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Wang J, Zhang H, Lin J, Yang L, Zhao L, Du A. Atypical and delayed spinal cord MRI features of COVID-19-associated myelopathies: a report of four cases and literature review. Neurol Sci 2024; 45:1835-1843. [PMID: 38430399 PMCID: PMC11021317 DOI: 10.1007/s10072-024-07351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024]
Abstract
We reported four patients with coronavirus disease 2019 (COVID-19)-associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.
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Affiliation(s)
- Jie Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
- Institute of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijun Zhang
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Jingya Lin
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Lingli Yang
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Lipeng Zhao
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Ailian Du
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China.
- Institute of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Liao R, Hu L, Yu J, Chen Y, Chen M, Yan J, Li X, Han X, Jike C, Yu G, Wang J, Liao Q, Xia L, Bai X, Shi J, Jiang T, Du L, Zhang T. Association between TB delay and TB treatment outcomes in HIV-TB co-infected patients: a study based on the multilevel propensity score method. BMC Infect Dis 2024; 24:457. [PMID: 38689228 PMCID: PMC11061920 DOI: 10.1186/s12879-024-09328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND HIV-tuberculosis (HIV-TB) co-infection is a significant public health concern worldwide. TB delay, consisting of patient delay, diagnostic delay, treatment delay, increases the risk of adverse anti-TB treatment (ATT) outcomes. Except for individual level variables, differences in regional levels have been shown to impact the ATT outcomes. However, few studies appropriately considered possible individual and regional level confounding variables. In this study, we aimed to assess the association of TB delay on treatment outcomes in HIV-TB co-infected patients in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) of China, using a causal inference framework while taking into account individual and regional level factors. METHODS We conducted a study to analyze data from 2068 patients with HIV-TB co-infection in Liangshan Prefecture from 2019 to 2022. To address potential confounding bias, we used a causal directed acyclic graph (DAG) to select appropriate confounding variables. Further, we controlled for these confounders through multilevel propensity score and inverse probability weighting (IPW). RESULTS The successful rate of ATT for patients with HIV-TB co-infection in Liangshan Prefecture was 91.2%. Total delay (OR = 1.411, 95% CI: 1.015, 1.962), diagnostic delay (OR = 1.778, 95% CI: 1.261, 2.508), treatment delay (OR = 1.749, 95% CI: 1.146, 2.668) and health system delay (OR = 1.480 95% CI: (1.035, 2.118) were identified as risk factors for successful ATT outcome. Sensitivity analysis demonstrated the robustness of these findings. CONCLUSIONS HIV-TB co-infection prevention and control policy in Liangshan Prefecture should prioritize early treatment for diagnosed HIV-TB co-infected patients. It is urgent to improve the health system in Liangshan Prefecture to reduce delays in diagnosis and treatment.
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Affiliation(s)
- Rujun Liao
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lin Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jie Yu
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Miaoshuang Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingmin Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Li
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinyue Han
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chunnong Jike
- Liangshan Center for Disease Control and Prevention, Xichang, 615000, Sichuan, People's Republic of China
| | - Gang Yu
- Liangshan Center for Disease Control and Prevention, Xichang, 615000, Sichuan, People's Republic of China
| | - Ju Wang
- Liangshan Center for Disease Control and Prevention, Xichang, 615000, Sichuan, People's Republic of China
| | - Qiang Liao
- Liangshan Center for Disease Control and Prevention, Xichang, 615000, Sichuan, People's Republic of China
| | - Lan Xia
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuefei Bai
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinhong Shi
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tian Jiang
- Editorial department of Journal of Sichuan University (Medical Sciences), Sichuan University, Chengdu, CN, People's Republic of China
| | - Liang Du
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Juan-Salvadores P, Castro-Rodríguez M, Jiménez-Díaz VA, Veiga C, Busto L, Fernández-Barbeira S, Iñiguez-Romo A. Sex differences in delay times in ST-segment elevation myocardial infarction: A cohort study. Med Clin (Barc) 2024:S0025-7753(24)00189-1. [PMID: 38688735 DOI: 10.1016/j.medcli.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The present study analyzes a cohort of consecutive patients with ST-segment elevation acute myocardial infarction (STEMI), evaluating the ischemia-reperfusion times from the perspective of gender differences (females versus males), with a long-term follow-up. METHODS Single-center analytical cohort study of patients with STEMI in a tertiary hospital, between January 2015 and December 2020. RESULTS A total of 2668 patients were included, 2002 (75%) men and 666 (25%) women. The time elapsed from the onset of symptoms to the opening of the artery was 197min (IQR 140-300) vs 220min (IQR 152-340), p=0.004 in men and women respectively. A delay in health care significantly impacts the occurrence of cardiovascular adverse events at follow-up, HR 1.34 [95%CI 1.06-1.70]; p=0.015. CONCLUSIONS Women took longer to go to health care services and had a longer delay both in the diagnosis of STEMI and in coronary reperfusion. It is imperative to emphasize the necessity of educating women about the recognition of ischemic heart disease symptoms, empowering them to raise early alarms and seek timely medical attention.
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Affiliation(s)
- Pablo Juan-Salvadores
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain.
| | - María Castro-Rodríguez
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain
| | - Víctor Alfonso Jiménez-Díaz
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain; Interventional Cardiology Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain
| | - Cesar Veiga
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - Laura Busto
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - Saleta Fernández-Barbeira
- Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain; Interventional Cardiology Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain
| | - Andrés Iñiguez-Romo
- Cardiovascular Research Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Cardiovascular Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain; Interventional Cardiology Unit, Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain; Department of Cardiology, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, Spain
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Shetty A, Bhandary R, Ahuja D, Venugopalan G, Grossi E, Tartaglia GM, Khijmatgar S. The impact of unmet treatment need on oral health related quality of life: a questionnaire survey. BMC Oral Health 2024; 24:432. [PMID: 38589820 PMCID: PMC11003014 DOI: 10.1186/s12903-024-04169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Based on the present global burden of oral diseases, unmet dental needs affect a more significant population worldwide. It is characterised by the need for dental care but receiving delayed or no care. The contributing factors include lack of knowledge about oral health, its consequences, and the availability of dental services. We need to find out the scale of the problem of unmet dental needs for the south Indian population. Therefore, the objective was to determine the relationship between the presence of oral disease and the quality of life-related to oral health using the OHIP-14 tool. METHODS The unmet dental requirements of the south Indian population were determined using a cross-sectional questionnaire survey. Close-ended questions were used to obtain data from two investigators trained to record the answers from the patients. The data was collected using the OHIP-14 questionnaire, which consists of 14 items divided into seven domains with two questions each. Physical pain, psychological impairment, physical disability, psychological disability, social disability, and disability were all considered. An additional analysis of artificial neural network (ANN) was done. RESULTS The response rate was 100 per cent. N = 1029 people replied to the questionnaire about their unmet dental needs. N = 497 (48.3%) were men, whereas N = 532 (51.7%) were women. The average age was 31.7811.72. As their current occupation, most of the included subjects (60.1%) were students. The respondents had no known personal habits and a mixed diet (94.93%). The average BMI was 24.022.59 (14-30.9). OHIP was present in 62.3% of the population. The average OHIP-14 severity score was 10.97. (8.54). The severity and degree of unmet dental need were substantial (p0.01) due to pain in the mouth/teeth/gums, malocclusion, and gum bleeding. The most common OHIP-14 domains affected by unmet oral needs were psychological discomfort, psychological limitation, social limitation, and feeling handicapped. The analysis of ANN revealed that high OHIP scores were primarily attributed to dental caries, poor oral health, and dental aesthetics. CONCLUSION The severity and degree of unmet dental needs were significant among the south Indian population. The most common oral health status that impacted OHIP-14 domains were pain, malocclusion, and bleeding gums. These patients were significantly impacted by psychological discomfort and social limitations and felt handicapped.
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Affiliation(s)
- Akshata Shetty
- Nitte (Deemed to be University), Department of Periodontics, A B Shetty Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Rahul Bhandary
- Nitte (Deemed to be University), Department of Periodontics, A B Shetty Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Dhruv Ahuja
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna International Institute of Research and Studies (MRIIRS), Manav Rachna Dental College, Faridabad, Haryana, India
| | - Geetu Venugopalan
- Nitte (Deemed to be University), Department of Periodontics, A B Shetty Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Enzo Grossi
- Villa Santa Maria Institute, Tavernerio, Italy
| | | | - Shahnawaz Khijmatgar
- Nitte (Deemed to be University), Department of Oral Biology and Genomic Studies, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India.
- SC Chirurgia Maxillo-Facciale e Odontostomatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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Kim CH, Chang JS, Lim Y, Lim D, Kim JW. Safety of urgent surgery for the patients with proximal femur fracture treated with platelet aggregation inhibitors: a propensity-score matching analysis. Eur J Trauma Emerg Surg 2024; 50:347-358. [PMID: 37768385 DOI: 10.1007/s00068-023-02368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION To compare the various perioperative outcomes in an urgent surgery setting among patients with proximal femur fracture (PFF) who received platelet aggregation inhibitors (PAIs) and those who did not. METHODS We retrospectively reviewed the data of 1,838 patients who underwent surgery for PFF between January 2011 and January 2021. We conducted 1:1 propensity-score matching and compared the perioperative outcomes, including operation time, postoperative complications, hospital stay, mortality, and variables related to bleeding risk (e.g., number of transfusion profiles, hemoglobin levels, and laboratory data, including coagulation battery). RESULTS Of the 492 patients who were treated with PAIs, 484 were 1:1 matched to the untreated control group. The PAI group showed shorter operation time than the matched control group (72.3 min for PAI vs. 77.7 min for control; P = 0.041), and the control group showed more pulmonary thromboembolism (0.2% for PAI vs 1.7% for control; P = 0.046) than the PAI group. The other complications and length of hospital stay, mortality rate, transfusion profile, and the laboratory test (except preoperative international normalized ratio, INR) showed no significant difference between the groups. Subgroup analyses of the patients treated with only aspirin (aspirin: 306, matched control: 306), only clopidogrel (clopidogrel: 100, matched control: 100), and others who were treated with dual anticoagulation (dual anticoagulation: 78, matched control: 78) showed no significant differences in perioperative outcomes among the groups. CONCLUSION The patients who were treated with PAI could undergo PFF surgery safely without delay, which led to no significant difference in operation time, postoperative complication risk, perioperative blood transfusion, and variables related to bleeding risk. Therefore, we believe that it is unnecessary to delay surgery for patients with PFF who receive PAI.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Yaeji Lim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Dongkyung Lim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea.
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Wang Q, Nacher M, Tosi A, Clarke L, Rwagitinywa J, Alsibai KD, Castor MJ. Coverage of BCG Vaccination for children aged until 7 years old and its determinants in French Guiana. J Epidemiol Popul Health 2024; 72:202381. [PMID: 38579396 DOI: 10.1016/j.jeph.2024.202381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The overall incidence of tuberculosis (TB) in France is low; thus, BCG vaccination is no longer mandatory. In French Guiana - a French overseas territory - BCG vaccination is strongly recommended because the incidence of TB is high in the context of mass immigration from endemic countries with low BCG vaccination rates. Thus, it is important to assess Bacillus Calmette-Guérin (BCG) vaccination coverage and its predictors. METHODS We used data from the 2014 French Guiana Yellow Fever survey, which was conducted by the Observatoire Régional de la Santé de Guyane. Demographic and immunization data from eligible children and their families were collected using a questionnaire. Children who had an immunization card and who were no older than 7 years of age at the time of the survey were eligible. The Coverage for BCG and other mandatory vaccines were estimated; the delay in BCG vaccination was also computed. Univariate and multivariate analyses identified predictors associated with BCG immunization and BCG delayed immunization (after 2 months of age). RESULTS AND CONCLUSION Overall, 469 children were eligible for this study. The total BCG coverage was 79.5 %, and the proportion of children vaccinated with delay was 50.7 %. The multivariate analysis indicated that BCVA was significantly greater among children younger than 3 years of age, whose household head was employed and whose education level was greater. None of the predictors were associated with the delay of BCG vaccination.
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Affiliation(s)
- Qiannan Wang
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana.
| | - Mathieu Nacher
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Département Formation Recherche Santé, Université de Guyane, Cayenne 97300, French Guiana
| | - Alice Tosi
- Amazonian Infrastructures for Population Health, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Registre des handicaps de l'enfant et observatoire périnatal de Guyane, Cayenne 97300, French Guiana
| | - Loreinzia Clarke
- Observatoire Régional de la Santé de Guyane, Cayenne 97300, French Guiana
| | - Joseph Rwagitinywa
- Observatoire Régional de la Santé de Guyane, Cayenne 97300, French Guiana
| | - Kinan Drak Alsibai
- Registre des Cancers de Guyane, Cayenne 97300, French Guiana; Département Recherche Innovation Santé Publique, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Centre de Ressources Biologiques Amazonie, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana; Service d'Anatomopathologie, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana
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Nuijens ST, van Osch FHM, van Hoogstraten LMC, Witjes JA, Aben KKH, Hermans TJN. Longer time to radical cystectomy in patients treated with neoadjuvant chemotherapy is associated with worse oncological outcomes. Urol Oncol 2024; 42:117.e11-117.e16. [PMID: 38238116 DOI: 10.1016/j.urolonc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 12/24/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Current muscle-invasive bladder cancer (MIBC) guidelines recommend not delaying radical cystectomy (RC) >3 months after diagnosis as it decreases overall survival (OS). However, literature investigating the impact of delay in RC in patients who receive NAC is limited, especially on a population-based level. OBJECTIVE To investigate the association between time from diagnosis of MIBC to RC (TTRC) in patients with urothelial bladder cancer (UBC) treated with NAC and RC and 1) 2-year OS and 2) pathological lymph node status (pN+) in a population-based cohort. METHODS Patients were selected from the Netherlands Cancer Registry. The study included 237 patients with cT2-T4aN0M0 UBC, treated with NAC and RC between November 2017 and October 2019. Association between TTRC and OS was assessed using multivariable Cox regression analyses. Schoenfeld and Martingale residuals were used to investigate the proportional hazards assumption and whether a cut-off in the TTRC could be identified. Association between TTRC and pN+ was assessed using multivariable logistic regression analyses. RESULTS Median TTRC was 23 weeks (interquartile range (IQR) 19-26). 2-year OS was 67% (95%CI 59%-74%). Each week of delay in the TTRC was independently associated with 2-year OS (HR 1.06; P = 0.03) in the Cox regression analysis. The sensitivity analyses, defining TTRC as the time between last cycle of NAC and RC, revealed that each week of delay between NAC and RC was associated with 2-year OS (Hazard ratio (HR) 1.13; P < 0.0001), and with pN+ (Odds ratio (OR) 1.21; P = 0.01) in the Cox and logistic regression analyses, respectively. CONCLUSIONS A longer TTRC is associated with worse oncological outcomes in patients treated with NAC and RC.
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Affiliation(s)
- Siberyn T Nuijens
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Lisa M C van Hoogstraten
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tom J N Hermans
- Department of Urology, VieCuri Medical Center, Venlo, the Netherlands; Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Xie M, Yin X. Switching-like event-triggered control of uncertain NCSs under delay distribution and DoS attacks. ISA Trans 2024:S0019-0578(24)00145-9. [PMID: 38584014 DOI: 10.1016/j.isatra.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
The paper addresses the switching-like event-triggered control for uncertain networked control systems with time-varying delay under DoS attacks. First of all, to reduce the communication burden, a switching-like event-triggered mechanism is designed to automatically select the trigger condition according to whether the system is under DoS attacks, which have the advantage of reducing the number of data packets transmitted. Secondly, unlike the traditional assumption of time-varying delay, here it satisfies the condition that the probability is known, and combines the networked control systems to propose a novel time-delay system model, which can obtain a larger upper bound on the delay. Then, by using both the Lyapunov functional method and linear matrix inequality technique, we obtain sufficient conditions of uncertain networked control systems to achieve exponentially stable in the mean square sense. Furthermore, under the common limitations of the maximum continuous packet losses caused by the DoS attacks and delay, the stability criterion is derived, which can be used to estimate the communication parameters and security controller gain. Finally, through two simulation examples, the larger upper bound of time delay, less trigger times, faster convergence rate are obtained, which verify the validity of our theoretical analysis.
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Affiliation(s)
- Minxia Xie
- Department of Mathematics, School of Mathematics and Computer Science, Nanchang University, Nanchang 330031, Jiangxi, China.
| | - Xiuxia Yin
- Department of Mathematics, School of Mathematics and Computer Science, Nanchang University, Nanchang 330031, Jiangxi, China.
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Salirrosas O, Vega EA, Panettieri E, Salehi O, Kozyreva O, Harandi H, Ganta S, Conrad C. The impact of the COVID-19 pandemic on patients with pancreatic cancer. J Gastrointest Surg 2024:S1091-255X(24)00361-5. [PMID: 38570231 DOI: 10.1016/j.gassur.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND It remains unclear today whether the poor prognosis of pancreatic ductal adenocarcinoma (PDAC) was further worsened by the COVID-19 pandemic and whether this may affect providers and patients, today. Hence, this study aimed to investigate the effect of COVID-19 on care delivery and outcomes of patients with PDAC in the United States. METHODS The National Cancer Database was queried for PDAC, between 2017 and 2020. Changes in the number of diagnoses and treatment patterns were compared annually for the entire cohort. Changes in surgical outcomes and median time from diagnosis to treatment were compared and analyzed. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were performed. RESULTS Of 127,613 patients with PDAC, PDAC diagnoses from 2017 (30,573) to 2019 (33,465) increased but decreased in 2020 (31,218). The number of patients receiving surgery or radiotherapy was stable between 2017 to 2019 (21.75% ± 0.05% and 13.9% ± 0.3%, respectively) but decreased in 2020 (20.7% and 12.4% respectively). Although patients received chemotherapy with increasing frequently from 2016 (60.7%) to 2019 (63.5%), this trend stopped in 2020 (63%). Of 27,490 patients undergoing surgery, the mean time from diagnosis to surgery increased from 2017 (34 days) to 2019 (56 days), with an increase in delay in 2020 (81 days). Moreover, patients who were tested for COVID-19, had a longer median time from diagnosis to surgery even if tested negative (COVID+, 140 days; COVID-, 112 days; P < .001). CONCLUSION Although the oncologic quality of PDAC surgery remained the same during the pandemic, not only did the pandemic lead to an underdiagnosis of PDAC and care delays, but even the suspicion of COVID-19 in patients with a negative test adversely affected their care.
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Affiliation(s)
- Oscar Salirrosas
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Elena Panettieri
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Olga Kozyreva
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Hamed Harandi
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Shree Ganta
- Department of Medicine, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States.
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Nguyen KH, Chen S, Zhao R, Vasudevan L, Beninger P, Bednarczyk RA. Vaccination patterns and up-to-date status of children 19-35 months, 2011-2021. Vaccine 2024; 42:1617-1629. [PMID: 38341291 DOI: 10.1016/j.vaccine.2024.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Being up-to-date with all recommended vaccines is needed to protect children from vaccine preventable diseases. Understanding vaccination patterns is needed to develop messaging and strategies to increase vaccination uptake and confidence. METHODS Data from the 2011 to 2021 National Immunization Surveys was used to assess trends and disparities in vaccination patterns, zero vaccination status, and up-to-date status of U.S. children by 19-35 months. RESULTS From 2011 to 2021, adherence to the recommended schedule using the stringent definition increased from 35.7 % to 52.2 % (p < 0.01), adherence to the alternate schedule decreased from 28.2 % to 15.1 % (p < 0.01), and proportion of children who were not up-to-date decreased from 49.0 % to 33.3 % (p < 0.01). However, the proportion of children who had zero vaccinations did not change from 2011 (0.9 %) to 2021 (0.9 %; p = 0.08). In 2021, children 19-23 months were less likely to follow the recommended schedule than children 24-29 months (49.2 % compared to 56.4 %, p < 0.01). Adherence to the recommended schedule among children 19-23 months decreased in 2021 compared to 2020 overall and for some subpopulations (e.g. those with non-Hispanic (NH) Black parents (33.2 % compared to 44.9 %, p < 0.01). Furthermore, it was lowest among children of NH Black parents living at or below the federal poverty level (31.2 %) compared to their respective NH White counterparts (43.6 %, p < 0.01). CONCLUSIONS While there were overall increases in adherence to the recommended schedule from 2011 to 2021, a sustained catch-up program is needed to prevent missed vaccinations and achieve equitable vaccination coverage for all children.
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Affiliation(s)
- Kimberly H Nguyen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA; Department of Epidemiology, George Washington University School of Public Health, Washington, DC 20037, USA.
| | - Siyu Chen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ruitong Zhao
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Lavanya Vasudevan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Paul Beninger
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Emory University, Atlanta, GA, USA
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11
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Hesso I, Kayyali R, Zacharias L, Charalambous A, Lavdaniti M, Stalika E, Ajami T, Acampa W, Boban J, Gebara SN. Cancer care pathways across seven countries in Europe: What are the current obstacles? And how can artificial intelligence help? J Cancer Policy 2024; 39:100457. [PMID: 38008356 DOI: 10.1016/j.jcpo.2023.100457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/25/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Cancer poses significant challenges for healthcare professionals across the disease pathway including cancer imaging. This study constitutes part of the user requirement definition of INCISIVE EU project. The project has been designed to explore the full potential of artificial intelligence (AI)-based technologies in cancer imaging to streamline diagnosis and management. The study aimed to map cancer care pathways (breast, prostate, colorectal and lung cancers) across INCISIVE partner countries, and identify bottle necks within these pathways. METHODS Email interviews were conducted with ten oncology specialised healthcare professionals representing INCISIVE partner countries: Greece, Cyprus, Spain, Italy, Finland, the United Kingdom (UK) and Serbia. A purposive sampling strategy was employed for recruitment and data was collected between December 2020 and April 2021. Data was entered into Microsoft Excel spreadsheet to allow content examination and comparative analysis. RESULTS The analysed pathways all shared a common characteristic: inequalities in relation to delays in cancer diagnosis and treatment. All the studied countries, except the UK, lacked official national data about diagnostic and therapeutic delays. Furthermore, a considerable variation was noted regarding the availability of imaging and diagnostic services across the seven countries. Several concerns were also noted for inefficiencies/inequalities with regards to national screening for the four investigated cancer types. CONCLUSIONS Delays in cancer diagnosis and treatment are an ongoing challenge and a source for inequalities. It is important to have systematic reporting of diagnostic and therapeutic delays in all countries to allow the proper estimation of its magnitude and support needed to address it. Our findings also support the orientation of the current policies towards early detection and wide scale adoption and implementation of cancer screening, through research, innovation, and technology. Technologies involving AI can have a great potential to revolutionise cancer care delivery. POLICY SUMMARY This study highlights the widespread delay in cancer diagnosis across Europe and supports the need for, systematic reporting of delays, improved availability of imaging services, and optimised national screening programs. The goal is to enhance cancer care delivery, encourage early detection, and implement research, innovation, and AI-based technologies for improved cancer imaging.
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Affiliation(s)
- Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Lithin Zacharias
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | | | | | - Evangelia Stalika
- International Hellenic University, Thessaloniki, Greece; Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tarek Ajami
- Urology Department, Hospital Clinic de Barcelona, Spain
| | - Wanda Acampa
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Jasmina Boban
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; Diagnostic Imaging Center, Oncology Institute of Vojvodine, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Shereen Nabhani Gebara
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom.
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Ottou JA, Baiden BK, Nani G, Tuuli MM. Enhancing performance measurement of public procurement processes through the application of procurement delay index. Heliyon 2024; 10:e25672. [PMID: 38379978 PMCID: PMC10877244 DOI: 10.1016/j.heliyon.2024.e25672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Considering procurement process performance assessment, measurement systems such as balance scorecard and capability maturity models are used to assess procurement performance to give a reasonable indication of actual performance. These tools are ideal for practical applications that depend on other performance criteria but are short of comparing planned to actual timelines set for procurement processes. This fosters persistent delays in public procurement. Six Sigma implementation benefits including addressing process delays have fostered its implementation for service improvements. Unfortunately, Six Sigma implementation in public procurement is very rare largely due to its expensive nature. The objective of this study is to develop a Procurement Delay Index (PDindex): a performance measure in the context of a Six Sigma methodology that provides a specific value to describe the delays in the procurement process. To enhance uniformity in performance measurement of process timeliness, a rating scale for determining the timeliness of the procurement process is proposed. A practical demonstration of the application of PDindex for use by procurement professionals is also presented. PDindex serves as a standard by which to determine procurement processes' timeliness and is less expensive to implement. A PDindex of 3σ has been recommended as the acceptable limit for procurement process delays.
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Affiliation(s)
- Jemima A. Ottou
- Department of Management Science, Business School, Ghana Institute of Management and Public Administration (GIMPA), Accra, Ghana
| | - Bernard K. Baiden
- Department of Construction Technology and Management, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gabriel Nani
- Department of Construction Technology and Management, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Morgan Tuuli
- Department of Management Science, Business School, Ghana Institute of Management and Public Administration (GIMPA), Accra, Ghana
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13
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Farhan-Alanie MM, Chinweze R, Walker R, Eardley WGP. The impact of anticoagulant medications on fragility femur fracture care: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study. Injury 2024; 55:111451. [PMID: 38507942 DOI: 10.1016/j.injury.2024.111451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/17/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Due to their hypocoagulable state on presentation, anticoagulated patients with femoral fragility fractures typically experience delays to surgery. There are no large, multicentre studies previously carried out within the United Kingdom (UK) evaluating the impact of anticoagulant use in this patient population. This study aimed to evaluate the current epidemiology and compare the perioperative management of anticoagulated and non-anticoagulated femoral fragility fracture patients. METHODS Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the United Kingdom. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Main outcomes under investigation included time to surgery, receipt of blood transfusion between admission and 48 h following surgery, length of stay, and 30-day mortality. These were assessed using multivariable linear and logistic regression, and Cox proportional hazards models. Only data from hospitals ≥90 % case ascertainment with reference to figures from the National Hip Fracture Database (NHFD) were analysed. RESULTS Data on 10,197 patients from 78 hospitals were analysed. 18.5 % of patients were taking anticoagulants. Compared to non-anticoagulated patients, time to surgery was longer by 7.59 h (95 %CI 4.83-10.36; p < 0.001). 42.41 % of anticoagulated patients received surgery within 36 h (OR 0.54, 95 %CI 0.48-0.60, p < 0.001). Differences in time to surgery were similar between countries however there was some variation across units. There were no differences in blood transfusion and length of stay between groups (OR 1.03, 95 %CI 0.88-1.22, p = 0.646 and 0.22 days, 95 %CI -0.45-0.89; p = 0.887 respectively). Mortality within 30 days of admission was higher in anticoagulated patients (HR 1.27, 95 %CI 1.03-1.57, p = 0.026). CONCLUSIONS Anticoagulated femoral fragility fracture patients comprise a substantial number of patients, and experience relatively longer delays to surgery with less than half receiving surgery within 36 h of admission. This may have resulted in their comparatively higher mortality rate. Inclusion of anticoagulation status in the minimum data set for the NHFD to enable routine auditing of performance, and development of a national guideline on the management of this growing and emerging patient group is likely to help standardise practice in this area and improve outcomes.
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Affiliation(s)
- M M Farhan-Alanie
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - R Chinweze
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK
| | - R Walker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BY, UK
| | - W G P Eardley
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BY, UK; University of Teesside, Middlesbrough, TS1 3BX, UK; University of York, York, YO10 5DD, UK
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14
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Lai SL, Chang CH, Lee PC, Ho CM, Wu JM, Lai HS, Lin BR. Impact of preoperative factors and waiting time on post-appendectomy complications: a retrospective study. Perioper Med (Lond) 2024; 13:8. [PMID: 38383484 PMCID: PMC10880317 DOI: 10.1186/s13741-024-00365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Several factors are associated with increased postoperative complications after appendectomies. However, few studies combined these potential factors for comprehensive prediction of surgical outcomes. Whether high-risk patients benefit from a shorter waiting time for surgery remains unclear. This study aimed to explore the impact of surgical waiting time and potential risk factors on postoperative complications. METHODS A total of 1343 patients diagnosed with acute appendicitis requiring an emergent appendectomy were included from 2013 to 2018. The preoperative risk factors associated with postoperative complications were selected and the probability of postoperative complications was calculated by multivariate logistic regression model. Patients were divided into four groups based on the risk (high & low) and time to surgery (> 12 & ≤12 hours). The odds ratios for complications were evaluated between groups. RESULTS The selected risk factors included age, neutrophil-lymphocyte ratio, systemic inflammatory response syndrome and abdominal pain duration. Compared with low-risk patients with time to surgery ≤12 hours, high-risk patients with time to surgery > 12 hours had significant increased overall postoperative complication rate (16.85% vs. 8.16%, p = 0.002) and a trend toward increased surgical site infection rate (10.99% vs. 6.46%, p = 0.058). When operated within 12 hours, there was no difference in outcomes between high- and low-risk patients. On the other hand, time to surgery > 12 hours did not increase complication rate in low-risk patients. CONCLUSIONS The surgical outcome may be affected by preoperative factors and time to surgery. It is suggested that high-risk patients receive appendectomy within 12 hours to avoid increased postoperative complications.
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Affiliation(s)
- Shuo-Lun Lai
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Chu Lee
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Maw Ho
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Ming Wu
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hong-Shiee Lai
- Division of Pediatric Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Been-Ren Lin
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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15
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Zhang Y, Rottman BM. Causal learning with delays up to 21 hours. Psychon Bull Rev 2024; 31:312-324. [PMID: 37580453 DOI: 10.3758/s13423-023-02342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
Considerable delays between causes and effects are commonly found in real life. However, previous studies have only investigated how well people can learn probabilistic relations with delays on the order of seconds. In the current study we tested whether people can learn a cause-effect relation with delays of 0, 3, 9, or 21 hours, and the study lasted 16 days. We found that learning was slowed with longer delays, but by the end of 16 days participants had learned the cause-effect relation in all four conditions, and they had learned the relation about equally well in all four conditions. This suggests that in real-world situations people may still be fairly accurate at inferring cause-effect relations with delays if they have enough experience. We also discuss ways that delays may interact with other real-world factors that could complicate learning.
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Carré J, Herzog B, Reil D, Schneider C, Pflüger M, Löbel M, Herzog M. [Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. HNO 2024; 72:90-101. [PMID: 38117331 DOI: 10.1007/s00106-023-01396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.
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Affiliation(s)
- Julia Carré
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Beatrice Herzog
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Daniela Reil
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Constanze Schneider
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Maren Pflüger
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Madlen Löbel
- Interdisziplinäre Studienzentrale des Carl-Thiem-Klinikums, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Michael Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland.
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Retell JD, Cameron JK, Aitken JF, Youl P, Pyke C, Dunn J, Chambers S, Baade PD. Individual and area level factors associated with the breast cancer diagnostic-treatment interval in Queensland, Australia. Breast Cancer Res Treat 2024; 203:575-586. [PMID: 37930491 PMCID: PMC10805972 DOI: 10.1007/s10549-023-07134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/22/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Delays to breast cancer treatment can lead to more aggressive and extensive treatments, increased expenses, increased psychological distress, and poorer survival. We explored the individual and area level factors associated with the interval between diagnosis and first treatment in a population-based cohort in Queensland, Australia. METHODS Data from 3216 Queensland women aged 20 to 79, diagnosed with invasive breast cancer (ICD-O-3 C50) between March 2010 and June 2013 were analysed. Diagnostic dates were sourced from the Queensland Cancer Registry and treatment dates were collected via self-report. Diagnostics-treatment intervals were modelled using flexible parametric survival methods. RESULTS The median interval between breast cancer diagnosis and first treatment was 15 days, with an interquartile range of 9-26 days. Longer diagnostic-treatment intervals were associated with a lack of private health coverage, lower pre-diagnostic income, first treatments other than breast conserving surgery, and residence outside a major city. The model explained a modest 13.7% of the variance in the diagnostic-treatment interval [Formula: see text]. Sauerbrei's D was 0.82, demonstrating low to moderate discrimination performance. CONCLUSION Whilst this study identified several individual- and area-level factors associated with the time between breast cancer diagnosis and first treatment, much of the variation remained unexplained. Increased socioeconomic disadvantage appears to predict longer diagnostic-treatment intervals. Though some of the differences are small, many of the same factors have also been linked to screening and diagnostic delay. Given the potential for accumulation of delay at multiple stages along the diagnostic and treatment pathway, identifying and applying effective strategies address barriers to timely health care faced by socioeconomically disadvantaged women remains a priority.
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Affiliation(s)
- James D Retell
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Jessica K Cameron
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, QLD, Australia
| | - Chris Pyke
- Mater Hospital, Brisbane, QLD, Australia
| | - Jeff Dunn
- Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - Suzanne Chambers
- Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Peter D Baade
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
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Sonavane SM, Prashantha G, Nikam PD, A V R M, Chauhan J, S S, Bavirisetti DP. Optimizing QoS and security in agriculture IoT deployments: A bioinspired Q-learning model with customized shards. Heliyon 2024; 10:e24224. [PMID: 38293533 PMCID: PMC10826176 DOI: 10.1016/j.heliyon.2024.e24224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Agriculture Internet of Things (AIoTs) deployments require design of high-efficiency Quality of Service (QoS) & security models that can provide stable network performance even under large-scale communication requests. Existing security models that use blockchains are either highly complex or require large delays & have higher energy consumption for larger networks. Moreover, the efficiency of these models depends directly on consensus-efficiency & miner-efficiency, which restricts their scalability under real-time scenarios. To overcome these limitations, this study proposes the design of an efficient Q-Learning bioinspired model for enhancing QoS of AIoT deployments via customized shards. The model initially collects temporal information about the deployed AIoT Nodes, and continuously updates individual recurring trust metrics. These trust metrics are used by a Q-Learning process for identification of miners that can participate in the block-addition process. The blocks are added via a novel Proof-of-Performance (PoP) based consensus model, which uses a dynamic consensus function that is based on temporal performance of miner nodes. The PoP consensus is facilitated via customized shards, wherein each shard is deployed based on its context of deployment, that decides the shard-length, hashing model used for the shard, and encryption technique used by these shards. This is facilitated by a Mayfly Optimization (MO) Model that uses PoP scores for selecting shard configurations. These shards are further segregated into smaller shards via a Bacterial Foraging Optimization (BFO) Model, which assists in identification of optimal shard length for underlying deployment contexts. Due to these optimizations, the model is able to improve the speed of mining by 4.5%, while reducing energy needed for mining by 10.4%, improving the throughput during AIoT communications by 8.3%, and improving the packet delivery consistency by 2.5% when compared with existing blockchain-based AIoT deployment models under similar scenarios. This performance was observed to be consistent even under large-scale attacks.
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Affiliation(s)
| | | | | | - Mayuri A V R
- School of Computing Science and Engineering, VIT Bhopal University, Sehore, Madhya Pradesh, India
| | - Jyoti Chauhan
- School of Computing Science and Engineering, VIT Bhopal University, Sehore, Madhya Pradesh, India
| | - Sountharrajan S
- Department of Computer Science and Engineering, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Chennai, India
| | - Durga Prasad Bavirisetti
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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19
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Denadai R, Lo LJ. Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns. J Pediatr (Rio J) 2024:S0021-7557(24)00004-4. [PMID: 38307119 DOI: 10.1016/j.jped.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. SOURCE OF DATA PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. SUMMARY OF THE FINDINGS Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age- and condition-specific protocols. CONCLUSIONS Encouraging neonatologists and pediatricians, who are the first to examine newborns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.
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Affiliation(s)
- Rafael Denadai
- Centro Avançado de Cirurgia Plástica Facial, A&D DermePlastique, São Paulo, SP, Brazil; Centro Universitário Max Planck (UniMAX), Faculdade de Medicina, Indaiatuba, SP, Brazil; Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan; Chang Gung University, Chang Gung Memorial Hospital, Department of Plastic and Reconstructive Surgery, Taoyuan, Taiwan
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Birlie TA, Amare AT, Agegn SB, Yirga GK, Bantie B, Nega TD, Eshetie Y, Woelile TA, Asmare G, Belay AT, Tasew SF. Treatment seeking delay and associated factors in adult heart failure patients admitted to Debre Tabor comprehensive specialized hospital, North West, Ethiopia. Heliyon 2024; 10:e23348. [PMID: 38187228 PMCID: PMC10767366 DOI: 10.1016/j.heliyon.2023.e23348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives This study was aimed at assessing the magnitude of treatment-seeking delay in adult heart failure patients and identifying factors that contribute to it. Design An institution-based cross-sectional study with a consecutive sampling technique was conducted at Debre Tabor Comprehensive Specialized Hospital from February 1 to November 1, 2021. Setting The study was conducted in the medical ward of the hospital. Participants A total of 187 patients aged 18 and above admitted with a diagnosis of heart failure, and able to provide information were included. Results The median delay time of adult heart failure patients admitted to the hospital was 15 days. The mean length of delay was also calculated to be 25.02 days. Urban residents and those who live at a ten or less-kilometer distance from healthcare facilities were found to be less likely to delay seeking care. Presenting with shortness of breath or paroxysmal nocturnal dyspnea, perceiving the cause to be heart-related, and getting positive responses from significant others were also associated with a relatively short delay time. Conclusion Treatment-seeking delay was found to be a major problematic issue in heart failure patients. Therefore, patients, patient families, and the community at large must be taught about the symptoms of heart failure and the need for timely care.
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Affiliation(s)
- Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Setegn Bayabil Agegn
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tadila Dires Nega
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Yeshambaw Eshetie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tamiru Alene Woelile
- Department of Pediatrics and Child Health Nursing, Injibara University, Ethiopia
| | - Getachew Asmare
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Ethiopia
| | - Alebachew Taye Belay
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Sheganew Fetene Tasew
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
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Rotejanaprasert C, Areechokchai D, Maude RJ. Two-step spatiotemporal anomaly detection corrected for lag reporting time with application to real-time dengue surveillance in Thailand. BMC Med Res Methodol 2024; 24:10. [PMID: 38218786 PMCID: PMC10787994 DOI: 10.1186/s12874-024-02141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Dengue infection ranges from asymptomatic to severe and life-threatening, with no specific treatment available. Vector control is crucial for interrupting its transmission cycle. Accurate estimation of outbreak timing and location is essential for efficient resource allocation. Timely and reliable notification systems are necessary to monitor dengue incidence, including spatial and temporal distributions, to detect outbreaks promptly and implement effective control measures. METHODS We proposed an integrated two-step methodology for real-time spatiotemporal cluster detection, accounting for reporting delays. In the first step, we employed space-time nowcasting modeling to compensate for lags in the reporting system. Subsequently, anomaly detection methods were applied to assess adverse risks. To illustrate the effectiveness of these detection methods, we conducted a case study using weekly dengue surveillance data from Thailand. RESULTS The developed methodology demonstrated robust surveillance effectiveness. By combining space-time nowcasting modeling and anomaly detection, we achieved enhanced detection capabilities, accounting for reporting delays and identifying clusters of elevated risk in real-time. The case study in Thailand showcased the practical application of our methodology, enabling timely initiation of disease control activities. CONCLUSION Our integrated two-step methodology provides a valuable approach for real-time spatiotemporal cluster detection in dengue surveillance. By addressing reporting delays and incorporating anomaly detection, it complements existing surveillance systems and forecasting efforts. Implementing this methodology can facilitate the timely initiation of disease control activities, contributing to more effective prevention and control strategies for dengue in Thailand and potentially other regions facing similar challenges.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Darin Areechokchai
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
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Richardson S, Chervu NL, Mabeza RM, Cho NY, Ng A, Verma A, Vadlakonda A, Bakhtiyar SS, Benharash P. Impact of delayed intervention following admission for small bowel obstruction: A contemporary analysis. Surg Open Sci 2023; 16:8-13. [PMID: 37744310 PMCID: PMC10514302 DOI: 10.1016/j.sopen.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background The optimal timing of surgical intervention for small bowel obstruction (SBO) remains debated. Methods All adults admitted for SBO were identified in the 2018-2019 National Inpatient Sample. Patients undergoing small bowel resection or lysis of adhesion after three days were considered part of the Delayed cohort. All others were classified as Early. Multivariable regressions were used to assess independent predictors of delayed surgical intervention as well as associations between delayed management and in-hospital mortality, major adverse events (MAE), perioperative complications, postoperative length of stay (LOS), hospitalization costs and non-home discharge. Results Among 28,440 patients who met study criteria, 52.0 % underwent delayed intervention. Black race (AOR 1.19, 95 % CI 1.03-1.36, ref.: White) and Medicare coverage (AOR 1.16, 95 % CI 1.01-1.33, ref.: private payer) were associated with increased odds of delayed surgical management. While delayed intervention was not significantly associated with death (AOR 1.27, 95 % CI 0.97-1.68), it was linked to greater odds of MAE (AOR 1.30, 95 % CI 1.16-1.45) and several perioperative complications. The Delayed cohort also faced an incremental increase in postoperative LOS (+1.29 days, 95 % CI 0.89-1.70) and hospitalization costs (+$11,000, 95 % CI 10,000-12,000). Moreover, delayed intervention was linked to increased odds of non-home discharge (AOR 1.64, 95 % CI 1.47-1.84). Conclusions Delay in surgical management following SBO is linked to inferior clinical outcomes and increased resource use. Our findings highlight the need to ensure proper timing of surgery for SBO as well as efforts to standardize these practices across all demographics of patients.
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Affiliation(s)
- Shannon Richardson
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nikhil L. Chervu
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Ayesha Ng
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado Aurora, CO, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Tan RY, Wong B, Lim R, Lee CL, Tan J, Tan KB, Wee LE. Factors associated with delayed diagnosis of symptomatic adult COVID-19 cases presenting to primary care: a population-wide study during transition from Delta to Omicron BA.1 in Singapore. Lancet Reg Health West Pac 2023; 41:100919. [PMID: 37780634 PMCID: PMC10534255 DOI: 10.1016/j.lanwpc.2023.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
Background During pandemics, avoiding time delay in diagnosing infection is crucial. We evaluated factors associated with delayed diagnosis of symptomatic SARS-CoV-2 infection in a national cohort of adult Singaporeans, during which emergence of the more transmissible Omicron variant shifted pandemic management towards endemicity. Methods Retrospective cross-sectional study amongst all adult Singaporeans diagnosed with symptomatic SARS-CoV-2 infection during the transition from Delta to Omicron BA.1 (September 2021-February 2022). SARS-CoV-2 testing was fully subsidised and compulsory for all symptomatic individuals presenting at primary care. Results and demographic information were extracted from national databases. Time to diagnosis was defined as days from symptom-onset to diagnosis (date of first positive SARS-CoV-2 test); dichotomising into no delay (≤24 h from symptom-onset) and delay >24 h. Multivariable logistic regression was utilised to assess factors associated with delay >24 h, and association of delay >24 h with progression to severe COVID-19. Findings Of 149,063 Singaporean adults presenting with symptomatic SARS-CoV-2 infection, 75.9% (113,195/149,063) were diagnosed within 24 h of symptom-onset. On multivariable analysis, female gender, older age (>60 years), Chinese (vs. Malay) ethnicity, socioeconomic status (housing type), primary care characteristics, presentation during Omicron BA.1 (vs. Delta), symptom-onset on Friday/Saturday (vs. Monday), and not having completed a primary vaccination series were independently associated with higher odds of delay >24 h. Delay >24 h was independently associated with severe COVID-19 (adjusted odds-ratio, aOR = 1.45, 95% CI = 1.27-1.65, p < 0.001). Interpretation At-risk populations (unvaccinated, age >60 years) had higher odds of delay in diagnosis. Delay >24 h in diagnosis was independently associated with severe COVID-19. Funding This study was not grant-funded.
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Affiliation(s)
| | | | | | | | | | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Liang En Wee
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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Ojewale LY, Mukumbang FC. Access to healthcare services for people with non-communicable diseases during the COVID-19 pandemic in Ibadan, Nigeria: a qualitative study. BMC Health Serv Res 2023; 23:1231. [PMID: 37946244 PMCID: PMC10636991 DOI: 10.1186/s12913-023-10278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Desirable outcomes for people with non-communicable diseases (NCDs) are achieved when they access routine monitoring and care services. Expectedly, the COVID-19 pandemic severely impacted access to healthcare services, leading to poor health outcomes among people with NCDs. We aimed to [1] explore the delays in accessing healthcare services and [2] understand alternative actions adopted by people with NCDs to overcome these delays. METHODS We conducted an exploratory qualitative research guided by the "Three Delays" model to unpack the barriers to healthcare access for people living with NCDs in Ibadan, Nigeria. The "Three Delays" model conceptualizes the reasons for negative/adverse healthcare outcomes related to the patient's decision-making to seek healthcare, reaching an appropriate healthcare facility, and receiving adequate care at the healthcare facility. Twenty-five (25) people with NCDs were purposively selected from the University College Hospital's medical outpatient department to participate in in-depth interviews. Interview recordings were transcribed verbatim and analyzed using a deductive-inductive hybrid thematic analysis. RESULTS At the level of individual decision-making, delays were related to fear of contracting COVID-19 in the hospital (considered a hotspot of the COVID-19 pandemic). Regarding reaching an appropriate healthcare facility, delays were mainly attributed to the intra- and inter-city lockdowns, limiting the movements of persons. For those who successfully arrived at the healthcare facilities, delays were related to the unavailability of healthcare professionals, prioritization of COVID-19 patients, and mandatory adherence to COVID-19 protocols, including COVID-19 testing. To overcome the delays mentioned above, people with NCDs resorted to (i) using private healthcare facilities, which were more costly, (ii) using virtual consultation through mobile phone Apps and (iii) self-management, usually by repeating previously prescribed prescriptions to obtain medication. CONCLUSION Pandemic conditions provide unique challenges to people with chronic illnesses. Recognizing the need for continuous access to monitoring and care services under such conditions remains critical. Alternative health service provision approaches should be considered in pandemic situations, including remote healthcare services such as Mobile health apps (mHealth) that can help manage and prevent NCDs.
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de Oliveira RP, de Moraes PHR, Drummond-Lage AP. Impact of the SARS-CoV-2 on the journey of high-risk colon cancer patients within the scope of the Unified Health System in Brazil. BMC Health Serv Res 2023; 23:1102. [PMID: 37845707 PMCID: PMC10580526 DOI: 10.1186/s12913-023-10083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Colon cancer is an important cause of mortality related to cancer. During the COVID-19 pandemic, an important reallotment of assistance resources was necessary to tackle the crisis, directly impacting medical practice all over the globe. OBJECTIVE To assess the impact of the Sars-Cov-2 pandemic on the time between diagnosis and the beginning of systemic treatment in patients diagnosed with high-risk colon neoplasia. METHODS This is a retrospective study based on the analysis of medical records of patients diagnosed with colon neoplasia who required systemic treatment and were treated between March 2019 and March 2022, in a reference Oncology unit of the Brazilian Unified Health System. The study's population was divided into two groups: (I) Pre-COVID-19: diagnoses made between March 2019 and February 2020, (II) COVID-19: diagnoses made between March 2020 and March 2022. RESULTS The sample consisted of 228 patients, 108 (47.97%) of whom were diagnosed during pre-COVID-19 and 118 (52.21%) diagnosed during the two years-period of COVID-19. Regarding the time between colonoscopy and surgery, the time between surgery and first consultation in clinical oncology, and the time between requesting and beginning of systemic treatment, a statistically significant reduction was observed during the COVID-19 period. CONCLUSION A decrease in time between diagnosis and systemic treatment of patients with colorectal cancer during the COVID-19 pandemic was observed. Yet, even with this improvement, the time to begin treatment remains greater than the recommended by the current guidelines, regardless of the time of diagnosis (before or after the pandemic), which negatively impacts the disease outcome.
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Affiliation(s)
- Raquel Pucci de Oliveira
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, 30.130.110, Brazil
| | | | - Ana Paula Drummond-Lage
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, 30.130.110, Brazil.
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Muñoz-Manchado LI, Perez-Revuelta JI, Banerjee A, Galindo-Guarin L, Bernardo M, González-Saiz F, Villagrán-Moreno JM, Fernández-Egea E. Influence of time to clozapine prescription on the clinical outcome. Schizophr Res 2023:S0920-9964(23)00339-0. [PMID: 37805277 DOI: 10.1016/j.schres.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/24/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND This study investigates whether early clozapine use is associated with improved responses in different clinical domains, including positive and negative symptoms, functioning, and well-being. METHODS Data from 254 clozapine-treated patients at Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) were analysed. Among them, 231 (90.9 %) had a diagnosis of schizophrenia, 21 (8.3 %) schizoaffective disorder, and 2 (0.8 %) had other diagnoses. The International Classification of Diseases-Mortality and Morbidity Statistics criteria (ICD-10) were employed (World Health Organization, 1992). The cohort was assessed using the positive and negative syndrome scale (PANSS), the Brief Negative Symptom Scale (BNSS), Global Assessment of Functioning Scale (GAF), and the short version of Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Logistic regression models (for positive and negative symptom remission) and linear regression (for functioning and well-being) were utilized to assess the influence of time to clozapine initiation (TCI), age at the first episode of psychosis (AFE), duration of clozapine treatment (DCT), and gender. RESULTS Early clozapine treatment (within the first three years after the first episode of psychosis) was associated with increased negative symptom remission (exp (B) = 0.38; p = 0.02) and higher functioning scores (β = -0.12, p = 0.046). However, no effect of time to clozapine initiation was found on positive symptom remission rates or well-being scores. CONCLUSIONS Initiating clozapine treatment within the first 3 years of the first episode of psychosis may lead to reduced severity of negative symptoms and improved functioning in clozapine-treated patients. The time to clozapine initiation did not influence its effect on positive symptom remission rates.
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Affiliation(s)
- Leticia I Muñoz-Manchado
- Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Jose I Perez-Revuelta
- Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - Arka Banerjee
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Liliana Galindo-Guarin
- Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
| | - Miguel Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 170, Villarroel St., 8037 Barcelona, Spain.
| | - Francisco González-Saiz
- Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - J M Villagrán-Moreno
- Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Emilio Fernández-Egea
- Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
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Guo ZK, Huo HF, Xiang H, Ren QY. Global dynamics of a tuberculosis model with age-dependent latency and time delays in treatment. J Math Biol 2023; 87:66. [PMID: 37798450 DOI: 10.1007/s00285-023-01999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/30/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
Since there exists heterogeneity in incubation periods of tuberculosis and a time lag between treatment and recovery. In this study, we develop a tuberculosis model that takes into account age-dependent latency and time delays in treatment to describe the transmission of tuberculosis. We first show that the solution semi-flow of the model is well-posed and has a global attractor [Formula: see text] within an infinite dimensional space [Formula: see text]. Then we define the basic reproduction number [Formula: see text] and prove that it determines the global dynamics of the model. If [Formula: see text], the global attractor [Formula: see text] reduces to the disease-free equilibrium state, indicating that the disease-free equilibrium state is globally asymptotically stable. When [Formula: see text], the semi-flow generated by the model is uniformly persistent, and there exists an interior global attractor [Formula: see text] for this uniformly persistent model. By constructing a suitable Lyapunov function and applying LaSalle's Invariance Principle, we show that the global attractor [Formula: see text] is reduced to the endemic equilibrium state, which means that the endemic equilibrium state is globally asymptotically stable. Based on the tuberculosis data in China from 2007 to 2020, we simulate the parameters and initial values of the proposed model. Furthermore, we calculate the sensitivity of [Formula: see text] to the parameters and find the most sensitive parameters to [Formula: see text]. Finally, we present an improved strategy to achieve the WHO's goal of reducing the incidence of tuberculosis by 90% by 2035 compared to 2015.
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Affiliation(s)
- Zhong-Kai Guo
- School of Traffic and Transportation, Lanzhou Jiaotong University, Lanzhou, 730070, Gansu, People's Republic of China
| | - Hai-Feng Huo
- Department of Applied Mathematics, Lanzhou University of Technology, Lanzhou, 730050, Gansu, People's Republic of China.
| | - Hong Xiang
- Department of Applied Mathematics, Lanzhou University of Technology, Lanzhou, 730050, Gansu, People's Republic of China
| | - Qiu-Yan Ren
- School of Information Engineering, Lanzhou University of Finance and Economics, Lanzhou, 730101, Gansu, People's Republic of China
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Maxwell S, Pearce C, Kynn M, Anderson LA, Weller D, Murchie P. The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: Further results from a national cancer diagnosis audit. Cancer Epidemiol 2023; 86:102414. [PMID: 37499334 DOI: 10.1016/j.canep.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND In Scotland 17 % of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways differ between urban and rural patients within Scotland. METHODS This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites. RESULTS A total of 4309 cancer diagnoses were included in the study; 22 % were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than their urban counterparts. There was no difference in prolonged cancer pathways between the two groups except in lung cancer patients where rural patients had a significantly increased odds of a diagnostic interval of >90 days. CONCLUSION Our findings suggest differences in the interaction between patients and GPs prior to referral in urban and rural settings. However, this does not appear to lead to prolonged patient pathways, except in lung cancer. Further research is needed to determine whether this delay is clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.
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Affiliation(s)
- Susanne Maxwell
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Clara Pearce
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mary Kynn
- Faculty of Science and Engineering, Curtin University, Kent Street, Bentley WA 6102, Australia
| | - Lesley Ann Anderson
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
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Dozie UW, Ezeala OV, David CI, Dozie KCN, Chukwuocha UM, Iwuala CC, Osuoji NJ, Okoro CC, Chukwu OR, Eneh SC, Dozie INS. Factors associated with health seeking delay in the screening of cervical cancer among women in Imo state, south Eastern Nigeria. Cancer Treat Res Commun 2023; 37:100765. [PMID: 37806167 DOI: 10.1016/j.ctarc.2023.100765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND TO THE STUDY Cervical cancer is a curable disease if diagnosed early. The mortality rate due to cervical cancer is high worldwide, mainly because of the absence of a functioning screening process and the advanced stage of the disease at diagnosis. The aim of this study was to assess the factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA, Imo State. METHODS A descriptive cross-sectional research design was employed in this study on factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA. A semi-structured questionnaire was used for the study, and Statistical Package for the Social Sciences (SPSS) version 20 was used in the analysis of the data gotten from the study. A probability-based multi-stage sampling method was adopted for the study in recruiting 432 women who participated in it. RESULT Results from the study showed that most of the women, 117 (27.1 %), were between the ages of 22 and 27. The study found that a high percentage of the respondents, 350 (81.0 %), had heard about cervical cancer screening, and when they were asked who they thought should be screened for cervical cancer, 154 (35.6 %) said women between the ages of 15 and 40. Further findings revealed that, 420 (97.2 %) said they had not been screened for cervical cancer. The study also demonstrated that 260 (60.2 %) believe long distance has an impact on your access to health care. The findings of this study revealed that age (P = 0.0247), educational level of women (P = 0.0214), and monthly income of the women (P = 0.0062) were all significantly associated with health-seeking delay in cervical screening. CONCLUSION The study concluded that there is no limited knowledge about cervical cancer among women in Owerri Municipal. Long distance to screening facilities, educational background, and monthly income are significantly associated with the delay in seeking health services for cervical screening. RECOMMENDATION The study recommended that there should be massive awareness and participation in the screening program across the state.
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Affiliation(s)
- Ugonma Winnie Dozie
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria.
| | | | | | | | | | | | - Nkechi Joy Osuoji
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria
| | - Chisomuaga Chidinma Okoro
- Department of Environmental Health Science, Federal University of Technology Owerri Imo State, Nigeria
| | - Ogechi Rita Chukwu
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria
| | - Stanley Chinedu Eneh
- Department of Community He4alth Department, Obafemi Awowolo University, Ile-Ife, Osun State, Nigeria
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George J, Sharma V, Farooque K, Mittal S, Trikha V, Malhotra R. The Impact of Surgical Timing of Hip Fracture on Mortality: Do the Cause and Duration of Delay Matter? Hip Pelvis 2023; 35:206-215. [PMID: 37727296 PMCID: PMC10505843 DOI: 10.5371/hp.2023.35.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/18/2023] [Accepted: 06/18/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose Delay in performance of hip fracture surgery can be caused by medical and/or administrative reasons. Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay. Materials and Methods A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality. Results A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (P=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: P=0.117; unfit: P=0.035). Conclusion The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.
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Affiliation(s)
- Jaiben George
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Sharma
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kamran Farooque
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Samarth Mittal
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vivek Trikha
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Zhang Y, Zhan B, Hao X, Wang W, Zhang X, Fang C, Wang M. Factors associated with diagnostic delay of pulmonary tuberculosis among children and adolescents in Quzhou, China: results from the surveillance data 2011-2021. BMC Infect Dis 2023; 23:541. [PMID: 37596514 PMCID: PMC10439644 DOI: 10.1186/s12879-023-08516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Tuberculosis is a high-burden disease and a major health concern in China, especially among children and adolescents. The purpose of this study was to assess risk factors for diagnostic delay in students with pulmonary tuberculosis in Quzhou City in eastern China. PATIENTS AND METHODS Cases of PTB in students and relevant information in Quzhou from 2011 to 2021 were collected using the TB Management Information System. The outcome of interest was diagnostic delay (i.e. ≥ 28 days between symptom onset and treatment initiation). Risk factors for diagnostic delay were identified using multivariable logistic regression. RESULTS A total of 629 students in Quzhou were diagnosed with PTB during the study period, of whom 55.5% were male. The median diagnostic delay was 18 days (Inter Quartile Range, [IQR]: 8-38) and 38.0% of the students had a diagnostic delay. Living in a rural area (adjusted odds ratio, [AOR]: 1.56, 95% confidence interval [CI:] 1.11-2.19), developing PTB symptoms in the first quarter of the year (AOR: 2.18, 95% CI: 1.40-3.40), and no sputum smear result (AOR: 8.73, 95% CI: 1.68-45.30) were significantly associated with a diagnostic delay. Discovery through health examinations (AOR: 0.33, 95% CI: 0.17-0.63) was associated with reduced risk of diagnostic delay. CONCLUSION Schools in rural areas should pay special attention to increasing student awareness of the symptoms of tuberculosis and provide health education on tuberculosis prevention and control to students and staff.
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Affiliation(s)
- Yating Zhang
- School of Public Health, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Bingdong Zhan
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xiaogang Hao
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Wei Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Xing Zhang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Chunfu Fang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China
| | - Min Wang
- Department of Tuberculosis Control and Prevention, Quzhou Center for Disease Control and Prevention, No.154, Xi'an Road, Ke Cheng District, Quzhou, Zhejiang, 324000, China.
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Krishnan A, Asadullah M, Kumar R, Amarchand R, Bhatia R, Roy A. Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India. Lancet Reg Health Southeast Asia 2023; 15:100222. [PMID: 37614354 PMCID: PMC10442961 DOI: 10.1016/j.lansea.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 08/25/2023]
Abstract
Background Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies including stroke. We assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India and identified the reasons and determinants of this delay. Methods We conducted a social audit among all civil-registered premature (30-69 years) deaths due to acute cardiac event or stroke in the district. The three-delays model was used to qualitatively classify the delays in care-seeking-deciding to seek care, reaching the appropriate health facility (AHF) and initiating definitive treatment. Based on the estimated time from symptom onset to reaching AHF, we classified patients as early (reached within one hour) or delayed arrivers. We used mixed-effect logistic regression with postal code as a random effect to identify determinants of delayed arrival. Findings Only 10.8% of the deceased reached an AHF within one hour. We noted level-1 delay in 38.4% (60% due to non-recognition of seriousness); level-2 delay in 20% (40% due to going to an inappropriate facility) and level-3 delay in 10.8% (57% due to lack of affordability). Patients with a monthly family income of >270US$ (aOR 0.44; 95% CI 0.21-0.93) were less and those staying farther from AHF (aOR 1.12; 95% CI 1.01-1.25 for each Km) were more likely to have delayed arrival in AHF. Interpretation A small proportion of patients with cardiac and stroke emergencies reach health facility early with delays at multiple levels. Addressing the reasons for delay could prevent these deaths. Funding : Indian Council of Medical Research, New Delhi, India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Md Asadullah
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Gao M, Hu S, Zhao X, You T, Jit M, Liu Y, Qiao Y, Zhao F, Wang C. Health and economic impact of delaying large-scale HPV vaccination and screening implementation on cervical cancer in China: a modelling study. Lancet Reg Health West Pac 2023; 36:100768. [PMID: 37547038 PMCID: PMC10398607 DOI: 10.1016/j.lanwpc.2023.100768] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/14/2023] [Accepted: 03/28/2023] [Indexed: 08/08/2023]
Abstract
Background Current uptake of HPV vaccination and screening in China is far below World Health Organization 2030 targets for cervical cancer elimination. We quantified health and economic losses of delaying large-scale HPV vaccination and screening implementation in China. Methods We used a previously validated transmission model to project lifetime health benefits, costs, effectiveness, and timeline for cervical cancer elimination of alternative scenarios, including combining HPV vaccination initiated from 2022 to 2030 with screening in different modalities and coverage increase rates, as well as screening alone. All women living or projected to be born in China during 2022-2100 were considered. We employed a societal perspective. Findings Regardless of vaccine type, immediate large-scale vaccination initiated in 2022 and achieving 70% coverage of HPV-based screening in 2030 (no-delay scenario) would be the least costly and most effective. Compared with the no-delay scenario, delaying vaccination by eight years would result in 434,000-543,000 additional cervical cancer cases, 138,000-178,000 deaths, and $2863-4437 million costs, and delay elimination by 9-10 years. Even with immediate vaccination, the gradual scale-up of LBC-based screening to 70% coverage in 2070 would result in 2,530,000-3,060,000 additional cases, 909,000-1,040,000 deaths, and $5098-5714 million costs compared with no-delay scenario, and could not achieve elimination if domestic 2vHPV or 4vHPV vaccines are used (4.09-4.21 cases per 100,000 woman in 2100). Interpretation Delaying large-scale HPV vaccination and/or high-performance screening implementation has detrimental consequences for cervical cancer morbidity, mortality, and expenditure. These findings should spur health authorities to expedite large-scale vaccine rollout and improve screening. Funding Bill & Melinda Gates Foundation (INV-031449 and INV-003174) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-004).
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Affiliation(s)
- Meng Gao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shangying Hu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuelian Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting You
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Wu A. Updates and confounding factors in delayed sleep-wake phase disorder. Sleep Biol Rhythms 2023; 21:279-287. [PMID: 37363638 PMCID: PMC9979143 DOI: 10.1007/s41105-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.
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Affiliation(s)
- Alexandra Wu
- Division of Biosciences, University College London, Gower Street, London, WC1E 6BT UK
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Nadarajan AR, George NA, Thomas S, Varghese BT, Iype EM, K.M JK. Impact of COVID-19 on Disease Progression and Postoperative Complications in Patients with Head and Neck Cancer. Indian J Surg Oncol 2023:1-5. [PMID: 37363709 PMCID: PMC10248326 DOI: 10.1007/s13193-023-01779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic has created a remarkable challenge for the healthcare system. The delayed presentation, diagnosis, and treatment of head and neck cancer during the COVID-19 pandemic is expected to adversely affect outcomes. COVIDSurg collaborative group in 2020 concluded surgery ≥ 4 weeks after a positive COVID-19 swab result was associated with a lower risk of postoperative mortality. The aim of this study is to assess the disease progression due to COVID-19 infection in patients with head and neck cancer planned for surgery and to analyze the postoperative complications in head and neck cancer patients who underwent surgery after COVID-19 infection. This is an ambispective observational study and included patients with head and neck cancer who recovered from COVID-19 infection and underwent surgery from June 2020 to May 2022. There were a total of 1849 patients with head and neck cancer operated in the mentioned study period during COVID-19 pandemic. One hundred fifty-nine patients had documented COVID-19 infection. One hundred two patients had oral cavity carcinoma (64%), and 38 patients had thyroid carcinoma (23.8%). Early disease was noted in 49 patients (30.8%) and locally advanced disease in 108 patients (67.9%). Mean duration of delay in surgery was 4 weeks. Disease progression was noted in 27 patients (17%) out of which 15 patients were inoperable. Thirty-seven out of 159 patients (23%) had postoperative complications, and it included 2 mortality. There was increased trend noted in pulmonary complications and hemorrhage when compared to pre-COVID-19 era. Due to COVID-19 pandemic, delayed elective head and neck cancer surgery has resulted in higher rates of inoperability. COVID-19 has been associated with increased postoperative pulmonary complications and hemorrhage.
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Affiliation(s)
- Abinaya R. Nadarajan
- Department of Surgical Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Nebu Abraham George
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Shaji Thomas
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Bipin T. Varghese
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Elizabeth Mathew Iype
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
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Schellenberg N, Petrucka P, Dietrich Leurer M, Crizzle AM. Determinants of vaccine refusal, delay and reluctance in parents of 2-year-old children in Canada: Findings from the 2017 Childhood National Immunization Coverage Survey (cNICS). Travel Med Infect Dis 2023; 53:102584. [PMID: 37149239 DOI: 10.1016/j.tmaid.2023.102584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Vaccine hesitancy is a barrier to improving childhood vaccination rates in Canada, but the scope of this problem is unclear due to inconsistent measurement of vaccine uptake indicators. Using 2017 data from a Canadian national vaccine coverage survey, this study analyzed the impact of demographics and parental knowledge, attitudes and beliefs (KAB) on vaccine decisions (refusal, delay and reluctance) in parents of 2-year-old children who had received at least one vaccine. The findings show that 16.8% had refused a vaccine, specifically influenza (73%), rotavirus (13%) and varicella (9%); female parents or those from Quebec or the Territories more likely to refuse. 12.8% were reluctant to accept a vaccine, usually influenza (34%), MMR (21%) and varicella (19%), but eventually accepted them upon advice from a health care provider. 13.1% had delayed a vaccine, usually because their child had health issues (54%) or was too young (18.6%) and was predicted by five or six person households. Recent immigration to Canada decreased likelihood of refusal, delay, or reluctance; however, after 10 years in Canada, these parents were as likely to refuse or be reluctant as parents born in Canada. Poor KAB increased likelihood of refusal and delay by 5 times, and reluctance by 15 times, while moderate KAB increased likelihood of refusal (OR 1.6), delay (OR 2.3) and reluctance (OR 3.6). Future research into vaccine decisions by female and/or single parents, and predictors of vaccine KAB would provide valuable information and help protect our children from vaccine preventable diseases.
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Affiliation(s)
- N Schellenberg
- School of Public Health, University of Saskatchewan, Canada
| | - P Petrucka
- College of Nursing, University of Saskatchewan, Canada
| | | | - A M Crizzle
- School of Public Health, University of Saskatchewan, Canada.
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Clement ND, Gaston MS, Simpson AH. Fractures in elderly mice demonstrate delayed ossification of the soft callus: a cellular and radiographic study. Eur J Orthop Surg Traumatol 2023; 33:977-985. [PMID: 35239001 PMCID: PMC10125932 DOI: 10.1007/s00590-022-03235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the cellular age-related changes in fracture repair and relate these to the observed radiographic assessments at differing time points. METHODS Transverse traumatic tibial diaphyseal fractures were created in 12-14 weeks old (young n = 16) and 18 months old (elderly n = 20) in Balb/C wild mice. Fracture calluses were harvested at five time points from 1 to 35 days post fracture for histomorphometry (percent of cartilage and bone), radiographic analysis (total callus volume, callus index, and relative bone mineral content). RESULTS The elderly mice produced an equal amount of cartilage when compared to young mice (p > 0.08). However, by day 21 there was a significantly greater percentage of bone at the fracture site in the young group (mean percentage 50% versus 11%, p < 0.001). It was not until day 35 when the elderly group produced a similar amount of bone compared to the young group at 21 days (50% versus 53%, non-significant (ns)). The callus area and callus index on radiographic assessment was not significantly different between young and elderly groups at any time point. Relative bone mineral content was significantly greater in the young group at 14 days (545.7 versus -120.2, p < 0.001) and 21 days (888.7 versus 451.0, p < 0.001) when compared to the elderly group. It was not until day 35 when the elderly group produced a similar relative bone mineral content as the young group at 21 days (888.7 versus 921.8, ns). CONCLUSIONS Elderly mice demonstrated a delay in endochondral ossification which was associated with a decreased relative bone mineral content at the fracture site and may help assess these cellular changes in a clinical setting.
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Affiliation(s)
- N. D. Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - M. S. Gaston
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - A. H. Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
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Khan H, Johnson C, Malwankar J, Battafarano R, Yang S, Broderick S, Huang P, Lam V, Ha J. The COVID-19 Era Is Associated With Delays in Esophageal Cancer Diagnosis and Treatment. J Surg Res 2023; 285:100-6. [PMID: 36652768 DOI: 10.1016/j.jss.2022.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/19/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The coronavirus disease-2019 (COVID-19) pandemic has substantially affected the delivery of healthcare globally. The purpose of this study was to evaluate the association of this era with the timeline of care in esophageal cancer patients. METHODS We performed a retrospective chart-review of patients presenting to a single high-volume tertiary care center with the diagnosis of esophageal cancer. COVID era was defined as March 2020-December 2020 and compared with the year before (3/2019-12/2019). RESULTS In total, 117 patients presented in the COVID-era versus 190 in pre-COVID. Stage 3 + 4 disease was found in 77.8% of the patients in the COVID-era compared to 68.9% in the pre-COVID era (P = 0.34). Diagnoses through emergency department admission were 35.5% in the COVID versus 26.7% in the pre-COVID group (P = 0.15). In the COVID era it took a median of 78 d to visit primary care provider (versus 52 d, P = 0.12 in pre-COVID), 45 d to endoscopy (versus 18 d, P = 0.004) and 38 d to treatment initiation (versus 36 d, P = 0.48). Thirty-five percent of the patients underwent esophagectomy compared to 26% in the pre-COVID-era. Median days of intensive-care-unit (ICU) (2 versus 3, P = 0.16) and hospital stay (14 versus 15, P = 0.28) were similar in both groups as well as postoperative 30-day morbidities (63 versus 63%, P = 0.48). One-year follow-up showed 83.7% (95% confidence interval [CI]: 73.8%-90.1%) survival in the COVID-group compared to 76.4% (95% CI: 66.9%-83.5%) in the pre-COVID-group (P = 0.58). Only three patients had a positive COVID result. CONCLUSIONS Our institution treated fewer esophageal cancer patients during COVID-19 accompanied by a delay in endoscopic diagnosis. Postoperative outcomes and 1-year survival remained similar.
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Syafiie S, AlHarbi F, Alshehri A, Hasanain B. PID and LQG Controllers for Diabetes System with Internal Delay: A comparison study. Biomed Phys Eng Express 2023; 9. [PMID: 37054685 DOI: 10.1088/2057-1976/accc8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 04/15/2023]
Abstract
Closed-loop treatment for insulin dependent type 1 diabetes patients is a recent medical practice in insulin delivery (bionic pancreas) which aims to achieve tight control of glucose level in plasma and ensure minimizing risk of hypoglicemia. Among those most popular closed-loop controller strategies, proportional integral derivative (PID) and linear quadratic Gaussian (LQG) controller are designed and compared for insulin delivery in diabetic patients. The controllers are designed based on individual and nominal model which is to study the ability of the controller to maintain blood glucose concentration for similar patient's dynamic. The comparison is conducted numerically not only for for patients suffering type 1 diabetes mellitus (T1DM), but also type 2 diabetes mellitus (T2DM), and double diabetes mellitus (DDM) in the present of internal delay systems, which causes instability. The responses show that the proposed PID controller is better at maintaining the blood glucose level in the normal range for a longer delay in delay in
hepatic glucose production. The patient with longer performing physical exercise has lower oscillation peaks in blood glucose concentration.
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Affiliation(s)
- S Syafiie
- King Abdulaziz University, jeddah, Jeddah, 21589, SAUDI ARABIA
| | - Fahd AlHarbi
- King Abdulaziz University, jeddah, Jeddah, Makkah, 21589, SAUDI ARABIA
| | - Abdullah Alshehri
- King Abdulaziz University, jeddah, Jeddah, Makkah, 21589, SAUDI ARABIA
| | - Bassam Hasanain
- King Abdulaziz University, jeddah, Jeddah, Makkah, 21589, SAUDI ARABIA
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Lindeberg T. A time-causal and time-recursive scale-covariant scale-space representation of temporal signals and past time. Biol Cybern 2023; 117:21-59. [PMID: 36689001 PMCID: PMC10160219 DOI: 10.1007/s00422-022-00953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 11/21/2022] [Indexed: 05/05/2023]
Abstract
This article presents an overview of a theory for performing temporal smoothing on temporal signals in such a way that: (i) temporally smoothed signals at coarser temporal scales are guaranteed to constitute simplifications of corresponding temporally smoothed signals at any finer temporal scale (including the original signal) and (ii) the temporal smoothing process is both time-causal and time-recursive, in the sense that it does not require access to future information and can be performed with no other temporal memory buffer of the past than the resulting smoothed temporal scale-space representations themselves. For specific subsets of parameter settings for the classes of linear and shift-invariant temporal smoothing operators that obey this property, it is shown how temporal scale covariance can be additionally obtained, guaranteeing that if the temporal input signal is rescaled by a uniform temporal scaling factor, then also the resulting temporal scale-space representations of the rescaled temporal signal will constitute mere rescalings of the temporal scale-space representations of the original input signal, complemented by a shift along the temporal scale dimension. The resulting time-causal limit kernel that obeys this property constitutes a canonical temporal kernel for processing temporal signals in real-time scenarios when the regular Gaussian kernel cannot be used, because of its non-causal access to information from the future, and we cannot additionally require the temporal smoothing process to comprise a complementary memory of the past beyond the information contained in the temporal smoothing process itself, which in this way also serves as a multi-scale temporal memory of the past. We describe how the time-causal limit kernel relates to previously used temporal models, such as Koenderink's scale-time kernels and the ex-Gaussian kernel. We do also give an overview of how the time-causal limit kernel can be used for modelling the temporal processing in models for spatio-temporal and spectro-temporal receptive fields, and how it more generally has a high potential for modelling neural temporal response functions in a purely time-causal and time-recursive way, that can also handle phenomena at multiple temporal scales in a theoretically well-founded manner. We detail how this theory can be efficiently implemented for discrete data, in terms of a set of recursive filters coupled in cascade. Hence, the theory is generally applicable for both: (i) modelling continuous temporal phenomena over multiple temporal scales and (ii) digital processing of measured temporal signals in real time. We conclude by stating implications of the theory for modelling temporal phenomena in biological, perceptual, neural and memory processes by mathematical models, as well as implications regarding the philosophy of time and perceptual agents. Specifically, we propose that for A-type theories of time, as well as for perceptual agents, the notion of a non-infinitesimal inner temporal scale of the temporal receptive fields has to be included in representations of the present, where the inherent nonzero temporal delay of such time-causal receptive fields implies a need for incorporating predictions from the actual time-delayed present in the layers of a perceptual hierarchy, to make it possible for a representation of the perceptual present to constitute a representation of the environment with timing properties closer to the actual present.
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Affiliation(s)
- Tony Lindeberg
- Computational Brain Science Lab, Division of Computational Science and Technology, KTH Royal Institute of Technology, 100 44, Stockholm, Sweden.
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Sachedina T, Sohal KS, Owibingire SS, Hamza OJM. Reasons for Delay in Seeking Treatment for Dental Caries in Tanzania. Int Dent J 2023; 73:296-301. [PMID: 36030120 PMCID: PMC10023585 DOI: 10.1016/j.identj.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The delay in seeking dental treatment is a universal health problem, with a reported prevalence as high as 98%. It is a critical feature not only in planning management but also in the final treatment outcome. AIM This study aimed to determine the reasons for the delay in seeking treatment for dental caries amongst patients attending public dental clinics in Dar es Salaam, Tanzania. METHODOLOGY This was a cross-sectional study carried out in 5 public hospitals in Dar es Salaam, Tanzania. It included 315 adult patients who had dental caries. Data were collected using a questionnaire that included questions regarding reasons for the delay in seeking care for dental caries. Data were analysed using the SPSS computer software version 26. A one-way analysis of variance was used to assess the association between variables, and the significance level was set at P < .05. RESULTS A majority (n = 244, 77.5%) of the participants delayed seeking dental care upon noting a problem in their teeth. However, the association between the sociodemographic characteristics of the participants and delay in seeking dental care was statistically insignificant (P > .05). The most common reason given by the participants who delayed seeking dental care for their decayed teeth included self-negligence (n = 184, 75.4%), the practice of self-medication (n = 164, 67.2%), and ignorance (n = 110, 45.1%). CONCLUSIONS The majority of patients experiencing dental caries seek dental care very late. Delay in seeking dental care is not dependent on sociodemographic characteristics of individuals. Self-negligence, the practice of self‑medication, and ignorance are the major reasons for the delay.
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Affiliation(s)
- Tatheer Sachedina
- Department of Orthodontics, Paedodontics and Community Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karpal Singh Sohal
- Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Sira Stanslaus Owibingire
- Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Omar J M Hamza
- Department of Oral and Maxillofacial Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Senapati BR, Khilar PM, Dash T, Swain RR. AI-assisted Emergency Healthcare using Vehicular Network and Support Vector Machine. Wirel Pers Commun 2023; 130:1929-1962. [PMID: 37206634 PMCID: PMC10031724 DOI: 10.1007/s11277-023-10366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 05/21/2023]
Abstract
The COVID-19 pandemic has created an emergency across the globe. The number of corona positive and death cases is still rising worldwide. All countries' governments are taking various steps to control the infection of COVID-19. One step to control the coronavirus's spreading is to quarantine. But the number of active cases at the quarantine center is increasing daily. Also, the doctors, nurses, and paramedical staff providing service to the people at the quarantine center are getting infected. This demands the automatic and regular monitoring of people at the quarantine center. This paper proposed a novel and automated method for monitoring people at the quarantine center in two phases. These are the health data transmission phase and health data analysis phase. The health data transmission phase proposed a geographic-based routing that involves components like Network-in-box, Roadside-unit, and vehicles. An effective route is determined using route value to transmit data from the quarantine center to the observation center. The route value depends on the factors such as density, shortest path, delay, vehicular data carrying delay, and attenuation. The performance metrics considered for this phase are E2E delay, number of network gaps, and packet delivery ratio, and the proposed work performs better than the existing routing like geographic source routing, anchor-based street traffic aware routing, Peripheral node based GEographic DIstance Routing . The analysis of health data is done at the observation center. In the health data analysis phase, the health data is classified into multi-class using a support vector machine. There are four categories of health data: normal, low-risk, medium-risk, and high-risk. The parameters used to measure the performance of this phase are precision, recall, accuracy, and F-1 score. The overall testing accuracy is found to be 96.8%, demonstrating strong potential for our technique to be adopted in practice.
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Affiliation(s)
- Biswa Ranjan Senapati
- Present Address: Department of CSE, ITER, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Pabitra Mohan Khilar
- Present Address: Department of CSE, ITER, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, India
- Department of Computer Science & Engineering, National Institute of Technology, Rourkela, 769008 India
| | - Tirtharaj Dash
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science Pilani, K.K. Birla Goa Campus, Goa, 403726 India
- Present Address: University of California, San Diego, CA 92093 USA
| | - Rakesh Ranjan Swain
- Post Doctoral Fellow at CSE Department, Indian Institute of Technology, Kanpur, India
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Factors influencing the timeliness of care for patients with lung cancer in Bangladesh. BMC Health Serv Res 2023; 23:261. [PMID: 36927788 PMCID: PMC10018894 DOI: 10.1186/s12913-023-09154-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND This study explored the factors associated with timeliness of care in the healthcare seeking pathway among patients with lung cancer in Bangladesh. METHODS A structured questionnaire was used for data collection from 418 patients with lung cancer through face-to-face interviews in three tertiary care hospitals. Log-rank tests were performed to test differences in the length of intervals between points in healthcare by socioeconomic characteristics and care seeking behaviours of the patients. Cox Proportional Hazard (PH) regression analysis was performed to identify the predictors of the intervals after adjustment for variations in other variables. RESULTS A higher education level was associated significantly (p < 0.05) with a shorter interval between first contact with a healthcare provider (HCP) and diagnosis (median 81 days) and initiation of treatment (median 101 days). Higher monthly household income was associated significantly with a shorter time from first contact and diagnosis (median 91 days), onset of symptom and diagnosis (median 99 days), onset of symptom and treatment (median 122 days), and first contact with any HCP to treatment (median 111 days). Consulting with additional HCPs prior to diagnosis was associated significantly with longer intervals from first contact with any HCP and diagnosis (median 127 days), onset of symptom and diagnosis (median 154 days), onset of symptom and treatment (median 205 days), and first contact with any HCP to treatment (median 174 days). Consulting with informal HCPs was associated significantly with a longer time interval from symptom to treatment (median 171 days). Having more than one triggering symptom was associated significantly with a shorter interval between onset of symptoms and first contact with any HCP. CONCLUSION The predictors for timeliness of lung cancer care used in this study affected different intervals in the care seeking pathway. Higher education and income predicted shorter intervals whereas consulting informal healthcare providers and multiple providers were associated with longer intervals.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia. .,Institute for Breathing and Sleep (IBAS), Melbourne, Australia.
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.,Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia.,School of Health, Federation University Australia, Berwick, Australia.,Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.,Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Goh R, Bacchi S, Kovoor JG, Gupta AK, To MS, Ovenden CD, Dawson J, Vallat W, Schultz D, Jannes J, Kleinig T. Factors associated with delay to carotid endarterectomy for acute ischaemic stroke in South Australia: A multicentre retrospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:106916. [PMID: 36565521 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The greatest benefits of carotid endarterectomy (CEA) accrue when performed within two weeks of acute ischaemic stroke (AIS) due to symptomatic carotid stenosis. Previous studies have identified multiple factors contributing to CEA delay. AIMS To determine factors associated with delayed CEA in patients admitted to tertiary stroke centres within a major metropolitan region with AIS METHODS: In a retrospective cohort study, consecutive patients admitted to the tertiary hospitals with stroke units within South Australia (Lyell McEwin Hospital, Royal Adelaide Hospital and Flinders Medical Centre) between 2016 to 2020 were included. Univariable and multivariable logistic regression were used to identify individual factors associated with time from symptom onset to CEA of over two weeks. RESULTS A total of 174 patients were included. The median time to CEA was 5 days (IQR 3-9.75). Delayed CEA beyond 14 days occurred in 28/174 (16%). Factors most associated with delayed CEA included presentation to a tertiary hospital without onsite Vascular Surgical Unit (OR 3.71, 95%CI 1.31-10.58), history of previous stroke (OR 3.38, 95% CI 1.11-9.84) and presenting NIHSS above 6 (OR 5.16, 95% CI 1.60-16.39). CONCLUSION This study identified that presentation to a tertiary hospital without a Vascular Surgery Unit, history of previous stroke and presenting NIHSS above 6 were associated with delay to CEA in AIS patients in South Australia. Interventional studies aiming to improve the proportion of patients that receive CEA within 14 days are required.
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Affiliation(s)
- Rudy Goh
- Lyell McEwin Hospital, Elizabeth Vale SA 5112, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; Flinders Medical Centre, Bedford Park SA 5042, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | - Joshua G Kovoor
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | | | - Minh-Son To
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park SA 5042, Australia.
| | - Christopher D Ovenden
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | - Joseph Dawson
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | - Wilson Vallat
- Lyell McEwin Hospital, Elizabeth Vale SA 5112, Australia.
| | - David Schultz
- Flinders Medical Centre, Bedford Park SA 5042, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park SA 5042, Australia.
| | - Jim Jannes
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
| | - Timothy Kleinig
- Royal Adelaide Hospital, Adelaide SA 5000, Australia; University of Adelaide, Adelaide SA 5005, Australia.
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Jain A, Joseph S, James J, James TS, Kumar K, Raza K, Greenfield S, Shenoy P. Delay in diagnosis of rheumatoid arthritis: reasons and trends over a decade. Rheumatol Int 2023; 43:503-508. [PMID: 35996027 DOI: 10.1007/s00296-022-05187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Delay in diagnosis and treatment initiation often lead to poorer outcomes in rheumatoid arthritis (RA). Most of the data on delay in diagnosis and management are from western population with no data from India. Additionally, with improved health care services, whether the delay has changed over years is not known. In this longitudinal observational study, we investigated delay to diagnosis and disease-modifying antirheumatic drugs (DMARDs) initiation over past 9 years. METHODS Patients aged ≥ 18 years having RA fulfilling 2010 ACR/EULAR criteria were enrolled from January to June in years 2012, 2017 and 2021. Diagnoses received before presenting to clinic, socioeconomic status, educational level and other demographic variables were recorded. RESULTS Each year, 323 patients (mean age 49.5-52.01 years) were enrolled. There was a significant reduction in delay in diagnosis from a median (IQR) of 36 (12-84, range 1-288) months in 2012 to 12 (4-36, range 1-180) months in 2017 and 10 (5-24, range 1-120) months) in 2021 (p < 0.0001). A significant improvement in time to initiating DMARDs from 2012 [48 (24-96) months] to 2017 [12 (6-36) months] (p < 0.0001) and from 2017 to 2021 [12 (5-24) months] (p = 0.03) was seen. Higher education, more patients opting for treatment from rheumatologists, and urbanisation contributed significantly to improvement in delay. There was no impact of age or gender on delay. CONCLUSION Delay in diagnosis has improved significantly between 2012 and 2021. However, delay still remains long as most patients miss the 3-month therapeutic window. Future work focussing on reasons for delays in the patient pathway could help improve consultation pathways in India.
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Affiliation(s)
- Avinash Jain
- Department of Clinical Immunology & Rheumatology, SMS Medical College and Hospital, Jaipur, India
| | - Sanjana Joseph
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Jeenamol James
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Tintus Sara James
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Padmanabha Shenoy
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India.
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Shimamura N, Katagai T, Ohkuma H, Fujiwara N, Nakahara I, Morioka J, Kawamata T, Ishikawa T, Kurita H, Suzuki K, Chin M, Uezato M, Sorimachi T, Shiokawa Y, Murayama Y, Ueba T, Ikawa F. Analysis of Factors Influencing Delayed Presentation in Japanese Patients with Subarachnoid Hemorrhage. World Neurosurg 2023; 171:e590-e595. [PMID: 36529428 DOI: 10.1016/j.wneu.2022.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Some aneurysmal subarachnoid hemorrhage (SAH) patients are delayed in their presentation. This can cause a washout of the subarachnoid hematoma and a potential misdiagnosis. As a result, they may suffer rerupture of the aneurysm and preventable deterioration. We investigated the factors that influence delayed SAH presentation. METHODS Aneurysmal SAH patients treated at 9 stroke centers from 2002 to 2020 were included. Age, gender, pre-SAH modified Rankin scale, World Federation of Neurological Surgeons grade, Fisher group, day of presentation, aneurysm treatment method, past history of cerebral stroke, comorbidity of hypertension and/or diabetes mellitus, and modified Rankin scaleat discharge were assessed retrospectively. We formed 2 groups based on the day of presentation after the onset of SAH: day 0-3 (early) and other (delayed). Logistic regression analyses detected the factors that influenced the day of presentation and outcome for SAH. A P- value <0.05 was considered significant. RESULTS Delayed presentation comprised 282 cases (6.3%) of 4507 included cases. Logistic regression analyses showed that patients in an urban area, of male gender, low WFNS grade and low Fisher group correlated significantly with a delayed presentation. But delayed presentation did not influence outcome at discharge. CONCLUSIONS Area of residency and gender correlated with delayed presentation after SAH in Japan. Urbanization, male gender, and mild SAH lead patients to delay presentation. The factors underlying these tendencies will be analyzed in a future prospective study.
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Affiliation(s)
- Norihito Shimamura
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan; Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Takeshi Katagai
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan; Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan
| | - Nozomi Fujiwara
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kaima Suzuki
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | | | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
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López-Martín N, Escalera-Alonso J, Thuissard-Vasallo IJ, Andreu-Vázquez C, Bielza-Galindo R. [Result of the update of the clinical pathway for hip fracture in the elderly at a university hospital in Madrid]. Rev Esp Geriatr Gerontol 2023; 58:61-67. [PMID: 36804952 DOI: 10.1016/j.regg.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge. MATERIAL AND METHOD A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year. RESULTS Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year. CONCLUSIONS Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
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Affiliation(s)
- Néstor López-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - Javier Escalera-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Israel John Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Cristina Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Rafael Bielza-Galindo
- Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Elamin D, Ozgur I, Steele SR, Khorana AA, Jia X, Gorgun E. Impact of COVID-19 pandemic on treatment of colorectal cancer patients. Am J Surg 2023; 225:934-936. [PMID: 36737399 PMCID: PMC9886390 DOI: 10.1016/j.amjsurg.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modifications to practice during COVID pandemic impacted health maintenance and treatment of cancer patients. METHODS We conducted a retrospective cohort study of all consecutive patients presenting to our institution with a new diagnosis of colorectal cancer pre-COVID (January 2017 to December 2019) and post-COVID (January to December 2020). RESULTS The total number of patients with a new diagnosis of CRC was 2196. The pre-COVID period had 1891 patients whereas post-COVID period had 305. The median number of patients diagnosed with CRC per month was 50 and 35.5 pre and post-COVID, respectively. Time to treatment initiation was similar with no difference in stage at presentation for the pre and post-COVID periods. CONCLUSION There was a significant decrease in colorectal cancer diagnosis number and rate (p < 0.01) during the COVID era with no difference in staging at diagnosis or time to treatment initiation.
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Affiliation(s)
- Doua Elamin
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ilker Ozgur
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R. Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alok A. Khorana
- Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Xue Jia
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA,Corresponding author. Colorectal Surgical Oncology, Department of Colorectal Surgery, Krause-Lieberman Chair in Laparoscopic Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH, 44195, USA
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Gong J, Rezaeipanah A. A fuzzy delay-bandwidth guaranteed routing algorithm for video conferencing services over SDN networks. Multimed Tools Appl 2023; 82:1-30. [PMID: 36712954 PMCID: PMC9868508 DOI: 10.1007/s11042-023-14349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/25/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
Video conferencing is one of the advanced technologies for users that allows online communication despite long distances. High quality communication and ongoing support for the principles of video conferencing service that can be achieved through Software-Defined Networking (SDN). SDN is a new architecture for computer networks that separates the control plane from the data plane to improve network resources and reduce operating costs. All routing decisions and control mechanisms are made by a device called a controller. Traffic engineering can be well implemented in SDN because the entire network topology is known to the controller. Considering SDN features, user requests can be dynamically routed according to current network status and Quality of Service (QoS) requirements. In general, the purpose of SDN routing algorithms is to maximize the acceptance rate of user requests by considering QoS requirements. In this literature, most routing studies to provide satisfactory video conferencing services have focused solely on bandwidth. Nevertheless, some studies have considered both delay and bandwidth constraints. In this paper, a Fuzzy Delay-Bandwidth Guaranteed Routing (FDBGR) algorithm is proposed that considers both delay and bandwidth constraints in routing. The proposed fuzzy system is based on rules that can postpone requests with high resource demands. Also, the purpose of the FDBGR is to distribute the network workload evenly for all requests, where this is done by maintaining the capacity to accept future requests. The combination of conventional routing algorithms and SDN provides remarkable improvements in mobility, scalability and the overall performance of the networks. Simulations are performed on different scenarios to evaluate the performance of the FDBGR compared to state-of-the-art methods. Besides, FDBGR has been compared with a number of most related previous works such as H-MCOP, MH-MCOP, QoMRA, QROUTE and REDO based on criteria such as number of accepted requests, average path length, energy consumption, load balancing, and average delay. The simulation results clearly prove the superiority of the proposed algorithm with an average delay of 48 ms in different topologies for video conferencing applications.
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Affiliation(s)
- Jianhu Gong
- School of Data and Computer Science, Guangdong Peizheng College, Guangzhou, 510830 People’s Republic of China
| | - Amin Rezaeipanah
- Department of Computer Engineering, University of Rahjuyan Danesh Borazjan, Bushehr, Iran
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50
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Nguyen KH, Zhao R, Mullins C, Corlin L, Beninger P, Bednarczyk RA. Trends in vaccination schedules and up-to-date status of children 19-35 months, United States, 2015-2020. Vaccine 2023; 41:467-475. [PMID: 36481107 DOI: 10.1016/j.vaccine.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To estimate trends in, and factors associated with, vaccination patterns and up-to-date immunization status of U.S. children by 19 to 35 months of age. METHODS Data from the 2015 to 2020 National Immunization Surveys were used to assess trends in vaccination patterns, up-to-date status, and zero vaccination status of U.S. children by 19-35 months. Vaccination patterns were categorized as: 1) recommended, 2) alternate, or 3) unknown or unclassifiable. Multivariable analyses were conducted to examine factors associated with each vaccination pattern and up-to-date status for all recommended vaccines. RESULTS From 2015 to 2020, the proportion of U.S. children completing the recommended schedule increased from 62.5% to 69.4%, alternative schedule decreased from 21.6% to 16.2%, and unknown or unclassifiable schedules decreased from 15.9% to 14.3%. In addition, being not up-to-date decreased from 39.7% to 35.6%. There was no change in the percentage of children receiving zero vaccinations from 2015 to 2020 (0.9% to 0.9%). Respondents with lower household income or who were uninsured were more likely to follow an alternate or unknown/unclassifiable schedule, or not be up-to-date with vaccines. CONCLUSION Following any schedule other than the recommended schedule was associated with not being up-to-date on immunizations. Increased efforts to catch up on recommended vaccines is important for protecting children's health. Further efforts should be made to improve timely adherence to recommended vaccination schedules, particularly among populations with the largest disparities in coverage through a tailored approach to increase confidence in and access to vaccines.
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Affiliation(s)
- Kimberly H Nguyen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Ruitong Zhao
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Corey Mullins
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Laura Corlin
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
| | - Paul Beninger
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Emory University, Atlanta, GA, USA
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