380 research outputs found
Prognosis in traumatic brain injury
Introduction:
The
general
purpose
of
this
thesis
was
to
study
prognosis
in
traumatic
brain
injury
(TBI)
patients,
with
the
aim
of
providing
useful
and
practical
information
in
clinical
practice
and
clinical
research.
The
specific
objectives
were:
to
develop
and
validate
practical
prognostic
models
for
TBI
patients
and
to
assess
the
validity
of
the
Modified
Oxford
Handicap
Scale
(mOHS)
for
predicting
disability
at
six
months.
Methods:
A
survey
was
first
conducted
to
understand
the
importance
of
prognostic
information
among
physicians.
A
systematic
review
of
prognostic
models
for
TBI
patients
was
then
carried
out.
Prognostic
models
were
developed
using
data
from
a
cohort
of
10,008
TBI
patients
(CRASH
trial)
and
validated
in
a
cohort
of
8,509
TBI
patients
(IMPACT
study).
Two
focus
groups
and
a
survey
were
conducted
to
develop
a
paper-based
prognostic
score
card.
The
correlation
between
the
mOHS
and
the
Glasgow
Outcome
Scale
(GOS)
was
assessed,
the
validity
of
different
mOHS
dichotomies
was
assessed,
and
the
discriminative
ability
of
the
mOHS
to
predict
GOS
was
evaluated.
Results:
Doctors
considered
prognostic
information
to
be
very important
in
the
clinical
management
of
TBI
patients,
and
believed
that
an
accurate
prognostic
model
would
change
their
current
clinical
practice.
Many
prognostic
models
for
TBI
have
been
published,
but
they
have
many
methodological
flaws
which
limit
their
validity.
Valid
prognostic
models
for
patients
from
high
income
countries
and
low
&
middle
income
.countries
were
developed
and
made
available
as
a
web
calculator,
and
as
a
paper
based
score
card.
The
mOHS
was
strongly
correlated
with
and
was
predictive
of
GOS
at
six
months.
Conclusion:
The
prognostic
models
developed
are
valid
and
practical
to
use
in
the
clinical
setting.
The
association
between
mOHS
and
GOS
suggest
that
the
mOHS
could
be
used
for
interim
analysis
in
randomised
clinical
trials
in
TBI
patients,
for
dealing
with
loss
to
follow-up,
or
could
be
used
as
simple
tool
to
inform
patients
and
relatives
about
their
prognosis
at
hospital
discharg
Estimación del costo económico en Argentina de la mortalidad atribuible al tabaco en adultos.
Existe amplia evidencia científica que vincula al tabaquismo con la mortalidad. Para estimar el costo de la mortalidad anual atribuible al tabaco (MAT) para adultos en Argentina se utilizaron datos de prevalencia de consumo de fumadores y ex fumadores (SEDRONAR), riesgos relativos de muerte por las patologías relevantes (Cancer Prevention Study II), muertes por dichas enfermedades y el valor de la consecuente productividad perdida. Se concluye que en el 2000, se produjeron 39.131 MAT en Argentina en los mayores de 35 años (16% de las de ese grupo). El costo anual medido como pérdida de ingresos futuros por mortalidad prematura fue de 469 millones de pesos, implicando esto $14 por habitante y 0,17% del PBI del año 2000. También se encontraron diferencias debidas a cada causa de mortalidad por sexo y edad.Epidemiología, Tabaco, Mortalidad, Valuación
Three Steps to Improve Management of Noncommunicable Diseases in Humanitarian Crises.
Kiran Jobanputra and colleagues argue that better evidence, guidance, and tools are needed to improve the effectiveness and feasibility of noncommunicable disease care in humanitarian settings
Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.
BACKGROUND: Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors via lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low-cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. OBJECTIVES: To establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two other databases on 21 June 2017 and two clinical trial registries on 14 July 2017. We searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA: We included randomised controlled trials investigating interventions delivered wholly or partly by mobile phones to improve adherence to cardiovascular medications prescribed for the primary prevention of CVD. We only included trials with a minimum of one-year follow-up in order that the outcome measures related to longer-term, sustained medication adherence behaviours and outcomes. Eligible comparators were usual care or control groups receiving no mobile phone-delivered component of the intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. We contacted study authors for disaggregated data when trials included a subset of eligible participants. MAIN RESULTS: We included four trials with 2429 randomised participants. Participants were recruited from community-based primary care or outpatient clinics in high-income (Canada, Spain) and upper- to middle-income countries (South Africa, China). The interventions received varied widely; one trial evaluated an intervention focused on blood pressure medication adherence delivered solely through short messaging service (SMS), and one intervention involved blood pressure monitoring combined with feedback delivered via smartphone. Two trials involved interventions which targeted a combination of lifestyle modifications, alongside CVD medication adherence, one of which was delivered through text messages, written information pamphlets and self-completion cards for participants, and the other through a multi-component intervention comprising of text messages, a computerised CVD risk evaluation and face-to-face counselling. Due to heterogeneity in the nature and delivery of the interventions, we did not conduct a meta-analysis, and therefore reported results narratively.We judged the body of evidence for the effect of mobile phone-based interventions on objective outcomes (blood pressure and cholesterol) of low quality due to all included trials being at high risk of bias, and inconsistency in outcome effects. Of two trials targeting medication adherence alongside other lifestyle modifications, one reported a small beneficial intervention effect in reducing low-density lipoprotein cholesterol (mean difference (MD) -9.2 mg/dL, 95% confidence interval (CI) -17.70 to -0.70; 304 participants), and the other found no benefit (MD 0.77 mg/dL, 95% CI -4.64 to 6.18; 589 participants). One trial (1372 participants) of a text messaging-based intervention targeting adherence showed a small reduction in systolic blood pressure (SBP) for the intervention arm which delivered information-only text messages (MD -2.2 mmHg, 95% CI -4.4 to -0.04), but uncertain evidence of benefit for the second intervention arm that provided additional interactivity (MD -1.6 mmHg, 95% CI -3.7 to 0.5). One study examined the effect of blood pressure monitoring combined with smartphone messaging, and reported moderate intervention benefits on SBP and diastolic blood pressure (DBP) (SBP: MD -7.10 mmHg, 95% CI -11.61 to -2.59; DBP: -3.90 mmHg, 95% CI -6.45 to -1.35; 105 participants). There was mixed evidence from trials targeting medication adherence alongside lifestyle advice using multi-component interventions. One trial found large benefits for SBP and DBP (SBP: MD -12.45 mmHg, 95% CI -15.02 to -9.88; DBP: MD -12.23 mmHg, 95% CI -14.03 to -10.43; 589 participants), whereas the other trial demonstrated no beneficial effects on SBP or DBP (SBP: MD 0.83 mmHg, 95% CI -2.67 to 4.33; DBP: MD 1.64 mmHg, 95% CI -0.55 to 3.83; 304 participants).Two trials reported on adverse events and provided low-quality evidence that the interventions did not cause harm. One study provided low-quality evidence that there was no intervention effect on reported satisfaction with treatment.Two trials were conducted in high-income countries, and two in upper- to middle-income countries. The interventions evaluated employed between three and 16 behaviour change techniques according to coding using Michie's taxonomic method. Two trials evaluated interventions that involved potential users in their development. AUTHORS' CONCLUSIONS: There is low-quality evidence relating to the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD; some trials reported small benefits while others found no effect. There is low-quality evidence that these interventions do not result in harm. On the basis of this review, there is currently uncertainty around the effectiveness of these interventions. We identified six ongoing trials being conducted in a range of contexts including low-income settings with potential to generate more precise estimates of the effect of primary prevention medication adherence interventions delivered by mobile phone
Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population.
AIMS: To assess the diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM and to compare its performance with the Latin-American FINDRISC (LA-FINDRISC) and the Peruvian Risk Score. MATERIALS AND METHODS: A population-based study was conducted. T2DM and undiagnosed T2DM were defined using oral glucose tolerance test (OGTT). Risk scores assessed were FINDRISC, LA-FINDRISC and Peruvian Risk Score. Diagnostic accuracy of risk scores was estimated using the c-statistic and the area under the ROC curve (aROC). A simplified version of FINDRISC was also derived. RESULTS: Data from 1609 individuals, mean age 48.2 (SD: 10.6), 810 (50.3%) women, were collected. A total of 176 (11.0%; 95%CI: 9.4%-12.5%) were classified as having T2DM, and 71 (4.7%; 95%CI: 3.7%-5.8%) were classified as having undiagnosed T2DM. Diagnostic accuracy of the FINDRISC (aROC=0.69), LA-FINDRISC (aROC=0.68), and Peruvian Risk Score (aROC=0.64) was similar (p=0.15). The simplified FINDRISC, with 4 variables, had a slightly better performance (aROC=0.71) than the other scores. CONCLUSION: The performance of FINDRISC, LA-FINDRISC and Peruvian Risk Score for undiagnosed T2DM was similar. A simplified FINDRISC can perform as well or better for undiagnosed T2DM. The FINDRISC may be useful to detect cases of undiagnosed T2DM in resource-constrained settings
Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis
Objective To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients
Atrial fibrillation: the current epidemic.
Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice. The consequences of AF have been clearly established in multiple large observational cohort studies and include increased stroke and systemic embolism rates if no oral anticoagulation is prescribed, with increased morbidity and mortality. With the worldwide aging of the population characterized by a large influx of "baby boomers" with or without risk factors for developing AF, an epidemic is forecasted within the next 10 to 20 years. Although not all studies support this evidence, it is clear that AF is on the rise and a significant amount of health resources are invested in detecting and managing AF. This review focuses on the worldwide burden of AF and reviews global health strategies focused on improving detection, prevention and risk stratification of AF, recently recommended by the World Heart Federation
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