scholarly journals Evaluation of the Validity of SAMe-TT2R2 Score in a Cohort of Venous Thromboembolism Patients Treated With Warfarin

2020 ◽  
Vol 26 ◽  
pp. 107602962094503
Author(s):  
Eman Nawash Alhmoud ◽  
Hazem Elewa ◽  
Mohammed S. Abdul Gelil ◽  
Osama B. Abd El Samad ◽  
Abdelnasser Y. Elzouki
Keyword(s):  
Venous Thromboembolism ◽  
Statistical Significance ◽  
Clinical Factors ◽  
Risk Of Bleeding ◽  
Clinical Events ◽  
Caucasian Origin ◽  
Anticoagulation Control ◽  
The Difference ◽  
Mean Time

Low SAMe-TT2R2 score of <2 was validated as a predictor of optimum anticoagulation control, reflected by mean time in therapeutic range (TTR) above 65% to 70%, among warfarin-treated atrial fibrillation patients. This study aimed to validate the ability of SAMe-TT2R2 score and its individual components in predicting anticoagulation control (mean TTR and clinical events) among a cohort of venous thromboembolism (VTE) patients in Qatar. A total of 295 patients were retrospectively evaluated. There was a trend toward statistical significance in mean TTR between low (<2) and high (≥ 2) SAMe-TT2R2 score groups ( P = .05), a difference that was not sustained when a cutoff of 3 was used (ie, a score of 3 or more). Patients with poor INR control (TTR <70%) were numerically less likely to have SAMe-TT2R2 score of <2 compared with those with good INR control, though the difference was not statistically significant (16.7% vs 83.3%, respectively, P = .4). No thromboembolic events were reported, and no association was found between the score and risk of bleeding. Non-Caucasian origin was the only significant predictor of good anticoagulation in the studied cohort. In conclusion, SAMe-TT2R2 score could not predict quality of anticoagulation control in a cohort of VTE patients treated with warfarin in Qatar. Contribution of other clinical factors and whether a different scoring may yield better prediction of anticoagulation control remains to be tested.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

The Quality Analysis of Hallux Valgus Videos on YouTube

2021 ◽  
Author(s):  
Enes Sari ◽  
Levent FAZLI Umur
Keyword(s):  
Hallux Valgus ◽  
Information Quality ◽  
Statistical Significance ◽  
Poor Quality ◽  
Quality Analysis ◽  
Accurate Information ◽  
Youtube Videos ◽  
The Mean ◽  
The Difference

BACKGROUND:The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. METHODS:A YouTube search was performed using the keyword 'hallux valgus' to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA) and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, video power index (VPI) values were calculated to determine video popularity. Video length (sec), video source and video content were also noted. The relation between information quality and these factors were statistically evaluated. RESULTS:The mean DISCERN score was 30.35{plus minus}11.56 (poor quality) (14-64), the mean JAMA score was 2.28{plus minus}0.96 (1-4), and the mean HAVIA score was 3.63{plus minus}2.42 (moderate quality) (0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by non-physicians, the difference was not statistically significant. Additionally, view rates and VPI values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r= 0.294, p= 0.028), and HAVIA scores (r= 0.326, p= 0.015). CONCLUSIONS:This present study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially in less frequently mentioned topics such as postoperative complications and healing period.

Long-term quality of VKA treatment and clinical outcome after extreme overanticoagulation in 14,777 AF and VTE patients

2015 ◽  
Vol 113 (04) ◽  
pp. 881-890 ◽  
Author(s):  
Nic J. G. M. Veeger ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Hilde A. M. Kooistra ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Clinical Outcome ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
P Value ◽  
Risk Of Bleeding ◽  
Increased Risk

SummaryVitamin K antagonists (VKA) are widely used in atrial fibrillation and venous thromboembolism (VTE). Their efficacy and safety depend on individual time in the therapeutic range (iTTR). Due to the variable dose-response relationship within patients, also patients with initially stable VKA treatment may develop extreme overanticoagulation (EO). EO is associated with an immediate bleeding risk, but it is unknown whether VKA treatment will subsequently restabilise. We evaluated long-term quality of VKA treatment and clinical outcome after EO. EO was defined as international normalized ratio (INR) ≥ 8.0 and/or unscheduled vitamin K supplementation. We included a consecutive cohort of initially stable atrial fibrillation and venous thromboembolism patients. In EO patients, the 90 days pre- and post-period were compared. In addition, patients with EO were compared with patients without EO using a matched 1:2 cohort. Of 14,777 initially stable patients, 800 patients developed EO. The pre-period was characterised by frequent overanticoagulation, and half of EO patients had an inadequate iTTR (< 65 %). After EO, underanticoagulation became more prevalent. Although the mean time between INR-measurements decreased from 18.6 to 13.2 days, after EO inadequate iTTR became more frequent (62 %), p-value < 0.001. A 2.3 times (95 % confidence interval [CI] 2.0–2.5) higher risk for iTTR< 65 % after EO, was accompanied by increased risk of bleeding (hazard ratio [HR] 2.1;CI 1.4–3.2), VKA-related death 17.0 (HR 17.0;CI 2.1–138) and thrombosis (HR 5.7;CI 1.5–22.2), compared to the 1600 controls. In conclusion, patients continuing VKA after EO have long-lasting inferior quality of VKA treatment despite intensified INR-monitoring, and an increased risk of bleeding, thrombosis and VKA-related death.Note: There have been no previous presentations, reports or publications of the complete data that appear in the article. Parts of the data in this article have been presented as a poster at the American Society of Hematology (ASH) congress 2013, New Orleans, United States.

A phase Ib/IIa study of combination therapy with gemcitabine and Atu027 in patients with locally advanced or metastatic pancreatic adenocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 385-385 ◽  
Author(s):  
Beate Schultheis ◽  
Dirk Strumberg ◽  
Jan Kuhlmann ◽  
Martin Wolf ◽  
Karin Link ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Combination Therapy ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Small Patient Number ◽  
The Difference ◽  
Grade 3

385 Background: Atu027 is a liposomally formulated short interfering RNA with anti-metastatic activity, which silences expression of protein kinase N3 (PKN3) in the vascular endothelium. PKN3 acts as a Rho effector downstream of PI3K. This trial was designed to assess safety, pharmacokinetics and efficacy of Atu027 in combination with gemcitabine in advanced pancreatic carcinoma (APC). Methods: 23 patients (pts) with APC stage 3 or 4 were enrolled and randomly assigned to different Atu027 dosing schedules (arm 1: 0.253mg/kg once weekly, n = 11; arm 2: 0.253mg/kg twice-weekly, n = 12) but identical gemcitabine regimen. Response was evaluated according to RECIST 1.1. Quality of life was assessed with EORTC questionnaire QLQ-C30. Results: Combination therapy with Atu027 and gemcitabine was given up to 7.8 months until progression. Grade 3 adverse events (AEs) were reported by 9/11 pts (82%) in arm 1 and 11/12 pts (92%) in arm 2. Grade 4 AEs were reported by two pts in each arm. Interestingly, there was a difference in median progression free survival (mPFS) between the two treatment arms. Arm 1 showed an mPFS of 1.8 [95%CI: 0.4-5.5] months vs. 5.3 [95%CI: 1.5-6.0] months in arm 2, p= 0.399. In a post-hoc analysis of metastatic disease only, the difference in mPFS between the two arms reached statistical significance (1.6 [95%CI:0.4-2.1] vs 2.9 [95%CI:1.0-7.3] months, n = 9 vs 10, p= 0.025). Disease control during treatment was achieved in 4/11 (36%) pts in arm 1 and in 7/12 (58%) pts in arm 2. New lesions occurred in all (6/6) pts in arm 1 who had at least one RECIST re-evaluation but only 5/10 pts (50%) in arm 2. In quality of life analysis, pts in the once-weekly arm showed a stable global health status while pts in the twice-weekly arm reported an improvement (0-100 score change from baseline: -2.3 vs +21.6 after one cycle, N = 7 vs 7). Conclusions: Combination of Atu027 with gemcitabine for the treatment of APC is safe and was well tolerated. Despite the small patient number, there is a clear signal that twice-weekly Atu027 dosing might be superior to the once-weekly regimen. These results suggest efficacy of Atu027 and warrant further investigation with Atu027 added to standard of care in APC. Clinical trial information: NCT01808638.

Death and quality in cardiac surgery

Clinical Risk ◽  
2010 ◽  
Vol 16 (4) ◽  
pp. 130-134 ◽  
Author(s):  
Samer AM Nashef
Keyword(s):  
Cardiac Surgery ◽  
Clinical Performance ◽  
Statistical Significance ◽  
Surgical Care ◽  
Quality Monitoring ◽  
Risk Models ◽  
Actual Outcome ◽  
The Difference ◽  
Care Evaluation

Quality monitoring in medicine was a neglected field until the last two decades. Doctors traditionally did their best, but how good that was could not be evaluated. This situation remains in some areas of medicine, but specialties with clearly-defined interventions and outcomes have progressed in quality of care evaluation, and cardiac surgery leads the way. Measuring the risk of an intervention allows prediction of the outcome and is essential for quality monitoring: without knowing the predicted outcome, the actual outcome cannot be evaluated. Cardiac surgery risk models like EuroSCORE and others have been adopted worldwide, so that measuring risk-adjusted performance is now an integral part of the delivery of good cardiac surgical care. When mortality for a procedure is higher for one surgeon (or hospital) than another, this can be due to one of three reasons, or a combination of the three: the difference is due to chance, or variation in risk profile, or better and safer service. We now have the tools to distinguish between the above factors. We can also observe performance over time: cusum curves plot the performance of surgeons and hospitals by showing hypothetical ‘lives saved’. This provides early warning of deterioration in performance before a problem reaches statistical significance. With the appropriate tools, it is possible not only to identify a problem, but also to anticipate and thus prevent a problem from happening. Monitoring clinical performance is an exciting and rewarding field for future development, and one that will yield real improvements in patient outcomes.

Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in patients with venous thromboembolism treated with vitamin K antagonists: Findings from the RIETE registry

2020 ◽  
Vol 194 ◽  
pp. 178-182
Author(s):  
Jorge del-Toro-Cervera ◽  
Pablo Demelo-Rodriguez ◽  
Francisco Galeano-Valle ◽  
Ángeles Fidalgo ◽  
Ángel Sampériz ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Anticoagulation Control

scholarly journals Open abdomen management: single institution experience

2015 ◽  
Vol 42 (2) ◽  
pp. 93-96 ◽  
Author(s):  
Adilson Costa Rodrigues Junior ◽  
Fernando da Costa Ferreira Novo ◽  
Rafael de Castro Santana Arouca ◽  
Francisco de Salles Collet e Silva ◽  
Edna Frasson de Souza Montero ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Statistical Significance ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Abdominal Closure ◽  
The Difference ◽  
Mean Time ◽  
De Medicina

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure

The Role of Migration in the Variety and Quality of Trade: Evidence from Germany

2016 ◽  
Vol 17 (1) ◽  
pp. 1-25 ◽  
Author(s):  
Antonella Bellino ◽  
Giuseppe Celi
Keyword(s):  
Consumer Goods ◽  
Statistical Significance ◽  
Two Dimensions ◽  
Information Flows ◽  
Information Effect ◽  
Industry Trade ◽  
Migrant Communities ◽  
The Difference

AbstractWe explore the migration-trade nexus in the case of Germany over the period 2000-09, disentangling the two dimensions of intra-industry trade (vertical and horizontal). We find that immigration is positively and significantly related to intraindustry trade. However, the magnitude and statistical significance of migration’s impact on trade are considerably higher for horizontal intra-industry trade and increase with the difference in the level of development between Germany and the partner countries. This pattern is consistent with the view that information flows between migrant communities and their country of origin may be more important for consumer goods (where trade in varieties prevails) and that this information effect is more important if trading countries are very different.

scholarly journals Effects of Natural Convalescent Factors Combined with Motor Intelligence Management on Patients’ Blood Pressure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Shasha Li ◽  
Zhuoming Hu ◽  
Jianping Zhang
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Physical Function ◽  
Statistical Significance ◽  
Blood Pressure Level ◽  
Control Group ◽  
Observation Group ◽  
Research Subjects ◽  
The Difference

To explore the application of natural convalescent factors combined with exercise intelligence management in blood pressure control of patients with hypertension, 102 patients with hypertension who were admitted from January 2017 to August 2019 were selected as the research subjects. According to the odd-even number method, they were divided into two groups with 51 cases in each group. The control group was treated with natural convalescent factor therapy alone, and the observation group was treated with natural convalescent factor combined with motor intelligence management. The application effects of the two groups were compared. Before sports intelligence management, the levels of systolic blood pressure (SBP) in control group and observation group were (145.45 ± 8.44) mmHg (1 mmHg = 0.133 kPa) and (146.55 ± 8.37) mmHg, respectively; the diastolic blood pressure (DBP) levels of the control group and the observation group were (98.47 ± 3.48) mmHg and (98.94 ± 3.48) mmHg, respectively, with no statistical significance ( P > 0.05 ). After the exercise intelligence management, the SBP levels of the control group and the observation group were (132.76 ± 4.48) mmHg and (130.06 ± 2.48) mmHg, respectively. The DBP levels of the control group and the observation group were (85.48 ± 5.38) mmHg and (83.47 ± 3.35) mmHg, respectively. The difference was statistically significant ( P < 0.05 ). The scores of each index of quality of life in the observation group were higher than those in the control group, and the differences of physical function and psychological/mental scores were significant. The scores of physical function in the two groups before administration were (48.36 ± 1.69) and (48.74 ± 1.62), and the differences were not statistically significant ( P > 0.05 ). After management, the physiological function scores of the two groups were (40.32 ± 1.33) and (32.15 ± 1.54) and the difference was statistically significant ( P < 0.05 ). There were no significant differences in the psychological (30.75 ± 1.26)/mental scores (30.26 ± 1.48) between the two groups before management ( P > 0.05 ), but there were significant differences in the psychological (25.30 ± 1.02)/mental scores (18.76 ± 1.36) between the two groups after management ( P < 0.05 ). The combination of natural convalescent factors and intelligent exercise management can effectively control the blood pressure level and improve the quality of life of patients with hypertension, and the clinical application effect is good.

A Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate Treated with Different Primary Surgical Techniques

2004 ◽  
Vol 41 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Chris D. Johnston ◽  
Alan G. Leonard ◽  
Donald J. Burden ◽  
Patrick F. McSherry
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Dental Arch ◽  
Soft Tissue Profile ◽  
Palate Repair ◽  
The Difference

Objective The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). Design Retrospective analysis. Patients Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. Main Outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. Conclusions Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.

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