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• A multi-variable regression analysis of data for hospitalized patients with coronavirus disease 2019 was undertaken. • The likelihood of death and cycle threshold (Ct) values at admission were studied. • Adjustments were made for known clinical risk factors for the disease. • Lower Ct values were associated with poorer outcomes in hospitalized patients. This single-centre observational study demonstrated that lower cycle threshold (Ct) values (indicating higher viral loads) on admission to hospital were associated with poorer outcomes in unvaccinated, hospitalized patients with coronavirus disease 2019 (COVID-19). Demographic and outcome data were collected prospectively for all adult patients who tested positive for severe acute respiratory syndrome coronavirus-2 on admission to the University Hospitals North Midlands NHS Trust between 1 February and 1 July 2020. Nasopharyngeal swab samples were obtained, and a valid Ct value was determined for all patients using the Viasure reverse transcription polymerase chain reaction assay, validated by Public Health England, on admission to hospital. Multi-variable logistic regression results based on data from 618 individuals demonstrated a significant inverse relationship between the odds of death and Ct values (adjusted odds ratio 0.95, 95% confidence interval 0.92–0.98, P =0.001). The association remained highly significant after adjusting for known clinical risk factors for COVID-19 [ABSTRACT FROM AUTHOR]

Background Cardiopulmonary resuscitation of cardiac arrest has poor outcomes. Extracorporeal life support (ECLS) could represent a salvage option. This study aimed to analyze the outcomes of ECLS used for refractory cardiac arrest. Methods In this observational analysis, patients were divided into an in-hospital cardiac arrest group (IHCA) and an out-of-hospital (OHCA) cardiac arrest group. The primary end point was survival to hospital discharge with good neurologic outcome. Both groups were compared after propensity score matching. Risk factors were searched with multivariate analyses. Results From January 2007 to December 2016, study investigators performed 131 ECLS procedures (IHCA, n = 45, 34.4%; OHCA, n = 86, 65.6%). The mean age of patients was 43.2 years, and 71.8% were male. Baseline characteristics were comparable between both groups except mean no-flow duration (0.2 minutes vs 2.5 minutes; p < 0.001) and low-flow duration (46.9 minutes vs 85.3 minutes; p < 0.001), which were significantly shorter in the IHCA group. A total of 103 (82.4%) patients died during ECLS (IHCA, 79.1% vs OHCA, 84.1%; p = 0.479). The complication rate during ECLS was comparable between both groups. Twenty (16%) patients were successfully weaned from ECLS (IHCA, 18.6% vs OHCA, 14.6%; p = 0.565) after a mean support period of 6.7 days. Survival to hospital discharge with good neurologic outcome was not different between the two matched groups (odds ratio OHCA vs IHCA 1.3; 95% confidence interval, 0.023 to 74.902; p = 0.9). Presence of shockable rhythm was associated with a better outcome (odds ratio shockable vs nonshockable 6.674; 95% confidence interval, 1.078 to 41.336; p = 0.044). Conclusions Patients in the IHCA and OHCA groups experienced the same survival with good neurologic outcome after ECLS support. A better selection of patients with IHCA is mandatory to avoid futile support. [ABSTRACT FROM AUTHOR]

Objectives: To review the methods currently used to synthesize evidence in public health evaluations and demonstrate the availability of more sophisticated approaches.Study Design and Setting: A systematic review of National Institute for Health and Care Excellence (NICE) public health appraisals published between 2006 and 2012 was performed to assess the methods used for the synthesis of effectiveness evidence. The ability of new developments in evidence synthesis methodology to address the challenges and opportunities present in a public health context is demonstrated.Results: Nine (23%) of the 39 NICE appraisals included in the review performed pairwise meta-analyses as part of the effectiveness review with one of these also including a network meta-analysis. Of the remainder, 29 (74.4%) presented narrative summaries of the evidence only, and 1 (2.6%) appraisal did not present any review of effectiveness and/or cost-effectiveness evidence. Heterogeneity of outcomes, methods, and interventions were the main reasons given for not pooling the data. Exploration of quantitative synthesis methods shows that pairwise meta-analyses can be extended to incorporate individual participant data (when it is available), extend the number of interventions being compared using a network meta-analysis, and adjust for both subject- and summary-level covariates. All these can contribute to ensuring the analysis answers directly the policy-relevant questions.Conclusion: More sophisticated methods in evidence synthesis should be considered to make evaluations in public health more useful for decision makers. [ABSTRACT FROM AUTHOR]