Variability of indication criteria in knee and hip replacement: an observational study

<p>Abstract</p> <p>Background</p> <p>Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication.</p> <p>Methods</p> <p>The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.</p> <p>The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ_5-95), variation coefficient (CV_5-95) and weighted variation coefficient (WCV_5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV_5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity.</p> <p>Results</p> <p>The variability expressed as WCV_5-95was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate.</p> <p>Conclusions</p> <p>A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.</p

How is genetic testing evaluated? A systematic review of the literature

open8Given the rapid development of genetic tests, an assessment of their benefits, risks, and limitations is crucial for public health practice. We performed a systematic review aimed at identifying and comparing the existing evaluation frameworks for genetic tests. We searched PUBMED, SCOPUS, ISI Web of Knowledge, Google Scholar, Google, and gray literature sources for any documents describing such frameworks. We identified 29 evaluation frameworks published between 2000 and 2017, mostly based on the ACCE Framework (n = 13 models), or on the HTA process (n = 6), or both (n = 2). Others refer to the Wilson and Jungner screening criteria (n = 3) or to a mixture of different criteria (n = 5). Due to the widespread use of the ACCE Framework, the most frequently used evaluation criteria are analytic and clinical validity, clinical utility and ethical, legal and social implications. Less attention is given to the context of implementation. An economic dimension is always considered, but not in great detail. Consideration of delivery models, organizational aspects, and consumer viewpoint is often lacking. A deeper analysis of such context-related evaluation dimensions may strengthen a comprehensive evaluation of genetic tests and support the decision-making process.openPitini, Erica*; de Vito, Corrado; Marzuillo, Carolina; D’Andrea, Elvira; Rosso, Annalisa; Federici, Antonio; Di Maria, Emilio; Villari, PaoloPitini, Erica; de Vito, Corrado; Marzuillo, Carolina; D’Andrea, Elvira; Rosso, Annalisa; Federici, Antonio; Di Maria, Emilio; Villari, Paol

VOLUMEN 25, NÚMERO 40 (2003)

TERMOCRONOLOGÍA K-Ar EN ILLITAS: ASPECTOS METODOLÓGICOS. Mantilla Figueroa, L. C.CINÉTICA DE LA NUCLEACIÓN Y EL CRECIMIENTO DEL GRANATE EN LAS ROCAS METAPELÍTICAS DE LA FORMACIÓN SILGARÁ, REGIÓN SUROCCIDENTAL DEL MACIZO DE SANTANDER. Ríos Reyes, C., Gélvez Llanes, J., Márquez Romero, R. y Castellanos Alarcón, O.INTRODUCCIÓN A LA GEOLOGÍA DEL SECTOR VÉLEZ–BOLÍVAR–GUAVATÁ (DPTO. DE SANTANDER, COLOMBIA) Y SU IMPORTANCIA PARA LA EXPLORACIÓN DE DEPÓSITOSHIDROTERMALES. Mantilla Figueroa, L. C.; Cruz G. L. E.; Colegial G. J. D.RECOGNITION OF ANCIENT SHOREFACE DEPOSITS. FACIES, FACIES SUCESSIONS, AND ASSOCIATIONS. AN EXAMPLE FROM THE CRETACEOUS GALLUP CLASTIC WEDGE, NEW MÉXICO. Álvarez Bastos, MNUEVAS EVIDENCIAS ACERCA DE LA PRESENCIA DE UNA BANDA DE CIZALLAMIENTO EN LA SECUENCIA METAPELÍTICA DE LA FORMACIÓN SILGARÁ, SECTOR ARATOCA-PESCADERO (REGION SUROCCIDENTAL DEL MACIZO DE SANTANDER). Mantilla Figueroa, L. C.; Ríos Reyes, C. A.; Gélvez Llanes, J. R.; Márquez Romero, R. E.; Ordóñez Calderón, J. C.; Cepeda Espitia, S.LOS DELIRIOS: UN YACIMIENTO HIDROTERMAL DE ORO Y PLATA EN LA REGIÓN DE VETAS, SANTANDER (COLOMBIA). García Ramírez, C. A., Uribe Portilla, E.MINERALOGÍA, GEOQUÍMICA Y ALGUNOS ASPECTOS GENÉTICOS DE LA MINA EL DIAMANTE - NARIÑO (COLOMBIA). Molano, J.C. and Shimazaki, H.COMPARATIVE FLUID INCLUSION STUDIES OF THE SAN MARTÍN SKARN (MÉXICO) AND THE EPITHERMAL COMSTOCK LODE (USA) AND PACHUCA-REAL DEL MONTE (MÉXICO) DEPOSITS. Campos Álvarez, N. O

VOLUMEN 25, NÚMERO 40 (2003)

TERMOCRONOLOGÍA K-Ar EN ILLITAS: ASPECTOS METODOLÓGICOS. Mantilla Figueroa, L. C.CINÉTICA DE LA NUCLEACIÓN Y EL CRECIMIENTO DEL GRANATE EN LAS ROCAS METAPELÍTICAS DE LA FORMACIÓN SILGARÁ, REGIÓN SUROCCIDENTAL DEL MACIZO DE SANTANDER. Ríos Reyes, C., Gélvez Llanes, J., Márquez Romero, R. y Castellanos Alarcón, O.INTRODUCCIÓN A LA GEOLOGÍA DEL SECTOR VÉLEZ–BOLÍVAR–GUAVATÁ (DPTO. DE SANTANDER, COLOMBIA) Y SU IMPORTANCIA PARA LA EXPLORACIÓN DE DEPÓSITOSHIDROTERMALES. Mantilla Figueroa, L. C.; Cruz G. L. E.; Colegial G. J. D.RECOGNITION OF ANCIENT SHOREFACE DEPOSITS. FACIES, FACIES SUCESSIONS, AND ASSOCIATIONS. AN EXAMPLE FROM THE CRETACEOUS GALLUP CLASTIC WEDGE, NEW MÉXICO. Álvarez Bastos, MNUEVAS EVIDENCIAS ACERCA DE LA PRESENCIA DE UNA BANDA DE CIZALLAMIENTO EN LA SECUENCIA METAPELÍTICA DE LA FORMACIÓN SILGARÁ, SECTOR ARATOCA-PESCADERO (REGION SUROCCIDENTAL DEL MACIZO DE SANTANDER). Mantilla Figueroa, L. C.; Ríos Reyes, C. A.; Gélvez Llanes, J. R.; Márquez Romero, R. E.; Ordóñez Calderón, J. C.; Cepeda Espitia, S.LOS DELIRIOS: UN YACIMIENTO HIDROTERMAL DE ORO Y PLATA EN LA REGIÓN DE VETAS, SANTANDER (COLOMBIA). García Ramírez, C. A., Uribe Portilla, E.MINERALOGÍA, GEOQUÍMICA Y ALGUNOS ASPECTOS GENÉTICOS DE LA MINA EL DIAMANTE - NARIÑO (COLOMBIA). Molano, J.C. and Shimazaki, H.COMPARATIVE FLUID INCLUSION STUDIES OF THE SAN MARTÍN SKARN (MÉXICO) AND THE EPITHERMAL COMSTOCK LODE (USA) AND PACHUCA-REAL DEL MONTE (MÉXICO) DEPOSITS. Campos Álvarez, N. O

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Double blind, randomized, placebo controlled clinical trial for the treatment of diabetic foot ulcers, using a nitric oxide releasing patch: PATHON

<p>Abstract</p> <p>Background</p> <p>Diabetes Mellitus constitutes one of the most important public health problems due to its high prevalence and enormous social and economic consequences. Diabetic foot ulcers are one of the chronic complications of diabetes mellitus and constitute the most important cause of non-traumatic amputation of inferior limbs. It is estimated that 15% of the diabetic population will develop an ulcer sometime in their lives. Although novel therapies have been proposed, there is no effective treatment for this pathology. Naturally produced nitric oxide participates in the wound healing process by stimulating the synthesis of collagen, triggering the release of chemotactic cytokines, increasing blood vessels permeability, promoting angiogenic activity, stimulating the release of epidermical growth factors, and by interfering with the bacterial mitochondrial respiratory chain. Topically administered nitric oxide has demonstrated to be effective and safe for the treatment of chronic ulcers secondary to cutaneous leishmaniasis. However, due to their unstable nitric oxide release, the topical donors needed to be applied frequently, diminishing the adherence to the treatment. This difficulty has led to the development of a multilayer polymeric transdermal patch produced by electrospinning technique that guarantees a constant nitric oxide release. The main objective of this study is to evaluate the effectiveness and safety of this novel nitric oxide releasing wound dressing for the treatment of diabetic foot ulcers.</p> <p>Methods and design</p> <p>A double-blind, placebo-controlled clinical trial, including 100 diabetic patients was designed. At the time of enrollment, a complete medical evaluation and laboratory tests will be performed, and those patients who meet the inclusion criteria randomly assigned to one of two groups. Over the course of 90 days group 1 will receive active patches and group 2 placebo patches. The patients will be seen by the research group at least every two weeks until the healing of the ulcer or the end of the treatment. During each visit the healing process of the ulcer, the patient's health status and the presence of adverse events will be assessed. Should the effectiveness of the patches be demonstrated an alternative treatment would then be available to patients.</p> <p>Trial registration</p> <p>NCT00428727.</p

Social factors related to the clinical severity of influenza cases in Spain during the A(H1N1)2009 virus pandemic

Background During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection. Methods We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models. Results Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87) Conclusions In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

Comparing Journalistic Role Performance Across Thematic Beats: A 37-Country Study

Studies suggest that, at the routine level, news beats function as unique “micro-cultures.” Exploring this “particularist” approach in news content, we compare how the interventionist, watchdog, loyal, service, infotainment, and civic roles materialize across 11 thematic news beats and analyze the moderating effect of platforms, ownership, and levels of political freedom on journalistic role performance in hard and soft news. Based on the second wave of the Journalistic Role Performance (JRP) project, this article reports the findings of a content analysis of 148,474 news items from 37 countries. Our results reveal the transversality of interventionism, the strong associations of some topics and roles, and the limited reach of news beat particularism in the face of moderating variables