Background: Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 10 9 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts. Methods:This was a retrospective cohort study of patients with very low PLT counts (<20 × 10 9 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant.Results: Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis. Conclusions:In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.

To describe our experience upon developing and implementing a hospital-based cancer registry (HBCR) in a quaternary-level of care private non-pro t academic medical center in Cali, Colombia. MethodsHBCRs capture, in a given institution, every single patient with a con rmed malignancy. In this study, all cases evaluated between 2014 and 2018 were included in the HBCR. In compliance with the International Agency for Research on Cancer (IARC) recommendations, cases were classi ed as analytic or nonanalytic. Data derived from an exhaustive selection of patients was stored in a computing platform owned by the institution, meeting the 2016 Facility Oncology Registry Data Standards (FORDS) recommendations. Quality control was performed by evaluating comparability, timeliness, validity, and completeness. ResultsA total of 24,405 new cases were registered between 2014 and 2018, from which 4,253 (17.4%) died. Among all cases, based on the anatomic location, most common malignancies were breast (n = 1,554), thyroid (n = 1,346), hematolymphoid (n = 1,251), prostatic (n = 805), and colorectal (n = 624). The behavior of the incidence was consistent with an incremental trend. ConclusionUpon implementing the HBCR, major challenges were identi ed (i.e. a precise de nition of cases, the development of processes for capturing new cases, a standardized data collection strategy, and carryingout an appropriate patient follow-up). Based on our experience, the success of an HBCR largely relies on the interest from the institution, the engagement of stakeholders and nancial support, that is, it depends on the adequate access over time to funding, technological, and sta ng resources.There are mainly two types of cancer registries. One that measures the impact of the disease in speci c demographics, known as Population-Based Cancer Registry (PBCR) [3]. On the other hand, Hospital-Based Cancer Registries (HBCRs), mainly evaluate the burden of the disease and the quality of healthcare services, as well as the organizational and administrative support from the institution [4,5]. Although PBCRs are a valuable source of information, in Colombia, these do not often include clinical data, thus limiting the assessment of important variables, such as accuracy of diagnosis, quality of treatment, demand for health services, among others [6].Although the bene ts of implementing an HBCR have been evidenced [7, 8], its success over time requires the interest from the institution, the engagement of stakeholders and nancial support. For instance, in Colombia, the National Cancer Institute (INC by its Spanish acronym: Instituto Nacional de Cancerología) is the only institution with an HBCR that has published data [9,10]. The purpose of this study is to describe our experience upon developing and implementing the Institutional Cancer Registry (RIC by its Spanish acronym: Registro Institucional de Cáncer) in Fundación Valle del Lili (FVL). Our methodology may serve as a role model for other health centers in the country, Latin America and the Caribbean. The ...

En el presente artículo se describe una metodología que permite tener un acercamiento a modelos probabilísticos alternativos para el análisis de supervivencia, con censura por la derecha, distintos a los que usualmente se estudian (distribución: exponencial, gamma, Weibull y log-normal), ya que es posible que los datos no se ajusten siempre con suficiente precisión por las distribuciones existentes. La metodología utilizada permite mayor flexibilidad de modelar observaciones extremas, ubicadas generalmente en la cola derecha de la distribución de los datos, lo cual admite que algunos eventos aún tengan la probabilidad de ocurrir, lo que no sucede con los modelos tradicionales y el estimador de Kaplan-Meier, el cual estima para los tiempos más prolongados, probabilidades de supervivencia aproximadamente iguales a cero. Para mostrar la utilidad de la propuesta metodológica, se consideró una aplicación con datos reales que relaciona tiempos de supervivencia de pacientes con cáncer de colon.

Purpose To describe our experience upon developing and implementing a hospital-based cancer registry (HBCR) in a quaternary-level of care private non-profit academic medical center in Cali, Colombia. Methods HBCRs capture, in a given institution, every single patient with a confirmed malignancy. In this study, all cases evaluated between 2014 and 2018 were included in the HBCR. In compliance with the International Agency for Research on Cancer (IARC) recommendations, cases were classified as analytic or non-analytic. Data derived from an exhaustive selection of patients was stored in a computing platform owned by the institution, meeting the 2016 Facility Oncology Registry Data Standards (FORDS) recommendations. Quality control was performed by evaluating comparability, timeliness, validity, and completeness. Results A total of 24,405 new cases were registered between 2014 and 2018, from which 4,253 (17.4%) died. Among all cases, based on the anatomic location, most common malignancies were breast (n = 1,554), thyroid (n = 1,346), hematolymphoid (n = 1,251), prostatic (n = 805), and colorectal (n = 624). The behavior of the incidence was consistent with an incremental trend. Conclusion Upon implementing the HBCR, major challenges were identified (i.e. a precise definition of cases, the development of processes for capturing new cases, a standardized data collection strategy, and carrying-out an appropriate patient follow-up). Based on our experience, the success of an HBCR largely relies on the interest from the institution, the engagement of stakeholders and financial support, that is, it depends on the adequate access over time to funding, technological, and staffing resources.

It is possible that data are not always fitted with sufficient precision by the existing distributions; therefore this article presents a methodology that enables the use of families of asymmetric distributions as alternative probabilistic models for survival analysis, with censorship on the right, different from those usually studied (the Exponential, Gamma, Weibull, and Lognormal distributions). We use a more flexible parametric model in terms of density behavior, assuming that data can be fit by a distribution of stable distribution families considered unconventional in the analyses of survival data that are appropriate when extreme values occur, with small probabilities that should not be ignored. In the methodology, the determination of the analytical expression of the risk function h(t) of the Lévy distribution is included, as it is not usually reported in the literature. A simulation was conducted to evaluate the performance of the candidate distribution when modeling survival times, including the estimation of parameters via the maximum likelihood method, survival functionŜ (t) and Kaplan-Meier estimator. The obtained estimates did not exhibit significant changes for different sample sizes and censorship fractions in the sample. To illustrate the usefulness of the proposed methodology, an application with real data, regarding the survival times of patients with colon cancer, was considered.