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1.
BMC Pulm Med ; 22(1): 1, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980061

RESUMO

BACKGROUND: Quantitative evaluation of radiographic images has been developed and suggested for the diagnosis of coronavirus disease 2019 (COVID-19). However, there are limited opportunities to use these image-based diagnostic indices in clinical practice. Our aim in this study was to evaluate the utility of a novel visually-based classification of pulmonary findings from computed tomography (CT) images of COVID-19 patients with the following three patterns defined: peripheral, multifocal, and diffuse findings of pneumonia. We also evaluated the prognostic value of this classification to predict the severity of COVID-19. METHODS: This was a single-center retrospective cohort study of patients hospitalized with COVID-19 between January 1st and September 30th, 2020, who presented with suspicious findings on CT lung images at admission (n = 69). We compared the association between the three predefined patterns (peripheral, multifocal, and diffuse), admission to the intensive care unit, tracheal intubation, and death. We tested quantitative CT analysis as an outcome predictor for COVID-19. Quantitative CT analysis was performed using a semi-automated method (Thoracic Volume Computer-Assisted Reading software, GE Health care, United States). Lungs were divided by Hounsfield unit intervals. Compromised lung (%CL) volume was the sum of poorly and non-aerated volumes (- 500, 100 HU). We collected patient clinical data, including demographic and clinical variables at the time of admission. RESULTS: Patients with a diffuse pattern were intubated more frequently and for a longer duration than patients with a peripheral or multifocal pattern. The following clinical variables were significantly different between the diffuse pattern and peripheral and multifocal groups: body temperature (p = 0.04), lymphocyte count (p = 0.01), neutrophil count (p = 0.02), c-reactive protein (p < 0.01), lactate dehydrogenase (p < 0.01), Krebs von den Lungen-6 antigen (p < 0.01), D-dimer (p < 0.01), and steroid (p = 0.01) and favipiravir (p = 0.03) administration. CONCLUSIONS: Our simple visual assessment of CT images can predict the severity of illness, a resulting decrease in respiratory function, and the need for supplemental respiratory ventilation among patients with COVID-19.


Assuntos
COVID-19/classificação , COVID-19/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Amidas/uso terapêutico , Antivirais/uso terapêutico , Temperatura Corporal , Proteína C-Reativa/metabolismo , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , L-Lactato Desidrogenase/sangue , Pulmão/diagnóstico por imagem , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Mucina-1/sangue , Neutrófilos , Valor Preditivo dos Testes , Prognóstico , Pirazinas/uso terapêutico , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , SARS-CoV-2 , Esteroides/uso terapêutico
2.
Sci Rep ; 11(1): 13851, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226611

RESUMO

We evaluated whether thyroid function test (TFT) screening is warranted for patients with autoimmune rheumatic diseases (ARD) by comparing the incidence of hypothyroidism requiring treatment (HRT) in ARD patients and healthy controls (HCs). Medical records of 2307 ARD patients and 78,251 HCs for whom thyroid-stimulating hormone (TSH) levels were measured between 2004 and 2018 were retrospectively reviewed. Cumulative incidence of HRT in ARD patients and HCs was compared. HRT development was evaluated with age- and sex-adjusted Kaplan-Meier curve. Risk factors were identified with Cox proportional hazard models. HRT was significantly more common in ARD patients than in HCs (6.3% vs. 1.9%, P < 0.001). After adjusting for age, sex, and baseline TSH level, hazard ratios for HRT were significantly higher in overall ARD patients (hazard ratio [95% confidence interval] 3.99 [3.27-4.87]; P < 0.001), particularly with rheumatoid arthritis and antinuclear antibody-associated diseases in female, and antinuclear antibody-associated diseases, spondyloarthritis, and vasculitis in male patients. Baseline high TSH level, thyroid-related autoantibody positivity, high IgG, and renal impairment were significant risk factors for hypothyroidism development in ARD patients; 20% of high-risk patients developed HRT during follow-up. HRT was significantly more frequent in ARD patients. Careful TFT screening and follow-up could help detecting clinically important hypothyroidism.


Assuntos
Artrite Reumatoide/sangue , Doenças Autoimunes/sangue , Hipotireoidismo/sangue , Doenças Reumáticas/sangue , Tireotropina/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/patologia , Doenças Autoimunes/complicações , Doenças Autoimunes/patologia , Estudos de Casos e Controles , Feminino , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Hipotireoidismo/patologia , Imunoglobulina G/sangue , Rim/metabolismo , Rim/patologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Doenças Reumáticas/complicações , Doenças Reumáticas/patologia , Fatores de Risco , Testes de Função Tireóidea
3.
Artigo em Inglês | MEDLINE | ID: mdl-34205663

RESUMO

Growing evidence suggests that PM2.5 is associated with diabetes mellitus (DM). Although DM is a major public health concern, there has not yet been a study of this association in Japan. We used health examination data from 66,885 individuals in Tokyo, Japan 2005-2019. Cox proportional hazards models were used to evaluate an association between annual exposure to PM2.5 and glycated hemoglobin A1c (HbA1c), or fasting plasma glucose (FPG). An increase of 1 µg/m3 in the annual average of PM2.5 concentration was associated (HR = 1.029; 95% CI = 1.004-1.055) with an increase in diabetes (incident + prevalent). For incident DM, a greater PM2.5 level was associated with more DM (HR = 1.029; 95% CI, 1.003-1.055). Compared to HbA1c, FPG showed a stronger association with the annual exposure to PM2.5 (HR = 1.065; 95% CI, 1.040-1.091). We found that greater exposure to PM2.5 in the long-term was associated with an increased risk of diabetes, and that the magnitude of association became stronger as the exposure duration increased. Omorogieva Ojo.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Diabetes Mellitus , Poluentes Atmosféricos/análise , Glicemia/análise , Diabetes Mellitus/epidemiologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Japão/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Tóquio
4.
Int J Clin Oncol ; 26(9): 1736-1744, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34117947

RESUMO

BACKGROUND: We aimed to establish an external validation of the Briganti 2019 nomogram in a Japanese cohort to preoperatively evaluate the probability of lymph node invasion in patients with high-risk, clinically localized prostate cancer. METHODS: The cohort consisted of 278 patients with prostate cancer diagnosed using magnetic resonance imaging-targeted biopsy who underwent radical prostatectomy and extended pelvic lymph node dissection from 2012 to 2020. Patients were rated using the Briganti 2019 nomogram, which evaluates the probability of lymph node invasion. We used the area under curve of the receiver operating characteristic analysis to quantify the accuracy of the nomogram. RESULTS: Nineteen (6.8%) patients had lymph node invasion. The median number of lymph nodes removed was 18. The area under the curve for the Briganti 2019 was 0.71. When the cutoff was set at 7%, 84 (30.2%) patients with extended pelvic lymph node dissection could be omitted, and only 1 (1.2%) patient with lymph node invasion would be missed. Sensitivity, specificity, and negative predictive values at the 7% cutoff were 94.7, 32.0, and 98.8%, respectively. CONCLUSION: This external validation showed that the Briganti 2019 nomogram was accurate, although there may still be scope for individual adjustments.

5.
Int J Environ Health Res ; : 1-11, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-33941000

RESUMO

While photochemical oxidants (Ox = O3+ NO2) are known to increase asthma flare-ups, there is a paucity of studies of the Japanese population, especially for Tokyo residents. We used data on asthma cases (n = 7,455) from ambulance dispatches in Tokyo, 2015-2016. Variables included date and time of incidence, age, sex, occurrence location at the ward (ku) level, and the symptom/cause of dispatch as recorded by paramedics. Ox data were obtained from the nearest air quality monitoring station to the occurrence location, then linked them with the outcomes based on occurrence date. We directly incorporated a distributed lag model into a bi-directional case-crossover study design controlling for ambient temperature and day of week. A 10-ppb increase in Ox for lag days 0-3 was associated with a 5.51% (95% CI: 0.13 to 11.18) increase in ambulance dispatches related to asthma. The association was strongest on lag day 1 (4.67%, 95% CI: 0.51 to 9.00). Exposure to high levels of Ox was associated with increased ambulance dispatches related to asthma exacerbations in Tokyo, Japan.

6.
Int J Soc Psychiatry ; : 207640211017586, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985382

RESUMO

BACKGROUND: Precarious employment has affected mental health, and limited data are available on the association of low stress tolerance with depressive symptoms among Japanese workers. AIMS: This study aimed to examine the relationship between stress tolerance and depressive symptoms among Japanese workers, including company employees, civil servants and self-employed persons in various industries. METHODS: We conducted a nationwide cross-sectional study. From March 26 to April 6, 2020, we performed a web-based survey of Japanese workers. The questionnaire included questions on socioeconomic factors, the SOC scale that assesses stress tolerance, the CES-D, and the EQ-5D-5L. Multivariate regression analyses were performed to determine the factors associated with depressive symptoms. RESULTS: We included 3,001 participants in the analysis. A high SOC score, adequate sleeping time and frequency of exercise were associated with higher depressive symptoms. Employment status and long working hours were not associated with depressive symptoms. Younger workers had lower SOC scores than older workers. An inverse correlation between the SOC score and CES-D score was found among Japanese workers. CONCLUSIONS: Improving stress tolerance among younger workers is needed to prevent worsening mental health regardless of employment status for Japanese workers.

7.
BMC Endocr Disord ; 21(1): 105, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022872

RESUMO

BACKGROUND: The best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in healthy individuals should be determined with consideration of HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness. METHODS: State transition models were constructed to investigate the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health individuals. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight, normal, overweight and obesity. In each model, different HbA1c test intervals were evaluated with respect to the incremental cost-effectiveness ratio (ICER) and costs per quality-adjusted life year (QALY). Annual intervals (Japanese current strategy), every 3 years (recommendations in US and UK) and intervals which are tailored to each risk stratification group were compared. All model parameters, including costs for screening and treatment, rates for complications and mortality and utilities, were taken from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY. RESULTS: The HbA1c test interval for detecting T2DM in healthy individuals varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages-30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8685/QALY-compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups-underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY-and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than 3 years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, results were consistent among any groups. CONCLUSIONS: The three-year screening interval was optimal among elderly at all ages, the obesity at all ages and the overweight in 45-59-year-old group. For those sin the low-BMI and younger age groups, the optimal HbA1c test interval could be longer than 3 years. Annual screening to detect T2DM was not cost effective and should not be applied in any population.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/análise , Programas de Rastreamento/economia , Adulto , Idoso , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Medição de Risco
8.
Int J Rheum Dis ; 24(5): 647-653, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33847455

RESUMO

AIM: Pre-administration screening of active infections is imperative for the safe use of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). However, a standardized screening method is lacking. We therefore implemented a novel systematic screening method with a simple predetermined questionnaire on infections and assessed its effectiveness. METHODS: We retrospectively reviewed medical records of individuals for whom intravenous bDMARDs were administered for RA from January 2016 to April 2019. We evaluated the performance of the new screening method based on physicians' assessments. In addition, a survey was administered to nurses, regarding their assessment of the usefulness of this new screening. The incidence of infections was also assessed. RESULTS: A total of 1636 cases underwent this new screening. The new screening method showed high sensitivity (0.97) and specificity (0.89) with a negative predictive value of 99.9%, as determined based on the physician's decision. Administration of bDMARDs was postponed in 37 (2.5%) patients, and there was only one case in which the screening failed to note an active infection. The nurses' survey demonstrated high agreement (87.5%) about the usefulness of this screening on the grounds of clarity, simplicity, ease, and time-saving effects. There was no significant increase in infections after implementation of this method. CONCLUSIONS: Systematic screening with a predetermined simple questionnaire is effective as an infection screening method, with a high negative predictive value. This approach contributes to high satisfaction of nurses and a time-efficient practice by focusing on screen-positive cases without increasing infections.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Produtos Biológicos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Infecções Bacterianas/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento
9.
BMC Med Educ ; 21(1): 226, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882929

RESUMO

BACKGROUND: In Japan, between 2010 and 2020, there were two post-graduate training curricula for post-graduate medical education, as follows: comprehensive rotation programmes (CRPs), which require rotation in at least seven clinical departments; and limited rotation programmes (LRPs), which require rotation in fewer clinical departments. The curriculum that should be used for standardized Japanese post-graduate training has long been debated. Multiple studies show that post-graduate trainees who trained with CRPs were more satisfied and confident and gained more clinical experience than those who trained with LRPs. However, a comparison of objective measurements of the clinical knowledge of Japanese post-graduate trainees has not been reported. The aim of this study is to objectively measure and compare the clinical knowledge of trainees in CRPs and LRPs using a component of the Professional and Linguistic Assessment Board test (PLAB test). METHODS: A nationwide cross-sectional study was conducted in February and March 2020. Post-graduate trainees who graduated from medical school were voluntarily recruited from general hospitals in Japan. To objectively measure the trainees' basic clinical knowledge, the PLAB test was adapted from the UK. The cut-off point was set at 63%, as recommended by the UK General Medical Council. A statistical analysis was conducted to determine whether post-graduate programme differences contributed to the trainees' test scores. RESULTS: Twenty-two facilities volunteered to participate after recruitment, and 97 trainees from 19 facilities participated in the study. Thirty-one participants (32%) were in a CRP, and 66 participants (68%) were in an LRP. According to multiple logistic regression, the adjusted odds ratio of CRP trainees being in the high-scoring group was 5.16 (95% CI: 1.28-20.73, p<0.05). Mean differences in the scores in paediatrics, mental health and neurology were statistically higher among CRP trainees than LRP trainees. CONCLUSION: Post-graduate trainees who were in a CRP had better basic clinical competence knowledge (PLAB test) scores and performed better when tested in a wider range of subspecialties. Not only exam performance but also clinical performance and the longitudinal trend of trainees' competency in post-graduate medical training should be evaluated in future studies.


Assuntos
Internato e Residência , Criança , Competência Clínica , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina , Humanos , Japão , Rotação
10.
Rheumatology (Oxford) ; 60(12): 5697-5704, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33723568

RESUMO

OBJECTIVE: Patients with IgG4-related disease (IgG4RD) usually require steroid-sparing agents due to relapse with tapering glucocorticoids (GC). We aimed to determine the efficacy and safety of mizoribine (MZR) among IgG4RD patients. METHODS: We retrospectively reviewed records of IgG4RD patients at Immuno-Rheumatology Center in St. Luke's International Hospital, Tokyo, Japan. Patients treated with MZR were classified into the MZR group, and those treated with GC alone or with other immunosuppressants were included in the control group. Disease exacerbation, GC dose, IgG-IgG4 titre and adverse events were evaluated using univariate analyses, including the Kaplan-Meier method. The Cox proportional hazard model was used to evaluate risk factors for disease exacerbation. RESULTS: A total of 14 and 29 cases were included in the MZR and control group. Multiple organ involvement (three or more organs) was significantly more frequent in the MZR group [10 (71.4%) vs 9 (31.0%), P= 0.021]. Kaplan-Meier analysis revealed a significant reduction inexacerbation in patients with multiple organ involvement (P< 0.001) but not in total (P= 0.42). The adjusted hazard ratios of MZR use and multiple organ involvement for exacerbation were 0.34 (95%CI 0.12-1.01; P = 0.052) and 3.51 (95%CI 1.29-9.51; P= 0.014). The cumulative GC dose (mg per year, interquartile range) tended to be lower in the MZR group [1448 (1003-1642) vs 2179 (1264-3425); P= 0.09]. CONCLUSION: MZR decreased disease exacerbation among IgG4RD patients with multi-organ involvement and showed a steroid-sparing effect. MZR could be a treatment option for IgG4RD.

11.
PLoS One ; 16(3): e0248999, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33750977

RESUMO

BACKGROUND: Delayed identification of infiltration and dysfunction of peripheral intravenous (PIV) access can lead to serious consequences during general anesthesia in children. This preliminary study aimed to describe the application of precordial Doppler ultrasound during general anesthesia in children to detect and confirm the correct PIV access and to evaluate the accuracy of this method. METHODS: This was a single-center, preliminary study that was conducted in children (<18 years) who were scheduled for elective surgeries between October 2019 and March 2020. Rater anesthesiologists judged the change in precordial Doppler sound (S test) before and after injection of 0.5 mL/kg of normal saline (NS) via PIV. Blood flow velocity before and after NS injection was recorded, and multiple cutoff points were set to analyze the accuracy of detecting the infiltration and dysfunction of PIV catheter (V test). RESULTS: The total incidence of peripheral infiltration and dysfunction of PIV catheter was 7/512 (1.4%). In the S test, the sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operating characteristic curves (AUCs) were 5/7 (71.4%; 95% confidence interval [CI], 29.0%-96.3%), 490/505 (97.0%; 95% CI, 95.1%-98.3%), 24.0, 0.29, and 0.84, respectively. The V test showed that the reasonable threshold of blood flow velocity change was 1.0 m/s, with sensitivity, specificity, positive and negative likelihood ratios, and AUC of 4/7 (57.1%; 95% CI, 18.4%-90.1%), 489/505 (96.8%; 95% CI, 94.9%-98.2%), 18.0 and 0.44, and 0.84, respectively. CONCLUSIONS: This preliminary study demonstrated that precordial Doppler ultrasound is a feasible, easy-to-use, and noninvasive technique with good accuracy to confirm the correct PIV access during general anesthesia in children. However, its accuracy requires further evaluation.


Assuntos
Anestesia Geral , Ultrassonografia Doppler , Veias/fisiologia , Administração Intravenosa , Velocidade do Fluxo Sanguíneo , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Masculino , Curva ROC , Fluxo Sanguíneo Regional/fisiologia
12.
BMC Public Health ; 21(1): 334, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573632

RESUMO

BACKGROUND: The outbreak of COVID-19 has caused mental health problems and increased unemployment due to the economic recession. This survey aimed to assess the psychological impact of the state of emergency. We estimated changes in mental health, quality of life, and unemployment experience for general workers during the first COVID-19 outbreak in Japan. METHODS: We conducted a nationwide follow-up study. During the periods of March 26 to April 6, 2020 and June 26 to July 2, 2020, we used the internet to survey general workers aged 15 to 59 years in Japan. The questionnaire items covered employment status and socioeconomic factors, and we used the Center for Epidemiologic Studies Depression Scale (CES-D) and EQ-5D-5L to assess depression and health-related quality of life (HR-QOL), respectively. The differences in outcomes of permanent and non-permanent workers were analyzed using propensity score analysis. A multiple linear regression analysis was performed to examine the relationship between unemployment and CES-D scores. RESULTS: We included 2351 subjects in the analysis. Changes in both CES-D scores and utility were not significantly different between the two groups. However, a significant difference was found regarding the rate of unemployment, which was associated with higher CES-D scores. CONCLUSIONS: The present study demonstrated that the mental health of non-permanent workers was not negatively affected following the state of emergency due to COVID-19 in Japan. Unemployment is an important factor that influences the mental health of general workers.


Assuntos
COVID-19/epidemiologia , Surtos de Doenças , Transtornos Mentais/epidemiologia , Desemprego/psicologia , Adolescente , Adulto , Recessão Econômica , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Desemprego/estatística & dados numéricos , Adulto Jovem
13.
Heart Vessels ; 36(5): 724-730, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33399899

RESUMO

Despite the recent attention given to palliative care for patients with heart disease, data about the treatments in their actively dying phase are not sufficiently elaborated. In this study, we used the sampling dataset of a national database to compare the aggressive treatments performed in patients with cancer and those with heart disease. We only included patients deceased in January or July from 2011 to 2015, using the Diagnosis Procedure Combination sampling dataset of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Patients who were discharged within the first 10 days of each month were excluded. We explored and compared aggressive treatments such as cardiopulmonary resuscitation and intensive care utilization, performed within seven days before death in cancer patients. We used 10,637 (0.4% of the dataset) deceased target population (40.0% female), with 7844 (73.7%) and 2793 (26.3%) being the proportion of cancer and heart disease patients, respectively. Aggressive treatments and procedures such as cardiopulmonary resuscitation (18.4%), intensive care utilization (5.4%), use of inotropes (43.4%), use of respirators (29.1%), and dialysis (4.5%) were frequently observed in heart disease patients. These associations remained after adjusting for age, sex, and disease severity. This study indicates the possible use of an NDB sampling dataset to evaluate the aggressive treatments and procedures in the actively dying phase in both heart disease and cancer patients. Our results showed the differences in aggressive treatment strategies in the actively dying phase between patients with cancer and those with heart disease.


Assuntos
Cardiopatias/terapia , Seguro Saúde/estatística & dados numéricos , Neoplasias/terapia , Cuidados Paliativos/métodos , Vigilância da População , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Cardiopatias/economia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Estudos Retrospectivos
14.
BMC Cardiovasc Disord ; 20(1): 262, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487160

RESUMO

BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potential biomarker for monitoring the status of heart failure. However, the optimal monitoring interval of NT-proBNP is unknown. This study sought to investigate the minimal informative monitoring interval of NT-proBNP in patients with stable chronic heart failure. METHODS: This retrospective cohort study included patients who were admitted due to heart failure and subsequently followed with serial NT-proBNP measurements in a tertiary hospital. We analyzed NT-proBNP measured between six months after discharge and the earliest timepoint of: an alteration of medication regimen, readmission due to worsening of heart failure, or all-cause death. To distinguish progression of the disease from biological variability and measurement error, the signal-to-noise ratio method was applied with a random-effects model. RESULTS: In the 368 patients included, NT-proBNP was measured for a median 6 times. In the random-effects model, signal (progression of disease) exceeded noise (biological variability and measurement error) at 7.9 months (95% confidence interval [CI]: 5.1-9.6), while noise corresponded to a 61% increase from baseline. In stratified analysis using the AHEAD risk score, the minimal informative monitoring interval shortened as the risk score increased (0-1 point: 12.2 months [95%CI: 10.3-14.4]; 2-3 points: 8.0 months [95%CI: 6.8-9.7]; 4-5 points: 3.3 months [95%CI: 3.0-3.8]). CONCLUSIONS: In patients with stable chronic heart failure, the minimal informative monitoring interval of NT-proBNP measurement was 7.9 months in the current population, which varied with underlying risks. The optimal monitoring interval could be lengthened for patients at lower risks.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doença Crônica , Progressão da Doença , Feminino , Fatores de Risco de Doenças Cardíacas , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo
15.
J Nurs Res ; 28(3): e90, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32073481

RESUMO

BACKGROUND: Delirium is an important and common medical condition, particularly in hospitalized patients, that is associated with adverse outcomes. The identification, prevention, and treatment of delirium are increasingly regarded as major public health priorities. PURPOSE: The aim of this study was to create a simple-to-use screening tool for delirium in hospitalized patients using clinical manifestations of delirium regularly observed by nurses. METHODS: This study was conducted using data on 2,168 patients who had been admitted to the surgical ward between January 2011 and December 2014. Data were collected retrospectively from medical records. Univariate and multivariate analyses were performed, and a logistic regression model was constructed for the development of a predictive screening tool. After constructing a new screening tool for delirium, a receiver operating characteristic curve was drawn, the most appropriate cutoff value was decided, and the area under the curve was obtained. Bootstrapping was used for the internal model validation. RESULTS: A screening tool for delirium (Subjective Delirium Screening Scale by Nurse) with a total score of 5 points was constructed as follows: 2 points for disorientation and 1 point each for restlessness, somnolence, and hallucination. The area under the curve for the Subjective Delirium Screening Scale by Nurse was 81.9% (95% CI [77.9%, 85.8%]), and the most appropriate cutoff value was determined to be 2 (sensitivity of 61.0% and specificity of 96.7%). Bootstrapped validation beta coefficients of the predictive factors were similar to the original cohort beta coefficients. CONCLUSIONS: We created a screening tool for delirium using factors that were regularly observed and recorded by nurses. This tool is simple and practical and has adequate diagnostic accuracy.


Assuntos
Delírio/diagnóstico , Programas de Rastreamento/instrumentação , Quartos de Pacientes/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Delírio/classificação , Delírio/enfermagem , Educação Continuada em Enfermagem/métodos , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Quartos de Pacientes/organização & administração
16.
Clin Rheumatol ; 39(6): 1823-1827, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32052228

RESUMO

The objective of the study is to evaluate the sensitivity of the new criteria for the classification of systemic lupus erythematosus (SLE), when applied to real SLE cases. We retrospectively reviewed the electronic medical records of 100 consecutive patients who visited St. Luke's International Hospital. Patients were included if they were clinically diagnosed as having SLE and excluded if they had other autoimmune disease or if they were less than 18 years old. Each patient was evaluated if they satisfied the American College of Rheumatology (ACR) 1997 classification criteria (1997 criteria), 2012 Systemic Lupus International Collaborating Clinics criteria (2012 criteria), or 2019 ACR/European League Against Rheumatism (EULAR) criteria. Among the 100 patients, the sensitivity of the 1997, 2012, and 2019 criteria was, 97, 99, and 92%, respectively. The total patient score with the 2019 criteria ranged from 12 to 44 (mean, 27.3). All patients who were classified as non-SLE with the 2019 criteria had an anti-nuclear antibody (ANA) titre of < 1:80. The 2019 criteria for SLE accomplished modestly high sensitivity in the real-world practice, but not as high as the 1997 and 2012 criteria. They possibly misclassify the real SLE cases as non-SLE, especially if patients have a low titre (< 1:80) of ANA.


Assuntos
Lúpus Eritematoso Sistêmico/classificação , Doenças Reumáticas , Reumatologia , Sociedades Médicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Registros Eletrônicos de Saúde , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Gen Thorac Cardiovasc Surg ; 68(3): 280-286, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31559588

RESUMO

OBJECTIVE: Perioperative C-reactive protein (CRP) levels have become a contentious topic on the surgical outcome of lung cancer, but the influence of the procedure types has not been precisely investigated. From this viewpoint, we compared two types of thoracoscopic anatomical lung resection: segmentectomy and lobectomy. METHODS: This was a retrospective study involving patients who underwent standardized anatomical lung resection at a single institute from 2014 to 2017; CRP levels were routinely measured on postoperative days 1, 3, and 5. Changes in the CRP levels from the preoperative period were calculated (ΔCRP), and factors associated with a higher ΔCRP value were analyzed. RESULTS: Among 186 patients included, 91 (48.9%) patients underwent stapler-based segmentectomy and 95 (51.1%) patients underwent lobectomy. The segmentectomy group showed significantly higher ΔCRP values on every measurement day than the lobectomy group, in spite of shorter operation time, smaller blood loss, shorter drainage periods, shorter dissection time, and limited lymph node dissection. The number of stapler cartridges for the lung parenchyma was significantly larger in the segmentectomy group. Regression analyses indicated that procedure type and smoking history were associated with a higher ΔCRP value, whereas no significant difference was indicated in the smoking history between the groups. CONCLUSION: In our cohort, stapler-based thoracoscopic segmentectomy was associated with an increase in acute inflammatory response despite favorable perioperative outcome compared to lobectomy. Local surgical stress and damage in the remaining segments might play a key role and warrants further investigation.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Toracoscopia/métodos , Adulto , Idoso , Proteína C-Reativa/análise , Drenagem , Feminino , Humanos , Inflamação , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos
18.
Pharmacoeconomics ; 38(3): 297-306, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31761994

RESUMO

AIM: The recently developed direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infections are costly. Cost-effectiveness analyses of DAAs require accurate healthcare expenditure estimates for the various HCV disease states, but few studies have produced such estimates using national-level data. This study utilized nationally representative data to estimate the healthcare expenditure for each HCV disease state. METHODS: We identified all patients infected with HCV between April 2010 and March 2018 from a nationwide administrative claims database in Japan. Monthly patient-level healthcare expenditures were calculated for the following disease states: chronic hepatitis C (CHC), compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). The expenditures for the CHC and CC states were also compared before DAA treatment and after sustained virologic response (SVR) was achieved. A longitudinal two-part model was employed to estimate the healthcare expenditures for each state. RESULTS: During the study period, 1,564,043 patients with 146,488,137 patient-months of data met the inclusion criteria. The year of valuation was 2017. The mean monthly healthcare expenditures per patient (95% confidence intervals) for the pre-DAA CHC, CC, DC, and HCC states were US$267 (US$267-268), US$428 (US$427-429), US$666 (US$663-669), and US$969 (US$966-972), respectively. The mean monthly healthcare expenditures per patient for the post-SVR (≥ 2 years) CHC and CC states were US$176 (US$176-177) and US$238 (US$236-240), respectively. Healthcare expenditure increased with increasing age in all disease states (P < 0.05). CONCLUSIONS: These healthcare expenditure estimates from a nationally representative sample have potential applications in cost-effectiveness analyses of DAAs.


Assuntos
Antivirais/economia , Análise Custo-Benefício , Gastos em Saúde , Hepatite C Crônica/economia , Demandas Administrativas em Assistência à Saúde , Antivirais/uso terapêutico , Carcinoma Hepatocelular/economia , Carcinoma Hepatocelular/etiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Humanos , Japão , Cirrose Hepática/economia , Cirrose Hepática/etiologia , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/etiologia , Resposta Viral Sustentada
19.
Intern Med ; 58(18): 2627-2632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527368

RESUMO

Objective In the management of patients with suspected acute drug poisoning, a screening test using the patient's urine is usually performed. The Triage DOA® and INSTANT-VIEW M-1® kits are two commonly used point-of-care screening kits in Japan. However, the relationship between the results of these screening kits and the blood concentration of the poisoning drug is not clear. In this study, we evaluated which kit is more useful for acute drug poisoning screening based on a comparison of their results with the results of a serum drug analysis. Methods This prospective cross-sectional study investigated all patients with acute drug poisoning admitted to a general hospital in Tokyo, Japan, over a nine-month period. The Triage DOA® and INSTANT-VIEW M-1® screening kits were used, and a qualitative serum analysis was conducted simultaneously in all cases. We compared the kits for use in screening patients with acute drug poisoning and evaluated the utility of the kits. Results For the 117 patients enrolled in this study, the 2 kits showed different sensitivities to benzodiazepines (Triage®, 78.6%; INSTANT-VIEW®, 90.5%). Both kits showed high sensitivity to barbiturates (Triage®, 87.0%; INSTANT-VIEW®, 91.3%) but low sensitivity to tricyclic antidepressants (Triage®, 25.0%; INSTANT-VIEW®, 45.8%). Conclusion Because the sensitivity varies depending on the kind of drug, it is difficult to discuss the superiority of these kits. However, this study compared the results of two types of urinary drug screening kits with the results of qualitative analysis of drugs in serum as a gold standard, providing important reference data.


Assuntos
Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Triagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos Tricíclicos/sangue , Antidepressivos Tricíclicos/urina , Barbitúricos/sangue , Barbitúricos/urina , Benzodiazepinas/sangue , Benzodiazepinas/urina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tóquio , Adulto Jovem
20.
ESMO Open ; 4(2): e000459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30962960

RESUMO

Purpose: Cancer treatment delay due to fertility preservation procedures is a barrier for patients with breast cancer who wish to preserve their fertility. This study aimed to describe the associations between fertility preservation and treatment delay in patients with breast cancer with reproductive concerns and assess the factors related to treatment delay. Methods: Patients with primary breast cancer who visited the reproductive unit at our institution before cancer treatment between 2007 and 2015 were enrolled. The treatment delay cut-off was defined as follows: time to chemotherapy (TTC) >8 weeks for patients intending to receive neoadjuvant chemotherapy, TTC >12 weeks for patients intending to receive adjuvant chemotherapy, time to endocrine therapy (TTE) >12 weeks for patients intending to receive endocrine therapy without radiation therapy and TTE >20 weeks for patients intending to receive endocrine therapy after radiation therapy. Multivariable models were constructed to examine the factors of treatment delay. Results: Overall, 212 patients met the inclusion criteria. Using the defined cut-offs, treatment delay was noted in 18% of the patients. Endocrine therapy was related to treatment delay (OR 4.49, 95% CI 1.02 to 19.7; p=0.05), but fertility preservation by artificial reproductive treatment (ART) was not. Pregnancy and delivery following treatment for breast cancer were achieved in 18 (19%) and 15 (16%) patients who underwent fertility preservation with ART. Conclusion: Fertility preservation with ART was not associated with treatment delay in patients with breast cancer who were referred to reproductive specialists before cancer treatment.

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