PD39-09 PATTERNS OF CARE AND OUTCOMES AROUND TRANSITION IN PATIENTS WITH SPINAL DYSRAPHISM: A POPULATION-BASED STUDY IN ONTARIO, CANADA
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You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Transitional Urology & GU Congenitalism (PD39)1 Apr 2019PD39-09 PATTERNS OF CARE AND OUTCOMES AROUND TRANSITION IN PATIENTS WITH SPINAL DYSRAPHISM: A POPULATION-BASED STUDY IN ONTARIO, CANADA Rano Matta*, Christopher J.D. Wallis, Humberto Vigil, Armando Lorenzo, Ronald T. Kodama, Robert K. Nam, Sidney B. Radomski, Lesley K. Carr, and Sender Herschorn Rano Matta*Rano Matta* More articles by this author , Christopher J.D. WallisChristopher J.D. Wallis More articles by this author , Humberto VigilHumberto Vigil More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , Ronald T. KodamaRonald T. Kodama More articles by this author , Robert K. NamRobert K. Nam More articles by this author , Sidney B. RadomskiSidney B. Radomski More articles by this author , Lesley K. CarrLesley K. Carr More articles by this author , and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556412.78022.9fAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Patients with neuropathic bladder dysfunction associated with spina bifida are typically diagnosed and initially treated by pediatric specialists. Abrupt transition of care to adult practices, often at age 18, has been hypothesized to compromise patient care. However, we lack robust data to support this idea. We hypothesize that if patients lack adequate transitional care, they are more likely seek care in the emergency room during this period for non-urgent issues that do not require hospital admission. Therefore, we evaluated the use of emergency room (ER) care, hospital admissions, and trends in care before and after the age of 18 in children with spina bifida in Ontario, Canada. METHODS: We conducted a retrospective population-based cohort study of patients with spinal dysraphism in Ontario, Canada. We included all patients with spina bifida turning 18 years old in Ontario between Jan 1, 2002 to Dec 31, 2011, with data available at least 5 years before and after the age of 18. The primary outcome was ER visits. Secondary outcomes included hospital admissions. We estimated primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates. RESULTS: We identified 1,215 individuals diagnosed with spina bifida during the study period. Most of the cohort were females (N=660, 54.3%), and they lived within 50 km of a tertiary-care center (N=764, 62.9%). 503 patients (41.4%) had a diagnosis of neuropathic bladder. The annual rate of ER visits progressively increased from 68 visits per person years at age 13 to 105 visits at age 23. The rate of hospital admissions decreased from 29 admissions per person years at age 13 to 20 at age 23. In adjusted models, age had a null effect (RR 0.99; 95%CI 0.98-1.02), however there was a significant increase in the relative rate of ER visits at age 18 to 23 (RR 1.14; 95%CI 1.03-1.27). Patients in the lowest income quintile (RR 1.31; 95%CI 1.07-1.61), those living further than 50 km from a tertiary center (RR 1.42; 95%CI 1.16-1.73), those diagnosed with neuropathic bowel (RR 1.23; 95%CI 1.08-1.41) or bladder (RR 1.20; 95%CI 1.03-1.40), and those requiring mobility aids (RR 1.76; 95%CI 1.08-2.86) all had increased rates of ER visits. CONCLUSIONS: In children with spina bifida, the rate of ER visits increased significantly from age 18 to 23 relative to age 13 to 18, while hospital admission decreased over the same time. Transitional care should aim to reduce non-urgent emergency room visits, especially in those patients at greater risk of seeking emergency room care. Source of Funding: Functional Urology Research Group, University of Toronto Toronto, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e735-e735 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rano Matta* More articles by this author Christopher J.D. Wallis More articles by this author Humberto Vigil More articles by this author Armando Lorenzo More articles by this author Ronald T. Kodama More articles by this author Robert K. Nam More articles by this author Sidney B. Radomski More articles by this author Lesley K. Carr More articles by this author Sender Herschorn More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».