Artemisia: Validation of a deep learning model for automatic breast density categorization

Background: The aim of this study is to validate a deep learning model for the classification of breast density according to American College of Radiology’s breast density patterns. Methods: A convolutional neural network was developed with 10,229 digital screening mammogram images. Once the network was developed and tested, its performance was evaluated before a group of six professionals, the majority report and a commercial software application. We selected randomly 451 new mammographic images from different studies and patients. The categorization process by professionals was repeated in two stages. Results: The agreement between the convolutional neural network and the majority report was k=0.64 (95% CI: 0.58–0.69) in the first stage and k=0.57 (95% CI: 0.52–0.63) in the second stage. The agreement between the CNN and the commercial software application was k=0.54 (95% CI: 0.48–0.60). In both cases, we observed that the concordances of the CNN were within or above the range of professionals’ concordances values. Conclusions: Considering the internal reference standard (majority report) and the external reference standard (commercial software application), we can affirm the CNN achieved professional level performance.Fil: Tajerian, Matías N.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Pesce, Karina. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Frangella, Julia. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Quiroga, Ezequiel. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Boietti, Bruno Rafael. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Chico, Maria José. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Swiecicki, María Paz. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Benitez, Sonia. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Rabellino, Martín. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Luna, Daniel Roberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentin

Telemedicina: Validação de um questionário para avaliar a experiência dos profissionais de saúde

Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discrimi- nante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.Objective. This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods. Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results. A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions. The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.Objetivo. Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos. Com base na versão abreviada em espanhol e validada localmente do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliouse a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados. Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões. O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a ava- liação objetiva da experiência dos profissionais que realizam telemedicina.Fil: Sommer, Janine. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Torres, Ana Clara. Hospital Italiano; ArgentinaFil: Bibiloni, Nuria. Hospital Italiano; ArgentinaFil: Plazzotta, Fernando. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Vázquez Peña, Fernando. Hospital Italiano; ArgentinaFil: Terrasa, Sergio Adrián. Hospital Italiano; ArgentinaFil: Boietti, Bruno Rafael. Hospital Italiano; ArgentinaFil: Bruchanski, Lucila. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Mazzuoccolo, Luis Daniel. Hospital Italiano; ArgentinaFil: Luna, Daniel Roberto. Hospital Italiano. Departamento de Informática En Salud.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentin

Emergency department visits and hospital readmissions in an Argentine health system

Background and goal of study: The scope of health in the Sustainable Development Goals is much broader than the Millennium Development Goals, spanning functions such as health-system access and quality of care. Hospital readmission rate and ED-visits within 30 days from discharge are considered low-cost quality indicators. This work assesses an indicator of quality of care in a tertiary referral hospital in Argentina, using data available from clinical records. Purpose: To estimate the rate of ED-visits and the hospital readmission rate (HRR) after a first hospitalization (First-H), and to identify associated factors. Methods: This retrospective cohort included patients who had a First-H in Hospital Italiano de Buenos Aires between 2014–2015. Follow-up occurred from discharge until ED-visit, readmission, death, disaffiliation from health insurance, or 13 months. We present HRR at 30 days and ED-visits rate at 72 h, using the Cox proportional-hazards regression model to explore associated factors, and reporting adjusted hazard ratios (HR) with their respective 95 %CI. Results: The study comprised 10,598 hospitalizations (median age was 68 years). Of these, 5966 had at least one consultation to the ED during follow up, resulting in a 24 h rate of consultations to ED of 1.51 % (95 %CI 1.29−1.72); at 48 h 3.18 % (95 %CI 2.86−3.54); at 72 h 4.71 % (95 %CI 4.32−5.13). In multivariable models, factors associated for 72 h ED-visits were: age (aHR 1.06), male (aHR 1.14), Charlson Comorbidity Index (aHR 1.16), unscheduled hospitalization (aHR 1.39), prior consultation with the ED (aHR 1.08) and long hospital stay (aHR 1.39). Meanwhile, 2345 patients had at least one hospital readmission (98 % unscheduled), resulting a 24 h rate of 0.5 % (95 %CI 0.42−0.71), at 48 h 0.98 % (95 %CI 0.80−1.18), at 72 h 1.4 % (95 %CI 1.2−1.6); at 30 days 7.7 % (95 %CI 7.2−8.2); at 90 days 13 % (95 %CI 12.4–13.8); and one-year 22.5 % (95 %CI 21.7−23.4). Associated factors for HRR at 30 days were: age (HR 1.16), male (HR 1.09), Charlson comorbidities score (HR 1.27), social service requirement during First-H (HR 1.37), unscheduled First-H (HR 1.16), previous ED-visits (HR 1.03) and length of stay (HR 1.08). Conclusion: Priorities efforts to improve must include greater attention to patients’ readiness prior discharge, to explore causes of preventable readmissions, and better support for patient self-management.Fil: Giunta, Diego Hernan. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Marquez Fosser, Santiago. Université Mcgill; CanadáFil: Boietti, Bruno Rafael. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Acion, Laura. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Calculo. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Calculo; ArgentinaFil: Pollan, Javier Alberto. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Martínez, Bernardo. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Luna, Daniel Roberto. Hospital Italiano. Instituto Universitario. Escuela de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bonella, Maria Belen. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Grande Ratti, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano. Instituto Universitario. Escuela de Medicina; Argentin

COVID-19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes: A multicontinental cohort study

The aim of this study was to analyze whether the coronavirus disease 2019 (COVID-19) vaccine reduces mortality in patients with moderate or severe COVID-19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID-19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9–24), compared to 19.5% (95% CI: 19–20) in unvaccinated patients, resulting in a crude odds ratio (OR) of 1.07 (95% CI: 0.89–1.29; p = 0.41). However, after considering the multiple comorbidities in the vaccinated group, the adjusted OR was 0.73 (95% CI: 0.56–0.95; p = 0.02) with a population attributable risk reduction of 4.3% (95% CI: 1–5). The higher risk reduction for mortality was with messenger RNA (mRNA) BNT162b2 (Pfizer) (OR 0.37; 95% CI: 0.23–0.59; p < 0.01), ChAdOx1 nCoV-19 (AstraZeneca) (OR 0.42; 95% CI: 0.20–0.86; p = 0.02), and mRNA-1273 (Moderna) (OR 0.68; 95% CI: 0.41–1.12; p = 0.13), and lower with Gam-COVID-Vac (Sputnik) (OR 0.93; 95% CI: 0.6–1.45; p = 0.76). COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate or severe disease (oxygen therapy).Fil: Huespe, Ivan. Hospital Italiano. Instituto Universitario. Escuela de Medicina; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Ferraris, Augusto. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Lalueza, Antonio. 12 de Octubre University Hospital; EspañaFil: Valdez, Pascual. Hospital General de Agudos Dalmacio Velez Sarsfield ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Peroni, María Leticia. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Cayetti, Luis A.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Mirofsky, Matias A.. Hospital Municipal Doctor Leónidas Lucero; ArgentinaFil: Boietti, Bruno Rafael. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Gómez Huelgas, Ricardo. Universidad de Málaga; EspañaFil: Casas Rojo, José M.. Infanta Cristina University Hospital; EspañaFil: Antón Santos, Juan M.. Infanta Cristina University Hospital; EspañaFil: Núñez Cortés, Jesús M.. Hospital General Universitario Gregorio Marañón (hosp Gral Univ G. Marañón); EspañaFil: Lumbreras, Carlos. 12 de Octubre University Hospital; España. Universidad Complutense de Madrid; EspañaFil: Ramos Rincón, Jose Manuel. Universidad de Miguel Hernández; EspañaFil: Barrio, Noelia G.. 12 de Octubre University Hospital; España. Universidad Complutense de Madrid; EspañaFil: Pedrera Jiménez, Miguel. 12 de Octubre University Hospital; España. Universidad Complutense de Madrid; EspañaFil: Martin Escalante, María D.. Costa del Sol Hospital; EspañaFil: Ruiz, Francisco R.. Costa del Sol Hospital; EspañaFil: Onieva García, María Á.. Costa del Sol Hospital; EspañaFil: Toso, Carlos R.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Risk, Marcelo. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; ArgentinaFil: Klén, Riku. University of Turku; FinlandiaFil: Pollán, Javier A.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Gómez Varela, David. Universidad de Viena; Austri