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1.
Vasc Endovascular Surg ; 54(1): 36-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570064

RESUMO

OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.


Assuntos
Veias Hepáticas/lesões , Veia Porta/lesões , Lesões do Sistema Vascular/epidemiologia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
2.
Vasc Endovascular Surg ; 54(1): 42-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31578127

RESUMO

OBJECTIVE: In clinical practice, the incidence of femoral pseudoaneurysms requiring repair is small, but at a tertiary care center, the repair rate is higher due to referrals. We sought to specifically study patients who suffered postcatheterization pseudoaneurysms requiring thrombin injection or operative repair and compare them to our routine transfemoral endovascular patients to identify predictors of clinically significant pseudoaneurysms. The underlying goal would be to identify what makes these patients that develop pseudoaneurysms different. METHODS: A search of our billing records for Current Procedural Technology (CPT) codes of these 2 procedures between January 2008 and April 2018 was combined with our institution's Peripheral Vascular Intervention Vascular Quality Initiative database spanning from January 2013 to December 2017. A comparison was then performed between patients who had the outcome of operative intervention for a pseudoaneurysm complication and those who did not, with the goal of elucidating patient demographics and periprocedural factors that would predict pseudoaneurysm formation using univariate and multivariate analyses. RESULTS: There were 77 patients who required thrombin injection or open repair for access-related pseudoaneurysms and 324 patients who did not. Complications occurred more often in patients who were older than 75 (40.2% vs 21.9%; P = .0009), female (57.1% vs 38.6%; P = .003), obese (59.7% vs 33.3%; P < .001), hypertensive (96.1% vs 79.3%; P = .0005), who received a sheath >6F (32.4% vs 13%; P < .0001), intraoperative and postoperative anticoagulation (77.3% vs 32.7% and 52.1% vs 24.2%, respectively; P < .0001), and periprocedural P2Y12 inhibitors (48.7% vs 28%; P = .0005). Less complications were observed in patients who had a closure device used (42.9% vs 8.45%; P < .0001) and protamine reversal (26.5% vs 13.3%; P = .0163). CONCLUSIONS: Our findings validate published reports that incriminate a larger sheath size, perioperative anticoagulation, and female gender as increasing the rate of access site complications, with the use of a closure device being protective.


Assuntos
Falso Aneurisma/etiologia , Cateterismo Periférico/efeitos adversos , Artéria Femoral/lesões , Virilha/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Bases de Dados Factuais , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Illinois , Injeções , Masculino , Estudos Retrospectivos , Fatores de Risco , Trombina/administração & dosagem , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia
3.
Vasc Endovascular Surg ; 54(1): 51-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31601161

RESUMO

BACKGROUND: Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. METHODS: A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. CONCLUSION: Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Transplante de Rim , Transplante de Fígado , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Inglaterra , Feminino , Humanos , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Food Chem ; 308: 125519, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-31648087

RESUMO

Food additives are considered to be the catalysts and headstones of the modern food industry, affecting every step of food production, processing, and storage. The urgent need for a comprehensive curation of food additives, including their molecular structures, biological activities, and precise toxicological evaluations, prompted the creation of the AdditiveChem database (http://www.rxnfinder.org/additivechem/). This database has curated >9064 types of food additives, along with their molecular structure, chemical and physical properties, absorption, distribution, metabolism, excretion and toxicity properties, biosynthesis and biodegradation methods, usage specifications, toxicological and risk assessment data, and targets in the human body from 16 databases to construct an efficient search platform for in silico preliminary evaluations. AdditiveChem database will enable an exploration of the relationship between the structure and function of food additives.


Assuntos
Biologia Computacional , Aditivos Alimentares , Bases de Dados Factuais , Alimentos , Medição de Risco , Software
5.
Int Endod J ; 53(1): 36-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31454086

RESUMO

AIM: To report the most common terminology used in titles of scientific papers published in the International Endodontic Journal (IEJ) and Journal of Endodontics (JOE) between 1980 and 2019 and to identify the most-cited papers in these journals. METHODOLOGY: The Web of Science database was searched to retrieve all the manuscripts published in the IEJ and JOE between 1980 and 2019. The articles were analysed using the VOS viewer software and the terms within the titles extracted. The top-10 terms were categorized according to the number of occurrences and the decade of publication. Maps were created using the text data for each decade of publication. Classic papers were identified when the number of citations was >400. During the same period of time, highly cited studies were identified including the authors, institutions and countries associated with these papers. RESULTS: Terms such as canal, molar and periapical lesion were the most commonly used in titles between 1980 and 1999. The terms instruments, expression, case report and cell were the most often terms used between 2000 and 2019. During the last 10 years, an increase in the number of reviews and papers on cone beam computed tomography occurred. The organizations with the largest number of citations in each decade were University of São Paulo, University College London, Loma Linda University and United States Army. The country with the largest number of citations and greatest number of top 10 and top 100 manuscripts was the United States. A paper had to be associated with more than 167 citations to be included in the top-100 most-cited list; at least 14 papers met the criteria to be categorized as a citation classic (>400 citations). CONCLUSION: While many diverse areas of endodontics have been explored in the last 40 years within the IEJ and JOE, only a relatively few topics are highly cited and can be considered as classics.


Assuntos
Endodontia , Publicações Periódicas como Assunto , Publicações , Bibliometria , Tomografia Computadorizada de Feixe Cônico , Bases de Dados Factuais
6.
J Environ Manage ; 254: 109800, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31739091

RESUMO

Treatment of highly polluted pharmaceutical effluents is a major challenge all over the world for technical and economic considerations. In this study, scientometric study is performed on the application of various methods for the treatment of pharmaceutical effluents to explore further developments. In this regard, a total of 1964 documents were retrieved from the Web of Science (WoS) database using a set of relevant keywords to cover all published documents. The extracted documents were subjected to scientometric study including the contributed authors, publications, citations received, contributing countries and institutions as well as the subject categories. From the data retrieved, the status of scientific knowledge on the subject history and current trends were identified and scientific gaps were critically discussed. Publications in this area started to appear since the sixties and were considerably promoted around the beginning of 2000s. Scientific publications of years 1960-2018 followed sigmoidal trend. It was found that leading countries are China and the United States in terms of scientific output on treatment technologies for pharmaceutical effluents. Among the active journals published, "Water Research" has received the most citations. A detailed discussion on the science and developments in this field is provided including the potential applications of scientometry.


Assuntos
Bibliometria , Preparações Farmacêuticas , China , Bases de Dados Factuais , Tecnologia , Estados Unidos
7.
Chimia (Aarau) ; 73(12): 1012-1017, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31883553

RESUMO

Pharmacoepidemiology is the study of the safety and effectiveness of medications following market approval. The increased availability and size of healthcare utilization databases allows for the study of rare adverse events, sub-group analyses, and long-term follow-up. These datasets are large, including thousands of patient records spanning multiple years of observation, and representative of real-world clinical practice. Thus, one of the main advantages is the possibility to study the real-world safety and effectiveness of medications in uncontrolled environments. Due to the large size (volume), structure (variety), and availability (velocity) of observational healthcare databases there is a large interest in the application of natural language processing and machine learning, including the development of novel models to detect drug-drug interactions, patient phenotypes, and outcome prediction. This report will provide an overview of the current challenges in pharmacoepidemiology and where machine learning applications may be useful for filling the gap.


Assuntos
Ciência de Dados , Farmacoepidemiologia , Bases de Dados Factuais , Humanos , Aprendizado de Máquina , Medicina de Precisão
8.
J Opioid Manag ; 15(6): 495-498, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850511

RESUMO

OBJECTIVE: Evaluate the accuracy of the Pennsylvania Prescription Drug Monitoring Program (PA PDMP) in patients undergoing upper extremity procedures. The authors hypothesized that the PA PDMP would provide an accurate account of the prescriptions that were filled. DESIGN: The authors prospectively collected post-operative pain prescription information of patients undergoing outpatient upper extremity surgery over a 2-week period. Patient-reported prescription-filling of opioid was cross-referenced with the PA PDMP information. SETTING: The study was performed at one private institution. PATIENTS: One hundred and thirty-nine consecutive patients undergoing upper extremity procedures. MAIN OUTCOME MEASURE(S): The PA PDMP information was cross-referenced with the post-operative prescription in the medical record to confirm the patient filled the surgeon's prescription. RESULTS: Of the 111 patients who reported filling their prescription, 107 (96.4 percent) of these were confirmed on the PA PDMP Web site (96.4 percent sensitivity; 95% confidence interval [CI]: 91.0-99.0 percent). None of 28 patients who did not fill their prescription appeared in the database search, resulting in 100 percent specificity (95% CI: 87.7-100 percent). Consequently, the overall accuracy of the PA PDMP was shown to be 97.1 percent (95% CI: 92.8-99.2 percent). CONCLUSIONS: The authors' results suggest that the PA PDMP and its many supplementary databases are accurate as it relates to monitoring opioid prescriptions.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Programas de Monitoramento de Prescrição de Medicamentos , Bases de Dados Factuais , Monitoramento de Medicamentos , Humanos , Programas de Monitoramento de Prescrição de Medicamentos/normas
9.
Anticancer Res ; 39(11): 6333-6337, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704864

RESUMO

BACKGROUND/AIM: To characterize the demographics, tumor staging and treatment of African American (AA) patients diagnosed with melanoma in the United States. PATIENTS AND METHODS: The National Cancer Database was used to extrapolate data from patients with melanoma between January 1, 2004, and December 31, 2015. The patients were then further divided based on ethnicity (AAs vs. Caucasians) to compare patient efficacy of treatment. RESULTS: The mean time for AA patients to receive treatment was 20.37 days compared with 11.25 days for Caucasians (p<0.001), while time to surgery was 38.86 days compared to 31.12 days for Caucasians (p<0.001). Moreover, AA race was a predictor of American Joint Committee on Cancer stage greater than II, tumor diagnosed at autopsy, presence of ulceration, and distribution in the extremities. CONCLUSION: AA patients with melanoma are more likely to have worse tumor staging, treatment delay, treatment at an Integrated Cancer Program, and diagnosis at autopsy.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Melanoma/etnologia , Melanoma/terapia , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/terapia , Tempo para o Tratamento/estatística & dados numéricos , Distribuição por Idade , Autopsia , Bases de Dados Factuais , Diagnóstico Tardio , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Distribuição por Sexo , Neoplasias Cutâneas/patologia , Estados Unidos
10.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-31668726

RESUMO

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Criança , Estudos de Coortes , Pesquisa Comparativa da Efetividade/métodos , Bases de Dados Factuais , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Medicina Baseada em Evidências/métodos , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto Jovem
11.
Medicine (Baltimore) ; 98(44): e17725, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689813

RESUMO

Bladder cancer (BC) is a common malignancy associated with high morbidity and mortality, however, accurate and convenient risk assessment tools applicable to BC patients are currently lacking. Previous studies using nomograms to evaluate bladder cancer (BC) survival have been based on small samples. Using a large dataset, this study aimed to construct more precise clinical nomograms to effectively predict bladder cancer survival.Data on patients with pathologically-confirmed bladder cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Additional BC patient data for an external validation cohort were extracted from the Cancer Genome Atlas (TCGA) database. Clinical parameters that constituted potential risk factors were reviewed and analyzed using univariate and multivariate Cox proportional hazards regression. A nomogram was constructed with parameters that significantly correlated with the overall survival (OS). Prognostic performance of a nomogram was assessed using the concordance index (c-index), area under the receiver operating characteristic curve (AUC), and a calibration curve. The model was then tested with data from an internal and external validation cohort. Patients' survival was analyzed and compared with the Kaplan-Meier (KM) method.Multivariate Cox regression showed that age, sex, race, stage_T1, stage_T2a, stage_T2b, stage_T3a, stage_Ta, stage_Tis, stage_N, stage_M were independent predictors of BC survival. A nomogram was constructed based on these factors. The c-index of the nomogram was 0.7916 (95% confidence interval CI, 0.79-0.80). The calibration curve showed excellent agreement between the predicted and observed values. The c-index for the internal validation cohort was 0.7917 (95% CI 0.79-0.80), which was higher than for the training cohort, suggesting robustness of the model. For the training cohort, the AUC for the 3- and the 5-year survival was 0.82 and 0.813, respectively. The c-index for the TNM-based model was superior to that for the AJCC-TNM classification.The models presented in this study might be suitable for clinical use, supporting clinicians in their individualized assessment of expected survival in BC patients. They might also be used as a layered tool for clinical research.


Assuntos
Nomogramas , Neoplasias da Bexiga Urinária/mortalidade , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Análise de Regressão , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Programa de SEER , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
12.
Medicine (Baltimore) ; 98(44): e17745, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689827

RESUMO

The aim of this study was to analyze the clinical manifestations of adverse reactions after the use of SonoVue contrast agent from a large retrospective database, and to evaluate the nursing care strategies and the efficacy of standardized procedure for adverse reactions of SonoVue (SPARS).From January 1, 2012 to December 30, 2018, 34,478 cases of contrast-enhanced ultrasonography were performed in our center. The clinical manifestations of adverse reactions after the use of SonoVue contrast agent were identified and analyzed. The nursing care strategies were evaluated and the outcomes of patients with moderate and severe adverse reactions before and after the application of SPARS were compared.Of the 34,478 cases, 40 cases (0.12%) of adverse reactions after the use of SonoVue were identified. Adverse reactions included anaphylatic shock, skin allergies, nausea or vomiting, dizziness or headache, numbness, chest distress, back pain, and local reactions of the injection site. Most of the adverse reactions were mild and self-limited. Only 3 cases of anaphylatic shock and 2 cases of severe rash underwent further treatments. The 3 patients who were managed by SPARS recovered quicker and spent less comparing with the other 2 patients who were not.SonoVue was a safe contrast agent, with few and mostly mild adverse reactions. SPARS may be an efficient way in tackling moderate to severe adverse reactions, although of which the incidence was rare.


Assuntos
Meios de Contraste/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/enfermagem , Cuidados de Enfermagem/estatística & dados numéricos , Fosfolipídeos/efeitos adversos , Hexafluoreto de Enxofre/efeitos adversos , Ultrassonografia/efeitos adversos , Idoso , Bases de Dados Factuais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia/métodos
14.
BMJ ; 367: l6015, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690553

RESUMO

OBJECTIVE: To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN: Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING: Primary care, France. PARTICIPANTS: 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES: The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS: The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION: The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION: OSF register OSF.IO/8M3QR.


Assuntos
Indústria Farmacêutica/economia , Prescrições de Medicamentos/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Doações , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Indústria Farmacêutica/estatística & dados numéricos , Prescrições de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , França , Clínicos Gerais/economia , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/economia , Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Adulto Jovem
15.
Nurs Res ; 68(6): 483-487, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693554

RESUMO

BACKGROUND: Limited guidelines to assist nurse researchers who use web-based interventions are available. Nurses must develop the supporting technology enabling participants to complete study activities and collected data while maintaining data security and participant confidentiality. OBJECTIVES: The aim of the study was to describe how the authors used advanced Research Electronic Data Capture (REDCap) functionality to support the data management infrastructure of an interactive, web-based therapeutic intervention. METHODS: The data management infrastructure for the WISER (Writing to Improve Self-in-Relationships) intervention pilot study consisted of two components: a website for presentation of the intervention and participant account management and a REDCap project for data capture and storage. The REDCap application programming interface connected these two components using HTML links and data exchanges. RESULTS: We completed an initial pilot study of WISER with 14 participants using the REDCap-based infrastructure. Minimal technical difficulties were encountered. DISCUSSION: REDCap is cost-effective, is readily available, and, through its advanced functionality, is able to facilitate confidential, secure interactions with participants, robust data management, and seamless participant progression in web-based intervention research.


Assuntos
Coleta de Dados , Gestão da Informação em Saúde , Pesquisa sobre Serviços de Saúde , Internet , Pesquisa em Enfermagem , Software , Bases de Dados Factuais , Humanos , Projetos Piloto , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 98(45): e17869, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702652

RESUMO

Nontuberculous mycobacteria (NTM) are important pathogens in humans, and hospital-based studies have shown an increased incidence of NTM infection. However, little is known about the treatment pattern of NTM infection with respect to the number of cases per population in South Korea. This study evaluated the trends in the incidence of NTM infection, respiratory comorbidities, and treatment patterns in South Korea.National claims data from the Health Insurance Review and Assessment service database for the years 2009 to 2015 were reviewed, and codes related to NTM infection, respiratory comorbidities occurring from one year before NTM infection and associated treatments were identified.In total, 52,551 patients were included in the study and the average annual incidence per 100,000 person-years was 12.8. The annual incidence was found to have increased from 6.6 to 26.6 per 100,000 persons. Accompanied comorbidities were tuberculosis (33.7%), followed by bronchial asthma (33.2%), chronic obstructive pulmonary disease (25.6%), and lung cancer (5.8%). A total of 76.6% of patients did not receive any combination treatment within one year after the diagnosis of NTM infection. Macrolide-based treatment was administered to 18.8% of patients.A dramatic increase in the incidence of NTM infection was noted in the population of South Korea. Approximately three-fourth of the patients with NTM infection were clinically observed without treatment for at least 1 year after the identification of NTM infection and most patients who treated NTM infection received macrolide-based combination therapy.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Infecções por Micobactéria não Tuberculosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/epidemiologia , Infecções por Micobactéria não Tuberculosa/terapia , República da Coreia/epidemiologia , Adulto Jovem
17.
Zootaxa ; 4695(5): zootaxa.4695.5.2, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719333

RESUMO

We present information on primary type specimens for 13,282 species and subspecies of reptiles compiled in the Reptile Database, that is, holotypes, neotypes, lectotypes, and syntypes. These represent 99.4% of all 13,361 currently recognized taxa (11,050 species and 2311 subspecies). Type specimens of 653 taxa (4.9%) are either lost or not located, were never designated, or we did not find any information about them. 51 species are based on iconotypes. To map all types to physical collections we have consolidated all synonymous and ambiguous collection acronyms into an unambiguous list of 364 collections holding these primary types. The 10 largest collections possess more than 50% of all (primary) reptile types, the 36 largest collections possess more than 10,000 types and the largest 73 collections possess over 90% of all types. Of the 364 collections, 107 hold type specimens of only 1 species or subspecies. Dozens of types are still in private collections. In order to increase their utility, we recommend that the description of type specimens be supplemented with data from high-resolution images and CT-scans, and clear links to tissue samples and DNA sequence data (when available). We request members of the herpetological community provide us with any missing type information to complete the list.


Assuntos
Répteis , Animais , Bases de Dados Factuais
19.
Zhongguo Zhen Jiu ; 39(11): 1247-53, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31724365

RESUMO

OBJECTIVE: To evaluate the methodological quality and reporting quality of Meta-analysis literature published by acupuncture journals included in Chinese Science Citation Database (CSCD), and to provide references and demonstration for relevant studies. METHODS: The Meta-analysis literature published before December 2017 in Chinese Acupuncture & Moxibustion, Acupuncture Research, Journal of Acupuncture and Tuina Science and World Journal of Acupuncture-Moxibustion was retrieved by computer. AMSTAR was used for methodology quality evaluation, and PRISMA was used for reporting quality evaluation. RESULTS: A total of 69 literature was included. Among them, the co-authorship rate was 100% and the cooperation degree was 5.45. The first authors came from 32 institutions, and 29 literature (42.0%) was funded. The cited rate was 98.6%, and averagely each paper was cited 16.3 times. The mean score of methodology quality evaluation was (7.78±1.14) points, including 14 high-quality literature (20.3%), 50 moderate-quality literature (72.5%) and 5 low-quality literature (7.2%). The average score of reporting quality evaluation was (20.33±2.36) points, including 24 relatively complete literature (34.8%), 41 literature with certain defects (59.4%) and 4 literature with serious defects (5.8%). CONCLUSION: The Meta-analysis reports published by acupuncture journals in CSCD have relatively high methodological quality and reporting quality, which could provide evidence for clinical decision making, but still the quality level needed to be further enhanced according to the writing standard of Meta-analysis report. At the same time, the overall level of experimental research should be constantly improved to promote the development of evidence-based research on acupuncture and promote the formation of high-quality evidence.


Assuntos
Terapia por Acupuntura , Moxibustão , Publicações Periódicas como Assunto , China , Bases de Dados Factuais , Humanos , Publicações Periódicas como Assunto/normas , Publicações Periódicas como Assunto/estatística & dados numéricos , Publicações
20.
J Surg Oncol ; 120(7): 1241-1251, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587292

RESUMO

BACKGROUND: Although shorter delays in soft tissue sarcoma (STS) diagnosis may improve overall survival (OS), the influence of time to treatment initiation (TTI) on OS in STS has not been determined. OBJECTIVE: To determine if TTI influences OS in localized, high-grade STS. METHODS: An analysis of the National Cancer Database identified 8648 patients meeting criteria with localized, high-grade STS diagnosed between 2004 and 2012. TTI and secondary variable associations with OS were determined using Kruskal-Wallis tests in univariate analyses, and a Cox regression multivariable model. RESULTS: In a multivariable Cox regression, TTI was associated with OS in a nonlinear fashion with a minimum hazard ratio (HR) demonstrated at 42 days. Secondary variables significantly associated (P < .05) with decreased OS included, advanced age, increased Charlson/Deyo score, nonprivate insurance, axial tumor location, tumor size more than 5 cm, stage III disease, and a nonsurgical treatment modality. CONCLUSIONS: Minimum HR was observed at a TTI of 42 days, with HR = 0.64, when compared with TTI = 1 day. Appropriate referrals to a higher volume sarcoma centers may account for these delays and explain a potential OS advantage. This is important in counseling patients, who may seek referral to a higher volume treatment center.


Assuntos
Bases de Dados Factuais , Sarcoma/mortalidade , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/terapia , Taxa de Sobrevida , Adulto Jovem
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