Adverse outcomes

不良结果
  • 文章类型: Journal Article
    BACKGROUND: Evidence is scarce on the effect of free fatty acid (FFA) level in the prognosis of coronary artery disease (CAD) patients with hypertension. This study.
    METHODS: A large prospective cohort study with a follow-up period of average 2 years was conducted at Xinjiang Medical University Affiliated First Hospital from December 2016 to October 2021. A total of 10,395 CAD participants were divided into groups based on FFA concentration and hypertension status, and then primary outcome mortality and secondary endpoint ischemic events were assessed in the different groups.
    RESULTS: A total of 222 all-cause mortality (ACMs), 164 cardiac mortality (CMs), 718 major adverse cardiovascular events (MACEs) and 803 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during follow-up period. A nonlinear relationship between FFA and adverse outcomes was observed only in CAD patients with hypertension. Namely, a \"U -shape\" relationship between FFA levels and long-term outcomes was found in CAD patients with hypertension. Lower FFA level (< 310 µmol/L), or higher FFA level (≥ 580 µmol/L) at baseline is independent risk factors for adverse outcomes. After adjustment for confounders, excess FFA increases mortality (ACM, HR = 1.957, 95%CI(1.240-3.087), P = 0.004; CM, HR = 2.704, 95%CI(1.495-4.890, P = 0.001) and MACE (HR = 1.411, 95%CI(1.077-1.848), P = 0.012), MACCE (HR = 1.299, 95%CI (1.013-1.666), P = 0.040) prevalence. Low levels of FFA at baseline can also increase the incidence of MACE (HR = 1.567,95%CI (1.187-2.069), P = 0.002) and MACCE (HR = 1.387, 95%CI (1.070-1.798), P = 0.013).
    CONCLUSIONS: Baseline FFA concentrations significantly associated with long-term mortality and ischemic events could be a better and novel risk biomarker for prognosis prediction in CAD patients with hypertension.
    BACKGROUND: The details of the design were registered on https://www.chictr.org.cn/ (Identifier NCT05174143).
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  • 文章类型: Journal Article
    BPA及其类似物正面临越来越严格的限制其使用的法规,这是由于对其有害影响的认识不断增加。因此,预计新型BPA类似物和替代品将在塑料制品中取代它们,易拉罐和热敏纸,以规避立法施加的限制。这引起了人们对“不含BPA”产品安全性的担忧,因为它们含有BPA替代品,其安全性在上市之前尚未得到充分评估。监管机构已经认可了BPAP,BPBP,BPC2,BPE,BPFL,BPG,BPP,BPPH,BPS-MAE,BPS-MPE,BP-TMC,BPZ和替代BTUM,D-90、UU和PF201为化合物,其安全性数据不足。我们证明上述化合物存在于消费品中,食物与环境,因此不仅对人类表现出毒理学风险,还有其他已经描述过其毒性作用的物种。计算机模拟结果,在体外和体内研究检查内分泌干扰和其他影响的BPA类似物表明,他们通过靶向各种核受体破坏内分泌系统,损害生殖功能并引起肝毒性等毒性作用,行为改变和生殖功能受损。关于BPA替代品的体外和体内数据实际上是不存在的,尽管这些化合物已经存在于常用的热敏纸中。然而,计算机模拟研究预测,它们也可能造成不良影响。本文的目的是全面整理有关选定BPA替代品的信息,以说明其潜在毒性并确定安全差距。
    BPA and its analogues are facing increasingly stringent regulations restricting their use due to the increasing knowledge of their harmful effects. It is therefore expected that novel BPA analogues and alternatives will replace them in plastic products, cans and thermal paper to circumvent restrictions imposed by legislation. This raises concerns about the safety of \"BPA-free\" products, as they contain BPA substitutes whose safety has not been sufficiently assessed prior to their market introduction. The regulatory agencies have recognised BPAP, BPBP, BPC2, BPE, BPFL, BPG, BPP, BPPH, BPS-MAE, BPS-MPE, BP-TMC, BPZ and the alternatives BTUM, D-90, UU and PF201 as compound with insufficient data regarding their safety. We demonstrate that the mentioned compounds are present in consumer products, food and the environment, thus exhibiting toxicological risk not only to humans, but also to other species where their toxic effects have already been described. Results of in silico, in vitro and in vivo studies examining the endocrine disruption and other effects of BPA analogues show that they disrupt the endocrine system by targeting various nuclear receptors, impairing reproductive function and causing toxic effects such as hepatotoxicity, altered behaviour and impaired reproductive function. In vitro and in vivo data on BPA alternatives are literally non-existent, although these compounds are already present in commonly used thermal papers. However, in silico studies predicted that they might cause adverse effects as well. The aim of this article is to comprehensively collate the information on selected BPA substitutes to illustrate their potential toxicity and identify safety gaps.
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  • 文章类型: Journal Article
    背景:计算信号预处理是开发用于临床决策支持的数据驱动预测模型的先决条件。因此,确定符合临床原则的最佳实践对于确保透明度和可重复性以推动临床采用至关重要.它进一步促进了可重复的,伦理,和可靠的研究。该程序对于建立软件质量管理系统以确保在开发软件作为旨在早期临床前检测临床恶化的医疗设备时符合法规也至关重要。
    目的:本范围综述侧重于新生儿重症监护病房的设置,并总结了用于预处理新生儿临床生理信号的最新计算方法;这些信号用于开发机器学习模型,以预测不良结局的风险。
    方法:五个数据库(PubMed,WebofScience,Scopus,IEEE,和ACM数字图书馆)使用关键字和MeSH(医学主题词)术语的组合进行搜索。根据定义的搜索词和纳入标准,从2013年到2023年1月共识别了3585篇论文。删除重复项后,2994篇(83.51%)论文按标题和摘要进行了筛选,81例(0.03%)被选中进行全文审查。其中,52(64%)符合纳入详细分析的条件。
    结果:在审查的52篇文章中,24项(46%)研究集中在诊断模型上,而其余的(n=28,54%)集中在预后模型上。在这些研究中进行的分析涉及各种生理信号,心电图是最普遍的。使用了不同的编程语言,MATLAB和Python值得注意。生理数据的监测和捕获使用不同的系统,影响数据质量并引入研究异质性。感兴趣的结果包括脓毒症,呼吸暂停,心动过缓,死亡率,坏死性小肠结肠炎,缺氧缺血性脑病,一些研究分析了不良结局的组合。我们发现在报告设置和用于信号预处理的方法时部分或完全缺乏透明度。这包括处理缺失数据的报告方法,用于考虑分析的段大小,以及关于生理信号处理的最新方法的修改的细节,以符合新生儿的临床原则。在52项审查的研究中,只有7项(13%)报告了所有推荐的预处理步骤,这可能会对下游分析产生影响。
    结论:该综述发现所使用的技术存在异质性,并且对用于预处理新生儿生理信号的参数和程序的报告不一致,这对于确认遵守临床和软件质量管理体系实践是必要的,有用性,以及最佳实践的选择。提高报告的透明度和标准化程序将提高研究的解释和可重复性,并加快临床采用。灌输对研究结果的信心,并简化研究结果转化为临床实践,最终有助于提高新生儿护理和患者预后。
    BACKGROUND: Computational signal preprocessing is a prerequisite for developing data-driven predictive models for clinical decision support. Thus, identifying the best practices that adhere to clinical principles is critical to ensure transparency and reproducibility to drive clinical adoption. It further fosters reproducible, ethical, and reliable conduct of studies. This procedure is also crucial for setting up a software quality management system to ensure regulatory compliance in developing software as a medical device aimed at early preclinical detection of clinical deterioration.
    OBJECTIVE: This scoping review focuses on the neonatal intensive care unit setting and summarizes the state-of-the-art computational methods used for preprocessing neonatal clinical physiological signals; these signals are used for the development of machine learning models to predict the risk of adverse outcomes.
    METHODS: Five databases (PubMed, Web of Science, Scopus, IEEE, and ACM Digital Library) were searched using a combination of keywords and MeSH (Medical Subject Headings) terms. A total of 3585 papers from 2013 to January 2023 were identified based on the defined search terms and inclusion criteria. After removing duplicates, 2994 (83.51%) papers were screened by title and abstract, and 81 (0.03%) were selected for full-text review. Of these, 52 (64%) were eligible for inclusion in the detailed analysis.
    RESULTS: Of the 52 articles reviewed, 24 (46%) studies focused on diagnostic models, while the remainder (n=28, 54%) focused on prognostic models. The analysis conducted in these studies involved various physiological signals, with electrocardiograms being the most prevalent. Different programming languages were used, with MATLAB and Python being notable. The monitoring and capturing of physiological data used diverse systems, impacting data quality and introducing study heterogeneity. Outcomes of interest included sepsis, apnea, bradycardia, mortality, necrotizing enterocolitis, and hypoxic-ischemic encephalopathy, with some studies analyzing combinations of adverse outcomes. We found a partial or complete lack of transparency in reporting the setting and the methods used for signal preprocessing. This includes reporting methods to handle missing data, segment size for considered analysis, and details regarding the modification of the state-of-the-art methods for physiological signal processing to align with the clinical principles for neonates. Only 7 (13%) of the 52 reviewed studies reported all the recommended preprocessing steps, which could have impacts on the downstream analysis.
    CONCLUSIONS: The review found heterogeneity in the techniques used and inconsistent reporting of parameters and procedures used for preprocessing neonatal physiological signals, which is necessary to confirm adherence to clinical and software quality management system practices, usefulness, and choice of best practices. Enhancing transparency in reporting and standardizing procedures will boost study interpretation and reproducibility and expedite clinical adoption, instilling confidence in the research findings and streamlining the translation of research outcomes into clinical practice, ultimately contributing to the advancement of neonatal care and patient outcomes.
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  • 文章类型: Journal Article
    创伤患者的预后高度依赖于早期医学诊断。通过构建列线图模型,不良后果的风险可以直观和单独地显示,这对医学诊断具有重要的临床意义。
    开发和评估可用于中国不同数据可用性设置的创伤不良结局患者预测模型。
    这是一项回顾性预后研究,使用2018年中国8家公立三甲医院的数据。将数据随机分为开发集和验证集。简单,开发了预测不良结局的改进和扩展模型,不良结局定义为院内死亡或ICU转移,和患者的临床特征,生命体征,诊断,和实验室测试值作为预测因子。模型的结果以列线图的形式呈现,并使用接受者工作特征曲线下面积(ROC-AUC)评估性能,精度-召回(PR)曲线(PR-AUC),Hosmer-Lemeshow拟合优度测试,校正曲线,和决策曲线分析(DCA)。
    我们的最终数据集包括18,629名患者(40.2%为女性,平均年龄52.3),其中1,089人(5.85%)导致不良后果。在外部验证集中,三个模型的ROC-AUC分别为0.872、0.881和0.903,PR-AUC分别为0.339、0.337和0.403。就校准曲线和DCA而言,模型也表现良好。
    这项预后研究发现,包括患者临床特征在内的三种预测模型和列线图,生命体征,诊断,和实验室检测值可以支持临床医生基于数据可用性更准确地识别在不同环境中存在不良结局风险的患者.
    UNASSIGNED: The prognosis of trauma patients is highly dependent on early medical diagnosis. By constructing a nomogram model, the risk of adverse outcomes can be displayed intuitively and individually, which has important clinical implications for medical diagnosis.
    UNASSIGNED: To develop and evaluate models for predicting patients with adverse outcomes of trauma that can be used in different data availability settings in China.
    UNASSIGNED: This was a retrospective prognostic study using data from 8 public tertiary hospitals in China from 2018. The data were randomly divided into a development set and a validation set. Simple, improved and extended models predicting adverse outcomes were developed, with adverse outcomes defined as in-hospital death or ICU transfer, and patient clinical characteristics, vital signs, diagnoses, and laboratory test values as predictors. The results of the models were presented in the form of nomograms, and performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), precision-recall (PR) curves (PR-AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis (DCA).
    UNASSIGNED: Our final dataset consisted of 18,629 patients (40.2% female, mean age of 52.3), 1,089 (5.85%) of whom resulted in adverse outcomes. In the external validation set, three models achieved ROC-AUC of 0.872, 0.881, and 0.903, and a PR-AUC of 0.339, 0.337, and 0.403, respectively. In terms of the calibration curves and DCA, the models also performed well.
    UNASSIGNED: This prognostic study found that three prediction models and nomograms including the patient clinical characteristics, vital signs, diagnoses, and laboratory test values can support clinicians in more accurately identifying patients who are at risk of adverse outcomes in different settings based on data availability.
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  • 文章类型: Journal Article
    孕妇精神药物治疗的进步对于解决围产期产妇的心理健康至关重要。建议在怀孕期间筛查情绪和焦虑症状,以便早期干预。精神药物,包括抗抑郁药,苯二氮卓类药物,抗精神病药,和情绪稳定剂,是常用的,但其在怀孕期间的安全性和有效性仍存在挑战.怀孕引起药代动力学的显着变化,需要个性化的给药策略和仔细的监测。实时监控技术,例如智能手机集成平台和基于家庭的监控,提高可达性和准确性。前瞻性研究和医疗保健提供者之间的合作对于循证指南和最佳治疗策略至关重要。减少怀孕期间心理健康的污名对于确保女性寻求帮助和讨论治疗方案至关重要。促进社区内的理解和接受。
    Advancements in psychotropic therapy for pregnant women are pivotal for addressing maternal mental health during the perinatal period. Screening for mood and anxiety symptoms during pregnancy is recommended to enable early intervention. Psychotropic medications, including antidepressants, benzodiazepines, antipsychotics, and mood stabilizers, are commonly used, but challenges remain regarding their safety and efficacy during pregnancy. Pregnancy induces significant changes in pharmacokinetics, necessitating personalized dosing strategies and careful monitoring. Real-time monitoring technologies, such as smartphone-integrated platforms and home-based monitoring, enhance accessibility and accuracy. Prospective studies and collaboration among healthcare providers are essential for evidence-based guidelines and optimal treatment strategies. Reducing stigma around mental health during pregnancy is crucial to ensure women seek help and discuss treatment options, promoting understanding and acceptance within the community.
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  • 文章类型: Systematic Review
    这项系统评价和荟萃分析(SRMA)评估了气道正压(PAP)疗法在肥胖手术患者围手术期护理中的有效性和安全性。我们回顾了24项研究,包括截至2023年3月23日的数据,分析了持续气道正压(CPAP)和双水平气道正压(BIPAP)对术后不良结局的影响,氧合,和肺功能。我们的发现强调了PAP治疗在围手术期管理肥胖患者方面的巨大潜力。尤其是那些有严重术后呼吸系统并发症风险的患者。PAP治疗不仅可以提高氧合水平和肺功能,而且可以大大降低肺不张的发生率并缩短住院时间,从而肯定了其在改善该患者人群围手术期结局方面的重要作用。
    This systematic review and meta-analysis (SRMA) evaluates the efficacy and safety of Positive Airway Pressure (PAP) therapy in perioperative care for obese surgical patients. We reviewed 24 studies, encompassing data up to March 23, 2023, analyzing the impacts of Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP) on postoperative adverse outcomes, oxygenation, and pulmonary function. Our findings underscore the significant potential of PAP therapy in managing obese patients during the perioperative period, particularly those at substantial risk for postoperative respiratory complications. PAP therapy not only enhances oxygenation levels and lung function but also substantially reduces the incidence of atelectasis and shortens hospital stays, thereby affirming its vital role in improving perioperative outcomes for this patient population.
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  • 文章类型: Journal Article
    本研究的目的是确定维持性血液透析患者的虚弱与不良结局之间的关联强度。
    系统评价和荟萃分析。
    年龄≥18岁接受维持性血液透析的患者。
    PubMed,WebofScience,Embase,Cochrane图书馆,Scopus,中国知识资源综合数据库,从开始到2024年4月11日,都搜索了万方数据库和维普数据库。审稿人独立选择研究,提取数据并评估研究质量。使用Stata15.1软件进行荟萃分析。
    本研究共纳入36篇文章,包括56,867名患者。本研究的主要结局事件是死亡率,住院治疗,和血管通路事件。次要结果是抑郁,认知障碍,falls,骨折,睡眠障碍,和生活质量。这项研究表明,虚弱与维持性血液透析患者的死亡率相关[风险比(HR),1.97;95%CI,1.62-2.40]。虚弱增加了患者死亡的风险[比值比(OR),2.33;95%CI,1.47-3.68]。此外,我们发现,在接受维持性血液透析的患者中,虚弱与住院显著相关(OR,2.47;95%CI,1.52-4.03)。正在接受维持性血液透析且身体虚弱的患者住院风险更大[RR,1.47;95%CI,1.05-2.08]和紧急就诊(RR,2.28;95%CI,1.78-2.92)。这项研究的结果还表明,虚弱与血管通路事件的更大风险相关(HR,1.72;95%CI,1.50-1.97)。最后,虚弱会增加患抑郁症的风险(或,4.31;95%CI,1.83-10.18),跌倒和骨折,降低了生活质量。
    这项研究的结果表明,虚弱是维持性血液透析患者不良结局的重要预测因素。在未来,医务人员应定期评估虚弱的迹象,制定个体化诊疗方案,根据患者病情调整透析计划,减少不良事件的发生。
    研究协议已在PROSPERO上注册(https://www.crd.约克。AC.英国/PROSPERO/,编号:CRD42023486239)。
    UNASSIGNED: The aim of this study was to determine the strength of the association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis.
    UNASSIGNED: A systematic review and meta-analysis.
    UNASSIGNED: Patients aged ≥18 years who were undergoing maintenance hemodialysis.
    UNASSIGNED: PubMed, Web of Science, Embase, the Cochrane Library, Scopus, the China Knowledge Resource Integrated Database, the Wanfang Database and the Weipu Database were searched from inception until 11 April 2024. The reviewers independently selected the studies, extracted the data and evaluated the quality of the studies. Stata 15.1 software was used to perform the meta-analysis.
    UNASSIGNED: A total of 36 articles were included in this study, including 56,867 patients. The primary outcome events in this study were mortality, hospitalization, and vascular access events. The secondary outcomes were depression, cognitive impairment, falls, fracture, sleep disturbances, and quality of life. This study suggested that frailty was associated with mortality in patients undergoing maintenance hemodialysis [hazard ratio (HR), 1.97; 95% CI, 1.62-2.40]. Frailty increased the risk of mortality in patients [odds ratio (OR), 2.33; 95% CI, 1.47-3.68]. In addition, we found that frailty was significantly associated with hospitalization in patients undergoing maintenance hemodialysis (OR, 2.47; 95% CI, 1.52-4.03). Patients who were undergoing maintenance hemodialysis and who were frail had a greater risk of hospitalization [RR, 1.47; 95% CI, 1.05-2.08] and emergency visits (RR, 2.28; 95% CI, 1.78-2.92). The results of this study also suggested that frailty was associated with a greater risk of vascular access events (HR, 1.72; 95% CI, 1.50-1.97). Finally, frailty increased the risk of depression (OR, 4.31; 95% CI, 1.83-10.18), falls and fractures, and reduced quality of life.
    UNASSIGNED: The findings of this study suggested that frailty was an important predictor of adverse outcomes in patients undergoing maintenance hemodialysis. In the future, medical staff should regularly evaluate signs of weakness, formulate individual diagnosis and treatment plans, adjust dialysis plans according to the patient\'s condition, and reduce the occurrence of adverse events.
    UNASSIGNED: The study protocol was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023486239).
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  • 文章类型: Journal Article
    背景:风湿性二尖瓣狭窄(MS)在亚洲仍然是一个常见且令人担忧的健康问题。经皮球囊二尖瓣成形术(PBMV)是有症状的重度MS和良好瓣膜形态患者的标准治疗方法。然而,在亚洲,关于PBMV后不良心脏结局的发生率和预测因素的研究有限.本研究旨在评估PBMV后风湿性MS患者不良结局的发生率和预测因素。
    方法:在泰国的一所高等学术机构,对2002年至2020年间成功接受PBMV的有症状的重度MS患者进行了一项回顾性队列研究。对患者进行随访以评估不良结果,定义为心脏死亡的复合物,心力衰竭住院,重复PBMV,或者二尖瓣手术.进行单变量和多变量分析以确定不良结局的预测因子。P值<0.05被认为是统计学上显著的。
    结果:本研究共纳入379例患者(平均年龄43±11岁,80%女性)。在5.9年的中位随访期间(IQR1.7-11.7),74例患者(19.5%)出现不良结局,年度事件率为2.7%。多变量分析表明,年龄(危险比[HR]1.03,95%置信区间[CI]1.008-1.05,p=0.006),显著三尖瓣返流(HR2.17,95%CI1.33-3.56,p=0.002),PBMV后即刻二尖瓣面积(HR0.39,95%CI0.25-0.64,p=0.01),PBMV后即刻二尖瓣返流(HR1.91,95%CI1.18-3.07,p=0.008)是不良结局的独立预测因子.
    结论:在有症状的严重风湿性MS患者中,PBMV后不良结局的发生率为每年2.7%.年龄,显著的三尖瓣反流,PBMV后即刻二尖瓣面积,PBMV术后即刻二尖瓣反流被确定为这些不良结局的独立预测因子.
    BACKGROUND: Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV.
    METHODS: A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of < 0.05 was considered statistically significant.
    RESULTS: A total of 379 patients were included in the study (mean age 43 ± 11 years, 80% female). During a median follow-up of 5.9 years (IQR 1.7-11.7), 74 patients (19.5%) experienced adverse outcomes, with an annualized event rate of 2.7%. Multivariable analysis showed that age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008-1.05, p = 0.006), significant tricuspid regurgitation (HR 2.17, 95% CI 1.33-3.56, p = 0.002), immediate post-PBMV mitral valve area (HR 0.39, 95% CI 0.25-0.64, p = 0.01), and immediate post-PBMV mitral regurgitation (HR 1.91, 95% CI 1.18-3.07, p = 0.008) were independent predictors of adverse outcomes.
    CONCLUSIONS: In patients with symptomatic severe rheumatic MS, the incidence of adverse outcomes following PBMV was 2.7% per year. Age, significant tricuspid regurgitation, immediate post-PBMV mitral valve area, and immediate post-PBMV mitral regurgitation were identified as independent predictors of these adverse outcomes.
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  • 文章类型: Journal Article
    已知患有精神健康(MH)问题的患者经常使用急诊科(ED)。这项研究确定了ED用户的概况,并将这些概况与患者特征和门诊服务使用相关联,以及随后的不良后果。对11,682名ED用户的5年队列进行了调查(2012-2017年),使用魁北克(加拿大)管理数据库。ED用户档案是通过潜在的类别分析来识别的,和多项logistic回归用于将患者特征与其门诊服务使用相关联。在最后一次ED使用后12个月进行Cox回归以评估不良结果。确定了四个ED用户配置文件:“主要使用ED访问MH服务的患者”(配置文件1,事件MD);“重复ED用户”(配置文件2);“高ED用户”(配置文件3);“非常高和反复出现的高ED用户”(配置文件4)。概况4和3患者表现出最高的ED使用率以及严重的病情,但仍接受了最多的门诊护理。在这些情况下,住院和死亡的风险更高。他们频繁的ED使用和不良后果可能源于未满足的需求和欠佳的护理。对于配置文件4和3,可以建议进行自信的社区治疗和强化病例管理,对于配置文件2和1,可以建议进行更广泛的基于团队的GP护理。
    Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012-2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients\' characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: \"Patients mostly using EDs for accessing MH services\" (Profile 1, incident MDs); \"Repeat ED users\" (Profile 2); \"High ED users\" (Profile 3); \"Very high and recurrent high ED users\" (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.
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  • 文章类型: Journal Article
    目的:确定年轻成年人(<65岁)有意义的估计肾小球滤过率(eGFR)降低可以指导预防工作。为了帮助解释和识别处于危险中的年轻人,我们研究了按年龄和临床结局划分的人口水平eGFR百分位数相对于中位数的相关性.
    方法:我们对来自安大略省的870万成年人进行了回顾性队列研究,加拿大从18岁到65岁,从2008年到2021年,采用eGFR措施(单一门诊价值和重复措施)。我们计算了按年龄划分的eGFR中位数,并检查了降低的eGFR百分位数(≤10,5th,2.5和1)使用时间到事件模型的结果。结果是全因死亡率的复合,主要不良心脏结局(MACE)伴/不伴心力衰竭(MACE)和肾衰竭以及每个组成部分。
    结果:从18岁到65岁,eGFR中位数随年龄(128至90)和百分位数的增加而下降[eGFR范围为102至68,≤10岁,96到63对于≤5,≤2.5时为90至58,1时为83至54]。任何不良结局的校正率在≤10百分位数(HR1.1495CI1.10-1.18)升高,并且对于全因死亡率是一致的,MACE,与年龄中位数eGFR相比,MACE+和肾衰竭占优势(HR5.5795CI3.79-8.19)。eGFR在较低百分位数的年轻人不太可能被转诊给专家,有一个重复的eGFR或白蛋白肌酐比值测量。
    结论:基于人群水平分布的第10百分位数或更低的eGFR值与不良临床结局相关,在年轻成年人(18至39岁)中,这对应于更高的eGFR水平,可能被低估。基于人群的eGFR百分位数的应用可能有助于解释并改善对处于危险中的年轻成年人的识别。
    OBJECTIVE: Identifying meaningful estimated glomerular filtration rate (eGFR) reductions in younger adults (<65 years) could guide prevention efforts. To aid in interpretation and identification of young adults at risk, we examined the association of population-level eGFR percentiles relative to the median by age and clinical outcomes.
    METHODS: We conducted a retrospective cohort study of 8.7 million adults from Ontario, Canada from age 18 to 65 from 2008 to 2021 with an eGFR measure (both single outpatient value and repeat measures). We calculated median eGFR values by age and examined the association of reduced eGFR percentiles (≤10th, 5th, 2.5th and 1st) with outcomes using time to event models. Outcomes were a composite of all-cause mortality, major adverse cardiac outcomes (MACE) with/without heart failure (MACE+) and kidney failure as well as each component individually.
    RESULTS: From age 18 to 65, the median eGFR declined with age (range 128 to 90) and across percentiles [eGFR ranges 102 to 68 for ≤10th, 96 to 63 for ≤5th, 90 to 58 for ≤2.5th and 83 to 54 for 1st]. The adjusted rate for any adverse outcome was elevated at ≤ 10th percentile (HR 1.14 95%CI 1.10-1.18) and was consistent for all-cause mortality, MACE, MACE+ and predominant for kidney failure (HR 5.57 95%CI 3.79-8.19) compared to the median eGFR for age. Young adults with an eGFR in the lower percentiles were less likely to be referred to a specialist, have a repeat eGFR or albumin to creatinine ratio measure.
    CONCLUSIONS: eGFR values at the 10th percentile or lower based on a population-level distribution are associated with adverse clinical outcomes and in younger adults (18 to 39) this corresponds to a higher level of eGFR that may be underrecognized. Application of population-based eGFR percentiles may aid interpretation and improve identification of younger adults at risk.
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