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Threshold Regression

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https://www.readbyqxmd.com/read/29143393/an-algorithm-to-detect-unexpected-increases-in-frequency-of-reports-of-adverse-events-in-eudravigilance
#1
Luis C Pinheiro, Gianmario Candore, Cosimo Zaccaria, Jim Slattery, Peter Arlett
PURPOSE: The European Medicines Agency developed an algorithm to detect unexpected increases in frequency of reports, to enhance the ability to detect adverse events that manifest as increases in frequency, in particular quality defects, medication errors, and cases of abuse or misuse. METHODS: An algorithm based on a negative binomial time-series regression model run on 6 sequential observations prior to the monitored period was developed to forecast monthly counts of reports...
November 16, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29143275/increasing-time-to-postoperative-stereotactic-radiation-therapy-for-patients-with-resected-brain-metastases-investigating-clinical-outcomes-and-identifying-predictors-associated-with-time-to-initiation
#2
Mehran B Yusuf, Mark J Amsbaugh, Eric Burton, Megan Nelson, Brian Williams, Maria Koutourousiou, Haring Nauta, Shiao Woo
We sought to determine the impact of time to initiation (TTI) of post-operative radiosurgery on clinical outcomes for patients with resected brain metastases and to identify predictors associated with TTI. All patients with resected brain metastases treated with postoperative SRS or fractionated stereotactic radiation therapy (fSRT) from 2012 to 2016 at a single institution were reviewed. TTI was defined as the interval from resection to first day of radiosurgery. Receiver operating characteristic (ROC) curves were used to identify an optimal threshold for TTI with respect to local failure (LF)...
November 15, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29143130/two-threshold-levels-of-vitamin-d-and-the-prevalence-of-comorbidities-in-outpatients-of-a-tertiary-hospital
#3
I N Furuie, M J J Mauro, S Petruzziello, S C Riechi, R R Petterle, C L Boguszewski, V Z C Borba
This study evaluated the number of comorbidities between two normal values of 25OHD in outpatients during 1 year of 25OHD measurements. Five hundred twenty-nine outpatients were included, patients with 25OHD ≥ 20 and < 30 ng/mL had the higher number of comorbidities, suggesting that for this specific population, 25OHD ≥ 30 ng/mL would be more appropriate. INTRODUCTION : This study evaluated the comorbidities between two values of 25OHD in outpatients of a tertiary hospital. METHODS: This is a cross-sectional study with measures of 25OHD in 1-year period, excluding 25OHD < 20 and > 50 ng/mL, clinical research participants, and liver disease and chronic renal failure patients...
November 15, 2017: Osteoporosis International
https://www.readbyqxmd.com/read/29143088/the-association-of-preoperative-hematocrit-and-transfusion-with-mortality-in-patients-undergoing-elective-non-cardiac-surgery
#4
Rodney A Gabriel, Anthony I Clark, Albert P Nguyen, Ruth S Waterman, Ulrich H Schmidt
BACKGROUND: Patients with anemia frequently undergo surgery, as it is unclear at what threshold clinicians should consider delaying surgery for preoperative anemia optimization. The primary objective of this study was to determine whether there is an association of varying degrees of anemia and transfusion with 30-day mortality. METHODS: This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2013...
November 15, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29139149/under-recognized-entity-of-the-transient-rise-in-the-atrial-capture-threshold-early-after-dual-chamber-pacemaker-implantation
#5
Yoshiko Uehara, Kentaro Yoshida, Akira Kimata, Kojiro Ogawa, Daisuke Abe, Yasuaki Tsumagari, Hidekazu Tsuneoka, Yoshiaki Yui, Yoko Ito, Mari Ebine, Noriyuki Takeyasu, Kazutaka Aonuma, Akihiko Nogami
BACKGROUND: Steroid-eluting pacemaker leads suppress acute rises in pacing threshold by preventing inflammatory processes. However, we occasionally encounter not persistent but transient rise in the atrial capture threshold (TRACT) early after pacemaker implantation. We believe that this phenomenon is under-recognized in clinical practice and may potentially lead to unnecessary re-intervention. We aimed to clarify the prevalence, predictors, and possible mechanisms of TRACT. METHODS AND RESULTS: We reviewed clinical records from 239 consecutive patients who underwent dual-chamber pacemaker implantation for sick sinus syndrome (SSS) (N = 102) or atrioventricular block (AVB) (N = 137)...
November 15, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29139015/defining-the-optimal-midline-shift-threshold-to-predict-poor-outcome-in-patients-with-supratentorial-spontaneous-intracerebral-hemorrhage
#6
Wen-Song Yang, Qi Li, Rui Li, Qing-Jun Liu, Xing-Chen Wang, Li-Bo Zhao, Peng Xie
BACKGROUND: Midline shift (MLS) has been associated with unfavorable outcome in patients with intracerebral hemorrhage (ICH). However, the optimal criteria to define the MLS measurements that indicate future outcome in ICH patients are absent, and the quantitative threshold of MLS that differentiates favorable and poor clinical outcome should be further explored. METHODS: We enrolled patients with ICH who underwent admission computed tomography (CT) within 6 h after onset of symptoms...
November 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29137197/effect-of-age-on-glasgow-coma-scale-in-patients-with-moderate-and-severe-traumatic-brain-injury-an-approach-with-propensity-score-matched-population
#7
Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Pao-Jen Kuo, Ching-Hua Hsieh
Background: The most widely used methods of describing traumatic brain injury (TBI) are the Glasgow Coma Scale (GCS) and the Abbreviated Injury Scale (AIS). Recent evidence suggests that presenting GCS in older patients may be higher than that in younger patients for an equivalent anatomical severity of TBI. This study aimed to assess these observations with a propensity-score matching approach using the data from Trauma Registry System in a Level I trauma center. Methods: We included all adult patients (aged ≥20 years old) with moderate to severe TBI from 1 January 2009 to 31 December 2016...
November 13, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29136449/does-this-patient-have-acute-mountain-sickness-the-rational-clinical-examination-systematic-review
#8
David Meier, Tinh-Hai Collet, Isabella Locatelli, Jacques Cornuz, Bengt Kayser, David L Simel, Claudio Sartori
Importance: Acute mountain sickness (AMS) affects more than 25% of individuals ascending to 3500 m (11 500 ft) and more than 50% of those above 6000 m (19 700 ft). AMS may progress from nonspecific symptoms to life-threatening high-altitude cerebral edema in less than 1% of patients. It is not clear how to best diagnose AMS. Objective: To systematically review studies assessing the accuracy of AMS diagnostic instruments, including the visual analog scale (VAS) score, which quantifies the overall feeling of sickness at altitude (VAS[O]; various thresholds), Acute Mountain Sickness-Cerebral score (AMS-C; ≥0...
November 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29136089/nutritional-status-during-inpatient-alcohol-detoxification
#9
Marie-Astrid Gautron, Frank Questel, Michel Lejoyeux, Frank Bellivier, Florence Vorspan
Aims: As low rates of thiamine are thought to be implicated in alcohol-related cognitive disorders, we wanted to assess patients with alcohol use disorders (AUD) during detoxification for their nutritional status and test if vitamins blood levels were associated with a surrogate of cognitive impairment. Methods: We performed a retrospective chart review of medical records of 94 consecutive patients hospitalized for alcohol detoxification in a specialized addiction medicine department...
November 9, 2017: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
https://www.readbyqxmd.com/read/29136086/intraoperative-oliguria-predicts-acute-kidney-injury-after-major-abdominal-surgery
#10
T Mizota, Y Yamamoto, M Hamada, S Matsukawa, S Shimizu, S Kai
Background: The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI. Methods: Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital...
October 9, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29136014/treatment-guidelines-and-early-loss-from-care-for-people-living-with-hiv-in-cape-town-south-africa-a-retrospective-cohort-study
#11
Ingrid T Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R Bangsberg, Linda-Gail Bekker, Catherine Orrell
BACKGROUND: South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl...
November 2017: PLoS Medicine
https://www.readbyqxmd.com/read/29135663/serum-fructosamine-a-simple-and-inexpensive-test-for-assessing-preoperative-glycemic-control
#12
Noam Shohat, Majd Tarabichi, Eric H Tischler, Serge Jabbour, Javad Parvizi
BACKGROUND: Although the medical community acknowledges the importance of preoperative glycemic control, the literature is inconclusive and the proper metric for assessment of glycemic control remains unclear. Serum fructosamine reflects the mean glycemic control in a shorter time period compared with glycated hemoglobin (HbA1c). Our aim was to examine its role in predicting adverse outcomes following total joint arthroplasty. METHODS: Between 2012 and 2013, we screened all patients undergoing total joint arthroplasty preoperatively using serum HbA1c, fructosamine, and blood glucose levels...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29135535/blood-glucose-concentrations-in-prehospital-trauma-patients-with-traumatic-shock-a-retrospective-analysis
#13
Janett Kreutziger, Wolfgang Lederer, Stefan Schmid, Hanno Ulmer, Volker Wenzel, Maarten W Nijsten, Daniel Werner, Thomas Schlechtriemen
BACKGROUND: Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. OBJECTIVES: The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone...
November 11, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29134489/the-quick-loss-of-carbapenem-susceptibility-in-pseudomonas-aeruginosa-at-intensive-care-units
#14
Yamin Zou, Jiangping Lian, Ying Di, Haisheng You, Hongping Yao, Junhui Liu, Yalin Dong
Background Patients colonized with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) strains upon admission to the intensive care unit (ICU) tend to be quickly followed by detected carbapenem-resistant P. aeruginosa strains after admission. Objective To assess the risk factors associated with the quick loss of carbapenem susceptibility and to identify time threshold of prior antimicrobial exposure for the loss during ICU stay. Setting A tertiary-care teaching hospital with 2560 beds located in the northwest region of China...
November 14, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29132699/is-endocan-a-diagnostic-marker-for-pneumonia-after-cardiac-surgery-the-endolung-study
#15
Andréa Perrotti, Camille Chenevier-Gobeaux, Fiona Ecarnot, Karine Bardonnet, Benoit Barrucand, Guillaume Flicoteaux, Philippe Lassalle, Sidney Chocron
BACKGROUND: Postoperative pneumonia is frequent after cardiac surgery and is associated with increased morbidity and mortality. We tested the hypothesis that endocan is an early biomarker for the detection of pneumonia after cardiac surgery. METHODS: Between January and May 2016, 155 patients scheduled to undergo elective cardiac surgery with cardiopulmonary bypass were prospectively included in the study. Serum level of endocan was measured at five timepoints (preoperative, and at 6, 24, 48, and 72 hours after the end of surgery)...
November 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29132624/the-value-of-ehr-based-assessment-of-physician-competency-an-investigative-effort-with-internal-medicine-physicians
#16
Kimberly Venta, Erin Baker, Cali Fidopiastis, Kay Stanney
OBJECTIVE: The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency. METHODS: The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29129762/risk-factors-for-the-rupture-of-intracranial-aneurysms-using-ct-angiography
#17
Guang-Xian Wang, Li Wen, Liu Yang, Qi-Chuang Zhang, Jin-Bo Yin, Chun-Mei Duan, Dong Zhang
PURPOSE: To study the clinical and morphological characteristics associated with risk factors for the rupture of intracranial aneurysms (IAs). METHODS: A total of 1115 consecutive patients with 1282 IAs were reviewed from August 2011 to February 2016. The patients and IAs were divided into ruptured and unruptured groups. Based on the clinical and morphologic findings, the risk factors for IA rupture were assessed using statistical methods. RESULTS: Age, hypertension, diabetes mellitus and cerebral atherosclerosis were associated with ruptured IAs...
November 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29129186/an-exploration-of-mortality-risk-factors-in-non-severe-pneumonia-in-children-using-clinical-data-from-kenya
#18
Timothy Tuti, Ambrose Agweyu, Paul Mwaniki, Niels Peek, Mike English
BACKGROUND: Childhood pneumonia is the leading infectious cause of mortality in children younger than 5 years old. Recent updates to World Health Organization pneumonia guidelines recommend outpatient care for a population of children previously classified as high risk. This revision has been challenged by policymakers in Africa, where mortality related to pneumonia is higher than in other regions and often complicated by comorbidities. This study aimed to identify factors that best discriminate inpatient mortality risk in non-severe pneumonia and explore whether these factors offer any added benefit over the current criteria used to identify children with pneumonia requiring inpatient care...
November 13, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29126915/steps-moderate-to-vigorous-physical-activity-and-cardiometabolic-profiles
#19
Samantha Hajna, Nancy A Ross, Kaberi Dasgupta
The relative benefits of meeting the current moderate-to-vigorous intensity physical activity (MVPA) and 'active' step count recommendations are unknown. Using robust linear regressions, we compared cardiometabolic marker differences (blood pressure, lipid levels, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), hemoglobin A1C, C-reactive protein (CRP), and body mass index (BMI)) across MVPA (150min/week) and step (10,000 steps/day) thresholds and between step categories (low active: 5000 to 7499, somewhat active: 7500 to 9999, and active: ≥10,000 steps/day vs...
November 7, 2017: Preventive Medicine
https://www.readbyqxmd.com/read/29122321/each-procedure-matters-threshold-for-surgeon-volume-to-minimize-complications-and-decrease-cost-associated-with-adrenalectomy
#20
Kevin L Anderson, Samantha M Thomas, Mohamed A Adam, Lauren N Pontius, Michael T Stang, Randall P Scheri, Sanziana A Roman, Julie A Sosa
BACKGROUND: An association has been suggested between increasing surgeon volume and improved patient outcomes, but a threshold has not been defined for what constitutes a "high-volume" adrenal surgeon. METHODS: Adult patients who underwent adrenalectomy by an identifiable surgeon between 1998-2009 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. Logistic regression modeling with restricted cubic splines was utilized to estimate the association between annual surgeon volume and complication rates in order to identify a volume threshold...
November 6, 2017: Surgery
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