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1دورية أكاديمية
المؤلفون: Li Wang, Onur Baser, Phil Wells, W Frank Peacock, Craig I Coleman, Gregory J Fermann, Jeff Schein, Concetta Crivera
المصدر: PLoS ONE, Vol 12, Iss 10, p e0185022 (2017)
الوصف: Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). This study measured the overall impact of early discharge of LRPE patients on clinical outcomes and costs in the Veterans Health Administration population. Adult patients with ≥1 inpatient diagnosis for pulmonary embolism (PE) (index date) between 10/2011-06/2015, continuous enrollment for ≥12 months pre- and 3 months post-index date were included. PE risk stratification was performed using the simplified Pulmonary Embolism Stratification Index. Propensity score matching (PSM) was used to compare 90-day adverse PE events (APEs) [recurrent venous thromboembolism, major bleed and death], hospital-acquired complications (HACs), healthcare utilization, and costs among short (≤2 days) versus long length of stay (LOS). Net clinical benefit was defined as 1 minus the combined rate of APE and HAC. Among 6,746 PE patients, 95.4% were men, 22.0% were African American, and 1,918 had LRPE. Among LRPE patients, only 688 had a short LOS. After 1:1 PSM, there were no differences in APE, but short LOS had fewer HAC (1.5% vs 13.3%, 95% CI: 3.77-19.94) and bacterial pneumonias (5.9% vs 11.7%, 95% CI: 1.24-3.23), resulting in better net clinical benefit (86.9% vs 78.3%, 95% CI: 0.84-0.96). Among long LOS patients, HACs (52) exceeded APEs (14 recurrent DVT, 5 bleeds). Short LOS incurred lower inpatient ($2,164 vs $5,100, 95% CI: $646.8-$5225.0) and total costs ($9,056 vs $12,544, 95% CI: $636.6-$6337.7). LRPE patients with short LOS had better net clinical outcomes at lower costs than matched LRPE patients with long LOS.
العلاقة: http://europepmc.org/articles/PMC5634547?pdf=renderTest; https://doaj.org/toc/1932-6203Test; https://doaj.org/article/374e98c26a874afba5f53fdf74213ea8Test
الإتاحة: https://doi.org/10.1371/journal.pone.0185022Test
https://doaj.org/article/374e98c26a874afba5f53fdf74213ea8Test -
2دورية أكاديمية
المؤلفون: Suosuo Yang, Benjamin Flores, Rotem Magal, Kyrsti Harris, Jonathan Gross, Amy Ewbank, Sasha Davenport, Pablo Ormachea, Waleed Nasser, Weidong Le, W Frank Peacock, Yael Katz, David M Eagleman
المصدر: PLoS ONE, Vol 12, Iss 7, p e0179352 (2017)
الوصف: Despite the high prevalence of traumatic brain injuries (TBI), there are few rapid and straightforward tests to improve its assessment. To this end, we developed a tablet-based software battery ("BrainCheck") for concussion detection that is well suited to sports, emergency department, and clinical settings. This article is a study of the diagnostic accuracy of BrainCheck. We administered BrainCheck to 30 TBI patients and 30 pain-matched controls at a hospital Emergency Department (ED), and 538 healthy individuals at 10 control test sites. We compared the results of the tablet-based assessment against physician diagnoses derived from brain scans, clinical examination, and the SCAT3 test, a traditional measure of TBI. We found consistent distributions of normative data and high test-retest reliability. Based on these assessments, we defined a composite score that distinguishes TBI from non-TBI individuals with high sensitivity (83%) and specificity (87%). We conclude that our testing application provides a rapid, portable testing method for TBI.
وصف الملف: electronic resource
العلاقة: http://europepmc.org/articles/PMC5501428?pdf=renderTest; https://doaj.org/toc/1932-6203Test
النص الكامل