1,721,174 research outputs found
Tips for calculating and displaying risk-standardized hospital outcomes in Stata
No full textA major challenge of outcomes research is measuring hospital performance using readily available administrative data. When the outcome measure is mortality or morbidity, rates are adjusted to account for preexisting conditions that may confound their assessment. However, the concept of risk-adjusted outcomes is frequently misunderstood. In this article, we try to clarify things, and we describe Stata tools for appropriately calculating and displaying risk-standardized outcome measures. We offer practical guidance and illustrate the application of these tools to an example based on real data (30-day mortality following acute myocardial infarction in Latvia)
Deaths, Countermeasures, and Obedience: How Countries' Non-pharmaceutical Measures Have Quelled the COVID-19 Death Toll
Full text linkThe Role of Cardiologists in the Management of Patients with Heart Failure
No full textHeart failure is a complex clinical syndrome with a remarkable impact on health care systems in terms of patients' morbidity and mortality, as well as direct and indirect costs. It is essential to redesign models of care for patients with heart failure that are tailored on personalized health care needs and carried out in the most appropriate setting. There is some debate about the role of cardiologists in the management of patients with heart failure. Indeed, results regarding the inclination of cardiologists' patients to achieve better outcomes are controversial, given the heterogeneity of studies in terms of study design, population, setting and variables considered. The aim of this chapter is to describe and synthesize the current state of knowledge about the role of specialists in the management of patient with heart failure, and to assess whether there is a type of patients for which cardiologists demonstrate the greatest value or a setting of care where they add more benefit
Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy
Full text linkTo assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy
Pseudo-aneurysm of a lumbar artery after flexion-distraction injury of the thoraco-lumbar spine and surgical realignment: rupture treated by endovascular embolization
No full textA unique case of pseudo-aneurysm of a lumbar artery after injury of the thoracolumbar spine was presented. Injury of a lumbar artery represents a potential cause of massive, life-threatening, retroperitoneal bleeding. It may be associated with lesions of the abdomen, lower limbs, pelvic bones, and spinal column. Fracture of a transverse process may be responsible for direct laceration of a lumbar artery, but formation of a pseudo-aneurysm is an uncommon event. The diagnosis is difficult and often delayed. The treatment of choice is endovascular embolization.
In a patient who had a posttraumatic severe thoracolumbar vertebral dislocation with complete spinal cord lesion after road accident, we performed surgical reduction and stabilization via posterior approach. After 7 days, he developed a progressive anemia due to retroperitoneal hemorrhage and formation of a pseudo-aneurysm of the lumbar artery at L1 level.
Endovascular embolization achieved resolution of the pseudo-aneurysm, regression of the hematoma and progressive recovery of the patient during a period of 6 months.
Pseudo-aneurysm of a lumbar artery has never previously been described in association with flexion-distraction type vertebral fracture, in which the spinal column is subjected to greater, shear-type, forces. Stretching of the arterial wall due to the traumatic dislocation of the spine and subsequent surgical realignment may be considered as the mechanism of formation and rupture of the pseudo-aneurysm. Dangerous bleeding in the retroperitoneal space and in the operative field can be effectively managed by endovascular intervention
Postoperative spondylodiscitis from Aspergillus fumigatus in immunocompetent subjects
No full textAbstract
The authors describe a case of spondylodiscitis from Aspergillus fumigatus which occurred subsequent to surgery for lumbar disc herniation in a non-immunodepressed patient. The results obtained by combined medical and surgical treatment are discussed
Diagnostic Technology: Trends of Use and Availability in a 10-Year Period (2011–2020) among Sixteen OECD Countries
Full text linkBackground. Overuse of imaging results in cost increases, with little to no benefit to patients. The purpose of this study is to evaluate imaging tests and radiology equipment over a ten-year period in 16 Organisation for Economic Co-operation and Development (OECD) countries. Methods. Twelve countries were included in a time-trend analysis based on OECD indicators on diagnostic imaging (computer tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]). These annual indicators included the number of exams per 1000 population, the number of devices per million population, and the number of exams per device. Average annual percent change was used to measure country-specific trends. Results. Most countries saw a rise in the exam-to-scanner ratio for CT, MRI, and PET, demonstrating a faster increase in exam volume than device volume. Italy exhibited an increase in CT, MRI, and PET equipment units during the same period, but not in exams, most likely due to a reduction in medical procedures during the pandemic. Only in Luxemburg, CT and PET examinations increased despite a reduction in scanners. Conclusions. Considering the expected increasing demand for diagnostics due to the evolving needs of the population, proper governance and resource allocation are necessary requirements for cost-efficient health systems
Diagnostic technology: trends of use and disponibility in the last decade among sixteen OECD countries
No full textBackground: Appropriate use of medical technologies affects several aspects of clinical practice. Besides the analytical validity, examinations’ clinical usefulness and validity allegedly lead to better outcomes. Further, a reasonable ethical and economic approach contributes to improving healthcare delivery. Conversely, imaging overuse and low-value care dramatically drive up costs with scarce or no benefit for patients. The current research aims to assess a trend over a 10-year timeframe on the proportion between imaging tests and radiology devices in 16 countries belonging to the Organisation for Economic Co-operation and Development (OECD). Methods: A time-trend analysis based on OECD indicators on diagnostic imaging (Computer Tomography _ CT, Magnetic resonance imaging _ MRI, and Positron emission tomography _ PET) involved 12 European countries and four overseas countries. OECD indicators were annual number of exams per 1000 population, annual number of devices per million population and annual number of exams per device. Country-specific trend was measured as average annual percent change. Results: The trend exam-to-scanner ratio for CT, RMI and PET grew during the study-period in most of countries (11, 13 and 12, respectively). Predominantly, it highlighted a faster rise of exams’ amount than number of devices. During the same timeframe, Italy registered an increase of CT, MRI and PET units, although exams did not. However, the contraction of medical procedures during 2020 was crucial in defining this trend. Solely in Luxemburg, CT and PET examinations increased despite the reduction of scanners, whereas for MRI a reverse trend was reported. Conclusion: According to our analysis, the exam-to-scanner ratio has grown in most of the countries involved, accounting for a raised amount of both exams and devices. Overuse is likely to be increasing worldwide, however these trends may reflect defensive medical decision making, or rather an improvement of diagnostic supply in response to a higher demand
Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review
No full textAneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery
- …
