scholarly journals Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paul Zajic ◽  
Philipp Zoidl ◽  
Marlene Deininger ◽  
Stefan Heschl ◽  
Tobias Fellinger ◽  
...  
Keyword(s):  
Heart Rhythm ◽  
Data Sets ◽  
Factors Associated ◽  
Independent Variables ◽  
Response System ◽  
Physician Decision Making ◽  
System Data ◽  
Situational Information ◽  
Signs Of Death ◽  
Physician Response

AbstractThis study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response system. Data on patients attended for cardiac arrest between January 1st, 2010 and December 31st, 2018 except babies at birth were included. Logistic regression analysis with start of CPR by physicians as the dependent variable and possible associated factors as independent variables adjusted for anonymised physician identifiers was conducted. 1525 patient data sets were analysed. Obvious signs of death were present in 278 cases; in the remaining 1247, resuscitation was attempted in 920 (74%) and were withheld in 327 (26%). Factors significantly associated with higher likelihood of CPR by physicians (OR 95% CI) were resuscitation efforts by EMS before physician arrival (60.45, 19.89–184.29), first monitored heart rhythm (3.07, 1.21–7.79 for PEA; 29.25, 1.93–442. 51 for VF / pVT compared to asystole); advanced patient age (modelled using cubic splines), physician response time (0.92, 0.87–0.97 per minute) and malignancy (0.22, 0.05–0.92) were significantly associated with lower odds of CPR. We thus conclude that prehospital physicians make decisions to start or withhold resuscitation routinely and base those mostly on situational information and immediately available patient information known to impact outcomes.

scholarly journals Segment-Based Approach for Assessing Hazard Risk of Coastal Highways in Hawai‘i

2019 ◽  
Vol 2673 (1) ◽  
pp. 83-91 ◽  
Author(s):  
Harrison Togia ◽  
Oceana P. Francis ◽  
Karl Kim ◽  
Guohui Zhang
Keyword(s):  
Qualitative Method ◽  
Data Sets ◽  
Regional Environment ◽  
The Road ◽  
Hazard Exposure ◽  
Multiple Indicators ◽  
System Data ◽  
Rural Highway ◽  
Geographic Information System Data

Hazards to roadways and travelers can be drastically different because hazards are largely dependent on the regional environment and climate. This paper describes the development of a qualitative method for assessing infrastructure importance and hazard exposure for rural highway segments in Hawai‘i under different conditions. Multiple indicators of roadway importance are considered, including traffic volume, population served, accessibility, connectivity, reliability, land use, and roadway connection to critical infrastructures, such as hospitals and police stations. The method of evaluating roadway hazards and importance can be tailored to fit different regional hazard scenarios. It assimilates data from diverse sources to estimate risks of disruption. A case study for Highway HI83 in Hawai‘i, which is exposed to multiple hazards, is conducted. Weakening of the road by coastal erosion, inundation from sea level rise, and rockfall hazards require adaptation solutions. By analyzing the risk of disruption to highway segments, adaptation approaches can be prioritized. Using readily available geographic information system data sets for the exposure and impacts of potential hazards, this method could be adapted not only for emergency management but also for planning, design, and engineering of resilient highways.

scholarly journals Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience

Perfusion ◽  
2021 ◽  
pp. 026765912199576
Author(s):  
Pasha Normahani ◽  
Ismail Yusuf Anwar ◽  
Alona Courtney ◽  
Amish Acharya ◽  
Viknesh Sounderajah ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Patency Rate ◽  
Bypass Graft ◽  
Graft Patency ◽  
Primary Patency ◽  
Rank Test ◽  
Secondary Patency ◽  
Factors Associated ◽  
Independent Variables ◽  
Secondary Patency Rate

Introduction: The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service. Methods: A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary’s Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging. Results: Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% ( n = 49/77) and the secondary patency rate was 67.5% ( n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04–5.7), p = 0.04). Conclusion: At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.

scholarly journals RISK FACTORS ASSOCIATED WITH TEMPORARY CATHETER-RELATED INFECTION IN PATIENTS ON DIALYSIS TREATMENT

2015 ◽  
Vol 24 (3) ◽  
pp. 680-685 ◽  
Author(s):  
Palmiane de Rezende Ramim Borges ◽  
João Bedendo
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Renal Failure ◽  
Dialysis Treatment ◽  
Catheter Related Infection ◽  
Hemodialysis Catheter ◽  
Factors Associated ◽  
Independent Variables ◽  
Hemodialysis Session ◽  
A Prospective Study

ABSTRACTThis study aims to identify risk factors associated with temporary hemodialysis catheter-related infection, in patients on dialysis treatment in a teaching hospital. This is a prospective study performed from November of 2012 to May of 2013, with 129 patients. Sociodemographic, clinical and biochemical data were collected from patient charts. In patients with a catheter,, 48.8% had catheter-related infection, 65% were male, 65% were 60 years of age or older, 85.3% had the catheter because they were diagnosed with acute renal failure, and 88% were hospitalized in an intensive care unit. There was a significant correlation between the independent variables and the outcome of infection. The risk factors associated with temporary hemodialysis catheter-related infection were: length of time of catheter use, the change of device, death, and complications during a hemodialysis session.

scholarly journals Factors associated with shock in children with dengue hemorrhagic fever

2016 ◽  
Vol 44 (5) ◽  
pp. 171 ◽  
Author(s):  
Erick F Kan ◽  
T H Rampengan
Keyword(s):  
Platelet Count ◽  
Abdominal Pain ◽  
Dengue Hemorrhagic Fever ◽  
Prospective Observational Study ◽  
Hemorrhagic Fever ◽  
Age Group ◽  
Hematocrit Level ◽  
Factors Associated ◽  
Independent Variables ◽  
Good Nutrition

Background Shock in dengue hemorrhagic fever (DHF) still con-stitutes an important problem in children. Predicting DHF patientswho will develop shock is difficult.Objective The aim of this study was to find out factors associatedwith shock in DHF.Methods This was a prospective observational study. Subjectswere children hospitalized from April to July 2000 who met theWHO criteria for DHF and had positive serological confirmation.Association between independent variables (age, gender, dura-tion of fever, abdominal pain, vomiting, hepatomegaly, plateletcount, hematocrit level, and nutritional status) and the dependentvariable (shock) was analyzed by logistic regression model..Results There were 85 children who met the eligibility criteriaconsisting of 50 (59%) boys and 35 (41%) girls with an averageage of 7.1 years (SD 2.88). Shock occurred in 42 (49%) children.Of the 42 children with shock, the age group of 5-9 years madeup the biggest group (57%) consisting of 23 (55%) boys and 19(45%) girls. Hepatomegaly was found in 32 (76%) children, ab-dominal pain and vomiting in 30 (71%) and 36 (86%) children,respectively, and good nutrition in 22 (52%) children. Shock oc-curred mainly on the fourth and fifth days (76%). Almost half ofthe patients (45% and 52%) had hematocrit level of 46-50% andplatelet count of 20,000-50,000/ml, respectively. By logistic re-gression analysis, it was found that duration of fever, abdominalpain, hematocrit level, and platelet count constituted indepen-dent factors correlating with shock in DHF.Conclusion Abdominal pain, fever lasting four to five days, hema-tocrit level of >46%, and platelet count of <50,000/μl were associ-ated with shock in DHF

scholarly journals Mendel’s pea crosses: varieties, traits and statistics

Hereditas ◽  
2019 ◽  
Vol 156 (1) ◽  
Author(s):  
T. H. Noel Ellis ◽  
Julie M. I. Hofer ◽  
Martin T. Swain ◽  
Peter J. van Dijk
Keyword(s):  
Statistical Analysis ◽  
Normal Distribution ◽  
Standard Normal Distribution ◽  
Data Sets ◽  
Crossing Experiments ◽  
Independent Variables ◽  
F2 Population ◽  
A Value ◽  
Segregation Ratios ◽  
Standard Normal

Abstract A controversy arose over Mendel’s pea crossing experiments after the statistician R.A. Fisher proposed how these may have been performed and criticised Mendel’s interpretation of his data. Here we re-examine Mendel’s experiments and investigate Fisher’s statistical criticisms of bias. We describe pea varieties available in Mendel’s time and show that these could readily provide all the material Mendel needed for his experiments; the characters he chose to follow were clearly described in catalogues at the time. The combination of character states available in these varieties, together with Eichling’s report of crosses Mendel performed, suggest that two of his F3 progeny test experiments may have involved the same F2 population, and therefore that these data should not be treated as independent variables in statistical analysis of Mendel’s data. A comprehensive re-examination of Mendel’s segregation ratios does not support previous suggestions that they differ remarkably from expectation. The χ2 values for his segregation ratios sum to a value close to the expectation and there is no deficiency of extreme segregation ratios. Overall the χ values for Mendel’s segregation ratios deviate slightly from the standard normal distribution; this is probably because of the variance associated with phenotypic rather than genotypic ratios and because Mendel excluded some data sets with small numbers of progeny, where he noted the ratios “deviate not insignificantly” from expectation.

scholarly journals Risk Factors for Cardiovascular Events in Patients on Antidementia Medications

2020 ◽  
Vol 35 ◽  
pp. 153331752092238
Author(s):  
Meiqi He ◽  
James M. Stevenson ◽  
Yuting Zhang ◽  
Inmaculada Hernandez
Keyword(s):  
Cardiovascular Events ◽  
Heart Rhythm ◽  
Combined Model ◽  
Factors Associated ◽  
C Statistic ◽  
Five Factors ◽  
Heart Rhythm Disorders ◽  
Increased Risk ◽  
History Of ◽  
Β Blockers

Objective: To identify characteristics associated with an increased risk of cardiovascular events in patients diagnosed with Alzheimer disease (AD) and treated with antidementia medications. Methods: Demographics, diagnoses, and medication usage of 30 433 Medicare patients were analyzed using 2006 to 2013 claims data and a combined model of screening, ranking and stepwise logistic regressions to evaluate factors associated with composite outcomes of 6 cardiovascular events. Results: Incidence rate of at least 1 cardiovascular event was 25.1%. Fifty-five factors were identified from the 10 381 candidate variables by the combined model with a c-statistic of 67% and an accuracy of 75%. Factors associated with increased risk of cardiovascular events include history of heart rhythm disorders, alteration of consciousness (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.14-1.36), and usage of β-blockers (OR: 1.19; 95% CI: 1.13-1.27). Conclusions: Clinicians should consider the increased risk of cardiovascular events in patients with AD with heart rhythm disorders and on β-blockers.

scholarly journals Factors associated with prenatal care and HIV and syphilis testing during pregnancy in primary health care

2019 ◽  
Vol 53 ◽  
pp. 76
Author(s):  
Cláudia Helena Soares de Morais Freitas ◽  
Franklin Delano Soares Forte ◽  
Angelo Giuseppe Roncalli ◽  
Maria Helena Rodrigues Galvão ◽  
Ardigleusa Alves Coelho ◽  
...  
Keyword(s):  
Health Care ◽  
Regression Analysis ◽  
Prenatal Care ◽  
Cash Transfer ◽  
Social Characteristics ◽  
Bivariate Analysis ◽  
Transfer Program ◽  
Factors Associated ◽  
Independent Variables ◽  
Syphilis Testing

OBJECTIVE: To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS: This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULTS: Poisson regression analysis showed a statistically significant association with the variables “less than eight years of study” [prevalence ratio (PR) = 1.31; 95%CI 1.19–1.45; p < 0.001] and “participants of the cash transfer program” (PR = 0.80; 95%CI 0.72–0.88; p < 0.001) for the outcome of “having less than six prenatal care appointments” and individual variables. A statistically significant association was found for “participants of the cash transfer program” (PR = 1.43; 95%CI 1.19–1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable “less than eight years of study” (PR =1.75; 95%CI 1.56–1.96; p < 0.001) and “participants of the cash transfer program” (PR = 1.21, 95%CI 1.07–1.36; p < 0.001). CONCLUSIONS: The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.

scholarly journals The Bambuí Health and Aging Study (BHAS): factors associated with hospitalization of the elderly

2001 ◽  
Vol 17 (6) ◽  
pp. 1345-1356 ◽  
Author(s):  
Henrique L. Guerra ◽  
Josélia O. A. Firmo ◽  
Elizabeth Uchoa ◽  
Maria Fernanda F. Lima-Costa
Keyword(s):  
Hospital Admissions ◽  
The Elderly ◽  
Living Alone ◽  
Prescription Medications ◽  
Related Factors ◽  
Factors Associated ◽  
Independent Variables ◽  
Minas Gerais State ◽  
Aging Study ◽  
History Of

This study aimed to identify factors associated with hospital admissions of the elderly. All residents of Bambuí, Minas Gerais State <FONT FACE=Symbol>³ 60 years (n = 1,742) were selected. Some 1,606 of these (92.2%) participated in the study. The dependent variable was the number of hospital admissions (none, one, and two or more) during the previous 12 months. Independent variables were grouped as enabling, predisposing, and need-related factors. The strongest associations with multiple hospital admissions were: living alone; financial constraints to purchase of medication; and various indicators of need (worse self-perceived health, more visits to physician, greater use of prescription medications, and history of coronary heart disease). Such variables could help identify older adults at greatest risk and thus prevent hospitalization.</font>

scholarly journals Do GPs accurately record date of death? A UK observational analysis

2018 ◽  
Vol 10 (3) ◽  
pp. e24-e24 ◽  
Author(s):  
Amelia Harshfield ◽  
Gary A Abel ◽  
Stephen Barclay ◽  
Rupert A Payne
Keyword(s):  
Primary Care ◽  
Young Patients ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Data Sets ◽  
Factors Associated ◽  
National Statistics ◽  
Primary Care Data ◽  
National Mortality ◽  
General Practices

ObjectiveTo examine the concordance between dates of death recorded in UK primary care and national mortality records.MethodsUK primary care data from the Clinical Practice Research Datalink were linked to Office for National Statistics (ONS) data, for 118 571 patients who died between September 2010 and September 2015. Logistic regression was used to examine factors associated with discrepancy in death dates between data sets.ResultsDeath dates matched in 76.8% of cases with primary care dates preceding ONS date in 2.9%, and following in 20.3% of cases; 92.2% of cases differed by <2 weeks. Primary care date was >4 weeks later than ONS in 1.5% of cases and occurred more frequently with deaths categorised as ‘external’ (15.8% vs 0.8% for cancer), and in younger patients (15.9% vs 1% for 18–29 and 80–89 years, respectively). General practices with the greatest discrepancies (97.5th percentile) had around 200 times higher odds of recording substantially discordant dates than practices with the lowest discrepancies (2.5th percentile).ConclusionDates of death in primary care records often disagree with national records and should be treated with caution. There is marked variation between practices, and studies involving young patients, unexplained deaths and where precise date of death is important are particularly vulnerable to these issues.

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