scholarly journals Geographical Differences and the National Meeting Effect in Patients with Out-of-Hospital Cardiac Arrests: A JCS–ReSS Study Report

2019 ◽  
Vol 16 (24) ◽  
pp. 5130
Author(s):  
Tetsuya Yumoto ◽  
Hiromichi Naito ◽  
Takashi Yorifuji ◽  
Yoshio Tahara ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Regional Variation ◽  
Population Based ◽  
Multivariate Logistic Regression Model ◽  
Geographical Differences ◽  
National Meeting ◽  
Neurological Outcomes ◽  
Before And After ◽  
Using Data ◽  
Hospital Cardiac Arrest

The “national meeting effect” refers to worse patient outcomes when medical professionals attend academic meetings and hospitals have reduced staffing. The aim of this study was to examine differences in outcomes of patients with out-of-hospital cardiac arrest (OHCA) admitted during, before, and after meeting days according to meeting location and considering regional variation of outcomes, which has not been investigated in previous studies. Using data from a nationwide, prospective, population-based, observational study in Japan, we analyzed adult OHCA patients who underwent resuscitation attempts between 2011 and 2015. Favorable one-month neurological outcomes were compared among patients admitted during the relevant annual meeting dates of three national scientific societies, those admitted on identical days the week before, and those one week after the meeting dates. We developed a multivariate logistic regression model after adjusting for confounding factors, including meeting location and regional variation (better vs. worse outcome areas), using the “during meeting days” group as the reference. A total of 40,849 patients were included in the study, with 14,490, 13,518, and 12,841 patients hospitalized during, before, and after meeting days, respectively. The rates of favorable neurological outcomes during, before, and after meeting days was 1.7, 1.6, and 1.8%, respectively. After adjusting for covariates, favorable neurological outcomes did not differ among the three groups (adjusted OR (95% CI) of the before and after meeting dates groups was 1.03 (0.83–1.28) and 1.01 (0.81–1.26), respectively. The “national meeting effect” did not exist in OHCA patients in Japan, even after comparing data during, before, and after meeting dates and considering meeting location and regional variation.

scholarly journals Sea water desalination and removal of iodine: effect on thyroid function

2018 ◽  
Vol 16 (3) ◽  
pp. 472-475
Author(s):  
Gideon Koren ◽  
Yona Amitai ◽  
Meital Shlezinger ◽  
Rachel Katz ◽  
Varda Shalev
Keyword(s):  
Thyroid Function ◽  
Sea Water ◽  
Population Based ◽  
Thyroid Stimulating Hormone ◽  
Water Desalination ◽  
Thyroid Function Tests ◽  
School Aged Children ◽  
Before And After ◽  
Using Data ◽  
The Impact

Abstract In Israel, about 55% of drinking water is derived from desalination (DSW) which removes all iodine. A recent study from Israel demonstrated high rates of iodine deficiency among school-aged children and pregnant women. There are concerns that low iodine may lead to impaired thyroid function. However, to date, the impact of consuming DSW on body iodine status has not been studied. The objective was to assess whether the increased use of DSW is associated with increased rates of hypothyroidism. Using data from a large health fund in Israel, we compared proportions of patients with higher than normal thyroid stimulating hormone (TSH), and lower than normal T3 and T4 levels before and after a massive desalination project became operational in August 2013 in areas with high vs. low use of DSW. Over 400,000 cases were compared in 2010–2013 vs. 2014–2016. Overall, there was no increase in the proportion of individuals with higher than normal TSH levels, or lower than normal T3 and T4 levels. In conclusion, in this population-based study, following the introduction of DSW, there was no evidence of increased incidence of low thyroid function tests, and the trends were similar in both areas highly consuming, or not consuming, DSW.

Text message alert system and resuscitation outcomes after out-of-hospital cardiac arrest: A before-and-after population-based study

Resuscitation ◽  
2019 ◽  
Vol 138 ◽  
pp. 198-207 ◽  
Author(s):  
Sun Young Lee ◽  
Sang Do Shin ◽  
Yu Jin Lee ◽  
Kyoung Jun Song ◽  
Ki Jeong Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Text Message ◽  
Population Based ◽  
Alert System ◽  
Population Based Study ◽  
Before And After ◽  
Hospital Cardiac Arrest

A SEER-based multiethnic picture of cholangiocarcinoma in the United States pre and post the advent of gemcitabine/cisplatin.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 448-448
Author(s):  
Kabir Mody ◽  
Samuel O Antwi ◽  
David O Hodge ◽  
Zahara Meghji ◽  
Sikander Ailawadhi ◽  
...  
Keyword(s):  
United States ◽  
Overall Survival ◽  
Older Patients ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Hazard Ratios ◽  
Before And After ◽  
Using Data ◽  
Ethnic Variations

448 Background: Cholangiocarcinoma (CCA) is a rare, lethal cancer with five-year survival of less than 10%. Although incidence rates have been increasing in the United States, ethnic variations in survival have not been investigated. We examined multi-ethnic variation in overall survival (OS) and CCA-specific survival (CSS) using data from the population-based Surveillance Epidemiology and End Results (SEER) program in the four year periods before and after introduction of gemcitabine/cisplatin as treatment for CCA. Methods: The study included data from 9,975 CCA cases reported in SEER between 2006 and 2013. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to examine overall and cholangiocarcinoma-specific survival by ethnicity, age, gender and in the pre- and post- gemcitabine/cisplatin era (2006-2009 vs. 2010-2013). Results: Compared to non-Hispanic Whites, Hispanics had poorer 3-year OS (HR = 1.18, 95% CI = 1.10-1.26) and 3-year CCA-specific survival (HR = 1.25, 95% CI = 1.16-1.35). Similarly, non-Hispanic Blacks had 3-year OS (HR = 1.22, 95% CI = 1.12-1.30) and 3-year CCA-specific survival (HR = 1.24, 95% CI = 1.13-1.37). Males and older patients also were found to have shorter survival compared to females and younger patients. Also noted was an increase in CCA incidence rate over time (2006-2013) of 5.93%. Among those < 50 versus ≥50 years old, a 23% higher rate of incidence in those < 50 was noted. Overall survival and CSS were both significantly improved for patients post-advent of Gemcitabine/Cisplatin. Statistically significant improvement in CSS pre- and post-advent of Gemcitabine/Cisplatin was noted in non-hispanic whites (p < 0.001) and Hispanics (p = 0.02). Conclusions: Hispanics and non-Hispanic Blacks have worse survival after diagnosis with CCA. Further studies are needed to determine the determinants of poor survival among these groups toward targeted intervention. Significant improvements in OS and CSS have been seen after the advent of Gemcitabine/Cisplatin. The incidence of CCA is rising faster in young persons, under the age of 50, compared with older patients.

scholarly journals The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH

2007 ◽  
Vol 156 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Agatha A van der Klaauw ◽  
Nienke R Biermasz ◽  
Edith J M Feskens ◽  
Marieke B Bos ◽  
Johannes W A Smit ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Gh Deficiency ◽  
Density Lipoprotein ◽  
Population Based ◽  
The Metabolic Syndrome ◽  
Adult Gh Deficiency ◽  
Cardiovascular Morbidity And Mortality ◽  
Before And After ◽  
Using Data

Objectives: Many reports demonstrate improvements in cardiovascular risk factors during GH replacement (rhGH) in adult GH deficiency (GHD). However, it remains to be determined to what extent these changes translate into a reduction of increased cardiovascular morbidity and mortality. The aim of this study was to evaluate the effects of long-term rhGH replacement on the prevalence of the metabolic syndrome (MS). Design, settings, main outcome measures: The MS was scored by the National Cholesterol Education Program-Adult Treatment Panel III definition in 50 consecutive GHD patients (45 ± 9 years of age), before and after 2 and 5 years of rhGH replacement, and the data of untreated patients were compared with the general population using data from a Dutch population-based study (n = 1062, 44 ± 8 years of age). Results: Hypertriglyceridaemia (46.0 vs 18.5%, P < 0.0001), hypertension (66.0 vs 35.5%, P < 0.0001) and abdominal obesity (38.0 vs 23.4%, P = 0.0178) were more prevalent in untreated patients when compared with controls, resulting in a higher prevalence of the MS in patients (38.0 vs 15.7%, P < 0.0001). During rhGH replacement at a mean dose of 0.5 ± 0.2 mg/day resulting in IGF-I concentrations in the normal age-adjusted reference range, mean high-density lipoprotein cholesterol level increased compared with baseline (P < 0.001). However, the prevalence of (components of) the MS did not change after 2 or 5 years of treatment with rhGH. Conclusion: In this study, the prevalence of the MS in patients with GHD is increased compared with healthy controls, irrespective of rhGH replacement.

Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study

The Lancet ◽  
2019 ◽  
Vol 394 (10216) ◽  
pp. 2255-2262 ◽  
Author(s):  
Takahiro Nakashima ◽  
Teruo Noguchi ◽  
Yoshio Tahara ◽  
Kunihiro Nishimura ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Population Based ◽  
Public Access ◽  
Neurological Outcomes ◽  
Public Access Defibrillation ◽  
Hospital Cardiac Arrest

Abstract 340: Effect of the 2015 CPR Guidelines for Patients With Out-Of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm: Results From the All-Japan Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Eizo Tachibana ◽  
Naohiro Yonemoto ◽  
Yoshio Tahara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Population Based ◽  
Inclusion Criteria ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm, PEA and asystole, as an initial rhythm. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G), and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Results: The 109,175 patients who met the inclusion criteria comprised 18,764 who received CPR based on 2015G and 90,411 who received CPR based on 2010G. The figure showed favorable neurological outcomes at 30 days in the two groups. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in 2015G patients as compared to 2010G patients was 1.28 (95%CI 1.11-1.46, p<0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

Epinephrine dosing interval and neurological outcome in out-of-hospital cardiac arrest

Perfusion ◽  
2021 ◽  
pp. 026765912110251
Author(s):  
Tatsuma Fukuda ◽  
Hirotsugu Kaneshima ◽  
Aya Matsudaira ◽  
Takumi Chinen ◽  
Hiroshi Sekiguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Standard Dose ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Time Interval ◽  
Epinephrine Administration ◽  
Dosing Interval ◽  
Using Data ◽  
Dosing Intervals ◽  
Hospital Cardiac Arrest

Objective: Current guidelines for cardiopulmonary resuscitation (CPR) recommend that standard-dose epinephrine be administered every 3–5 minutes during cardiac arrest. However, there is a knowledge gap regarding the optimal epinephrine dosing interval. This study aimed to examine the association between epinephrine dosing intervals and outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This was a nationwide population-based observational study using data from a Japanese government-led registry of OHCA, including patients who experienced OHCA in Japan from 2011 to 2017. We defined the epinephrine dosing interval as the time interval between the first epinephrine administration and return of spontaneous circulation in the prehospital setting, divided by the total number of epinephrine doses. The primary outcome was 1-month neurologically favorable survival. Results: A total of 10,965 patients (mean (SD) age, 75.8 (14.3) years; 59.8% male) were included. The median epinephrine dosing interval was 3.5 minutes (IQR, 2.5–4.5; mean (SD), 3.6 (1.8)). Only approximately half of the patients received epinephrine administration with a standard dosing interval, as recommended in the current CPR guidelines. After multivariable adjustment, compared with the standard dosing interval, neither shorter nor longer epinephrine dosing intervals were associated with neurologically favorable survival after OHCA (Short vs Standard: adjusted OR 0.87 [95%CI 0.66–1.15]; and Long vs Standard: adjusted OR 1.08 [95%CI 0.76–1.55]). Similar associations were observed in propensity score-matched analyses. Conclusions: The epinephrine dosing interval was not associated with 1-month neurologically favorable survival after OHCA. Our findings do not deny the recommended epinephrine dosing interval in the current CPR guidelines.

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