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1.
Praxis (Bern 1994) ; 109(2): 97-103, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019458

RESUMO

Fitness to Drive from a Neuropsychological Point of View Abstract. Driving a car is an important issue for many people concerning participation in social and professional life. On the other hand, there is the need of society for a high level of security in road traffic. Neuropsychological deficits as a result of different neurological diseases can affect the fitness to drive for a certain time or permanently. In this article, we first provide a brief description of the legal framework. In the following section we summarize aspects of the driving behavior of different neurological patient groups and give an overview of procedures of neuropsychological examination and evaluation of fitness to drive. Apart from the psychometric methods there will also be a focus on the meaning of compensation and awareness. Finally, various treatment options are presented.


Assuntos
Condução de Veículo , Definição da Elegibilidade , Testes Neuropsicológicos , Conscientização , Exercício , Humanos , Psicometria
2.
N C Med J ; 81(1): 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908336

RESUMO

Medicaid is an essential source of health coverage that finances more than half of all births in North Carolina. This paper examines current eligibility for pregnant women and its impacts on health outcomes for mothers and children. The authors provide suggestions to increase access to this vital health insurance program and better promote the health of North Carolina's families.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid , Criança , Saúde da Criança , Definição da Elegibilidade , Feminino , Humanos , Saúde Materna , North Carolina , Gravidez , Estados Unidos
4.
Health Serv Res ; 54(6): 1233-1245, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31576563

RESUMO

OBJECTIVE: To examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. DATA SOURCE: 2010-2013 Medicare Current Beneficiary Survey. STUDY DESIGN: Retrospective analyses of survey-reported health and socioeconomic status (SES) measures among low-income Medicare beneficiaries and low-income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between-state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. PRINCIPAL FINDINGS: Between-state differences in health and socioeconomic risk among low-income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between-state differences were comparable among the subset of low-income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. CONCLUSIONS: Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies. Risk-adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state-level heterogeneity.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Definição da Elegibilidade/normas , Medicaid/estatística & dados numéricos , Medicaid/normas , Medicare/estatística & dados numéricos , Medicare/normas , Risco Ajustado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Governo Estadual , Estados Unidos
5.
BMC Cancer ; 19(1): 863, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470823

RESUMO

BACKGROUND: Most clinical trials on colorectal cancer (CRC) exclude cases who have history of a prior malignancy. However, no prior research studied this history's actual impact on the survival of CRC. In the paper, we study the effects of having a malignancy preceding CRC diagnosis on its survival outcomes. METHODS: CRC patients diagnosed during 1973-2008 were reviewed using the SEER 18 database. We calculated overall survival and cancer-specific survival of subsequent CRC, and more specifically stage IV CRC, using Kaplan-Meier test and adjusted Cox models. RESULTS: A total 550,325 CRC patients were reviewed, of whom 31,663 had history of a prior malignancy. The most commonly reported sites of a prior malignancy were: prostate, breast, urinary bladder, lung, and endometrium. Patients with history of a prior non-leukemic malignancy or history of a prior leukemia were found to have worse overall survival (HR = 1.165 95%CI = 1.148-1.183, P < 0.001) and (HR = 1.825 95%CI = 1.691-1.970, P < 0.001), respectively. However, CRC patients with history of a prior non-leukemic malignancy showed an improved colorectal cancer-specific survival (HR = .930 95%CI = .909-.952, P < 0.001). Analysis of stage IV CRC patients showed that patients with history of any non-leukemic malignancy did not have a significant change in overall survival. Whereas, patients with a prior leukemia showed a worse overall survival (HR = 1.535, 95%CI = 1.303-1.809, P < 0.001). When analyzed separately, right CRC and left CRC showed similar survival patterns. CONCLUSION: A prior malignancy before CRC -in general- can be associated with worse clinical survival outcomes. These worse outcomes are not observed in stage IV CRC. Considering these results when including/excluding stage IV CRC patients with prior malignancies in clinical trials may play help improve their generalizability.


Assuntos
Ensaios Clínicos como Assunto/métodos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Leucemia/epidemiologia , Definição da Elegibilidade , Feminino , Humanos , Leucemia/complicações , Masculino , Estadiamento de Neoplasias , Seleção de Pacientes , Projetos de Pesquisa , Estudos Retrospectivos , Programa de SEER , Análise de Sobrevida
6.
Health Serv Res ; 54(6): 1166-1173, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31385302

RESUMO

OBJECTIVE/STUDY QUESTION: To examine changes in uninsurance rates among U.S. adolescents ages 12-17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. DATA SOURCES/STUDY SETTING: 2007-2016 National Health Insurance Survey (NHIS). STUDY DESIGN: Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. PRINCIPAL FINDINGS: Across all 12- to 17-year-olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish-speaking households saw declines in their adjusted uninsurance rate that was proportional to non-Latino and English-speaking youth. CONCLUSIONS: Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish-speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity-focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.


Assuntos
Definição da Elegibilidade/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Adolescente , Criança , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos/etnologia
7.
JAMA ; 322(5): 422-429, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386135

RESUMO

Importance: Although independent charity patient assistance programs improve patient access to costly prescription drugs, recent federal investigations have raised questions about their potential to increase pharmaceutical spending and to violate the federal Anti-Kickback Statute. Little is known about the design of the programs, patient eligibility, or drug coverage. Objective: To examine the eligibility criteria of the independent charity patient assistance programs and the drugs covered by them. Design, Setting, and Participants: Descriptive cross-sectional study of the 6 largest independent charities offering patient assistance programs for patients including, but not limited to, Medicare beneficiaries in 2018. These charities offered 274 different disease-specific patient assistance programs. Drugs were identified for subgroup analysis that had any use reported on the Medicare Part D spending dashboard and any off-patent brand-name drugs that incurred more than $10 000 in Medicare spending per beneficiary in 2016. Exposures: Support by independent charity patient assistance programs. Main Outcomes and Measures: The primary outcomes were the characteristics of patient assistance programs, including assistance type, insurance coverage (vs uninsured), and income eligibility. The secondary outcomes were the cost of the drugs covered by the patient assistance programs and the coverage of expensive off-patent brand-name drugs vs substitutable generic drugs. Results: Among the 6 independent charity foundations included in the analysis, their total revenue in 2017 ranged from $24 million to $532 million, and expenditures on patient assistance programs ranged from $24 million to $353 million, representing on average, 86% of their revenue. Of the 274 patient assistance programs offered by these organizations, 168 (61%) provided only co-payment assistance, and the most common therapeutic area covered was cancer or cancer treatment-related symptoms (113 patient assistance programs; 41%). A total of 267 programs (97%) required insurance coverage as an eligibility criterion (ie, excluded uninsured patients). The most common income eligibility limit was 500% of the federal poverty level. The median annual cost of the drugs per beneficiary covered by the programs was $1157 (interquartile range, $247-$5609) compared with $367 (interquartile range, $100-$1500) for the noncovered drugs. Off-patent brand-name drugs (cost: >$10 000) were covered by a mean of 3.1 (SD, 2.0) patient assistance programs, whereas their generic equivalents were covered by a mean of 1.2 (SD, 1.0) patient assistance programs. Conclusions and Relevance: In 2018, among 274 patient assistance programs operated by the 6 independent charity foundations, the majority did not provide coverage for uninsured patients. Medications that were covered by the patient assistance programs were generally more expensive than those that were not covered.


Assuntos
Instituições de Caridade/economia , Definição da Elegibilidade , Renda , Pessoas sem Cobertura de Seguro de Saúde , Medicamentos sob Prescrição/economia , Instituições de Caridade/legislação & jurisprudência , Estudos Transversais , Custos de Medicamentos , Indústria Farmacêutica/economia , Gastos em Saúde , Humanos , Cobertura do Seguro , Assistência Médica/economia , Medicare Part D , Estados Unidos
8.
J Stroke Cerebrovasc Dis ; 28(11): 104315, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31409537

RESUMO

INTRODUCTION: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) can prevent severe disability and mortality. There is currently limited data on the epidemiology of LVO strokes and ET eligibility. We aim to determine the incidence of intracranial vessel occlusion (IVO) strokes eligible for ET per 2018 American Heart Association (AHA) guidelines and characteristics of an AHA ineligible population at a comprehensive stroke center (CSC). METHODS: Retrospective chart review of all consecutive AISs at a CSC between November 2014 and February 2017. Demographic, clinical, and radiographic data were analyzed to determine ET eligibility per AHA guidelines and characteristics of ineligible patients were investigated. RESULTS: Twenty-four percent of AIS harbor an IVO. Thirty percent of IVO strokes and 47% of anterior circulation LVO strokes are thrombectomy eligible per AHA guidelines. Most common reasons for thrombectomy ineligibility among IVO strokes are presence of IVO other than anterior circulation LVO (35%, n = 224), presence of large stroke burden (15%, n = 93), baseline modified Rankin scale greater than or equal to 2 (14%, n = 89), and NIHSS score less than 6 (15%, n = 96). CONCLUSIONS: At a CSC, 1 in 4 AISs harbor an IVO. Seven in 100 acute ischemic strokes, 3 in 10 strokes with vessel occlusion, and 1 in 2 strokes with internal carotid or middle cerebral artery M1 occlusion are thrombectomy eligible per AHA 2018 guidelines. These data highlight that current guidelines render a majority of strokes thrombectomy ineligible and a large window of opportunity exists for clinical investigation.


Assuntos
Isquemia Encefálica/terapia , Assistência Integral à Saúde , Definição da Elegibilidade , Trombose Intracraniana/terapia , Seleção de Pacientes , Acidente Vascular Cerebral/terapia , Trombectomia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Tomada de Decisão Clínica , Humanos , Incidência , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/epidemiologia , Pennsylvania/epidemiologia , Prevalência , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
9.
BMC Public Health ; 19(1): 1075, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395045

RESUMO

BACKGROUND: The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. METHODS: We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15-30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. RESULTS: Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. CONCLUSION: Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.


Assuntos
Serviços de Saúde Bucal/economia , Serviços de Saúde Bucal/estatística & dados numéricos , Definição da Elegibilidade/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Financiamento Governamental , Idoso , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Singapura
10.
Stud Health Technol Inform ; 264: 1476-1477, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438189

RESUMO

Automated extraction of patient trial eligibility for clinical research studies can increase enrollment at a decreased time and money cost. We have developed a modular trial eligibility pipeline including patient-batched processing and an internal webservice backed by a uimaFIT pipeline as part of a multi-phase approach to include note-batched processing, the ability to query trials matching patients or patients matching trials, and an external alignment engine to connect patients to trials.


Assuntos
Definição da Elegibilidade , Custos e Análise de Custo , Humanos , Seleção de Pacientes
11.
Int J Med Inform ; 129: 13-19, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445247

RESUMO

INTRODUCTION: Insufficient patient enrollment in clinical trials remains a serious and costly problem and is often considered the most critical issue to solve for the clinical trials community. In this project, we assessed the feasibility of automatically detecting a patient's eligibility for a sample of breast cancer clinical trials by mapping coded clinical trial eligibility criteria to the corresponding clinical information automatically extracted from text in the EHR. METHODS: Three open breast cancer clinical trials were selected by oncologists. Their eligibility criteria were manually abstracted from trial descriptions using the OHDSI ATLAS web application. Patients enrolled or screened for these trials were selected as 'positive' or 'possible' cases. Other patients diagnosed with breast cancer were selected as 'negative' cases. A selection of the clinical data and all clinical notes of these 229 selected patients was extracted from the MUSC clinical data warehouse and stored in a database implementing the OMOP common data model. Eligibility criteria were extracted from clinical notes using either manually crafted pattern matching (regular expressions) or a new natural language processing (NLP) application. These extracted criteria were then compared with reference criteria from trial descriptions. This comparison was realized with three different versions of a new application: rule-based, cosine similarity-based, and machine learning-based. RESULTS: For eligibility criteria extraction from clinical notes, the machine learning-based NLP application allowed for the highest accuracy with a micro-averaged recall of 90.9% and precision of 89.7%. For trial eligibility determination, the highest accuracy was reached by the machine learning-based approach with a per-trial AUC between 75.5% and 89.8%. CONCLUSION: NLP can be used to extract eligibility criteria from EHR clinical notes and automatically discover patients possibly eligible for a clinical trial with good accuracy, which could be leveraged to reduce the workload of humans screening patients for trials.


Assuntos
Definição da Elegibilidade , Automação , Neoplasias da Mama , Data Warehousing , Bases de Dados Factuais , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Processamento de Linguagem Natural , Seleção de Pacientes , Carga de Trabalho
12.
Trials ; 20(1): 422, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296253

RESUMO

BACKGROUND: Enrolling participants in clinical trials can be challenging, especially with respect to prophylactic vaccine trials. The vaccination of study personnel in Ebola vaccine trials during the 2014-2016 epidemic played a crucial role in inspiring trust and facilitating volunteer enrollment. We evaluated the ethical and methodological considerations as they applied to an ongoing phase 2 randomized prophylactic Ebola vaccine trial that enrolled healthy volunteers in Guinea, Liberia, Sierra Leone, and Mali in a non-epidemic context. METHODS: On the assumption that the personnel on site involved in executing the protocol, as well as community mobilizers (not involved in the on-site procedures), might also volunteer to enter the trial, we considered both ethical and methodological considerations to set clear rules that can be shared a priori with these persons. We reviewed the scientific and gray literature to identify relevant references and then conducted an analysis of the ethical and methodological considerations. RESULTS: There are currently no regulations preventing a clinical investigator or site staff from participating in a trial. However, the enrollment of personnel raises the risk of undue influence and challenges the basic ethical principle of voluntary participation. The confidentiality of personal medical information, such as HIV test results, may also be difficult to ensure among personnel. There is a risk of disruption of trial operations due to the potential absence of the personnel for their commitment as trial participants, and there is also a potential for introducing differential behavior of on-site staff as they obtain access to accumulating information during the trial (e.g., the incidence of adverse events). Blinding could be jeopardized, given knowledge of product-specific adverse event profiles and the proximity to unblinded site staff. These aspects were considered more relevant for on-site staff than for community mobilizers, who have limited contact with site staff. CONCLUSION: In a non-epidemic context, ethical and methodological considerations limit the collective benefit of enrolling site staff in a vaccine trial. These considerations do not apply to community mobilizers, whose potential enrollment should be considered as long as they meet the inclusion criteria and they are not exposed to any form of coercion.


Assuntos
Ensaios Clínicos Fase II como Assunto/normas , Vacinas contra Ebola/uso terapêutico , Doença pelo Vírus Ebola/prevenção & controle , Estudos Multicêntricos como Assunto/normas , Seleção de Pacientes , Guias de Prática Clínica como Assunto/normas , Pesquisadores/normas , Sujeitos da Pesquisa , África Ocidental , Atitude do Pessoal de Saúde , Ensaios Clínicos Fase II como Assunto/ética , Vacinas contra Ebola/efeitos adversos , Definição da Elegibilidade , Conhecimentos, Atitudes e Prática em Saúde , Doença pelo Vírus Ebola/imunologia , Doença pelo Vírus Ebola/virologia , Humanos , Estudos Multicêntricos como Assunto/ética , Seleção de Pacientes/ética , Pesquisadores/ética , Pesquisadores/psicologia , Sujeitos da Pesquisa/psicologia
14.
BMC Med Educ ; 19(1): 247, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277625

RESUMO

BACKGROUND: In Australia, the number of medical graduates per year has increased at a greater rate than the increase in the number of specialist training places. Consequently, competition for training positions is intensifying. There is anecdotal evidence to suggest that medical graduates are acquiring additional qualifications to compete with their peers Stevenson 2017 ( https://insightplus.mja.com.au/2017/36/specialty-training-places-the-other-looming-crisis/ ). Our study investigates this phenomenon of additional credentialing and demonstrates the number and type of postgraduate and research qualifications obtained by specialists in training in Australia. This is the first study to assess the number and type of credentials acquired by registrars in each specialty and to provide insight into differences between specialities. METHODS: Information on specialists in training was obtained through the Medicine in Australia: Balancing Employment and Life (MABEL) survey conducted between 2008 and 2014. The number of any additional qualifications and specific PhD, Master's degree, postgraduate diploma/certificate and research degrees from medical school were assessed for each specialist training scheme in the database. RESULTS: Overall, 995 registrars representing 13 specialties were included. Just under a third (30.4%) completed a research-based degree during their medical degree and almost half (46.7%) of specialist registrars obtained further qualifications after completing medicine. A significantly higher proportion of ophthalmology (78.6%) and paediatric (67.5%) registrars, and a lower percentage of emergency medicine (36.7%) registrars, held postgraduate qualifications. Overall, 2.4% of registrars held a PhD and 10.1% held a Master's degree. A higher percentage of either PhD or Master's was held by ophthalmology (64.3%) and surgical (30.6%) trainees and a lower percentage by anaesthetics (6.3%) and physician trainees (7.9%). Postgraduate diplomas or certificates were most common among paediatric (41.2%) and obstetrics and gynaecology (25.6%) registrars. CONCLUSION: This is the first study to investigate the additional qualifications of specialists in training in Australia. Almost half of specialists in training surveyed (46.7%) have completed some form of additional study, whether it is a PhD, Master's, postgraduate diploma/certificate or research degree from medical school. Trainees of specialist training schemes are more qualified than specialists who trained in the past Aust Fam Physician 32:92-4, 2003.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Definição da Elegibilidade , Especialização , Austrália , Estágio Clínico , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional , Humanos , Internato e Residência , Estudos Longitudinais , Modelos Educacionais , Especialização/estatística & dados numéricos
16.
Ann Surg Oncol ; 26(9): 2667-2674, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31168736

RESUMO

BACKGROUND: Complex general surgical oncology (CGSO) fellowships recently obtained Accreditation Council for Graduate Medical Education (ACGME) accreditation and board certification eligibility. We aimed to characterize the applicant pool and identify factors predictive of matching into our program. METHODS: We conducted a retrospective review of CGSO fellowship applications to a major cancer center from 2008 to 2018. Data were analyzed for trends over time, including a comparison of pre- versus post-American Board of Surgery (ABS) certification eligibility. RESULTS: A total of 846 applications were reviewed. Most applicants (86.2%) trained in a US residency program; 58.4% performed ≥ 1 research year during residency; 29.6% had a dual degree. Fewer applicants (34.5%) were female, a trend which did not change over time. Post-ABS, applicants were more likely to complete ≥ 1 year between residency and fellowship (20.9% versus 13.2%, p = 0.003), to be in practice at the time of application (12.2% versus 6.6%, p = 0.005), and to reapply (5.5% versus 1.0%, p < 0.001). Post-ABS applicants listed more peer-reviewed publications (8 [interquartile range (IQR) 4, 15] versus 5 [IQR 2, 10]; p < 0.001). On multivariable analysis, factors associated with matching into our program included: US allopathic medical school graduation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8-11.7], Alpha Omega Alpha (AOA) Honor Medical Society distinction (OR 2.7, 95% CI 1.6-4.7), dual degree (OR 2.0, 95% CI 1.1-3.4), and performance of a clinical/research rotation at our institution (OR 4.9, 95% CI 2.2-10.7). CONCLUSIONS: After establishment of CGSO board certification eligibility, applicants were more likely to apply while in practice and to reapply. A number of factors, including having a dual degree and rotating at our institution, were associated with matriculation.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Definição da Elegibilidade/estatística & dados numéricos , Bolsas de Estudo/normas , Internato e Residência/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/tendências , Oncologia Cirúrgica/normas , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Cirurgiões/provisão & distribução , Estados Unidos
17.
J Stroke Cerebrovasc Dis ; 28(8): 2268-2272, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31160220

RESUMO

BACKGROUND AND PURPOSE: Early disability after stroke is common, though many patients improve. Stroke secondary prevention trials often prohibit the recruitment of nonambulatory patients, limiting their access to potential treatment options and impeding trial enrollment. We aimed to determine outcomes after early dependence around the time of transition from acute care to recovery. METHODS: Data were obtained from a composite of patients enrolled in acute stroke clinical trials within the Virtual International Stroke Trials Archive (VISTA-Acute). Early disability was defined by the modified Rankin Scale (mRS) of 4 or 5 between days 3-10 after onset, representing the time of discharge or transition to a rehabilitation-focused care setting. We developed multivariable models to identify factors associated with recovery to independent ambulatory function and recurrent stroke during the 90 days after stroke. RESULTS: 4965 patients were included, with 2905 (59%) having early disability. Patients with early dependence were older, more likely to be women, had higher baseline NIHSS scores, and had more atrial fibrillation and diabetes mellitus, compared with those who were initially ambulatory. Recovery to ambulatory function occurred in 58% with early mRS = 4, compared to only 16% with early mRS = 5. Of those with early mRS = 4, return to independent ambulatory status by 90 days was associated in multivariable analysis with age, diabetes, prior stroke, NIH motor and gaze subscores, and thrombolysis. Recurrent ischemic stroke through day 90 was reported in 126 of 2905 (4.3%) subjects with early dependence compared to 63 of 2060 (3.1%), which was not different after adjustment for age, sex, and risk factors (odds ratio 1.27; 95% confidence interval 0.92-1.73). CONCLUSIONS: Favorable outcomes are common among ischemic stroke patients previously enrolled in acute clinical trials despite early dependence (mRS = 4) after initial acute hospital care. Further, their risk of recurrent stroke is high in the short term. These patients likely benefit from aggressive poststroke care and should be actively recruited into secondary prevention trials.


Assuntos
Ensaios Clínicos como Assunto/métodos , Avaliação da Deficiência , Definição da Elegibilidade , Seleção de Pacientes , Prevenção Secundária/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
Public Health ; 173: 42-47, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254676

RESUMO

OBJECTIVES: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. STUDY DESIGN: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). METHODS: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis. RESULTS: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. CONCLUSIONS: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Neoplasias/diagnóstico , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Idoso , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Definição da Elegibilidade , Feminino , Humanos , Seguro Saúde , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias da Próstata/prevenção & controle , Classe Social , Fatores Socioeconômicos
19.
Emerg Med Pract ; 21(Suppl 6): 1-22, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31233301

RESUMO

This review examines the evidence and indications for the use of intravenous thrombolysis in the treatment of acute ischemic stroke.


Assuntos
Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Administração Intravenosa , Definição da Elegibilidade/métodos , Humanos , Terapia Trombolítica/tendências
20.
Geriatr Gerontol Int ; 19(7): 598-603, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037829

RESUMO

AIM: The present population-based study investigated the predictive ability of the Kihon Checklist (a self-reported frailty questionnaire) and the cognitive domain therein for incident long-term care need certification. This is the first large population-based study to investigate an association between the Kihon Checklist and the outcome measure, long-term care need certification. METHODS: The study population consisted of community-dwelling citizens aged >65 years who responded to the Kihon Checklist in Kobe City. The Kihon Checklist is a simple 26-item questionnaire to identify frail citizens, including three items (Q18-20) on subjective cognitive function (the cognitive domain). RESULTS: A total of 182 099 citizens were included for statistical analysis. The overall incidence of long-term care need certification was 1.6%, 3.5% and 5.4% at 1, 2 and 3 years. Associations were found between the Kihon Checklist questions and long-term care need certification. Furthermore, each unfavorable answer on the cognitive domain was associated with the risk for long-term care need (HR 1.493 for Q18, 1.285 for Q19, 1.321 for Q20, all P < 0.0001), independent of age, sex and other items on the Kihon Checklist. Also, after 3 years, as the number of unfavorable answers to the cognitive domain increased from 0 to 1, 2 and 3, the incidence of long-term care need certification progressively increased from 3.5% to 6.4%, 12.6% and 29.6%. CONCLUSIONS: The Kihon Checklist, especially the cognitive domain therein, appears to be predictive of long-term care need in community-dwelling citizens, suggesting the potential utility of the questionnaire for early detection of high-risk individuals. Geriatr Gerontol Int 2019; 19: 598-603.


Assuntos
Lista de Checagem , Disfunção Cognitiva/diagnóstico , Avaliação da Deficiência , Definição da Elegibilidade/métodos , Vida Independente , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem/métodos , Lista de Checagem/normas , Cognição , Feminino , Idoso Fragilizado/psicologia , Avaliação Geriátrica/métodos , Humanos , Incidência , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Medição de Risco/métodos , Autorrelato , Inquéritos e Questionários
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