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[PMID]:29326249
[Au] Autor:Roberts L
[Ti] Título:In Pakistan, surveillance for polio reveals a paradox.
[So] Source:Science;359(6372):142-143, 2018 Jan 12.
[Is] ISSN:1095-9203
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Monitoramento Epidemiológico
Poliomielite/epidemiologia
Poliovirus/isolamento & purificação
Esgotos/virologia
[Mh] Termos MeSH secundário: Área Programática (Saúde)
Criança
Pré-Escolar
Erradicação de Doenças
Seres Humanos
Programas de Imunização
Lactente
Paquistão/epidemiologia
Paralisia
Poliomielite/imunologia
Poliomielite/prevenção & controle
Poliovirus/imunologia
Poliovirus/fisiologia
Vacinas contra Poliovirus/administração & dosagem
[Pt] Tipo de publicação:NEWS
[Nm] Nome de substância:
0 (Poliovirus Vaccines); 0 (Sewage)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.1126/science.359.6372.142


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[PMID]:28982876
[Au] Autor:Haque W; Verma V; Butler EB; Teh BS
[Ad] Endereço:Department of Radiation Oncology, CHI St Luke's Health, The Woodlands, TX, U.S.A.
[Ti] Título:Radical Cystectomy Chemoradiation for Muscle-invasive Bladder Cancer: Impact of Treatment Facility and Sociodemographics.
[So] Source:Anticancer Res;37(10):5603-5608, 2017 10.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The present study sought to compare the differences in practice patterns, as well as clinical outcomes for patients with muscle-invasive bladder cancer undergoing treatment with either radical cystectomy (RC) or concurrent chemoradiaiton (CRT). PATIENTS AND METHODS: The National Cancer Data Base (NCDB) was queried for patients diagnosed with T2/T3/T4aN0M0 bladder cancer, between 2004-2013, that received definitive treatment with either RC or CRT. RESULTS: 16,960 patients met the inclusion criteria; 1,450 (8.5%) underwent CRT, while 15,510 (91.5%) were treated with RC. Patients undergoing CRT were older, more likely to be female, African American, received treatment at an academic facility, and lived <20 miles of the treatment facility. CRT was associated with worse median OS (32.8 months vs. 36.1 months; p=0.0004). CONCLUSION: Older patients are more likely to undergo bladder preservation therapy, while those living farther away from treatment facilities are less likely to under CRT.
[Mh] Termos MeSH primário: Quimiorradioterapia/tendências
Cistectomia/tendências
Acesso aos Serviços de Saúde/tendências
Disparidades em Assistência à Saúde/tendências
Oncologistas/tendências
Padrões de Prática Médica/tendências
Fatores Socioeconômicos
Neoplasias da Bexiga Urinária/terapia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Área Programática (Saúde)
Quimiorradioterapia/efeitos adversos
Quimiorradioterapia/mortalidade
Cistectomia/efeitos adversos
Cistectomia/mortalidade
Bases de Dados Factuais
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Invasividade Neoplásica
Estadiamento de Neoplasias
Modelos de Riscos Proporcionais
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Estados Unidos
Neoplasias da Bexiga Urinária/mortalidade
Neoplasias da Bexiga Urinária/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE


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[PMID]:28978659
[Au] Autor:Nurmonen HJ; Huttunen T; Huttunen J; Kurki MI; Helin K; Koivisto T; von Und Zu Fraunberg M; Jääskeläinen JE; Lindgren AE
[Ad] Endereço:From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Bosto
[Ti] Título:Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population.
[So] Source:Neurology;89(18):1852-1859, 2017 Oct 31.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To define the association of autosomal dominant polycystic kidney disease (ADPKD) with the characteristics of aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (IA) disease. METHODS: We fused data from the Kuopio Intracranial Aneurysm database (n = 4,436 IA patients) and Finnish nationwide registries into a population-based series of 53 IA patients with ADPKD to compare the aneurysm- and patient-specific characteristics of IA disease in ADPKD and in the general IA population, and to identify risks for de novo IA formation. RESULTS: In total, there were 33 patients with ADPKD with aSAH and 20 patients with ADPKD with unruptured IAs. The median size of ruptured IAs in ADPKD was significantly smaller than in the general population (6.00 vs 8.00 mm) and the proportion of small ruptured IAs was significantly higher (31% vs 18%). Median age at aSAH was 42.8 years, 10 years younger than in the general IA population. Multiple IAs were present in 45% of patients with ADPKD compared to 28% in the general IA population. Cumulative risk of de novo IA formation was 1.3% per patient-year (vs 0.2% in the general IA population). Hazard for de novo aneurysm formation was significantly elevated in patients with ADPKD (Cox regression hazard ratio 7.7, 95% confidence interval 2.8-20; < 0.0005). CONCLUSIONS: Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs.
[Mh] Termos MeSH primário: Aneurisma Intracraniano/epidemiologia
Doenças Renais Policísticas/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Área Programática (Saúde)
Planejamento em Saúde Comunitária
Bases de Dados Factuais
Feminino
Finlândia/epidemiologia
Seguimentos
Seres Humanos
Incidência
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/diagnóstico por imagem
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Doenças Renais Policísticas/complicações
Doenças Renais Policísticas/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004597


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[PMID]:28945663
[Au] Autor:Parikh ND; Marrero WJ; Sonnenday CJ; Lok AS; Hutton DW; Lavieri MS
[Ad] Endereço:1 Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Industrial and Operational Engineering, University of Michigan, Ann Arbor, MI.3 Department of Surgery, University of Michigan, Ann Arbor, MI.4 School of Public Health, University of Michigan Ann Arbor, MI.
[Ti] Título:Population-Based Analysis and Projections of Liver Supply Under Redistricting.
[So] Source:Transplantation;101(9):2048-2055, 2017 Sep.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply. METHODS: We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model. RESULTS: The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model. CONCLUSIONS: The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.
[Mh] Termos MeSH primário: Área Programática (Saúde)
Prestação Integrada de Cuidados de Saúde/tendências
Acesso aos Serviços de Saúde/tendências
Necessidades e Demandas de Serviços de Saúde/tendências
Disparidades em Assistência à Saúde/tendências
Transplante de Fígado/tendências
Determinação de Necessidades de Cuidados de Saúde/tendências
Avaliação de Processos (Cuidados de Saúde)/tendências
Doadores de Tecidos/provisão & distribuição
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Censos
Bases de Dados Factuais
Feminino
Previsões
Seres Humanos
Masculino
Meia-Idade
Regionalização/tendências
Fatores de Tempo
Obtenção de Tecidos e Órgãos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170926
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001785


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[PMID]:28692655
[Au] Autor:Guiraud I; Post A; Diallo SN; Lompo P; Maltha J; Thriemer K; Tahita CM; Ley B; Derra K; Bottieau E; Kazienga A; Schurmans C; Ravinetto R; Rouamba E; Van Griensven J; Bertrand S; Tinto H; Jacobs J
[Ad] Endereço:IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
[Ti] Título:Population-based incidence, seasonality and serotype distribution of invasive salmonellosis among children in Nanoro, rural Burkina Faso.
[So] Source:PLoS One;12(7):e0178577, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Bloodstream infections (BSI) caused by Salmonella Typhi and invasive non-Typhoidal Salmonella (iNTS) frequently affect children living in rural sub-Saharan Africa but data about incidence and serotype distribution are rare. OBJECTIVE: The present study assessed the population-based incidence of Salmonella BSI and severe malaria in a Health and Demographic Surveillance System in a rural area with seasonal malaria transmission in Nanoro, Burkina Faso. METHODS: Children between 2 months-15 years old with severe febrile illness were enrolled during a one-year surveillance period (May 2013-May 2014). Thick blood films and blood cultures were sampled and processed upon admission. Population-based incidences were corrected for non-referral, health seeking behavior, non-inclusion and blood culture sensitivity. Adjusted incidence rates were expressed per 100,000 person-years of observations (PYO). RESULTS: Among children < 5 years old, incidence rates for iNTS, Salmonella Typhi and severe malaria per 100,000 PYO were 4,138 (95% Confidence Interval (CI): 3,740-4,572), 224 (95% CI: 138-340) and 2,866 (95% CI: 2,538-3,233) respectively. Among those aged 5-15 years, corresponding incidence rates were 25 (95% CI: 8-60), 273 (95% CI: 203-355) and 135 (95% CI: 87-195) respectively. Most iNTS occurred during the peak of the rainy season and in parallel with the increase of Plasmodium falciparum malaria; for Salmonella Typhi no clear seasonal pattern was observed. Salmonella Typhi and iNTS accounted for 13.3% and 55.8% of all 118 BSI episodes; 71.6% of iNTS (48/67) isolates were Salmonella enterica serovar Typhimurium and 25.4% (17/67) Salmonella enterica serovar Enteritidis; there was no apparent geographical clustering. CONCLUSION: The present findings from rural West-Africa confirm high incidences of Salmonella Typhi and iNTS, the latter with a seasonal and Plasmodium falciparum-related pattern. It urges prioritization of the development and implementation of Salmonella Typhi as well as iNTS vaccines in this setting.
[Mh] Termos MeSH primário: Infecções por Salmonella/sangue
Infecções por Salmonella/epidemiologia
Sorotipagem/métodos
[Mh] Termos MeSH secundário: Burkina Faso/epidemiologia
Área Programática (Saúde)
Criança
Pré-Escolar
Demografia
Feminino
Geografia
Seres Humanos
Incidência
Lactente
Malária/complicações
Malária/epidemiologia
Masculino
Salmonella/isolamento & purificação
Estações do Ano
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178577


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[PMID]:28575128
[Au] Autor:Kurtelius A; Kallionpää RA; Huttunen J; Huttunen TJ; Helin K; Koivisto T; Frösen J; von Und Zu Fraunberg M; Peltonen S; Peltonen J; Jääskeläinen JE; Lindgren AE
[Ad] Endereço:Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
[Ti] Título:Neurofibromatosis type 1 is not associated with subarachnoid haemorrhage.
[So] Source:PLoS One;12(6):e0178711, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of intracranial aneurysms (IAs) has been proposed to be elevated in the patients with neurofibromatosis type 1 (NF1). Our aims were to determine the prevalence of NF1 in a large Finnish population based cohort of IA patients and, on the other hand, the occurrences of subarachnoid haemorrhage and unruptured intracranial aneurysms in a nationwide population-based cohort of NF1 patients and its matched ten-fold control cohort. METHODS: The Kuopio IA Database (www.kuopioneurosurgery.fi) includes all ruptured and unruptured IA cases admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population since 1980. In this registry-based study, we cross-linked the Kuopio IA database with the Finnish national registry covering all hospital diagnoses. The NF1 diagnoses of the 4543 patients with either saccular of fusiform IA were identified from 1969 to 2015 and verified from patient records. Our second approach was to analyze the occurrence of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured IAs in a nationwide population-based database of 1410 NF1 patients and its ten-fold matched control cohort (n = 14030) using national registry of hospital diagnoses between 1987 and 2014. RESULTS: One NF1 patient was identified among the 4543 IA patients. Three verified IA cases (one unruptured IA and two aSAH cases) were identified in the cohort of 1410 NF1 patients, with similar occurrences in the control cohort. CONCLUSIONS: We found no evidence in our population-based cohorts to support the conception that NF1 is associated with IAs. Our results indicate that the incidence of aSAH is not elevated in patients with NF1. Further studies are required to confirm that there is no association between NF1 and unruptured IAs.
[Mh] Termos MeSH primário: Neurofibromatose 1/complicações
Hemorragia Subaracnóidea/etiologia
[Mh] Termos MeSH secundário: Adulto
Aneurisma Roto/epidemiologia
Aneurisma Roto/etiologia
Estudos de Casos e Controles
Área Programática (Saúde)
Bases de Dados Factuais
Saúde da Família
Feminino
Finlândia/epidemiologia
Hospitais Universitários/estatística & dados numéricos
Seres Humanos
Classificação Internacional de Doenças
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/epidemiologia
Masculino
Meia-Idade
Prevalência
Sistema de Registros
Hemorragia Subaracnóidea/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178711


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[PMID]:28538643
[Au] Autor:Snyder CW; Chandler NM; Litz CN; Pracht EE; Danielson PD; Ciesla DJ
[Ad] Endereço:From the Division of Pediatric Surgery (C.W.S., N.M.C., C.N.L., P.D.D.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Division of Trauma and Acute Care Surgery (C.W.S., D.J.C.), University of South Florida, Tampa, Florida; and College of Public Health (E.E.P.), University of South Florida, Tampa, Florida.
[Ti] Título:Immature patients in a mature system: Regional analysis of Florida's pediatric trauma system.
[So] Source:J Trauma Acute Care Surg;83(4):711-715, 2017 Oct.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The state of Florida's trauma system is organized into seven regions, two of which lack designated pediatric trauma centers. Injured children residing in these regions often require transfer out of their home region for definitive care. The purpose of this study was to evaluate the effectiveness and efficiency of the current regionalization approach, focusing on variations between regions. METHODS: Using the Florida Agency for Health Care Administration database, we identified all trauma patients 15 years old or younger admitted between 2009 and 2014. Patients with high-risk injury (ICD-9 Injury Severity Score < 0.85) who did not receive definitive treatment at a pediatric trauma center (PTC) were considered undertriaged. Outcomes of interest included mortality and long-term disability. Patients who were definitively treated at a facility outside their home region, but who had low risk injuries (ICD-9 Injury Severity Score > 0.9), required no procedures or ICU monitoring, and were discharged within 48 hours, were considered to have received potentially avoidable out-of-region treatment. Regions were compared, and patients treated in-region were compared to those treated out-of-region. Regression models were used to adjust for covariates. RESULTS: Of 34,816 patients, 8% had high-risk injuries and the overall mortality rate was 1%. Risk-adjusted outcomes were generally similar across all regions. Regional rates of undertriage varied from 0.4% to 4.7% and were highest in regions lacking a PTC. Eleven percent of patients required definitive treatment outside their home region; these patients had higher hospital charges and stayed in the hospital 0.96 days longer (least-squares mean). Rates of potentially avoidable out-of-region treatment ranged from 7% to 12% in the two regions lacking a PTC. After adjustment for confounders, significant unexplained differences in potentially avoidable out-of-region treatment remained between these two regions (OR 2.0, 95% CI 1.6-2.6). CONCLUSIONS: Florida's regionalized pediatric trauma system performs effectively, with low undertriage and acceptable outcomes. Out-of-region treatment, an inevitable byproduct of the current regionalization approach, imposes a measurable burden on the treating facility and patient/family. Unexplained variations in potentially avoidable out-of-region treatment suggest improvements can be made in system efficiency. LEVEL OF EVIDENCE: Economic/decision study, level III.
[Mh] Termos MeSH primário: Transferência de Pacientes/estatística & dados numéricos
Pediatria
Transporte de Pacientes/estatística & dados numéricos
Centros de Traumatologia/organização & administração
[Mh] Termos MeSH secundário: Adolescente
Área Programática (Saúde)
Criança
Pré-Escolar
Florida
Seres Humanos
Lactente
Recém-Nascido
Escala de Gravidade do Ferimento
Triagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170525
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001580


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[PMID]:28408154
[Au] Autor:Medhekar AN; Mix DS; Aquina CT; Trakimas LE; Noyes K; Fleming FJ; Glocker RJ; Stoner MC
[Ad] Endereço:University of Rochester, Strong Memorial Hospital, Rochester, NY.
[Ti] Título:Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital.
[So] Source:J Vasc Surg;66(2):476-487.e1, 2017 Aug.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective of this study was to identify relationships among geographic access to care, vascular procedure volume, limb preservation, and survival in patients diagnosed with critical limb ischemia (CLI). METHODS: Using New York State administrative data from 2000 to 2013, we identified a patient's first presentation with CLI defined by International Classification of Diseases, Ninth Revision diagnosis and procedure codes. Distance from the patient's home to the index hospital was calculated using the centroids of the respective ZIP codes. A multivariable logistic regression model was employed to estimate the impact of distance, major lower extremity amputation (LEA) volume, and lower extremity revascularization (LER) volume on major amputation and 30-day mortality. Volumes and distances were analyzed in quintiles. The farthest distance quintile and the highest procedure volume quintiles were used as references for generating odds ratios (ORs). RESULTS: There were 49,576 patients identified with an initial presentation of CLI. The median age was 73 years, 35,829 (73.2%) had Medicare as a primary insurer, 11,395 (23.0%) had a major amputation, and 4249 (8.6%) died within 30 days of admission. Patients in the closest distance quintile were more likely to undergo amputation (OR, 1.53 [1.39-1.68]; P < .0001). Patients who visited hospitals in the lowest LER volume quintile with at least one procedure per year faced higher 30-day mortality rates (OR, 2.05 [1.67-2.50]; P < .0001) and greater odds of amputation (OR, 9.94 [8.5-11.63]; P < .0001). Patients who visited hospitals in the lowest LEA volume quintile had lower odds of 30-day mortality (OR, 0.66 [0.50-0.87]; P = .0033) and lower odds of amputation (OR, 0.180 [0.142-0.227]; P < .0001). CONCLUSIONS: Rates of major amputation are inversely associated with distance from the index hospital, whereas rates of both major amputation and mortality are inversely associated with LER volume. Rates of major amputation and mortality are directly associated with LEA volume. We believe that unless it is otherwise contraindicated, these data support consideration for selective referral of CLI patients to high-volume centers for LER regardless of distance. Within the context of value-based health care delivery, policy supporting regionalization of CLI care into centers of excellence may improve outcomes for these patients.
[Mh] Termos MeSH primário: Área Programática (Saúde)
Acesso aos Serviços de Saúde
Disparidades em Assistência à Saúde
Hospitais com Alto Volume de Atendimentos
Hospitais com Baixo Volume de Atendimentos
Isquemia/cirurgia
Extremidade Inferior/irrigação sanguínea
Doença Arterial Periférica/cirurgia
Avaliação de Processos (Cuidados de Saúde)
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Amputação
Distribuição de Qui-Quadrado
Estado Terminal
Feminino
Seres Humanos
Isquemia/diagnóstico por imagem
Isquemia/mortalidade
Isquemia/fisiopatologia
Salvamento de Membro
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
New York
Razão de Chances
Doença Arterial Periférica/diagnóstico por imagem
Doença Arterial Periférica/mortalidade
Doença Arterial Periférica/fisiopatologia
Serviços Postais
Estudos Retrospectivos
Fatores de Risco
Fatores Socioeconômicos
Fatores de Tempo
Resultado do Tratamento
Procedimentos Cirúrgicos Vasculares/efeitos adversos
Procedimentos Cirúrgicos Vasculares/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE


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[PMID]:28407769
[Au] Autor:Kimsey L; Olaiya S; Smith C; Hoburg A; Lipsitz SR; Koehlmoos T; Nguyen LL; Weissman JS
[Ad] Endereço:Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. lkimsey@georgiasouthern.edu.
[Ti] Título:Geographic variation within the military health system.
[So] Source:BMC Health Serv Res;17(1):271, 2017 Apr 13.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). METHODS: Data for fiscal years 2007 - 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE. Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation (CoV) and interquartile ranges (IQR) were calculated and analyzed using residence catchment area as the geographic unit. Catchment areas anchored by a Military Treatment Facility (MTF) were compared to catchment areas not anchored by a MTF. RESULTS: Variation, as measured by CoV, was 0.37 for back surgery and 0.13 for C-sections in FY 2010- comparable to rates documented in other healthcare systems. The 2010 CoV (and average cost) for per capita costs was 0.26 ($3,479.51). Procedure rates were generally lower and CoVs higher in regions anchored by a MTF compared with regions not anchored by a MTF, based on both system-wide comparisons and comparisons of neighboring areas. CONCLUSIONS: In spite of its centrally managed system and relatively healthy beneficiaries with very robust health benefits, the MHS is not immune to unexplained variation in utilization and cost of healthcare.
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/estatística & dados numéricos
Medicina Militar
Saúde dos Veteranos
[Mh] Termos MeSH secundário: Área Programática (Saúde)
Feminino
Órgãos Governamentais
Hospitais Militares
Seres Humanos
Militares
Gravidez
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170529
[Lr] Data última revisão:
170529
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2216-1


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[PMID]:28398381
[Au] Autor:Andreotti F; D'Angela D; Mancusi RL; Spandonaro F
[Ad] Endereço:Istituto di Cardiologia, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma.
[Ti] Título:[Prevalence of atrial fibrillation, treatment eligibility and consumption of oral anticoagulants in Italian Local Health Authorities: impact of non-vitamin K antagonist oral anticoagulants].
[Ti] Título:Prevalenza della fibrillazione atriale, eleggibilità al trattamento e consumo di anticoagulanti orali nelle Aziende Sanitarie italiane: impatto dei nuovi anticoagulanti..
[So] Source:G Ital Cardiol (Rome);18(3):230-238, 2017 Mar.
[Is] ISSN:1827-6806
[Cp] País de publicação:Italy
[La] Idioma:ita
[Ab] Resumo:BACKGROUND: Atrial fibrillation (AF) increases significantly the risk of comorbidities and premature death. This paper aims to estimate: 1) the current prevalence of AF in Italy as a whole and within individual local health authorities (LHA); 2) the proportion of strongly eligible patients receiving oral anticoagulants; 3) the impact of non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: The prevalence of AF and the proportion of patients strongly eligible for anticoagulant treatment (defined by a CHADS2 score ≥2) were obtained by applying the results of a systematic literature search to the Italian population stratified by gender, age and LHA. The consumption of oral anticoagulants in eligible patients within each LHA was derived from Intercontinental Marketing Services data. RESULTS: Altogether, the detected prevalence of AF in Italy is 1.7%, i.e. 1 036 448 cases. Of these, 62.6%, i.e. 648 832 subjects, are estimated to have a CHADS2 ≥2 and therefore strongly eligible for anticoagulant treatment. The estimated percentage of eligible treated patients in 2015 was 43.7%, significantly greater compared to 2014 (31.3%), with local and regional variabilities. In 2015 the estimated use of NOACs for AF was 36.4% of all oral anticoagulants, with marked local and regional variabilities. NOAC prescription appears influenced by financial limitations and by factors related to the network of anticoagulation services. CONCLUSIONS: The present analysis shows a prevalence of AF in Italy of 1.7%. The overall rate of anticoagulant use is increasing, but is still insufficient, with marked regional and local variations. In 2015, approximately one third of oral anticoagulation in eligible patients was based on NOACs.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
Tromboembolia/prevenção & controle
[Mh] Termos MeSH secundário: Administração Oral
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Fibrilação Atrial/complicações
Fibrilação Atrial/epidemiologia
Área Programática (Saúde)
Feminino
Seres Humanos
Itália/epidemiologia
Masculino
Meia-Idade
Prevalência
Acidente Vascular Cerebral/etiologia
Tromboembolia/etiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1714/2674.27400



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