, functions and context; and healthcare outcomes. The 12 constructs gauge performance in terms of coverage, accessibility, appropriateness, effectiveness, safety, productivity, efficiency, impact, sustainability, resilience, adaptability and equity. They reflect four performance perspectives (patient, population, delivery organisation and system). CONCLUSIONS: Internationally, healthcare systems and researchers have used a variety of terms to categorise indicators of healthcare performance, however few frameworks are based on a theoretically-based conceptual underpinning. The proposed framework incorporates a manageable number of performance domains that together provide a comprehensive assessment, as well as conceptual and operational clarity and coherence that support multifaceted measurement systems for healthcare.


Asunto(s)
Evaluación de Resultado en la Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Humanos
14.
Cancer Invest ; 38(2): 122-129, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985315

RESUMEN

The aim of this study was to assess the association of serum C-reactive protein (CRP) levels with outcomes in 81 patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). Patients with high serum CRP levels had lower therapeutic responses to EGFR-tyrosine kinase inhibitors (43.8%), and shorter time to treatment failure (TTF; 5.8 months) and overall survival (OS; 14.2 months) than those with low CRP levels. In multivariate analysis, serum CRP level was associated with TTF (hazard ratio [HR] 4.86) and OS (HR 49.42). High serum CRP levels may predict poor outcomes in patients with EGFR-mutated NSCLC.


Asunto(s)
Proteína C-Reactiva/análisis , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Mutación , Inhibidores de Proteínas Quinasas/uso terapéutico , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/genética , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/genética , Receptores ErbB/genética , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/genética , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos
15.
BMJ ; 368: l6802, 2020 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-31964641

RESUMEN

OBJECTIVES: To study the impact of blinding on estimated treatment effects, and their variation between trials; differentiating between blinding of patients, healthcare providers, and observers; detection bias and performance bias; and types of outcome (the MetaBLIND study). DESIGN: Meta-epidemiological study. DATA SOURCE: Cochrane Database of Systematic Reviews (2013-14). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Meta-analyses with both blinded and non-blinded trials on any topic. REVIEW METHODS: Blinding status was retrieved from trial publications and authors, and results retrieved automatically from the Cochrane Database of Systematic Reviews. Bayesian hierarchical models estimated the average ratio of odds ratios (ROR), and estimated the increases in heterogeneity between trials, for non-blinded trials (or of unclear status) versus blinded trials. Secondary analyses adjusted for adequacy of concealment of allocation, attrition, and trial size, and explored the association between outcome subjectivity (high, moderate, low) and average bias. An ROR lower than 1 indicated exaggerated effect estimates in trials without blinding. RESULTS: The study included 142 meta-analyses (1153 trials). The ROR for lack of blinding of patients was 0.91 (95% credible interval 0.61 to 1.34) in 18 meta-analyses with patient reported outcomes, and 0.98 (0.69 to 1.39) in 14 meta-analyses with outcomes reported by blinded observers. The ROR for lack of blinding of healthcare providers was 1.01 (0.84 to 1.19) in 29 meta-analyses with healthcare provider decision outcomes (eg, readmissions), and 0.97 (0.64 to 1.45) in 13 meta-analyses with outcomes reported by blinded patients or observers. The ROR for lack of blinding of observers was 1.01 (0.86 to 1.18) in 46 meta-analyses with subjective observer reported outcomes, with no clear impact of degree of subjectivity. Information was insufficient to determine whether lack of blinding was associated with increased heterogeneity between trials. The ROR for trials not reported as double blind versus those that were double blind was 1.02 (0.90 to 1.13) in 74 meta-analyses. CONCLUSION: No evidence was found for an average difference in estimated treatment effect between trials with and without blinded patients, healthcare providers, or outcome assessors. These results could reflect that blinding is less important than often believed or meta-epidemiological study limitations, such as residual confounding or imprecision. At this stage, replication of this study is suggested and blinding should remain a methodological safeguard in trials.


Asunto(s)
Ensayos Clínicos como Asunto , Diseño de Investigaciones Epidemiológicas , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos como Asunto/métodos , Ensayos Clínicos como Asunto/organización & administración , Ensayos Clínicos como Asunto/normas , Humanos , Variaciones Dependientes del Observador , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Proyectos de Investigación/normas
18.
Am J Epidemiol ; 189(2): 81-90, 2020 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-31165875

RESUMEN

We propose a general class of 2-phase epidemiologic study designs for quantitative, longitudinal data that are useful when phase 1 longitudinal outcome and covariate data are available but data on the exposure (e.g., a biomarker) can only be collected on a subset of subjects during phase 2. To conduct a study using a design in the class, one first summarizes the longitudinal outcomes by fitting a simple linear regression of the response on a time-varying covariate for each subject. Sampling strata are defined by splitting the estimated regression intercept or slope distributions into distinct (low, medium, and high) regions. Stratified sampling is then conducted from strata defined by the intercepts, by the slopes, or from a mixture. In general, samples selected with extreme intercept values will yield low variances for associations of time-fixed exposures with the outcome and samples enriched with extreme slope values will yield low variances for associations of time-varying exposures with the outcome (including interactions with time-varying exposures). We describe ascertainment-corrected maximum likelihood and multiple-imputation estimation procedures that permit valid and efficient inferences. We embed all methodological developments within the framework of conducting a substudy that seeks to examine genetic associations with lung function among continuous smokers in the Lung Health Study (United States and Canada, 1986-1994).


Asunto(s)
Diseño de Investigaciones Epidemiológicas , Modelos Estadísticos , Evaluación de Resultado en la Atención de Salud/métodos , Estudios de Casos y Controles , Humanos , Modelos Lineales , Estudios Longitudinales , Muestreo
19.
Support Care Cancer ; 28(2): 779-786, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31144172

RESUMEN

PURPOSE: Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. METHODS: Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. RESULTS: The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. CONCLUSIONS: The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.


Asunto(s)
Neoplasias de la Mama/fisiopatología , Enfermedades Musculoesqueléticas/fisiopatología , Evaluación de Resultado en la Atención de Salud/métodos , Rango del Movimiento Articular/fisiología , Extremidad Superior/fisiología , Adulto , Anciano , Femenino , Estado de Salud , Humanos , Persona de Mediana Edad , Movimiento , Dolor/fisiopatología , Calidad de Vida/psicología , Encuestas y Cuestionarios
20.
Am J Phys Med Rehabil ; 99(4): 310-317, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31634206

RESUMEN

OBJECTIVE: Predicting recovery of functional performance within pediatric rehabilitation after brain injury is important for health professionals and families, but information regarding factors associated with change in functional skills ("what the child can do") and functional independence ("what the child does") is limited. The aim of the study was to examine change in functional skills and independence over time in children with moderate-severe brain injury during prolonged inpatient rehabilitation. DESIGN: This study used a retrospective cohort design. Longitudinal data from 139 children (age 1.6-20.6 yrs), hospitalized for 115.4 ± 72 days, were examined. Growth curve analysis was used to examine factors associated with change in the Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance, ie, functional independence) in mobility and self-care. Typical estimates for change per hospitalization day were obtained. RESULTS: Traumatic brain injury and older age at injury, but not sex, were associated with faster recovery. Length of stay was associated with rate of change in functional skills but not in functional independence, suggesting that improvement in functional independence during rehabilitation may be associated with other factors. CONCLUSIONS: Identifying the factors associated with individual profiles of functional improvement can provide valuable information for clinicians and decision-makers to optimize performance after prolonged inpatient rehabilitation.


Asunto(s)
Lesiones Encefálicas/rehabilitación , Evaluación de la Discapacidad , Tiempo de Internación/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Autocuidado/estadística & datos numéricos , Adolescente , Lesiones Encefálicas/fisiopatología , Niño , Preescolar , Análisis Factorial , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Rendimiento Físico Funcional , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
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