scholarly journals Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

2014 ◽  
Vol 45 (2) ◽  
pp. 463-472 ◽  
Author(s):  
Takashi Tagami ◽  
Hiroki Matsui ◽  
Hiromasa Horiguchi ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Propensity Score ◽  
Low Dose ◽  
Community Acquired Pneumonia ◽  
Administrative Database ◽  
Control Groups ◽  
Inverse Probability ◽  
Dose Corticosteroid ◽  
Severe Community Acquired Pneumonia ◽  
Inverse Probability Weighted ◽  
And Control

The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear.6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality.2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44).Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP.

scholarly journals Usefulness of β-lactam and Macrolide Combination Therapy for Treating Community-acquired Pneumonia Patients Hospitalized in the Intensive Care Unit: Propensity Score Analysis of a Prospective Cohort Study

2020 ◽  
Author(s):  
Akihiro Ito ◽  
Tadashi Ishida ◽  
Hiromasa Tachibana ◽  
Yosuke Nakanishi ◽  
Fumiaki Tokioka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Combination Therapy ◽  
Odds Ratio ◽  
Propensity Score Analysis ◽  
Therapy Group ◽  
Community Acquired Pneumonia ◽  
Icu Mortality ◽  
Inverse Probability ◽  
Score Analysis ◽  
Severe Community Acquired Pneumonia

Abstract Background: Previous studies reported that β-lactam and macrolide combination therapy significantly improved outcomes for patients with severe community-acquired pneumonia hospitalized in the intensive care unit (ICU) compared with a non-macrolide regimen. However, whether β-lactam and macrolide therapy truly reduces mortality is controversial, because no randomized, controlled trials have been conducted. The aim of the present study was to evaluate the usefulness of β-lactam and macrolide combination therapy for severe community-acquired pneumonia patients hospitalized in the ICU compared with a non-macrolide β-lactam-containing regimen.Methods: A prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized severe community-acquired pneumonia patients admitted to the ICU within 24 hours between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score.Results: A total of 78 patients were included. There were 48 patients in the non-macrolide-containing β-lactam therapy group, including β-lactam monotherapy and β-lactam and non-macrolide-containing combination therapy, and 30 patients in the macrolide combination therapy group. β-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P=0.015) and 14-day mortality (6.7% vs. 31.3%; P=0.020), but not ICU mortality (10% vs 27.1%, P=0.08) compared with non-macrolide-containing β-lactam therapy. After adjusting by inverse probability of treatment weighting, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09-0.96; P=0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04-0.92; P=0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08-1.36; P=0.13).Conclusions: Combination therapy with β-lactam and macrolides significantly improved the prognosis of severe community-acquired pneumonia patients hospitalized in the ICU compared with a non-macrolide-containing β-lactam regimen on propensity score analysis.Trial registration: UMIN Clinical Trials Registry, UMIN000004353. Registered on 7 October 2010,

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

scholarly journals Effect of low-dose atropine on myopia progression, pupil diameter and accommodative amplitude: low-dose atropine and myopia progression

2020 ◽  
pp. bjophthalmol-2019-315440 ◽  
Author(s):  
Aicun Fu ◽  
Fiona Stapleton ◽  
Li Wei ◽  
Weiqun Wang ◽  
Bingxin Zhao ◽  
...  
Keyword(s):  
Low Dose ◽  
Pupil Diameter ◽  
Repeated Measurements ◽  
Control Group ◽  
Eye Drops ◽  
Control Groups ◽  
Myopia Progression ◽  
Registration Number ◽  
And Control ◽  
Accommodative Amplitude

PurposeTo evaluate the effects of 0.01% and 0.02% atropine eye drops on myopia progression, pupil diameter and accommodative amplitude in myopic children.MethodsA cohort study assessed 400 myopic children divided into three groups: 138 and 142 children were randomised to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine eye drop applied to both eyes once nightly. Control children (n=120) only wore SV spectacles. Repeated measurements of spherical equivalent refractive errors (SERs), axial length (AL), pupil diameter and accommodative amplitude were performed at baseline, and 4, 8 and 12 months after treatment.ResultsAfter 12 months, the SER change was −0.38±0.35D, −0.47±0.45D, −0.70±0.60D and AL change was 0.30±0.21 mm, 0.37±0.22 mm, 0.46±0.35 mm in the 0.02%, 0.01% atropine and control groups, respectively. There were significant differences in the change in AL and SER between three groups (all p<0.001). Between baseline and the 12-month visit, the overall change in accommodative amplitude was 1.50±0.25D, 1.61±0.31D and change in pupil diameter was 0.78±0.42 mm, 0.69±0.39 mm, with 0.02% and 0.01% atropine, respectively. Accommodative amplitude significantly decreased and pupil diameter significantly increased in two atropine groups (all p<0.001). Moreover, there was no statistical difference in the change difference in accommodative amplitude and pupil diameter between two atropine groups (p=0.24, p=0.38), whereas the accommodative amplitude (p=0.45) and pupil diameter (p=0.39) in the control group remained stable.Conclusions0.02% atropine eye drops had a better effect on myopia progression than 0.01% atropine, but 0.02% and 0.01% atropine showed similar effects on pupil diameter and accommodative amplitude after 12 months of treatment.Trial registration numberChiCTR-IPD-16008844.

scholarly journals Occupational stress and psychological health impact on hypertension of miners in noisy environment in Wulumuqi, China: a case-control study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yaoqin Lu ◽  
Huan Yan ◽  
Jiandong Yang ◽  
Jiwen Liu
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Occupational Stress ◽  
Psychological Health ◽  
Case Control Study ◽  
Case Control ◽  
Noisy Environment ◽  
Control Groups ◽  
And Control ◽  
Control Study

Abstract Background Hypertension has been declared as a global public health crisis by the World Health Organization, because of its high prevalence. It affects the health of one billion people worldwide and is directly responsible for the deaths of more than 10 million people per year. The purpose of our research was to explore the influence of occupational stress and psychological health on hypertension of miners who work in a noisy environment and provide decision reference for relevant departments to keep miners’ health. Methods A case-control study was carried out in this research. The study subjects were divided into case groups and control groups based on whether they had hypertension or not. Effort-Reward Imbalance questionnaire and Self-Reporting Inventory questionnaire were used to investigate the psychological health status and occupational stress of the target population. General information was balanced between case and control groups through propensity score matching method. After propensity score matching, a multifactorial analysis was used to explore the impact of occupational stress and psychological health on hypertension. Results According to the result of the multivariate analysis, psychological health was hazard to hypertension (t = 5.080, P<0.001) and occupational stress was not a direct risk factor for hypertension (t = 1.760, P = 0.080). The model was statistically significant (χ2 = 20.4, P<0.01). Conclusions For miners working in the noisy environment, psychological status was a direct risk factor to hypertension, while occupational stress was an indirect factor.

scholarly journals Bootstrap bias correction for average treatment effects with inverse propensity weights

2019 ◽  
Vol 52 (2) ◽  
pp. 187-200
Author(s):  
GUBHINDER KUNDHI ◽  
MARCEL VOIA
Keyword(s):  
Propensity Score ◽  
Treatment Effect ◽  
Bias Correction ◽  
Treatment Effects ◽  
Potential Problem ◽  
Average Treatment Effect ◽  
Omitted Variables ◽  
Control Groups ◽  
Average Treatment ◽  
And Control

The estimated average treatment effect in observational studies is biased if the assumptions of ignorability and overlap are not satisfied. To deal with this potential problem when propensity score weights are used in the estimation of the treatment effects, in this paper we propose a bootstrap bias correction estimator for the average treatment effect (ATE) obtained with the inverse propensity score (BBC-IPS) estimator. We show in simulations that the BBC-IPC performs well when we have misspecifications of the propensity score (PS) due to: omitted variables (ignorability property may not be satisfied), overlap (imbalances in distribution between treatment and control groups) and confounding effects between observables and unobservables (endogeneity). Further refinements in bias reductions of the ATE estimates in smaller samples are attained by iterating the BBC-IPS estimator.

scholarly journals Effectiveness of Physical Therapy for the Management of Chronic Spine Disorders: A Propensity Score Approach

2006 ◽  
Vol 86 (3) ◽  
pp. 381-394 ◽  
Author(s):  
Janet K Freburger ◽  
Timothy S Carey ◽  
George M Holmes
Keyword(s):  
Physical Therapy ◽  
Propensity Score ◽  
Short Form ◽  
Intervention Group ◽  
Control Group ◽  
Control Groups ◽  
Sf 36 ◽  
Spine Disorders ◽  
And Control

Abstract Background and Purpose. Evidence on the effectiveness of physical therapy for the management of chronic spine disorders is limited. The purpose of this study was to use a large current database, the National Spine Network database, to assess the effectiveness of physical therapy in the management of chronic spine disorders. Subjects. The participants were people who had spine problems lasting 3 months or longer and who were seen for an initial visit and a follow-up visit (N=4,479) at 1 of 17 US spine centers. Methods. A propensity score approach was used to create a matched sample of participants who received physical therapy (intervention group) and participants who did not receive physical therapy (control group). The 2 groups were similar with regard to more than 50 baseline characteristics. Outcomes were assessed with the Oswestry Disability Index (ODI) and the 36-Item Short-Form Health Survey (SF-36). Results. Both the intervention and control groups improved between the initial and the follow-up visits on ODI scores and on SF-36 physical function, role physical, and bodily pain scores. Although the amount of improvement in the outcome measures was significantly greater for the intervention group than for the control group, the differences were small (3–5 points). When the subgroup of participants who had the greatest propensity for receiving physical therapy was examined, differences in the amount of improvement between the intervention and control groups were larger (5–13 points). Discussion and Conclusion. Physical therapy was effective in the management of chronic spine disorders in participants with the greatest propensity for receiving physical therapy. When the entire sample was considered, differences in the amount of improvement between the intervention and control groups were not clinically relevant. [Freburger JK, Carey TS, Holmes GM. Effectiveness of physical therapy for the management of chronic spine disorders: a propensity score approach.

scholarly journals Impact of Vitamin C and Thiamine Administration on Delirium-Free Days in Patients with Septic Shock

2020 ◽  
Vol 9 (1) ◽  
pp. 193 ◽  
Author(s):  
Jong Eun Park ◽  
Tae Gun Shin ◽  
Ik Joon Jo ◽  
Kyeongman Jeon ◽  
Gee Young Suh ◽  
...  
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Vitamin C ◽  
Control Group ◽  
Matched Pairs ◽  
Control Groups ◽  
Icu Delirium ◽  
Definition Of ◽  
And Control ◽  
The Impact

Sepsis is a common cause of delirium in the intensive care unit (ICU). Recently, vitamin C and thiamine administration has been gaining interest as a potential adjunct therapy for sepsis. We investigated the impact of early vitamin C and thiamine administration on ICU delirium-free days among critically ill patients in septic shock. We performed a single-center, retrospective study of patients who visited the emergency department (ED) from January 2017 to July 2018. We categorized patients into a treatment (received vitamin C and thiamine) and control group. We compared delirium-free days within 14 days after ICU admission using propensity score matching. Of 435 patients with septic shock, we assigned 89 propensity score-matched pairs to the treatment and control groups. The median delirium-free days did not differ between treatment (11, interquartile range [IQR] 5–14 days) and control (12, IQR 6–14 days) groups (p = 0.894). Secondary outcomes were not different between the two groups, including delirium incidence and 28-day mortality. These findings were consistent after subgroup analysis for patients who met the sepsis-3 definition of septic shock. Vitamin C and thiamine administration showed no association with ICU delirium-free days among patients in septic shock.

scholarly journals Biomarkers in Community-Acquired Pneumonia Assessment

2017 ◽  
Vol 71 (1-2) ◽  
pp. 8-13
Author(s):  
Natalja Voskresenska ◽  
Sergejs Babikovs ◽  
Jūlija Voicehovska ◽  
Andrejs Šķesters ◽  
Alise Silova ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Enzymes ◽  
Community Acquired Pneumonia ◽  
Treatment Efficiency ◽  
Control Groups ◽  
Plasma Selenium ◽  
Healthy Control ◽  
Males And Females ◽  
And Control ◽  
Reduced Activity

AbstractThe paper presents information on pneumonia (P) patients with features of oxidative stress (OS). Identifying features of OS in patients with P is of interest not only for diagnosis, but also for monitoring of treatment efficiency. We recruited 73 patients with community-acquired P (CAP), previously healthy adults, both males and females with mean age of 68.0 ± 15.2, hospitalised, and 61 healthy control patients matched for age. For quantitative evaluation of lipid peroxidation in CAP patients, the levels of aldehydic lipid peroxidation products like malondialdehyde (MDA) and 4- hydroxynon-2-enal (HNE) were quantified. Furthermore, concentrations of reduced glutathione (GSH) and several antioxidant enzymes and selenium in plasma were determined. In CAP patients, decreased levels of GSH and plasma selenium were observed. Plasma levels of MDA, and HNE did significantly differ between patient and control groups. We also noted reduced activity of antioxidant enzymes, namely, glutation peroxidase and superoxide dismutase. Low antioxidant enzymes activity was associated with a more severe CAP pattern. Both GSH and antioxidant enzymes may serve as markers for inflammation-related OS in CAP patients, and measurement of these biomarkers may be a valid indentifier for its management.

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