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2.
RECIIS (Online) ; 14(3): 524-528, jul.-set. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1121406

RESUMO

Los registros médicos han ido transformándose desde ser exclusivamente basados en papel a ser, en muchos casos, exclusivamente digitales. Este cambio se ha dado gradualmente: inicialmente aislados del sistema local o nacional de información en salud y luego en proceso de integración o ya completamente interconectados con todo el sistema. Esto fue gracias al acceso de la sociedad a sistemas electrónicos que pueden comunicarse e intercambiar datos entre sí de manera ágil y tecnológicamente interoperable. Existen sin embargo aún grandes retos sobre cómo lograr esta interoperabilidad, así como el establecimiento de la seguridad, privacidad y confidencialidad de los datos; sin embargo, los registros médicos en formato digital son hoy una poderosa e indispensable herramienta para la toma de decisiones, la formulación de políticas y la adecuada gestión de la salud pública.


Os prontuários médicos foram se transformando desde ser exclusivamente em papel para ser, em muitos casos, exclusivamente digitais. Essa mudança tem acontecido gradativamente: inicialmente isolada do sistema local ou nacional de informação em saúde e depois em processo de integração ou já totalmente interligada a todo o sistema. Isso graças ao acesso da sociedade a sistemas eletrônicos que podem se comunicar e trocar dados de forma ágil e tecnologicamente interoperável. No entanto, ainda existem grandes desafios para atingir essa interoperabilidade, bem como o estabelecimento da segurança, privacidade e confidencialidade dos dados; entretanto, os prontuários em formato digital são hoje uma ferramenta poderosa e indispensável para a tomada de decisões, a formulação de políticas e a gestão adequada da saúde pública.


Medical records have been transforming from exclusively paper-based into, in many cases, exclusively digital. This change has occurred gradually: initially isolated from the local or national health information system and then in the integration process or already completely interconnected with the entire system. This is due to the society's access to electronic systems that can communicate and exchange data with each other in an agile and technologically interoperable way. However, there are still great challenges on how to achieve this interoperability and to establish data security, privacy, and confidentiality; however, medical records in digital format are today a powerful and indispensable tool for decision-making, policy formulation, and proper public health management.


Assuntos
Humanos , Alfabetização Digital , Registros Médicos , Confidencialidade , Saúde Pública , Informação , Pandemias , Confiabilidade dos Dados , Gerenciamento de Dados
3.
Ther Innov Regul Sci ; 54(5): 1236-1255, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32865809

RESUMO

Two phase-III, double-blind, randomized clinical trials of remdesivir plus SOC (standard of care) versus placebo plus SOC have been conducted in Wuhan hospitals by Chinese investigators during the urgent COVID-19 epidemic [ClincalTrials.gov NCT04257656 and NCT04252664]. These trials have been highly anticipated worldwide. We expect investigators of the trials will soon report the clinical and laboratory findings from the medical perspective. This manuscript provides documentary style information on the process of monitoring key data and making recommendations to the sponsor and investigators based on analytical insights when dealing with the emergent situation from the statistical viewpoint. Having monitored data sequentially from 237 patients, we comment on the strength and weakness of the study design and suggest the treatment effect of remdesivir on severe COVID-19 cases. Our experience with using the Dynamic Data Monitoring (DDM) tool has demonstrated its efficiency and reliability in supporting DSMB's instantaneous review of essential data during the emergent situation. DDM, when used properly by disciplined statisticians, has shown its capability of exploring the trial data flexibly and, in the meantime, protecting the trial's scientific integrity.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Ensaios Clínicos Fase III como Assunto , Infecções por Coronavirus/tratamento farmacológico , Confiabilidade dos Dados , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/uso terapêutico , Alanina/efeitos adversos , Alanina/uso terapêutico , Antivirais/efeitos adversos , Betacoronavirus/patogenicidade , China , Comitês de Monitoramento de Dados de Ensaios Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Tempo , Resultado do Tratamento
4.
BMC Infect Dis ; 20(1): 652, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894059

RESUMO

BACKGROUND: Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method's performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angus' and Martin's methods. METHOD: In this single centre retrospective study we applied our sepsis surveillance method on adult patients admitted to a tertiary hospital in Hong Kong. Two clinicians independently reviewed the clinical notes to determine which patients had sepsis. Performance was assessed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of Angus', Martin's and our surveillance methods using clinical review as "gold standard." RESULTS: Between January 1 and February 28, 2018, our sepsis surveillance method identified 1352 adult patients hospitalised with suspected infection. We found that 38.9% (95%CI 36.3-41.5) of these patients had sepsis. Using a 490 patient validation cohort, two clinicians had good agreement with weighted kappa of 0.75 (95% CI 0.69-0.81) before coming to consensus on diagnosis of uncomplicated infection or sepsis for all patients. Our method had sensitivity 0.93 (95%CI 0.89-0.96), specificity 0.86 (95%CI 0.82-0.90) and an AUC 0.90 (95%CI 0.87-0.92) when validated against clinician review. In contrast, Angus' and Martin's methods had AUCs 0.56 (95%CI 0.53-0.58) and 0.56 (95%CI 0.52-0.59), respectively. CONCLUSIONS: A sepsis surveillance method based on objective data from a population EHR in Hong Kong was more accurate than administrative methods. It may be used to estimate sepsis population incidence and outcomes in Hong Kong. TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov on October 3, 2019 ( NCT04114214 ).


Assuntos
Registros Eletrônicos de Saúde , Monitoramento Epidemiológico , Carga Global da Doença/métodos , Sepse/diagnóstico , Sepse/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Confiabilidade dos Dados , Estudos de Viabilidade , Feminino , Hong Kong/epidemiologia , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/mortalidade , Centros de Atenção Terciária
5.
BMC Infect Dis ; 20(1): 657, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894079

RESUMO

BACKGROUND: Tuberculosis is still a significant diagnostic and therapeutic challenge with high proportion of smear- and culture- negative incidences worldwide. The conventional diagnostic tests are time-consuming and have a low sensitivity. Digital PCR is a novel technology which can detect target sequences with relatively low abundance and obtain the absolute copy numbers of the targets. METHODS: We assessed the accuracy of dPCR in TB diagnosis using more than 250 specimens, and for the first time, we selected M.tuberculosis-specific IS1081 in addition to widely used IS6110 as the amplification targets for dPCR. The quantification of target DNA was calculated using QuantaSoft Version 1.7.4.0917 (BioRad), and SPSS version 13.0 software (SPSS Inc., Chicago, IL, USA) was used for statistical analyses. RESULTS: IS6110-dPCR was more sensitive than IS1081, with the sensitivity and specificity accounting for 40.6 and 93.4% respectively. When we classified the TB patients by personal factors for high copy number of M.tuberculosis derived DNA in plasma: bilateral TB, extrapulmonary TB and disseminated TB, the sensitivity of both IS6110- and IS1081- dPCR was the highest in patients with disseminated TB (IS6110, 100%; IS1081, 68.8%), while their sensitivity was a bit higher in patients with extrapulmonary TB (IS6110, 50.0%; IS1081, 39.3%) than that in bilateral TB (IS6110, 43.3%; IS1081, 33.3%). Compared with traditional TB diagnostic tests, joint detection IS6110 & IS1081-dPCR was not as sensitive as smear microscope or mycobacterial culture, but it was higher than IS6110 qPCR (p < 0.05) and was able to detect 47.4% of smear-negative TB patients. CONCLUSION: Our study suggested that plasma IS6110-dPCR is a rapid, moderate accurate and less-invasive method to detect M.tuberculosis DNA in plasma of TB patients and IS6110 & IS1081-dPCR has a potential to aid diagnosis of smear-negative TB.


Assuntos
Elementos de DNA Transponíveis/genética , DNA Bacteriano/genética , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , DNA Bacteriano/sangue , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
7.
BMC Infect Dis ; 20(1): 718, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993559

RESUMO

BACKGROUND: Schistosoma antigen detection in urine is a valuable diagnostic approach for schistosomiasis control programmes because of the higher sensitivity compared to parasitological methods and preferred sampling of urine over stool. Highly accurate diagnostics are important in low Schistosoma transmission areas. Pregnant women and young children could particularly benefit from antigen testing as praziquantel (PZQ) can be given to only confirmed Schistosoma cases. This prevents the unborn baby from unnecessary exposure to PZQ. We present here the protocol of a diagnostic study that forms part of the freeBILy project. The aim is to evaluate the accuracy of circulating anodic antigen (CAA) detection for diagnosis of Schistosoma haematobium infections in pregnant women and to validate CAA as an endpoint measure for anti-Schistosoma drug efficacy. The study will also investigate Schistosoma infections in infants. METHODS: A set of three interlinked prospective, observational studies is conducted in Gabon. The upconverting phosphor lateral flow (UCP-LF) CAA test is the index diagnostic test that will be evaluated. The core trial, sub-study A, comprehensively evaluates the accuracy of the UCP-LF CAA urine test against a set of other Schistosoma diagnostics in a cross-sectional trial design. Women positive for S. haematobium will proceed with sub-study B and will be randomised to receive PZQ treatment immediately or after delivery followed by weekly sample collection. This approach includes comparative monitoring of CAA levels following PZQ intake and will also contribute further data for safety of PZQ administration during pregnancy. Sub-study C is a longitudinal study to determine the incidence of S. haematobium infection as well as the age for first infection in life-time. DISCUSSION: The freeBILy trial in Gabon will generate a comprehensive set of data on the accuracy of the UCP-LF CAA test for the detection of S. haematobium infection in pregnant women and newborn babies and for the use of CAA as a marker to determine PZQ efficacy. Furthermore, incidence of Schistosoma infection in infants will be reported. Using the ultrasensitive diagnostics, this information will be highly relevant for Schistosoma prevalence monitoring by national control programs as well as for the development of medicaments and vaccines. TRIAL REGISTRATION: The registration number of this study is NCT03779347 ( clinicaltrials.gov , date of registration: 19 December 2018).


Assuntos
Antígenos de Helmintos/análise , Testes Imunológicos/métodos , Schistosoma haematobium/imunologia , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Pré-Escolar , Estudos Transversais , Confiabilidade dos Dados , Feminino , Seguimentos , Gabão/epidemiologia , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Praziquantel/uso terapêutico , Gravidez , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Schistosoma haematobium/genética , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/parasitologia
8.
PLoS One ; 15(8): e0237155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866200

RESUMO

BACKGROUND: Stringent complete response (sCR) is used as a deeper response category than complete response (CR) in multiple myeloma (MM) but may be of limited value in the era of minimal residual disease (MRD) testing. METHODS: Here, we used 4-colour multiparametric flow cytometry (MFC) or next-generation sequencing (NGS) of immunoglobulin genes to analyse and compare the prognostic impact of sCR and MRD monitoring. We included 193 treated patients in two institutions achieving CR, for which both bone marrow aspirates and biopsies were available. RESULTS: We found that neither the serum free light chain ratio, clonality by immunohistochemistry (IHC) nor plasma cell bone marrow infiltration identified CR patients at distinct risk. Patients with sCR had slightly longer progression-free survival. Nevertheless, persistent clonal bone marrow disease was detectable using MFC or NGS and was associated with significantly inferior outcomes compared with MRD-negative cases. CONCLUSION: Our results confirm that sCR does not predict a different outcome and indicate that more sensitive techniques are able to identify patients with differing prognoses. We suggest that MRD categories should be implemented over sCR for the future classification of MM responses.


Assuntos
Mieloma Múltiplo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Confiabilidade dos Dados , Feminino , Citometria de Fluxo/métodos , Seguimentos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Cadeias Leves de Imunoglobulina/sangue , Cadeias Leves de Imunoglobulina/genética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Plasmócitos/imunologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos
9.
BMJ Open ; 10(9): e040487, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912996

RESUMO

OBJECTIVE: To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries. DESIGN: Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association (JAMA) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public. DATA SOURCES: Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information. RESULTS: Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001). CONCLUSION: This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.


Assuntos
Infecções por Coronavirus , Internet/normas , Pandemias , Pneumonia Viral , Informática em Saúde Pública , Betacoronavirus , Informação de Saúde ao Consumidor/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Confiabilidade dos Dados , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Informática em Saúde Pública/métodos , Informática em Saúde Pública/normas , Informática em Saúde Pública/tendências
10.
Trials ; 21(1): 784, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917258

RESUMO

The COVID-19 pandemic has presented unique challenges for the clinical trial community, both in the rapid establishment of COVID-19 clinical trials and many existing non-COVID-19 studies either being temporarily paused (whether that is a complete pause or pause in some activities) and/or adapting their processes. Trial managers have played a key role in decision-making, undertaking risk assessments and adapting trial processes, working closely with other members of the research team. This article presents some of the ways in which trial management processes have been altered and the key role that trial managers have played. It has been born out of discussions between trial managers in the UK who are members of the UK Trial Managers' Network (UKTMN), a national network of trial management professionals managing non-commercial trials.In these unprecedented times, clinical trials have faced many uncertainties and broad-ranging challenges encompassing a range of activities including prioritising patient safety amidst the pandemic, consenting and recruiting new participants into trials, data collection and management and intervention delivery. In many cases, recruitment has been paused whilst mitigations have been put in place to continue data collection. Innovative solutions have been implemented to ensure we continue, where possible, to deliver high-quality clinical trials. Technology has provided many solutions to these challenges, and trial managers have adapted to new ways of working whilst continuing to deliver their clinical trials. Trial management groups are now faced with new uncertainties around re-starting clinical trials, and it is unclear currently how this will go, though working together with sponsors, funders and site teams is clearly a priority.Clinical trial teams have worked together to ensure their trials have adapted quickly whilst ensuring participant safety is given utmost importance. There are clear examples where the trial community have come together to share experiences and expertise, and this should continue in the future to ensure the innovative practices developed become embedded in the design and conduct of clinical trials in the future.


Assuntos
Ensaios Clínicos como Assunto/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Projetos de Pesquisa , Betacoronavirus/patogenicidade , Comitês de Monitoramento de Dados de Ensaios Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Confiabilidade dos Dados , Coleta de Dados , Interações Hospedeiro-Patógeno , Humanos , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Fluxo de Trabalho
11.
Nat Commun ; 11(1): 4553, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917902

RESUMO

Eye tracking has been widely used for decades in vision research, language and usability. However, most prior research has focused on large desktop displays using specialized eye trackers that are expensive and cannot scale. Little is known about eye movement behavior on phones, despite their pervasiveness and large amount of time spent. We leverage machine learning to demonstrate accurate smartphone-based eye tracking without any additional hardware. We show that the accuracy of our method is comparable to state-of-the-art mobile eye trackers that are 100x more expensive. Using data from over 100 opted-in users, we replicate key findings from previous eye movement research on oculomotor tasks and saliency analyses during natural image viewing. In addition, we demonstrate the utility of smartphone-based gaze for detecting reading comprehension difficulty. Our results show the potential for scaling eye movement research by orders-of-magnitude to thousands of participants (with explicit consent), enabling advances in vision research, accessibility and healthcare.


Assuntos
Confiabilidade dos Dados , Medições dos Movimentos Oculares , Movimentos Oculares , Smartphone , Adolescente , Adulto , Compreensão , Feminino , Fixação Ocular , Humanos , Masculino , Pessoa de Meia-Idade , Leitura , Visão Ocular , Percepção Visual , Adulto Jovem
12.
Medicine (Baltimore) ; 99(36): e22034, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899060

RESUMO

BACKGROUND: As a novel ultrasound technique, superb microvascular imaging can quickly, simply and noninvasively study the microvascular distribution in the tumor and evaluate the microvascular perfusion. Studies suggested that superb microvascular imaging is helpful for the differentiation between benign and malignant lymph nodes. However, the results of these studies have been contradictory. Therefore, the present meta-analysis aimed at determining the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the July 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS: This systematic review will determine the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. CONCLUSION: Its findings will provide helpful evidence for the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. SYSTEMATIC REVIEW REGISTRATION: INPLASY202070133.


Assuntos
Linfonodos/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Ultrassonografia/métodos , Confiabilidade dos Dados , Diagnóstico Diferencial , Testes Diagnósticos de Rotina , Humanos , Linfonodos/irrigação sanguínea , Linfonodos/patologia , Ultrassonografia/tendências
13.
PLoS One ; 15(7): e0236386, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735581

RESUMO

This paper proposes a dynamic model to describe and forecast the dynamics of the coronavirus disease COVID-19 transmission. The model is based on an approach previously used to describe the Middle East Respiratory Syndrome (MERS) epidemic. This methodology is used to describe the COVID-19 dynamics in six countries where the pandemic is widely spread, namely China, Italy, Spain, France, Germany, and the USA. For this purpose, data from the European Centre for Disease Prevention and Control (ECDC) are adopted. It is shown how the model can be used to forecast new infection cases and new deceased and how the uncertainties associated to this prediction can be quantified. This approach has the advantage of being relatively simple, grouping in few mathematical parameters the many conditions which affect the spreading of the disease. On the other hand, it requires previous data from the disease transmission in the country, being better suited for regions where the epidemic is not at a very early stage. With the estimated parameters at hand, one can use the model to predict the evolution of the disease, which in turn enables authorities to plan their actions. Moreover, one key advantage is the straightforward interpretation of these parameters and their influence over the evolution of the disease, which enables altering some of them, so that one can evaluate the effect of public policy, such as social distancing. The results presented for the selected countries confirm the accuracy to perform predictions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Previsões/métodos , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Doenças Assintomáticas , China/epidemiologia , Infecções Comunitárias Adquiridas , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Infecção Hospitalar , Confiabilidade dos Dados , Europa (Continente)/epidemiologia , Hospitalização , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estados Unidos/epidemiologia
14.
PLoS One ; 15(8): e0237418, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790779

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has crudely demonstrated the need for massive and rapid diagnostics. By the first week of July, more than 10,000,000 positive cases of COVID-19 have been reported worldwide, although this number could be greatly underestimated. In the case of an epidemic emergency, the first line of response should be based on commercially available and validated resources. Here, we demonstrate the use of the miniPCR, a commercial compact and portable PCR device recently available on the market, in combination with a commercial well-plate reader as a diagnostic system for detecting genetic material of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of COVID-19. We used the miniPCR to detect and amplify SARS-CoV-2 DNA sequences using the sets of initiators recommended by the World Health Organization (WHO) for targeting three different regions that encode for the N protein. Prior to amplification, samples were combined with a DNA intercalating reagent (i.e., EvaGreen Dye). Sample fluorescence after amplification was then read using a commercial 96-well plate reader. This straightforward method allows the detection and amplification of SARS-CoV-2 nucleic acids in the range of ~625 to 2×105 DNA copies. The accuracy and simplicity of this diagnostics strategy may provide a cost-efficient and reliable alternative for COVID-19 pandemic testing, particularly in underdeveloped regions where RT-QPCR instrument availability may be limited. The portability, ease of use, and reproducibility of the miniPCR makes it a reliable alternative for deployment in point-of-care SARS-CoV-2 detection efforts during pandemics.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase/instrumentação , Reação em Cadeia da Polimerase/métodos , Sequência de Bases , Betacoronavirus/química , Infecções por Coronavirus/virologia , DNA Viral/genética , Confiabilidade dos Dados , Humanos , Proteínas do Nucleocapsídeo/genética , Pandemias , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase/economia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
J Med Syst ; 44(9): 170, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32794042

RESUMO

For COVID-19, predictive modeling, in the literature, uses broadly SEIR/SIR, agent-based, curve-fitting techniques/models. Besides, machine-learning models that are built on statistical tools/techniques are widely used. Predictions aim at making states and citizens aware of possible threats/consequences. However, for COVID-19 outbreak, state-of-the-art prediction models are failed to exploit crucial and unprecedented uncertainties/factors, such as a) hospital settings/capacity; b) test capacity/rate (on a daily basis); c) demographics; d) population density; e) vulnerable people; and f) income versus commodities (poverty). Depending on what factors are employed/considered in their models, predictions can be short-term and long-term. In this paper, we discuss how such continuous and unprecedented factors lead us to design complex models, rather than just relying on stochastic and/or discrete ones that are driven by randomly generated parameters. Further, it is a time to employ data-driven mathematically proved models that have the luxury to dynamically and automatically tune parameters over time.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Previsões , Modelos Estatísticos , Pandemias , Pneumonia Viral , Confiabilidade dos Dados , Surtos de Doenças , Humanos , Aprendizado de Máquina
16.
BMC Infect Dis ; 20(1): 571, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758162

RESUMO

BACKGROUND: The incidence of cryptococcal meningitis (CM) has gradually increased in recent years. Cerebrospinal fluid (CSF) cytology and cell count are very important for CM on etiology diagnosis and assessment of disease status and therapeutic response. However, the clinical significance of CSF white cell count (WCC) in CM patients is not fully understood. Using longitudinal data of CSF WCC and its relationship with clinical outcomes in CM patients, we aimed to elucidate the clinical significance of this test. METHODS: We retrospectively analyzed the medical records of 150 CM patients admitted to our hospital between January 2008 and December 2018. RESULTS: CM patients with lower baseline CSF WCC, CSF protein concentration or CD4/CD8 ratio, and those with altered mentation or HIV coinfection were more likely to have poor clinical outcome (P<0.05). CM patients with triple therapy during the induction period presented with a better clinical outcome (P<0.05). Baseline CSF WCC had a moderate positive correlation with peripheral CD4+ T lymphocyte count (r = 0.738, P < 0.001) and CD4+ T lymphocyte percentage (r = 0.616, P < 0.001). The best cut-off value to predict a poor clinical outcome was 40 cells/µL during baseline CSF WCC. The predictive model incorporating longitudinal data of CSF WCC had better sensitivity, specificity, and accuracy than a model incorporating only baseline CSF WCC data. CONCLUSIONS: Our results indicated that baseline CSF WCC and changes in CSF WCC over time could be used to assess the prognosis of CM patients.


Assuntos
Relação CD4-CD8/métodos , Cryptococcus neoformans , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/diagnóstico , Adulto , Antirretrovirais/uso terapêutico , Antifúngicos/uso terapêutico , China , Confiabilidade dos Dados , Feminino , Previsões/métodos , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(34): e21914, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846858

RESUMO

We aimed to evaluate the accuracy and interchangeability of stroke volume and cardiac output measured by electrical velocimetry and transthoracic echocardiography during cesarean delivery.We enrolled 20 parturients in this prospective observational study. We recorded the stroke volume and cardiac output using both methods and compared the values at seven specific time points. We analyzed the data using linear regression analysis for Pearson's correlation coefficients and Bland-Altman analysis to determine percentage errors. We conducted a trending ability analysis based on the four-quadrant plot with the concordance rate and correlation coefficient.We recorded 124 paired datasets during cesarean delivery. The correlation coefficients of the measured cardiac output and stroke volume between the two methods were 0.397 (P < .001) and 0.357 (P < .001). The 95% limits of agreement were -1.0 to 8.1 L min for cardiac output and -10.4 to 90.4 ml for stroke volume. Moreover, the corresponding percentage errors were 62% and 60%. The concordance correlation coefficients were 0.447 (95% CI: 0.313-0.564) for stroke volume and 0.562 (95% CI: 0.442-0.662) for cardiac output. Both methods showed a moderate trending ability for stroke volume (concordance rate: 82% (95% CI: 72-90%)) and cardiac output (concordance rate: 85% (95% CI: 78-93%)).Our findings indicated that electrical velocimetry monitoring has limited accuracy, precision, and interchangeability with transthoracic echocardiography; however, it had a moderate trending ability for stroke volume and cardiac output measurements during cesarean delivery.


Assuntos
Débito Cardíaco , Cesárea/métodos , Ecocardiografia/métodos , Reologia/métodos , Adulto , Algoritmos , China/epidemiologia , Confiabilidade dos Dados , Ecocardiografia/estatística & dados numéricos , Feminino , Hemodinâmica , Humanos , Monitorização Intraoperatória/instrumentação , Gravidez , Estudos Prospectivos , Reologia/estatística & dados numéricos , Volume Sistólico
18.
Sci Rep ; 10(1): 14042, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32820210

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in thousands of deaths in the world. Information about prediction model of prognosis of SARS-CoV-2 infection is scarce. We used machine learning for processing laboratory findings of 110 patients with SARS-CoV-2 pneumonia (including 51 non-survivors and 59 discharged patients). The maximum relevance minimum redundancy (mRMR) algorithm and the least absolute shrinkage and selection operator logistic regression model were used for selection of laboratory features. Seven laboratory features selected in the model were: prothrombin activity, urea, white blood cell, interleukin-2 receptor, indirect bilirubin, myoglobin, and fibrinogen degradation products. The signature constructed using the seven features had 98% [93%, 100%] sensitivity and 91% [84%, 99%] specificity in predicting outcome of SARS-CoV-2 pneumonia. Thus it is feasible to establish an accurate prediction model of outcome of SARS-CoV-2 pneumonia based on laboratory findings.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/sangue , Modelos Estatísticos , Pneumonia Viral/sangue , Idoso , Bilirrubina/sangue , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Confiabilidade dos Dados , Estudos de Viabilidade , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Previsões/métodos , Humanos , Leucócitos , Aprendizado de Máquina , Masculino , Mioglobina/sangue , Pandemias , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , Protrombina/análise , Receptores de Interleucina-2/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Ureia/sangue
19.
Int J Health Plann Manage ; 35(5): 1009-1013, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32744745

RESUMO

Having an accurate account of the number of national COVID-19 cases is essential for understanding the national and global burden of the disease and managing COVID-19 prevention and control efforts. There is also substantial under-reporting of COVID-19 cases and deaths in many countries. In this article, the COVID-19 under-reporting problem in Turkey is addressed, and examples and reasons for the under-reporting are discussed.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Confiabilidade dos Dados , Humanos , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Turquia/epidemiologia
20.
Nat Commun ; 11(1): 3923, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32782264

RESUMO

Machine learning promises to revolutionize clinical decision making and diagnosis. In medical diagnosis a doctor aims to explain a patient's symptoms by determining the diseases causing them. However, existing machine learning approaches to diagnosis are purely associative, identifying diseases that are strongly correlated with a patients symptoms. We show that this inability to disentangle correlation from causation can result in sub-optimal or dangerous diagnoses. To overcome this, we reformulate diagnosis as a counterfactual inference task and derive counterfactual diagnostic algorithms. We compare our counterfactual algorithms to the standard associative algorithm and 44 doctors using a test set of clinical vignettes. While the associative algorithm achieves an accuracy placing in the top 48% of doctors in our cohort, our counterfactual algorithm places in the top 25% of doctors, achieving expert clinical accuracy. Our results show that causal reasoning is a vital missing ingredient for applying machine learning to medical diagnosis.


Assuntos
Confiabilidade dos Dados , Diagnóstico , Aprendizado de Máquina , Algoritmos , Teorema de Bayes , Coleta de Dados , Tomada de Decisões , Diagnóstico por Computador , Doença , Humanos , Modelos Estatísticos
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