Abstract 176: Door to Needle Targets in the Real World: A Dynamic Statistical Tool for Institutional Stroke Code Metrics

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Benjamin Y Andrew ◽  
Matthew E Ehrlich ◽  
Colleen M Stack ◽  
Julian P Yang ◽  
Jodi A Dodds
Keyword(s):  
Real World ◽  
Clinical Care ◽  
University Hospital ◽  
Prolonged Treatment ◽  
Statistical Tool ◽  
Institutional Data ◽  
Systems Planning ◽  
Time Period ◽  
Duke University ◽  
Definition Of

Background: The benefit of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke is time-dependent. AHA/ASA guidelines recommend a goal door-to-needle (DTN) time of 60 minutes or less. In practice, medically complicated patients can pose challenges leading to prolonged treatment times that skew institutional mean DTN values. We aimed to produce a simple statistical tool to calculate individualized DTN targets while accounting for outliers to help institutions achieve a mean DTN < 60 minutes. Methods: An IRB approved, single-center, retrospective analysis of consecutive acute stroke code case data from Duke University Hospital (Durham, NC) between January 2014 and July 2016 was conducted. We devised a formula (Figure 1) to calculate the goal DTN time (t g ) necessary to achieve an overall mean DTN of < 60 minutes while adjusting for the frequency and magnitude of outliers. This formula was created as a modifiable tool using an individual institution’s outlier definition, current outlier frequency (f m ), and outlier DTN average (t m ) over a pre-defined time period. As proof of concept, the formula was tested using an outlier definition of ≥100 minutes. The formula was modeled using both real-world institutional data and a simulated sample of 200 patients. Results: In 1069 consecutive stroke codes, tPA was administered in 135 cases with mean DTN 68.2 minutes (range 15-205). Of these, 18 cases (13.3%) met our definition of outlier, with t m of 134 minutes. Using the developed formula with institutional data resulted in a target DTN of 48.6 minutes for non-outlier cases to achieve overall mean DTN < 60 minutes. Using the simulated dataset, our tool similarly calculated a goal DTN of 49 minutes. Conclusions: This simple statistical tool is a novel solution for generating an institution-specific goal DTN based on unique organizational data, experiences, and nuances in order to meet the recommended mean DTN. Additionally, these individualized goals may further motivate stroke teams to carry out more efficient clinical care rather than consistently aiming for DTN values < 60 minutes. The tool presented here is easily adaptable to future changes in recommended target goals and can be seamlessly incorporated into institution-wide systems planning.

scholarly journals Early real-world effectiveness of ustekinumab for Crohn’s disease

2019 ◽  
Vol 11 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Richard James Harris ◽  
Martin McDonnell ◽  
David Young ◽  
Marion Bettey ◽  
Louise Downey ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Response ◽  
Real World ◽  
Clinical Remission ◽  
Clinical Care ◽  
University Hospital ◽  
Reactive Protein ◽  
Inflammatory Bowel ◽  
Clinical Records

ObjectiveTo understand the effectiveness of ustekinumab in treating Crohn’s disease (CD) in a UK real-world setting.DesignRetrospective cohort study using prospectively maintained clinical records.SettingSingle UK inflammatory bowel disease centre.PatientsAdult patients with an established diagnosis of CD prescribed ustekinumab outside of clinical trials at University Hospital Southampton (UHS).InterventionsUstekinumab, a monoclonal antibody to the shared p40 subunit of interleukin (IL) 12 and IL-23 as part of routine clinical care.Main outcome measuresEffectiveness as measured by an improvement in physician’s global assessment, drug persistence and improvement in biomarkers (C-reactive protein (CRP), albumin and calprotectin).Results84 patients were included, 72 had a postinduction review and 49 had 1-year data. At postinduction clinical review, clinical response occurred in 53% of patients and clinical remission occurred in 8%. For patients on ustekinumab at 1 year, clinical response occurred in 71% and remission in 14%. Adverse events included four patients with infections requiring admission, one drug-related rash, five CD surgeries and two CD exacerbations.ConclusionsUstekinumab was well tolerated in a complex UK CD population and demonstrated benefit to patients in terms of clinical response and improvement of biomarkers and with some patients attaining clinical remission. No unexpected safety signals were seen.

scholarly journals The quality of research with real-world evidence

2019 ◽  
pp. 39-41
Author(s):  
Mauricio Palacios Gómez
Keyword(s):  
Clinical Trials ◽  
Clinical Data ◽  
Real World ◽  
Clinical Care ◽  
Medical Science ◽  
Clinical Information ◽  
Real World Data ◽  
Real World Evidence ◽  
Definition Of ◽  
Time Required

Most of the medical practice has not been proven by controlled clinical trials, and there are no plans to conduct such trials in order to decrease clinician uncertainty. This happens partly due to the difficulty of making designs with scientific and ethical validity, the costs of this type of research and the time required to generate results, which can be several years. Clinical trials do not have the capability to generate information that allows to make decisions in some sectors of clinical care and public health, such as when an epidemic occurs. Therefore, medical science is based on observational studies, past practices and therapeutic tradition (1). Observation of clinical data that have defined a clinical behavior precedes the clinical trial. The knowledge about scurvy, the fact that this pathology is considered a nutritional deficiency and its treatment with citrus fruits, originated thanks to the collection of clinical data on sailors, soldiers and prisoners of the British Crown in the 18th and 19th centuries (2). This clinical information, which was collected uniformly and served to produce new knowledge, is what is now known as Real World Data (RWD). A modern definition of RWD would be one that talks about data obtained by any non-interventionist methodology that is collected prospectively and retrospectively from observations of routine clinical practice, and which comes from various sources including data from patients, doctors, hospitals, payers, social data, etc (3).

Biomarkers of Acromegaly and Growth Hormone Action

2020 ◽  
Vol 27 (12) ◽  
pp. 1231-1245
Author(s):  
Filippo Maffezzoni ◽  
Teresa Porcelli ◽  
Andrea Delbarba ◽  
Letizia Pezzaioli ◽  
Carlo Cappelli ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Biological Markers ◽  
Clinical Care ◽  
Hormone Deficiency ◽  
Surrogate Outcomes ◽  
Current State ◽  
Growth Hormone Action ◽  
Igf I ◽  
Definition Of

: Biological markers (biomarkers) play a key role in drug development, regulatory approval and clinical care of patients and are linked to clinical and surrogate outcomes. : Both acromegaly and Growth Hormone Deficiency (GHD) are pathological conditions related to important comorbidities that, in addition to having stringent diagnostic criteria, require valid markers for the definition of treatment, treatment monitoring and follow-up. GH and insulin-like growth factor-I (IGF-I) are the main biomarkers of GH action in children and adults while, in acromegaly, both GH and IGF-I are established biomarkers of disease activity. : However, although GH and IGF-I are widely validated biomarkers of GHD and acromegaly, their role is not completely exhaustive or suitable for clinical classification and follow-up. Therefore, new biological markers for acromegaly and GH replacement therapy are strongly needed. : The aim of this paper is to review and summarize the current state in the field pointing out new potential biomarkers for acromegaly and GH use/abuse.

Personalised attraction recommendation for enhancing topic diversity and accuracy

2021 ◽  
pp. 016555152199980
Author(s):  
Yuanyuan Lin ◽  
Chao Huang ◽  
Wei Yao ◽  
Yifei Shao
Keyword(s):  
Real World ◽  
Information Overload ◽  
Two Stage ◽  
Misclassification Cost ◽  
Second Stage ◽  
Low Visibility ◽  
Recommendation Diversity ◽  
Optimisation Model ◽  
Definition Of ◽  
Improved Methods

Attraction recommendation plays an important role in tourism, such as solving information overload problems and recommending proper attractions to users. Currently, most recommendation methods are dedicated to improving the accuracy of recommendations. However, recommendation methods only focusing on accuracy tend to recommend popular items that are often purchased by users, which results in a lack of diversity and low visibility of non-popular items. Hence, many studies have suggested the importance of recommendation diversity and proposed improved methods, but there is room for improvement. First, the definition of diversity for different items requires consideration for domain characteristics. Second, the existing algorithms for improving diversity sacrifice the accuracy of recommendations. Therefore, the article utilises the topic ‘features of attractions’ to define the calculation method of recommendation diversity. We developed a two-stage optimisation model to enhance recommendation diversity while maintaining the accuracy of recommendations. In the first stage, an optimisation model considering topic diversity is proposed to increase recommendation diversity and generate candidate attractions. In the second stage, we propose a minimisation misclassification cost optimisation model to balance recommendation diversity and accuracy. To assess the performance of the proposed method, experiments are conducted with real-world travel data. The results indicate that the proposed two-stage optimisation model can significantly improve the diversity and accuracy of recommendations.

scholarly journals The Value of Real-World Data in Understanding Prostate Cancer Risk and Improving Clinical Care: Examples from Swedish Registries

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 875
Author(s):  
Kerri Beckmann ◽  
Hans Garmo ◽  
Ingela Franck Lissbrant ◽  
Pär Stattin
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Clinical Care ◽  
Prostate Cancer Risk ◽  
Real World Data ◽  
Level Of Evidence ◽  
World Data ◽  
Cancer Data ◽  
Using Data ◽  
Randomised Controlled

Real-world data (RWD), that is, data from sources other than controlled clinical trials, play an increasingly important role in medical research. The development of quality clinical registers, increasing access to administrative data sources, growing computing power and data linkage capacities have contributed to greater availability of RWD. Evidence derived from RWD increases our understanding of prostate cancer (PCa) aetiology, natural history and effective management. While randomised controlled trials offer the best level of evidence for establishing the efficacy of medical interventions and making causal inferences, studies using RWD offer complementary evidence about the effectiveness, long-term outcomes and safety of interventions in real-world settings. RWD provide the only means of addressing questions about risk factors and exposures that cannot be “controlled”, or when assessing rare outcomes. This review provides examples of the value of RWD for generating evidence about PCa, focusing on studies using data from a quality clinical register, namely the National Prostate Cancer Register (NPCR) Sweden, with longitudinal data on advanced PCa in Patient-overview Prostate Cancer (PPC) and data linkages to other sources in Prostate Cancer data Base Sweden (PCBaSe).

scholarly journals Betweenness centrality for temporal multiplexes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Silvia Zaoli ◽  
Piero Mazzarisi ◽  
Fabrizio Lillo
Keyword(s):  
Information Flow ◽  
Real World ◽  
Betweenness Centrality ◽  
Temporal Structure ◽  
Shortest Paths ◽  
Single Layer ◽  
Distance Metric ◽  
Definition Of

AbstractBetweenness centrality quantifies the importance of a vertex for the information flow in a network. The standard betweenness centrality applies to static single-layer networks, but many real world networks are both dynamic and made of several layers. We propose a definition of betweenness centrality for temporal multiplexes. This definition accounts for the topological and temporal structure and for the duration of paths in the determination of the shortest paths. We propose an algorithm to compute the new metric using a mapping to a static graph. We apply the metric to a dataset of $$\sim 20$$ ∼ 20 k European flights and compare the results with those obtained with static or single-layer metrics. The differences in the airports rankings highlight the importance of considering the temporal multiplex structure and an appropriate distance metric.

scholarly journals 3124 Early Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

2019 ◽  
Vol 3 (s1) ◽  
pp. 38-38
Author(s):  
Safa Kaleem ◽  
Christa B. Swisher
Keyword(s):  
Positive Predictive Value ◽  
Real Time ◽  
Predictive Value ◽  
Quantitative Eeg ◽  
University Hospital ◽  
Duke University ◽  
Study Population ◽  
Time To Detection ◽  
Sensitivity Specificity ◽  
Improve Patient

OBJECTIVES/SPECIFIC AIMS: 1. Determine positive predictive value, negative predictive value, sensitivity, and specificity of Neuro ICU nurse interpretation of real-time bedside qEEG. 2. Determine difference in time to detection of first seizure between Neuro ICU nurse qEEG interpretation and EEG fellow reads of cEEG. 3. Determine what qualities of seizures make detection by neuro ICU nurses more or less likely – e.g. duration of seizures, type of seizures, spatial extent of seizures. METHODS/STUDY POPULATION: Recruit neuro ICU nurses taking care of 150 patients admitted to the Neuro ICU at Duke University Hospital who are initiated on cEEG monitoring. Nurses will be consented for their participation in the study. Neuro ICU nurses will evaluate the qEE RESULTS/ANTICIPATED RESULTS: From literature estimates of a 20% seizure prevalence in critical care settings, we hope to have 30 patients with seizures and 120 without. Based on prior study in the Duke Neuro ICU, we hypothesize that Neuro ICU nurses will have sensitivity and DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first prospective study of neuro ICU nurse interpretation of real-time bedside qEEG in patients with unknown NCSE/NCS presence. If nurse sensitivity, specificity, and positive predictive value are clinically useful, which we deem would be so at a sensitivity of 70% or greater, with acceptable false alarm rate, nurse readings of qEEG could significantly decrease the time to treatment of seizures in the Neuro ICU patient population, and perhaps could improve patient outcomes.

scholarly journals GMP production of 6-[18F]Fluoro-l-DOPA for PET/CT imaging by different synthetic routes: a three center experience

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Valdemar L. Andersen ◽  
Mikkel A. Soerensen ◽  
Johan Hygum Dam ◽  
Niels Langkjaer ◽  
Henrik Petersen ◽  
...  
Keyword(s):  
Radiochemical Yield ◽  
Ct Imaging ◽  
University Hospital ◽  
Dopamine Synthesis ◽  
Congenital Hyperinsulinism ◽  
Molar Activity ◽  
Time Period ◽  
Pet Ct ◽  
Synthetic Routes ◽  
Radiochemical Yields

Abstract Background The radiofluorinated levodopa analogue 6-[18F]F-l-DOPA (3,4-dihydroxy-6-18F-l-phenylalanine) is a commonly employed radiotracer for PET/CT imaging of multiple oncological and neurological indications. An unusually large number of different radiosyntheses have been published to the point where two different Ph. Eur. monographs exist depending on whether the chemistry relies on electrophilic or nucleophilic radiosubstitution of appropriate chemical precursors. For new PET imaging sites wishing to adopt [18F]FDOPA into clinical practice, selecting the appropriate production process may be difficult and dependent on the clinical needs of the site. Methods Data from four years of [18F]FDOPA production at three different clinical sites are collected and compared. These three sites, Aarhus University Hospital (AUH), Odense University Hospital (OUH), and Herlev University Hospital (HUH), produce the radiotracer by different radiosynthetic routes with AUH adopting an electrophilic strategy, while OUH and HUH employ two different nucleophilic approaches. Production failure rates, radiochemical yields, and molar activities are compared across sites and time. Additionally, the clinical use of the radiotracer over the time period considered at the different sites are presented and discussed. Results The electrophilic substitution route suffers from being demanding in terms of cyclotron operation and maintenance. This challenge, however, was found to be compensated by a production failure rate significantly below that of both nucleophilic approaches; a result of simpler chemistry. The five-step nucleophilic approach employed at HUH produces superior radiochemical yields compared to the three-step approach adopted at OUH but suffers from the need for more comprehensive synthesis equipment given the multi-step nature of the procedure, including HPLC purification. While the procedure at OUH furnishes the lowest radiochemical yield of the synthetic routes considered, it produces the highest molar activity. This is of importance across the clinical applications of the tracer discussed here, including dopamine synthesis in striatum of subjects with schizophrenia and congenital hyperinsulinism in infants. Conclusion For most sites either of the two nucleophilic substitution strategies should be favored. However, which of the two will depend on whether a given site wishes to optimize the radiochemical yield or the ease of the use.

INTERPRETATION IN FOREIGN LANGUAGES EDUCATION: PSYCHOLOGICAL ASPECT

2021 ◽  
Vol 54 (2) ◽  
pp. 121-129
Author(s):  
Vera B. Tsarcova ◽  
Keyword(s):  
Foreign Language ◽  
Real World ◽  
Language Education ◽  
Foreign Language Education ◽  
Educational Process ◽  
Personal Meanings ◽  
The Subject ◽  
Definition Of ◽  
Educational Potential

The article is devoted to one of the problems of foreign language education – the definition of the role of interpretation in preparing students of special (language) directions to participate in the dialogue of cultures. Interpretation is considered as a phenomenon and as a way of comprehending reality, which allows the subjects of the dialogue of cultures to reach mutual understanding. The main characteristic of interpretation, which is necessary for the purposes of foreign language education, is its psychological character. It is determined by the psychology of the author, the psychology of the work, as well as the psychology of the reader-interpreter. It is proved that the interpretation of a work of art, which has universal, historical and personal plans, has huge epistemological and axiological possibilities. They activate the entire educational potential of interperetation (educational, developmental, cognitive, and educational). Russian Russian poet A. A. Fet (1820–1892) uses the poem “Wir saßen am Fischerhaus” by the famous German poet and publicist Heinrich Hein (1797–1856) and the translation of this poem into Russian to illustrate the interpretation technology. The poem is considered as a space of personal meanings of the author. They are the ones that are subject to interpretation and bring the reader-interpreter back from the poet's world to the modern real world. And the real world is full of unexpected cultural facts, closely related to the content of the work of G. Heine, with distant Lapland and the life of modern lapps. Thus, interpretation is presented as an educational strategy. Together with the strategies of contextualization, philologization and argumentation, it ensures the achievement of the main goal of foreign language education – the creation of an individual who can act as a genuine subject of the dialogue of cultures. The article also emphasizes the importance of the teacher as the organizer of the educational process and the subject of the dialogue of cultures.

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