Background COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK.Methods We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. FindingsBetween Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49•7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71•1 years (SD 18•7), with 56•0% (41 025 of 73 197) being male and 81•0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years:
Características do acesso e utilização de serviços odontológicos em municípios de médio porteCharacteristics of the access and utilization of public dental services in medium-sized cities
Governo local e serviços odontológicos: análise da desigualdade na utilização Local government and public dental health services: an analysis of inequality in use Gobierno local y servicios odontológicos: análisis de la desigualdad en el uso
Objective To externally validate various prognostic models and scoring rules for predicting short term mortality in patients admitted to hospital for covid-19. Design Two stage individual participant data meta-analysis. Setting Secondary and tertiary care. Participants 46 914 patients across 18 countries, admitted to a hospital with polymerase chain reaction confirmed covid-19 from November 2019 to April 2021. Data sources Multiple (clustered) cohorts in Brazil, Belgium, China, Czech Republic, Egypt, France, Iran, Israel, Italy, Mexico, Netherlands, Portugal, Russia, Saudi Arabia, Spain, Sweden, United Kingdom, and United States previously identified by a living systematic review of covid-19 prediction models published in The BMJ , and through PROSPERO, reference checking, and expert knowledge. Model selection and eligibility criteria Prognostic models identified by the living systematic review and through contacting experts. A priori models were excluded that had a high risk of bias in the participant domain of PROBAST (prediction model study risk of bias assessment tool) or for which the applicability was deemed poor. Methods Eight prognostic models with diverse predictors were identified and validated. A two stage individual participant data meta-analysis was performed of the estimated model concordance (C) statistic, calibration slope, calibration-in-the-large, and observed to expected ratio (O:E) across the included clusters. Main outcome measures 30 day mortality or in-hospital mortality. Results Datasets included 27 clusters from 18 different countries and contained data on 46 914patients. The pooled estimates ranged from 0.67 to 0.80 (C statistic), 0.22 to 1.22 (calibration slope), and 0.18 to 2.59 (O:E ratio) and were prone to substantial between study heterogeneity. The 4C Mortality Score by Knight et al (pooled C statistic 0.80, 95% confidence interval 0.75 to 0.84, 95% prediction interval 0.72 to 0.86) and clinical model by Wang et al (0.77, 0.73 to 0.80, 0.63 to 0.87) had the highest discriminative ability. On average, 29% fewer deaths were observed than predicted by the 4C Mortality Score (pooled O:E 0.71, 95% confidence interval 0.45 to 1.11, 95% prediction interval 0.21 to 2.39), 35% fewer than predicted by the Wang clinical model (0.65, 0.52 to 0.82, 0.23 to 1.89), and 4% fewer than predicted by Xie et al’s model (0.96, 0.59 to 1.55, 0.21 to 4.28). Conclusion The prognostic value of the included models varied greatly between the data sources. Although the Knight 4C Mortality Score and Wang clinical model appeared most promising, recalibration (intercept and slope updates) is needed before implementation in routine care.
Background and Objective Medical machine learning (ML) models tend to perform better on data from the same cohort than on new data, often due to overfitting, or co-variate shifts. For these reasons, external validation (EV) is a necessary practice in the evaluation of medical ML. However, there is still a gap in the literature on how to interpret EV results and hence assess the robustness of ML models. Methods We fill this gap by proposing a meta-validation method, to assess the soundness of EV procedures. In doing so, we complement the usual way to assess EV with an assessment in terms of the dataset cardinality, as well as with a novel method that considers the similarity of the EV dataset with respect to the training set. We then investigate how the notions of cardinality and similarity can be used to inform on the reliability of a validation procedure, by integrating them into two summative data visualizations. Results We illustrate our methodology by applying it to the validation of a state-of-the-art COVID-19 diagnostic model on 8 EV sets, collected across 3 different continents. The model performance was moderately impacted by data similarity (Pearson ρ = .38, p < .001). In the EV, the validated model reported good AUC (average: .84), acceptable calibration (average: .17) and utility (average: .50). The validation datasets were adequate in terms of dataset cardinality and similarity, thus suggesting the soundness of the results. We also provide
The author list is alphabetical and does not reflect the respective author contributions. The task was coordinated by Mariana Neves. sions were judged to be better than the reference translations, for instance, for de/en, en/es and es/en. 10 https://github.com/glample/fastBPE 11 1 encoder layer, 1 decoder layer, both with with GRU cells, embedding dimension of 512, hidden state of dimension 1024, using layer normalization, implemented using Marian NMT and trained using the Adam optimizer.
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