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1.
Ann Fam Med ; 19(2): 135-140, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33685875

RESUMO

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the coronavirus disease 2019 (COVID-19) pandemic. Routinely collected primary care data have previously been used for national pandemic surveillance, quantifying associations between exposures and outcomes, identifying high risk populations, and examining the effects of interventions at scale, but there is no consensus on how to effectively conduct or report these data for COVID-19 research. A COVID-19 primary care database consortium was established in April 2020 and its researchers have ongoing COVID-19 projects in overlapping data sets with over 40 million primary care records in the United Kingdom that are variously linked to public health, secondary care, and vital status records. This consensus agreement is aimed at facilitating transparency and rigor in methodological approaches, and consistency in defining and reporting cases, exposures, confounders, stratification variables, and outcomes in relation to the pharmacoepidemiology of COVID-19. This will facilitate comparison, validation, and meta-analyses of research during and after the pandemic.


Assuntos
/epidemiologia , Consenso , Bases de Dados Factuais/normas , Sistemas Computadorizados de Registros Médicos/normas , Atenção Primária à Saúde/organização & administração , Vigilância em Saúde Pública , Big Data , Humanos , Farmacoepidemiologia , Saúde Pública , Reino Unido/epidemiologia
2.
Pharmacoepidemiol Drug Saf ; 30(6): 707-715, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33650210

RESUMO

PURPOSE: To describe the characteristics of adverse event reporting in the United States (US) Food and Drug Administration Adverse Event Reporting System (FAERS) before and after the outbreak of the COVID-19 pandemic. METHODS: We included all FAERS reports from the US and Canada from November 7, 2019 to July 15, 2020 and divided the study period into three equal time intervals (pre-pandemic, first pandemic, second pandemic). We focused on methotrexate, a broadly used drug unrelated to COVID-19, and (hydroxy)chloroquine, another broadly used drug implicated in COVID-19 treatment. Using descriptive statistics, we compared reporting characteristics before and after the COVID-19 outbreak. RESULTS: During the study period, 366 998 cases (60% female, median age: 59 years) were submitted to FAERS. The daily median number of reports (1796 in the pre-pandemic, 1810 in the second pandemic time interval) and other characteristics remained stable. The daily median number of reports for methotrexate decreased from 28 in the pre-pandemic to 15 in the second pandemic time interval, with no considerable differences in other characteristics. The daily median number of reports for (hydroxy)chloroquine increased slightly from 1 in the pre-pandemic to 3 in the second pandemic time interval, while there were also changes in the demographics of cases and an increase in the proportion of cases reported by health professionals. CONCLUSIONS: The overall reporting to FAERS did not change after the outbreak of the COVID-19 pandemic. However, some stimulated reporting was observed for (hydroxy)chloroquine, highlighting the need for caution when conducting pharmacovigilance analyses with substances related to COVID-19.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , United States Food and Drug Administration/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais/normas , Feminino , Humanos , Hidroxicloroquina/efeitos adversos , Lactente , Recém-Nascido , Masculino , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
4.
Drug Saf ; 44(1): 95-105, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33354753

RESUMO

INTRODUCTION: Evidence-based clinical data on coronavirus disease 2019 (COVID-19) pharmacotherapies are scarce. OBJECTIVE: This study documented and characterized COVID-19 cases reported in individuals receiving treatment with Pfizer pharmaceutical products and cases that reported use of Pfizer pharmaceutical products for COVID-19 treatment. METHODS: This retrospective observational review leveraged the Pfizer safety database containing adverse event data collected in association with use of Pfizer products between 1 October, 2019, and 25 June, 2020; the database includes worldwide adverse event data from various sources. Selected Medical Dictionary for Drug Regulatory Activities (MedDRA®) Preferred Terms and subsequent clinical review were used to characterize COVID-19 cases. RESULTS: Over 1500 relevant cases were identified over an 8-month period. In cases that reported COVID-19, immunosuppressant/immunomodulating agents, followed by anticoagulant/antithrombic agents and corticosteroids, were the most frequently reported agents. The frequent reporting of immunosuppressant/immunomodulating agents among cases of COVID-19 suggests increased vulnerability to infection among treated patients, either because of immunosuppressive effects of certain agents or the nature of the underlying treated condition. In cases involving off-label pharmacotherapy use for the treatment of COVID-19-related conditions, the most frequently reported therapeutic classes included antibiotics, antimalarial agents, antivirals/antiretroviral agents, immunosuppressant/immunomodulating agents, corticosteroids, anticoagulants, and immunoglobulin/interferons. The most frequently reported pharmacotherapeutic agents were azithromycin and chloroquine/hydroxychloroquine, followed by lopinavir-ritonavir, ceftriaxone, and tofacitinib. The most frequently reported clinical adverse events associated with azithromycin (as sole therapy or combined with chloroquine/hydroxychloroquine) include electrocardiogram QT prolonged, drug interaction, hepatitis, diarrhea, and hepatitis acute. Regarding cardiac-related events, 19% (120/645) of azithromycin cases reported events associated with QT prolongation/torsade de pointes (which included seven fatal cardiac events). The most frequently reported clinical adverse events associated with other commonly used agents are also presented. CONCLUSIONS: This pharmacovigilance surveillance study provides a unique characterization of cases in which a broad range of pharmaceutical products was reported in relation to COVID-19.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Indústria Farmacêutica/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Saúde Global/tendências , Farmacovigilância , Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Anticoagulantes/efeitos adversos , Antimaláricos/efeitos adversos , Antivirais/efeitos adversos , Bases de Dados Factuais/normas , Bases de Dados Factuais/tendências , Indústria Farmacêutica/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Saúde Global/normas , Humanos , Imunossupressores/efeitos adversos , Estudos Retrospectivos
5.
Diabetes Res Clin Pract ; 172: 108641, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33359573

RESUMO

AIMS: There is sufficient scientific evidence for the bidirectional association between periodontal diseases and diabetes. In this context, we hypothesized that periodontal treatment leads to lower healthcare costs in newly diagnosed diabetes patients by promoting a milder disease course. METHODS: A total of 23,771 persons were investigated who were continuously insured by German health insurances between 2011 and 2016, 18 years or older, and newly diagnosed with diabetes in 2013. The study population was divided into a periodontal treatment and control group (no periodontal treatment). The average treatment effect of a periodontal treatment on various types of healthcare costs (inpatient, outpatient, drug costs) was analyzed by a doubly robust method. RESULTS: Finally, 5.3% of the study population could be assigned to the treatment group. In newly diagnosed diabetes patients with periodontal treatment, a reduction in total healthcare costs (0.96, 95%CI 0.89; 1.04), inpatient costs (0.87, 95%CI 0.69; 1.08), diabetes-related drug costs (0.93, 95%CI 0.84; 1.03) and other drug costs (0.97, 95%CI 0.89; 1.05) could be shown compared to the control group. CONCLUSIONS: This study provides evidence that periodontal treatment for diabetes patients reduces healthcare costs. Fewer diabetes-specific complications and hospitalizations are expected.


Assuntos
Bases de Dados Factuais/normas , Diabetes Mellitus Tipo 2/complicações , Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças Periodontais/economia , Feminino , Alemanha , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/terapia , Estudos Retrospectivos
7.
PLoS Comput Biol ; 16(7): e1007897, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32645081

RESUMO

Network-based intervention strategies can be effective and cost-efficient approaches to curtailing harmful contagions in myriad settings. As studied, these strategies are often impractical to implement, as they typically assume complete knowledge of the network structure, which is unusual in practice. In this paper, we investigate how different immunization strategies perform under realistic conditions-where the strategies are informed by partially-observed network data. Our results suggest that global immunization strategies, like degree immunization, are optimal in most cases; the exception is at very high levels of missing data, where stochastic strategies, like acquaintance immunization, begin to outstrip them in minimizing outbreaks. Stochastic strategies are more robust in some cases due to the different ways in which they can be affected by missing data. In fact, one of our proposed variants of acquaintance immunization leverages a logistically-realistic ongoing survey-intervention process as a form of targeted data-recovery to improve with increasing levels of missing data. These results support the effectiveness of targeted immunization as a general practice. They also highlight the risks of considering networks as idealized mathematical objects: overestimating the accuracy of network data and foregoing the rewards of additional inquiry.


Assuntos
Bases de Dados Factuais , Epidemias , Imunização , Algoritmos , Biologia Computacional , Simulação por Computador , Coleta de Dados , Bases de Dados Factuais/normas , Bases de Dados Factuais/estatística & dados numéricos , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Saúde Global , Humanos , Imunização/métodos , Imunização/estatística & dados numéricos
8.
Pain Physician ; 23(4): 413-422, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709176

RESUMO

BACKGROUND: The aim of this study was to examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. OBJECTIVES: To examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. STUDY DESIGN: Retrospective review. SETTING: Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. METHODS: Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. Data collected for each case included year, state, patient age, patient gender, defendant specialty, legal outcome, award amount, alleged cause of malpractice, and factors in plaintiff's decision to file. After elimination of duplicates and applying inclusion/exclusion criteria to our initial search yielding over 1,500 cases, a total of 82 cases were included in this study. RESULTS: A total of 57.3% of cases resulted in a jury verdict in favor of the defendant, whereas 41.5% favored the plaintiff. When comparing cases that were performed in the operating room to cases performed outside the operating room, we found the jury verdicts to favor the plaintiff 83.3% of the time for operating room procedures (P = 0.003). In other words, interventional pain practitioners were more likely to be found at fault for complications from procedures performed in the operating room. To eliminate confounders, a logistical regression was performed and confirmed operating room procedures were an independent predictor of a verdict awarded to the plaintiff (P = 0.008). The median amount awarded to the plaintiff for all cases was $333,000, and the single highest award amount was $36,636,288. The median payout for operating room procedures was $450,000 (P = 0.010), which was significantly different from the median payout for nonoperating room procedures. Procedure categorization demonstrated a statistically significant difference in jury verdicts (P = 0.01411) and procedural error was the leading reason for pursuing litigation, followed by lack of informed consent and unnecessary procedure performed. LIMITATIONS: There is more than one database that captures medicolegal claims brought against practitioners. Westlaw, which has been previously utilized by other studies, is only one of them and the extent to which overlap exists in unclear. For each, data input are not necessarily consistent and data capture are not complete. As a result, there could exist a skew toward more severe complications and the details of individual cases likely vary. During data extraction, we found that all details of the procedure were not always included. For example, not all cases specified the type of injectate utilized for epidural injection (i.e., local anesthetic, steroid, mixture, and others) or route of injection (i.e., transforaminal vs. interlaminar). Moreover, as previously mentioned, cases that are settled out of court or finalized prior to trial are not necessarily reported by the Westlaw database, and therefore were not always included in our data search. CONCLUSIONS: Overall, interventional pain medicine physicians were favored by jury verdicts for malpractice claims. However, when filtering by procedure or setting, jury verdicts favored the plaintiff in some cases. KEY WORDS: Interventional pain, medical, malpractice, anesthesiology.


Assuntos
Anestesiologia/legislação & jurisprudência , Governo Federal , Imperícia/legislação & jurisprudência , Manejo da Dor/normas , Dor/epidemiologia , Governo Estadual , Adulto , Anestesiologia/métodos , Anestesiologia/normas , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bases de Dados Factuais/normas , Feminino , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Projetos Piloto , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
Mutat Res ; 854-855: 503199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32660827

RESUMO

The bacterial reverse mutation test (Ames test) is the most commonly used genotoxicity test; it is a primary component of the chemical safety assessment data required by regulatory agencies worldwide. Within the current accepted in vitro genotoxicity test battery, it is considered capable of revealing DNA reactivity, and identifying substances that can produce gene mutations via different mechanisms. The previously published consolidated EURL ECVAM Genotoxicity and Carcinogenicity Database, which includes substances that elicited a positive response in the Ames test, constitutes a collection of data that serves as a reference for a number of regulatory activities in the area of genotoxicity testing. Consequently, we considered it important to expand the database to include substances that fail to elicit a positive response in the Ames test, i.e., Ames negative substances. Here, we describe a curated collection of 211 Ames negative substances, with a summary of complementary data available for other genotoxicity endpoints in vitro and in vivo, plus available carcinogenicity data. A descriptive analysis of the data is presented. This includes a representation of the chemical space formed by the Ames-negative database with respect to other substances (e.g. REACH registered substances, approved drugs, pesticides, etc.) and a description of the organic functional groups found in the database. We also provide some suggestions on further analyses that could be made.


Assuntos
Testes de Carcinogenicidade/normas , Carcinógenos/toxicidade , Bases de Dados Factuais/normas , Testes de Mutagenicidade/normas , Mutagênicos/toxicidade , Resultados Negativos/normas , Animais , Dano ao DNA/efeitos dos fármacos , Dano ao DNA/genética , Gerenciamento de Dados/normas , Humanos
11.
Clin Neuropsychol ; 34(7-8): 1411-1452, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32519594

RESUMO

Objective: Due to the recent COVID-19 pandemic, the field of neuropsychology must rapidly evolve to incorporate assessments delivered via telehealth, or teleneuropsychology (TNP). Given the increasing demand to deliver services electronically due to public health concerns, it is important to review available TNP validity studies. This systematic review builds upon the work of Brearly and colleagues' (2017) meta-analysis and provides an updated review of the literature, with special emphasis on test-level validity data.Method: Using similar methodology as Brearly and colleagues (2017) three internet databases (PubMed, EBSCOhost, PsycINFO) were searched for relevant articles published since 2016. Studies with older adults (aged 65+) who underwent face-to-face and TNP assessments in a counterbalanced cross-over design were included. After review, 10 articles were retained. Combined with nine articles from Brearly's analysis, a total of 19 studies were included in the systematic review.Results: Retained studies included samples from 5 different countries, various ethnic/cultural backgrounds, and diverse diagnostic populations. Test-level analysis suggests there are cognitive screeners (MMSE, MoCA), language tests (BNT, Letter Fluency), attention/working memory tasks (Digit Span Total), and memory tests (HVLT-R) with strong support for TNP validity. Other measures are promising but lack sufficient support at this time. Few TNP studies have done in-home assessments and most studies rely on a PC or laptop.Conclusions: Overall, there appears to be good support for TNP assessments in older adults. Challenges to TNP in the current climate are discussed. Finally, a provisional outline of viable TNP procedures used in our clinic is provided.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Testes Neuropsicológicos/normas , Neuropsicologia/normas , Pneumonia Viral/terapia , Telemedicina/normas , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais/normas , Feminino , Humanos , Masculino , Neuropsicologia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes , Telemedicina/métodos
13.
Obesity (Silver Spring) ; 28(7): 1205-1214, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32478469

RESUMO

OBJECTIVE: Administrative data are increasingly used in research and evaluation yet lack standardized guidelines for constructing measures using these data. Body weight measures from administrative data serve critical functions of monitoring patient health, evaluating interventions, and informing research. This study aimed to describe the algorithms used by researchers to construct and use weight measures. METHODS: A structured, systematic literature review of studies that constructed body weight measures from the Veterans Health Administration was conducted. Key information regarding time frames and time windows of data collection, measure calculations, data cleaning, treatment of missing and outlier weight values, and validation processes was collected. RESULTS: We identified 39 studies out of 492 nonduplicated records for inclusion. Studies parameterized weight outcomes as change in weight from baseline to follow-up (62%), weight trajectory over time (21%), proportion of participants meeting weight threshold (46%), or multiple methods (28%). Most (90%) reported total time in follow-up and number of time points. Fewer reported time windows (54%), outlier values (51%), missing values (34%), or validation strategies (15%). CONCLUSIONS: A high variability in the operationalization of weight measures was found. Improving methods to construct clinical measures will support transparency and replicability in approaches, guide interpretation of findings, and facilitate comparisons across studies.


Assuntos
Peso Corporal , Pesos e Medidas Corporais/estatística & dados numéricos , Bases de Dados Factuais/provisão & distribução , Programas Nacionais de Saúde/organização & administração , Pesos e Medidas Corporais/métodos , Bases de Dados Factuais/normas , Humanos , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Sistema de Registros , Projetos de Pesquisa , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares/organização & administração , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
14.
Epilepsia ; 61(7): 1319-1335, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32474909

RESUMO

Our objective was to undertake a systematic review ascertaining the accuracy of using administrative healthcare data to identify epilepsy cases. We searched MEDLINE and Embase from 01/01/1975 to 03/07/2018 for studies evaluating the diagnostic accuracy of routinely collected healthcare data in identifying epilepsy cases. Any disease coding system in use since the International Classification of Diseases, Ninth Revision (ICD-9) was permissible. Two authors independently screened studies, extracted data, and quality-assessed studies. We assessed positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity. The primary analysis was a narrative synthesis of review findings. Thirty studies were included, published between 1989 and 2018. Risks of bias were low, high, and unclear in 4, 14, and 12 studies, respectively. Coding systems included ICD-9, ICD-10, and Read Codes, with or without antiepileptic drugs (AEDs). PPVs included ranges of 5.2%-100% (Canada), 32.7%-96.0% (USA), 47.0%-100% (UK), and 37.0%-88.0% (Norway). Sensitivities included ranges of 22.2%-99.7% (Canada), 12.2%-97.3% (USA), and 79.0%-94.0% (UK). Nineteen studies contained at least one algorithm with a PPV >80%. Sixteen studies contained at least one algorithm with a sensitivity >80%. PPV was highest in algorithms consisting of disease codes (ICD-10 G40-41, ICD-9 345) in combination with one or more AEDs. The addition of symptom codes to this (ICD-10 R56; ICD-9 780.3, 780.39) lowered PPV. Sensitivity was highest in algorithms consisting of symptom codes with one or more AEDs. Although using AEDs alone achieved high sensitivities, the associated PPVs were low. Most NPVs and specificities were >90%. We conclude that it is reasonable to use administrative data to identify people with epilepsy (PWE) in epidemiological research. Studies prioritizing high PPVs should focus on combining disease codes with AEDs. Studies prioritizing high sensitivities should focus on combining symptom codes with AEDs. We caution against the use of AEDs alone to identify PWE.


Assuntos
Coleta de Dados/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Epilepsia/epidemiologia , Estudos de Validação como Assunto , Coleta de Dados/normas , Bases de Dados Factuais/normas , Assistência à Saúde/normas , Epilepsia/diagnóstico , Humanos
16.
Tunis Med ; 98(1): 17-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395773

RESUMO

INTRODUCTION: Although the use of Reference Management Software (RMS) is increasing in developed countries, they seem to be unknown and less used in low-income countries. AIM: To discover the major trends in the use of RMS among researchers and Ph.D. students in Tunisia, as a low-income country. METHODS: A hardcopy survey was filled out by researchers and Ph.D. students during an educational seminar at the faculty of medicine of Sfax in 2016 with the aim to collect qualitative data to determine the participants' knowledge and use of RMS. RESULTS: The survey collected 121 participants, among them, 53.7% know RMS. Mendeley proved to be the best-known software (41.5%), followed by Zotero (35.3%) and Endnote (23%). Training sessions in RMS were taken by 5% of participants. Among the 121 participants, 26.5%of them use RMS., Mendeley was the most used (46.9%), followed by EndNote (28.1%) and Zotero (25%). The most commonly popular feature in RMS is inserting citations (66.9%). Therefore, the analysis, of the reasons behind the choice of RMS proves that the software was used because it is convenient (38.4%),  most known (38.4%),  easy (30.7%), or suggested by colleagues (30.7%). The free and open-source software was preferred by 81% of the participants. g. However, 50.4% ignore the fact that Zotero is free. Several types and sources of captured citations were unknown by 53.8% and 59% of the rest of the participants. CONCLUSION: The results clearly show that the lack of awareness about RMS in Tunisia is due to the absence of a formal training. As a result, the need for such training is highly important for researchers to be able to benefit from the different advantages of RMS while conducting their academic medical education.


Assuntos
Bases de Dados Factuais , Conhecimentos, Atitudes e Prática em Saúde , Gestão da Informação , Pessoal de Laboratório/estatística & dados numéricos , Publicações Seriadas/provisão & distribução , Software , Estudantes de Medicina/estatística & dados numéricos , Acesso à Informação , Bases de Dados Factuais/economia , Bases de Dados Factuais/normas , Bases de Dados Factuais/provisão & distribução , Educação Médica/economia , Educação Médica/normas , Humanos , Gestão da Informação/economia , Gestão da Informação/educação , Gestão da Informação/métodos , Gestão da Informação/normas , Pessoal de Laboratório/economia , Pobreza/estatística & dados numéricos , Publicações Seriadas/economia , Publicações Seriadas/normas , Software/economia , Inquéritos e Questionários , Tunísia/epidemiologia
17.
Accid Anal Prev ; 142: 105571, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32413544

RESUMO

BACKGROUND: Cervical spine injury is a common result of traffic crashes, and such injuries range in severity from minor (i.e. sprain/strain) to moderate (intervertebral disk derangement) to serious and greater (fractures, dislocations, and spinal cord injuries). There are currently no reliable estimates of the number of crash-related spine injuries occurring in the US annually, although several publications have used national crash injury samples as a basis for estimating the frequency of both cervical and lumbar spinal disk injuries occurring in lower speed rear impact crashes. PURPOSE: To develop a reliable estimate of the number of various types of cervical spine injuries occurring in the US by comparing data from national crash injury to national hospital ED and inpatient samples. STUDY DESIGN: Comparative cross-sectional METHODS: Cervical spine injury data were accessed, analyzed, and compared from 3 national databases; the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), Nationwide Emergency Department Sample (NEDS), and the Nationwide Inpatient Sample (NIS). RESULTS: It is estimated that there are approximately 869,000 traffic crash-related cervical spine injuries seen in hospitals in the US annually, including around 841,000 sprain/strain (whiplash) injuries, 2800 spinal disk injuries, 23,500 fractures, 2800 spinal cord injuries, and 1500 dislocations. Because of a highly restrictive inclusion criteria for both crash and injury types, as well as a very small sample size, the NASS-CDS underestimated all types of crash-related cervical spine injuries seen in US hospital emergency departments by 84 %. The injury type with the largest degree of underestimation in the NASS-CDS was cervical disk injuries, which were estimated at an 88 % lower frequency than in the NEDS. National insurance claim data, which include cases of cervical disk injury diagnosed both in and outside of the ED, indicate that the NEDS likely undercounts cervical disk injuries by 92 %, and thus the NASS-CDS correspondingly undercounts such injuries by 99 % or more. CONCLUSIONS: Because of a limited sample size and restrictive criteria for both crash and injury inclusion, the NASS-CDS cannot be used to estimate the number of crash-related spinal injuries of any type or severity in the US. The most inappropriate use of the database is for estimating the number of spinal injuries resulting from low speed rear impact collisions, as the NASS-CDS samples fewer than 1 in 100,000 of the cervical spine injuries of any type occurring in low speed rear impact collisions.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Bases de Dados Factuais/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos da Medula Espinal/epidemiologia , Vértebras Cervicais/lesões , Estudos Transversais , Feminino , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/epidemiologia , Masculino , Fraturas da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia , Traumatismos em Chicotada/epidemiologia
18.
World Neurosurg ; 139: 526-534, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360928

RESUMO

BACKGROUND: Patient counseling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remain debatable. We aimed to develop a clinical calculator predicting the risk of nonhome discharge and reoperation using the American College of Surgeons-National Surgical Quality Improvement Program database. METHODS: The database from years 2011 through 2017 was queried to identify the subset of CM-1 patients undergoing suboccipital decompression. Univariable analysis was conducted to identify baseline factors associated with nonhome discharge and 30-day reoperation following the initial decompression procedure. Logistic regression and the Akaike Information Criterion were used to identify the optimal models predictive of both outcomes. Performance was assessed using receiver operating curves and validated with bootstrapping. RESULTS: In 706 CM-1 patients, the rate of nonhome discharge was 5.2% and the reoperation rate was 6.6% with most reoperations consisting of cerebrospinal fluid flow diversion and cerebrospinal fluid leak repair. The optimal model predictive of nonhome discharge consisted of age (odds ratio [OR] = 1.05, P = 0.001), diabetes (OR = 2.44, P = 0.080), and American Society of Anesthesiologists class (OR = 1.94, P = 0.082) with an area under the curve of 0.720. The optimal model predictive of reoperation consisted of female sex (OR = 0.48, P = 0.031), body mass index (OR = 1.05, P = 0.002), and ASA class (OR = 3.44, P = 0.001) with an area under the curve of 0.726. A calculator for both outcomes was deployed under the following URL: https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/. CONCLUSIONS: We have used a large international database to develop a simple risk calculator based on readily available preoperative variables. Following subsequent validation, this tool can help optimize patient counseling and decision making in adult CM-1.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Bases de Dados Factuais/normas , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/normas , Internacionalidade , Lobo Occipital/cirurgia , Adulto , Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/epidemiologia , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Readmissão do Paciente/normas , Reoperação/efeitos adversos , Reoperação/métodos , Reoperação/normas , Medição de Risco/normas
19.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320996

RESUMO

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Assuntos
Bases de Dados Factuais , Oftalmologia/educação , Estudantes de Medicina , Adulto , Idoso , Estudos Transversais , Bases de Dados Factuais/normas , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmologia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
20.
Am J Hum Genet ; 106(5): 679-693, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330416

RESUMO

Accurate construction of polygenic scores (PGS) can enable early diagnosis of diseases and facilitate the development of personalized medicine. Accurate PGS construction requires prediction models that are both adaptive to different genetic architectures and scalable to biobank scale datasets with millions of individuals and tens of millions of genetic variants. Here, we develop such a method called Deterministic Bayesian Sparse Linear Mixed Model (DBSLMM). DBSLMM relies on a flexible modeling assumption on the effect size distribution to achieve robust and accurate prediction performance across a range of genetic architectures. DBSLMM also relies on a simple deterministic search algorithm to yield an approximate analytic estimation solution using summary statistics only. The deterministic search algorithm, when paired with further algebraic innovations, results in substantial computational savings. With simulations, we show that DBSLMM achieves scalable and accurate prediction performance across a range of realistic genetic architectures. We then apply DBSLMM to analyze 25 traits in UK Biobank. For these traits, compared to existing approaches, DBSLMM achieves an average of 2.03%-101.09% accuracy gain in internal cross-validations. In external validations on two separate datasets, including one from BioBank Japan, DBSLMM achieves an average of 14.74%-522.74% accuracy gain. In these real data applications, DBSLMM is 1.03-28.11 times faster and uses only 7.4%-24.8% of physical memory as compared to other multiple regression-based PGS methods. Overall, DBSLMM represents an accurate and scalable method for constructing PGS in biobank scale datasets.


Assuntos
Bases de Dados Factuais/normas , Conjuntos de Dados como Assunto/normas , Herança Multifatorial , Teorema de Bayes , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Humanos , Modelos Lineares , Masculino , Polimorfismo de Nucleotídeo Único , Reprodutibilidade dos Testes , Tamanho da Amostra , Reino Unido
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