Probability Of Death Research Articles

13. Abnormal Cardiac Finding Increases Mortality Risk in Hypertensive COVID-19 Patients

Background: The probability of in-hospital death was significantly higher in patients with hypertension, hence increasing the risk for severe clinical presentations of COVID-19. Objective: We aimed to determine whether cardiac examination is correlated with increasing mortality risk among hypertensive COVID-19. Methods: This retrospective cohort study included 406 patients with hypertension and confirmed COVID-19 in referral hospitals in East Java between March 2020 to April 2021. Clinical finding, electrocardiograph (ECG), laboratory and chest x-ray (CXR) findings are examined to predict mortality of the hypertensive COVID-19 patients. Results: The median patient age was 57 years with range 49–64 years old, predominantly men 58.4%. The final model associated with an increase of mortality in hypertensive COVID-19 patients include cardiomegaly (p = 0.036), sinus tachycardia (p = 0.001), ST-segment abnormalities (p = 0.036), right bundle branch block (p = 0.008), left bundle branch block (p = 0.046), left ventricle hypertrophy (p = 0,023)., which were found to be significant predictors of mortality in hypertensive COVID-19 patients after the multivariable regression analysis. Conclusion: We concluded that specific abnormal cardiac examination (cardiomegaly, tachycardia, ST Segment abnormalities, left ventricle hypertrophy, right and left bundle branch block) increase the mortality risk in hypertensive COVID-19 patients. Therefore, complete cardiac examination is important for hypertensive COVID-19 patients to determine prognosis.

Development and validation of echocardiography-based machine-learning models to predict mortality.

Echocardiography (echo) based machine learning (ML) models may be useful in identifying patients at high-risk of all-cause mortality. We developed ML models (ResNet deep learning using echo videos and CatBoost gradient boosting using echo measurements) to predict 1-year, 3-year, and 5-year mortality. Models were trained on the Mackay dataset, Taiwan (6083 echos, 3626 patients) and validated in the Alberta HEART dataset, Canada (997 echos, 595 patients). We examined the performance of the models overall, and in subgroups (healthy controls, at risk of heart failure (HF), HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)). We compared the models' performance to the MAGGIC risk score, and examined the correlation between the models' predicted probability of death and baseline quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ). Mortality rates at 1-, 3- and 5-years were 14.9%, 28.6%, and 42.5% in the Mackay cohort, and 3.0%, 10.3%, and 18.7%, in the Alberta HEART cohort. The ResNet and CatBoost models achieved area under the receiver-operating curve (AUROC) between 85% and 92% in internal validation. In external validation, the AUROCs for the ResNet (82%, 82%, and 78%) were significantly better than CatBoost (78%, 73%, and 75%), for 1-, 3- and 5-year mortality prediction respectively, with better or comparable performance to the MAGGIC score. ResNet models predicted higher probability of death in the HFpEF and HFrEF (30%-50%) subgroups than in controls and at risk patients (5%-20%). The predicted probabilities of death correlated with KCCQ scores (all p<0.05). Echo-based ML models to predict mortality had good internal and external validity, were generalizable, correlated with patients' quality of life, and are comparable to an established HF risk score. These models can be leveraged for automated risk stratification at point-of-care. Funding for Alberta HEART was provided by an Alberta Innovates - Health Solutions Interdisciplinary Team Grant no. AHFMRITG 200801018. P.K. holds a Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair and a Heart & Stroke Foundation Chair in Cardiovascular Research. A.V. and V.S. received funding from the Mitacs Globalink Research Internship.

A study of complications encountered in chronic kidney disease patient undergoing hemodialysis at tertiary health center: A cross sectional study

Background: The prevalence of chronic kidney disease (CKD) is increasing worldwide. The progression of CKD aetiology increases the probability of death, which lowers quality of life (QOL). Therefore, we studied complications encountered in CKD patient undergoing hemodialysis at tertiary health center. Methods: This is a cross sectional, observational study conducted among 100 patients for 24 months duration. All CKD patients who were undergoing maintenance hemodialysis at tertiary health care center in Vidharba, India. Patients with CKD (stages 3-5) who required hemodialysis, regardless of gender, were included, as were all patients older than 12 years old. Results: We studied 100 CKD patients undergoing hemodialysis in which 33 (33%) were females and 67 (67%) were males. Hypotension was the most common intradialytic complication (34.2%), followed by muscle cramps (19.5%) and rigors (17.5%). Other complications such as hypoglycemia, nausea, vomiting, chest pain, itching, arrhythmias, and pulmonary edema were reported at lower frequencies. The study found no significant association between age, gender and intradialytic complications. (P value= 0.072). Conclusion: Based on the outcomes of the study, we can conclude that hypotension is the most frequent intradialytic complications followed by, hypoglycemia, nausea/vomiting, muscle cramp, rigors, chest pain, itching, arrhythmias and pulmonary edema. Majority of patients were found to be comorbid having hypertension, diabetes which again are the factors responsible for worsening of disease.

Development of a Nomogram to Estimate the 60-Day Probability of Death or Culling Due to Severe Clinical Mastitis in Dairy Cows at First Veterinary Clinical Evaluation

Severe clinical mastitis is a frequent disease of dairy cattle. An effective mean of predicting survival despite treatment would be helpful for making euthanasia decisions in poor prognosis cases. The objective was to develop a nomogram for prediction of death or culling in the 60 days following a severe mastitis episode in dairy cows at first veterinary visit in farm settings. A total of 224 dairy cows presenting severe clinical mastitis and examined for the first time by a veterinarian were included in a prospective study. Clinical and laboratory (complete blood cell count, L-lactate, cardiac troponin I, milk culture) variables were recorded. Animals were followed for 60 days. A nomogram was built with an adaptive elastic-net Cox proportional hazards model. Performances and relevance were evaluated by area under the receiver operating characteristic curve (AUC), Harrell's concordance index (C-index), calibration curve, decision curve analysis (DCA) and misclassification cost term (MCT). The nomogram included: lactation number, recumbency, depression intensity, capillary refilling time, ruminal motility rate, dehydration level, lactates concentration, hematocrit, band neutrophils count, monocyte count, and milk bacteriology. The AUC and C-index showed a good calibration and ability to discriminate. The DCA suggested that the nomogram was clinically relevant. Euthanizing animals having less than 25% probability of survival is economically optimal. It could be used for early euthanasia decisions in animals that would not survive despite treatment. To facilitate the use of this nomogram by veterinarians, a web-based app was developed.

Пропозиції щодо удосконалення правового регулювання використання тахографів на автомобільному транспорті

The probability of death or serious injury in an accident with a road vehicle involved is almost 50% higher compared to other accidents due to the large size and mass of the vehicles involved, as well as due to the fact the driver who fell asleep cannot undertake braking or motion to a side , to avoid a collision or abate an impact. Although it is impossible to calculate the exact number of fatigue-related crashes, studies show that driver fatigue may be a contributing factor in about 20% of all traffic crashes and approximately 25% of all fatal and serious injury crashes. In order to reduce the number of road accidents by means preventing the driving by tired drivers of com-mercial vehicles with a gross weight of more than 3.5 ton, as well as those that carry more than 9 people in the pro-cess of road transportation, tachograph systems have been implemented in many countries. The major documents implementing the tachograph systems (depending on the country) are Regulation (EC) No. 561/2006 of the European Parliament and of the Council or the European agreement concerning the work of crews of vehicles engaged in international road transport (AETR). In order to contribute to the improvement of the level of safety during the internal road transportation of passengers and cargo, Ukraine, in accordance with the Association Agreement between the European Union and the European Atomic Energy Community and their Member States, of the one part, and Ukraine, of the other part, has undertaken to implement the requirements of the Council Regulation (EEC) No. 3821/85 and Regulation (EC) No. 561/2006 of the European Parliament and of the Council in the legislative and regulatory acts of Ukraine. When implementing the requirements of the aforementioned Regulations into the legislative and regulatory acts of Ukraine, it is necessary to take into account the recent changes to the specified documents, as well as the introduc-tion into the EU legislation of associate documents that are directly related to the aforementioned Regulations. Keywords: road safety, tachograph system.

National panorama of adolescent pregnancy in Mexico: lessons learned in a six-year period.

Globally, adolescent pregnancy constitutes a serious public health problem of a multifactorial nature. Specifically for women, it entails various educational, economic and social implications that affect their life project and widen the social gaps in this age group. Furthermore, adolescent girls are more vulnerable because of the health risk involved with pregnancy at a younger age. According to the World Health Organization, "the probability of maternal death is twice as high in adolescents in comparison with women aged between 20 and 30 years, and for those younger than 15 years, the risks are five times higher". In general, adolescents are in great need for education on sexual and reproductive health issues, which should be aimed at increasing information and knowledge about correct use and access to modern contraceptive methods, as well as at demystifying fears and beliefs around their possible side effects. Ensuring proper counseling with trained personnel is equally vital. Public institutions have a social responsibility to support efforts aimed at preventing adolescent pregnancy, based on relevant lines of action and health policies.

The Mortality from External Causes: Impact of the COVID-19 Pandemic and the War in Ukraine

Extreme events (the COVID-19 pandemic and the Russian aggression beginning with 24.02.2022) had adverse effects for the number of premature deaths, the overall mortality, the death rate and structure due to external causes (ECs). While the change determined by spread of COVID-19 in 2019–2021 can be revealed with a high reliability by use of official statistics data, mortality statistics in Ukraine became hardly accessible after 24.02.2022. The exact number of deaths caused by the war (for military men and civil population alike) has not been known by now. Even on the territories outside the warfare zone, not all the death occurrences due to ECs have been identified and classified with accuracy. There exist a series of factors for the increased probability of death caused by ECs in time of war due to injuries provoked by warfare and other factors. &#x0D; The research objective is to assess the change in mortality due to external causes resulting from the spread of COVID-19 pandemic and the subsequent large-scale Russian invasion of Ukraine; to identify and assess risk factors with impact on this change, and, given the lack of updated statistical data, to articulate hypotheses on a probable change in the mortality by cause, on conformity with Chapter XX “External causes of morbidity and mortality” of the International Statistical Classification of Deceases and Related Health Problems (10th revision).&#x0D; An assessment of the prewar situation and the change in time of the COVID-19 pandemic was made by data of the State Statistics Service of Ukraine on the distribution of deaths by cause, gender and age for 2019–2021; the situation in time of the war was assessed by selected data of the official departmental statistics and data of international agencies for 2022. It was revealed that in 2021 a smaller share of deaths (3.20% against 4.25% in2019) fell into Chapter XX. Ukraine did not feature a reduced mortality due to ECs relative to 2019, with the estimate by Eurostandard being virtually unchanged.&#x0D; Factors determining the potentially increasing mortality due to ECs in Ukraine are as follows: the war and massive injuries (of military men and civil population) resulting from the warfare throughout the active period of war and its consequences, e. g. hitting by explosive devices after its cessation; the acute or chronic mental pressure with the majority of the population and the spreading post-traumatic disorders provoking the increasing scales of risky behaviors and suicide; ruining of transport infrastructures and loosening control over the traffic safety, especially in times of blackout; the increasing probability of unintentional poisoning (with chemical substances, carbon monoxide, poisonous plants and mushrooms, alcohol), thermal injuries and overcooling/frostbites. carbon monoxide&#x0D; The increasing mortality due to ECs (mainly from injuries resulting from warfare, suicides, injuries with undefined intentions, road traffic accidents or poisonings) was predicted for 2022–2023, for the period before the end of the war and in the short run after it, with the widening gap between the mortality of men and women. The additional factor increasing a probability of death from nonfatal injuries and traumas or preventable ECs is the worse access to the medical aid due to objective and/or subjective reasons and the overburdened health protection system.

Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy.

Continuous kidney replacement therapy (CKRT) has been expanded from simple kidney replacement therapy to the field of critical illness in children. However, CKRT is rarely used in critically ill neonates in the neonatal intensive care unit (NICU). This study aimed to describe patients' clinical characteristics at admission and CKRT initiation, CKRT effects, short-term outcomes, and predictors of death in critically ill neonates. A 7-year single-center retrospective study in a tertiary NICU. Thirty-nine critically ill neonates received CKRT between May 2015 and April 2022 with a mortality rate of 35.9%. The most common primary diagnosis was neonatal sepsis in 15 cases (38.5%). Continuous veno-venous hemodiafiltration and continuous veno-venous hemofiltration were applied in 43.6% and 56.4% of neonates, respectively. The duration of CKRT was 44 (18, 72) h. Thirty-one patients (79.5%) had complications due to CKRT-related adverse events, and the most common complication was thrombocytopenia. Approximately 12h after the CKRT initiation, urine volume, mean arterial pressure, and pH were increased, and serum creatinine, blood urea nitrogen, and blood lactate were decreased. In the multivariate logistic regression analysis, neonatal critical illness score [odds ratio 0.886 (0.786 ~ 0.998), P = 0.046] was an independent risk factor for death in critically ill neonates who received CKRT. CKRT can be an effective and feasible technique in critically ill neonates, but the overall mortality and CKRT-related complications are relatively high. Furthermore, the probability of death is greater among neonates with greater severity of illness at CKRT initiation. A higher resolution version of the Graphical abstract is available as Supplementary information.

In-hospital mortality among patients admitted for hypertension-related complications in Goma, in the Democratic Republic of the Congo

Introduction: The aim of this study was to determine the in-hospital mortality rate related to complications of hypertension in Goma. Material and methods: We conducted a retrospective and analytical study during the study period from 1st January 2020 to 31st December 2021. We assessed in-hospital mortality among patients admitted for hypertension-related complications in 8 hospitals in Goma, the Democratic Republic of the Congo. We modeled the probability of death using stepwise logistic regression. Results: Of 485 hypertensive patients (mean age: 60.57 years; 221 women), 67 (13.8%) were unaware that they had hypertension. Among 418 conscious patients (86.2%), 25 (6.0%) were not taking antihypertensive medication. During the 15 days (median) of hospitalization, 181 deaths (37.2%) occurred. The multivariate adjusted probability of death increased with comorbidities: heart failure (adjusted OR=4.1; 95% CI: 1.76-10.8), chronic renal failure (adjusted OR= 5.43; 95% CI: 1.97-17.8), and cerebrovascular complications of hypertension (adjusted OR=2.14; 95% CI: 1.28-3.61). Conclusion: In-hospital mortality of African patients hospitalized for hypertension-related disorders in Goma is above 30%. These results highlight that screening and treatment of hypertension and prevention of cardiovascular disease should be much higher on the political agenda in sub-Saharan Africa.

GLOBAL SIGNATURES OF THE MICROBIOME AND METABOLOME DURING HOSPITALIZATION OF SEPTIC PATIENTS.

Background: The gut plays an important role in the development of sepsis and acts as one of the possible drivers of multiple-organ dysfunction syndrome. This study aimed to explore the dynamic alterations in the gut microbiota and its metabolites in septic patients at different stages of intensive care unit (ICU) admission. Methods: In this prospective observational study, a total of 109 fecal samples from 23 septic patients, 16 nonseptic ICU patients and 10 healthy controls were analyzed. 16S rRNA gene sequencing and ultra-performance liquid chromatography coupled to tandem mass spectrometry targeted metabolomics were used for microbiota and metabolome analysis. A prediction model combining the Sequential Organ Failure Assessment score, Klebsiella , taurocholic acid, and butyric acid was used to predict the prognosis of sepsis. Results: The diversity and dominant species of the gut microbiota of septic patients were significantly disturbed. The proportions of normal gut microbiota, such as Firmicutes on the phylum level, as well as Faecalibacterium, Subdoligranulum , Ruminococcus , Agathobacter , and Blautia on the genus level, were decreased at different stages of ICU admission, while the proportions of potential pathogenic bacteria, such as Proteobacteria on the phylum level, and Enterococcus and Stenotrophomonas on the genus level were significantly increased. In addition, the amount of short-chain fatty acids and secondary bile acids decreased in septic patients, while that of the primary bile acids increased markedly. Bacterial richness and diversity were lower in the nonsurviving patients than those in the surviving patients in the later stage of ICU admission. In the nomogram model, the higher abundance of Klebsiella , concentration of taurocholic acid, and Sequential Organ Failure Assessment score, combined with a lower butyric acid concentration, could predict a higher probability of death from sepsis. Conclusions: Our study indicated that the dynamical alterations of gut microbiota and its metabolites were associated with the prognosis of the sepsis. Based on these alterations and clinical indicators, a nomogram model to predict the prognosis of septic patients was performed.

Factors associated with long-term outcomes in adult congenital heart disease patients with infective endocarditis: a 16-year tertiary single-centre experience.

Studies concerning factors associated with long-term outcomes in adult congenital heart disease (ACHD) patients after infective endocarditis (IE) are scarce, while IE-related mortality in these patients remains a burden. We evaluated the factors associated with long-term survival in ACHD patients admitted for IE. We performed a retrospective single-centre study of all ACHD patients admitted for IE to a tertiary cardiothoracic centre between 1999 and 2015. Underlying ACHD, detailed echocardiographic and clinical data, surgical treatment and long-term follow-up were analysed. We identified 151 ACHD patients admitted due to 176 episodes IE with 30-day, 6-month and 1-, 5- and 10-year survival of 95.4%, 92.7%, 92.7%, 84.7% and 75.6%, respectively. In a multivariable analysis, adjusted estimated probability of death was consistently higher after an IE episode among patients with complex as compared to simple/moderate ACHD: 10.6% vs 2.4% at 30 days, 15.0% vs 3.4% at 6 months and 1 year, 30.4% vs 7.8% at 5 years and 44.9% vs 13.1% at 10 years. Risk of death was higher among patients with prosthetic valve in comparison with those without (risk ratios 1.73-1.92). Surgical treatment was required in 76 (43.2%) episodes with 30-day mortality of 3.9%. Risk of death appeared to be lower than in the conservatively treated subgroup (risk ratios 0.71-0.78). We demonstrated satisfactory long-term survival in ACHD patients who were treated for IE in a tertiary cardiothoracic centre. Early mortality tended to be lower in the surgically treated subgroup. Factors negatively associated with long-term survival were complex ACHD and presence of prosthetic valve.

Does conditioning cash transfers on health treatment harm the health of other families on low incomes who depend on public services? Evidence from Brazil

SummaryMotivationCash transfers have become popular for relieving poverty in the Global South. Many programmes are conditional on beneficiaries complying with medical check‐ups, nutritional assessments, and vaccinations. Such conditions may improve the health of beneficiaries, above all the health of their young children. But often public health provision is strained. Might the increased attention to those getting the transfers reduce health services to non‐beneficiaries, and especially those on low incomes who cannot afford private medicine?PurposeWhat are the impacts of the largest and longest‐lived conditional cash transfer programme in the world, Brazil's Bolsa Família (BF), on the health of non‐beneficiaries living in poverty? Does the health of non‐beneficiaries suffer when BF requirements come into place? Do the health requirements of BF lead to increased administrative costs for local health centres? Do they squeeze remaining resources for health care?Methods and approachSurveys from before and after the creation of BF are used to model the probability of death for infants born into poor households, comparing those enrolled in BF to those not included. The impacts of the BF programme on local health budgets are modelled through regression analysis. The analysis takes advantage of the varying degree of coverage of BF at the level of municipalities across Brazil.FindingsImplementation of BF led to lower risk of death of infants from beneficiary families than predicted by trends before BF, while infants from impoverished non‐beneficiary families developed a higher‐than‐expected risk of death. The benefits to the former group were larger than the harm to the latter group, which explains why BF appears to reduce infant and child mortality in aggregate. The expansion of BF depressed local spending on primary health care. Above all, more of the health budget and staff time was spent on monitoring compliance with health conditionalities.Policy implicationsThe harmful spillovers from BF to the health of low‐income households who were not included in the programme pose questions about the conditions that often accompany cash transfer programmes. In cases like Brazil, where budgets for public health care are limited, unconditional transfers might be preferable. Or, if health conditions are applied to cash transfer beneficiaries, then extra resources need to be granted to health centres to allow them to deal with the increased demand from beneficiaries for services.

Impact of Sarcopenia on Survival in Patients Treated with FOLFIRINOX in a First-Line Setting for Metastatic Pancreatic Carcinoma.

Sarcopenia, defined as decreased muscle mass and strength, can be evaluated by a computed tomography (CT) examination and might be associated with reduced survival in patients with carcinoma. The prognosis of patients with metastatic pancreatic carcinoma is poor. The FOLFIRINOX (a combination of 5-fluorouracil, irinotecan, and oxaliplatin) chemotherapy regimen is a validated first-line treatment option. We investigated the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS) in patients with metastatic pancreatic carcinoma. Clinical data and CT examinations of patients treated with FOLFIRINOX were retrospectively reviewed. Sarcopenia was estimated using baseline CT examinations. Seventy-five patients were included. Forty-three (57.3%) were classified as sarcopenic. The median OS of non-sarcopenic and sarcopenic patients were 15.6 and 14.1 months, respectively (p = 0.36). The median PFS was 10.3 in non-sarcopenic patients and 9.3 in sarcopenic patients (p = 0.83). No differences in toxicity of FOLFIRINOX were observed. There was a trend towards a higher probability of short-term death (within 4 months of diagnosis) in sarcopenic patients. In this study, the detection of sarcopenia failed to predict a longer OS or PFS in selected patients deemed eligible by a physician for triplet chemotherapy and receiving the FOLFIRINOX regimen in a first-line setting, confirming the major importance of a comprehensive patient assessment by physicians in selecting the best treatment option.

Comprehensive Cardiac Care: How Much Does It Cost?

The analysis involved data from 1 October 2017 to 31 March 2020 for 263,619 patients who received treatment after a diagnosis of first or recurrent myocardial infarction as well as data for 26,457 patients treated during that period under the CCMI programme. The average costs of treating patients covered by the full scope of comprehensive care and cardiac rehabilitation under the programme (EUR 3113.74/person) were higher than the costs of treating patients outside of that programme (EUR 2238.08/person). At the same time, a survival analysis revealed a statistically significantly lower probability of death (p < 0.0001) in the group of patients covered by CCMI compared to the group not covered by the programme. The coordinated care programme introduced for patients after myocardial infarction is more expensive than the care for patients who do not participate in the programme. Patients covered by the programme were more often hospitalised, which might have been due to the good coordination between specialists and responses to sudden changes in patients' conditions.

The impacts of China's drug price zero-markup policy on medical expenditures and health outcomes

Drug overuse and high drug expenditures have long been of concern in China. In 2012, the Chinese government implemented the drug price zero-markup policy (ZMP) to contend with these problems. This paper investigates the impact of the ZMP on the hospitalization expenses and health outcomes of inpatients, using administrative data from Beijing. The findings show that the ZMP reduces inpatients' medicine expenses by an average of 20.4%, while total hospitalization expenses do not change significantly. The findings also show that the average length of hospital stay increases by 0.588 days. The results jointly indicate that hospitals adopt substitution behavior to make up for the drug revenue loss. The paper finds no evidence that the ZMP has a negative impact on patients' probability of death or readmission.

Prognostic factors for satellitosis or in-transit metastasis in cutaneous squamous cell carcinoma: A multicentric cohort study

Satellitosis or in-transit metastasis (S-ITM) has clinical outcomes comparable to node-positivity in cutaneous squamous cell carcinoma (cSCC). There is a need to stratify the risk groups. To determine which prognostic factors of S-ITM confer an increased risk of relapse and cSCC-specific-death. A retrospective, multicenter cohort study. Patients with cSCC developing S-ITM were included. Multivariate competing risk analysis evaluated which factors were associated with relapse and specific death. Of a total of 111 patients with cSCC and S-ITM, 86 patients were included for analysis. An S-ITM size of ≥20mm, >5 S-ITM lesions, and a primary tumor deep invasion was associated with an increased cumulative incidence of relapse (subhazard ratio [SHR]: 2.89 [95% CI, 1.44-5.83; P=.003], 2.32 [95% CI, 1.13-4.77; P=.021], and 2.863 [95% CI, 1.25-6.55; P=.013]), respectively. Several >5 S-ITM lesions were also associated with an increased probability of specific death (SHR: 3.48 [95% CI, 1.18-10.2; P=.023]). Retrospective study and heterogeneity of treatments. The size and the number of S-ITM lesions confer an increased risk of relapse and the number of S-ITM an increased risk of specific-death in patients with cSCC presenting with S-ITM. These results provide new prognostic information and can be considered in the staging guidelines.

A56 DEVELOPMENT OF A PROGNOSTIC SURVIVAL MODEL FOR PATIENTS DIAGNOSED WITH PANCREATIC CANCER IN ONTARIO

Abstract Background Pancreatic adenocarcinoma (PAC) is a deadly disease with an overall 5-year survival of less than 8%. The current literature on patient outcomes are limited by small samples sizes and patients enrolled in clinical trials. There are no prognostic tools for patients with pancreatic cancer. Purpose To develop a prognostic survival model for patients with pancreatic cancer Method All patients with a diagnosis of pancreatic cancer cancer from January 2007 to December 2020 were identified through the Ontario Cancer Registry. The primary outcome was survival. The cohort was used to develop a multivariable cox proportional hazards regression model with baseline characteristics under a backward stepwise variable selection process to predict the risk of mortality. Covariates included patient age, sex, tumour location, cancer stage, treatment types, distance to a cancer centre, hospitalizations, comorbidities, access to family physician, and symptoms as captured using the Edmonton Symptom Assessment System datasets. Result(s) There was a total of 17,450 pancreatic cancer patients in the cohort, 48% of which were female and the mean age was 72 years. 44% of patients presented with a tumor in the head of the pancreas. Among those with stage data (44%), 24% were stage IV at diagnosis. Mean survival was approximately 0.7 years. Approximately 60% were hospitalized in the 3 months prior to diagnosis. Almost all patients had a family doctor rostered (95%). In multivariate analysis, key predictors of survival assessed at the time of diagnosis were age, sex, tumour location in the pancreas, stage at diagnosis, pain, appetite functional status and treatment choice (all p&amp;lt;0.001). Using these variables, we created a prediction model that can estimate one-year probability of death with high discrimination (area under the curve = 0.82, c-statistic 0.76). Conclusion(s) Our model accurately predicts one-year pancreatic cancer survival risk using clinical symptom and performance status data. The model has the potential to be a useful prognostic tool that can be completed by patients and their caregivers in support of patient-centered care. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest None Declared

Performance of Brazilian Pediatric Risk of Severity Model for Illness (Brprism) Compared to Pediatric Index of Mortality and Pediatric Risk of Mortality 2

Introduction: The best prognosis score with which to evaluate high-risk patients upon admission into pediatric intensive care is not well established in resource-limited settings. The objective of study was to formulate a risk-of-illness severity model for pediatric mortality to be applied upon PICU admission in resource-limited settings. Methods: Our study was designed to develop an illness severity index and a prognostic model for critically ill children. A prospective, observational multicenter pilot study, performed between February 1995 and October 1999, evaluated the variables, methodology and statistical techniques for the development of a model. A single-center prospective cohort study, performed between November 1999 and October 2004, collected information from consecutive admissions into the Pediatric Intensive Care Unit (PICU) at a high-complexity university, teaching, and reference hospital in São Paulo, Brazil. Results: In the pilot study, 1,459 patients (a PICU mortality rate of 16%) were included, and in the second study, 1,033 patients (a PICU mortality rate of 13.9% and a hospital mortality rate of 6.9% after PICU discharge) were included. We used multivariable regression to determine two probabilistic models; the first addressed survival and the overall probability of death (hospital plus PICU deaths), and the second was conditional (i.e., PICU death). An illness severity index stratified these probabilities into three risk strata: low-, medium- and high-risk patients. In the final step, the new death probabilities were estimated using a Bayesian adjustment. Conclusions: The model estimates three probabilities (survival, death in the PICU and death in the hospital after PICU discharge) stratified into three risk categories. To the best of our knowledge, this is the first study using a Bayesian adjustment to determine a prognosis and illness severity, and it should enable us to make therapeutic adjustments and provide appropriate counseling for high-risk patients in resource-limited settings.

Factors related to death from ventilator-associated pneumonia in a university hospital: a retrospective study

The objective of this study was to identify factors related to death in patients diagnosed with ventilator-associated pneumonia admitted to the intensive care unit of the University Hospital of Brasília. Methodology: Retrospective study, based on the analysis of the medical records of 73 patients diagnosed with ventilator-associated pneumonia, from March 2017 to December 2020. Statistical analyzes were performed using the unpaired Student's t test and the Chi test. -Pearson square. Results: The factors age, Simplified Acute Physiology III, probability of death, relative mechanical ventilation time, relative intensive care unit time and respiratory comorbidities were related to mortality in the patients studied. Conclusion: This study contributed to a better understanding of ventilator-associated pneumonia, reinforcing the need for control and epidemiological surveillance of its risk of death..

Agent-based modeling of mass shooting case with the counterforce of policemen

AbstractMass shooting cases have caused large casualties worldwide. The counterforce, such as the policemen, is of great significance to reducing casualties, which is the core issue of social safety governance. Therefore, we model both the killing force and counterforce, to explore the crowd dynamics under the shooting. Taking the “Borderline” shooting in 2018 as the target case, the agent-based modeling is applied to back-calculate this dynamic process and explore key behavior rules of individuals. The real death tolls of three classes of agents (civilians, policemen, &amp; killers) are as the real function, based on which we calculate the gaps between real target case and simulations. Eventually, we obtain three optimal solutions, which achieve the least gap or highest matching degree. Besides, we make counterfactual inferences under the optimal solutions, to explore the strategic interactions between policemen and killers. For strategies of killers, we explore different sizes, positions, and moving patterns of the killers. The optimal size of policemen is four to five, for each one killer. For strategies of policemen, we explore the size, locations, and the response time. It indicates that optimal response time of policemen is thirty to forty shots of the killer, and the death of civilians and policemen can be minimized, and the death probability of the killer can be maximized. These findings help to improve public safety governance for our cities. To effectively deal with sudden shooting terrorist cases, patrol routes, reasonable settings, and swift dispatches of the police (stations) should be considered.