Background
Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. ...Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation. This article reports the rationale, study design and analysis plan of the ANDROMEDA-SHOCK Study.
Methods
ANDROMEDA-SHOCK is a randomized controlled trial which aims to determine if a peripheral perfusion-targeted resuscitation is associated with lower 28-day mortality compared to a lactate-targeted resuscitation in patients with septic shock with less than 4 h of diagnosis. Both groups will be treated with the same sequential approach during the 8-hour study period pursuing normalization of capillary refill time versus normalization or a decrease of more than 20% of lactate every 2 h. The common protocol starts with fluid responsiveness assessment and fluid loading in responders, followed by a vasopressor and an inodilator test if necessary. The primary outcome is 28-day mortality, and the secondary outcomes are: free days of mechanical ventilation, renal replacement therapy and vasopressor support during the first 28 days after randomization; multiple organ dysfunction during the first 72 h after randomization; intensive care unit and hospital lengths of stay; and all-cause mortality at 90-day. A sample size of 422 patients was calculated to detect a 15% absolute reduction in mortality in the peripheral perfusion group with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle.
Conclusions
If peripheral perfusion-targeted resuscitation improves 28-day mortality, this could lead to simplified algorithms, assessing almost in real-time the reperfusion process, and pursuing more physiologically sound objectives. At the end, it might prevent the risk of over-resuscitation and lead to a better utilization of intensive care unit resources.
Trial registration
ClinicalTrials.gov Identifier: NCT03078712 (registered retrospectively March 13th, 2017)
Objectives
The aim of this study was to evaluate adherence to the recommendations of the Spanish guidelines for the initial assessment of patients with HIV infection in the multicentre Cohort of the ...Spanish HIV/AIDS Network (CoRIS) during the years 2004–2017.
Methods
We calculated the percentage of patients who had each of 11 clinical and analytical recommended examinations performed in their initial evaluation. We evaluated the factors associated with not performing each examination with multivariable logistic regression models.
Results
We included 13 612 patients in the study. In the initial assessment, CD4 count and viral load were determined in more than 98.0% of the patients. Serologies for hepatitis A, B and C and syphilis were determined in 55.8%, 66.4%, 89.8% and 81.7% of the patients, respectively. Total cholesterol and creatinine were determined in 78.7% and 78.9% of the patients, respectively. The lowest proportions of examinations were observed for blood pressure, smoking status and latent tuberculosis screening, which were performed in 43.2%, 50.6% and 53.9% of the patients, respectively. Injecting drug users and heterosexual patients (compared to men who have sex with men) and patients with a lower educational level had a higher risk of having an incomplete initial assessment for a substantial number of examinations. Latent tuberculosis screening was less likely in patients with CD4 counts < 200 cells/µL.
Conclusions
The initial assessment of HIV‐infected patients is suboptimal for the evaluation of cardiovascular risk, smoking status, screening of syphilis and viral hepatitis, and diagnosis of latent tuberculosis: adherence to the guidelines was low for these examinations.
Contextualizing data warehouses with documents Manuel Pérez-Martínez, Juan; Berlanga-Llavori, Rafael; Aramburu-Cabo, María José ...
Decision Support Systems,
04/2008, Letnik:
45, Številka:
1
Journal Article, Conference Proceeding
Recenzirano
Current data warehouse and OLAP technologies are applied to analyze the structured data that companies store in databases. The context that helps to understand data over time is usually described ...separately in text-rich documents. This paper proposes to integrate the traditional corporate data warehouse with a document warehouse, resulting in a contextualized warehouse. Thus, the user first selects an analysis context by supplying some keywords. Then, the analysis is performed on a novel type of OLAP cube, called an R-cube, which is materialized by retrieving and ranking the documents and corporate facts related to the selected context.
To study the prevalence of Delayed HIV Diagnosis (DHD) and its associated risk factors, to evaluate the effect of DHD on virological and immunological responses to HAART and to estimate the impact of ...DHD on all-causes mortality. Prospective cohort of 2, 564 HIV-positive HAART-naïve subjects attending 19 hospitals in Spain, 2004-2006. Estimations were made by logistic regression and survival analyses by Cox regression models. Prevalence of DHD was 37.3% (35.0-39.6). DHD was related to low educational level (OR:1.31, 95% CI:1.0-1.7). Compared to men who have sex with men (MSM), DHD was more frequent in heterosexuals (OR:1.9 95% CI:1.5-2.5) and injection drug users (IDUs) (OR:2.0 95% CI:1.5-2.8). An interaction between age and sex was found. Although risk of having DHD did not increase after age 30 in women, it increased linearly with age in men. No differences in virological (OR 1.2 95% CI: 0.8-1.8) and CD4 T cell (OR 1.1 95% CI: 0.7-1.8) responses to HAART were seen. The adjusted hazard ratio for death in patients with DHD was 5.2, (95% CI: 1.9-14.5). DHD is very common, especially in older men, heterosexuals and IDUs. Although we did not find differences in virological and immunological responses to HAART, we did observe higher mortality in people with DHD. Increased efforts to early diagnose HIV infection are urgently needed.
We aim to describe rates and risk factors of Hepatitis C Virus (HCV) diagnoses, follow-up HCV testing and HCV seroconversion from 2004-2011 in a cohort of HIV-positive persons in Spain.
CoRIS is a ...multicentre, open and prospective cohort recruiting adult HIV-positive patients naïve to antiretroviral therapy. We analysed patients with at least one negative and one follow-up HCV serology. Incidence Rates (IR) were calculated and multivariate Poisson regression was used to estimate adjusted Rates Ratios (aIRR).
Of 2112 subjects, 53 HCV diagnoses were observed, IR = 0.93/100 py (95%CI: 0.7-1.2). IR increased from 0.88 in 2004-05 to 1.36 in 2010-11 (aIRR = 1.55; 95%CI: 0.37-6.55). In men who have sex with men (MSM) from 0.76 to 1.10 (aIRR = 1.45; 95%CI: 0.31-6.82); in heterosexual (HTX) subjects from 1.19 to 1.28 (aIRR = 1.08; 95%CI: 0.11-10.24). HCV seroconversion rates decreased from 1.77 to 0.65 (aIRR = 0.37; 95%CI: 0.12-1.11); in MSM from 1.06 to 0.49 (aIRR = 0.46; 95%CI: 0.09-2.31); in HTX from 2.55 to 0.59 (aIRR = 0.23; 95%CI: 0.06-0.98). HCV infection risk was higher for injecting drug users (IDU) compared to HTX (aIRR = 9.63;95%CI: 2.9-32.2); among MSM, for subjects aged 40-50 compared to 30 or less (IRR = 3.21; 95%CI: 1.7-6.2); and among HTX, for female sex (aIRR = 2.35; 95%CI: 1.03-5.34) and <200 CD4-count (aIRR = 2.39; 95%CI: 0.83-6.89).
We report increases in HCV diagnoses rates which seem secondary to intensification of HCV follow-up testing but not to rises in HCV infection rates. HCV IR is higher in IDU. In MSM, HCV IR increases with age. Among HTX, HCV IR is higher in women and in subjects with impaired immunological situation.
There are few data in the Spanish population about the causes of death in patients admitted to Internal Medicine departments for heart failure (HF). Their study according to left ventricular ejection ...fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis.
Prospective multicentre cohort study of 4144 patients admitted with HF to Internal Medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥50%), mEF (40%–49%) and rEF (<40%). Patients were followed-up for a median of one year.
There were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly HF (50%) and sudden cardiac death (SCD, 7.5%). Non-cardiovascular (Non-CV) causes were responsible for 365 deaths (30.5%). The most common Non-CV causes were infections (13%). The most frequent and early cause in all groups was HF. Patients with pEF, compared to the other groups, had lower risk of SCD and higher risk of infections (P < .05). The causes of death in patients with mrEF were closer to those with pEF.
The causes of death in patients with HF were different depending on EF strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by Internal Medicine.
Los datos disponibles de las causas de muerte en pacientes ingresados por Insuficiencia Cardíaca (IC) en Servicios de Medicina Interna y en población española según Fracción de eyección (FE) reducida (FER), preservada (FEP) e intermedia (FEI) son escasos. Su estudio puede mejorar el conocimiento de estos pacientes y su pronóstico.
Estudio de cohortes multicéntrico y prospectivo de 4144 pacientes que ingresaron por IC en unidades de Medicina Interna. Se registraron sus características clínicas, tasa de fallecimientos y sus causas agrupados según FEP (≥ 50%), FEI (40%–49%) y FER (<40%) durante una mediana de seguimiento de un año.
Se registraron 1198 fallecimientos (29%), de los que 833 fallecieron por causas cardiovasculares (CV) (69,5%), fundamentalmente por IC (50%) y por muerte súbita (MS) (7,5%); y 365 por causas no cardiovasculares (NoCV) (30,5%), principalmente por infecciones (13%). La causa más frecuente y temprana en todos los grupos fue la IC. Los pacientes con FEP tenían menor tasa de MS y mayor de infecciones (P < ,05). Las causas de muerte en FEI fueron más parecidas a las de FEP.
Las causas de muerte en pacientes con IC fueron diferentes dependiendo del tipo de FE. Los pacientes con FEI y FEP, por su elevada comorbilidad y mayor frecuencia de muerte NoCV, son los que más se beneficiarían de un manejo integral por parte de Medicina Interna.
•Synthesis of healable waterborne polyurethanes with coumarin moieties incorporated in the polymeric backbone.•Evaluation of coumarin reversible photodimerization reaction by UV spectroscopy and ...determination of the cycloaddition reaction kinetics.•Dependence of the radiation conditions on the scratch filling abilities of the polymeric coatings.•Influence of the polyurethane physical properties on the healing efficiency of the polymeric systems.•Study of coumarin cycloaddition reaction under sunlight conditions.
Waterborne polyurethanes containing coumarin as chain extenders were successfully synthesized. Taking advantage of the photoinduced 2+2 cycloaddition reaction of coumarin moieties, this work evaluated the healing abilities of these materials. The photochemical process was analyzed by UV spectroscopy and the cycloaddition reaction kinetics was studied. In addition, the healing abilities of the synthesized waterborne polyurethanes were determined by means of scratch refilling studies and strain-stress tests. The irradiation conditions as well as the polymeric chain mobility on the fracture and the capacity to generate polymer networks by coumarin linkages were demonstrated to be the main factors affecting the healing process. The behavior of these systems was also determined under the direct irradiation of sunlight.
Summary Objectives To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004–2013). Methods Cox models and logistic ...regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. Results Of 7165 new HIV diagnoses, 46.9% (CI95% :45.7–48.0) were LP, 240 patients died. First-year mortality was the highest (aHRLP.vs.nLP = 10.3CI95% :5.5–19.3); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2–3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7–3.1). First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004–05) to 39.4% (2012–13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women. Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.41.2–1.7); age (OR31–40.vs.<30 = 1.61.4–1.8, OR41–50.vs.<30 = 2.21.8–2.6, OR>50.vs.<30 = 3.62.9–4.4); behavior (ORInjectedDrugUse.vs.MSM = 2.82.0–3.8; ORHeterosexual.vs.MSM = 2.21.7–3.0); education (ORPrimaryEducation.vs.University = 1.51.1–2.0, ORLowerSecondary.vs.University = 1.31.1–1.5); and geographical origin (ORSub-Saharan.vs.Spain = 1.61.3–2.0, ORLatin-American.vs.Spain = 1.41.2–1.8). Conclusions LP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women.
During the last decade, data warehouse and OLAP techniques have helped companies to gather, organize and analyze the structured data they produce. Simultaneously, digital libraries have applied ...Information Retrieval mechanisms to query their repositories of unstructured text-rich documents. In this paper we explain how XML allows for the convergence of these two approaches, making possible the development of warehouses for semi-structured information. So far, the proposals of extending data warehouse technology to manage semi-structured information have not been able to exploit the textual contents, mainly because they are not based on a proper document model. In our opinion, such a model must integrate IR and OLAP techniques. In this paper we present a set of requirements for semi-structured information warehouses, as well as a document model to support their construction. In this model, new Relevance Modeling mechanisms are used for ranking the facts described in the text of the documents according to their relevance to an IR – OLAP query. Preliminary evaluations show the usefulness of the document model.
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