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1.
J Med Syst ; 45(5): 59, 2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33829303

RESUMEN

Health systems are struggling to manage a fluctuating volume of critically ill patients with COVID-19 while continuing to provide basic surgical services and expand capacity to address operative cases delayed by the pandemic. As we move forward through the next phases of the pandemic, we will need a decision-making system that allows us to remain nimble as clinicians to meet our patient's needs while also working with a new framework of healthcare operations. Here, we present our quality improvement process for the adaptation and application of the Medically Necessary Time-Sensitive (MeNTS) toolto gynecologic surgical services beyond the initial COVID response and into recovery of surgical services; with analysis of the reliability of the modified-MeNTS tool in our multi-site safety net hospital network. This multicenter study evaluated the gynecology surgical case volume at three tertiary acute care safety net institutions within the LA County Department of Health Services: Harbor-UCLA (HUMC), Olive View Medical Center (OVMC), and Los Angeles County + University of Southern California (LAC+USC). We describe our modified-Delphi approach to adapt the MeNTS tool in a structured fashion and its application to gynecologic surgical services. Blinded reviewers engaged in a three-round iterative adaptation and final scoring utilizing the modified tool. The cohort consisted of 392 female consecutive gynecology patients across three Los Angeles County Hospitals awaiting scheduled procedures in the surgical queue.The majority of patients were Latina (74.7%) and premenopausal (67.1%). Over half (52.4%) of the patients had cardiovascular disease, while 13.0% had lung disease, and 13.8% had diabetes. The most common indications for surgery were abnormal uterine bleeding (33.2%), pelvic organ prolapse (19.6%) and presence of an adnexal mass (14.3%). Minimally invasive approaches via laparoscopy, robotic-assisted laparoscopy, or vaginal surgery was the predominant planned surgical route (54.8%). Modified-MeNTS scores assumed a normal distribution across all patients within our cohort (Median 33, Range 18-52). Overall, ICC across all three institutions demonstrated "good" interrater reliability (0.72). ICC within institutions at HUMC and OVMC were categorized as "good" interrater reliability, while LAC-USC interrater reliability was categorized as "excellent" (HUMC 0.73, OVMC 0.65, LAC+USC 0.77). The modified-MeNTS tool performed well across a range of patients and procedures with a normal distribution of scores and high reliability between raters. We propose that the modified-MeNTS framework be considered as it employs quantitative methods for decision-making rather than subjective assessments.


Asunto(s)
/epidemiología , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Mejoramiento de la Calidad/organización & administración , Triaje/organización & administración , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Técnica Delfos , Femenino , Humanos , Los Angeles/epidemiología , Persona de Mediana Edad , Pandemias , Reproducibilidad de los Resultados , Factores de Tiempo , Adulto Joven
2.
Implement Sci ; 16(1): 38, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33845863

RESUMEN

BACKGROUND: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION: ChiCTR 2100043319 . Registered on 10 February 2021.


Asunto(s)
/epidemiología , Mejoramiento de la Calidad/organización & administración , Infarto del Miocardio con Elevación del ST/terapia , China/epidemiología , Humanos , Tiempo de Tratamiento
7.
Adv Ther ; 38(3): 1382-1396, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33586006

RESUMEN

INTRODUCTION: Widespread misuse of short-acting beta-agonists (SABAs) may contribute to asthma-related morbidity and mortality. Recognizing this, the Global Initiative for Asthma neither recommends SABA monotherapy nor regards this formulation as a preferred reliever. Many health systems and healthcare professionals (HCPs) experience practical issues in implementing guidelines. Clear quality standards can drive improvements in asthma care and encourage implementation of global and national medical guidelines. METHODS: A steering group of global asthma experts came together between May and September 2019 to develop quality statements codifying the minimum elements of good quality asthma care. These statements were either evidence based (when robust evidence was available) or reflected a consensus based on clinical expertise and experience of the group. RESULTS: The quality statements (and associated essential criteria) developed emphasize key elements concerning (1) objective diagnosis specific to individual symptoms, (2) treatment appropriate to the long-term management of asthma as an inflammatory disease, consistent with evidence-based recommendations, (3) controlled dispensing of SABA canisters and monitoring to prevent overuse, (4) regular review of patients after treatment initiation or change, and (5) follow-up of patients in primary care after treatment for an exacerbation in a hospital or an emergency department. CONCLUSIONS: The steering group proposes quality statements that national and local clinical groups can implement as quantitative quality standards that are appropriate to their local circumstances, including during the coronavirus disease 2019 (Covid-19) pandemic. By translating these statements into locally relevant quality standards, primary care physicians and HCPs can encourage optimal management and reduce preventable healthcare interactions. The evidence-based evolution of care encapsulated in these statements will further engender high-quality, patient-centered holistic management that addresses asthma as an inflammatory disease. In particular, the statements empower self-management by patients and encourage health-promoting behaviors, which are essential to reduce exacerbations, the primary goal of asthma management.


Asunto(s)
Agonistas Adrenérgicos beta/farmacología , Asma , Abuso de Medicamentos/prevención & control , Administración del Tratamiento Farmacológico/normas , Mejoramiento de la Calidad/organización & administración , Adulto , Antiasmáticos/farmacología , Asma/diagnóstico , Asma/tratamiento farmacológico , /prevención & control , Niño , Femenino , Salud Global/normas , Adhesión a Directriz , Humanos , Masculino , Inhaladores de Dosis Medida , Guías de Práctica Clínica como Asunto
8.
Gynecol Oncol ; 161(1): 236-243, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33526258

RESUMEN

OBJECTIVE: International guidelines recommend pneumococcal pneumonia and influenza vaccination for all patients with solid organ malignancies prior to initiating chemotherapy. Baseline vaccination rates (March 2019) for pneumococcal pneumonia and influenza at our tertiary cancer centre were 8% and 40%, respectively. The aim of this study was to increase the number of gynecologic chemotherapy patients receiving pneumococcal and influenza vaccinations to 80% by March 2020. METHODS: We performed an interrupted time series study using structured quality improvement methodology. Three interventions were introduced to address vaccination barriers: an in-house vaccination program, a staff education campaign, and a patient care bundle (pre-printed prescription, information brochure, vaccine record booklet). Process and outcome data were collected by patient survey and pharmacy audit and analyzed on statistical process control charts. RESULTS: We identified 195 eligible patients. Pneumococcal and influenza vaccination rates rose significantly from 5% to a monthly mean of 61% and from 36% to a monthly mean of 67%, respectively. The 80% target was reached for both vaccines during one or more months of study. The in-house vaccination and staff education programs were major contributors to the improvement, whereas the information brochure and record booklet were minor contributors. CONCLUSIONS: Three interventions to promote pneumococcal and influenza vaccination among chemotherapy patients resulted in significantly improved vaccination rates. Lessons learned about promoting vaccine uptake may be generalizable to different populations and vaccine types. In response to the global COVID-19 pandemic, initiatives to expand the program to all chemotherapy patients at our centre are underway.


Asunto(s)
Neoplasias de los Genitales Femeninos/complicaciones , Programas de Inmunización/organización & administración , Vacunas contra la Influenza , Gripe Humana/prevención & control , Vacunas Neumococicas , Neumonía Neumocócica/prevención & control , Mejoramiento de la Calidad/organización & administración , Instituciones Oncológicas/organización & administración , Femenino , Neoplasias de los Genitales Femeninos/tratamiento farmacológico , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Gripe Humana/etiología , Ontario , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Neumocócica/etiología , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Relaciones Profesional-Paciente , Centros de Atención Terciaria/organización & administración
9.
Medicine (Baltimore) ; 100(2): e23670, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466122

RESUMEN

ABSTRACT: Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.


Asunto(s)
Cultura Organizacional , Seguridad del Paciente/normas , Farmacéuticos/psicología , Administración de la Seguridad/organización & administración , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Comunicación , Estudios Transversales , Femenino , Humanos , Capacitación en Servicio/organización & administración , Masculino , Errores de Medicación/prevención & control , Persona de Mediana Edad , Admisión y Programación de Personal/organización & administración , Mejoramiento de la Calidad/organización & administración , Administración de la Seguridad/normas , Arabia Saudita , Carga de Trabajo , Adulto Joven
10.
Isr Med Assoc J ; 23(1): 23-27, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33443338

RESUMEN

BACKGROUND: The Israel National Cancer Registry (INCR) was established in 1960. Reporting has been mandatory since 1982. All neoplasms of uncertain/unknown behavior, in situ and invasive malignancies (excluding basal and squamous cell carcinomas of the skin), and benign neoplasms of the brain and central nervous system (CNS) are reportable. OBJECTIVES: To assess completeness and timeliness of the INCR for cases diagnosed or treated in 2005. METHODS: Abstractors identified cases of in situ and invasive malignancies and tumors of benign and uncertain behavior of the brain and CNS diagnosed or treated in 2005 in the files of medical records departments, pathology and cytology laboratories, and oncology and hematology institutes in 39 Israeli medical facilities. Cases were linked to the INCR database by national identity number. Duplicate cases, and those found to be non-reportable were excluded from analysis. Completeness was calculated as the percent of reportable cases identified by the survey that were present in the registry. Timeliness was calculated as the percent of reportable cases diagnosed in 2005, which were incorporated into the registry prior to 31 December 2007. RESULTS: The INCR's completeness is estimated at 93.7% for all reportable diseases, 96.8% for invasive solid tumors, and 88.0% for hematopoietic tumors. Incident cases for the calendar year 2005 were less likely to be present in the registry database than those diagnosed prior to 2005. CONCLUSIONS: Completeness and timeliness of the INCR are high and meet international guidelines. Fully automated reporting will likely improve the quality and timeliness of INCR data.


Asunto(s)
Neoplasias , Sistema de Registros , Bases de Datos Factuales , Humanos , Israel/epidemiología , Notificación Obligatoria , Neoplasias/clasificación , Neoplasias/epidemiología , Neoplasias/patología , Neoplasias/terapia , Mejoramiento de la Calidad/organización & administración , Sistema de Registros/normas , Sistema de Registros/estadística & datos numéricos , Encuestas y Cuestionarios
11.
J Nurs Adm ; 51(2): 67-73, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449595

RESUMEN

This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.


Asunto(s)
Centros Comunitarios de Salud/organización & administración , Eficiencia Organizacional , Atención Dirigida al Paciente/organización & administración , Mejoramiento de la Calidad/organización & administración , Niño , Femenino , Humanos , Estudios de Casos Organizacionales , Grupo de Atención al Paciente/organización & administración , Servicios de Salud para Mujeres/organización & administración
13.
BMC Pregnancy Childbirth ; 21(1): 77, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482762

RESUMEN

BACKGROUND: Childbirth is a complex process, and checklists are useful tools to remember steps of such complex processes. The World Health Organization safe childbirth checklist is a tool used to improve the quality of care provided to women giving birth. The checklist was modified by Ministry of Health and was introduced to health centers in Ethiopia by the USAID Transform: Primary Health Care Activity. METHODS: A pre and post intervention study design with prospective data collection was employed. The availability of essential childbirth supplies and adherence of health care providers to essential birth practices were compared for the pre and post intervention periods. RESULTS: The pre and post intervention assessments were conducted in 247 and 187 health centers respectively. A statistically significant improvement from 63.6% pre intervention to 83.5% post intervention was observed in the availability of essential childbirth supplies, t (389.7) = - 7.1, p = 0.000. Improvements in adherence of health care providers to essential birth practices were observed with the highest being at pause point three (26.2%, t (306.3) = - 10.6, p = 0.000) followed by pause point four (21.1%, t (282.5) = - 8.0, p = 0.000), and pause point two (18.2%, t (310.8) = - 9.7, p = 0.000). The least and statistically non-significant improvement was observed at pause point one (3.3%, t (432.0) = - 1.5, p = 0.131). CONCLUSION: Improvement in availability of essential childbirth supplies and adherence of health care providers towards essential birth practices was observed after introduction of a modified World Health Organization safe childbirth checklist. Scale up of the use of the checklist is recommended.


Asunto(s)
Lista de Verificación/estadística & datos numéricos , Parto Obstétrico/normas , Servicios de Salud Materna/organización & administración , Grupo de Atención al Paciente/organización & administración , Complicaciones del Embarazo/prevención & control , Mejoramiento de la Calidad/organización & administración , Adulto , Etiopía , Femenino , Muerte Fetal/prevención & control , Estado de Salud , Humanos , Guías de Práctica Clínica como Asunto , Embarazo , Estudios Prospectivos , Medición de Riesgo , Organización Mundial de la Salud
14.
PLoS Med ; 18(1): e1003490, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33428624

RESUMEN

BACKGROUND: The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. METHODS AND FINDINGS: We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%-59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%-71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% -27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%-23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. CONCLUSIONS: Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.


Asunto(s)
/mortalidad , Disparidades en Atención de Salud/normas , Salud Pública , Determinantes Sociales de la Salud/estadística & datos numéricos , Factores Socioeconómicos , Anciano , Comorbilidad , Grupos Étnicos/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Mortalidad , Salud Pública/métodos , Salud Pública/normas , Mejoramiento de la Calidad/organización & administración , Estados Unidos , Salud de los Veteranos/estadística & datos numéricos
16.
Am J Surg ; 221(2): 401-409, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323275

RESUMEN

BACKGROUND: There is global momentum to establish scalable Quality Improvement (QI) skills training curricula. We report development of an implementation plan for national scale-up of the 'Education in Quality Improvement' program (EQUIP) in UK urology residencies. MATERIALS & METHODS: Theory-of-Change (ToC) methodology was used, which engaged EQUIP stakeholders in developing a single-page implementation 'Logic Model' in 4 study phases (2 stakeholder workshops (N = 20); 10 stakeholder interviews). The framework method was used for analysis. RESULTS: Core elements of the EQUIP Logic Model include: (i) QI curriculum integration into national surgical curricula; (ii) resident-led, modular, team-based QI projects; (iii) development of a national web-platform as QI projects library; (iv) a train-the-trainers module to develop attendings as QI mentors; and (v) knowledge transfer activities (e.g., peer-reviewed publications of residents' QI projects). CONCLUSIONS: ToC methodology was useful in developing a stakeholder-driven, actionable implementation plan for the national scale-up of EQUIP in the UK.


Asunto(s)
Curriculum , Internado y Residencia/organización & administración , Evaluación de Programas y Proyectos de Salud/métodos , Mejoramiento de la Calidad/organización & administración , Urología/educación , Competencia Clínica , Humanos , Modelos Educacionales , Estudios Prospectivos , Investigación Cualitativa , Encuestas y Cuestionarios , Reino Unido
18.
Anesth Analg ; 132(1): 31-37, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33315601

RESUMEN

BACKGROUND: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training. METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training. CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.


Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Anestesia Obstétrica , Lista de Verificación , Prestación de Atención de Salud/organización & administración , Control de Infecciones/organización & administración , Flujo de Trabajo , /transmisión , Vías Clínicas/organización & administración , Femenino , Humanos , Embarazo , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración
19.
Medicine (Baltimore) ; 99(50): e23687, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327358

RESUMEN

To explore the effects of the project-achievement quality control circle in constructing a new health education model for patients with chronic hepatitis B.The quality control circle group was established and the theme of "constructing a new health education model for patients with chronic hepatitis B" was selected. The circle staff determined that this quality control circle was of project-achievement according to the quality control story judgment table, and then carry out activities in strict accordance with the 10 steps of project-achievement quality control circle, evaluate the tangible results and non-tangible results before and after the activity.After the implementation of the activity, the health education integrity of patients with chronic hepatitis B increased from 74.75 ±â€Š11.00 to 95.00 ±â€Š5.55 points (P < .001). The awareness of health education increased from 71.90 ±â€Š13.48 to 95.60 ±â€Š2.84 points (P < .001), the satisfaction rate of health education increased from 76.60 ±â€Š8.71 points to 98.00 ±â€Š2.03 points (P < .001), and the evaluation rate after health education increased from 10% to 100% (P < .001).The circle members have much more confidence in quality control circle activities, the use of techniques, and the knowledge related to scientific research.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hepatitis B Crónica/epidemiología , Educación del Paciente como Asunto/organización & administración , Mejoramiento de la Calidad/organización & administración , Concienciación , China/epidemiología , Humanos , Educación del Paciente como Asunto/normas , Satisfacción del Paciente
20.
JAMA Netw Open ; 3(12): e2029655, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337494

RESUMEN

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. Design, Setting, and Participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. Exposures: Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. Main Outcomes and Measures: The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. Results: Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. Conclusions and Relevance: This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.


Asunto(s)
Perfilación de la Expresión Génica/métodos , Metabolómica/métodos , Atención Perinatal , Embarazo , Nacimiento Prematuro , Mejoramiento de la Calidad/organización & administración , Adulto , Causalidad , Reglas de Decisión Clínica , Países en Desarrollo , Diagnóstico Precoz , Femenino , Edad Gestacional , Humanos , Recién Nacido , Aprendizaje Automático , Atención Perinatal/métodos , Atención Perinatal/normas , Mortalidad Perinatal , Embarazo/sangre , Embarazo/orina , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/diagnóstico , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control
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