Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This ...Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.展开更多
Publication biases and collection limitations are the main disadvantages of a traditional meta-analysis based on aggregate patient data（APD）from published articles.Individual patient data（IPD）meta-analysis,as the ...Publication biases and collection limitations are the main disadvantages of a traditional meta-analysis based on aggregate patient data（APD）from published articles.Individual patient data（IPD）meta-analysis,as the gold standard of systematic review,is a possible alternative in this context.However,the publications relative to IPD meta-analyses are still rare compared with the traditional ones,especially in the research oriented to Chinese medicine（CM）.In this article,the strengths and detailed functioning of IPD meta-analysis are described.Furthermore,the need for IPD meta-analysis to assess the treatments based on CM was also discussed.Compared with the traditional APD meta-analysis,the IPD meta-analysis might give a more accurate and unbiased assessment and is worth to be recommended to CM researchers.展开更多
BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 ...BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 and 385 patients,respectively),but their results are discordant.AIM To synthetize the available evidence on the effectiveness of lutetium in pre-treated metastatic castration-resistant prostate cancer;and to test the application of a new artificial intelligence technique that synthetizes effectiveness based on reconstructed patient-level data.METHODS We employed a new artificial intelligence method(shiny method)to pool the survival data of these two trials and evaluate to what extent the lutetium cohorts differed from one another.The shiny technique employs an original reconstruction of individual patient data from the Kaplan-Meier curves.The progression-free survival graphs of the two lutetium cohorts were analyzed and compared.RESULTS The hazard ratio estimated was in favor of the vision trial;the difference was statistically significant(P<0.001).These results indicate that further studies on lutetium are needed because the survival data of the two trials published thus far are conflicting.CONCLUSION Our study confirms the feasibility of reconstructing patient-level data from survival graphs in order to generate a survival statistics.展开更多
Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to...Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinical research progress.In response,our research team has embarked on the development of a specialized clinical research database for cardiology,thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors.Methods The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021.It included comprehensive data on patients'basic information,medical history,non-invasive imaging studies,laboratory test results,as well as peri-procedural information related to interventional surgeries,extracted from the Hospital Information System.Additionally,an innovative artificial intelligence(AI)-powered interactive follow-up system had been developed,ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up,thereby achieving comprehensive data management throughout the entire care continuum for highrisk patients.Results This database integrates extensive cross-sectional and longitudinal patient data,with a focus on higher-risk acute coronary syndrome patients.It achieves the integration of structured and unstructured clinical data,while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency.It creates a comprehensive patient view,thereby improving diagnostic and follow-up quality,and provides high-quality data to support clinical research.Despite limitations in unstructured data standardization and biological sample integrity,the database's development is accompanied by ongoing optimization efforts.Conclusion The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research,which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes.It supports clinical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.展开更多
Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive u...Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.展开更多
患者生成型健康数据(patient-generated health data,PGHD)在急危重症早期识别与风险预警中扮演核心角色,但传统监测技术存在采集指标单一、精度不稳定等局限性,难以应对急危重症患者复杂、动态、多维度的监测需求。护理新材料凭借高灵...患者生成型健康数据(patient-generated health data,PGHD)在急危重症早期识别与风险预警中扮演核心角色,但传统监测技术存在采集指标单一、精度不稳定等局限性,难以应对急危重症患者复杂、动态、多维度的监测需求。护理新材料凭借高灵敏度、可穿戴性与智能响应特性,为PGHD的连续获取与实时分析提供新途径。该文综述了护理新材料在围手术期急症监测、慢性疾病急性加重识别及肿瘤急症预警中的应用进展,重点分析其在监测精度、灵敏度及与数字技术协同的机制,评估其在临床适应性、多源数据价值转化、患者数据主权保障等方面的现实挑战,探讨护理新材料由被动响应向智能预警转型的新思路,为急危重症护理监测的精准化、智能化研究提供参考。展开更多
There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this i...There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.展开更多
Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemeti...Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.展开更多
Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital sig...Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital signs information such as heart rate and blood pressure to identify critically injured patients eventually replaced by heartrate complexity (HRC) analysis to the electrocardiogram (ECG) of patients in trauma centers. In this respect, different nonlinear analysis tools such as;power spectra, entropy, fractal dimension, auto-correlation function and auto-correlation have been adapted for this complexity analysis of ECG signal. Reidbord and Redington [1] were one of the early reports on applications of nonlinear analysis of the heart physiology. Moody and his colleagues could confidently predicted survival in heart failure cases by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics [2]. Further studies were reported in cases of arrhythmia or general anesthesia by Pomfrett [3], Fortrat [4], Lass [5] and references therein. Recently, noteworthy works of Batchinsky and coworkers have shown that prehospital loss of RRI complexity is associated with mortality in trauma patients [6-8]. They have also shown that prediction of trauma survival by analysis of heart rate complexity is even possible by reducing data set size from 800-beat to 200 or lower beat data sets. In this article, we will use different data nonlinear analysis tools such as;power spectrum, entropy, Lyapunov exponent, capacity dimension and correlation function to analyze HRC as a sensitive indictor of physiologic deterioration. In these analyses, we will use real data of 270-beat sections of ECG from 45 emergency patients brought to Shiraz Rejaee Hospetal trauma center prior to any medication. As we can see, using some manipulation on raw data will provide more informative vital signs in our nonlinear analyses.展开更多
Although pediatric cancer survival rates have improved, cancer is still the leading cause of death by disease among children in the United States. With nearly 16,000 new diagnoses each year of children having an avera...Although pediatric cancer survival rates have improved, cancer is still the leading cause of death by disease among children in the United States. With nearly 16,000 new diagnoses each year of children having an average age of six years old, there is still much to be done to improve survival rates among children diagnosed with cancer. Additionally, clinical outcomes can be greatly improved by first understanding the patient perspective and, consequently, there is a need to understand the pediatric cancer patient experience. Interest in the analysis of patient-reported outcome (PRO) measures, including those specific to patient experience, has grown in recent years as attempts are made to understand and assess latent (</span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;">, unobserved) traits such as quality of life. While most traditional PRO measures involve lengthy and costly surveys that are limited in scope, posts on social media platforms are frequently lauded as more authentic, unbiased measures of patient experience. While many previous studies have utilized Twitter as a source for patient experience data that is not easily captured by traditional PROs, very few studies have examined the use of Twitter data to explore and better understand the experience of pediatric cancer patients specifically. Lexicon-based sentiment analysis of Twitter data was used both to examine the pediatric cancer patient experience as well as to compare the attitudes, perceptions, and overall impressions of individuals with St. Jude experiences to those with more general experiences. Results indicated that patients reflected on their care with more relative negativity when speaking of experiences other than St. Jude. While there were some notable differences between the two comparison groups, the sentiment of both was still mostly positive. Pediatric oncology differs greatly from adult oncological care and, thus, the proposed use of sentiment analysis with patient social media posts serving as authentic PRO data likely differentiates more between medical providers and clinical care settings when assessing adult patient experience. Despite limitations, this exploratory study suggests that Twitter can be utilized as a source for authentic, real-time patient experience data that will improve overall care and better clinical outcomes, even among the pediatric cancer patient population.展开更多
Objective: With the goal of improving health-related quality of life (HRQOL) in cancer patients, we previously reported a structural equation model (SEM) of subjected QOL and qualifications of pharmacists, based on a ...Objective: With the goal of improving health-related quality of life (HRQOL) in cancer patients, we previously reported a structural equation model (SEM) of subjected QOL and qualifications of pharmacists, based on a series of questionnaires completed by patients and pharmacists. However, several patients and pharmacists were excluded from the previous study because it was not always possible to obtain all the data intended for collection. In order to reveal the effect of missing data on the SEM, we established SEMs of HRQOL and the competency of pharmacists, using correlation matrices derived by two different statistical methods for handling missing data. Method: Fifteen cancer patients hospitalized for cancer and were receiving opioid analgesics for pain control, and eight pharmacists were enrolled in this study. Each subject was asked four times weekly to answer questions presented in a questionnaire. SEMs were explored using two correlation matrices derived with pair-wise deletion (PD matrix) and list-wise deletion (LD matrix). The final models were statistically evaluated with certain goodness-of-fit criteria. Results: Data were intended to be collected four times weekly for each patient, but there were some missing values. The same SEMs for HRQOL were optimized using both the LD and PD matrices. Although the path diagrams of the SEMs were not identical in the “competency of pharmacists,” the two models suggested that a higher competency of a pharmacist lowered the “severity” of condition and increased the “comfort” of patients, resulting in an increase in the subjected QOL. Conclusion: In collecting data for clinical research, missing values are unavoidable. When the structure of the model was robust enough, the missing data had a minor effect on our SEM of QOL. In QOL research, the LD matrix as well as the PD matrix would be effective, provided the model is sufficiently robust.展开更多
Advances in Information Technology (IT) have enhanced our ability to gather, collect and analyze information from individuals and specific groups of people online. The emergence of online networks has facilitated conn...Advances in Information Technology (IT) have enhanced our ability to gather, collect and analyze information from individuals and specific groups of people online. The emergence of online networks has facilitated connections between individuals by leveraging data exchange in a variety of fields. Online networking in life sciences transforms data collection into actionable information that will improve individual and population health, deliver effective therapies and, consequently, reduce the cost of healthcare. These novel tools might also have a direct impact in personalized medicine programs, since the adoption of new products by health care professionals in life sciences and peer-to-peer learning could be improved using social networks and big data analytics. However, one of the main concerns of information exchange online is data privacy. In this article, we will review how online networks and big data analytics are impacting the life sciences sector.展开更多
Purpose: This research aims to evaluate the potential threats to patient privacy and confidentiality posed by mHealth applications on mobile devices. Methodology: A comprehensive literature review was conducted, selec...Purpose: This research aims to evaluate the potential threats to patient privacy and confidentiality posed by mHealth applications on mobile devices. Methodology: A comprehensive literature review was conducted, selecting eighty-eight articles published over the past fifteen years. The study assessed data gathering and storage practices, regulatory adherence, legal structures, consent procedures, user education, and strategies to mitigate risks. Results: The findings reveal significant advancements in technologies designed to safeguard privacy and facilitate the widespread use of mHealth apps. However, persistent ethical issues related to privacy remain largely unchanged despite these technological strides.展开更多
基金Beijing Hospitals Authority’s Ascent Plan(DFL20220702)National Natural Science Foundation of China(82101398).
文摘Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.
基金Supported by the Fundamental Research Funds for the CentralPublic Welfare Research Institutes of China(No.ZZ070818 andZ0259)National Natural Science Foundation of China(No.81072920 and 81303149)
文摘Publication biases and collection limitations are the main disadvantages of a traditional meta-analysis based on aggregate patient data（APD）from published articles.Individual patient data（IPD）meta-analysis,as the gold standard of systematic review,is a possible alternative in this context.However,the publications relative to IPD meta-analyses are still rare compared with the traditional ones,especially in the research oriented to Chinese medicine（CM）.In this article,the strengths and detailed functioning of IPD meta-analysis are described.Furthermore,the need for IPD meta-analysis to assess the treatments based on CM was also discussed.Compared with the traditional APD meta-analysis,the IPD meta-analysis might give a more accurate and unbiased assessment and is worth to be recommended to CM researchers.
文摘BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 and 385 patients,respectively),but their results are discordant.AIM To synthetize the available evidence on the effectiveness of lutetium in pre-treated metastatic castration-resistant prostate cancer;and to test the application of a new artificial intelligence technique that synthetizes effectiveness based on reconstructed patient-level data.METHODS We employed a new artificial intelligence method(shiny method)to pool the survival data of these two trials and evaluate to what extent the lutetium cohorts differed from one another.The shiny technique employs an original reconstruction of individual patient data from the Kaplan-Meier curves.The progression-free survival graphs of the two lutetium cohorts were analyzed and compared.RESULTS The hazard ratio estimated was in favor of the vision trial;the difference was statistically significant(P<0.001).These results indicate that further studies on lutetium are needed because the survival data of the two trials published thus far are conflicting.CONCLUSION Our study confirms the feasibility of reconstructing patient-level data from survival graphs in order to generate a survival statistics.
基金Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0503906)。
文摘Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinical research progress.In response,our research team has embarked on the development of a specialized clinical research database for cardiology,thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors.Methods The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021.It included comprehensive data on patients'basic information,medical history,non-invasive imaging studies,laboratory test results,as well as peri-procedural information related to interventional surgeries,extracted from the Hospital Information System.Additionally,an innovative artificial intelligence(AI)-powered interactive follow-up system had been developed,ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up,thereby achieving comprehensive data management throughout the entire care continuum for highrisk patients.Results This database integrates extensive cross-sectional and longitudinal patient data,with a focus on higher-risk acute coronary syndrome patients.It achieves the integration of structured and unstructured clinical data,while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency.It creates a comprehensive patient view,thereby improving diagnostic and follow-up quality,and provides high-quality data to support clinical research.Despite limitations in unstructured data standardization and biological sample integrity,the database's development is accompanied by ongoing optimization efforts.Conclusion The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research,which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes.It supports clinical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.
文摘Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.
文摘患者生成型健康数据(patient-generated health data,PGHD)在急危重症早期识别与风险预警中扮演核心角色,但传统监测技术存在采集指标单一、精度不稳定等局限性,难以应对急危重症患者复杂、动态、多维度的监测需求。护理新材料凭借高灵敏度、可穿戴性与智能响应特性,为PGHD的连续获取与实时分析提供新途径。该文综述了护理新材料在围手术期急症监测、慢性疾病急性加重识别及肿瘤急症预警中的应用进展,重点分析其在监测精度、灵敏度及与数字技术协同的机制,评估其在临床适应性、多源数据价值转化、患者数据主权保障等方面的现实挑战,探讨护理新材料由被动响应向智能预警转型的新思路,为急危重症护理监测的精准化、智能化研究提供参考。
文摘There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.
文摘Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.
文摘Recently, nonlinear analysis of R-to-R interval (RRI) in heart rate has brought research attention in medicine to improve predictive accuracy of medication in severely injured patients. It seems conventional vital signs information such as heart rate and blood pressure to identify critically injured patients eventually replaced by heartrate complexity (HRC) analysis to the electrocardiogram (ECG) of patients in trauma centers. In this respect, different nonlinear analysis tools such as;power spectra, entropy, fractal dimension, auto-correlation function and auto-correlation have been adapted for this complexity analysis of ECG signal. Reidbord and Redington [1] were one of the early reports on applications of nonlinear analysis of the heart physiology. Moody and his colleagues could confidently predicted survival in heart failure cases by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics [2]. Further studies were reported in cases of arrhythmia or general anesthesia by Pomfrett [3], Fortrat [4], Lass [5] and references therein. Recently, noteworthy works of Batchinsky and coworkers have shown that prehospital loss of RRI complexity is associated with mortality in trauma patients [6-8]. They have also shown that prediction of trauma survival by analysis of heart rate complexity is even possible by reducing data set size from 800-beat to 200 or lower beat data sets. In this article, we will use different data nonlinear analysis tools such as;power spectrum, entropy, Lyapunov exponent, capacity dimension and correlation function to analyze HRC as a sensitive indictor of physiologic deterioration. In these analyses, we will use real data of 270-beat sections of ECG from 45 emergency patients brought to Shiraz Rejaee Hospetal trauma center prior to any medication. As we can see, using some manipulation on raw data will provide more informative vital signs in our nonlinear analyses.
文摘Although pediatric cancer survival rates have improved, cancer is still the leading cause of death by disease among children in the United States. With nearly 16,000 new diagnoses each year of children having an average age of six years old, there is still much to be done to improve survival rates among children diagnosed with cancer. Additionally, clinical outcomes can be greatly improved by first understanding the patient perspective and, consequently, there is a need to understand the pediatric cancer patient experience. Interest in the analysis of patient-reported outcome (PRO) measures, including those specific to patient experience, has grown in recent years as attempts are made to understand and assess latent (</span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;">, unobserved) traits such as quality of life. While most traditional PRO measures involve lengthy and costly surveys that are limited in scope, posts on social media platforms are frequently lauded as more authentic, unbiased measures of patient experience. While many previous studies have utilized Twitter as a source for patient experience data that is not easily captured by traditional PROs, very few studies have examined the use of Twitter data to explore and better understand the experience of pediatric cancer patients specifically. Lexicon-based sentiment analysis of Twitter data was used both to examine the pediatric cancer patient experience as well as to compare the attitudes, perceptions, and overall impressions of individuals with St. Jude experiences to those with more general experiences. Results indicated that patients reflected on their care with more relative negativity when speaking of experiences other than St. Jude. While there were some notable differences between the two comparison groups, the sentiment of both was still mostly positive. Pediatric oncology differs greatly from adult oncological care and, thus, the proposed use of sentiment analysis with patient social media posts serving as authentic PRO data likely differentiates more between medical providers and clinical care settings when assessing adult patient experience. Despite limitations, this exploratory study suggests that Twitter can be utilized as a source for authentic, real-time patient experience data that will improve overall care and better clinical outcomes, even among the pediatric cancer patient population.
文摘Objective: With the goal of improving health-related quality of life (HRQOL) in cancer patients, we previously reported a structural equation model (SEM) of subjected QOL and qualifications of pharmacists, based on a series of questionnaires completed by patients and pharmacists. However, several patients and pharmacists were excluded from the previous study because it was not always possible to obtain all the data intended for collection. In order to reveal the effect of missing data on the SEM, we established SEMs of HRQOL and the competency of pharmacists, using correlation matrices derived by two different statistical methods for handling missing data. Method: Fifteen cancer patients hospitalized for cancer and were receiving opioid analgesics for pain control, and eight pharmacists were enrolled in this study. Each subject was asked four times weekly to answer questions presented in a questionnaire. SEMs were explored using two correlation matrices derived with pair-wise deletion (PD matrix) and list-wise deletion (LD matrix). The final models were statistically evaluated with certain goodness-of-fit criteria. Results: Data were intended to be collected four times weekly for each patient, but there were some missing values. The same SEMs for HRQOL were optimized using both the LD and PD matrices. Although the path diagrams of the SEMs were not identical in the “competency of pharmacists,” the two models suggested that a higher competency of a pharmacist lowered the “severity” of condition and increased the “comfort” of patients, resulting in an increase in the subjected QOL. Conclusion: In collecting data for clinical research, missing values are unavoidable. When the structure of the model was robust enough, the missing data had a minor effect on our SEM of QOL. In QOL research, the LD matrix as well as the PD matrix would be effective, provided the model is sufficiently robust.
文摘Advances in Information Technology (IT) have enhanced our ability to gather, collect and analyze information from individuals and specific groups of people online. The emergence of online networks has facilitated connections between individuals by leveraging data exchange in a variety of fields. Online networking in life sciences transforms data collection into actionable information that will improve individual and population health, deliver effective therapies and, consequently, reduce the cost of healthcare. These novel tools might also have a direct impact in personalized medicine programs, since the adoption of new products by health care professionals in life sciences and peer-to-peer learning could be improved using social networks and big data analytics. However, one of the main concerns of information exchange online is data privacy. In this article, we will review how online networks and big data analytics are impacting the life sciences sector.
文摘Purpose: This research aims to evaluate the potential threats to patient privacy and confidentiality posed by mHealth applications on mobile devices. Methodology: A comprehensive literature review was conducted, selecting eighty-eight articles published over the past fifteen years. The study assessed data gathering and storage practices, regulatory adherence, legal structures, consent procedures, user education, and strategies to mitigate risks. Results: The findings reveal significant advancements in technologies designed to safeguard privacy and facilitate the widespread use of mHealth apps. However, persistent ethical issues related to privacy remain largely unchanged despite these technological strides.
