11 research outputs found
Performance of SAPS II and SAPS 3 in Intermediate Care
Objective: The efficacy and reliability of prognostic scores has been described extensively for intensive care, but
their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field,
we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center
intermediate care unit (ImCU).
Materials and Methods: Cohort study with prospectively collected data from all patients admitted to a single center
ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted
mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the
area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of
fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model.
Results: The study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87
(95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable
discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3.
Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9,
p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3.
Conclusions: Although both scores overpredicted mortality, SAPS II showed better discrimination for patients
admitted to ImCU in terms of SMR
The Compact Linear Collider (CLIC) - 2018 Summary Report
The Compact Linear Collider (CLIC) is a TeV-scale high-luminosity linear collider under development at CERN. Following the CLIC conceptual design published in 2012, this report provides an overview of the CLIC project, its current status, and future developments. It presents the CLIC physics potential and reports on design, technology, and implementation aspects of the accelerator and the detector. CLIC is foreseen to be built and operated in stages, at centre-of-mass energies of 380 GeV, 1.5 TeV and 3 TeV, respectively. CLIC uses a two-beam acceleration scheme, in which 12 GHz accelerating structures are powered via a high-current drive beam. For the first stage, an alternative with X-band klystron powering is also considered. CLIC accelerator optimisation, technical developments and system tests have resulted in an increased energy efficiency (power around 170 MW) for the 380 GeV stage, together with a reduced cost estimate at the level of 6 billion CHF. The detector concept has been refined using improved software tools. Significant progress has been made on detector technology developments for the tracking and calorimetry systems. A wide range of CLIC physics studies has been conducted, both through full detector simulations and parametric studies, together providing a broad overview of the CLIC physics potential. Each of the three energy stages adds cornerstones of the full CLIC physics programme, such as Higgs width and couplings, top-quark properties, Higgs self-coupling, direct searches, and many precision electroweak measurements. The interpretation of the combined results gives crucial and accurate insight into new physics, largely complementary to LHC and HL-LHC. The construction of the first CLIC energy stage could start by 2026. First beams would be available by 2035, marking the beginning of a broad CLIC physics programme spanning 25-30 years
Performance of SAPS II and SAPS 3 in Intermediate Care
Objective: The efficacy and reliability of prognostic scores has been described extensively for intensive care, but
their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field,
we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center
intermediate care unit (ImCU).
Materials and Methods: Cohort study with prospectively collected data from all patients admitted to a single center
ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted
mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the
area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of
fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model.
Results: The study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87
(95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable
discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3.
Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9,
p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3.
Conclusions: Although both scores overpredicted mortality, SAPS II showed better discrimination for patients
admitted to ImCU in terms of SMR
Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients
Despite current guidelines, venous thromboembolism (VTE) prophylaxis is underused. Computerized programs to encourage physicians to apply thromboprophylaxis have been shown to be effective in selected populations. Our aim was to analyze the impact of the implementation of a computer-alert system for VTE risk in all hospitalized patients of a teaching hospital. A computer program linked to the clinical record database was developed to assess all hospitalized patients' VTE risk daily. The physician responsible for patients at high risk was alerted, but remained free to order or withhold prophylaxis. Over 19,000 hospitalized, medical and surgical, adult patients between January to June 2005 (pre-intervention phase), January to June 2006 and January to June 2007 (post-intervention phase), were included. During the first semesters of 2006 and 2007, an electronic alert was sent to 32.8% and 32.2% of all hospitalized patients, respectively. Appropriate prophylaxis among alerted patients was ordered in 89.7% (2006) and 88.5% (2007) of surgical patients, and in 49.2% (2006) and 64.4% (2007) of medical patients. A sustained reduction of VTE during hospitalization was achieved, Odds ratio (OR): 0.53, 95% confidence interval (CI) (0.25-1.10) and OR: 0.51, 95%CI (0.24-1.05) during the first semesters of 2006 and 2007 respectively, the impact being significant (p < 0.05) among medical patients in 2007, OR: 0.36, 95%CI (0.12-0.98). The implementation of a computer-alert program helps physicians to assess each patient's thrombotic risk, leading to a better use of thromboprophylaxis, and a reduction in the incidence of VTE among hospitalized patients. For the first time, an intervention aimed to improve VTE prophylaxis shows maintained effectiveness over time
Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients
Despite current guidelines, venous thromboembolism (VTE) prophylaxis is underused. Computerized programs to encourage physicians to apply thromboprophylaxis have been shown to be effective in selected populations. Our aim was to analyze the impact of the implementation of a computer-alert system for VTE risk in all hospitalized patients of a teaching hospital. A computer program linked to the clinical record database was developed to assess all hospitalized patients' VTE risk daily. The physician responsible for patients at high risk was alerted, but remained free to order or withhold prophylaxis. Over 19,000 hospitalized, medical and surgical, adult patients between January to June 2005 (pre-intervention phase), January to June 2006 and January to June 2007 (post-intervention phase), were included. During the first semesters of 2006 and 2007, an electronic alert was sent to 32.8% and 32.2% of all hospitalized patients, respectively. Appropriate prophylaxis among alerted patients was ordered in 89.7% (2006) and 88.5% (2007) of surgical patients, and in 49.2% (2006) and 64.4% (2007) of medical patients. A sustained reduction of VTE during hospitalization was achieved, Odds ratio (OR): 0.53, 95% confidence interval (CI) (0.25-1.10) and OR: 0.51, 95%CI (0.24-1.05) during the first semesters of 2006 and 2007 respectively, the impact being significant (p < 0.05) among medical patients in 2007, OR: 0.36, 95%CI (0.12-0.98). The implementation of a computer-alert program helps physicians to assess each patient's thrombotic risk, leading to a better use of thromboprophylaxis, and a reduction in the incidence of VTE among hospitalized patients. For the first time, an intervention aimed to improve VTE prophylaxis shows maintained effectiveness over time
Insights into venous thromboembolism prevention in hospitalized cancer patients: Lessons from a prospective study
Hospitalized cancer patients are at high risk of venous thromboembolism (VTE). Despite
current recommendations in clinical guidelines, thromboprophylaxis with low molecular
weight heparin (LMWH) is underused. We performed an observational prospective study to
analyse factors influencing prophylaxis use, VTE events and mortality in cancer-hospitalized
patients. 1072 consecutive adult cancer patients were included in an University Hospital
from April 2014 to February 2017, and followed-up for 30 days after discharge. The rate of
LMWH prophylaxis was 67.6% (95% confidence interval [CI] 64.7% to 70.4%), with a 2.8%
rate of VTE events (95% CI 1.9% to 3.9%) and 3.5% rate of major bleeding events (95% CI
2.5% to 4.8%). 80% of VTE events occurred despite appropriate thromboprophylaxis. Overall, 30-day mortality rate was 13.2% (95% CI 11.2% to 15.3%). Active chemotherapy treatment, hospital stay 4 days, and metastatic disease were associated with a higher use of
LMWH. On the contrary, patients with hematologic malignancies, anemia or thrombocytopenia were less prone to receive thromboprophylaxis. The main reasons for not prescribing
LMWH prophylaxis were thrombocytopenia (23.9%) and active/recent bleeding (21.8%).
The PRETEMED score, used for VTE risk stratification, correlated with 30-day mortality.
There is room for improvement in thromboprophylaxis use among hospitalized-cancer
patients, especially among those with hematologic malignancies. A relevant number of VTE
events occurred despite prophylaxis with LMWH. Therefore, identification of risk factors for
thromboprophylaxis failure is needed
Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care
Background
Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Inva-
sive Ventilation (NIV). The limited number of prognostic studies in this population support
the need of mortality prediction evaluation in this context.
Objective
The objective of this study is to analyze the performance of Simplified Acute Physiology
Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for
new variables that could be useful to customize these scores, in order to improve mortality
prediction.
Design
Cohort study with prospectively collected data from all patients admitted to a single center
ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality
rates were calculated. Discrimination and calibration were evaluated by calculating the area
under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow
goodness of fit test for the models, respectively. Binary logistic regression was used to iden-
tify new variables to customize the scores for mortality prediction in this setting.
Patients
The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists
from April 2006 to December 2013. Key Results
The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio
(SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC
was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppres-
sion, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic
acid, pCO2 and haemoglobin levels showed better discrimination than old scores with simi-
lar calibration power.
Conclusions
These results suggest that SAPS II and 3 should be customized with additional patient-risk
factors to improve mortality prediction in patients undergoing NIV in intermediate care