Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34.917
Filtrar
1.
Cochrane Database Syst Rev ; 3: CD013639, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33724443

RESUMEN

BACKGROUND: The respiratory illness caused by SARS-CoV-2 infection continues to present diagnostic challenges. Our 2020 edition of this review showed thoracic (chest) imaging to be sensitive and moderately specific in the diagnosis of coronavirus disease 2019 (COVID-19). In this update, we include new relevant studies, and have removed studies with case-control designs, and those not intended to be diagnostic test accuracy studies. OBJECTIVES: To evaluate the diagnostic accuracy of thoracic imaging (computed tomography (CT), X-ray and ultrasound) in people with suspected COVID-19. SEARCH METHODS: We searched the COVID-19 Living Evidence Database from the University of Bern, the Cochrane COVID-19 Study Register, The Stephen B. Thacker CDC Library, and repositories of COVID-19 publications through to 30 September 2020. We did not apply any language restrictions. SELECTION CRITERIA: We included studies of all designs, except for case-control, that recruited participants of any age group suspected to have COVID-19 and that reported estimates of test accuracy or provided data from which we could compute estimates. DATA COLLECTION AND ANALYSIS: The review authors independently and in duplicate screened articles, extracted data and assessed risk of bias and applicability concerns using the QUADAS-2 domain-list. We presented the results of estimated sensitivity and specificity using paired forest plots, and we summarised pooled estimates in tables. We used a bivariate meta-analysis model where appropriate. We presented the uncertainty of accuracy estimates using 95% confidence intervals (CIs). MAIN RESULTS: We included 51 studies with 19,775 participants suspected of having COVID-19, of whom 10,155 (51%) had a final diagnosis of COVID-19. Forty-seven studies evaluated one imaging modality each, and four studies evaluated two imaging modalities each. All studies used RT-PCR as the reference standard for the diagnosis of COVID-19, with 47 studies using only RT-PCR and four studies using a combination of RT-PCR and other criteria (such as clinical signs, imaging tests, positive contacts, and follow-up phone calls) as the reference standard. Studies were conducted in Europe (33), Asia (13), North America (3) and South America (2); including only adults (26), all ages (21), children only (1), adults over 70 years (1), and unclear (2); in inpatients (2), outpatients (32), and setting unclear (17). Risk of bias was high or unclear in thirty-two (63%) studies with respect to participant selection, 40 (78%) studies with respect to reference standard, 30 (59%) studies with respect to index test, and 24 (47%) studies with respect to participant flow. For chest CT (41 studies, 16,133 participants, 8110 (50%) cases), the sensitivity ranged from 56.3% to 100%, and specificity ranged from 25.4% to 97.4%. The pooled sensitivity of chest CT was 87.9% (95% CI 84.6 to 90.6) and the pooled specificity was 80.0% (95% CI 74.9 to 84.3). There was no statistical evidence indicating that reference standard conduct and definition for index test positivity were sources of heterogeneity for CT studies. Nine chest CT studies (2807 participants, 1139 (41%) cases) used the COVID-19 Reporting and Data System (CO-RADS) scoring system, which has five thresholds to define index test positivity. At a CO-RADS threshold of 5 (7 studies), the sensitivity ranged from 41.5% to 77.9% and the pooled sensitivity was 67.0% (95% CI 56.4 to 76.2); the specificity ranged from 83.5% to 96.2%; and the pooled specificity was 91.3% (95% CI 87.6 to 94.0). At a CO-RADS threshold of 4 (7 studies), the sensitivity ranged from 56.3% to 92.9% and the pooled sensitivity was 83.5% (95% CI 74.4 to 89.7); the specificity ranged from 77.2% to 90.4% and the pooled specificity was 83.6% (95% CI 80.5 to 86.4). For chest X-ray (9 studies, 3694 participants, 2111 (57%) cases) the sensitivity ranged from 51.9% to 94.4% and specificity ranged from 40.4% to 88.9%. The pooled sensitivity of chest X-ray was 80.6% (95% CI 69.1 to 88.6) and the pooled specificity was 71.5% (95% CI 59.8 to 80.8). For ultrasound of the lungs (5 studies, 446 participants, 211 (47%) cases) the sensitivity ranged from 68.2% to 96.8% and specificity ranged from 21.3% to 78.9%. The pooled sensitivity of ultrasound was 86.4% (95% CI 72.7 to 93.9) and the pooled specificity was 54.6% (95% CI 35.3 to 72.6). Based on an indirect comparison using all included studies, chest CT had a higher specificity than ultrasound. For indirect comparisons of chest CT and chest X-ray, or chest X-ray and ultrasound, the data did not show differences in specificity or sensitivity. AUTHORS' CONCLUSIONS: Our findings indicate that chest CT is sensitive and moderately specific for the diagnosis of COVID-19. Chest X-ray is moderately sensitive and moderately specific for the diagnosis of COVID-19. Ultrasound is sensitive but not specific for the diagnosis of COVID-19. Thus, chest CT and ultrasound may have more utility for excluding COVID-19 than for differentiating SARS-CoV-2 infection from other causes of respiratory illness. Future diagnostic accuracy studies should pre-define positive imaging findings, include direct comparisons of the various modalities of interest in the same participant population, and implement improved reporting practices.


Asunto(s)
/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos X , Ultrasonografía , Adolescente , Adulto , Anciano , Sesgo , Niño , Intervalos de Confianza , Humanos , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Radiografía Torácica/normas , Radiografía Torácica/estadística & datos numéricos , Estándares de Referencia , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/normas , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Ultrasonografía/normas , Ultrasonografía/estadística & datos numéricos , Adulto Joven
2.
Nat Commun ; 12(1): 1545, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750775

RESUMEN

Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.


Asunto(s)
Tormentas Ciclónicas , Hospitalización/estadística & datos numéricos , Anciano , Enfermedades Transmisibles/epidemiología , Intervalos de Confianza , Ambiente , Humanos , Estudios Interdisciplinarios , Enfermedades Pulmonares/epidemiología , Medicare , Enfermedades Parasitarias/epidemiología , Salud Pública , Factores de Riesgo , Estados Unidos/epidemiología , Viento , Heridas y Traumatismos/epidemiología
3.
Acta Med Port ; 34(2): 87-94, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33641702

RESUMEN

INTRODUCTION: The aim of this study was to estimate and describe the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific antibodies (immunoglobulin M and/or immunoglobulin G) in Portugal in May-July 2020. MATERIAL AND METHODS: A cross-sectional seroepidemiological survey was developed after the peak of the first epidemic wave on a sample of 2301 Portuguese residents, aged 1 year or older. Survey sample was selected using a two-stage stratified non-probability sampling design (quota sampling). SARS-CoV-2 immunoglobulin M and immunoglobulin G antibodies were measured in serum samples by enzyme-linked immunosorbent assay. Seroprevalence estimates of immunoglobulin M and/or immunoglobulin G and 95% confidence intervals were stratified by sex, age group, health region and education. RESULTS: Overall, seroprevalence was 2.9% (95% confidence interval: 2.0% - 4.2%). Higher prevalence rates were observed in male (4.1%, 95% confidence interval: 2.6% - 6.6%) and those with secondary education (6.4%, 95% confidence interval: 3.2% - 12.5%). Differences in seroprevalence by age group and region were not statistically significant. DISCUSSION: The estimated seroprevalence of SARS-CoV-2 was higher than the cumulative incidence reported by the National Surveillance System but far from necessary to reach herd immunity. CONCLUSION: Our results support limited extent of infection by SARS-CoV-2 in the study population possibly due to early lockdown measures implemented in Portugal and support the need to continue monitoring of SARS-CoV-2 seroprevalence in order to increase our knowledge about the evolution of the epidemic and to estimate the proportion of the susceptible population over time.


Asunto(s)
Anticuerpos Antivirales/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , /inmunología , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Intervalos de Confianza , Estudios Transversales , Escolaridad , Epidemias , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Prevalencia , Estudios Seroepidemiológicos , Distribución por Sexo , Adulto Joven
4.
Molecules ; 26(4)2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33669834

RESUMEN

Applied datasets can vary from a few hundred to thousands of samples in typical quantitative structure-activity/property (QSAR/QSPR) relationships and classification. However, the size of the datasets and the train/test split ratios can greatly affect the outcome of the models, and thus the classification performance itself. We compared several combinations of dataset sizes and split ratios with five different machine learning algorithms to find the differences or similarities and to select the best parameter settings in nonbinary (multiclass) classification. It is also known that the models are ranked differently according to the performance merit(s) used. Here, 25 performance parameters were calculated for each model, then factorial ANOVA was applied to compare the results. The results clearly show the differences not just between the applied machine learning algorithms but also between the dataset sizes and to a lesser extent the train/test split ratios. The XGBoost algorithm could outperform the others, even in multiclass modeling. The performance parameters reacted differently to the change of the sample set size; some of them were much more sensitive to this factor than the others. Moreover, significant differences could be detected between train/test split ratios as well, exerting a great effect on the test validation of our models.


Asunto(s)
Algoritmos , Bases de Datos como Asunto , Relación Estructura-Actividad Cuantitativa , Intervalos de Confianza , Aprendizaje Automático
5.
Cochrane Database Syst Rev ; 2: CD012844, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33539561

RESUMEN

BACKGROUND: Commercial video games are a vastly popular form of recreational activity. Whilst concerns persist regarding possible negative effects of video games, they have been suggested to provide cognitive benefits to users. They are also frequently employed as control interventions in comparisons of more complex cognitive or psychological interventions. If independently effective, video games - being both engaging and relatively inexpensive - could provide a much more cost-effective add-on intervention to standard treatment when compared to costly, cognitive interventions. OBJECTIVES: To review the effects of video games (alone or as an additional intervention) compared to standard care alone or other interventions including, but not limited to, cognitive remediation or cognitive behavioural therapy for people with schizophrenia or schizophrenia-like illnesses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (March 2017, August 2018, August 2019). SELECTION CRITERIA: Randomised controlled trials focusing on video games for people with schizophrenia or schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS: Review authors extracted data independently. For binary outcomes we calculated risk ratio (RR) with its 95% confidence interval (CI) on an intention-to-treat basis. For continuous data we calculated the mean difference (MD) between groups and its CI. We employed a fixed-effect model for analyses. We assessed risk of bias for the included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS: This review includes seven trials conducted between 2009 and 2018 (total = 468 participants, range 32 to 121). Study duration varied from six weeks to twelve weeks. All interventions in the included trials were given in addition to standard care, including prescribed medication. In trials video games tend to be the control for testing efficacy of complex, cognitive therapies; only two small trials evaluated commercial video games as the intervention. We categorised video game interventions into 'non-exergame' (played statically) and 'exergame' (the players use bodily movements to control the game). Our main outcomes of interest were clinically important changes in: general functioning, cognitive functioning, social functioning, mental state, quality of life, and physical fitness as well as clinically important adverse effects. We found no clear difference between non-exergames and cognitive remediation in general functioning scores (Strauss Carpenter Outcome Scale) (MD 0.42, 95% CI -0.62 to 1.46; participants = 86; studies = 1, very low-quality evidence) or social functioning scores (Specific Levels of Functioning Scale) (MD -3.13, 95% CI -40.17 to 33.91; participants = 53; studies = 1, very low-quality evidence). There was a clear difference favouring cognitive remediation for cognitive functioning (improved on at least one domain of MATRICS Consensus Cognitive Battery Test) (RR 0.58, 95% CI 0.34 to 0.99; participants = 42; studies = 1, low-quality evidence). For mental state, Positive and Negative Syndrome Scale (PANSS) overall scores showed no clear difference between treatment groups (MD 0.20, 95% CI -3.89 to 4.28; participants = 269; studies = 4, low-quality evidence). Quality of life ratings (Quality of Life Scale) similarly showed no clear intergroup difference (MD 0.01, 95% CI -0.40 to 0.42; participants = 87; studies = 1, very low-quality evidence). Adverse effects were not reported; we chose leaving the study early as a proxy measure. The attrition rate by end of treatment was similar between treatment groups (RR 0.96, 95% CI 0.87 to 1.06; participants = 395; studies = 5, low-quality evidence). One small trial compared exergames with standard care, but few outcomes were reported. No clear difference between interventions was seen for cognitive functioning (measured by MATRICS Consensus Cognitive Battery Test) (MD 2.90, 95% CI -1.27 to 7.07; participants = 33; studies = 1, low-quality evidence), however a benefit in favour of exergames was found for average change in physical fitness (aerobic fitness) (MD 3.82, 95% CI 1.75 to 5.89; participants = 33; studies = 1, low-quality evidence). Adverse effects were not reported; we chose leaving the study early as a proxy measure. The attrition rate by end of treatment was similar between treatment groups (RR 1.06, 95% CI 0.75 to 1.51; participants = 33; studies = 1). Another small trial compared exergames with non-exergames. Only one of our main outcomes was reported - physical fitness, which was measured by average time taken to walk 3 metres. No clear intergroup difference was identified at six-week follow-up (MD -0.50, 95% CI -1.17 to 0.17; participants = 28; studies = 1, very low-quality evidence). No trials reported adverse effects. We chose leaving the study early as a proxy outcome. AUTHORS' CONCLUSIONS: Our results suggest that non-exergames may have a less beneficial effect on cognitive functioning than cognitive remediation, but have comparable effects for all other outcomes. These data are from a small number of trials, and the evidence is graded as of low or very low quality and is very likely to change with more data. It is difficult to currently establish if the more sophisticated cognitive approaches do any more good - or harm - than 'static' video games for people with schizophrenia. Where players use bodily movements to control the game (exergames), there is very limited evidence suggesting a possible benefit of exergames compared to standard care in terms of cognitive functioning and aerobic fitness. However, this finding must be replicated in trials with a larger sample size and that are conducted over a longer time frame. We cannot draw any firm conclusions regarding the effects of video games until more high-quality evidence is available. There are ongoing studies that may provide helpful data in the near future.


Asunto(s)
Remediación Cognitiva/métodos , Esquizofrenia/terapia , Juegos de Video , Actividades Cotidianas , Adulto , Sesgo , Intervalos de Confianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Aptitud Física , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Psicología del Esquizofrénico , Nivel de Atención , Adulto Joven
6.
Cochrane Database Syst Rev ; 2: CD010945, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33566374

RESUMEN

BACKGROUND: Dementia is a syndrome that comprises many differing pathologies, including Alzheimer's disease dementia (ADD), vascular dementia (VaD) and frontotemporal dementia (FTD). People may benefit from knowing the type of dementia they live with, as this could inform prognosis and may allow for tailored treatment. Beta-amyloid (1-42) (ABeta42) is a protein which decreases in both the plasma and cerebrospinal fluid (CSF) of people living with ADD, when compared to people with no dementia. However, it is not clear if changes in ABeta42 are specific to ADD or if they are also seen in other types of dementia. It is possible that ABeta42 could help differentiate ADD from other dementia subtypes. OBJECTIVES: To determine the accuracy of plasma and CSF ABeta42 for distinguishing ADD from other dementia subtypes in people who meet the criteria for a dementia syndrome. SEARCH METHODS: We searched MEDLINE, and nine other databases up to 18 February 2020. We checked reference lists of any relevant systematic reviews to identify additional studies. SELECTION CRITERIA: We considered cross-sectional studies that differentiated people with ADD from other dementia subtypes. Eligible studies required measurement of participant plasma or CSF ABeta42 levels and clinical assessment for dementia subtype. DATA COLLECTION AND ANALYSIS: Seven review authors working independently screened the titles and abstracts generated by the searches. We collected data on study characteristics and test accuracy. We used the second version of the 'Quality Assessment of Diagnostic Accuracy Studies' (QUADAS-2) tool to assess internal and external validity of results. We extracted data into 2 x 2 tables, cross-tabulating index test results (ABeta42) with the reference standard (diagnostic criteria for each dementia subtype). We performed meta-analyses using bivariate, random-effects models. We calculated pooled estimates of sensitivity, specificity, positive predictive values, positive and negative likelihood ratios, and corresponding 95% confidence intervals (CIs). In the primary analysis, we assessed accuracy of plasma or CSF ABeta42 for distinguishing ADD from other mixed dementia types (non-ADD). We then assessed accuracy of ABeta42 for differentiating ADD from specific dementia types: VaD, FTD, dementia with Lewy bodies (DLB), alcohol-related cognitive disorder (ARCD), Creutzfeldt-Jakob disease (CJD) and normal pressure hydrocephalus (NPH). To determine test-positive cases, we used the ABeta42 thresholds employed in the respective primary studies. We then performed sensitivity analyses restricted to those studies that used common thresholds for ABeta42. MAIN RESULTS: We identified 39 studies (5000 participants) that used CSF ABeta42 levels to differentiate ADD from other subtypes of dementia. No studies of plasma ABeta42 met the inclusion criteria. No studies were rated as low risk of bias across all QUADAS-2 domains. High risk of bias was found predominantly in the domains of patient selection (28 studies) and index test (25 studies). The pooled estimates for differentiating ADD from other dementia subtypes were as follows: ADD from non-ADD: sensitivity 79% (95% CI 0.73 to 0.85), specificity 60% (95% CI 0.52 to 0.67), 13 studies, 1704 participants, 880 participants with ADD; ADD from VaD: sensitivity 79% (95% CI 0.75 to 0.83), specificity 69% (95% CI 0.55 to 0.81), 11 studies, 1151 participants, 941 participants with ADD; ADD from FTD: sensitivity 85% (95% CI 0.79 to 0.89), specificity 72% (95% CI 0.55 to 0.84), 17 studies, 1948 participants, 1371 participants with ADD; ADD from DLB: sensitivity 76% (95% CI 0.69 to 0.82), specificity 67% (95% CI 0.52 to 0.79), nine studies, 1929 participants, 1521 participants with ADD. Across all dementia subtypes, sensitivity was greater than specificity, and the balance of sensitivity and specificity was dependent on the threshold used to define test positivity. AUTHORS' CONCLUSIONS: Our review indicates that measuring ABeta42 levels in CSF may help differentiate ADD from other dementia subtypes, but the test is imperfect and tends to misdiagnose those with non-ADD as having ADD. We would caution against the use of CSF ABeta42 alone for dementia classification. However, ABeta42 may have value as an adjunct to a full clinical assessment, to aid dementia diagnosis.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Péptidos beta-Amiloides/sangre , Péptidos beta-Amiloides/líquido cefalorraquídeo , Fragmentos de Péptidos/sangre , Fragmentos de Péptidos/líquido cefalorraquídeo , Alcoholismo/complicaciones , Enfermedad de Alzheimer/sangre , Enfermedad de Alzheimer/líquido cefalorraquídeo , Sesgo , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Disfunción Cognitiva/sangre , Disfunción Cognitiva/líquido cefalorraquídeo , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Intervalos de Confianza , Síndrome de Creutzfeldt-Jakob/sangre , Síndrome de Creutzfeldt-Jakob/líquido cefalorraquídeo , Síndrome de Creutzfeldt-Jakob/diagnóstico , Demencia Vascular/sangre , Demencia Vascular/líquido cefalorraquídeo , Demencia Vascular/diagnóstico , Diagnóstico Diferencial , Demencia Frontotemporal/sangre , Demencia Frontotemporal/líquido cefalorraquídeo , Demencia Frontotemporal/diagnóstico , Humanos , Hidrocéfalo Normotenso/sangre , Hidrocéfalo Normotenso/líquido cefalorraquídeo , Hidrocéfalo Normotenso/diagnóstico , Enfermedad por Cuerpos de Lewy/sangre , Enfermedad por Cuerpos de Lewy/líquido cefalorraquídeo , Enfermedad por Cuerpos de Lewy/diagnóstico , Funciones de Verosimilitud , Sensibilidad y Especificidad
7.
PLoS Comput Biol ; 17(2): e1008728, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33635863

RESUMEN

Large-scale serological testing in the population is essential to determine the true extent of the current SARS-CoV-2 pandemic. Serological tests measure antibody responses against pathogens and use predefined cutoff levels that dichotomize the quantitative test measures into sero-positives and negatives and use this as a proxy for past infection. With the imperfect assays that are currently available to test for past SARS-CoV-2 infection, the fraction of seropositive individuals in serosurveys is a biased estimator of the cumulative incidence and is usually corrected to account for the sensitivity and specificity. Here we use an inference method-referred to as mixture-model approach-for the estimation of the cumulative incidence that does not require to define cutoffs by integrating the quantitative test measures directly into the statistical inference procedure. We confirm that the mixture model outperforms the methods based on cutoffs, leading to less bias and error in estimates of the cumulative incidence. We illustrate how the mixture model can be used to optimize the design of serosurveys with imperfect serological tests. We also provide guidance on the number of control and case sera that are required to quantify the test's ambiguity sufficiently to enable the reliable estimation of the cumulative incidence. Lastly, we show how this approach can be used to estimate the cumulative incidence of classes of infections with an unknown distribution of quantitative test measures. This is a very promising application of the mixture-model approach that could identify the elusive fraction of asymptomatic SARS-CoV-2 infections. An R-package implementing the inference methods used in this paper is provided. Our study advocates using serological tests without cutoffs, especially if they are used to determine parameters characterizing populations rather than individuals. This approach circumvents some of the shortcomings of cutoff-based methods at exactly the low cumulative incidence levels and test accuracies that we are currently facing in SARS-CoV-2 serosurveys.


Asunto(s)
/métodos , /epidemiología , Modelos Estadísticos , Pandemias , Anticuerpos Antivirales/sangre , Infecciones Asintomáticas/epidemiología , /estadística & datos numéricos , Biología Computacional , Simulación por Computador , Intervalos de Confianza , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Incidencia , Funciones de Verosimilitud , Pandemias/estadística & datos numéricos , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
8.
PLoS One ; 16(2): e0246285, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33556129

RESUMEN

Limited testing capacity for COVID-19 has hampered the pandemic response. Pooling is a testing method wherein samples from specimens (e.g., swabs) from multiple subjects are combined into a pool and screened with a single test. If the pool tests positive, then new samples from the collected specimens are individually tested, while if the pool tests negative, the subjects are classified as negative for the disease. Pooling can substantially expand COVID-19 testing capacity and throughput, without requiring additional resources. We develop a mathematical model to determine the best pool size for different risk groups, based on each group's estimated COVID-19 prevalence. Our approach takes into consideration the sensitivity and specificity of the test, and a dynamic and uncertain prevalence, and provides a robust pool size for each group. For practical relevance, we also develop a companion COVID-19 pooling design tool (through a spread sheet). To demonstrate the potential value of pooling, we study COVID-19 screening using testing data from Iceland for the period, February-28-2020 to June-14-2020, for subjects stratified into high- and low-risk groups. We implement the robust pooling strategy within a sequential framework, which updates pool sizes each week, for each risk group, based on prior week's testing data. Robust pooling reduces the number of tests, over individual testing, by 88.5% to 90.2%, and 54.2% to 61.9%, respectively, for the low-risk and high-risk groups (based on test sensitivity values in the range [0.71, 0.98] as reported in the literature). This results in much shorter times, on average, to get the test results compared to individual testing (due to the higher testing throughput), and also allows for expanded screening to cover more individuals. Thus, robust pooling can potentially be a valuable strategy for COVID-19 screening.


Asunto(s)
/métodos , Tamizaje Masivo , /virología , Intervalos de Confianza , Humanos , Probabilidad , Factores de Riesgo , /fisiología
9.
Cochrane Database Syst Rev ; 2: CD012006, 2021 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-33625741

RESUMEN

BACKGROUND: Pressure ulcers (PUs) are injuries to the skin and underlying tissues that occur most commonly over bony prominences, such as the hips and heels as a result of pressure and shear forces. PUs cause pain, discomfort, longer hospital stays, and decreased quality of life. They are also very costly to treat and consume substantial parts of healthcare budgets. PUs are largely preventable, and education targeted at patients and their carers is considered important. OBJECTIVES: To assess the effects of patient and/or lay carer education on preventing pressure ulceration in at-risk people, in any care setting. SEARCH METHODS: In June 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; Ovid PsycINFO and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies.  There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that recruited people of any age at risk of pressure ulceration, and RCTs that recruited people who informally care for someone at risk of pressure ulceration. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, 'Risk of bias' assessment, and GRADE assessment of the certainty of the evidence. MAIN RESULTS: We included 10 studies with 11 publications (2261 participants analysed). Seven targeted their intervention at people at risk of ulceration and measured outcomes on these at risk people; two targeted those at risk and their family carers and measured outcomes on the at risk people cared for by their families; and one targeted lay carers only and measured outcomes on the at risk people they cared for. There were two main types of interventions: the provision of information on prevention of pressure ulcers, and the use of different types of education programmes. Provision of information on the prevention of pressure ulcers Three studies (237 participants) reported data for this comparison: two provided information directly to those at risk and their carers, and the third provided information to lay carers. As data could not be pooled we present individual study data. The evidence for primary outcomes is of very low certainty (downgraded twice for study limitations and twice for imprecision). We are uncertain whether the combined use of a self-instruction manual and one-to-one patient training and counselling versus a self-instruction manual alone reduces the proportion of at risk people developing a new PU (risk ratio (RR) 0.40, 95% confidence interval (CI) 0.14 to 1.18), or whether carer self-instruction and one-to-one counselling versus self-instruction alone reduces the proportion of at risk people developing a new PU (RR 2.05, 95% CI 0.19 to 21.70). We are uncertain whether the use of home-based training, compared with routine ward-based training, reduces the proportion of at risk people developing a new PU (RR 0.53, 95% CI 0.27 to 1.02). One study explored the secondary outcome patient knowledge of pressure ulcer prevention; however, as usable data were not provided, we were unable to carry out further analysis, and no effect estimate could be calculated. Educational programmes on the prevention of pressure ulcers Seven studies (2024 participants analysed) provided data for this comparison. In all studies the intervention was aimed at people at risk of ulceration. Risk of pressure ulceration One secondary report of an included study reported the primary outcome as time to PU development or occurrence and three studies and one secondary report of an included study reported this as the proportion of at risk people developing a new PU. One study reported the secondary outcome grade of PU and five studies and one secondary report of an included study reported on patient knowledge. There is low certainty evidence of there being no clear difference in the proportion of participants developing a new PU between use of a pressure ulcer prevention care bundle (PUPCB) and standard care: HR 0.58, 95% CI 0.25 to 1.33 (downgraded twice for imprecision). One secondary report of an included study explored whether individualised PU education and monthly structured telephone follow-up reduces the mean time to PU occurrence. Not all participants in this study developed a pressure ulcer, therefore the mean time to pressure ulcer occurrence could not be calculated from the data. We are uncertain whether the following three interventions reduce the proportion of at risk people developing a new PU as we assessed the certainty of evidence as very low: individualised PU education and monthly structured telephone follow-up (RR 0.55, 95% CI 0.23 to 1.30), education delivery (RR 3.57, 95% CI 0.78 to 16.38), (downgraded twice for risk of bias and twice for imprecision); and computerised feedback and one-to-one consultations (no clear data provided), (downgraded twice for risk of bias and once for indirectness). Grade of pressure ulcer There is low certainty evidence that use of a PU prevention care bundle may make no difference to the severity of new PU development when compared with standard care. Patient knowledge We are uncertain whether the following interventions improve patient knowledge: enhanced educational intervention and structured follow-up (mean difference (MD) 9.86, 95% CI 1.55 to 18.17); multi component motivational interviewing/self-management with a multi component education intervention (no clear data provided); Spinal Cord Injury Navigator programme (no clear data provided); individualised PU education and monthly structured telephone follow-up (no clear data provided); computerised feedback (no clear data provided), structured, patient-centric PU prevention education event (MD 30.15, 95% CI 23.56 to 36.74). We assessed the certainty of the evidence for this outcome as low or very low (downgraded for risk of bias, imprecision, or indirectness). AUTHORS' CONCLUSIONS: We are uncertain whether educational interventions make any difference to the number of new PUs that develop, or to patient knowledge based on evidence from the 10 included studies, which we assessed as of low or very low certainty due to problems with risk of bias, serious imprecision and indirectness. The low certainty of evidence means that additional research is required to confirm these results.


Asunto(s)
Cuidadores/educación , Educación del Paciente como Asunto/métodos , Úlcera por Presión/prevención & control , Intervalos de Confianza , Instituciones de Salud/estadística & datos numéricos , Humanos , Úlcera por Presión/epidemiología , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Cuidados de la Piel , Traumatismos de la Médula Espinal/complicaciones , Cicatrización de Heridas
10.
Artículo en Inglés | MEDLINE | ID: mdl-33445651

RESUMEN

In Bayesian analysis of clinical trials data, credible intervals are widely used for inference on unknown parameters of interest, such as treatment effects or differences in treatments effects. Highest Posterior Density (HPD) sets are often used because they guarantee the shortest length. In most of standard problems, closed-form expressions for exact HPD intervals do not exist, but they are available for intervals based on the normal approximation of the posterior distribution. For small sample sizes, approximate intervals may be not calibrated in terms of posterior probability, but for increasing sample sizes their posterior probability tends to the correct credible level and they become closer and closer to exact sets. The article proposes a predictive analysis to select appropriate sample sizes needed to have approximate intervals calibrated at a pre-specified level. Examples are given for interval estimation of proportions and log-odds.


Asunto(s)
Tamaño de la Muestra , Teorema de Bayes , Intervalos de Confianza , Probabilidad
11.
BMC Nephrol ; 22(1): 33, 2021 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-33468081

RESUMEN

BACKGROUND: The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. METHODS: This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. RESULTS: COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55-4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p -values < 0.05). CONCLUSIONS: Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.


Asunto(s)
/mortalidad , Mortalidad Hospitalaria , Fallo Renal Crónico/mortalidad , Factores de Edad , Anciano , /complicaciones , Comorbilidad , Intervalos de Confianza , Femenino , Humanos , Irán/epidemiología , Fallo Renal Crónico/sangre , Luteólisis , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
12.
Cancer Radiother ; 25(1): 72-76, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33414058

RESUMEN

PURPOSE: This study aimed to compare the absolute numbers of various types of lymphocytes in the peripheral blood before and after chemotherapy following radio-chemotherapy in patients with cervical cancer, so as to explore the correlation between the changes in the absolute numbers of peripheral various types of lymphocytes and the overall survival rate of patients. METHODS: Data of 205 patients with cervical cancer admitted to the hospital from June 2014 to August 2016 were retrospectively analyzed. These patients underwent concurrent radio-chemotherapy, followed by chemotherapy. The absolute numbers of peripheral blood lymphocytes and subtypes were compared before and after re-chemotherapy. RESULTS: For patients with a good prognosis, the number of lymphocytes, T cells, and cytotoxic T cells (Tc) significantly decreased (P<0.05) after re-chemotherapy, while this phenomenon was not observed in patients with poor prognosis. Kaplan-Meier univariate analysis showed that patients with cervical cancer who had an advanced FIGO stage before treatment, presence of lymph node metastasis, and increased numbers of Tc and T helper cells after re-chemotherapy showed a low 30-month survival rate; the overall log-rank analysis showed significant differences (P<0.05). Multivariate Cox proportional hazards regression analysis, presence of lymph node metastasis: HR=9.718, P=0.002, 95% CI=0.183-0.679; Tc grouping: HR=3.239, P=0.0.072, 95% CI=0.950-03.347; Th group: HR=3.197, P=0.074, 95% CI=0.943-3.564. CONCLUSIONS: After radio-chemotherapy, in patients with advanced cervical cancer, the change in the numbers of peripheral blood Tc and Th before and after re-chemotherapy was associated with the 30-month overall survival rate of patients. It can be considered as a predictor of the survival of patients with advanced cervical cancer.


Asunto(s)
Quimioradioterapia , Linfocitos T , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/mortalidad , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Intervalos de Confianza , Femenino , Humanos , Estimación de Kaplan-Meier , Células Asesinas Naturales , Recuento de Linfocitos , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Tasa de Supervivencia , Linfocitos T Citotóxicos , Linfocitos T Colaboradores-Inductores , Linfocitos T Reguladores , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia , Adulto Joven
13.
JAMA ; 325(3): 244-253, 2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33464334

RESUMEN

Importance: Whether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear. Objective: To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Design, Setting, and Participants: Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in Japan from January 1, 2017, to July 31, 2019, with final follow-up on October 31, 2019. Interventions: Patients were randomly assigned to mechanical thrombectomy alone (n = 101) or combined intravenous thrombolysis (alteplase at a 0.6-mg/kg dose) plus mechanical thrombectomy (n = 103). Main Outcomes and Measures: The primary efficacy end point was a favorable outcome defined as a modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]) of 0 to 2 at 90 days, with a noninferiority margin odds ratio of 0.74, assessed using a 1-sided significance threshold of .025 (97.5% CI). There were 7 prespecified secondary efficacy end points, including mortality by day 90. There were 4 prespecified safety end points, including any intracerebral hemorrhage and symptomatic intracerebral hemorrhage within 36 hours. Results: Among 204 patients (median age, 74 years; 62.7% men; median National Institutes of Health Stroke Scale score, 18), all patients completed the trial. Favorable outcome occurred in 60 patients (59.4%) in the mechanical thrombectomy alone group and 59 patients (57.3%) in the combined intravenous thrombolysis plus mechanical thrombectomy group, with no significant between-group difference (difference, 2.1% [1-sided 97.5% CI, -11.4% to ∞]; odds ratio, 1.09 [1-sided 97.5% CI, 0.63 to ∞]; P = .18 for noninferiority). Among the 7 secondary efficacy end points and 4 safety end points, 10 were not significantly different, including mortality at 90 days (8 [7.9%] vs 9 [8.7%]; difference, -0.8% [95% CI, -9.5% to 7.8%]; odds ratio, 0.90 [95% CI, 0.33 to 2.43]; P > .99). Any intracerebral hemorrhage was observed less frequently in the mechanical thrombectomy alone group than in the combined group (34 [33.7%] vs 52 [50.5%]; difference, -16.8% [95% CI, -32.1% to -1.6%]; odds ratio, 0.50 [95% CI, 0.28 to 0.88]; P = .02). Symptomatic intracerebral hemorrhage was not significantly different between groups (6 [5.9%] vs 8 [7.7%]; difference, -1.8% [95% CI, -9.7% to 6.1%]; odds ratio, 0.75 [95% CI, 0.25 to 2.24]; P = .78). Conclusions and Relevance: Among patients with acute large vessel occlusion stroke, mechanical thrombectomy alone, compared with combined intravenous thrombolysis plus mechanical thrombectomy, failed to demonstrate noninferiority regarding favorable functional outcome. However, the wide confidence intervals around the effect estimate also did not allow a conclusion of inferiority. Trial Registration: umin.ac.jp/ctr Identifier: UMIN000021488.


Asunto(s)
Fibrinolíticos/administración & dosificación , /cirugía , Trombectomía , Activador de Tejido Plasminógeno/administración & dosificación , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/etiología , Terapia Combinada , Intervalos de Confianza , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trombectomía/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento
15.
Cochrane Database Syst Rev ; 1: CD011490, 2021 01 20.
Artículo en Inglés | MEDLINE | ID: mdl-33471373

RESUMEN

BACKGROUND: Pancreatic and periampullary adenocarcinomas account for some of the most aggressive malignancies, and the leading causes of cancer-related mortalities. Partial pancreaticoduodenectomy (PD) with negative resection margins is the only potentially curative therapy. The high prevalence of lymph node metastases has led to the hypothesis that wider excision with the removal of more lymphatic tissue could result in an improvement of survival, and higher rates of negative resection margins. OBJECTIVES: To compare overall survival following standard (SLA) versus extended lymph lymphadenectomy (ELA) for pancreatic head and periampullary adenocarcinoma. We also compared secondary outcomes, such as morbidity, mortality, and tumour involvement of the resection margins between the two procedures. SEARCH METHODS: We searched CENTRAL, MEDLINE, PubMed, and Embase from 1973 to September 2020; we applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCT) comparing PD with SLA versus PD with ELA, including participants with pancreatic head and periampullary adenocarcinoma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references and extracted data from study reports. We calculated pooled risk ratios (RR) for most binary outcomes except for postoperative mortality, for which we estimated a Peto odds ratio (Peto OR), and mean differences (MD) for continuous outcomes. We used a fixed-effect model in the absence of substantial heterogeneity (I² < 25%), and a random-effects model in cases of substantial heterogeneity (I² > 25%). Two review authors independently assessed risk of bias, and we used GRADE to assess the quality of the evidence for important outcomes. MAIN RESULTS: We included seven studies with 843 participants (421 ELA and 422 SLA). All seven studies included Kaplan-Meier curves for overall survival. There was little or no difference in survival between groups (log hazard ratio (log HR) 0.12, 95% confidence interval (CI) -3.06 to 3.31; P = 0.94; seven studies, 843 participants; very low-quality evidence). There was little or no difference in postoperative mortality between the groups (Peto odds ratio (OR) 1.20, 95% CI 0.51 to 2.80; seven studies, 843 participants; low-quality evidence). Operating time was probably longer for ELA (mean difference (MD) 50.13 minutes, 95% CI 19.19 to 81.06 minutes; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 88%; P < 0.00001). There may have been more blood loss during ELA (MD 137.43 mL, 95% CI 11.55 to 263.30 mL; two studies, 463 participants; very low-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P = 0.02). There may have been more lymph nodes retrieved during ELA (MD 11.09 nodes, 95% CI 7.16 to 15.02; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P < 0.00001). There was little or no difference in the incidence of positive resection margins between groups (RR 0.81, 95% CI 0.58 to 1.13; six studies, 783 participants; very low-quality evidence). AUTHORS' CONCLUSIONS: There is no evidence of an impact on survival with extended versus standard lymph node resection. However, the operating time may have been longer and blood loss greater in the extended resection group. In conclusion, current evidence neither supports nor refutes the effect of extended lymph lymphadenectomy in people with adenocarcinoma of the head of the pancreas.


Asunto(s)
Adenocarcinoma/cirugía , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Escisión del Ganglio Linfático/métodos , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/mortalidad , Adulto , Pérdida de Sangre Quirúrgica , Neoplasias del Conducto Colédoco/mortalidad , Intervalos de Confianza , Vaciamiento Gástrico , Humanos , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático/mortalidad , Márgenes de Escisión , Tempo Operativo , Fístula Pancreática/etiología , Neoplasias Pancreáticas/mortalidad , Pancreaticoduodenectomía/métodos , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
Cancer Radiother ; 25(2): 141-146, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33422416

RESUMEN

PURPOSE: The ultimate goal of stereotactic radiotherapy (SRT) of brain metastases (BM) is to avoid or postpone whole brain radiotherapy (WBRT). A nomogram based on multi-institutional data was developed by Gorovets, et al. to estimate the 6 and 12-months WBRT-free survival (WFS). The aim of the current retrospective study was to validate the nomogram in a cohort of postoperative BM patients treated with adjuvant SRT. MATERIAL AND METHODS: We reviewed the data of 68 patients treated between 2008-2017 with postoperative SRT for BM. The primary endpoint was the WFS. The receiver operating characteristic curve and area under the curve (AUC) were calculated for both 6- and 12-months time points. RESULTS: After a median follow-up of 64 months, the 1-year cumulative incidence of local and distant brain relapse rates were 15% [95% CI=8-26%] and 34% [95% CI=24-48%], respectively. At recurrence, repeated SRT or salvage WBRT were applied in 33% and 57% cases, respectively. The WFS rates at 6 and 12 months were 88% [95% CI=81-97%] and 67% [95% CI=56-81%], respectively. Using the Gorovets nomogram, the 6 months rates were overestimated while they were accurate at 12 months. AUC values were 0.47 and 0.62 for the 6- and 12-months respectively. Overall, Harrell's concordance index was 0.54. CONCLUSION: This nomogram-predicted well the 12 months WFS but its discriminative power was quite low. This underlines the limits of this kind of predictive tool and leads us to consider the use of big data analysis in the future.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundario , Irradiación Craneana , Nomogramas , Radiocirugia/métodos , Terapia Recuperativa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Neoplasias Encefálicas/epidemiología , Neoplasias Encefálicas/cirugía , Intervalos de Confianza , Irradiación Craneana/estadística & datos numéricos , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Periodo Posoperatorio , Curva ROC , Radiocirugia/estadística & datos numéricos , Estudios Retrospectivos , Terapia Recuperativa/estadística & datos numéricos , Factores de Tiempo
17.
Emergencias (Sant Vicenç dels Horts) ; 32(6): 427-428, dic. 2020.
Artículo en Español | IBECS | ID: ibc-197995

RESUMEN

FUNDAMENTO: La terapia de fluidos intravenosos sirve como piedra angular del tratamiento de un amplio espectro de enfermedades graves. Conocer su impacto en términos de resultados clínicos es una cuestión importante. Existen algunas dudas sobre si el uso de una solución salina al 0,9%puede causar mayor mortalidad entre pacientes hospitalizados o un empeoramiento relevante de su función renal. El objetivo de esta revisión Cochrane fue averiguar si la fluidoterapia con soluciones tamponadas (solución salina a base de agua con un búfer para mantener un pH constante) daba como resultado menos muertes en el hospital y menos daño en los riñones de adultos y niños gravemente enfermos, en comparación con la solución salina al 0,9%. CARACTERÍSTICAS DE LOS ESTUDIOS: Se encontraron 21 estudios realizados tanto en niños como en adultos, con un total de 20.213 participantes. Estos estudios compararon las soluciones tamponadas con las soluciones salinas al 0,9% para adultos y niños gravemente enfermos (incluidos aquellos con sepsis, traumatismos, quemaduras o conmoción) a quienes no se les había realizado una cirugía planificada. Se excluyeron los ensayos en los que los participantes recibieron una cirugía planificada (electiva). Estos estudios se realizaron en 13 países. FUENTES DE FINANCIACIÓN: Doce de los estudios incluidos fueron financiados por gobiernos u organizaciones sin ánimo de lucro, 2 recibieron financiación mixta, uno fue financiado por una empresa cuyo papel en el estudio no se aclaró, y 6 no proporcionaron detalles. Resultados principales. Las soluciones tamponadas no parecen reducir las muertes hospitalarias o el empeoramiento de la función renal (del riñón) en adultos y niños gravemente enfermos, en comparación con la solución salina al 0,9%. La revisión muestra que, en comparación con los pacientes que recibieron soluciones salinas al 0,9%: 1) las soluciones tamponadas tuvieron poca o ninguna repercusión en la mortalidad general (19.664 participantes; 14 estudios; evidencia de calidad alta); 2) las soluciones tamponadas probablemente pueden tener poco o ningún efecto en la reducción del número de pacientes con empeoramiento de la función renal (18.701participantes; 9 estudios; evidencia de calidad baja); y 3) no hay certeza de que las soluciones tamponadas reduzcan el deterioro funcional de otros órganos (por ejemplo, pulmonar, hepática o cerebral), las alteraciones electrolíticas (aumento o disminución del cloruro o el sodio u otras sales)y la necesidad de recibir transfusiones de sangre, porque la calidad de la evidencia es muy baja. Ninguno de los estudios examinó la pérdida de sangre, los trastornos de la coagulación (en relación con el riesgo de hemorragias o coágulos) y la calidad de vida. Los resultados variaron en cuanto a los puntos temporales en los que se informaron, la unidad de medida utilizada y las medidas informadas. No se registró la cantidad total de líquido administrado durante la terapia de fluidos. Solo 4 estudios incluyeron niños. Estos niños estaban menos enfermos que los participantes incluidos en los ensayos con adultos, y no se informó sobre el daño renal. Los 3 estudios en curso, una vez publicados y evaluados, pueden alterar las conclusiones de esta revisión. ¿Cómo de actual es esta revisión? Se buscaron los estudios publicados hasta julio de 2018


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Fluidoterapia/métodos , Solución Salina Hipertónica/administración & dosificación , Medicina Basada en la Evidencia/métodos , Soluciones Cristaloides/uso terapéutico , Intervalos de Confianza
19.
Cir. plást. ibero-latinoam ; 46(4): 411-420, oct.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198724

RESUMEN

INTRODUCCIÓN Y OBJETIVO: Últimamente ha surgido gran controversia sobre diversos aspectos de los implantes mamarios. De hecho, la posible relación entre la texturación del implante y el linfoma anaplásico de células grandes llevó a la retirada voluntaria del mercado de los implantes con cubierta Biocell(R) de Allergan en julio de 2019. El propósito principal de este estudio fue evaluar las preferencias y prácticas habituales de los miembros de la Asociación Española de Cirugía Plástica Estética (AECEP) con respecto a la cirugía con implantes mamarios. Además, analizamos los cambios en la práctica clínica experimentados desde la encuesta publicada en 2016. MATERIAL Y MÉTODO: Llevamos a cabo una encuesta con 15 preguntas relativas a la selección y diferentes aspectos clínicos relacionados con el aumento mamario, en diciembre del año 2019 entre los miembros de la AECEP. Por otro lado, hacemos un estudio comparativo entre los datos actuales y los obtenidos en la encuesta publicada en el año 2017. RESULTADOS: Los 146 miembros de la AECEP recibieron una invitación a participar en la encuesta, de los cuales respondieron 74 (50.7%). De las respuestas obtenidas, 50 (67.6%) correspondieron a hombres. El 89.2% (n=66) tenían una experiencia profesional superior a 10 años y un 70.2% (n=52) tenían una edad comprendida entre los 46 y los 65 años. Respecto al tipo de implante, un 52.7% (n=39) mostró preferencia por los implantes microtexturizados redondos y un 47.3% (n=35) prefirió los microtexturizados anatómicos. En comparación con la encuesta del 2017, una proporción significativamente mayor de participantes prefirió los implantes microtexturizados redondos y microtexturizados anatómicos (p = 0.0025 y p = 0.0015 respectivamente). Por el contrario, una proporción significativamente menor prefirió el uso de implantes macrotexturizados redondos (p = 0.0018) y macrotexturizados anatómicos (p < 0.0001). El plano submuscular fue de elección para el 44.6% de los participantes (n=33). La contractura capsular grado III/IV fue la principal indicación de capsulectomia total para el 94.5% (n=70). La mayor parte fueron partidarios de una actitud vigilante en pacientes con implantes con cubierta Biocell(R) (n=68, 93.1%). El 85.1% (n=63) recomendó vigilancia con técnicas de imagen y sólo 19 participantes (25.7%) fueron partidarios de prohibir el uso de implantes macrotexturizados. CONCLUSIONES: Los resultados de esta encuesta muestran un cambio significativo en la práctica clínica habitual de los encuestados. Respecto a 2017 se ha producido un incremento significativo en el uso de implantes mamarios lisos/nanotexturizados y microtexturizados, mientras que se ha reducido, de forma significativa, el uso de implantes mamarios macrotexturizados


BACKGROUND AND OBJECTIVE: Over the last several years there has been great controversy about different aspects related to breast implants. In fact, the potential relationship between implant texture and anaplastic large cell lymphoma led to the voluntary recall of Biocell(R) coated implants (Allergan(R)) in July 2019. The main purpose of this study was to evaluate the preferences and daily practice of members of Spanish Association of Aesthetic Plastic Surgery (AECEP) regarding to breast implant surgery. Additionally, we assessed possible changes experienced in clinical practice since our survey published in 2017. METHODS: A 15 questions survey, regarding to the selection and different clinical aspects related to breast augmentation, was carried out between January and March 2019 among AECEP members. In addition, a comparative study between current data and those reported in 2017 survey was conducted. RESULTS: The 146 members of the AECEP received an invitation to participate in the survey, of whom 74 (50.7%) responded to it. Of the responses obtained, 67.6% (n=50) corresponded to men, 89.2% (n=66) had more than 10 years of professional experience and 70.2% (n=52) had an age between 46 and 65 years. Regarding the type of implant, 52.7% (n=39) showed a preference for round microtextured implants and 47.3% (n=35) preferred anatomical microtextured implants. Compared to the 2017 survey, a significantly greater proportion of participants preferred round microtextured and anatomical microtextured implants (p = 0.0025 and p = 0.0015, respectively). In contrast, a significantly lower proportion preferred the use of round macrotextured implants (p = 0.0018) and anatomical macrotextured ones (p <0.0001). The submuscular plane was of choice for 44.6% (n=33). Grade III / IV capsular contracture was the main indication for total capsulectomy for 94.5% (n=70). Most of participants ( 93.1%, n=68) were in favor of a vigilant attitude in patients with Biocell(R)-coated implants. 85.1% (n=63) recommended surveillance with imaging techniques and only 25.7% (n=19) thought that the use of macro-textured implants must be prohibited. CONCLUSIONS: The results of this survey showed a significant change in the current clinical practices among the participants. Comparing with 2017 survey, there has been a significant increase in the use of smooth / nano-textured and microtextured breast implants, while the use of macro-textured breast implants has been significantly reduced


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Implantes de Mama/clasificación , Implantes de Mama/estadística & datos numéricos , Sociedades Médicas/estadística & datos numéricos , Prótesis e Implantes/clasificación , Percepción , Encuestas y Cuestionarios , Estudios Transversales , Intervalos de Confianza , Prótesis e Implantes/estadística & datos numéricos , Complicaciones Posoperatorias , Cirujanos/estadística & datos numéricos
20.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(4): 130-135, oct.-dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-197639

RESUMEN

OBJETIVO: Evaluar y comparar la precisión diagnóstica de las Simple rules, el sistema de regresión logística LR2 de IOTA y la valoración subjetiva aplicados por residentes de ginecología en la clasificación de benignidad o malignidad de lesiones anexiales. MATERIAL Y MÉTODOS: Fueron evaluadas las imágenes ecográficas de 94 lesiones anexiales por 3residentes de ginecología con un año de experiencia y con un entrenamiento teórico y práctico previo similar. La benignidad o malignidad fue determinada mediante 3 métodos: valoración subjetiva, Simple rules y modelo LR2. El grado de precisión en la clasificación de las lesiones se valoró mediante la sensibilidad, la especificidad, el valor predictivo positivo y negativo y la likelihood ratio positiva y negativa. Fue aportado también un diagnóstico de presunción histológica por cada ecografista. RESULTADOS: De las 94 lesiones, 73 resultaron benignas y 21 malignas. Los resultados estadísticos fueron los siguientes: Simple rules, sensibilidad 84,2% y especificidad 79,7%; LR2, sensibilidad 71,4% y especificidad 74%; valoración subjetiva, sensibilidad 65% y especificidad 76,1%. CONCLUSIONES: Los sistemas ecográficos de clasificación objetiva de lesiones anexiales han mostrado en la bibliografía mejores resultados diagnósticos que la valoración subjetiva aplicados por ecografistas no expertos. Las Simple rules y el LR2 se han descrito como 2de los más precisos y de más sencilla aplicación, por lo que podrían incorporarse en la evaluación ecográfica de masas anexiales por residentes de ginecología. En nuestro estudio observamos esta tendencia de una mayor precisión diagnóstica de estos sistemas predictivos respecto a la valoración subjetiva por residentes de ginecología, aunque sin que resultara estadísticamente significativa


OBJECTIVE: To evaluate and compare the diagnostic accuracy of the Simple Rules, the second logistic regression system of IOTA (LR2) and the subjective assessment used by gynaecology residents in the classification of benign or malignant adnexal lesions. MATERIAL AND METHODS: The ultrasound images of 94 adnexal lesions were evaluated by 3gynaecology junior doctors with one year of experience and with similar theoretical and practical training. The benignity or malignancy was determined by 3methods: subjective assessment, Simple Rules, and model LR2. The assessment of the degree of accuracy in the classification of the lesions was made by determining sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio. A diagnosis of histological presumption was also provided by each ultrasound operator. RESULTS: Of the 94 lesions, 73 were benign and 21 malignant. The statistical results were the following: Simple rules sensitivity 84.2% and specificity 79.7%; LR2 sensitivity 71.4% and specificity 74%; subjective assessment 65% sensitivity and specificity 76.1%. CONCLUSION: The ultrasound systems for objective classification of adnexal lesions have shown better diagnostic results in the literature than subjective assessment applied by non-expert sonographers. The Simple Rules and the LR2 have been described as 2of the most precise and simplest to apply, so they could be incorporated into the ultrasound evaluation of adnexal masses by gynaecology junior doctors. In this study, this trend of greater diagnostic accuracy was observed in these predictive systems regarding subjective assessment by gynaecology junior doctors, although without being statistically significant


Asunto(s)
Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades de los Anexos/clasificación , Enfermedades de los Anexos/diagnóstico por imagen , Modelos Logísticos , Internado y Residencia/estadística & datos numéricos , Neoplasias Ováricas/diagnóstico , Sensibilidad y Especificidad , Valor Predictivo de las Pruebas , Ultrasonografía/clasificación , Ultrasonografía/instrumentación , Estudios Retrospectivos , Intervalos de Confianza
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...