240 research outputs found
Estimating incidence of venous thromboembolism in COVID-19:Methodological considerations
Background Coagulation abnormalities and coagulopathy are recognized as consequences of severe acute respiratory syndrome coronavirus 2 infection and the resulting coronavirus disease 2019 (COVID-19). Specifically, venous thromboembolism (VTE) has been reported as a frequent complication. By May 27, 2021, at least 93 original studies and 25 meta-analyses investigating VTE incidence in patients with COVID-19 had been published, showing large heterogeneity in reported VTE incidence ranging from 0% to 85%. This large variation complicates interpretation of individual study results as well as comparisons across studies, for example, to investigate changes in incidence over time, compare subgroups, and perform meta-analyses. Objectives This study sets out to provide an overview of sources of heterogeneity in VTE incidence studies in patients with COVID-19, illustrated using examples. Methods The original studies of three meta-analyses were screened and a list of sources of heterogeneity that may explain observed heterogeneity across studies was composed. Results The sources of heterogeneity in VTE incidence were classified as clinical sources and methodologic sources. Clinical sources of heterogeneity include differences between studies regarding patient characteristics that affect baseline VTE risk and protocols used for VTE testing. Methodologic sources of heterogeneity include differences in VTE inclusion types, data quality, and the methods used for data analysis. Conclusions To appreciate reported estimates of VTE incidence in patients with COVID-19 in relation to its etiology, prevention, and treatment, researchers should unambiguously report about possible clinical and methodological sources of heterogeneity in those estimates. This article provides suggestions for that.Thrombosis and Hemostasi
Text-mining in electronic healthcare records can be used as efficient tool for screening and data collection in cardiovascular trials: a multicenter validation study
Objective: This study aimed to validate trial patient eligibility screening and baseline data collection using text-mining in electronic
healthcare records (EHRs), comparing the results to those of an international trial.
Study Design and Setting: In three medical centers with different EHR vendors, EHR-based text-mining was used to automatically
screen patients for trial eligibility and extract baseline data on nineteen characteristics. First, the yield of screening with automated
EHR text-mining search was compared with manual screening by research personnel. Second, the accuracy of extracted baseline data
by EHR text mining was compared to manual data entry by research personnel.
Results: Of the 92,466 patients visiting the out-patient cardiology departments, 568 (0.6%) were enrolled in the trial during its recruitment period using manual screening methods. Automated EHR data screening of all patients showed that the number of patients needed to
screen could be reduced by 73,863 (79.9%). The remaining 18,603 (20.1%) contained 458 of the actual participants (82.4% of participants).
In trial participants, automated EHR text-mining missed a median of 2.8% (Interquartile range [IQR] across all variables
0.4e8.5%) of all data points compared to manually collected data. The overall accuracy of automatically extracted data was
88.0% (IQR 84.7e92.8%).
Conclusion: Automatically extracting data from EHRs using text-mining can be used to identify trial participants and to collect baseline informatio
Prognostic factors of early metastasis and mortality in dogs with appendicular osteosarcoma after receiving surgery: An individual patient data meta-analysis
Effectiveness and toxicity of lenvatinib in refractory thyroid cancer:Dutch real-life data
Objective: The SELECT trial showed progression-free survival (PFS) benefit for lenvatinib for advanced radioiodine-refractory differentiated thyroid cancer (RAI-refractory or RR-DTC) patients, on which current clinical practice is based. We assessed whether the effectiveness and toxicity of lenvatinib in real-life clinical practice in the Netherlands were comparable to the pivotal SELECT trial. Methods: From three Dutch centres Electronic Health Records (EHRs) of patients treated in the lenvatinib compassionate use program or as standard of care were reviewed and checked for SELECT eligibility criteria. Baseline characteristics, safety, and efficacy measures were compared and PFS and overall survival (OS) were calculated. Furthermore, PFS was compared to estimates of PFS reported in other studies. Results: A total of 39 DTC patients with a median age of 62 years were analysed. Of these, 27 patients (69%) did not fulfil the SELECT eligibility criteria. The most common grade >= 3 toxicities were hypertension (n = 11, 28%), diarrhoea (n = 7, 18%), vomiting (n = 4, 10%), and gallbladder disease (n = 3, 8%). Median PFS and median OS were 9.7 (95% confidence interval (CI): 4.0-15.5) and 18.3 (95% CI: 4.9-31.7) months, respectively, response rate was 38% (95% CI: 23-54%). PFS in the Dutch real-life situation was comparable to previous real-life studies, but inferior to PFS as shown in the SELECT trial (P = 0.04). Conclusions: PFS in our non-trial population was significantly shorter than in the SELECT trial population. In the interpretation of results, differences in the real-life population and the SELECT study population regarding patient characteristics should be taken into account
Epidemiology and outcome of rib fractures:a nationwide study in the Netherlands
Purpose Rib fractures following thoracic trauma are frequently encountered injuries and associated with a significant morbidity and mortality. The aim of this study was to provide current data on the epidemiology, in-hospital outcomes and 30-day mortality of rib fractures, and to evaluate these results for different subgroups. Methods A nationwide retrospective cohort study was performed with the use of the Dutch Trauma Registry which covers 99% of the acutely admitted Dutch trauma population. All patients aged 18 years and older admitted to the hospital between January 2015 and December 2017 with one or more rib fractures were included. Incidence rates were calculated using demographic data from the Dutch Population Register. Subgroup analyses were performed for flail chest, polytrauma, primary thoracic trauma, and elderly patients. Results A total of 14,850 patients were admitted between 2015 and 2017 with one or more rib fractures, which was 6.0% of all trauma patients. Of these, 573 (3.9%) patients had a flail chest, 4438 (29.9%) were polytrauma patients, 9273 (63.4%) were patients with primary thoracic trauma, and 6663 (44.9%) were elderly patients. The incidence rate of patients with rib fractures for the entire cohort was 29 per 100.000 person-years. The overall 30-day mortality was 6.9% (n = 1208) with higher rates observed in flail chest (11.9%), polytrauma (14.8%), and elderly patients (11.7%). The median hospital length of stay was 6 days (IQR, 3-11) and 37.3% were admitted to the intensive care unit (ICU). Conclusions Rib fractures are a relevant and frequently occurring problem among the trauma population. Subgroup analyses showed that there is a substantial heterogeneity among patients with rib fractures with considerable differences regarding the epidemiology, in-hospital outcomes, and 30-day mortality
Declining daily functioning as a prelude to a hip fracture in older persons-an individual patient data meta-analysis
Background Daily functioning is known to decline after a hip fracture, but studies of self-reported functioning before the fracture suggest this decline begins before the fracture. Objective Determine whether change in functioning in the year before a hip fracture in very old (80+) differs from change in those without a hip fracture. Design Two-stage individual patient data meta-analysis including data from the Towards Understanding Longitudinal International older People Studies (TULIPS)-consortium. Setting Four population-based longitudinal cohorts from the Netherlands, New Zealand and the UK. Subjects Participants aged 80+ years. Methods Participants were followed for 5 years, during which (instrumental) activities of daily living [(I)ADL] scores and incident hip fractures were registered at regular intervals. Z-scores of the last (I)ADL score and the change in (I)ADL in the year before a hip fracture were compared to the scores of controls, adjusted for age and sex. Results Of the 2,357 participants at baseline, the 161 who sustained a hip fracture during follow-up had a worse (I)ADL score before the fracture (0.40 standard deviations, 95% CI 0.19 to 0.61, P = 0.0002) and a larger decline in (I)ADL in the year before fracture (-0.11 standard deviations, 95% CI -0.22 to 0.004, P = 0.06) compared to those who did not sustain a hip fracture. Conclusions In the very old a decline in daily functioning already starts before a hip fracture. Therefore, a hip fracture is a sign of ongoing decline and what full recovery is should be seen in light of the pre-fracture decline.Clinical epidemiolog
The effects of exercise on the quality of life of patients with breast cancer (the UMBRELLA Fit study): study protocol for a randomized controlled trial
ΠΠ°ΡΠ°Π΄ΠΈΠ³ΠΌΠ° ΡΡΠΈΠ΄ΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ·ΠΈΠΊΡ Π² ΡΠΈΡΡΠ΅ΠΌΡ Π½Π°ΡΡΠΎΠ½Π°Π»ΡΠ½ΠΎΡ Π±Π΅Π·ΠΏΠ΅ΠΊΠΈ Π£ΠΊΡΠ°ΡΠ½ΠΈ (ΠΏΡΠΈΠΊΠ»Π°Π΄Π½ΠΈΠΉ Π°ΡΠΏΠ΅ΠΊΡ)
Π ΠΎΠ·Π³Π»ΡΠ΄Π°ΡΡΡΡΡ Π·Π°Π³Π°Π»ΡΠ½Π° ΠΌΠΎΠ΄Π΅Π»Ρ ΡΠΈΡΡΠ΅ΠΌΠΈ Π½Π°ΡΡΠΎΠ½Π°Π»ΡΠ½ΠΎΡ Π±Π΅Π·ΠΏΠ΅ΠΊΠΈ. ΠΠΈΠ·Π½Π°ΡΠ°ΡΡΡΡΡ ΠΌΡΡΡΠ΅
ΡΠ° ΡΠΎΠ»Ρ ΡΡΠΈΠ΄ΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ·ΠΈΠΊΡ Π² ΡΡΠ½ΠΊΡΡΠΎΠ½ΡΠ²Π°Π½Π½Ρ ΡΠΈΡΡΠ΅ΠΌΠΈ Π½Π°ΡΡΠΎΠ½Π°Π»ΡΠ½ΠΎΡ Π±Π΅Π·ΠΏΠ΅ΠΊΠΈ.
ΠΠ½Π°Π»ΡΠ·ΡΡΡΡΡΡ ΠΊΠ°ΡΠ΅Π³ΠΎΡΡΡ Β«ΡΡΠΈΠ΄ΠΈΡΠ½ΠΈΠΉ ΡΠΈΠ·ΠΈΠΊΒ» ΡΠ° ΠΉΠΎΠ³ΠΎ ΠΎΡΠ½ΠΎΠ²Π½Ρ ΡΠΊΠ»Π°Π΄ΠΎΠ²Ρ, ΡΠΌΠΎΠ²ΠΈ Π²ΠΈΠ½ΠΈΠΊΠ½Π΅Π½Π½Ρ ΡΠ° ΡΡΠ½ΠΊΡΡΠΎΠ½ΡΠ²Π°Π½Π½Ρ. ΠΡΠΎΠΏΠΎΠ½ΡΡΡΡΡΡ ΡΠΌΠΎΠ²ΠΈ ΠΏΡΠΎΡΠΈΠ΄ΡΡ ΡΠΈΠ·ΠΈΠΊΠ°ΠΌ ΡΠ° ΠΏΠΎΠ΄Π°ΡΡΡΡΡ ΠΌΠΎΠ΄Π΅Π»Ρ
Π·Π½ΠΈΠΆΠ΅Π½Π½Ρ ΡΡΠΈΠ΄ΠΈΡΠ½ΠΈΡ
ΡΠΈΠ·ΠΈΠΊΡΠ² Ρ ΡΠΈΡΡΠ΅ΠΌΡ Π½Π°ΡΡΠΎΠ½Π°Π»ΡΠ½ΠΎΡ Π±Π΅Π·ΠΏΠ΅ΠΊΠΈ .
ΠΠ»ΡΡΠΎΠ²Ρ ΡΠ»ΠΎΠ²Π°: Π½Π°ΡΡΠΎΠ½Π°Π»ΡΠ½Π° Π±Π΅Π·ΠΏΠ΅ΠΊΠ°, ΡΡΠΈΠ΄ΠΈΡΠ½ΠΈΠΉ ΡΠΈΠ·ΠΈΠΊ.Π Π°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅ΡΡΡ ΠΎΠ±ΡΠ°Ρ ΠΌΠΎΠ΄Π΅Π»Ρ ΡΠΈΡΡΠ΅ΠΌΡ Π½Π°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ. ΠΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ ΠΌΠ΅ΡΡΠΎ ΠΈ ΡΠΎΠ»Ρ ΡΡΠΈΠ΄ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΡΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΡ Π½Π°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ
Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ. ΠΠ½Π°Π»ΠΈΠ·ΠΈΡΡΠ΅ΡΡΡ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΡ Β«ΡΡΠΈΠ΄ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΈΡΠΊΒ» ΠΈ Π΅Π³ΠΎ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΡΠΎΡΡΠ°Π²Π»ΡΡΡΠΈΠ΅, ΡΡΠ»ΠΎΠ²ΠΈΡ Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ ΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ. ΠΡΠ΅Π΄Π»Π°Π³Π°ΡΡΡΡ ΡΡΠ»ΠΎΠ²ΠΈΡ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡ ΡΠΈΡΠΊΠ°ΠΌ ΠΈ ΠΏΠΎΠ΄Π°Π΅ΡΡΡ ΠΌΠΎΠ΄Π΅Π»Ρ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΡΠΈΠ΄ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΈΡΠΊΠΎΠ² Π² ΡΠΈΡΡΠ΅ΠΌΠ΅ Π½Π°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ
ΠΠ»ΡΡΠ΅Π²ΡΠ΅ ΡΠ»ΠΎΠ²Π°: Π½Π°ΡΠΈΠΎΠ½Π°Π»ΡΠ½Π°Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΡ, ΡΡΠΈΠ΄ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΈΡΠΊ.The problems of forming and development of the system of national safety are examined
in the article. The general model of the system of national safety is offered and the role of legal
risk is determined in this system. The location and role of legal risk is determined at functioning of the system of national safety. A category is analysed Β«legal riskΒ» and his basic component elements, terms of origin and functioning. The terms of counteraction risks are offered
and the model of decline of legal risks is given in the system of national safety.
Key words: national safety, legal risk
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