Lancet Regional Health-Europe最新文献

{"title":"Development of a prognostic model to predict 90-day mortality in hospitalised cancer patients (PROMISE tool): a prospective observational study","authors":"Oriol Mirallas ,&nbsp;Berta Martin-Cullell ,&nbsp;Víctor Navarro ,&nbsp;Kreina Sharela Vega ,&nbsp;Jordi Recuero-Borau ,&nbsp;Diego Gómez-Puerto ,&nbsp;Daniel López-Valbuena ,&nbsp;Clara Salva de Torres ,&nbsp;Laura Andurell ,&nbsp;Anna Pedrola ,&nbsp;Roger Berché ,&nbsp;Fiorella Palmas ,&nbsp;José María Ucha ,&nbsp;Guillermo Villacampa ,&nbsp;Alejandra Rezqallah ,&nbsp;Judit Sanz-Beltran ,&nbsp;Rafael Bach ,&nbsp;Sergio Bueno ,&nbsp;Cristina Viaplana ,&nbsp;Gaspar Molina ,&nbsp;Joan Carles","doi":"10.1016/j.lanepe.2024.101063","DOIUrl":"10.1016/j.lanepe.2024.101063","url":null,"abstract":"<div><h3>Background</h3><div>Prognostic factors for ambulatory oncology patients have been described, including Eastern Cooperative Oncology Group (ECOG), tumor stage and malnutrition. However, there is no firm evidence on which variables best predict mortality in hospitalized patients receiving active systemic treatment. Our main goal was to develop a predictive model for 90-day mortality upon admission.</div></div><div><h3>Methods</h3><div>Between 2020 and 2022, we prospectively collected data from three sites for cancer patients with hospitalizations. Those with metastatic disease receiving systemic therapy in the 6 months before unplanned admission were eligible to this study. The least absolute shrinkage and selection operator (LASSO) method was used to select the most relevant factors to predict 90-day mortality at admission. A multivariable logistic regression was fitted to create the PROgnostic Score for Hospitalized Cancer Patients (PROMISE) score. The score was developed in a single-center training cohort and externally validated.</div></div><div><h3>Findings</h3><div>Of 1658 hospitalized patients, 1009 met eligibility criteria. Baseline demographics, patient and disease characteristics were similar across cohorts. Lung cancer was the most common tumor type in both cohorts. Factors associated with higher 90-day mortality included worse ECOG, stable/progressive disease, low levels of albumin, increased absolute neutrophil count, and high lactate dehydrogenase. The c-index after bootstrap correction was 0.79 (95% CI, 0.75–0.82) and 0.74 (95% CI, 0.68–0.80) in the training and validation cohorts, respectively. A web tool (<span><span>https://promise.vhio.net/</span><svg><path></path></svg></span>) was developed to facilitate the clinical deployment of the model.</div></div><div><h3>Interpretation</h3><div>The PROMISE tool demonstrated high performance for identifying metastatic cancer patients who are alive 90 days after an unplanned hospitalization. This will facilitate healthcare providers with rational clinical decisions and care planning after discharge.</div></div><div><h3>Funding</h3><div><span>Merck S.L.U.</span>, Spain.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"46 ","pages":"Article 101063"},"PeriodicalIF":13.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation for critically ill patients with acute on chronic liver failure: a prospective national programme of waitlist prioritisation","authors":"William Bernal ,&nbsp;Rhiannon Taylor ,&nbsp;Ian A. Rowe ,&nbsp;Abhishek Chauhan ,&nbsp;Matthew J. Armstrong ,&nbsp;Michael E.D. Allison ,&nbsp;Gwilym Webb ,&nbsp;Tasneem Pirani ,&nbsp;Joanna Moore ,&nbsp;Laura Burke ,&nbsp;Steven Masson ,&nbsp;David Cressy ,&nbsp;Brian J. Hogan ,&nbsp;Rachel Westbrook ,&nbsp;Rajiv Jalan ,&nbsp;Kenneth J. Simpson ,&nbsp;John Isaac ,&nbsp;Douglas Thorburn","doi":"10.1016/j.lanepe.2024.101067","DOIUrl":"10.1016/j.lanepe.2024.101067","url":null,"abstract":"<div><h3>Background</h3><div>Acute on Chronic Liver Failure (ACLF) complicates chronic liver disease (CLD) combining rapidly progressive hepatic with extra-hepatic multiple organ failure and high short-term mortality. Effective therapeutic options are very limited, and liver transplantation (LT) seldom utilised through concerns of high recipient mortality and resource use. Retrospective reports suggest recent outcomes may have improved, but use of LT for ACLF has not been prospectively assessed.</div></div><div><h3>Methods</h3><div>A prospective programme of prioritised liver graft allocation for selected recipients with ACLF through registration on a new national tier, initiated in May 2021 in all 7 United Kingdom LT centres. Candidates were selected by centre multidisciplinary teams, with inclusion criteria mandating cirrhotic CLD with ACLF requiring critical care (CC) organ support and expected 1-month mortality &gt;50%. Exclusion criteria included age ≥60 years, previous LT, comorbidity or substance misuse profile precluding elective LT. A pilot 50 registrations were planned, with pre-specified futility criteria of a 1-year post-LT survival of 60%.</div></div><div><h3>Findings</h3><div>Fifty-two patients were registered on the ACLF tier, median (IQR) age 46 (39–52) years, ACLF grade 3 (3–3) and Model for End-stage Liver Disease (MELD) 39 (35–40). At registration 32 (62%) required mechanical ventilation, 44 (85%) vasopressors and 46 (89%) renal replacement. Forty-two (81%) underwent LT 2 (2–5) days after registration: 10 (19%) did not. All non-transplanted died at median 7 (4–13) days after registration (p &lt; 0.0001 vs. LT). Post-LT follow-up was 212 (119–530) days and patient survival 81% (95% CI 66–91): 28-, 90-day and 1-year survival after registration 93%, 86% and 77%. Median length of CC and hospital stay in LT recipients was 16 (8–28) and 35 (23–54) days respectively.</div></div><div><h3>Interpretation</h3><div>We report the first prospective national series of prioritised liver transplantation for critically ill patients with ACLF. For selected recipients LT is a practical and highly effective treatment option where no other similarly effective interventions exist.</div></div><div><h3>Funding</h3><div>There was no funding for the study.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"46 ","pages":"Article 101067"},"PeriodicalIF":13.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutri-score and cardiovascular risk: new insights from the EPIC cohorts","authors":"Andrea Poli,&nbsp;Franca Marangoni","doi":"10.1016/j.lanepe.2024.101059","DOIUrl":"10.1016/j.lanepe.2024.101059","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"46 ","pages":"Article 101059"},"PeriodicalIF":13.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Society for Medical Oncology (ESMO) congress 2024","authors":"Daniela Marín-Hernández,&nbsp;Ivana Nedic","doi":"10.1016/j.lanepe.2024.101087","DOIUrl":"10.1016/j.lanepe.2024.101087","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"46 ","pages":"Article 101087"},"PeriodicalIF":13.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solidarity and trust in European Union health governance: three ways forward","authors":"Anniek de Ruijter ,&nbsp;Tamara Hervey ,&nbsp;Barbara Prainsack","doi":"10.1016/j.lanepe.2024.101047","DOIUrl":"10.1016/j.lanepe.2024.101047","url":null,"abstract":"<div><div>Trust and solidarity are centrally important to the functioning of healthcare systems, and for societal resilience and stability more broadly. The European Union is increasingly shaping governance and norms that affect trust and solidarity in health—a process that has intensified with the announcement of the ‘European Health Union’ in response to the COVID-19 pandemic. In this context, how can the EU ensure solidarity in health while generating public trust as a pre-condition for solidaristic institutions? We propose three strategies to reach this goal. First, both at national and European levels, institutions and mechanisms of solidarity should be strengthened. Second, the Union should boost the resilience and stability of national healthcare systems through mechanisms of risk-sharing. Third, the Union should mandate or encourage its member countries to enhance prevention and other public health policies to strengthen pre-distribution, aimed to ensure a more equal baseline of public health before inequalities arise.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"46 ","pages":"Article 101047"},"PeriodicalIF":13.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Impact of COVID-19 on total excess mortality and geographic disparities in Europe, 2020–2023: a spatio-temporal analysis” The Lancet Regional Health – Europe, Vol 44, 100996","authors":"Margherita Pizzato ,&nbsp;Alberto Giovanni Gerli ,&nbsp;Carlo La Vecchia ,&nbsp;Gianfranco Alicandro","doi":"10.1016/j.lanepe.2024.101117","DOIUrl":"10.1016/j.lanepe.2024.101117","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"47 ","pages":"Article 101117"},"PeriodicalIF":13.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of understanding pelvic inflammatory disease as a polymicrobial infection - authors’ reply","authors":"Zoïe W. Alexiou ,&nbsp;Bernice M. Hoenderboom ,&nbsp;Christian J.P.A. Hoebe ,&nbsp;Nicole H.T.M. Dukers-Muijrers ,&nbsp;Hannelore M. Götz ,&nbsp;Marianne A.B. van der Sande ,&nbsp;Henry J.C. de Vries ,&nbsp;Janneke E. den Hartog ,&nbsp;Servaas A. Morré ,&nbsp;Birgit H.B. van Benthem","doi":"10.1016/j.lanepe.2024.101116","DOIUrl":"10.1016/j.lanepe.2024.101116","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"47 ","pages":"Article 101116"},"PeriodicalIF":13.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of understanding pelvic inflammatory disease as a polymicrobial infection","authors":"Kenyon Chris","doi":"10.1016/j.lanepe.2024.101115","DOIUrl":"10.1016/j.lanepe.2024.101115","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"47 ","pages":"Article 101115"},"PeriodicalIF":13.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monkeypox clade IIb in France in 2023–2024","authors":"Mayda Rahi ,&nbsp;Sebastien Fouere ,&nbsp;Marie Gilbert ,&nbsp;Antoine Bachelard ,&nbsp;Fabien Taieb ,&nbsp;Baptiste Sellem ,&nbsp;Florian Herms ,&nbsp;Charles Cazanave ,&nbsp;Nadia Valin ,&nbsp;Gentiane Monsel ,&nbsp;Yazdan Yazdanpanah ,&nbsp;Jade Ghosn ,&nbsp;Nathan Peiffer-Smadja","doi":"10.1016/j.lanepe.2024.101114","DOIUrl":"10.1016/j.lanepe.2024.101114","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"47 ","pages":"Article 101114"},"PeriodicalIF":13.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial","authors":"Mike Slade ,&nbsp;Stefan Rennick-Egglestone ,&nbsp;Clare Robinson ,&nbsp;Chris Newby ,&nbsp;Rachel A. Elliott ,&nbsp;Yasmin Ali ,&nbsp;Caroline Yeo ,&nbsp;Tony Glover ,&nbsp;Sean P. Gavan ,&nbsp;Luke Paterson ,&nbsp;Kristian Pollock ,&nbsp;Stefan Priebe ,&nbsp;Graham Thornicroft ,&nbsp;Jeroen Keppens ,&nbsp;Melanie Smuk ,&nbsp;Donna Franklin ,&nbsp;Rianna Walcott ,&nbsp;Julian Harrison ,&nbsp;Dan Robotham ,&nbsp;Simon Bradstreet ,&nbsp;Fiona Ng","doi":"10.1016/j.lanepe.2024.101101","DOIUrl":"10.1016/j.lanepe.2024.101101","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The Narrative Experiences Online (NEON) Intervention provides self-managed web-based access to mental health recovery narratives (n = 659). We evaluated effectiveness and cost-effectiveness in improving quality of life for adults resident in England with mental health problems and recent psychosis experience.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Prospectively registered pragmatic parallel-group randomised trial controlling for usual care, recruiting from statutory mental health services and through community engagement activities, with a 52-week primary endpoint (ISRCTN11152837). All trial procedures and the NEON Intervention were delivered by an integrated web-application. Randomisation was through an independently generated list (no stratification). Allocation was masked for statistical staff and the Chief Investigator but not participants. Intervention arm participants received immediate NEON Intervention access. Control arm participants received access after completing primary endpoint questionnaires. The primary outcome was quality of life through the Manchester Short Assessment (MANSA). Serious Adverse Events (SAEs) were collected through web-based safety report forms and identified from health service usage data. The primary analysis was by a prospectively described Intention To Treat principle excluding participants who had registered multiple times, with multiple imputation for missing data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between 9 March 2020 and 1 March 2021, 739 participants were randomised (intervention:370; control: 369), providing more than 90% power to detect a baseline-adjusted difference of 0.25 in the MANSA score. Mean age was 34.8 years (standard deviation (SD) 12.0), 561 (75.9%) were white British, 443 (59.9%) were female, 609 (82.4%) had accessed specialist care mental health services, and 698 (94.5%) had accessed primary care mental health services. Mean baseline MANSA score was 3.7 for control and intervention arms (SD 0.9 and 1.0). 565 (76.5%) participants provided primary endpoint MANSA data with a mean score of 4.1 (SD 1.0) for both arms. We found no significant difference in Quality of Life between the two arms at the primary endpoint (baseline-adjusted difference 0.07, 95% CI −0.07 to 0.21, p = 0.35). The incremental cost-effectiveness ratio (£110,501 per quality-adjusted life-year (QALY)) exceeded the prospectively defined cost-effectiveness threshold (£30,000 per QALY). 158 (42.8%) control arm and 194 (52.4%) intervention arm participants accessed narratives outside of the NEON Intervention. There were no related serious adverse events (SAEs). 116 unrelated SAEs were reported by control arm participants, and 107 by intervention arm participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Our findings do not indicate NEON Intervention access for all people with psychosis experience. Future research should consider a) evaluation with current mental health services users; b) optimisa","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"47 ","pages":"Article 101101"},"PeriodicalIF":13.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}