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1.
J Clin Neurosci ; 90: 39-47, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275579

RESUMO

The optimal timing of adjuvant radiochemotherapy (RCT) in glioblastoma (GBM) patients remains unknown and the paradigm of 'the sooner, the better' has been challenged by many recent publications. In this study, we present unique data on the outcomes of patients with significant treatment delays. The study group consisted of 346 GBM patients (median age 56.8 years) who received surgical treatment (total or subtotal resection) and then underwent adjuvant concurrent RCT at one institution. The main endpoint was overall survival (OS). The Univariate and multivariate Cox Proportional-Hazard Model, log-rank test, and Kaplan-Meier method were used for the analysis. The median OS was 18.7 months and the 5-year overall survival was 8.5%. The median time interval from surgery to RCT was 9.8 weeks. The Cox regression showed that the time interval had no statistically significant impact on OS both in uni- and multivariate analysis. The explorative analysis suggested a positive trend for improved survival for patients in the 1st quartile of the time interval, especially for patients with residual disease or local recurrence prior to RCT, However, considering the 6.9 weeks median interval in the 1st quartile, this subgroup should still be regarded as 'moderate delay' compared with other literature data. The results indicate that the time interval is not a clear prognostic factor in the treatment of GBM. Prospective trials are highly warranted, as data suggest that moderate delays in the initiation of adjuvant treatment might be associated with survival benefit.


Assuntos
Neoplasias Encefálicas/terapia , Quimiorradioterapia Adjuvante/métodos , Glioblastoma/terapia , Procedimentos Neurocirúrgicos/métodos , Tempo para o Tratamento , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Terapia Combinada/métodos , Feminino , Glioblastoma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/tratamento farmacológico , Prognóstico , Modelos de Riscos Proporcionais
3.
Artigo em Inglês | MEDLINE | ID: mdl-34215570

RESUMO

OBJECTIVE: COVID-19 has put a strain on regular healthcare worldwide. For inflammatory bowel disease (IBD), gastrointestinal surgeries were postponed and changes in treatment and diagnostic procedures were made. As abrupt changes in treatment regimens may result in an increased morbidity and consequent well-being of patients with IBD, the aim of this study was to determine the effect of the COVID-19 pandemic on health-related quality of life (HRQoL) in patients with IBD. DESIGN: All patients with IBD who completed both Inflammatory Bowel Disease Questionnaire (IBDQ) and 36-Item Short Form Health Survey (SF-36) questionnaire between 31 August and 13 September 2020 were included in our cohort study. The primary end point was to determine the HRQoL in patients with IBD, measured by the IBDQ and SF-36 questionnaire. The secondary end point was determining which factors influence the HRQoL in patients with IBD. RESULTS: 582 patients with IBD filled in the IBDQ and SF-36 questionnaire. The HRQoL in our study population was low according to the questionnaires on both physical and mental subscales. In addition, multivariate analysis showed that increased age, female sex and patients who underwent surgery had a significantly lower HRQoL, most frequently on the physical domains in both questionnaires. CONCLUSION: Patients with IBD had an overall low HRQoL during the COVID-19 pandemic. Furthermore, older patients, women and patients who underwent surgical procedures had the lowest physical HRQoL.


Assuntos
COVID-19/epidemiologia , Doenças Inflamatórias Intestinais/psicologia , Pandemias , Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Questionário de Saúde do Paciente , SARS-CoV-2 , Fatores Sexuais , Tempo para o Tratamento , Adulto Jovem
4.
BMC Infect Dis ; 21(1): 641, 2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34217245

RESUMO

BACKGROUND: Recent approaches to TB control have focused on identifying and treating active cases to halt further transmission. Patients with TB symptoms often delay to seek care, get appropriate diagnosis, and initiate effective treatment. These delays are partly influenced by whom the patients contact within their community network. We aimed to evaluate the community drivers of diagnostic delay in an urban setting in Uganda. METHODS: In this study we analyze data from a retrospective cohort of 194 TB patients in Kampala, Uganda. We characterized the patterns of contacts made by patients seeking care for TB symptoms. The main outcome of interest was total community contact delay, defined as the time patients spent seeking care before visiting a provider capable of diagnosing TB. RESULTS: Visits to health providers without access to appropriate diagnostic services accounted for 56% of contacts made by cohort members, and were significantly associated with community contact delay, as were symptoms common to other prevalent illnesses, such as bone and joint pain. CONCLUSIONS: Education programs aimed at primary care providers, as well as other community members, may benefit case identification, by informing them of rarer symptoms of TB, potential for co-infections of TB and other prevalent diseases, and the availability of diagnostic services.


Assuntos
Diagnóstico Tardio , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Saúde Pública , Estudos Retrospectivos , Uganda , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-34199816

RESUMO

Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Atenção à Saúde , Eletrocardiografia , Humanos , Melhoria de Qualidade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento
6.
Emerg Med Clin North Am ; 39(3): 589-603, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215404

RESUMO

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Cuidadores , Criança , Desenvolvimento Infantil , Serviços de Proteção Infantil , Diagnóstico Diferencial , Diagnóstico por Imagem , Medicina Legal , Humanos , Notificação de Abuso , Anamnese , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Exame Físico , Profilaxia Pós-Exposição , Encaminhamento e Consulta , Doenças Sexualmente Transmissíveis/prevenção & controle , Tempo para o Tratamento
7.
J Investig Med High Impact Case Rep ; 9: 23247096211031135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34259086

RESUMO

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.


Assuntos
Aneurisma Cardíaco/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento , Ruptura do Septo Ventricular/cirurgia , COVID-19 , Procedimentos Cirúrgicos Cardíacos , Ponte de Artéria Coronária , Aneurisma Cardíaco/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações
8.
PLoS One ; 16(7): e0254228, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34260632

RESUMO

BACKGROUND: In the current study we investigated the causes of pre-hospital delay as this can compromise the patient's chance to receive thrombolytic therapy and thus impact stroke outcome. METHODS: We surveyed 254 patients regarding reasons for delayed and early arrival to hospital after acute ischemic stroke. The survey was performed over five months, spanning a period pre- and during COVID-19 (between December 7, 2019 and May 10, 2020). RESULTS: A total of 71.2% of patients arrived beyond four hours of onset of ischemic stroke. The commonest cause for delay pre-Covid-19 was receiving treatment in a non-stroke hospital, while that during COVID-19 was fear of infection and lock down issues. Not realizing the urgency of the condition and stroke during sleep were common in both periods. Early arrival because of the patient's previous experience with stroke accounted for approximately 25% of cases in both periods. The effect of media was more evident during COVID-19, accounting for 47.7% of cases. CONCLUSION: Pre-hospital delay secondary to misperception of the urgency of stroke and management in a non-stroke hospital reflect the lack of awareness among the public and medical staff. This concept is emphasized by early arrival secondary to previous experience with stroke and the pronounced effect of media in the time of COVID-19.


Assuntos
Isquemia Encefálica/psicologia , COVID-19/psicologia , AVC Isquêmico/psicologia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , COVID-19/epidemiologia , Egito , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
10.
Ulus Travma Acil Cerrahi Derg ; 27(4): 449-456, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212997

RESUMO

BACKGROUND: The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity. METHODS: A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I-III) or poor (IV-V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1-2) or favorable (3-5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed. RESULTS: A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p<0.001). CONCLUSION: This study supports the growing trend toward early or ultra-early intervention in aneurysmatic subarachnoid hemorrhage. Our findings showed that both early and ultra-early interventions have positive effects on the outcome in poor-grade aneurysmatic subarachnoid hemorrhage patients. Future studies with more homogenized and larger samples should be realized to clarify the optimal timing of intervention for aneurysmatic subarachnoid hemorrhage.


Assuntos
Hemorragia Subaracnóidea , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Tempo para o Tratamento , Resultado do Tratamento
11.
Bone Joint J ; 103-B(7): 1176-1186, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192937

RESUMO

AIMS: The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures. METHODS: MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics. RESULTS: This review included 46 studies (January 1991 to June 2020), comprising 521,857 hip fractures with 64,047 postoperative deaths. No randomized controlled trials were eligible for inclusion. In a pooled analysis of 15 studies, RR of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86 (95% CI 0.82 to 0.91; I 2 = 69%; 95% CI 50% to 81%; p-value for heterogeneity < 0.001). The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates. In a pooled analysis of six studies, the RR of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87 (95% CI 0.81 to 0.93; I 2 = 65%; 95% CI 16% to 85%; p-value for heterogeneity = 0.014). CONCLUSION: This meta-analysis indicates reduced mortality for patients operated within 24 hours compared with those operated on beyond 24 hours or within 24 to 36 hours. Where resources allow and there is no specific reversible contraindication to early surgery, we recommend that hip fractures should be surgically treated within 24 hours. Cite this article: Bone Joint J 2021;103-B(7):1176-1186.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Tempo para o Tratamento , Artroplastia de Quadril , Fixação Interna de Fraturas/métodos , Mortalidade Hospitalar , Humanos
12.
J Contemp Dent Pract ; 22(2): 194-198, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34257182

RESUMO

AIM: The objective of this case report was to present a rare case of simultaneous multiple internal root resorption (IRR) in four mandibular incisors and discuss the possible etiology and suitable armamentarium for its treatment based on different morphological considerations. BACKGROUND: IRR in permanent dentition is a rare pathological condition and its etiology is not yet fully understood. Very few cases of multiple IRR were reported. This is the first reported case of multiple IRR due to traumatic injury. CASE DESCRIPTION: A 23-year-old man suffered trauma to his mandible after falling from a trampoline. His mandibular incisors suffered subluxation injuries and his orthodontic fixed retainer got detached. He delayed treatment and visited our clinic 4.5 months after the incident. Clinical and radiographic examination revealed four mandibular incisors with almost identical IRR defects at the apical third of the roots. The patient was then treated with four non-surgical root canal treatments using various endodontic instruments and techniques. Fifteen-month post-trauma, he showed no evidence of pathology at the follow-up examination. CONCLUSION: Delayed treatment of dental trauma might cause multiple IRR, and the presence of an orthodontic fixed retainer can distribute surface forces and result in uniform IRR defects. CLINICAL SIGNIFICANCE: The combination of the self-adjusting file (SAF) and the XP-endo finisher is recommended for chemomechanical preparation of IRR defects in oval canals, especially at the apical third.


Assuntos
Reabsorção da Raiz , Adulto , Cavidade Pulpar , Humanos , Masculino , Mandíbula , Preparo de Canal Radicular , Tratamento do Canal Radicular/efeitos adversos , Reabsorção da Raiz/diagnóstico por imagem , Reabsorção da Raiz/etiologia , Reabsorção da Raiz/terapia , Tempo para o Tratamento , Adulto Jovem
13.
Curr Oncol ; 28(3): 1867-1878, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068441

RESUMO

Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.


Assuntos
Ansiedade/epidemiologia , COVID-19/prevenção & controle , Depressão/epidemiologia , Neoplasias/cirurgia , Tempo para o Tratamento , Adaptação Psicológica , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/psicologia , COVID-19/epidemiologia , COVID-19/transmissão , Controle de Doenças Transmissíveis/normas , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Nova Escócia/epidemiologia , Pandemias/prevenção & controle , Angústia Psicológica , Psicometria/estatística & dados numéricos , Pesquisa Qualitativa , Autorrelato/estatística & dados numéricos , Triagem/normas , Incerteza
14.
Curr Oncol ; 28(3): 2007-2013, 2021 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-34073214

RESUMO

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in quality of life and survival in cancer patients during this time of pandemic?; (2) Should we vaccinate cancer patients against COVID-19 if scientific studies have not included this subgroup of patients? Regarding the first question, the best available evidence applied to the ethical principles of Beauchamp and Childress shows that treatments (such as chemotherapy) with clinical benefit are fair and beneficial. Indeed, the suspension or delay of such treatments should be considered malefic. Regarding the second question, applying the doctrine of double-effect, we show that the potential beneficial effect of vaccines in the population with cancer (or those one that has had cancer) is much higher than the potential adverse effects of these vaccines. In addition, there is no better and less harmful known solution.


Assuntos
COVID-19/prevenção & controle , Tomada de Decisão Clínica/ética , Neoplasias/tratamento farmacológico , Seleção de Pacientes/ética , Tempo para o Tratamento/ética , Antineoplásicos/administração & dosagem , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Humanos , Oncologia/ética , Neoplasias/imunologia , Neoplasias/mortalidade , Neoplasias/psicologia , Pandemias/prevenção & controle , Qualidade de Vida , Fatores de Risco , SARS-CoV-2/imunologia , Fatores de Tempo , Vacinação/efeitos adversos , Vacinação/ética
15.
Bone Joint J ; 103-B(6): 1055-1062, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058873

RESUMO

AIMS: Despite long-standing dogma, a clear relationship between the timing of surgical irrigation and debridement (I&D) and the development of subsequent deep infection has not been established in the literature. Traditionally, I&D of an open fracture has been recommended within six hours of injury based on animal studies from the 1970s, however the clinical basis for this remains unclear. Using data from a multicentre randomized controlled trial of 2,447 open fracture patients, the primary objective of this secondary analysis is to determine if a relationship exists between timing of wound I&D (within six hours of injury vs beyond six hours) and subsequent reoperation rate for infection or healing complications within one year for patients with open limb fractures requiring surgical treatment. METHODS: To adjust for the influence of patient and injury characteristics on the timing of I&D, a propensity score was developed from the dataset. Propensity-adjusted regression allowed for a matched cohort analysis within the study population to determine if early irrigation put patients independently at risk for reoperation, while controlling for confounding factors. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs), and p-values. All analyses were conducted using STATA 14. RESULTS: In total, 2,286 of 2,447 patients randomized to the trial from 41 orthopaedic trauma centres across five countries had complete data regarding time to I&D. Prior to matching, the patients managed with early I&D had a higher proportion requiring reoperation for infection or healing complications (17% vs 13%; p = 0.019), however this does not account for selection bias of more severe injuries preferentially being treated earlier. When accounting for propensity matching, early irrigation was not associated with reoperation (OR 0.71 (95% CI 0.47 to 1.07); p = 0.73). CONCLUSION: When accounting for other variables, late irrigation does not independently increase risk of reoperation. Cite this article: Bone Joint J 2021;103-B(6):1055-1062.


Assuntos
Traumatismos do Braço/cirurgia , Desbridamento , Fraturas Expostas/cirurgia , Traumatismos da Perna/cirurgia , Reoperação/estatística & dados numéricos , Irrigação Terapêutica/métodos , Tempo para o Tratamento , Adulto , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
16.
Bone Joint J ; 103-B(6): 1142-1149, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058874

RESUMO

AIMS: Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. METHODS: We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI. RESULTS: Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI. CONCLUSION: A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142-1149.


Assuntos
Sarcoma/mortalidade , Sarcoma/cirurgia , Tempo para o Tratamento , Idoso , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Sistema de Registros , Estudos Retrospectivos , Sarcoma/patologia , Taxa de Sobrevida , Tórax , Estados Unidos/epidemiologia
17.
Clin Transl Gastroenterol ; 12(6): e00365, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34060496

RESUMO

INTRODUCTION: The initial surge of the coronavirus disease 2019 (COVID-19) pandemic prompted national recommendations to delay nonurgent endoscopic procedures. The objective of this study was to provide real-world data on the impact of COVID-19 on endoscopic procedures in a safety-net healthcare system and cancer center affiliated with a tertiary academic center. METHODS: This retrospective cohort study used a combination of electronic health record data and a prospective data tool created to track endoscopy procedures throughout COVID-19 to describe patient and procedural characteristics of endoscopic procedures delayed during the initial COVID-19 surge. RESULTS: Of the 480 patients identified, the median age was 57 years (interquartile range 46-66), 55% (n = 262) were male, and 59% self-identified as white. Colonoscopy was the most common type of delayed procedure (49%), followed by combined esophagogastroduodenoscopy (EGD) and colonoscopy (22%), and EGD alone (20%). Colorectal cancer screening was the most common indication for delayed colonoscopy (35%), and evaluation of suspected bleeding (30%) was the most common indication for delayed combined EGD and colonoscopy. To date, 46% (223/480) of delayed cases have been completed with 12 colorectal, pancreatic, and stomach cancers diagnosed. Sociodemographic factors, procedure type, and sedation type were not significantly associated with endoscopy completion. The median time to endoscopy after delayed procedure was 88 days (interquartile range 63-119) with no differences by procedure type. DISCUSSION: To minimize potential losses to follow-up, delayed, or missed diagnoses and to reduce progression of gastrointestinal diseases, all efforts should be used to ensure follow-up in those whose endoscopic procedures were delayed because of COVID-19.


Assuntos
COVID-19/epidemiologia , Diagnóstico Tardio , Endoscopia Gastrointestinal/estatística & dados numéricos , Gastroenteropatias/diagnóstico , Pandemias , Idoso , Feminino , Gastroenteropatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Tempo para o Tratamento , Washington/epidemiologia
18.
Front Public Health ; 9: 644536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095053

RESUMO

Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.


Assuntos
COVID-19 , Tuberculose , China/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Tempo para o Tratamento , Tuberculose/diagnóstico
19.
Medicina (Kaunas) ; 57(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069433

RESUMO

Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.


Assuntos
Isquemia Encefálica , COVID-19 , Acidente Vascular Cerebral , Adulto , Estudos Transversais , Humanos , Malásia/epidemiologia , Pandemias , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Resultado do Tratamento
20.
Cad Saude Publica ; 37(5): e00214919, 2021.
Artigo em Português | MEDLINE | ID: mdl-34076098

RESUMO

Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.


Assuntos
Neoplasias Colorretais , Tempo para o Tratamento , Brasil/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos
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