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1.
BMC Nephrol ; 21(1): 419, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004002

RESUMEN

BACKGROUND: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. METHODS: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. RESULTS: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. CONCLUSION: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus , Fallo Renal Crónico , Trasplante de Riñón/estadística & datos numéricos , Pandemias , Neumonía Viral , Terapia de Reemplazo Renal , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Salud Pública/métodos , Sistema de Registros/estadística & datos numéricos , Terapia de Reemplazo Renal/métodos , Terapia de Reemplazo Renal/estadística & datos numéricos , Escocia/epidemiología
3.
BMJ Open ; 10(10): e044566, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020111

RESUMEN

OBJECTIVES: To analyse enrolment to interventional trials during the first wave of the COVID-19 pandemic in England and describe the barriers to successful recruitment in the circumstance of a further wave or future pandemics. DESIGN: We analysed registered interventional COVID-19 trial data and concurrently did a prospective observational study of hospitalised patients with COVID-19 who were being assessed for eligibility to one of the RECOVERY, C19-ACS or SIMPLE trials. SETTING: Interventional COVID-19 trial data were analysed from the clinicaltrials.gov and International Standard Randomized Controlled Trial Number databases on 12 July 2020. The patient cohort was taken from five centres in a respiratory National Institute for Health Research network. Population and modelling data were taken from published reports from the UK government and Medical Research Council Biostatistics Unit. PARTICIPANTS: 2082 consecutive admitted patients with laboratory-confirmed SARS-CoV-2 infection from 27 March 2020 were included. MAIN OUTCOME MEASURES: Proportions enrolled, and reasons for exclusion from the aforementioned trials. Comparisons of trial recruitment targets with estimated feasible recruitment numbers. RESULTS: Analysis of trial registration data for COVID-19 treatment studies enrolling in England showed that by 12 July 2020, 29 142 participants were needed. In the observational study, 430 (20.7%) proceeded to randomisation. 82 (3.9%) declined participation, 699 (33.6%) were excluded on clinical grounds, 363 (17.4%) were medically fit for discharge and 153 (7.3%) were receiving palliative care. With 111 037 people hospitalised with COVID-19 in England by 12 July 2020, we determine that 22 985 people were potentially suitable for trial enrolment. We estimate a UK hospitalisation rate of 2.38%, and that another 1.25 million infections would be required to meet recruitment targets of ongoing trials. CONCLUSIONS: Feasible recruitment rates, study design and proliferation of trials can limit the number, and size, that will successfully complete recruitment. We consider that fewer, more appropriately designed trials, prioritising cooperation between centres would maximise productivity in a further wave.


Asunto(s)
Investigación Biomédica , Infecciones por Coronavirus , Pandemias , Selección de Paciente , Neumonía Viral , Ensayos Clínicos Controlados Aleatorios como Asunto , Betacoronavirus/aislamiento & purificación , Investigación Biomédica/organización & administración , Investigación Biomédica/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Determinación de la Elegibilidad , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Reino Unido
5.
JAMA ; 324(14): 1419-1428, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048155

RESUMEN

Importance: Coagulopathy may deter physicians from performing a lumbar puncture. Objective: To determine the risk of spinal hematoma after lumbar puncture in patients with and without coagulopathy. Design, Setting, and Participants: Danish nationwide, population-based cohort study using medical registries to identify persons who underwent lumbar puncture and had cerebrospinal fluid analysis (January 1, 2008-December 31, 2018; followed up through October 30, 2019). Coagulopathy was defined as platelets lower than 150 × 109/L, international normalized ratio (INR) greater than 1.4, or activated partial thromboplastin time (APTT) longer than 39 seconds. Exposures: Coagulopathy at the time of lumbar puncture. Main Outcomes and Measures: Thirty-day risk of spinal hematoma. Risks were provided as numbers and percentages with 95% CIs. Secondary analyses included risks of traumatic lumbar puncture (>300 × 106 erythrocytes/L after excluding patients diagnosed with subarachnoid hemorrhage). Adjusted hazard rate ratios (HRs) were computed using Cox regression models. Results: A total of 83 711 individual lumbar punctures were identified among 64 730 persons (51% female; median age, 43 years [interquartile range, 22-62 years]) at the time of the procedure. Thrombocytopenia was present in 7875 patients (9%), high INR levels in 1393 (2%), and prolonged APTT in 2604 (3%). Follow-up was complete for more than 99% of the study participants. Overall, spinal hematoma occurred within 30 days for 99 of 49 526 patients (0.20%; 95% CI, 0.16%-0.24%) without coagulopathy vs 24 of 10 371 patients (0.23%; 95% CI, 0.15%-0.34%) with coagulopathy. Independent risk factors for spinal hematoma were male sex (adjusted hazard ratio [HR], 1.72; 95% CI, 1.15-2.56), those aged 41 through 60 years (adjusted HR, 1.96; 95% CI, 1.01-3.81) and those aged 61 through 80 years (adjusted HR, 2.20; 95% CI, 1.12-4.33). Risks did not increase significantly according to overall severity of coagulopathy, in subgroup analyses of severity of coagulopathy by pediatric specialty or medical indication (infection, neurological condition, and hematological malignancy), nor by cumulative number of procedures. Traumatic lumbar punctures occurred more frequently among patients with INR levels of 1.5 to 2.0 (36.8%; 95% CI, 33.3%-40.4%), 2.1 to 2.5 (43.7%; 95% CI, 35.8%-51.8%), and 2.6 to 3.0 (41.9% 95% CI 30.5-53.9) vs those with normal INR (28.2%; 95% CI, 27.7%-28.75%). Traumatic spinal tap occurred more often in patients with an APTT of 40 to 60 seconds (26.3%; 95% CI, 24.2%-28.5%) vs those with normal APTT (21.3%; 95% CI, 20.6%-21.9%) yielding a risk difference of 5.1% (95% CI, 2.9%-7.2%). Conclusions and Relevance: In this Danish cohort study, risk of spinal hematoma following lumbar puncture was 0.20% among patients without coagulopathy and 0.23% among those with coagulopathy. Although these findings may inform decision-making about lumbar puncture by describing rates in this sample, the observed rates may reflect bias due to physicians selecting relatively low-risk patients for lumbar puncture.


Asunto(s)
Trastornos de la Coagulación Sanguínea/complicaciones , Hematoma/etiología , Enfermedades de la Columna Vertebral/etiología , Punción Espinal/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Coagulación Sanguínea/sangre , Líquido Cefalorraquídeo/química , Niño , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Modelos de Riesgos Proporcionales , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Punción Espinal/estadística & datos numéricos , Trombocitopenia/epidemiología , Factores de Tiempo , Adulto Joven
6.
BMC Public Health ; 20(1): 1557, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066742

RESUMEN

BACKGROUND: Tuberculosis (TB) is one of the major infectious diseases that seriously endanger people's health. In Shandong province, the relationship between the level of economic development and TB incidence has not been studied. This study aims to provide more research basis for the government to prevent and control TB by exploring the impact of different economic factors on TB incidence. METHODS: By constructing threshold regression model (TRM), we described the extent to which different economic factors contribute to TB registered incidence and differences in TB registered incidence among seventeen cities with different levels of economic development in Shandong province, China, during 2006-2017. Data were retrieved from the China Information System for Disease Control and Prevention. RESULTS: Per capita medical expenditure (regression coefficient, -0.0314462; SD, 0.0079305; P > |t|, 0.000) and per capita savings (regression coefficient, 0.0001924; SD, 0.0000566; P > |t|, 0.001) passed the significance test at the level of 1%.They are the two economic indicators that have the greatest impact on TB registered incidence. Through the threshold test, we selected the per capita savings as the threshold variable. In the three stages of per capita savings (<9772.8086 China Yuan(CNY); 9772.8086-33,835.5391 CNY; >33,835.5391 CNY), rural per capita income always has a significant negative impact on the TB registered incidence (The regression coefficients are - 0.0015682, - 0.0028132 and - 0.0022253 respectively. P is 0.007,0.000 and 0.000 respectively.).In cities with good economies, TB registered incidence was 38.30% in 2006 and dropped to 25.10% by 2017. In cities with moderate economies, TB registered incidence peaked in 2008 at 43.10% and dropped to 27.1% by 2017.In poorer cities, TB registered incidence peaked in 2008 at 56.30% and dropped to 28.9% in 2017. CONCLUSION: We found that per capita savings and per capita medical expenditure are most closely related to the TB incidence. Therefore, relevant departments should formulate a more complete medical system and medical insurance policy to effectively solve the problem of "difficult and expensive medical treatment". In order to further reduce the TB incidence, in addition to timely and accurate diagnosis and treatment, it is more important for governments to increase investment in medicine and health care.


Asunto(s)
Desarrollo Económico/estadística & datos numéricos , Tuberculosis/epidemiología , China/epidemiología , Ciudades/epidemiología , Humanos , Incidencia , Sistema de Registros
7.
BMC Fam Pract ; 21(1): 208, 2020 10 10.
Artículo en Inglés | MEDLINE | ID: mdl-33038926

RESUMEN

BACKGROUND: To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. METHODS: Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator's percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. RESULTS: We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of - 2.69% (95%CI - 3.17% to - 2.23%) in March and - 3.41% (95%CI - 3.82% to - 3.01%) in April; and the control of blood pressure with a reduction of - 2.13% (95%CI - 2.34% to - 1.9%) and - 2.59% (95%CI - 2.8% to - 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of - 2.86% (95%CI - 3.33% to - 2.39%) and - 4.13% (95%CI - 4.55% to - 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. CONCLUSIONS: The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Atención Primaria de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Cuarentena/estadística & datos numéricos , Adulto , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Sistema de Registros , Estudios Retrospectivos , España
8.
BMC Infect Dis ; 20(1): 744, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33036570

RESUMEN

BACKGROUND: The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the twenty-first century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field. However, several gaps remain in the knowledge of the burden of COVID-19 on patients with TB and HIV. This study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB, to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. METHODS: We conducted an electronic search of potentially eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and July, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB in adults. We screened titles, abstracts and full articles for eligibility. Descriptive and meta-analysis were done and results have been presented in graphs and tables. RESULTS: After removing 95 duplicates, 58 out of 437 articles were assessed for eligibility, of which 14 studies were included for descriptive analysis and seven studies were included in the meta-analysis. Compared to the descriptive analysis, the meta-analysis showed strong evidence that current TB exposure was high-risk COVID-19 group (OR 1.67, 95% CI 1.06-2.65, P = 0.03). The pooled of COVID-19/TB severity rate increased from OR 4.50 (95% CI 1.12-18.10, P = 0.03), the recovery rate was high among COVID-19 compared to COVID-19/TB irrespective of HIV status (OR 2.23, 95% CI 1.83-2.74, P < 0.001) and the mortality was reduced among non-TB group (P < 0.001). CONCLUSION: In summary, TB was a risk factor for COVID-19 both in terms of severity and mortality irrespective of HIV status. Structured diagnostic algorithms and clinical management are suggested to improve COVID-19/HIV/TB or COVID-19/TB co-infections outcomes.


Asunto(s)
Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Salud Global/estadística & datos numéricos , Infecciones por VIH/epidemiología , Neumonía Viral/epidemiología , Tuberculosis/epidemiología , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Humanos , Pandemias , Neumonía Viral/mortalidad , Prevalencia , Sistema de Registros , Factores de Riesgo
9.
Stud Health Technol Inform ; 273: 117-122, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-33087600

RESUMEN

INTRODUCTION: The electronically submitted data from midwives and hospitals to the Netherlands perinatal registry vary significantly in their data definitions, and electronic message versions. The purpose of this article is to describe the semantic cross-mapping tool and execution procedure to prepare the data for statistical analysis. METHODS: requirements analysis, design, development and testing. RESULTS: The tool for governance of versions of datasets, CIMs, data, and value sets is designed, developed, and tested. The test is based on the data-mart of version PRN 1.3 based data from 2019. Data are semantically cross mapped to current version perinatology data 2.2. CONCLUSION: The cross-mapping of PRN 1.3 data to perinatology 2.2 data are defined in the tool, testing revealed this mapping is successful.


Asunto(s)
Partería , Semántica , Femenino , Humanos , Países Bajos/epidemiología , Parto , Embarazo , Sistema de Registros
10.
Medicine (Baltimore) ; 99(40): e22447, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019430

RESUMEN

The aim of this study was to investigate the relationship between textbook outcome and survival in patients with surgically treated colon cancer. A total of 804 surgical cases were enrolled between June 1, 2010 and December 31, 2014. Textbook outcome was defined as patients who had colon cancer surgery and met the six healthcare parameters of surgery within 6 weeks, radical resection, lymph node (LN) yield ≥12, no ostomy, no adverse outcome and colonoscopy before/after surgery within 6 months. The effect of textbook outcome on 5-year disease-specific survival (DSS) was calculated using the Kaplan-Meier method. A Cox regression model was used to find significant independent variables and stratified analysis used to determine whether text-book outcome had a survival benefit. A textbook outcome was achieved in 59.5% of patients undergoing colon cancer surgery. Important obstacles to achieving textbook outcome were no stomy, no adverse outcome and LN yield ≥12. Patients with text-book outcome had statistically significant better 5-year DSS compared to those with-out (80.1% vs. 58.3%). Multivariate analyses indicated that colon cancer patients with textbook outcome had better 5-year DSS after adjusting for various confounders ([aHR], 0.44; 95% CI, 0.34-0.57). Thus, besides being an index of short-term quality of care, textbook outcomes could be used as a prognosticator of long-term outcomes, such as 5-year survival rates.


Asunto(s)
Neoplasias del Colon/cirugía , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Anciano , Neoplasias del Colon/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Tasa de Supervivencia
11.
Medicine (Baltimore) ; 99(40): e22465, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019438

RESUMEN

The present study aimed to investigate the predictive value of free fatty acid (FFA) in embolic stroke of undetermined source (ESUS) according to the presence of potential embolic sources (PES) after extensive etiologic evaluation.This was a retrospective observational study based on a single-center registry from January 2011 to July 2017. Stroke subtypes were determined through laboratory findings, brain, and angiographic imaging, carotid ultrasonography, transthoracic echocardiography, and 24-hour Holter monitoring. If ESUS was suspected, transesophageal echocardiography was additionally performed. Patients were classified into ESUS with PES and ESUS without PES. PES included mitral annular calcification, mitral valve prolapse, patent foramen ovale, atrial septal aneurysm, spontaneous echo contrast, ventricular aneurysm, and high-risk plaques of aortic arch, or carotid bulb. We compared clinical and laboratory findings between the two groups.Of a total of 110 ESUS patients, 61 patients (55.5%) had no PES. Patients with ESUS without PES had higher levels of serum FFA, systolic blood pressure, diastolic blood pressure (DBP), and left atrial (LA) enlargement compared with those of ESUS with PES. Multivariable analysis demonstrated that the FFA level, DBP, and LA volume index were associated with ESUS without PES [odds ratio (OR) 1.038, 95% confidence interval (CI) 1.019-1.058 for FFA/10 µEq/L, OR 1.414, 95% CI 1.037-1.928 for DBP/10 mm Hg, and OR 1.073, 95% CI 1.009-1.141 for LA volume index].Higher levels of FFA, DBP, and LA volume index are associated with ESUS without PES, highlighting the need to identify the role of these markers in ESUS through further large-scale, multi-center and prospective studies.


Asunto(s)
Ácidos Grasos no Esterificados/sangre , Embolia Intracraneal/sangre , Accidente Cerebrovascular/sangre , Anciano , Biomarcadores/sangre , Femenino , Humanos , Embolia Intracraneal/complicaciones , Embolia Intracraneal/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sistema de Registros , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología
12.
Medicine (Baltimore) ; 99(41): e22366, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031272

RESUMEN

To investigate the prognoses associated with different locations of medulloblastoma (MB) in terms of survival through a case-control study and evaluate the prognostic factors for MB.The Surveillance, Epidemiology, and End Results database was used to identify MB patients diagnosed from 1975 to 2016. Each brainstem MB (bMB) patient was matched to a cerebellum MB (cMB) patient by propensity score matching based on age, sex, tumor size, extent of metastasis, extent of surgical resection, radiotherapy status and chemotherapy status. Univariate and multivariate analyses were performed to assess the effect of prognostic factors on overall survival. Ethical approval was not necessary as this study is based on a public database.A total of 172 bMB patients and 1417 cMB patients were included in the study. A total of 144 pairs of patients were matched to constitute the matched cohort. Within the matched cohort, the median survival times were 213 months and 96 months for cMB and bMB, respectively. Within the unmatched cohort, the median survival times were 111 months and 97 months for cMB and bMB, respectively. Brainstem location detrimentally affected the survival time of MB patients in both the matched cohort (hazard ratios =8.14, 95% confidence interval =5.98-11.08) and the unmatched cohort (hazard ratios =1.44, 95% confidence interval =1.20-1.74). Age <5 years and receipt of radiotherapy were favorable prognostic factors, whereas gross total resection, brainstem location and receipt of chemotherapy were unfavorable prognostic factors. Radiotherapy alone was associated with superior outcomes concerning adjuvant chemotherapy or radiotherapy.This study uncovers a survival advantage for cMB patients versus bMB patients. Additionally, prognostic factors include age, extent of surgical resection, and receipt of radiotherapy or chemotherapy. Radiotherapy after surgery and rational use of chemotherapy drugs are crucial for treatment of MB patients. Further studies of these prognostic factors are required to improve the survival time.


Asunto(s)
Neoplasias del Tronco Encefálico/mortalidad , Meduloblastoma/mortalidad , Neoplasias del Tronco Encefálico/terapia , Estudios de Casos y Controles , Neoplasias Cerebelosas/mortalidad , Neoplasias Cerebelosas/terapia , Preescolar , China/epidemiología , Femenino , Humanos , Lactante , Masculino , Meduloblastoma/terapia , Pronóstico , Puntaje de Propensión , Sistema de Registros , Estudios Retrospectivos , Programa de VERF , Tasa de Supervivencia
13.
Medicine (Baltimore) ; 99(41): e22523, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031294

RESUMEN

There is scarce evidence that the erythrocyte sedimentation rate (ESR) could efficiently improve the prediction accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in cases of ST-elevation myocardial infarction (STEMI).A cohort of 1094 STEMI patients undergoing primary percutaneous coronary intervention was retrospectively recruited. Patients were categorized based on the ESR values. Final endpoints included cardiovascular death and major adverse cardiovascular event (MACE) occurrence. The predictive value of combined models with the GRACE score and ESR was assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement.During the mean follow-up of 23 months, 34 patients died and 190 experienced MACEs, of which 23 patients died in the first year; both endpoints were more frequent in the higher group. The ESR and high-sensitivity C-reactive protein (hs-CRP) were independent risk factors of 1-year cardiovascular death, together with the GRACE score (ESR: hazard ratio = 1.03, P = .006 hs-CRP: hazard ratio = 1.00, P = .001; GRACE: 1.03, P = .012). Although no statistical improvement in the area under the ROC curve was observed in either the GRACE/ESR or the GRACE/hs-CRP model (GRACE/ESR models: 0. 8073 vs GRACE: 0.7714, P = .22; GRACE/ESR models: 0. 7815 vs GRACE: 0.7714, P = .61), the GRACE score and ESR together significantly improved the NRI (0.633; P< .001) compared with the GRACE alone. Regarding the mid-term mortality, adding the ESR to the GRACE score not only improved the NRI (0.8433; P < .001), but also increased the integrated discrimination improvement (0.0509; P = .04).The ESR is an independent risk factor of cardiovascular death and MACE in STEMI patients receiving primary percutaneous coronary intervention. The ESR comparatively enhanced the predictive values of the prognostic model, including the GRACE risk score.


Asunto(s)
Sedimentación Sanguínea , Infarto del Miocardio con Elevación del ST/sangre , Biomarcadores/sangre , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Sistema de Registros , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía
14.
Nihon Koshu Eisei Zasshi ; 67(9): 593-602, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-33041285

RESUMEN

Objective The purpose of this study was to investigate the influence of age, period, birth cohort, and regional differences in the detection of breast cancer using screening data.Method Data from the Japan Cancer Society's breast cancer screening program, collected from 21 prefectural branches between 2004 to 2015, were used to generate age-specific estimates of cancer detection for women aged between 40 to 79 years. We used Bayesian age-period-cohort (APC) analyses based on the cohort table to describe the simultaneous effects of age, period, and cohort on breast cancer detection rates to understand the population dynamics underlying the detection patterns. We also incorporated region as a random effect to examine regional characteristics.Results The age effect showed bimodality in the late 40s and late 50s. The period effect decreased from 2004 to 2007 and remained constant thereafter. The cohort effect showed that the detection rate for women born between 1943 and 1958 was high. Furthermore, we found regional differences in the breast cancer detection rate: Miyazaki, Fukui, Tochigi, and Hokkaido prefectures showed higher detection rates, while Kagoshima and Chiba prefecture had lower rates.Conclusion Age effect has the strongest influence on the secular trend of breast cancer detection, and there is a regional difference in the detection rate. The present study that used screening data presented similar results to those of previous studies. The National Cancer Registry, based on the Cancer Registry Act of 2016, reports accurate national data. Similar to the National Cancer Registry data, analysis using screening data has immediacy and could be used for disease prevention.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Detección Precoz del Cáncer/estadística & datos numéricos , Tamizaje Masivo , Factores de Edad , Teorema de Bayes , Neoplasias de la Mama/prevención & control , Estudios de Cohortes , Interpretación Estadística de Datos , Japón/epidemiología , Sistema de Registros , Factores de Tiempo
15.
Cien Saude Colet ; 25(9): 3345-3354, 2020 Sep.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32876246

RESUMEN

Given the growing number of deaths due to the COVID-19 pandemic in Brazil, this study presents an initial and exploratory descriptive analysis of the excess mortality observed from March to May 2020 in capitals and other municipalities. The data source was the death registers from the Civil Registry Offices. The data were disaggregated by gender and capitals and other municipalities of the 26 federative units and the Federal District. The standardized mortality ratio for 2020 was calculated with the 2019 mortality coefficients as standards. The results showed 39,146 excess deaths for the period studied and is higher among men. This increase was more significant among the capitals of the North, Northeast, and Southeast regions. In the other municipalities in these regions, the increase was observed in May, indicating a possible inland-bound COVID-19 transmission. The need to improve the detection and registration of cases is highlighted to enable the efficient monitoring of the pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Ciudades , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Sistema de Registros , Factores Sexuales
16.
Orthopade ; 49(9): 808-814, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32885289

RESUMEN

BACKGROUND: The German Arthroplasty Registry, EPRD, has the ability to examine early factors influencing the probability of failure of total hip arthroplasty (THA) and knee arthroplasty (TKA). The study analyses the influence of the overall experience of a hospital, as well as the change in supplier on the revision rate. MATERIALS AND METHODS: A total of 164,903 cementless THA and 155,577 cemented TKA were in follow-up from 656 hospitals from 2012 to 2019. The number of arthroplasties performed per hospital per year was used as a surrogate parameter for institutional experience. This number was subdivided into 250, 251-500 and more than 500 for hip and knee per year and the overall revision rate was analysed. Additionally, the effects of the change of a major supplier of implant systems to a hospital were analysed. At least 70% of the documented implant components for each calendar quarter were used in that hospital to define the company as a major supplier. RESULTS: The overall revision rate for THA was 3.9% for hospitals with up to 250 arthroplasties per year, 3.3% for hospitals with 251-500 arthroplasties per year and 2.9% for hospitals performing over 500 surgeries per year (p < 0.0001). The revision rate for TKA was also significantly different between the three groups with 3.4, 3.3 and 2.7% (p < 0.0001). Changing the supplier of implant systems also showed a significant increase of the revision rate (p < 0.0001 for THA, p = 0.02 for TKA). CONCLUSION: The institutional experience significantly influences short-term results in terms of the revision rate of hip and knee arthroplasty. Changing the implant system even in an experienced hospital has a major impact on the early revision rate and, therefore, needs careful transition.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Alemania , Humanos , Articulación de la Rodilla , Sistema de Registros , Reoperación , Estudios Retrospectivos
18.
Bull Cancer ; 107(9): 867-880, 2020 Sep.
Artículo en Francés | MEDLINE | ID: mdl-32919610

RESUMEN

INTRODUCTION: Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15 years after cancer diagnosis. METHODS: From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. RESULTS: At 5, 10 or 15 years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. DISCUSSION: Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.


Asunto(s)
Supervivientes de Cáncer , Empleo/estadística & datos numéricos , Adulto , Neoplasias de la Mama/terapia , Neoplasias Colorrectales/terapia , Estudios Transversales , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Tiempo , Neoplasias del Cuello Uterino/terapia , Adulto Joven
19.
RMD Open ; 6(2)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32878994

RESUMEN

OBJECTIVES: Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. METHODS: Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters-for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection-are documented. RESULTS: Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. CONCLUSIONS: In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.


Asunto(s)
Antirreumáticos/uso terapéutico , Productos Biológicos/uso terapéutico , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/fisiopatología , Sistema de Registros , Enfermedades Reumáticas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Artritis Psoriásica/complicaciones , Artritis Psoriásica/tratamiento farmacológico , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Femenino , Alemania , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Hospitalización , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Polimialgia Reumática/complicaciones , Polimialgia Reumática/tratamiento farmacológico , Pronóstico , Enfermedades Reumáticas/complicaciones , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/tratamiento farmacológico , Adulto Joven
20.
S Afr Med J ; 110(6): 484-490, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32880559

RESUMEN

BACKGROUND: Airway management is an essential skill for doctors working in the emergency department (ED). Safety and efficacy are crucial to its success. Analysis of an airway registry can provide feedback that can be used for quality improvement purposes. OBJECTIVES: To examine the first airway registry from an ED in South Africa (SA), a low- to middle-income country (LMIC), and compare the findings with international data. METHODS: A retrospective analysis of 13 months' data from the airway registry of an academic ED with an annual census of 60 000 patients. Data analysed included demographics, indications for intubation, intubator training level, type of intubation device, number of attempts, adverse events, pre-oxygenation methods, and drug and intravenous fluid use. RESULTS: A total of 321 intubations were included. The majority of the patients (71.6%) had non-traumatic indications for intubation. The overall first-pass intubation success (FPS) rate for doctors was 81.8%. Although this rate is lower than the mean rate suggested in an international meta-analysis (84.1%), it is within the 95% confidence interval (80.1 - 87.4%). Overall FPS rates showed no difference between video laryngoscopy (81.7%) compared with direct laryngoscopy (73.3%) (p-value 0.079), although better glottic views were obtained with video laryngoscopy (80.5% were Cormack-Lehane grade 1). Analysis of pre-oxygenation methods found that although sicker patients had received more aggressive pre-oxygenation, e.g. with non-invasive or bag-mask ventilation techniques, they still desaturated more often (35.8% and 62.5%, respectively) than less sick patients who received simple non-rebreather facemask pre-oxygenation (4.5%). CONCLUSIONS: This analysis of the first airway registry from an SA ED highlights that airway management in an LMIC can be performed on par with accepted international standards. It serves as a good baseline for further research into airway management in other LMICs and provides useful feedback for quality improvement purposes.


Asunto(s)
Manejo de la Vía Aérea/métodos , Servicio de Urgencia en Hospital , Adulto , Anciano , Femenino , Fluidoterapia/estadística & datos numéricos , Humanos , Intubación Intratraqueal/estadística & datos numéricos , Laringoscopía , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Sistema de Registros , Estudios Retrospectivos , Sudáfrica
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