Stroke severity is an important outcome predictor for intracerebral hemorrhage (ICH) but is typically unavailable in administrative claims data. We validated a claims-based stroke severity index (SSI) in patients with ICH in Taiwan.
Methods
Consecutive ICH patients from hospital-based stroke registries were linked with a nationwide claims database. Stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes, assessed using the modified Rankin Scale (mRS), were obtained from the registries. The SSI was calculated based on billing codes in each patient's claims. We assessed two types of criterion-related validity (concurrent validity and predictive validity) by correlating the SSI with the NIHSS and the mRS. Logistic regression models with or without stroke severity as a continuous covariate were fitted to predict mortality at 3, 6, and 12 months.
Results
The concurrent validity of the SSI was established by its significant correlation with the admission NIHSS (r = 0.731; 95% confidence interval [CI], 0.705–0.755), and the predictive validity was verified by its significant correlations with the 3-month (r = 0.696; 95% CI, 0.665–0.724), 6-month (r = 0.685; 95% CI, 0.653–0.715) and 1-year (r = 0.664; 95% CI, 0.622–0.702) mRS. Mortality models with NIHSS had the highest area under the receiver operating characteristic curve, followed by models with SSI and models without any marker of stroke severity.
Conclusions
The SSI appears to be a valid proxy for the NIHSS and an effective adjustment for stroke severity in studies of ICH outcome with administrative claims data. 相似文献
Objective. To assess the biomechanical evidence in support of advocating the squat lifting technique as an administrative control to prevent low back pain.
Background. Instruction with respect to lifting technique is commonly employed to prevent low back pain. The squat technique is the most widely advised lifting technique. Intervention studies failed to show health effects of this approach and consequently the rationale behind the advised lifting techniques has been questioned.
Methods. Biomechanical studies comparing the stoop and squat technique were systematically reviewed. The dependent variables used in these studies and the methods by which these were measured or estimated were ranked for validity as indicators of low back load.
Results. Spinal compression as indicated by intra-discal pressure and spinal shrinkage appeared not significantly different between both lifting techniques. Net moments and compression forces based on model estimates were found to be equal or somewhat higher in squat than in stoop lifting. Only when the load could be lifted from a position in between the feet did squat lifting cause lower net moments, although the studies reporting this finding had a marginal validity. Shear force and bending moments acting on the spine appeared lower in squat lifting. Net moments and compression forces during lifting reach magnitudes, that can probably cause injury, whereas shear forces and bending moments remained below injury threshold in both techniques.
Conclusion. The biomechanical literature does not provide support for advocating the squat technique as a means of preventing low back pain.Relevance
Training in lifting technique is widely used in primary and secondary prevention of low back pain, though health effects have not been proven. The present review assesses the biomechanical evidence supporting the most widely advocated lifting technique. 相似文献
The Hospital-patient One-year Mortality Risk (HOMR) score is an externally validated index using health administrative data to accurately predict the risk of death within 1 year of admission to the hospital. This study derived and internally validated a HOMR modification using data that are available when the patient is admitted to the hospital.
Methods
From all adult hospitalizations at our tertiary-care teaching hospital between 2004 and 2015, we randomly selected one per patient. We added to all HOMR variables that could be determined from our hospital's data systems on admission other factors that might prognosticate. Vital statistics registries determined vital status at 1 year from admission.
Results
Of 2,06,396 patients, 32,112 (15.6%) died within 1 year of admission to the hospital. The HOMR-now! model included patient (sex, comorbidities, living and cancer clinic status, and 1-year death risk from population-based life tables) and hospitalization factors (admission year, urgency, service and laboratory-based acuity score). The model explained that more than half of the total variability (Regenkirke's R2 value of 0.53) was very discriminative (C-statistic 0.92), and accurately predicted death risk (calibration slope 0.98).
Conclusion
One-year risk of death can be accurately predicted using routinely collected data available when patients are admitted to the hospital. 相似文献
Hepatitis B-related liver cirrhosis and hepatocellular carcinoma is a serious problem in China. Radiofrequency ablation had been considered a good option because it is minimally invasive. The aim of this study was to compare the perioperative outcomes of laparoscopic liver resection (LLR) with percutaneous radiofrequency ablation (RFA) for patients with hepatocellular carcinoma patients.
Methods
A retrospective analysis of a prospective database for liver tumours identified patients with liver cirrhosis who underwent LLR and RFA of hepatocellular carcinoma in the University of Hong Kong, Queen Mary Hospital, Hong Kong between March 18, 2002, and Nov 23, 2015. The complications and-long term outcome after the operations were compared.
Findings
We identified 217 patients who underwent laparoscopic treatment of hepatocellular carcinoma with liver cirrhosis in the University of Hong Kong, Queen Mary Hospital, between 2000 and 2015. 112 patients had undergone percutaneous RFA, and 105 patients who had undergone LLR with similar were selected for comparison. The patient baseline parameters, including age, sex, comorbidity, tumour size, number, and stage of hepatocellular carcinoma, did not differ between patients in the LLR and RFA groups. The median number of tumours was one tumour per patient in both treatment groups (range 1–3; p=0·517). Patients in the RFA group and LLR group had similar duration of hospital stay (2 days vs 4 days, p<0·0001), morbidity (4·5% vs 9·5%, p=0·142), and mortality (0% vs 0%). Intrahepatic recurrence was 70·5% in the RFA group versus 28·6% in the LLR group (p<0·0001). RFA was associated with the lowest overall survival (90·8 months in the RFA group vs >146·4 months in the LLR group, p=0·00019) and lowest disease-free survival (16·9 months vs 74·9 month; p<0·0001).
Interpretation
LLR and RFA are well tolerated in patients with liver cirrhosis. A better survival outcome has been observed in the LLR group. We suggest LLR be considered as an option in selected patients who are deemed poor candidates for open hepatectomy.
