Mortality after discharge from a public tertiary cardiovascular referral hospital.

It is critically important for stakeholders with distinct foci of attention on healthcare to understand patient evolution in the presence of an established diagnosis or with a suspected diagnosis of various diseases, specially considering death as an outcome. To study the long-term mortality of patients at a cardiovascular referral hospital. Deterministic binding (selection of pairs of registers from the hospital electronic health records and the mortality records of São Paulo state) from 2002 to 2017 was performed. Studied variables were: age, sex, hospital treatment unit where the first visit occurred (Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostics Services), treatment type, elapsed time between the first visit and death, diagnosis at first and last visits and variables related to death. Statistical Methods: descriptive, survival (with Kaplan-Meier method), correspondence and competitive risks analyses; in case of nonoccurrence of death until the end of 2017, the patients were considered alive. Statistical significance was set at values of P < .05. Median age at the first visit to the Hospital was 51.9 years. Birth locations included 4496 cities, 17.33% in São Paulo, 0.41% in Rio de Janeiro, 0.40% in Osasco, 24.04% in other cities. Sex included females (46.7%), males (44.2%), not defined (6.3%), and other (2.8%). We observed an association between diseases in ICD-10 Chapter 16 (certain conditions originating in the perinatal period) and Chapter 17 (congenital malformations, deformations, and chromosomal abnormalities), both as diagnoses and underlying causes of death, as well as between neoplasms as diagnoses and as the underlying cause of death. In this sample, there was an association between admission diagnoses and underlying causes of death, such as neoplasms, cardiovascular diseases, and congenital heart malformations. Additionally, patients who underwent a cardiac intervention had a smaller less mortality rate than those who were not operated on. There were also differences in cardiovascular mortality between distinct treatment units of the hospital ((Emergency Unit, Outpatient Unit, Hospital Admissions, Diagnostic Services).

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Abstract Background This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Machine learning to predict 30-day quality-adjusted survival in critically ill patients with cancer.

PURPOSE: To develop and compare the predictive performance of machine-learning algorithms to estimate the risk of quality-adjusted life year (QALY) lower than or equal to 30 days (30-day QALY). MATERIAL AND METHODS: Six machine-learning algorithms were applied to predict 30-day QALY for 777 patients admitted in a prospective cohort study conducted in Intensive Care Units (ICUs) of two public Brazilian hospitals specialized in cancer care. The predictors were 37 characteristics collected at ICU admission. Discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve. Sensitivity, 1-specificity, true/false positive and negative cases were measured for different estimated probability cutoff points (30%, 20% and 10%). Calibration was evaluated with GiViTI calibration belt and test. RESULTS: Except for basic decision trees, the adjusted predictive models were nearly equivalent, presenting good results for discrimination (AUROC curves over 0.80). Artificial neural networks and gradient boosted trees achieved the overall best calibration, implying an accurately predicted probability for 30-day QALY. CONCLUSIONS: Except for basic decision trees, predictive models derived from different machine-learning algorithms discriminated the QALY risk at 30 days well. Regarding calibration, artificial neural network model presented the best ability to estimate 30-day QALY in critically ill oncologic patients admitted to ICUs.

Utility and quality-adjusted life-years in coronary artery disease: Five-year follow-up of the MASS II trial.

OBJECTIVES: This study evaluated the utility and quality-of-life year measurements for patients with coronary artery disease who underwent any of 3 therapeutic strategies with a 5-year follow-up. METHODS: Quality-of-life data were obtained from the Medicine, Angioplasty, or Surgery Study II trial. To obtain utilities, the 36-Item Short-Form questionnaire was converted to a 6-Dimensional Health State Classification System. RESULTS: Of the 611 initial patients, 579 completed the questionnaire. In all, 188 patients received the surgical treatment-194 the percutaneous, and the remaining 197 the medical. The median utility scores for the 5 years analyzed were 0.809 (95% confidence interval [CI] 0.794-0.842) for patients assigned to percutaneous coronary intervention, 0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI 0.761-0.809) for coronary artery bypass graft surgery. The difference between percutaneous coronary intervention and medical treatment was statistically significant (P < .05, Dunn test). The median cumulative quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936) for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95% CI 3.638-3.890) for surgery. Additionally, the median quality-of-life years between percutaneous and medical treatment was 0.262 (95% CI 0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI 0.036-0.413), and between surgery and percutaneous coronary intervention it was -0.038 (95% CI -0.221 to -0.146). CONCLUSION: Coronary artery bypass surgery and percutaneous coronary intervention were similar regarding cumulative quality-of-life years; however, they were both superior to that of medical treatment. The results presented are valuable data for further cost-utility studies.

Confiabilidade do Instrumento para Classificação de Idosos quanto à Capacidade para o Autocuidado / Reliability of the Instrument for Classifying Elderly People's Capacity for Self-care

OBJETIVO: Avaliar a confiabilidade do Instrumento para Classificação de Idosos quanto à Capacidade para o Autocuidado, desenvolvido para auxiliar o terapeuta ocupacional na atenção a idosos em unidades básicas de saúde. MÉTODOS: Foram realizados testes de estabilidade e consistência interna. Para validação do Instrumento, os testes foram aplicados à amostra de 30 indivíduos com 60 anos ou mais, em dois momentos. A análise estatística foi realizada a partir de agrupamentos criteriosos de respostas, o que levou à formulação de uma versão simplificada do Instrumento. A estabilidade desta versão foi avaliada pelo coeficiente kappa e a consistência interna pelo coeficiente alpha de Cronbach. RESULTADOS: A estabilidade variou de moderada a excelente. A consistência interna foi verificada somente para áreas que se mostraram adequadas para o uso da metodologia baseada no cálculo do alpha de Cronbach: três das seis questões da área "perfil social" e os blocos das atividades básicas e instrumentais de vida diária da área "capacidade funcional", respectivamente com nove e oito atividades. CONCLUSÕES: Após os testes de estabilidade e consistência interna, o Instrumento possibilita classificação sucinta e simplificada de idosos quanto à capacidade funcional para atividades básicas e instrumentais e sua caracterização quanto aos demais aspectos do autocuidado. Evidências acerca de sua confiabilidade e validade podem ser ampliadas por meio de novos estudos.

OBJECTIVE: To evaluate the reliability of an instrument for classifying elderly people regarding their capacity for self-care, which was developed to assist occupational therapists in attending elderly people at primary healthcare units. METHODS: Stability and internal consistency tests were carried out. To validate the instrument, tests were applied to a sample of 30 individuals aged 60 years and over, on two occasions. The statistical analysis was performed after careful grouping of the responses. This led to the formulation of a simplified version of the instrument. The stability of this version was assessed using the kappa coefficient and the internal consistency by Cronbach's alpha coefficient. RESULTS: The stability ranged from moderate to excellent. The internal consistency was checked only for areas that were shown to be appropriate for using the methodology, based on calculations of Cronbach's alpha: three of the six questions in the "social profile" area and the blocks of basic and instrumental activities of daily living in the "functional capacity" area, which respectively consisted of nine and eight activities. CONCLUSIONS: Following the stability and internal consistency tests, the instrument made it possible to succinctly and simply classify elderly people with regard to their functional capacity for basic and instrumental activities, and to characterize them regarding other aspects of self-care. The evidence regarding its reliability and validity could be expanded by means of new studies.

[Reliability of the instrument for classifying elderly people's capacity for self-care]. / Confiabilidade do Instrumento para Classificação de Idosos quanto à Capacidade para o Autocuidado.

OBJECTIVE: To evaluate the reliability of an instrument for classifying elderly people regarding their capacity for self-care, which was developed to assist occupational therapists in attending elderly people at primary healthcare units. METHODS: Stability and internal consistency tests were carried out. To validate the instrument, tests were applied to a sample of 30 individuals aged 60 years and over, on two occasions. The statistical analysis was performed after careful grouping of the responses. This led to the formulation of a simplified version of the instrument. The stability of this version was assessed using the kappa coefficient and the internal consistency by Cronbach's alpha coefficient. RESULTS: The stability ranged from moderate to excellent. The internal consistency was checked only for areas that were shown to be appropriate for using the methodology, based on calculations of Cronbach's alpha: three of the six questions in the "social profile" area and the blocks of basic and instrumental activities of daily living in the "functional capacity" area, which respectively consisted of nine and eight activities. CONCLUSIONS: Following the stability and internal consistency tests, the instrument made it possible to succinctly and simply classify elderly people with regard to their functional capacity for basic and instrumental activities, and to characterize them regarding other aspects of self-care. The evidence regarding its reliability and validity could be expanded by means of new studies.

Left ventricular mass in patients with heart failure.

OBJECTIVE: To assess left ventricular mass in patients with heart failure and its correlations with other clinical variables and prognosis. METHODS: The study comprised 587 patients aged from 13.8 years to 68.9 years, 461 (78.5%) being males and 126 (21.5%) females. Left ventricular mass was estimated by using M-mode echocardiography and was indexed by height. RESULTS: The left ventricular mass index ranged from 35.3 g/m to 333.5 g/m and increased with age. The left ventricular mass index was greater in males (mean, 175.7 g/m) than in females (mean, 165.7 g/m). The left ventricular mass index was greater in patients with hypertensive cardiomyopathy (mean of 188.1 g/m), with idiopathic dilated cardiomyopathy (mean, 177.7 g/m) and with cardiomyopathies of other etiologies (mean, 175.1 g/m) than in patients with chagasic (mean, 164.3 g/m) or ischemic (mean, 162 g/m) cardiomyopathy. The left ventricular mass index in patients with heart failure showed a correlation with age, sex, etiology, and left atrial diameter. The correlation with left ventricular ejection fraction was negative: the increase in the left ventricular mass index was associated with a reduction in ejection fraction. The relative risk of death was 1.22 for each 50-g/m increase in the left ventricular mass index. CONCLUSIONS: The estimate of left ventricular mass may contribute to the prognostic assessment of patients with heart failure.

Massa ventricular esquerda em portadores de insuficiência cardíaca / Left ventricular mass in patients with heart failure

OBJETIVO: Avaliar a massa ventricular esquerda em pacientes com insuficiência cardíaca, as correlações com outras variáveis clínicas e com o prognóstico. MÉTODOS: Foram estudados 587 pacientes com idades entre 13,8 anos e 68,9 anos, 461 (78,5 por cento) homens e 126 (21,5 por cento) mulheres. A massa ventricular esquerda foi estimada com o uso do ecocardiograma no modo M e indexada pela altura. RESULTADOS: O índice da massa ventricular esquerda variou de 35,3 g/m a 333,5 g/m e aumentou conforme a idade. O índice da massa ventricular esquerda foi maior nos homens (média 175,7 g/m) do que nas mulheres (média 165,7 g/m). O índice da massa ventricular esquerda foi maior nos portadores de cardiomiopatia hipertensiva (média 188,1 g/m), de cardiomiopatia dilatada idiopática (média 177,7 g/m) e de cardiomiopatias de outras etiologias (média 175,1 g/m) do que nos portadores de cardiomiopatia chagásica (média 164,3 g/m) e isquêmica (média 162 g/m). O índice da massa ventricular esquerda de portadores de insuficiência cardíaca demonstrou associação com a idade, o sexo, a etiologia e o diâmetro do átrio esquerdo. A correlação com a fração de ejeção do ventrículo esquerdo foi negativa - o aumento do índice da massa ventricular esquerda associou-se à redução da fração de ejeção. O risco relativo de óbito foi 1,22 para cada acréscimo de 50 g/m no índice da massa ventricular esquerda. CONCLUSÕES: A estimação da massa ventricular esquerda pode contribuir para a avaliação prognóstica de portadores de insuficiência cardíaca.

A SAS macro for estimating transition probabilities in semiparametric models for recurrent events / A SAS macro for estimating transition probabilities in semiparametric models for recurrent events

In many clinical studies involving event history analysis, the event of interest is non-fatal and may occur more than once for each subject. Models based on the theory of counting processes have been developed to deal with such data, the recurrences being considered as transitions in a Markovian process. Under this setting, the experimental units can move between states over time, and it is possible to estimate the corresponding transition probabilities employing regression models that incorporate the influence of covariates. Despite of this, most of the softwares are concerned only in the estimation of regression parameters and do not provide transition probabilities estimates. The aim of this paper is to present a SAS macro developed to estimate the transition probabilities, considering three approaches for the regression modeling. The macro is flexible enough to allow the user to select the model to be fit providing, for a given set of covariates, plots of the estimates for the predicted transition probabilities as a function of time.

Clinical evaluation of an adhesive used as a fissure sealant / Avaliação clínica de um adesivo usado como selante de fissura

Purpose: To compare the retention of a multi-use bonding agent (OptiBond) to a conventional sealant (Delton) used as pit and fissure sealants. Materials and Method: An informed consent was obtained from 38 subjects aged 11-17 yrs. Delton, a self-cured sealant, was applied to 86 teeth, and OptiBond, a dual-cure glass filled adhesive, was applied to 85 teeth, under cotton roll isolation and saliva ejector. Each subject received both sealing materials, randomly assigned to the sides of the mouth. The sealed teeth were followed up to 30 months. Clinical evaluation was performed by two examiners and the retention was classified as failure or success. Results: Statistical analysis based on a stratified Cox proportional hazards regression model indicated that OptiBond had better clinical performance than Delton (P<0.001)