Hollisyildirim2506

They reveal that through the past four decades, newly approved drugs often showed initially exaggerated results, which tended to diminish and stabilize after approximately a decade. Over the years, the drugs with relative superiority changed dramatically; but as the evidence network grew larger and better connected, the overall confidence improved. The Shiny app visualizes how evidence evolved over years, emphasizing the need for a careful interpretation of relative effects between drugs, especially for the potentially amplified performance of newly approved drugs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.OBJECTIVE The authors sought to evaluate 10-year national trends, incidence and clinical outcomes of stroke in CS-STEMI. BACKGROUND Stroke is a devastating complication among patients with ST-elevation myocardial infarction (STEMI). Concomitant cardiogenic shock (CS) may further increase the risk of stroke. Use of percutaneous mechanical circulatory support (pMCS) devices may further increase stroke risk in CS-STEMI. No studies have evaluated the risk of stroke in contemporary CS-STEMI. METHODS We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database between 2005 and 2014. Previously validated codes for stroke were used to identify events of ischemic or hemorrhagic stroke. They were then divided into different groups without MCS, with intra-aortic balloon pump, percutaneous ventricular assist device (PVAD, includes Impella or TandemHeart devices), or extracorporeal membrane oxygenation. RESULTS In 172,491 admissions, stroke was noted in 5,613 (3.2%). Between 2005 and 2014, we observed an increase in the events of overall stroke from 3.1% in 2005 to 5.0% in 2014 (p for the trend less then .001). The number of ischemic stroke events (2.4%) was higher than hemorrhagic stroke (0.1%) during the study period. Presence of stroke was associated with higher in-hospital mortality (40.6 vs. 29.8%, 95% CI adjusted odds ratio 1.57, 1.44-1.67; p  less then  .0001 among stroke vs. without stroke). CONCLUSIONS The incidence of stroke events in CS-STEMI patients increased between 2005 and 2014, and is associated with higher in-hospital mortality, length of stay, and cost of hospitalization. The incidence of both hemorrhagic and ischemic stroke was higher with pMCS device use. Stroke prevention is a priority for CS-STEMI patients. © 2020 Wiley Periodicals, Inc.OBJECTIVE To explore the potential association of obesity and other chronic diseases with severe outcomes, such as intensive care unit (ICU) admission and invasive mechanical ventilation (IMV), in patients hospitalized with COVID-19. METHODS Retrospective cohort of 103 patients hospitalized with COVID-19. Demographic data, past medical history and hospital course were collected and analyzed. A multivariate logistic regression analysis was implemented to examine associations. RESULTS From February 17th to April 5th, 103 consecutive patients were hospitalized with COVID-19. Among them, 41 patients (39.8%) were admitted to the ICU and 29 (70.7%) required (IMV). The prevalence of obesity was 47.5% (49/103). In a multivariate analysis, severe obesity (BMI ≥35 kg/m2) was associated with ICU admission (aOR 5.39; 95% CI1.13-25.64). Moreover, patients who required IMV, were more likely to have had heart disease (aOR 3.41; 95% CI1.05-11.06), obesity (BMI=30-34.9 kg/m2) (aOR 6.85; 95% CI 1.05-44.82) or severe obesity (BMI≥35 kg/m2) (aOR 9.99; 95% CI1.39-71.69). CONCLUSION In our analysis, severe obesity (BMI ≥35 kg/m2) was associated with ICU admission, while history of heart disease and obesity (BMI ≥30 kg/m2) were independently associated with the use of IMV. Increased vigilance and aggressive treatment of patients with obesity and COVID-19 are warranted. This article is protected by copyright. All rights reserved.BACKGROUND AND AIMS Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has been reported to be an effective treatment for acute cholecystitis. However, ETGBD is considered to be more difficult than percutaneous transhepatic gallbladder drainage (PTGBD), and few studies have evaluated the factors that affect technical success of the procedure. We investigated the factors predicting its technical success from among patient characteristics and image findings before treatment. METHODS 323 patients who underwent ETGBD for acute cholecystitis from November 2006 to December 2018 were analyzed retrospectively. RESULTS The technical success rate was 72.8% (235/323). The technical success rate by cystic duct direction was as follows proximal/distal, 65.9%/93.6%; right/left 74.0%/65.2%; cranial/caudal, 83.5%/20.0%. The clinical response rate was 96.2% (226/235). Adverse events were encountered in 5.9% of cases (19/323), including cystic duct injury (11 patients), pancreatitis (5 patients), and bleeding (3 patients). In both univariate and multivariate analysis, presence of cystic duct stone, dilation of the common bile duct (CBD), and cystic duct direction (proximal and caudal branches) were identified as significant factors affecting technical failure of ETGBD. CONCLUSION Although ETGBD was an effective and safe procedure for acute cholecystitis, it has a limited success rate. The presence of cystic duct stone, dilation of CBD, and cystic duct direction (proximal and caudal branches) can serve as important predictors of ETGBD difficulties. These findings should be considered before procedures and the necessary adaptation of ETGBD made. This article is protected by copyright. All rights reserved.INTRODUCTION The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. METHODS A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. MI-773 MDMX antagonist RESULTS Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. DISCUSSION Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States.