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[PMID]:29173311
[Au] Autor:Bhatt D; Travers C; Patel RM; Shinnick J; Arps K; Keene S; Raval MV
[Ad] Endereço:Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA. Electronic address: darshna.bhatt@vcuhealth.org.
[Ti] Título:Predicting Mortality or Intestinal Failure in Infants with Surgical Necrotizing Enterocolitis.
[So] Source:J Pediatr;191:22-27.e3, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare existing outcome prediction models and create a novel model to predict death or intestinal failure (IF) in infants with surgical necrotizing enterocolitis (NEC). STUDY DESIGN: A retrospective, observational cohort study conducted in a 2-campus health system in Atlanta, Georgia, from September 2009 to May 2015. Participants included all infants ≤37 weeks of gestation with surgical NEC. Logistic regression was used to model the probability of death or IF, as a composite outcome, using preoperative variables defined by specifications from 3 existing prediction models: American College of Surgeons National Surgical Quality Improvement Program Pediatric, Score for Neonatal Acute Physiology Perinatal Extension, and Vermont Oxford Risk Adjustment Tool. A novel preoperative hybrid prediction model was also derived and validated against a patient cohort from a separate campus. RESULTS: Among 147 patients with surgical NEC, discrimination in predicting death or IF was greatest with American College of Surgeons National Surgical Quality Improvement Program Pediatric (area under the receiver operating characteristic curve [AUC], 0.84; 95% CI, 0.77-0.91) when compared with the Score for Neonatal Acute Physiology Perinatal Extension II (AUC, 0.60; 95% CI, 0.48-0.72) and Vermont Oxford Risk Adjustment Tool (AUC, 0.74; 95% CI, 0.65-0.83). A hybrid model was developed using 4 preoperative variables: the 1-minute Apgar score, inotrope use, mean blood pressure, and sepsis. The hybrid model AUC was 0.85 (95% CI, 0.78-0.92) in the derivation cohort and 0.77 (95% CI, 0.66-0.86) in the validation cohort. CONCLUSIONS: Preoperative prediction of death or IF among infants with surgical NEC is possible using existing prediction tools and, to a greater extent, using a newly proposed 4-variable hybrid model.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Enterocolite Necrosante/diagnóstico
Doenças do Prematuro/diagnóstico
Índice de Gravidade de Doença
[Mh] Termos MeSH secundário: Enterocolite Necrosante/mortalidade
Enterocolite Necrosante/fisiopatologia
Enterocolite Necrosante/cirurgia
Feminino
Seres Humanos
Recém-Nascido
Recém-Nascido Prematuro
Doenças do Prematuro/mortalidade
Doenças do Prematuro/fisiopatologia
Doenças do Prematuro/cirurgia
Modelos Logísticos
Masculino
Prognóstico
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28465299
[Au] Autor:Jacobs L; Efremov L; Ferreira JP; Thijs L; Yang WY; Zhang ZY; Latini R; Masson S; Agabiti N; Sever P; Delles C; Sattar N; Butler J; Cleland JGF; Kuznetsova T; Staessen JA; Zannad F; Heart "OMics" in AGEing (HOMAGE) investigators
[Ad] Endereço:Research Unit of Hypertension and Cardiovascular Epidemiology, Studies Coordinating Centre, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
[Ti] Título:Risk for Incident Heart Failure: A Subject-Level Meta-Analysis From the Heart "OMics" in AGEing (HOMAGE) Study.
[So] Source:J Am Heart Assoc;6(5), 2017 May 02.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To address the need for personalized prevention, we conducted a subject-level meta-analysis within the framework of the Heart "OMics" in AGEing (HOMAGE) study to develop a risk prediction model for heart failure (HF) based on routinely available clinical measurements. METHODS AND RESULTS: Three studies with elderly persons (Health Aging and Body Composition [Health ABC], [PREDICTOR], and Prospective Study of Pravastatin in the Elderly at Risk [PROSPER]) were included to develop the HF risk function, while a fourth study (Anglo-Scandinavian Cardiac Outcomes Trial [ASCOT]) was used as a validation cohort. Time-to-event analysis was conducted using the Cox proportional hazard model. Incident HF was defined as HF hospitalization. The Cox regression model was evaluated for its discriminatory performance (area under the receiver operating characteristic curve) and calibration (Grønnesby-Borgan χ statistic). During a follow-up of 3.5 years, 470 of 10 236 elderly persons (mean age, 74.5 years; 51.3% women) developed HF. Higher age, BMI, systolic blood pressure, heart rate, serum creatinine, smoking, diabetes mellitus, history of coronary artery disease, and use of antihypertensive medication were associated with increased HF risk. The area under the receiver operating characteristic curve of the model was 0.71, with a good calibration (χ 7.9, =0.54). A web-based calculator was developed to allow easy calculations of the HF risk. CONCLUSIONS: Simple measurements allow reliable estimation of the short-term HF risk in populations and patients. The risk model may aid in risk stratification and future HF prevention strategies.
[Mh] Termos MeSH primário: Envelhecimento
Técnicas de Apoio para a Decisão
Insuficiência Cardíaca/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Envelhecimento/sangue
Área Sob a Curva
Biomarcadores/sangue
Pressão Sanguínea
Distribuição de Qui-Quadrado
Comorbidade
Feminino
Avaliação Geriátrica
Insuficiência Cardíaca/sangue
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/fisiopatologia
Frequência Cardíaca
Hospitalização
Seres Humanos
Incidência
Estilo de Vida
Modelos Lineares
Masculino
Meia-Idade
Análise Multivariada
Valor Preditivo dos Testes
Prognóstico
Modelos de Riscos Proporcionais
Curva ROC
Medição de Risco
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


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Registro de Ensaios Clínicos
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[PMID]:29450523
[Au] Autor:Freund Y; Cachanado M; Aubry A; Orsini C; Raynal PA; Féral-Pierssens AL; Charpentier S; Dumas F; Baarir N; Truchot J; Desmettre T; Tazarourte K; Beaune S; Leleu A; Khellaf M; Wargon M; Bloom B; Rousseau A; Simon T; Riou B; PROPER Investigator Group
[Ad] Endereço:Sorbonne Université, INSERM UMRS 1166, IHU ICAN, Paris, France.
[Ti] Título:Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial.
[So] Source:JAMA;319(6):559-566, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The safety of the pulmonary embolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonary embolism (PE), has not been assessed in a randomized clinical trial. Objective: To prospectively validate the safety of a PERC-based strategy to rule out PE. Design, Setting, and Patients: A crossover cluster-randomized clinical noninferiority trial in 14 emergency departments in France. Patients with a low gestalt clinical probability of PE were included from August 2015 to September 2016, and followed up until December 2016. Interventions: Each center was randomized for the sequence of intervention periods. In the PERC period, the diagnosis of PE was excluded with no further testing if all 8 items of the PERC rule were negative. Main Outcomes and Measures: The primary end point was the occurrence of a thromboembolic event during the 3-month follow-up period that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission. Results: Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients in the control group (2.7%) vs 14 (1.5%) in the PERC group (difference, 1.3% [95% CI, -0.1% to 2.7%]; P = .052). One PE (0.1%) was diagnosed during follow-up in the PERC group vs none in the control group (difference, 0.1% [95% CI, -∞ to 0.8%]). The proportion of patients undergoing CTPA in the PERC group vs control group was 13% vs 23% (difference, -10% [95% CI, -13% to -6%]; P < .001). In the PERC group, rates were significantly reduced for the median length of emergency department stay (mean reduction, 36 minutes [95% CI, 4 to 68]) and hospital admission (difference, 3.3% [95% CI, 0.1% to 6.6%]). Conclusions and Relevance: Among very low-risk patients with suspected PE, randomization to a PERC strategy vs conventional strategy did not result in an inferior rate of thromboembolic events over 3 months. These findings support the safety of PERC for very low-risk patients presenting to the emergency department. Trial Registration: clinicaltrials.gov Identifier: NCT02375919.
[Mh] Termos MeSH primário: Protocolos Clínicos
Técnicas de Apoio para a Decisão
Serviço Hospitalar de Emergência
Embolia Pulmonar/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Estudos Cross-Over
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Risco
Tromboembolia/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; EQUIVALENCE TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21904


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[PMID]:29368497
[Au] Autor:Foster DS; Gupta R
[Ti] Título:Choosing Wisely.
[So] Source:W V Med J;112(6):12, 2016 Nov-Dec.
[Is] ISSN:0043-3284
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Tomada de Decisões
Assistência à Saúde/economia
Conhecimentos, Atitudes e Prática em Saúde
Qualidade da Assistência à Saúde/economia
[Mh] Termos MeSH secundário: Técnicas de Apoio para a Decisão
Assistência à Saúde/normas
Guias como Assunto
Seres Humanos
Medicina Interna/economia
Educação de Pacientes como Assunto
Qualidade da Assistência à Saúde/normas
Estados Unidos
Procedimentos Desnecessários/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE


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[PMID]:29340526
[Au] Autor:Yousefi M; Yousefi M; Fogliatto FS; Ferreira RPM; Kim JH
[Ad] Endereço:Departamento de Engenharia de Produção e Transportes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
[Ti] Título:Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework.
[So] Source:Braz J Med Biol Res;51(3):e6961, 2018 Jan 11.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.
[Mh] Termos MeSH primário: Comportamento
Serviço Hospitalar de Emergência/organização & administração
Pacientes Desistentes do Tratamento/estatística & dados numéricos
Triagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Brasil
Simulação por Computador
Aglomeração
Tomada de Decisões
Técnicas de Apoio para a Decisão
Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitais Públicos
Seres Humanos
Tempo de Internação
Modelos Teóricos
Pacientes Desistentes do Tratamento/psicologia
Modelagem Computacional Específica para o Paciente
Treinamento por Simulação
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE


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[PMID]:29377891
[Au] Autor:Hadjichrysanthou C; Ower AK; de Wolf F; Anderson RM; Alzheimer's Disease Neuroimaging Initiative
[Ad] Endereço:Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom.
[Ti] Título:The development of a stochastic mathematical model of Alzheimer's disease to help improve the design of clinical trials of potential treatments.
[So] Source:PLoS One;13(1):e0190615, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Alzheimer's disease (AD) is a neurodegenerative disorder characterised by a slow progressive deterioration of cognitive capacity. Drugs are urgently needed for the treatment of AD and unfortunately almost all clinical trials of AD drug candidates have failed or been discontinued to date. Mathematical, computational and statistical tools can be employed in the construction of clinical trial simulators to assist in the improvement of trial design and enhance the chances of success of potential new therapies. Based on the analysis of a set of clinical data provided by the Alzheimer's Disease Neuroimaging Initiative (ADNI) we developed a simple stochastic mathematical model to simulate the development and progression of Alzheimer's in a longitudinal cohort study. We show how this modelling framework could be used to assess the effect and the chances of success of hypothetical treatments that are administered at different stages and delay disease development. We demonstrate that the detection of the true efficacy of an AD treatment can be very challenging, even if the treatment is highly effective. An important reason behind the inability to detect signals of efficacy in a clinical trial in this therapy area could be the high between- and within-individual variability in the measurement of diagnostic markers and endpoints, which consequently results in the misdiagnosis of an individual's disease state.
[Mh] Termos MeSH primário: Doença de Alzheimer/diagnóstico
Biometria/métodos
Técnicas de Apoio para a Decisão
[Mh] Termos MeSH secundário: Biomarcadores
Estudos de Coortes
Erros de Diagnóstico
Progressão da Doença
Seres Humanos
Estudos Longitudinais
Computação Matemática
Modelos Teóricos
Probabilidade
Projetos de Pesquisa
Processos Estocásticos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190615


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[PMID]:29362916
[Au] Autor:Tanaka T; Voigt MD
[Ad] Endereço:Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, USA. tomohiro-tanaka@uiowa.edu.
[Ti] Título:Decision tree analysis to stratify risk of de novo non-melanoma skin cancer following liver transplantation.
[So] Source:J Cancer Res Clin Oncol;144(3):607-615, 2018 Mar.
[Is] ISSN:1432-1335
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Non-melanoma skin cancer (NMSC) is the most common de novo malignancy in liver transplant (LT) recipients; it behaves more aggressively and it increases mortality. We used decision tree analysis to develop a tool to stratify and quantify risk of NMSC in LT recipients. METHODS: We performed Cox regression analysis to identify which predictive variables to enter into the decision tree analysis. Data were from the Organ Procurement Transplant Network (OPTN) STAR files of September 2016 (n = 102984). RESULTS: NMSC developed in 4556 of the 105984 recipients, a mean of 5.6 years after transplant. The 5/10/20-year rates of NMSC were 2.9/6.3/13.5%, respectively. Cox regression identified male gender, Caucasian race, age, body mass index (BMI) at LT, and sirolimus use as key predictive or protective factors for NMSC. These factors were entered into a decision tree analysis. The final tree stratified non-Caucasians as low risk (0.8%), and Caucasian males > 47 years, BMI < 40 who did not receive sirolimus, as high risk (7.3% cumulative incidence of NMSC). The predictions in the derivation set were almost identical to those in the validation set (r = 0.971, p < 0.0001). Cumulative incidence of NMSC in low, moderate and high risk groups at 5/10/20 year was 0.5/1.2/3.3, 2.1/4.8/11.7 and 5.6/11.6/23.1% (p < 0.0001). CONCLUSIONS: The decision tree model accurately stratifies the risk of developing NMSC in the long-term after LT.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Árvores de Decisões
Transplante de Fígado/efeitos adversos
Neoplasias Cutâneas/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Imunossupressores/uso terapêutico
Incidência
Transplante de Fígado/estatística & dados numéricos
Masculino
Meia-Idade
Neoplasia de Células Basais/epidemiologia
Neoplasia de Células Basais/etiologia
Neoplasias de Células Escamosas/epidemiologia
Neoplasias de Células Escamosas/etiologia
Medição de Risco
Fatores de Risco
Neoplasias Cutâneas/epidemiologia
Condicionamento Pré-Transplante/efeitos adversos
Condicionamento Pré-Transplante/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunosuppressive Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1007/s00432-018-2589-5


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[PMID]:29311468
[Au] Autor:Shida T; Endo Y; Shiraishi T; Yoshioka T; Suzuki K; Kobayashi Y; Ono Y; Ito T; Inoue T
[Ad] Endereço:Division of Pharmacy, Yamagata University Hospital.
[Ti] Título:[Economic Evaluation of mFOLFOX6-based First-line Regimens for Unresectable Advanced or Recurrent Colorectal Cancer Using Clinical Decision Analysis].
[So] Source:Yakugaku Zasshi;138(1):83-90, 2018.
[Is] ISSN:1347-5231
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:We evaluated four representative chemotherapy regimens for unresectable advanced or recurrent KRAS-wild type colorectal cancer: mFOLFOX6, mFOLFOX6+bevacizumab (Bmab), cetuximab (Cmab), or panitumumab (Pmab). We employed a decision analysis method in combination with clinical and economic evidence. The health outcomes of the regimens were analyzed on the basis of overall and progression-free survival. The data were drawn from the literature on randomized controlled clinical trials of the above-mentioned drugs. The total costs of the regimens were calculated on the basis of direct costs obtained from the medical records of patients diagnosed with unresectable advanced or recurrent colorectal cancer at Yamagata University Hospital and Yamagata Prefecture Central Hospital. Cost effectiveness was analyzed using a Markov chain Monte Carlo (MCMC) method. The study was designed from the viewpoint of public medical care. The MCMC analysis revealed that expected life months and expected cost were 20 months/3,527,119 yen for mFOLFOX6, 27 months/8,270,625 yen for mFOLFOX6+Bmab, 29 months/13,174,6297 yen for mFOLFOX6+Cmab, and 6 months/12,613,445 yen for mFOLFOX6+Pmab. Incremental costs per effectiveness ratios per life month against mFOLFOX6 were 637,592 yen for mFOLFOX6+Bmab, 1,075,162 yen for mFOLFOX6+Cmab, and 587,455 yen for mFOLFOX6+Pmab. Compared to the conventional mFOLFOX6 regimen, molecular-targeted drug regimens provide better health outcomes, but the cost increases accordingly. mFOLFOX 6+Pmab is the most cost-effective regimen among those surveyed in this study.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/economia
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias Colorretais/tratamento farmacológico
Neoplasias Colorretais/economia
Análise Custo-Benefício
Técnicas de Apoio para a Decisão
Recidiva Local de Neoplasia/dietoterapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anticorpos Monoclonais/administração & dosagem
Anticorpos Monoclonais/economia
Bevacizumab/administração & dosagem
Bevacizumab/economia
Cetuximab/administração & dosagem
Cetuximab/economia
Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/patologia
Feminino
Fluoruracila/economia
Seres Humanos
Leucovorina/economia
Masculino
Cadeias de Markov
Meia-Idade
Estadiamento de Neoplasias
Compostos Organoplatínicos/economia
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Organoplatinum Compounds); 2S9ZZM9Q9V (Bevacizumab); 6A901E312A (panitumumab); PQX0D8J21J (Cetuximab); Q573I9DVLP (Leucovorin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1248/yakushi.17-00159


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[PMID]:29450510
[Au] Autor:Kline JA
[Ad] Endereço:Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis.
[Ti] Título:Utility of a Clinical Prediction Rule to Exclude Pulmonary Embolism Among Low-Risk Emergency Department Patients: Reason to PERC Up.
[So] Source:JAMA;319(6):551-553, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Embolia Pulmonar
[Mh] Termos MeSH secundário: Serviço Hospitalar de Emergência
Produtos de Degradação da Fibrina e do Fibrinogênio
Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Fibrin Fibrinogen Degradation Products)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21901


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[PMID]:27778168
[Au] Autor:Docimo S; Lee Y; Chatani P; Rogers AM; Lacqua F
[Ad] Endereço:Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA. sdocimo@gmail.com.
[Ti] Título:Visceral to subcutaneous fat ratio predicts acuity of diverticulitis.
[So] Source:Surg Endosc;31(7):2808-2812, 2017 Jul.
[Is] ISSN:1432-2218
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There is an association between obesity and more complicated diverticular disease. We hypothesize that this link may be due to an increased level of visceral fat rather than an elevated body mass index alone. Adipose tissue secretes inflammatory cytokines, and chronic inflammation may account for the link between obesity and a more severe presentation of diverticular disease. We have applied a quantitative measure of visceral fat content in a series of patients admitted with diverticulitis, comparing those who required emergent versus elective surgical procedures for diverticulitis. METHODS: We performed a retrospective review of all adult patients who underwent emergent or elective surgery at our institution for diverticulitis from 2010 to 2014. Data were collected on demographics, comorbidities, operative findings, complications, and length of stay. Radiologic measurements of adiposity were obtained from preoperative CT scans. Visceral fat areas and subcutaneous fat areas were measured, and the V/S ratio was calculated. RESULTS: Thirty-four patients underwent emergent and 32 patients underwent elective surgery. The mean age was 66.3 years for the emergent and 57.11 for the elective group (p = 0.04178). The perinephric, visceral, subcutaneous fat, and V/S ratio for the emergent group were 1.71, 185.22, 338.22, and 0.56 and were 1.11, 127.18, 295.28, and 0.46 for the elective group. The difference between the V/S ratio for each group was significant (p = 0.0238). The emergent group had an average LOS of 16.11 days compared to 5.15 for the elective group (p = <0.00001). The complication rate was significantly higher (p = 0.024) in the emergent group (n = 12, 35.2 %) compared to the elective group (n = 4, 12.5 %). CONCLUSION: Our study demonstrates a clinically significant link between visceral fat and severity of presentation of diverticulitis. Patients with higher V/S fat ratios were more likely to require emergency surgery and have more complications and a longer LOS.
[Mh] Termos MeSH primário: Diverticulite/diagnóstico
Gordura Intra-Abdominal
Gravidade do Paciente
Gordura Subcutânea
[Mh] Termos MeSH secundário: Adulto
Idoso
Técnicas de Apoio para a Decisão
Diverticulite/cirurgia
Procedimentos Cirúrgicos Eletivos
Emergências
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s00464-016-5290-2



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