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[PMID]:28457798
[Au] Autor:Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM
[Ad] Endereço:Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill.
[Ti] Título:Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.
[So] Source:Am J Med;130(9):1112.e17-1112.e31, 2017 Sep.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
[Mh] Termos MeSH primário: Cardiologia/normas
Serviço Hospitalar de Emergência/utilização
Insuficiência Cardíaca/terapia
Educação de Pacientes como Assunto/organização & administração
Readmissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Cardiologia/economia
Cardiologia/métodos
Estudos de Casos e Controles
Chicago
Controle de Custos/métodos
Controle de Custos/normas
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/organização & administração
Feminino
Insuficiência Cardíaca/economia
Seres Humanos
Masculino
Meia-Idade
Estudos de Casos Organizacionais
Alta do Paciente/economia
Alta do Paciente/normas
Alta do Paciente/estatística & dados numéricos
Educação de Pacientes como Assunto/economia
Educação de Pacientes como Assunto/métodos
Readmissão do Paciente/economia
Guias de Prática Clínica como Assunto
Pontuação de Propensão
Encaminhamento e Consulta/economia
Encaminhamento e Consulta/normas
Estudos Retrospectivos
Fatores Socioeconômicos
Centros de Atenção Terciária/economia
Centros de Atenção Terciária/organização & administração
Saúde da População Urbana/economia
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29288428
[Au] Autor:Scappaticci GB; Marini BL; Nachar VR; Uebel JR; Vulaj V; Crouch A; Bixby DL; Talpaz M; Perissinotti AJ
[Ad] Endereço:Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
[Ti] Título:Outcomes of previously untreated elderly patients with AML: a propensity score-matched comparison of clofarabine vs. FLAG.
[So] Source:Ann Hematol;97(4):573-584, 2018 Apr.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The 5-year overall survival (OS) in patients ≥ 60 years old with acute myeloid leukemia (AML) remains < 10%. Clofarabine-based induction (CLO) provides an alternative to low-intensity therapy (LIT) and palliative care for this population, but supporting data are conflicted. Recently, our institution adopted the FLAG regimen (fludarabine, cytarabine, and granulocyte colony-stimulating factor) based on data reporting similar outcomes to CLO in elderly patients with AML unable to tolerate anthracycline-based induction. We retrospectively analyzed the efficacy and safety of patients ≥ 60 years old with AML treated with FLAG or CLO over the past 10 years. We performed a propensity score match that provided 32 patients in each group. Patients treated with FLAG had a higher CR/CRi rate (65.6 vs. 37.5%, P = 0.045) and OS (7.9 vs. 2.8 months, P = 0.085) compared to CLO. Furthermore, FLAG was better tolerated with significantly less grade 3/4 toxicities and a shorter duration of neutropenia (18.5 vs. 30 days, P = 0.002). Finally, we performed a cost analysis that estimated savings to be $30,000-45,000 per induction with FLAG. Our study supports the use of FLAG both financially and as an effective, well-tolerated high-dose treatment regimen for elderly patients with AML. No cases of cerebellar neurotoxicity occurred.
[Mh] Termos MeSH primário: Nucleotídeos de Adenina/uso terapêutico
Envelhecimento
Antimetabólitos Antineoplásicos/uso terapêutico
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Arabinonucleosídeos/uso terapêutico
Quimioterapia de Indução
Leucemia Mieloide Aguda/tratamento farmacológico
Vidarabina/análogos & derivados
[Mh] Termos MeSH secundário: Nucleotídeos de Adenina/efeitos adversos
Nucleotídeos de Adenina/economia
Idoso
Idoso de 80 Anos ou mais
Antimetabólitos Antineoplásicos/efeitos adversos
Antimetabólitos Antineoplásicos/economia
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/economia
Arabinonucleosídeos/efeitos adversos
Arabinonucleosídeos/economia
Estudos de Casos e Controles
Doença Hepática Induzida por Substâncias e Drogas/economia
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia
Doença Hepática Induzida por Substâncias e Drogas/mortalidade
Doença Hepática Induzida por Substâncias e Drogas/terapia
Estudos de Coortes
Terapia Combinada/economia
Redução de Custos
Custos e Análise de Custo
Citarabina/efeitos adversos
Citarabina/economia
Citarabina/uso terapêutico
Fator Estimulador de Colônias de Granulócitos/efeitos adversos
Fator Estimulador de Colônias de Granulócitos/economia
Fator Estimulador de Colônias de Granulócitos/uso terapêutico
Custos Hospitalares
Seres Humanos
Incidência
Quimioterapia de Indução/efeitos adversos
Quimioterapia de Indução/economia
Tempo de Internação
Leucemia Mieloide Aguda/economia
Leucemia Mieloide Aguda/mortalidade
Michigan/epidemiologia
Meia-Idade
Neutropenia/induzido quimicamente
Neutropenia/economia
Neutropenia/mortalidade
Neutropenia/terapia
Pontuação de Propensão
Estudos Retrospectivos
Análise de Sobrevida
Centros de Atenção Terciária
Vidarabina/efeitos adversos
Vidarabina/economia
Vidarabina/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adenine Nucleotides); 0 (Antimetabolites, Antineoplastic); 0 (Arabinonucleosides); 04079A1RDZ (Cytarabine); 143011-72-7 (Granulocyte Colony-Stimulating Factor); 762RDY0Y2H (clofarabine); FA2DM6879K (Vidarabine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171231
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3217-1


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[PMID]:28454568
[Au] Autor:Nguyen TL; Collins GS; Spence J; Daurès JP; Devereaux PJ; Landais P; Le Manach Y
[Ad] Endereço:Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France.
[Ti] Título:Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance.
[So] Source:BMC Med Res Methodol;17(1):78, 2017 Apr 28.
[Is] ISSN:1471-2288
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Double-adjustment can be used to remove confounding if imbalance exists after propensity score (PS) matching. However, it is not always possible to include all covariates in adjustment. We aimed to find the optimal imbalance threshold for entering covariates into regression. METHODS: We conducted a series of Monte Carlo simulations on virtual populations of 5,000 subjects. We performed PS 1:1 nearest-neighbor matching on each sample. We calculated standardized mean differences across groups to detect any remaining imbalance in the matched samples. We examined 25 thresholds (from 0.01 to 0.25, stepwise 0.01) for considering residual imbalance. The treatment effect was estimated using logistic regression that contained only those covariates considered to be unbalanced by these thresholds. RESULTS: We showed that regression adjustment could dramatically remove residual confounding bias when it included all of the covariates with a standardized difference greater than 0.10. The additional benefit was negligible when we also adjusted for covariates with less imbalance. We found that the mean squared error of the estimates was minimized under the same conditions. CONCLUSION: If covariate balance is not achieved, we recommend reiterating PS modeling until standardized differences below 0.10 are achieved on most covariates. In case of remaining imbalance, a double adjustment might be worth considering.
[Mh] Termos MeSH primário: Algoritmos
Modelos Estatísticos
Pontuação de Propensão
[Mh] Termos MeSH secundário: Viés
Simulação por Computador
Seres Humanos
Modelos Logísticos
Método de Monte Carlo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1186/s12874-017-0338-0


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[PMID]:28465095
[Au] Autor:Arriola CS; Vasconez N; Thompson MG; Olsen SJ; Moen AC; Bresee J; Ropero AM
[Ad] Endereço:Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wus3@cdc.gov.
[Ti] Título:Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua.
[So] Source:Vaccine;35(23):3056-3063, 2017 05 25.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua. METHODS: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM). RESULTS: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75-0.99 and aOR: 0.66; 95% CI: 0.45-0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64-0.97). CONCLUSIONS: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.
[Mh] Termos MeSH primário: Vacinas contra Influenza/administração & dosagem
Influenza Humana/prevenção & controle
Complicações Infecciosas na Gravidez/prevenção & controle
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Modelos Logísticos
Registros Médicos
Nicarágua/epidemiologia
Gravidez
Complicações Infecciosas na Gravidez/epidemiologia
Trimestres da Gravidez
Nascimento Prematuro/epidemiologia
Pontuação de Propensão
Estudos Retrospectivos
População Urbana/estatística & dados numéricos
Vacinação
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


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[PMID]:28453802
[Au] Autor:Kostron A; Friess M; Inci I; Hillinger S; Schneiter D; Gelpke H; Stahel R; Seifert B; Weder W; Opitz I
[Ad] Endereço:Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
[Ti] Título:Propensity matched comparison of extrapleural pneumonectomy and pleurectomy/decortication for mesothelioma patients.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):740-746, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The objective of this retrospective study was to assess perioperative outcomes, overall survival and freedom from recurrence after induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) in patients with mesothelioma in a propensity score matched analysis. METHODS: Between September 1999 and August 2015, 167 patients received multimodality treatment (platinum-based chemotherapy followed by EPP [ n = 141] or P/D [ n = 26]). We performed 2:1 propensity score matching for gender, laterality, epithelioid histological subtype and International Mesothelioma Interest Group (iMig) stage (52 EPP and 26 P/D). RESULTS: Postoperative major morbidity (48% vs 58%, P = 0.5) was similar in both groups; however, the complication profile and severity were different and favoured P/D; the 90-day mortality (8% vs 0%, P = 0.3) rate was lower in P/D although not statistically significant. Prolonged air leak (≥10 days) occurred in 15 patients (58%) undergoing P/D. The intensive care unit stay was significantly longer after EPP ( P = 0.001). Freedom from recurrence was similar for both groups (EPP: median 15 months, 95% confidence interval [CI]: 10-21; P/D: 13 months, 95% CI: 11-17) ( P = 0.2). Overall survival was significantly longer for patients undergoing P/D (median 32 months, 95% CI: 29-35) compared to EPP (23 months, 95% CI: 21-25) ( P = 0.031), but in the P/D group many cases were censored (73%) and the follow-up time was relatively short. CONCLUSIONS: P/D and EPP seem to have similar rates of major morbidity, although the profile of complications is different and more severe after EPP. Freedom from recurrence is comparable in both groups whereas improved overall survival needs to be confirmed in a large patient group with longer follow-up.
[Mh] Termos MeSH primário: Mesotelioma/cirurgia
Pleura/cirurgia
Neoplasias Pleurais/cirurgia
Pneumonectomia/métodos
Complicações Pós-Operatórias/epidemiologia
Pontuação de Propensão
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seguimentos
Seres Humanos
Masculino
Mesotelioma/diagnóstico
Meia-Idade
Morbidade/tendências
Recidiva Local de Neoplasia/epidemiologia
Neoplasias Pleurais/diagnóstico
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Suíça/epidemiologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw422


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[PMID]:28453793
[Au] Autor:Sabashnikov A; Heinen S; Deppe AC; Zeriouh M; Weymann A; Slottosch I; Eghbalzadeh K; Popov AF; Liakopoulos O; Rahmanian PB; Madershahian N; Kroener A; Choi YH; Kuhn-Régnier F; Simon AR; Wahlers T; Wippermann J
[Ad] Endereço:Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
[Ti] Título:Impact of gender on long-term outcomes after surgical repair for acute Stanford A aortic dissection: a propensity score matched analysis.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):702-707, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Previous research suggests that female gender is associated with increased mortality rates after surgery for Stanford A acute aortic dissection (AAD). However, women with AAD usually present with different clinical symptoms that may bias outcomes. Moreover, there is a lack of long-term results regarding overall mortality and freedom from major cerebrovascular events. We analysed the impact of gender on long-term outcomes after surgery for Stanford A AAD by comparing genders with similar risk profiles using propensity score matching. METHODS: A total of 240 patients operated for Stanford A AAD were included in this study. To control for selection bias and other confounders, propensity score matching was applied to gender groups. RESULTS: After propensity score matching, the gender groups were well balanced in terms of risk profiles. There were no statistically significant differences regarding duration of cardiopulmonary bypass ( P = 0.165) and duration of aortic cross-clamp time ( P = 0.111). Female patients received less fresh frozen plasma ( P = 0.021), had shorter stays in the intensive care unit ( P = 0.031), lower incidence of temporary neurological dysfunction ( P < 0.001) and lower incidence of dialysis ( P = 0.008). There were no significant differences regarding intraoperative mortality ( P = 1.000), 30-day mortality ( P = 0.271), long-term overall cumulative survival ( P = 0.954) and long-term freedom from cerebrovascular events ( P = 0.235) with up to a 9-year follow-up. CONCLUSIONS: Considering patients with similar risk profiles, female gender per se is not associated with worse long-term survival and freedom from stroke after surgical aortic repair. Moreover, female patients might even benefit from a smoother early postoperative course and lower incidence of early postoperative complications.
[Mh] Termos MeSH primário: Aneurisma Dissecante/cirurgia
Aneurisma da Aorta Torácica/cirurgia
Complicações Pós-Operatórias/epidemiologia
Pontuação de Propensão
Procedimentos Cirúrgicos Vasculares/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
Seguimentos
Alemanha/epidemiologia
Seres Humanos
Incidência
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Distribuição por Sexo
Fatores Sexuais
Taxa de Sobrevida/tendências
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw426


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[PMID]:29489656
[Au] Autor:Shang Q; Geng Q; Zhang X; Xu H; Guo C
[Ad] Endereço:Department of Pathology, Linyi People's Hospital, Linyi, Shandong province.
[Ti] Título:The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis.
[So] Source:Medicine (Baltimore);97(9):e0045, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study was conducted to assess the clinical advantages of early enteral nutrition (EEN) in pediatric patients who underwent surgery with gastrointestinal (GI) anastomosis.EEN has been associated with clinical benefits in various aspect of surgical intervention, including GI function recovery and postoperative complications reduction. Evaluable data documenting clinical advantages with EEN for pediatric patients after surgery with GI anastomosis are limited.We retrospectively reviewed the medical records of 575 pediatric patients undergoing surgical intervention with GI anastomosis. Among them, 278 cases were managed with EEN and the remaining cases were set as late enteral nutrition (LEN) group. Propensity score (PS) matching was conducted to adjust biases in patient selection. Enteral feeding related complications were evaluated with symptoms, including serum electrolyte abnormalities, abdominal distention, abdominal cramps, and diarrhea. Clinical outcomes, including GI function recovery, postoperative complications, length of hospital stay, and postoperative follow-up, were assessed according to EEN or LEN.Following PS matching, the baseline variables of the 2 groups were more comparable. There were no differences in the incidence of enteral feeding-related complications. EEN was associated with postoperative GI function recovery, including time to first defecation (3.1 ±â€Š1.4 days for EEN vs 3.8 ±â€Š1.0 days for LEN, risk ratio [RR], 0.62; 95% confidence interval [CI] 0.43-1.08, P = .042). A lower total episodes of complication, including infectious complications and major complications were noted in patients with EEN than in patients with LEN (117 [45.9%] vs 137 [53.7%]; OR, 0.73, 95% CI 0.52-1.03, P = .046). Mean postoperative length of stay in the EEN group was 7.4 ±â€Š1.8 days versus 9.2 ±â€Š1.4 days in the LEN group (P = .007). Furthermore, the incidence of adhesive small bowel obstruction was lower for patients with laxative administration compared with control, but no significant difference was attained (P = .092)EEN was safe and associated with clinical benefits, including shorten hospital stay, and reduced overall postoperative complications on pediatric patients undergoing GI anastomosis.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Nutrição Enteral
Cuidados Pós-Operatórios
[Mh] Termos MeSH secundário: Anastomose Cirúrgica/efeitos adversos
Pré-Escolar
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Nutrição Enteral/efeitos adversos
Feminino
Seguimentos
Seres Humanos
Perfuração Intestinal/cirurgia
Intestinos/cirurgia
Tempo de Internação
Masculino
Cuidados Pós-Operatórios/efeitos adversos
Complicações Pós-Operatórias
Pontuação de Propensão
Recidiva
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010045


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[PMID]:29489646
[Au] Autor:Kang S; Na Y; Joung SY; Lee SI; Oh SC; Min BW
[Ad] Endereço:Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea.
[Ti] Título:The significance of microsatellite instability in colorectal cancer after controlling for clinicopathological factors.
[So] Source:Medicine (Baltimore);97(9):e0019, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The colorectal cancer (CRC) patients with microsatellite instability (MSI) have distinct clinicopathological characteristics consisting of factors predicting positive and negative outcomes, such as a high lymph node harvest and poor differentiation. In this study, we measured the value of MSI as a prognostic factor after controlling for these discrepant factors. A total of 603 patients who underwent curative surgery for stages I to III colorectal cancer were enrolled. The patients were divided into microsatellite instability high (MSI-H) and microsatellite stable/microsatellite instability low (MSS/MSI-L) groups. Propensity score matching was used to match clinicopathological factors between the 2 groups. MSI-H patients had a high lymph node harvest (median: 31.0 vs 23.0, P < .001), earlier-stage tumors (P < .001), advanced T stage (89.3% vs 74.0%, P = .018), and poor differentiation (19.6% vs 2.0%, P < .001). Survival analysis showed better survival in the MSI-H group, but the difference was not statistically significant (P = .126). Propensity score matching was performed for significant prognostic factors identified by Cox hazard regression. After the matching, the survival difference by MSI status was estimated to be larger than before, and reached statistical significance (P = .045). In conclusion, after controlling for pathological characteristics, MSI-H could be a potent prognostic factor regarding patient survival.
[Mh] Termos MeSH primário: Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/patologia
Instabilidade de Microssatélites
[Mh] Termos MeSH secundário: Seres Humanos
Linfonodos/patologia
Metástase Linfática
Estadiamento de Neoplasias
Prognóstico
Pontuação de Propensão
Modelos de Riscos Proporcionais
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010019


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[PMID]:29443474
[Au] Autor:Raithel J; Yates M; Dworsky A; Schretzman M; Welshimer W
[Ti] Título:Partnering to Leverage Multiple Data Sources: Preliminary Findings from a Supportive Housing Impact Study.
[So] Source:Child Welfare;94(1):73-85, 2015.
[Is] ISSN:0009-4021
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article presents preliminary findings from an impact study that drew upon administrative data collected by city agencies and data collected by a supportive housing program for young adults who are aging out of foster care, homeless, or at risk of homelessness. Participation in the program was associated with a reduction in shelter use and jail stays during the two years after program entry. The study demonstrates the benefits of collaboration and the possibilities of using administrative data from multiple public agencies to evaluate program impacts on young adult outcomes.
[Mh] Termos MeSH primário: Cuidados no Lar de Adoção
Jovens em Situação de Rua/psicologia
Vida Independente/psicologia
Habitação Popular/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Feminino
Seres Humanos
Masculino
Cidade de Nova Iorque
Pontuação de Propensão
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; 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:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:29183076
[Au] Autor:Pincus D; Ravi B; Wasserstein D; Huang A; Paterson JM; Nathens AB; Kreder HJ; Jenkinson RJ; Wodchis WP
[Ad] Endereço:Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
[Ti] Título:Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery.
[So] Source:JAMA;318(20):1994-2003, 2017 11 28.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Although wait times for hip fracture surgery have been linked to mortality and are being used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications. Objective: To use population-based wait-time data to identify the optimal time window in which to conduct hip fracture surgery before the risk of complications increases. Design, Setting, and Participants: Population-based, retrospective cohort study of adults undergoing hip fracture surgery between April 1, 2009, and March 31, 2014, at 72 hospitals in Ontario, Canada. Risk-adjusted restricted cubic splines modeled the probability of each complication according to wait time. The inflection point (in hours) when complications began to increase was used to define early and delayed surgery. To evaluate the robustness of this definition, outcomes among propensity-score matched early and delayed surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs). Exposure: Time elapsed from hospital arrival to surgery (in hours). Main Outcomes and Measures: Mortality within 30 days. Secondary outcomes included a composite of mortality or other medical complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia). Results: Among 42 230 patients with hip fracture (mean [SD] age, 80.1 years [10.7], 70.5% women) who met study entry criteria, overall mortality at 30 days was 7.0%. The risk of complications increased when wait times were greater than 24 hours, irrespective of the complication considered. Compared with 13 731 propensity-score matched patients who received surgery earlier, 13 731 patients who received surgery after 24 hours had a significantly higher risk of 30-day mortality (898 [6.5%] vs 790 [5.8%]; % absolute RD, 0.79; 95% CI, 0.23-1.35) and the composite outcome (1680 [12.2%]) vs 1383 [10.1%]; % absolute RD, 2.16; 95% CI, 1.43-2.89). Conclusions and Relevance: Among adults undergoing hip fracture surgery, increased wait time was associated with a greater risk of 30-day mortality and other complications. A wait time of 24 hours may represent a threshold defining higher risk.
[Mh] Termos MeSH primário: Fraturas do Quadril/mortalidade
Fraturas do Quadril/cirurgia
Complicações Pós-Operatórias/epidemiologia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Fixação Interna de Fraturas
Seres Humanos
Masculino
Complicações Pós-Operatórias/mortalidade
Pontuação de Propensão
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.17606



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