Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 56
Filtrar
1.
Fam Syst Health ; 39(1): 7-18, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34014726

RESUMO

OBJECTIVE: For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD: We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS: We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION: As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Informática Aplicada à Saúde dos Consumidores , Divórcio , Implementação de Plano de Saúde/métodos , Poder Familiar , Pais/educação , Adulto , COVID-19 , Criança , Saúde da Criança , Educação Infantil , Feminino , Humanos , Masculino , Relações Pais-Filho , Avaliação de Programas e Projetos de Saúde , SARS-CoV-2
2.
Catheter Cardiovasc Interv ; 98(2): 371-379, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33876881

RESUMO

OBJECTIVES: To evaluate the safety and performance of the Hydra transcatheter aortic valve (THV) in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND: The Hydra THV (Vascular Innovations Co. Ltd., Nonthaburi, Thailand) is a novel flexible repositionable self-expanding system with supra-annular bovine pericardial leaflets, available in three sizes, covering aortic annuli between 17 and 27 mm. METHODS: The GENESIS trial was a prospective, multi-center, single-arm, 6 month follow-up study conducted in India. The primary performance endpoint was device success defined as per VARC-II criteria at 30 days. The primary safety endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS: Forty high-risk patients (74.5 ± 6.7 years, 60% men; STS Score:5.6 ± 4.2%) were enrolled in 11 centres. Device success was achieved in 92.5%. The effective orifice area improved from 0.7 ± 0.2 to 2.3 ± 0.6 cm2 at 30 days and to 2.2 ± 0.7 cm2 at 6 months (p < .0001). Mean aortic valve gradient decreased from 53.5 ± 18.1 to 8.9 ± 4.9 mmHg at 30 days and to 7.6 ± 2.7 mmHg at 6 months (p < .0001). The rate of new permanent pacemaker implantation was 7.5% at 30 days, and no patient had more than mild paravalvular leak at 6 months. The 30 days and 6 month all-cause mortality was 10.0 and 17.5%, cardiovascular mortality 7.5 and 7.5%, device-related mortality 5.0 and 5.0%, respectively. No patients had stroke up to 6 months. CONCLUSIONS: The GENESIS trial demonstrated high efficacy of the self-expanding Hydra THV. The cardiovascular mortality rate of 7.5% may partly be explained by the inclusion of some centres with no or limited previous experience in transcatheter aortic valve implantation.

3.
Transplantation ; 105(9): 2054-2071, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534531

RESUMO

BACKGROUND: Despite the kidney supply shortage, 18%-20% of deceased donor kidneys are discarded annually in the United States. In 2018, 3569 kidneys were discarded. METHODS: We compared machine learning (ML) techniques to identify kidneys at risk of discard at the time of match run and after biopsy and machine perfusion results become available. The cohort consisted of adult deceased donor kidneys donated between December 4, 2014, and July 1, 2019. The studied ML models included Random Forests (RF), Adaptive Boosting (AdaBoost), Neural Networks (NNet), Support Vector Machines (SVM), and K-nearest Neighbors (KNN). In addition, a Logistic Regression (LR) model was fitted and used for comparison with the ML models' performance. RESULTS: RF outperformed other ML models. Of 8036 discarded kidneys in the test dataset, LR correctly classified 3422 kidneys, whereas RF correctly classified 4762 kidneys (area under the receiver operative curve [AUC]: 0.85 versus 0.888, and balanced accuracy: 0.681 versus 0.759). For the kidneys with kidney donor profile index of >85% (6079 total), RF significantly outperformed LR in classifying discard and transplant prediction (AUC: 0.814 versus 0.717, and balanced accuracy: 0.732 versus 0.657). More than 388 kidneys were correctly classified using RF. Including biopsy and machine perfusion variables improved the performance of LR and RF (LR's AUC: 0.888 and balanced accuracy: 0.74 versus RF's AUC: 0.904 and balanced accuracy: 0.775). CONCLUSIONS: Kidneys that are at risk of discard can be more accurately identified using ML techniques such as RF.

5.
Clin Transplant ; 34(11): e14054, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32738167

RESUMO

Despite the shortage of kidneys for transplantation in the United States, approximately 18%-20% of deceased donor kidneys are discarded each year. These discarded kidneys can offer a survival benefit to suitable patients. Revisions to the current kidney allocation policy may be needed to reduce deceased donor kidney discard. We surveyed transplant physicians and patients to assess their perceived acceptability of policy proposals to reduce the discard of deceased donor kidneys. Members of professional societies (AST, ASTS) and a patient organization (AAKP) were invited to complete the survey. Responses were obtained from 97 physicians and 107 patients. The majority of physicians (73.4%) and patients (73.8%) "somewhat" or "completely" accepted a policy for fast-tracking kidneys at risk of discard. Physicians and patients also supported returning a proportion of waiting time to patients who accept KDPI >85 kidneys and experience graft failure within the first 12 months, with 36% of physicians and 50% of patients electing to return 100% of the waiting time. The majority of physicians (75%) "somewhat or completely" accepted a policy to skip less aggressive centers for KDPI 90 + offers. Physicians and patients provided insights into factors researchers, and policymakers should consider in the design and implementation of these policies.


Assuntos
Transplante de Rim , Médicos , Obtenção de Tecidos e Órgãos , Seleção do Doador , Sobrevivência de Enxerto , Humanos , Rim , Políticas , Fatores de Risco , Doadores de Tecidos , Estados Unidos
6.
EuroIntervention ; 16(5): 421-429, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-31566572

RESUMO

AIMS: The aim of this study was to demonstrate the safety and efficacy of the next-generation balloon-expandable Myval transcatheter heart valve (THV) in an intermediate- or high-risk patient population with severe symptomatic native aortic stenosis. METHODS AND RESULTS: MyVal-1 was a first-in-human, prospective, multicentre, single-arm, open-label study. Between June 2017 and February 2018, a total of 30 patients were enrolled at 14 sites across India. Mean age was 75.5±6.7 years; 43.3% had coronary artery disease. The mean Society of Thoracic Surgeons score was 6.4±1.8% and 100% of the patients were in New York Heart Association (NYHA) functional Class II/III/IV pre-procedure. The six-minute walk test and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were recorded. After successful implantation of the Myval THV, 96.6% and 100% were in NYHA functional Class I/II at 30-day and 12-month follow-up, respectively. Outcomes of the six-minute walk test (148.0±87.4 vs 336.0±202.9 m) and KCCQ score (36.6±11.0 vs 65.9±11.4) improved from baseline to 12-month follow-up. The effective orifice area (0.6±0.2 vs 1.8±0.3 cm2, p<0.0001), mean aortic valve gradient (47.4±8.8 vs 12.0±3.3 mmHg, p<0.0001), peak aortic valve gradient (71.7±13.0 vs 20.3±5.9 mmHg, p<0.0001) and transaortic velocity (4.5±0.4 vs 2.2±0.4 m/s, p<0.0001) improved substantially from baseline to 12 months post procedure. Four all-cause mortality cases were reported up to 12 months. Moreover, there was no other moderate/severe paravalvular leak, aortic regurgitation or need for new permanent pacemaker (PPM) up to 12-month follow-up. CONCLUSIONS: The MyVal-1 study demonstrated the primary safety and efficacy of the Myval THV with no new PPM requirement up to 12-month follow-up. However, future trials with a larger number of patients and long-term follow-up are warranted to establish the safety and efficacy of the device.


Assuntos
Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Humanos , Índia , Estudos Prospectivos , Desenho de Prótese , Resultado do Tratamento
8.
PLoS One ; 14(9): e0222826, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539417

RESUMO

IMPORTANCE: Despite its efficacy, low tidal volume ventilation (LTVV) remains severely underutilized for patients with acute respiratory distress syndrome (ARDS). Physician under-recognition of ARDS is a significant barrier to LTVV use. We propose a computational method that addresses some of the limitations of the current approaches to automated measurement of whether ARDS is recognized by physicians. OBJECTIVE: To quantify patient and physician factors affecting physicians' tidal volume selection and to build a computational model of physician recognition of ARDS that accounts for these factors. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, electronic health record data were collected for 361 ARDS patients and 388 non-ARDS hypoxemic (control) patients in nine adult intensive care units at four hospitals between June 24 and December 31, 2013. METHODS: Standardized tidal volumes (mL/kg predicted body weight) were chosen as a proxy for physician decision-making behavior. Using data-science approaches, we quantified the effect of eight factors (six severity of illness, two physician behaviors) on selected standardized tidal volumes in ARDS and control patients. Significant factors were incorporated in computational behavioral models of physician recognition of ARDS. RESULTS: Hypoxemia severity and ARDS documentation in physicians' notes were associated with lower standardized tidal volumes in the ARDS cohort. Greater patient height was associated with lower standardized tidal volumes (which is already normalized for height) in both ARDS and control patients. The recognition model yielded a mean (99% confidence interval) physician recognition of ARDS of 22% (9%-42%) for mild, 34% (19%-49%) for moderate, and 67% (41%-100%) for severe ARDS. CONCLUSIONS AND RELEVANCE: In this study, patient characteristics and physician behaviors were demonstrated to be associated with differences in ventilator management in both ARDS and control patients. Our model of physician ARDS recognition measurement accounts for these clinical variables, providing an electronic approach that moves beyond relying on chart documentation or resource intensive approaches.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Relações Médico-Paciente , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/terapia , Volume de Ventilação Pulmonar , Adulto , Algoritmos , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Modelos Teóricos , Projetos de Pesquisa , Síndrome do Desconforto Respiratório/diagnóstico
9.
Transpl Int ; 32(12): 1297-1312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31323698

RESUMO

Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005-2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10-40, 50-70, and 80-100. With KDPI 0-99 KT, KPS 10-40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81-99 KT than from remaining on dialysis.


Assuntos
Transplante de Rim/efeitos adversos , Diálise Renal , Adulto , Idoso , Humanos , Avaliação de Estado de Karnofsky , Transplante de Rim/mortalidade , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Doadores de Tecidos
10.
Transplantation ; 103(5): 980-989, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30720682

RESUMO

BACKGROUND: Underutilization of marginal-quality kidneys for transplantation produced ideas of expediting kidney placement for populations with decreased opportunities of receiving transplants. Such policies can be less efficacious for specific individuals and should be scrutinized until the decision-making for accepting marginal-quality organs, which has relied on experiential judgment, is better understood at the individual level. There exist rigorous tools promoting personalized decisions with useful and objective information. METHODS: This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. Survival benefit calculation accounts for patients' and donors' characteristics and transplant centers' and organ procurement organizations' performances and incorporates patients' perceived transplant and dialysis utilities. Valuations of rejecting an offer are contingent on future opportunities and subject to uncertainty in the timing of successive kidney offers and their quality and donor characteristics. RESULTS: The decision tree was applied to a realistic patient profile as a demonstration. The tool was tested on 1000 deceased-donor kidney offers in 2016. Evaluating up to 1 year of future offers, the tool attains 61% accuracy, with transplant utility of 1.0 and dialysis utility of 0.5. The accuracy reveals potential bias in kidney offer acceptance/rejection at transplant centers. CONCLUSIONS: The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer.


Assuntos
Árvores de Decisões , Seleção do Doador/métodos , Falência Renal Crônica/terapia , Transplante de Rim/métodos , Modelos Biológicos , Adolescente , Adulto , Idoso , Tomada de Decisões , Feminino , Humanos , Falência Renal Crônica/mortalidade , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Diálise Renal/estatística & dados numéricos , Alocação de Recursos/métodos , Alocação de Recursos/estatística & dados numéricos , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Transplantes/estatística & dados numéricos , Listas de Espera , Adulto Jovem
11.
Transplantation ; 103(5): 1051-1063, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30086093

RESUMO

BACKGROUND: Recorded at the time of transplant and reported to the Organ Procurement and Transplantation Network, patient's functional status is measured using the Karnofsky performance score (KPS), ranging 0 to 100. Functional status analysis may provide insights on candidate listing and posttransplant survival outcomes for deceased-donor kidney transplants. METHODS: The cohort consisted of adult deceased-donor kidney transplant recipients transplanted beginning January 2007. One-year and 3-year Cox models for posttransplant survival were fitted with current Scientific Registry of Transplant Recipients (SRTR) variables and KPS. Comparative analyses were performed between the SRTR model without KPS and augmented model with it. Using the augmented model, we examined the impact of Kidney Donor Profile Index on posttransplant survivals for 5 different KPS strata: 10 to 30, 40 to 50, 60 to 70, 80 to 90, and 100. RESULTS: Comparative analyses showed that KPS was a statistically significant predictor for posttransplant survival: it improved model calibration, discrimination, and predictive accuracy. From the augmented model, the survival curves illustrated that recipients with KPS 40 to 50 and kidneys with Kidney Donor Profile Index as high as 99 have expected survival probabilities of above 90% in 1 year and above 80% in 3 years. The expected survival probabilities improve as KPS increases. Recipients with KPS 10 to 30 have the worst survival probability, even if they received high-quality kidneys. CONCLUSIONS: Insights from the survival analyses recommend possible inclusion of functional status into SRTR's risk-adjusted models. Moreover, they invite further examination of its use to improve current listing and transplantation strategies at transplant centers and potentially reduce deceased-donor kidney discard rate.


Assuntos
Avaliação de Estado de Karnofsky/estatística & dados numéricos , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Modelos Biológicos , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Análise de Sobrevida , Transplantados/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
Am J Med ; 131(5): 532-539.e5, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29273191

RESUMO

BACKGROUND: Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death. METHODS: The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants. RESULTS: During 10 years' follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P = .82; black-specific chi-squared 4.1, P = .77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99). CONCLUSIONS: The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Medição de Risco , Afro-Americanos , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Índice de Massa Corporal , Colesterol/sangue , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Hipolipemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores Sexuais , Fumar/epidemiologia , Estados Unidos/epidemiologia
13.
Transplantation ; 102(2): 255-278, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28885499

RESUMO

BACKGROUND: Policymakers are deliberating reforms to reduce geographic disparity in liver allocation. Public comments and the United Network for Organ Sharing Liver and Intestinal Committee have expressed interest in refining the neighborhoods approach. Share 35 and Share 15 policies affect geographic disparity. METHODS: We construct concentric neighborhoods superimposing the current 11 regions. Using concepts from concentric circles, we construct neighborhoods for each donor service area (DSA) that consider all DSAs within 400, 500, or 600 miles as neighbors. We consider limiting each neighborhood to 10 DSAs and use no metrics for liver supplies and demands. We change Model for End-Stage Liver Disease (MELD) thresholds for the Share 15 policy to 18 or 20 and apply 3- and 5-point MELD proximity boosts to enhance local priority, control travel distances, and reduce disparity. We conduct simulations comparing current allocation with the neighborhoods and sharing policies. RESULTS: Concentric neighborhoods structures provide an array of solutions where simulation results indicate that they reduce geographic disparity, annual mortalities, and the airplane travel distances by varying degrees. Tuning of the parameters and policy combinations can lead to beneficial improvements with acceptable transplant volume loss and reductions in geographic disparity and travel distance. Particularly, the 10-DSA, 500-mile neighborhood solution with Share 35, Share 15, and 0-point MELD boost achieves such while limiting transplant volume losses to below 10%. CONCLUSIONS: The current 11 districts can be adapted systematically by adding neighboring DSAs to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements. The solutions may be refined further for implementation.


Assuntos
Disparidades em Assistência à Saúde , Transplante de Fígado , Obtenção de Tecidos e Órgãos , Humanos , Características de Residência , Doadores de Tecidos
15.
Transplantation ; 101(2): 350-359, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27906775

RESUMO

BACKGROUND: Geographic disparities persist in access to liver transplantation. Candidates with similar urgency experience varying opportunities for transplants across the United States. Policymakers are poised to act and 1 proposal entails reorganizing the current Organ Procurement and Transplant Network (OPTN) of 11 regions into 8 districts. However, redistricting has the shortcomings that Organ Procurement Organizations (OPOs) are disconnected from their immediate neighbors by district borders and that it is not easily responsive to uncertainty resulting from variability in donor and listing rates. METHODS: We introduce the notion of an OPO's neighborhood-a collection of donor service areas (DSA) surrounding the OPO that acts as the OPO's region in the current local-regional-national framework. Districts and concentric circles are special cases. We design 58 neighborhoods for the DSAs with several attractive properties and optimize them to balance supplies and demands using 10 years of Organ Procurement and Transplant Network data. We conduct a simulation experiment comparing current allocation, redistricting, and neighborhoods under current sharing policies with respect to the following metrics: total mortalities, DSA-average model for end-stage liver disease (MELD) at transplant, DSA-average MELD standard deviation, and average organ transport distance. Liver-simulated allocation model cannot accommodate neighborhoods, so we programmed a discrete-event simulator, LivSim, to approximate liver-simulated allocation model. RESULTS: We exhibited a neighborhood solution. Compared with the current allocation, simulation results showed that neighborhoods reduce the DSA-average MELD standard deviation by 29% and save about 65 lives annually. Compared with redistricting, the neighborhoods had smaller average transport distances that were more uniform across DSAs, saved about 20 additional lives, and reduced DSA-average MELD standard deviation by an additional 17%. CONCLUSIONS: Alternatives to redistricting with desirable properties and performance are possible and should be considered.


Assuntos
Área Programática de Saúde , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde , Transplante de Fígado/métodos , Determinação de Necessidades de Cuidados de Saúde , Características de Residência , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Simulação por Computador , Humanos , Formulação de Políticas , Regionalização da Saúde/organização & administração , Fatores de Tempo , Tempo para o Tratamento , Transporte de Pacientes/organização & administração , Estados Unidos , Listas de Espera
16.
J Assoc Physicians India ; 65(12): 14-19, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29327516

RESUMO

Objectives: Cardiac biomarkers have been studied in sepsis in the past and various mechanisms for their rise have been elucidated. However their association with severity of sepsis, mortality and myocardial dysfunction warrants further studies. We have studied three different cardiac biomarkers- troponin T (trop T), creatine phosphokinase MB isoform (CPK MB) and NT pro brain natriuretic peptide (NT Pro BNP) in patients with septicemia. We have attempted to observe the levels of these biomarkers in sepsis, their individual abilities to predict the severity of sepsis, mortality and association with myocardial dysfunction noted in echocardiography. Results: There were 54 patients each of septicaemia and controls. The means of the three biomarkers, namely Troponin T, CPK MB and NT Pro BNP, were significantly elevated in patients with sepsis- mean values of 0.23±0.8 ng/ml, 9.9±13.4 ng/ml and 5988.62±13.7 pg/ml respectively. Myocardial dysfunction was observed in 27 cases. There were 13 non-survivors. Troponin T and NT pro BNP were strongly associated with higher mortality. CPK MB had better correlation with myocardial dysfunction. Conclusion: We conclude that myocardial dysfunction using echocardiography is seen in around half of the patients with sepsis. Cardiac biomarkers can be routinely used in patients of septicemia to suggest the severity of sepsis,to detect myocardial injury and dysfunction and prognostication. CPK MB may be very useful to suspect myocardial dysfunction in such patients.


Assuntos
Cardiomiopatias , Creatina Quinase Forma MB , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Sepse , Troponina T , Biomarcadores/sangue , Cardiomiopatias/sangue , Creatina Quinase Forma MB/sangue , Ecocardiografia , Humanos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Sepse/sangue , Sepse/complicações , Troponina T/sangue
17.
Big Data ; 4(3): 160-78, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27642719

RESUMO

Synthetic data are becoming increasingly important mechanisms for sharing data among collaborators and with the public. Multiple methods for the generation of synthetic data have been proposed, but many have short comings with respect to maintaining the statistical properties of the original data. We propose a new method for fully synthetic data generation that leverages linear and integer mathematical programming models in order to match the moments of the original data in the synthetic data. This method has no inherent disclosure risk and does not require parametric or distributional assumptions. We demonstrate this methodology using the Framingham Heart Study. Existing synthetic data methods that use chained equations were compared with our approach. We fit Cox proportional hazards, logistic regression, and nonparametric models to synthetic data and compared with models fitted to the original data. True coverage, the proportion of synthetic data parameter confidence intervals that include the original data's parameter estimate, was 100% for parametric models when up to four moments were matched, and consistently outperformed the chained equations approach. The area under the curve and accuracy of the nonparametric models trained on synthetic data marginally differed when tested on the full original data. Models were also trained on synthetic data and a partition of original data and were tested on a held-out portion of original data. Fourth-order moment matched synthetic data outperformed others with respect to fitted parametric models but did not always outperform other methods with fitted nonparametric models. No single synthetic data method consistently outperformed others when assessing the performance of nonparametric models. The performance of fourth-order moment matched synthetic data in fitting parametric models suggests its use in these cases. Our empirical results also suggest that the performance of synthetic data generation techniques, including the moment matching approach, is less stable for use with nonparametric models. The benefits of the moment matching approach should be weighed against additional computational costs. In summary, our results demonstrate that the introduced moment matching approach may be considered as an alternative to existing synthetic data generation methods.


Assuntos
Modelos Teóricos , Pesquisa Empírica
18.
J Am Heart Assoc ; 5(7)2016 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-27356557

RESUMO

BACKGROUND: Sudden cardiac death (SCD) is a leading cause of death in the United States and often occurs without previous cardiac symptoms. Lifetime risk for SCD and the influence of established risk factors on lifetime risks for SCD have not been estimated previously. METHODS AND RESULTS: We followed Framingham Heart Study participants who were free of cardiovascular disease before their earliest examination. SCD was defined as death attributed to coronary heart disease within 1 hour of symptom onset without another probable cause of death, as adjudicated by a panel of 3 physicians. Lifetime risk for SCD was estimated to 85 years of age for men and women, with death attributed to other causes as the competing risk, and stratified by risk factor levels. We followed 2294 men and 2785 women for 160 396 person-years; 375 experienced SCD. At 45 years of age, lifetime risks were 10.9% (95% CI, 9.4-12.5) for men and 2.8% (95% CI, 2.1-3.5) for women. Greater aggregate burden of established risk factors was associated with a higher lifetime risk for SCD. Categorizing men and women solely by blood pressure levels resulted in a clear stratification of lifetime risk curves. CONCLUSIONS: We present the first lifetime risk estimates for SCD. Greater aggregate risk factor burden, or blood pressure level alone, is associated with higher lifetime risks for SCD. This high risk of premature death attributed to SCD (approximately 1 in 9 men and 1 in 30 women) should serve as a motivator of public health efforts in preventing and responding to SCD.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Hipertensão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Vida Independente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2016: 4395-4398, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28269252

RESUMO

This paper describes a system using Kinect sensor to detect patient walk automatically in a hospital room setting. The system is especially essential for the case when the patient is alone and the nursing staff is absent. The patient activities are represented by the features extracted from Kinect V2 skeletons. The analysis to the recognized walk could help us to better understand the health situation of the patient and the possible hospital acquired infection (HAI), and provide valuable information to healthcare givers for making a corresponding treatment decision and alteration. The Kinect V2 depth sensor provides the ground truth.


Assuntos
Hospitais , Monitorização Fisiológica/métodos , Caminhada , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/fisiopatologia , Humanos , Monitorização Fisiológica/instrumentação , Software
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...