BACKGROUND: Postoperative nausea and vomiting (PONV) in pediatric patients is a common and clinically significant postoperative complication. The incidence of PONV has not been extensively studied in large pediatric cohorts. Furthermore, in 2020, the Fourth Consensus Guidelines for the management of PONV were published. However, the association between perioperative factors and adherence to these guidelines remains unclear. This study aims to assess both the incidence of PONV and guideline adherence within a large and diverse pediatric population. METHODS: We conducted a retrospective observational study at a large tertiary medical center, including pediatric patients (≤18 years) who underwent surgery between September 2020 and March 2023. We conducted a retrospective analysis of data from our electronic health records, focusing on patient demographics, surgical details, anesthesia details, and prophylaxis for PONV. We calculated the incidence of PONV and used multivariable logistic regression to identify the predictors of guideline adherence. RESULTS: The cohort included 3772 patients with a median (interquartile range [IQR]) age of 9.21 (3.55-14.68) years. The incidence (95% confidence intervals) of early PONV was 1.0% (0.7-1.4) and 3.8% (3.2-4.5) for delayed PONV. Adherence to the fourth consensus guidelines for PONV management was observed in 32.5% (31.0-34.0) of cases. A high risk of PONV was identified in 55.9% (54.3-57.5) of the patients. The most common number of PONV risk factors was 3, observed in 1151 patients (30.5% [29.1-32.0]). Significant predictors of guideline adherence included the intraoperative use of long-acting opioids (odds ratio [OR], 2.711, P < .001) and age ≥3 years (OR, 2.074, P < .001). Nonadherence was associated with a higher incidence of PONV at 24 hours postsurgery (4.4% (3.6-5.2) vs 2.7% (1.9-3.8), P = .012). Factors such as specific high PONV risk surgeries ( P = .001), maintenance with inhalational agents solely ( P = .017), and neostigmine use ( P < .001) were also all statistically significant. CONCLUSIONS: Our study revealed a lower-than-expected incidence of PONV in pediatric patients, highlighting the need for standardized definitions and improved reporting. Adherence to PONV guidelines was suboptimal, emphasizing the need for better implementation strategies.
- MeSH
- antiemetika terapeutické užití MeSH
- dítě MeSH
- dodržování směrnic * normy MeSH
- incidence MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- pooperační nevolnost a zvracení * epidemiologie diagnóza prevence a kontrola MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. METHODS: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). RESULTS: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. CONCLUSION: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups.
- MeSH
- analýza nákladů a výnosů metody normy MeSH
- dodržování směrnic ekonomika normy MeSH
- koronární nemoc ekonomika epidemiologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- rozhodovací stromy * MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Severe aortic stenosis (AS) is a common, serious valve disease in which no effective medical therapy is available and, if not treated by intervention, has a 5-year survival of only 40-60%. Despite the availability of guidelines supporting the effective use of surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) to treat the majority of these patients, adherence to these guidelines in clinical practice is still unsatisfactory. Several recent studies have emphasised the necessity for improved communication between multidisciplinary teams, with the aim to ensure that severe AS patients receive appropriate treatment. METHODS/DESIGN: IMPULSE is a prospective, multicentre, European registry designed to gather data over 12 months on the treatment decisions made by referring physicians for patients newly diagnosed with severe AS. Each patient has a follow-up of 3 months. The study will consist of two observational phases to assess the appropriateness and rate of referral based on current guidelines prior to and after an interventional phase aiming to determine whether a simple quality of care intervention improves patient management. DISCUSSION: Data will be analysed firstly, to determine the appropriateness of treatment decisions for the management of severe AS in current European clinical practice, and secondly, to evaluate the effectiveness of facilitated data relay from a designated echocardiography department nurse to the referring physician early after diagnosis in improving quality of care. Additionally, variables will be identified that are associated with inappropriate decision-making. Collectively, the aim will be to design a clinical pathway that will improve the timely management of patients with newly diagnosed severe AS.
- MeSH
- aortální stenóza diagnóza chirurgie MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně škodlivé účinky normy MeSH
- dodržování směrnic normy MeSH
- hodnocení postupů (zdravotní péče) normy MeSH
- klinické rozhodování MeSH
- konziliární vyšetření a konzultace normy MeSH
- lékařská praxe - způsoby provádění normy MeSH
- lidé MeSH
- prospektivní studie MeSH
- registrace MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- transkatetrální implantace aortální chlopně škodlivé účinky normy MeSH
- ukazatele kvality zdravotní péče normy MeSH
- výsledek terapie MeSH
- výzkum zdravotnických služeb MeSH
- výzkumný projekt MeSH
- zlepšení kvality normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: In clinical trials, the use of intermediate time-to-event end points (TEEs) is increasingly common, yet their choice and definitions are not standardized. This limits the usefulness for comparing treatment effects between studies. The aim of the DATECAN Kidney project is to clarify and recommend definitions of TEE in renal cell cancer (RCC) through a formal consensus method for end point definitions. MATERIALS AND METHODS: A formal modified Delphi method was used for establishing consensus. From a 2006-2009 literature review, the Steering Committee (SC) selected 9 TEE and 15 events in the nonmetastatic (NM) and metastatic/advanced (MA) RCC disease settings. Events were scored on the range of 1 (totally disagree to include) to 9 (totally agree to include) in the definition of each end point. Rating Committee (RC) experts were contacted for the scoring rounds. From these results, final recommendations were established for selecting pertinent end points and the associated events. RESULTS: Thirty-four experts scored 121 events for 9 end points. Consensus was reached for 31%, 43% and 85% events during the first, second and third rounds, respectively. The expert recommend the use of three and two endpoints in NM and MA setting, respectively. In the NM setting: disease-free survival (contralateral RCC, appearance of metastases, local or regional recurrence, death from RCC or protocol treatment), metastasis-free survival (appearance of metastases, regional recurrence, death from RCC); and local-regional-free survival (local or regional recurrence, death from RCC). In the MA setting: kidney cancer-specific survival (death from RCC or protocol treatment) and progression-free survival (death from RCC, local, regional, or metastatic progression). CONCLUSIONS: The consensus method revealed that intermediate end points have not been well defined, because all of the selected end points had at least one event definition for which no consensus was obtained. These clarified definitions of TEE should become standard practice in all RCC clinical trials, thus facilitating reporting and increasing precision in between trial comparisons.
- MeSH
- delfská metoda MeSH
- dodržování směrnic normy MeSH
- karcinom z renálních buněk mortalita terapie MeSH
- lidé MeSH
- lokální recidiva nádoru mortalita terapie MeSH
- nádory ledvin mortalita terapie MeSH
- přežití bez známek nemoci MeSH
- randomizované kontrolované studie jako téma metody normy MeSH
- stanovení cílového parametru metody normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVES: The aim of the CoreValve prospective, international, post-market ADVANCE-II study was to define the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement with the Medtronic CoreValve System (Minneapolis, Minnesota) using optimized implantation techniques and application of international guidelines on cardiac pacing. BACKGROUND: Conduction disturbances are a frequent complication of transcatheter aortic valve replacement. The rates of PPI in the published reports vary according to bioprosthesis type and the indications for PPI. METHODS: The primary endpoint was the 30-day incidence of PPI with Class I/II indications when the Medtronic CoreValve System was implanted at an optimal depth (≤6 mm below the aortic annulus). The timing and resolution of all new-onset conduction disturbances were analyzed. RESULTS: A total of 194 patients were treated. The overall rate of PPI for Class I/II indications was 18.2%. An optimal depth was reached in 43.2% of patients, with a nonsignificantly lower incidence of PPI in patients with depths ≤6 mm, compared with those with deeper implants (13.3% vs. 21.1%; p = 0.14). In a paired analysis, new-onset left bundle branch block and first-degree atrioventricular block occurred in 45.4% and 39.0% of patients, respectively, and resolved spontaneously within 30 days in 43.2% and 73.9%, respectively. In patients with new PPI, the rate of intrinsic sinus rhythm increased from 25.9% at 7 days to 59.3% at 30 days (p = 0.004). CONCLUSIONS: Optimal Medtronic CoreValve System deployment and adherence to international guidelines on cardiac pacing are associated with a lower rate of new PPI after transcatheter aortic valve replacement, compared with results reported in previous studies. (CoreValve Advance-II Study: Prospective International Post-Market Study [ADVANCE II]; NCT01624870).
- MeSH
- aortální chlopeň * patofyziologie MeSH
- aortální stenóza diagnóza mortalita patofyziologie terapie MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně škodlivé účinky přístrojové vybavení metody mortalita MeSH
- dodržování směrnic * normy MeSH
- Kaplanův-Meierův odhad MeSH
- kardiostimulace umělá * škodlivé účinky mortalita normy MeSH
- lékařská praxe - způsoby provádění * normy MeSH
- lidé MeSH
- postmarketingový dozor MeSH
- prospektivní studie MeSH
- protézy - design MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma * normy MeSH
- srdeční arytmie diagnóza etiologie mortalita patofyziologie terapie MeSH
- srdeční chlopně umělé * MeSH
- srdeční katetrizace škodlivé účinky přístrojové vybavení metody mortalita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- cholangiografie kontraindikace metody MeSH
- cholangitida prevence a kontrola MeSH
- chybná zdravotní péče prevence a kontrola trendy MeSH
- dodržování směrnic normy trendy MeSH
- drenáž kontraindikace metody MeSH
- hemobilie prevence a kontrola MeSH
- intervenční radiologie metody normy přístrojové vybavení MeSH
- katetrizace metody normy MeSH
- kontrastní látky diagnostické užití MeSH
- lidé MeSH
- referenční standardy MeSH
- řízení kvality MeSH
- sepse prevence a kontrola MeSH
- statistika jako téma MeSH
- stenty normy škodlivé účinky využití MeSH
- úspěšnost MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) metody normy MeSH
- zlepšení kvality normy MeSH
- žlučové cesty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- Klíčová slova
- pracovní postupy, standardy, stres, infúzní linka, bodná poranění, mimořádná událost, pracovní úraz,
- MeSH
- bezpečnost MeSH
- bodné poranění jehlou prevence a kontrola psychologie MeSH
- bodné rány prevence a kontrola MeSH
- dodržování směrnic normy MeSH
- hygiena práce MeSH
- infekce MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- nemoci z povolání MeSH
- ochranné prostředky využití MeSH
- pracovní expozice prevence a kontrola MeSH
- pracovní nehody prevence a kontrola statistika a číselné údaje MeSH
- přenos infekce z pacienta na zdravotnického pracovníka statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- zdravotnická zařízení normy MeSH
- zdravotničtí pracovníci MeSH
- Check Tag
- lidé MeSH
