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1.
Am Surg ; 85(7): 733-737, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405418

RESUMO

Several models exist to predict trauma center need in the prehospital setting; however, there is lack of simple clinical tools to predict the need for ICU admission and mortality in trauma patients. The aim of our study was to develop a simple clinical tool that can be used with ease in the prehospital or emergency setting and can reliably predict the need for ICU admission and mortality in trauma patients. We abstracted one year of National Trauma Data Bank for all patients aged ≥ 18 years. Transferred patients and those dead on arrival were excluded. Patient demographics, injury parameters, vital signs, and Glasgow Coma Scale (GCS) were recorded. Our primary outcome measures were mortality and ICU admission. Logistic regression analysis was performed using three variables (age > 55 years, shock index (SI) > 1, and GCS score) to determine the appropriate weights for predicting mortality. Appropriate weights derived from regression analysis were used to construct a simple SI, age, and GCS (SAG) score, and associated mortality and ICU admissions were calculated for three different risk groups (low, intermediate, and high). A total of 281,522 patients were included. The mean age was 47 ± 20 years, and 65 per cent were male. The overall mortality rate was 2.9 per cent, and the rate of ICU admission was 28.7 per cent. The SAG score was constructed using weights derived from regression analysis for age ≤ 55 years (4 points), SI < 1 (3 points), and GCS (3-15 points). The median [IQR] SAG score was 21 [18-22]. The area under the receiver operating curve [95% Confidence Interval (CI)] of the SAG score for predicting mortality and ICU admission was 0.873 [0.870-0.877] and 0.644 [0.642-0.647], respectively. Each 1-point increase in the SAG score was associated with 18 per cent lower odds of mortality (odds ratio [95% CI]: 0.822 [0.820-0.825]) and 10 per cent lower odds of ICU admission (odds ratio [95% CI]: 0.901 [0.899-0.902]). The SAG score is a simple clinical tool derived from variables that can be assessed with ease during the initial evaluation of trauma patients. It provides a rapid assessment and can reliably predict mortality and need for ICU admission in trauma patients. This simple tool may allow early resource mobilization possibly even before the arrival of the patient.


Assuntos
Mortalidade Hospitalar , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Adulto Jovem
2.
Am Surg ; 85(7): 781-787, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405429

RESUMO

We hypothesize that soft tissue infections (SSIs) related to intravenous drug usage (IVDU) are associated with a more complicated and costly course than those not associated with IVDU. For the period 2005-2018, ICD 9/ICD 10 billing codes were used to identify patients admitted with SSIs and their causes/complications and associated costs. IVDU-related infections were then compared with non-IVDU-related infections. t test was used to compare treatment costs and length of stay. Logistic regression analysis was used to assess the likelihood/risk of specific events in the IVDU versus non-IVDU populations. Of 47,281 patients admitted with SSIs, 1323 were associated with IVDU. IVDU-related patients tended to be younger (36.2 vs 49.3 years, P = 0.001). Both cost and length of stay were significantly greater in the IVDU group ($30,471 vs $16,020, P = 0.001; 5.7days vs 3.7days, P = 0.001). In addition, IVDU admissions were more likely to be associated with chronic blood-borne infections (hepatitis B/C, HIV, P = 0.001) and a significantly greater incidence of secondary infectious complications, including endocarditis (P = 0.001), bacteremia (P = 0.001), and osteomyelitis (P = 0.003). SSI admissions related to IVDU are a unique subgroup of patients. These patients not only have longer and more costly lengths of stay but are also at higher risk for secondary complications such as chronic blood-borne viral illness and secondary bacterial infectious complications, such as bacteremia, endocarditis, and osteomyelitis. Further prospective study of these findings is warranted as we continue to battle the growing problem of IVDU in the United States.


Assuntos
Infecções dos Tecidos Moles/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Infecções Bacterianas/etiologia , Feminino , Custos Hospitalares , Hospitalização/economia , Humanos , Incidência , Tempo de Internação , Modelos Logísticos , Masculino , Análise de Regressão , Fatores de Risco , Infecções dos Tecidos Moles/epidemiologia , Viroses/etiologia
3.
Braz Oral Res ; 33: e048, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432924

RESUMO

This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.


Assuntos
Hipoplasia do Esmalte Dentário/epidemiologia , Dente Decíduo , Brasil/epidemiologia , Criança , Estudos Transversais , Hipoplasia do Esmalte Dentário/patologia , Feminino , Humanos , Incisivo/patologia , Masculino , Dente Molar/patologia , Prevalência , Análise de Regressão , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Fatores Socioeconômicos , Dente Decíduo/patologia
4.
Medicine (Baltimore) ; 98(32): e16687, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393370

RESUMO

Obstructive sleep apnea (OSA) has a high prevalence in patients with obesity. Only patients with clinical symptoms of OSA are admitted to polysomnography; however, many patients with OSA are asymptomatic. We aimed to create and validate a population-based risk score that predicts the severity of OSA in patients with obesity.We here report the cross-sectional analysis at baseline of an ongoing study investigating the long-term effect of bariatric surgery on OSA. One-hundred sixty-one patients of the Obesity Center of the Catholic University Hospital in Rome, Italy were included in the study. The patients underwent overnight cardiorespiratory monitoring, blood chemistry analyses, hepatic ultrasound, and anthropometric measurements. The patients were divided into 2 groups according OSA severity assessed by the apnea-hypopnea index (AHI): AHI < 15 = no or mild and AHI ≥ 15 moderate to severe OSA. A statistical prediction model was created and validated. C statistics was used to evaluate the discrimination performance of the model.The prevalence of OSA was 96.3% with 74.5% of the subjects having moderate/severe OSA. Sex, body mass index, diabetes, and age were included in the final prediction model that had excellent discrimination ability (C statistics equals to 83%). An OSA risk chart score for clinical use was created.Patients with severe obesity are at a very high risk for moderate or severe OSA in particular if they are men, older, more obese, and/or with type 2 diabetes. The OSA risk chart can be useful for general practitioners and patients as well as for bariatric surgeons to select patients with high risk of moderate to severe OSA for further polysomnography.


Assuntos
Obesidade Mórbida/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade Mórbida/epidemiologia , Prevalência , Curva ROC , Análise de Regressão , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais
5.
Medicine (Baltimore) ; 98(31): e16686, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374053

RESUMO

This study provided the baseline for establishing policies for community health promotion programs to propose the clusters of multiple health risk factors and identify the risks of laryngeal disorders according to the clusters by using the national level survey representing the South Korean population. This study targeted 5941 people who completed the 5th Korean National Health and Nutrition Examination Survey. The independent variables were age, sex, smoking, high-risk drinking, education level, occupation, household income, and self-reported voice problems. The identify cluster relationship with laryngeal disorders by conducting 2-way cluster analysis and multinomial logit analysis. The prevalence of laryngeal disorder was 6.7%. The results of analysis, 3 clusters were automatically extracted. Multinomial logistic regression analysis showed that sociodemographic factors, health risk behaviors, and health status clusters were significantly related to the risk of laryngeal disorders. The males who were smoking, high-risk drinking, college graduate and above, high income, and non-manual workers had a higher risk of laryngeal disorders than females who were non-smokers, non-drinkers, 60 years old and older, economically inactive, and high school graduate. The results of this study suggested that it may be effective to classify population according to sociodemographic and health behaviors and develop health education materials and health promotion program accordingly in order to prevent laryngeal disorders.


Assuntos
Comportamentos de Risco à Saúde , Doenças da Laringe/epidemiologia , Fatores Socioeconômicos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Análise por Conglomerados , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fumar/epidemiologia
6.
Rev Assoc Med Bras (1992) ; 65(7): 988-992, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389510

RESUMO

OBJECTIVE: The objective of this study was to investigate the effects of low triiodothyronine syndrome (LT3S) on platelet function and clotting factors in patients with nephrotic syndrome(NS). METHODS: Patients with primary nephrotic syndrome were divided into two groups, normal thyroid function (group A) and LT3S (group B), based on whether they had LT3S or not. Healthy subjects were selected as the control group (group C). Blood coagulation function was detected in each group. The platelet activation function (CD62P, CD63) was determined by flow cytometry. The platelet aggregation rate was detected by an optical method using adenosine diphosphate and arachidonic acid as inducers. RESULTS: The proportion of primary nephrotic syndrome with LT3S was 23.2% (69/298). Compared with group C, group A had higher CD62P and PAgTADP, and group B had higher CD62P, CD63, PAgTAA, and PAgTADP; the difference was statistically significant (all P < 0.05). There was no significant difference in renal pathology between group A and group B (X2 = 4.957, P = 0.421). Compared with group A, the 24-hour urine protein, CD63, PAgTAA, and PAgTADP were higher in group B, and APTT and Alb were lower. The difference was statistically significant (P < 0.05). Logistic regression analysis showed that LT3S was associated with CD36 (OR: 3.516; 95% CI: 1.742~8.186; P = 0.004) and PAgTAA (OR: 0.442; 95% CI: 1.001~1.251; P = 0.037). CONCLUSION: NS patients are prone to LT3S. Patients with LT3S may have abnormal platelet activation and increase of platelet aggregation.


Assuntos
Plaquetas/fisiologia , Síndromes do Eutireóideo Doente/sangue , Síndromes do Eutireóideo Doente/fisiopatologia , Síndrome Nefrótica/sangue , Síndrome Nefrótica/fisiopatologia , Tri-Iodotironina/sangue , Adulto , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/complicações , Ativação Plaquetária/efeitos dos fármacos , Ativação Plaquetária/fisiologia , Agregação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/fisiologia , Contagem de Plaquetas , Testes de Função Plaquetária , Valores de Referência , Análise de Regressão , Tri-Iodotironina/deficiência
7.
Genet Sel Evol ; 51(1): 43, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409294

RESUMO

BACKGROUND: Random regression models (RRM) are widely used to analyze longitudinal data in genetic evaluation systems because they can better account for time-course changes in environmental effects and additive genetic values of animals by fitting the test-day (TD) specific effects. Our objective was to implement a random regression model for the evaluation of dairy production traits in French goats. RESULTS: The data consisted of milk TD records from 30,186 and 32,256 first lactations of Saanen and Alpine goats. Milk yield, fat yield, protein yield, fat content and protein content were considered. Splines were used to model the environmental factors. The genetic and permanent environmental effects were modeled by the same Legendre polynomials. The goodness-of-fit and the genetic parameters derived from functions of the polynomials of orders 0 to 4 were tested. Results were also compared to those from a lactation model with total milk yield calculated over 250 days and to those of a multiple-trait model that considers performance in six periods throughout lactation as different traits. Genetic parameters were consistent between models. Models with fourth-order Legendre polynomials led to the best fit of the data. In order to reduce complexity, computing time, and interpretation, a rank reduction of the variance covariance matrix was performed using eigenvalue decomposition. With a reduction to rank 2, the first two principal components correctly summarized the genetic variability of milk yield level and persistency, with a correlation close to 0 between them. CONCLUSIONS: A random regression model was implemented in France to evaluate and select goats for yield traits and persistency, which are independent i.e. no genetic correlation between them, in first lactation.


Assuntos
Cabras/genética , Lactação/genética , Modelos Genéticos , Modelos Estatísticos , Animais , Indústria de Laticínios , Feminino , Cabras/fisiologia , Masculino , Leite , Análise de Regressão
9.
Pan Afr Med J ; 33: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303949

RESUMO

Introduction: Self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. Methods: A cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. Results: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. Conclusion: This study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.


Assuntos
Hospitais de Distrito/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Listas de Espera , Adulto , Fatores Etários , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , África do Sul , Inquéritos e Questionários , Fatores de Tempo
10.
Semin Ophthalmol ; 34(5): 359-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257965

RESUMO

To evaluate the factors affecting the amount of myopic regression after laser refractive surgery for high myopia, we retrospectively reviewed medical records of 1591 eyes with high myopia treated by laser in situ keratomileusis or laser-assisted subepithelial keratectomy at Shandong Eye Hospital between January 2008 and December 2012. Thirty-five eyes suffering a postoperative myopic shift of manifest spherical equivalent (MSE) of 0.25 diopter (D) or greater were included in this study. The mean refractive error was -9.34 ± 1.89 D before surgery, and the mean regression was -1.22 ± 0.70 D. Correlation analysis and multiple regression analysis were performed to assess the factors that were associated with the refractive regression. The age displayed a negative correlation with the diopter of regression (R = -0.404, P = .016), while the optical zone diameter had a positive correlation with it (R = 0.406, P = .016). Explanatory variables relevant to the diopter of regression were age (partial regression coefficient B = -0.045, P = .016) and optical zone diameter (partial regression coefficient B = 0.979, P = .014). Advanced-age patients with small optical zones were more predisposed to a larger amplitude of regression after laser refractive surgery for high myopia.


Assuntos
Ceratectomia Subepitelial Assistida por Laser , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia Degenerativa/cirurgia , Adulto , Feminino , Humanos , Masculino , Miopia Degenerativa/fisiopatologia , Refração Ocular/fisiologia , Análise de Regressão , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto Jovem
11.
BMJ ; 366: l4064, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296584

RESUMO

OBJECTIVE: To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China. DESIGN: Regression discontinuity analysis using data from a national cohort study. SETTING: 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China. PARTICIPANTS: 3899 older adults who had previously undiagnosed hypertension. INTERVENTION: Community based hypertension screening among older adults in 2011-12. MAIN OUTCOME MEASURE: Blood pressure two years after initial screening. RESULTS: The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups. CONCLUSIONS: Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Determinação da Pressão Arterial , China , Diagnóstico Precoce , Feminino , Humanos , Estudos Longitudinais , Masculino , Programas de Rastreamento , Análise de Regressão , Resultado do Tratamento
12.
Pan Afr Med J ; 32: 216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312327

RESUMO

Introduction: African studies have reported high rates of loss to follow up (LTFU) among children in HIV care and treatment centres. Factors associated with LTFU may vary across populations. Few studies have been conducted among HIV infected children in care in rural areas of Kenya. Methods: this involved children aged less than 15 years on follow up at Kangundo Level 4 Hospital HIV clinic from January 2010 to December 2015. We obtained sociodemographic and clinical information from patient files and electronic databases. Univariate and multivariate regression analyses were conducted to identify factors predictive of LTFU. Results: a total of 261 HIV-infected children were followed up. The mean age was 10.0 years (IQR, 7-13) and median CD4 count of 582cells/ul (IQR 314-984). By December 2015, 171 children (65.5%) remained in active care, 32 (12.3%) transferred out, 13 (5%) died, while 45 (17.2%) were classified as LTFU. Out of the 45 children presumed as LTFU, we traced 44 out of the 45 children (98%) and found that their actual current status was as follows: 33 of the 44 children (75.0%) had dropped out of care (true LTFU). Factors strongly predictive of LTFU included low caregiver level of education (HR 2.3, 1.9-3.9, P = 0.001), WHO stage I and II at enrolment (HR 1.6, 1.4-2.1, P = 0.05). Conclusion: LTFU of HIV infected children was common with an incidence of 32.9 per 1000 child years and occurred early in treatment and risk factors included poverty, low caregiver education, male child and early HIV disease stage.


Assuntos
Infecções por HIV/terapia , Perda de Seguimento , Cooperação do Paciente/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Lactente , Quênia , Masculino , Pobreza , Análise de Regressão , Fatores de Risco , Fatores Sexuais
13.
Health Qual Life Outcomes ; 17(1): 116, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277648

RESUMO

BACKGROUND: Multimorbidity, the coexistence of two or more chronic conditions is increasingly prevalent in primary care populations. Despite reports on its adverse impact on health outcomes, functioning and well-being, it's association with quality of life is not well known in low and middle income countries. We assessed the health-related quality of life (HRQoL) of primary care patients with multimorbidity and identified the influencing factors. METHODS: This cross-sectional study was done across 20 public and 20 private primary care facilities in Odisha, India. Data were collected from 1649 adult out-patients using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). HRQoL was assessed by the 12-item short-form health survey (SF-12). Both physical (PCS) and mental components scores (MCS) were calculated. Multiple regression analysis was performed to determine the association of HRQoL with socio-demographics, number, severity and typology of chronic conditions. RESULTS: Around 28.3% [95% CI: 25.9-30.7] of patients had multimorbidity. Mean physical component scope (PCS) and mental component score (MCS) of QoL in the study population was 43.56 [95% CI: 43.26-43.86] and 43.69 [95% CI: 43.22-44.16], respectively. Patients with multimorbidity reported poorer mean PCS [43.23, 95% CI: 42.62-43.84] and MCS [41.58, 95% CI: 40.74-42.43] compared to those without. After adjusting for other variables, morbidity severity burden score was found to be negatively associated with MCS [adjusted coefficient: -0.24, 95% CI - 0.41 to - 0.08], whereas no significant association was seen with PCS. Hypertension and diabetes with arthritis and acid peptic diseases were found to be negatively related with MCS. Within multimorbidity, lower education was inversely associated with mental QoL and positively associated with physical QoL score after adjusting for other variables. CONCLUSION: Our findings demonstrate the diverse negative effects of multimorbidity on HRQoL and reveal that apart from count of chronic conditions, severity and pattern also influence HRQoL negatively. Health care providers should consider severity as an outcome measure to improve QoL especially in individuals with physical multimorbidity. Given the differences observed between age groups, it is important to identify specific care needs for each group. Musculoskeletal clusters need prioritised attention while designing clinical guidelines for multimorbidity.


Assuntos
Doença Crônica , Multimorbidade , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Índice de Gravidade de Doença , Adulto Jovem
14.
Medicine (Baltimore) ; 98(30): e16528, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348268

RESUMO

BACKGROUND: Early diagnosis and treatment of breast cancer are important to prevent fatal tumor progression. Axillary lymph node (ALN) status is the most significant prognostic factor for diagnosing overall survival in breast cancer patients. Axillary lymph node dissection (ALND) is regarded as the reference standard for determining ALN status. However, ALND is an invasive therapy with high morbidity and complications such as lymphedema, seroma and nerve injury. Comparatively, magnetic resonance imaging (MRI) and ultrasound are noninvasive and non-radiative techniques that are common imaging methods to diagnose breast cancer lymph node metastasis. Many studies have investigated the diagnostic value of MRI combined with ultrasound for breast cancer ALN metastasis, but the evidence has been insufficient to apply these modalities when diagnosing new patients. METHODS: We will search electronic databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedical Database, WangFang Database, and China National Knowledge Infrastructure. The language of studies is limited in English or Chinese. The final search includes articles published in June, 2018. Stata 14.0 software will be used for all statistical analyses, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) will be utilized to evaluate the quality of the included studies. Meta-regression and subgroup analyses will be performed to explore heterogeneity, which will be derived from the different countries of origin of the included studies. Deeks' funnel plot asymmetry test will be demonstrated the inexistence of publication bias. RESULT: This study will provide a rational synthesis of current evidences for magnetic resonance imaging combined with ultrasound for breast cancer. CONCLUSION: The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer. REGISTRATION: PROS-PERO CRD42019134474.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/estatística & dados numéricos , Metástase Linfática/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Axila , Neoplasias da Mama/patologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Metanálise como Assunto , Valor Preditivo dos Testes , Análise de Regressão , Projetos de Pesquisa , Ultrassonografia/métodos
15.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
16.
J Forensic Odontostomatol ; 1(37): 32-39, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31187741

RESUMO

This study is aimed at finding the predictive accuracy of Demirjian's (D), modified Demirjian's (MD) and India specific age estimation methods (AA) Indian specific age estimation methods in 522 healthy children of Odisha population among 3-18 years. Correlations between chronological age (CA) and derived age (DA) by above mentioned methods were evaluated by Wilcoxon signed rank test and Pearson's correlation analysis. Analysis of mean absolute error concluded that D and MD predicted the CA with fair accuracy, whereas, AA had lower accuracy in Odisha children. Odisha specific polynomial regression formula, derived in this study is showing a strong correlation with CA (r=0.84). Comparison of mean absolute error of D, MD, AA and Odisha specific method indicated a better predictive accuracy of Odisha specific method.


Assuntos
Determinação da Idade pelos Dentes/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Masculino , Radiografia Panorâmica , Análise de Regressão , Reprodutibilidade dos Testes , Dente/diagnóstico por imagem , Dente/crescimento & desenvolvimento , Calcificação de Dente
17.
J Forensic Odontostomatol ; 1(37): 40-50, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31187742

RESUMO

BACKGROUND: Demirjian's method of age estimation has been reported to overestimate age and Willems' method to give consistently more accurate results. Not enough, however, is known about the applicability of Chaillet's standards. AIM: The present study aimed to compare the accuracy of Demirjian's, Willems' and Chaillet's standards in age estimation of 5 to 15 year-old Indian children. DESIGN: In this cross-sectional observational study, three methods were compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years. RESULTS: Demirjian's method overestimated age by +0.24 ± 0.80 years, +0.11 ± 0.81years and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80 years, +0.08 ± 0.80 years and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Chaillet's method underestimated age by -0.12 ± 0.69 years, -0.45 ± 0.88 years and -0.25 ± 0.83 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant sex-based differences were observed only with Demirjian's and Chaillet's methods (p < 0.05). CONCLUSION: Willems' method was the most accurate in age estimation, followed by Demirjian's and Chaillet's methods. While Demirjian's method was more accurate than Chaillet's in females, Chaillet's method better predicted the age of males.


Assuntos
Determinação da Idade pelos Dentes/métodos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Masculino , Radiografia Panorâmica , Análise de Regressão , Dente/diagnóstico por imagem , Dente/crescimento & desenvolvimento , Calcificação de Dente
18.
Forensic Sci Int ; 301: 160-165, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31158613

RESUMO

This pilot study examines the applicability of osteometric models for addressing commingled remains, which were originally developed for dry specimens, on 3-Dimensional bony elements in relation to a modern cadaveric population. A total of 70 bony elements (humeri, radii, ulnae, femora, tibiae and fibulae) were segmented and virtually reconstructed from cadaveric whole-body CT scans. Linear measurements were taken (using MeshLab v.2016.12) of the 3-Dimensional elements and osteometric models for sorting applied to them (Byrd and Adams, 2003). This study showed that on the selected specimens the quality of the surface of the reconstructed specimens compromised the efficacy of the models, and consequently the reliability of the results.


Assuntos
Restos Mortais , Osso e Ossos/diagnóstico por imagem , Imagem Tridimensional , Tomografia Computadorizada por Raios X , Cadáver , Antropologia Forense/métodos , Humanos , Projetos Piloto , Análise de Regressão , Reprodutibilidade dos Testes , Software
19.
Forensic Sci Int ; 301: 358-370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212143

RESUMO

Hammer blows cause serious, often fatal injuries, especially when massive blunt violence is targeted at the head region. The evaluation of the injury potential depends not only on the body region hit, but also on the characteristics of the hammer as a weapon and on the physical characteristics of the attacker. This study aimed at elucidating the dependency between the physical constitution of a perpetrator and the intensity of hammer blows, thus to verify or refute this seemingly obvious interrelation sometimes expressed in the saying that a "strong hand strikes harder". For this purpose, 113 volunteers of different ages and sexes took part in different experimental settings. While, as expected, clear differences between male and female were detectable in the striking power of single and multiple strokes, there were no age or sex differences with regard to the maximum number of strokes per time unit. Strength differences in slamming with a hammer between men and women exceeded expectations in this study. Using the fracture forces as described by Sharkey et al. in an exemplary manner, one can expect a fracture of the skull in 9 out of 10 cases with a 300 g hammer by men for intensively executed single strokes, whereas this was only the case for approx. 2/10 women in this study. The maximum circumference of the upper arm and the width of the shoulder girdle correlate significantly with the achievable impact forces of individual hammer blows in both sexes. A simple measurement of the hand force with a manometer using the regression formula y [kN] = 0.144 × manual grip force -1.08 can be used as a rough estimation parameter for the theoretically achievable impact force. If one strikes repeatedly with the same hammer for 1 min, the magnitude of a single strike decreases continuously from 4.5 kN to 2.6 kN on average. If a 1500 g hammer is used instead of a 300 g hammer, one does not get the fivefold impact force you might expect at first sight, but only on the order of twice the impact force, about 14 kN on average. The results prove the importance of physical experiments, whose results can help to better interpret the magnitude and effects of hammer blows as a form of potentially life-threatening violence.


Assuntos
Composição Corporal , Força Muscular , Fraturas Cranianas/etiologia , Armas , Ferimentos não Penetrantes/etiologia , Adolescente , Adulto , Feminino , Medicina Legal , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Extremidade Superior/anatomia & histologia , Adulto Jovem
20.
APMIS ; 127(8): 570-576, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31231825

RESUMO

Two quite different disc contents are used for antimicrobial susceptibility testing of two fluoroquinolone drugs, flumequine and enrofloxacin, in the disc diffusion test, 30 and 5 µg, respectively. Using the SRA method, single-strain regression analysis, we studied the impact of disc content when testing two relevant bacterial species, Aeromonas sobria and Vibrio anguillarum. There were no major differences between the antimicrobial regression lines for the two species. Wild-type strains produced acceptable zones of inhibition over a wide range of disc contents. The flumequine 30 µg disc should be lowered in its drug content. No rational reasons for choosing so different disc contents for the two antimicrobials were apparent. At present, the choice of disc content for new antimicrobials are outside the realm of clinical microbiologists. It is recommended that reference authorities, such as EUCAST, CLSI and USCAST, are consulted for the choice of disc contents in the future.


Assuntos
Aeromonas/efeitos dos fármacos , Enrofloxacina/farmacologia , Fluoroquinolonas/farmacologia , Testes de Sensibilidade Microbiana/métodos , Vibrio/efeitos dos fármacos , Aeromonas/crescimento & desenvolvimento , Antibacterianos/farmacologia , Análise de Regressão , Vibrio/crescimento & desenvolvimento
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