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1,167 results for “Real-world”
Chest x-ray in the COVID-19 pandemic: Radiologists real-world reader performance.
<p>Dataset from the article Cozzi A, Schiaffino S, Arpaia F, Della Pepa G, Tritella S, Bertolotti P, Menicagli L, Monaco CG, Carbonaro LA, Spairani R, Babaei Paskeh B, Sardanelli F. Chest x-ray in the COVID-19 pandemic: Radiologists' real-world reader performance. Eur J Radiol. 2020 Nov;132:109272. doi: 10.1016/j.ejrad.2020.109272. Epub 2020 Sep 10. PMID: 32971326; PMCID: PMC7481070.</p> <p><strong>Abstract</strong></p> <p><strong>Purpose: </strong>To report real-world diagnostic performance of chest x-ray (CXR) readings during the COVID-19 pandemic.</p> <p><strong>Methods: </strong>In this retrospective observational study we enrolled all patients presenting to the emergency department of a Milan-based university hospital from February 24th to April 8th 2020 who underwent nasopharyngeal swab for reverse transcriptase-polymerase chain reaction (RT-PCR) and anteroposterior bedside CXR within 12 h. A composite reference standard combining RT-PCR results with phone-call-based anamnesis was obtained. Radiologists were grouped by CXR reading experience (Group-1, >10 years; Group-2, <10 years), diagnostic performance indexes were calculated for each radiologist and for the two groups.</p> <p><strong>Results: </strong>Group-1 read 435 CXRs (77.0 % disease prevalence): sensitivity was 89.0 %, specificity 66.0 %, accuracy 83.7 %. Group-2 read 100 CXRs (73.0 % prevalence): sensitivity was 89.0 %, specificity 40.7 %, accuracy 76.0 %. During the first half of the outbreak (195 CXRs, 66.7 % disease prevalence), overall sensitivity was 80.8 %, specificity 67.7 %, accuracy 76.4 %, Group-1 sensitivity being similar to Group-2 (80.6 % versus 81.5 %, respectively) but higher specificity (74.0 % versus 46.7 %) and accuracy (78.4 % versus 69.0 %). During the second half (340 CXRs, 81.8 % prevalence), overall sensitivity increased to 92.8 %, specificity dropped to 53.2 %, accuracy increased to 85.6 %, this pattern mirrored in both groups, with decreased specificity (Group-1, 58.0 %; Group-2, 33.3 %) but increased sensitivity (92.7 % and 93.5 %) and accuracy (86.5 % and 81.0 %, respectively).</p> <p><strong>Conclusions: </strong>Real-world CXR diagnostic performance during the COVID-19 pandemic showed overall high sensitivity with higher specificity for more experienced radiologists. The increase in accuracy over time strengthens CXR role as a first line examination in suspected COVID-19 patients.</p>
Calibration of adaptive energy management strategies for fuel cell trucks using real-world driving scenarios
<p>Energy management strategies have a significant impact on the hydrogen economy of fuel cell trucks and the lifetime of battery and fuel cell systems. Usually, the strategy design and calibration involve a multi-objective optimization of performance indexes related to hydrogen consumption, fuel cell transients, battery thermal state, and battery charge control. This contribution presents the calibration of an energy management strategy that is adaptive to battery and ambient temperature. Indeed, fuel cell trucks face critical operating conditions due to high ambient temperatures or high loads on long uphill roads. However, the presented adaptive energy management strategy can effectively avoid thermal issues to preserve the battery life without hindering the hydrogen economy. The strategy calibration can be optimized using a simulation environment consisting of drivetrain components in AVL CRUISE M and vehicle control unit functions in MATLAB Simulink. Moreover, AVL CAMEO can systematically vary the adaptive strategy's curve parameters to find the best trade-off between the key performance indexes. The calibration considers real-world driving cycles of road freight vehicles, including measured speed, road elevation, and variable vehicle mass. The calibration is robust because the performance indexes are optimized over more than 9000 kilometers, covering an extensive range of real-world driving scenarios. Besides the benefits of optimal calibrations, this contribution also provides interesting insights into the energy and thermal management problem of fuel cell trucks.</p>
Dataset related to article "Real-World Effectiveness of Denosumab and Bisphosphonates on Risk of Vertebral Fractures in Women with Breast Cancer Undergoing Treatment with Aromatase Inhibitors "
<p>This record contains raw data related to article “Real-World Effectiveness of Denosumab and Bisphosphonates on Risk of Vertebral Fractures in Women with Breast Cancer Undergoing Treatment with Aromatase Inhibitors"</p> <p>Abstract</p> <p>Bone-active drugs are recommended to protect the skeleton from detrimental actions of aromatase inhibitors (AIs). However, most of literature data are focused on bone mineral density (BMD), whereas data on fractures are scant. The aim of this prospective study was to investigate the real-life effectiveness of denosumab, oral bisphosphonates (BPs) and intravenous zoledronate on risk of vertebral fractures (VFs) induced by AIs. 567 consecutive women (median age 62 years, range 28-83) with early breast cancer undergoing treatment with AIs were evaluated for morphometric VFs and BMD at baseline and after 18-24 months of follow-up. After enrollment, 268 women (47.3%) started denosumab 60 mg subcutaneously every 6 months, 115 (20.3%) BPs (59 with oral BPs and, 56 with intravenous zoledronate 5 mg/12 months), whereas 184 women (32.5%) were not treated with bone-active drugs for several reasons. During follow-up, 54 women (9.5%) developed incident VFs in association with age of subjects (P < 0.001), baseline FRAX scores for major fractures (P < 0.001) and hip fractures (P = 0.003), pre-existing VFs (P < 0.001), change in BMD at lumbar spine (P = 0.015), femoral neck (P = 0.003) and total hip (P < 0.001). Risk of VFs was higher in subjects who were untreated as compared to those treated with bone-active drugs (32/184 vs. 22/383; P < 0.001). Specifically, fracture risk was significantly decreased by denosumab [odds ratio (OR) 0.22; P < 0.001] and zoledronate (OR 0.27; P = 0.035), but not by oral BPs (P = 0.317). These data suggest that in real-world clinical practice, denosumab and zoledronate can reduce AI-related risk of VFs after only 24 months of treatment.</p>
Dataset related to article "Biochemical Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors by Cardiovascular Risk Profile and Volume Status in a Real-World Diabetic Population "
<p>This record contains raw data related to article “Biochemical Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors by Cardiovascular Risk Profile and Volume Status in a Real-World Diabetic Population"</p> <p>Abstract</p> <p>Despite large-scale randomized clinical trials (RCTs) highlighting a consistent prognostic benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2is) both in diabetic patients at high cardiovascular risk and in those with heart failure, there is relative paucity of data on their biochemical effects in a real-world setting. We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral center and completed at least 1 year of treatment. Changes in glycated hemoglobin, weight, and hematocrit were compared across 2 cardiovascular risk categories, defined through the inclusion criteria of 3 large RCTs. Of the 459 patients screened, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%), and 55 were lost to follow-up (12.0%). The most common cause of drug discontinuation was genital or urinary tract infections (9.4%). At 1 year, reduction in glycated hemoglobin concentration (-0.7 ± 1.5%, P < 0.001) and body weight (2.4 ± 4.6 kg, P < 0.001) was comparable between patients at high versus low cardiovascular risk, while hematocrit increase (2.3 ± 3.3%, P < 0.001) was more marked in patients with high cardiovascular risk and low baseline hematocrit. In a real-world population of diabetic patients, SGLT2is were well-tolerated at 1 year and led to improved glycemic control and weight loss. Hematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating euvolemic restoration as a potential cardioprotective mechanism mediated by these compounds.</p>
Sacubitril/valsartan use in a real-world population of patients with heart failure and reduced ejection fraction
<p>This record contains raw data related to the article “Sacubitril/valsartan use in a real-world population of patients with heart failure and reduced ejection fraction”</p> <p> </p> <p><strong>Aims: </strong>Practice guidelines recommend sacubitril/valsartan for heart failure with reduced ejection fraction. The aim of our study was to describe the use of sacubitril/valsartan in real-world clinical practice to help identify patients best able to tolerate titration to higher doses.</p> <p><strong>Methods: </strong>We retrospectively analyzed clinical data for 201 patients with heart failure with reduced ejection fraction prescribed sacubitril/valsartan at our heart failure clinic (Centro Cardiologico Monzino) between September 2016/December 2018. Patients had a mean age of 67.2 years, mean left ventricular ejection fraction of 30.1%, New York Heart Association class II (65%), class III (35%), and poor cardiopulmonary exercise capacity. Median 2-year risk of death/urgent cardiac transplantation was 8.9% [Metabolic Exercise Cardiac Kidney Index (MECKI) score].</p> <p><strong>Results: </strong>After a median follow-up of 230 (interquartile interval: 105-366) days, 57 patients achieved higher-dose sacubitril/valsartan, 103 tolerated medium/low doses, nine died, and 20 interrupted treatment. The highest dose of sacubitril/valsartan was reached by younger patients with better hemoglobin (Hb) levels, renal function, and blood pressure (BP). Patients continuing on sacubitril/valsartan had significantly higher serum Hb and sodium, better BP, and lower MECKI scores than patients who discontinued treatment or died during follow-up. Our patients were older and frailer than those in the pivotal PARADIGM-HF trial.</p> <p><strong>Conclusion: </strong>In our experience, more than one-third of the patients were able to tolerate the higher dose of sacubitril/valsartan, and these patients were younger, had higher Hb, and better BP and renal function. MECKI score stratification was useful to discriminate patients who continued treatment from those who did not. Future prospective studies should test if these clinical variables can guide the up-titration of sacubitril/valsartan.</p>
Dataset related to article: "Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study"
<p>This record contains data related to article "<strong>Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study" </strong></p><p>Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in cardiovascular outcome trials in type 2 diabetes mellitus. However, the most convincing evidence was obtained in subjects with established cardiovascular (CV) disease. We analyzed the determinants of GLP-1 RA-mediated CV protection in a real-world population of persons with type 2 diabetes with and without a history of CV events with long-term follow-up.</p><p>Methods: Retrospective cohort study of 550 individuals with type 2 diabetes (395 in primary CV prevention, 155 in secondary CV prevention), followed at a single center after the first prescription of a GLP-1 RA between 2009 and 2019. CV and metabolic outcomes were assessed.</p><p>Results: Median duration of follow-up was 5.0 years (0.25-10.8) in primary prevention and 3.6 years (0-10.3) in secondary prevention, with a median duration of treatment of 3.2 years (0-10.8) and 2.5 years (0-10.3) respectively. In the multivariable Cox regression model considering GLP-1 RA treatment as a time-dependent covariate, in the primary prevention group, changes in BMI and glycated hemoglobin did not have an impact on MACE risk, while age at the time of GLP-1 initiation (HR 1.08, 95% CI 1.03-1.14, p = 0.001) and GLP-1 RA cessation by time (HR 3.40, 95% CI 1.82-6.32, p < 0.001) increased the risk of MACE. Regarding the secondary prevention group, only GLP-1 RA cessation by time (HR 2.71, 95% CI 1.46-5.01, p = 0.002) increased the risk of MACE. With respect to those who withdrew treatment, subjects who continued the GLP-1 RA had significantly greater weight loss and lower glycated hemoglobin levels during follow-up.</p><p>Conclusions: In this real-world type 2 diabetes population, discontinuation of GLP-1 RA treatment was associated to a higher risk of major cardiovascular events, in both subjects with and without a history of CV events.</p><p> </p>
Are IF-ANA the guiding light for SLE classification in the real-world setting?
<p>IF-ANA detected by HEp-2 cells appear a reliable and stable marker of the disease in a real-world cohort of SLE patients with and without renal involvement and during a long follow-up. In fact, IFANAbecame negative in only 8% of patients and around 40% of them showed a decrease in IF-ANA titer during the follow-up, independent of disease characteristics and treatment. The evaluation of clinical and laboratory data from different clinical centers further stresses the reproducibility of the finding. Additional studies to clarify the mechanisms responsible for IF-ANA seroconversion and titer variation in SLE patients are warranted.</p>
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Allen Brain Atlas
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International Brain Laboratory public data
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OpenNeuro
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