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- 저자 : Shahram Paydar (검색결과 2 건)
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Shahram Paydar,Behnam Dalfardi,Hosseinali Khalili,Golnar Sabetian,Shahram Bolandparvaz,Mohammad Hadi Niakan,Hamidreza Abbasi,Donat R. Spahn 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.6
Background: The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP). Methods: Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16. Results: No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74). Conclusions: Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.
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Improving the Accuracy of Early Diagnosis of Thyroid Nodule Type Based on the SCAD Method
Shahraki, Hadi Raeisi,Pourahmad, Saeedeh,Paydar, Shahram,Azad, Mohsen Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4
Although early diagnosis of thyroid nodule type is very important, the diagnostic accuracy of standard tests is a challenging issue. We here aimed to find an optimal combination of factors to improve diagnostic accuracy for distinguishing malignant from benign thyroid nodules before surgery. In a prospective study from 2008 to 2012, 345 patients referred for thyroidectomy were enrolled. The sample size was split into a training set and testing set as a ratio of 7:3. The former was used for estimation and variable selection and obtaining a linear combination of factors. We utilized smoothly clipped absolute deviation (SCAD) logistic regression to achieve the sparse optimal combination of factors. To evaluate the performance of the estimated model in the testing set, a receiver operating characteristic (ROC) curve was utilized. The mean age of the examined patients (66 male and 279 female) was $40.9{\pm}13.4years$ (range 15- 90 years). Some 54.8% of the patients (24.3% male and 75.7% female) had benign and 45.2% (14% male and 86% female) malignant thyroid nodules. In addition to maximum diameters of nodules and lobes, their volumes were considered as related factors for malignancy prediction (a total of 16 factors). However, the SCAD method estimated the coefficients of 8 factors to be zero and eliminated them from the model. Hence a sparse model which combined the effects of 8 factors to distinguish malignant from benign thyroid nodules was generated. An optimal cut off point of the ROC curve for our estimated model was obtained (p=0.44) and the area under the curve (AUC) was equal to 77% (95% CI: 68%-85%). Sensitivity, specificity, positive predictive value and negative predictive values for this model were 70%, 72%, 71% and 76%, respectively. An increase of 10 percent and a greater accuracy rate in early diagnosis of thyroid nodule type by statistical methods (SCAD and ANN methods) compared with the results of FNA testing revealed that the statistical modeling methods are helpful in disease diagnosis. In addition, the factor ranking offered by these methods is valuable in the clinical context.
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