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Verstraete J, Booth C, Booth J, Peer S, McGuire J, Kritzinger F, Gray T, Zibi N, Shabangu P, Zampoli M. Fighting to Breathe and Fighting for Health-Related Quality of Life: Measuring the Impact of Being Dependent on Technology for Breathing on the Child and Their Caregiver. THE PATIENT 2024; 17:65-82. [PMID: 37991685 PMCID: PMC10769921 DOI: 10.1007/s40271-023-00657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Medical advancement has enabled children to survive congenital airway anomalies, rare diseases and critical illnesses with medical technology including tracheostomies and long-term ventilation to support breathing. This study aimed to assess (1) the validity of the EQ-TIPS and EQ-5D-Y-3L in children dependent on technology and (2) the impact of caring for these children on the EQ-5D-5L and CarerQoL. METHODS Caregivers of children aged 1 month to 18 years completed the EQ-TIPS or EQ-5D-Y-3L, Pediatric Quality of Life Inventory (PedsQL) and Paediatric Tracheostomy Health Status Instrument (PTHSI) to reflect the child's health. In addition, caregivers self-completed the EQ-5D-5L and CarerQoL. Reports of problems on EQ dimensions were compared across age groups with the Fisher's exact test. Spearman and Pearson's correlation coefficients and Kruskal-Wallis H-test were used to explore the association between caregiver and child scores, concurrent validity, and known-group validity of the EQ-TIPS and EQ-5D-Y-3L. RESULTS Responses from 144 caregivers were collected, 66 for children aged 1 month to 4 years completing EQ-TIPS and 78 for children aged 5-18 years completing EQ-5D-Y-3L. The EQ-TIPS showed a higher report of no problems for social interaction for children aged 1-12 months (p = 0.040) than the older age groups, there were however no differences in the level sum score (LSS) or EQ Visual Analogue Scale scores between the age groups. The EQ-5D-Y-3L showed a significantly less report of problems for mobility (p = 0.013) and usual activities (p = 0.006) for children aged 5-7 years compared with children aged 8-12 and children aged 13-18 years. Similarly, the 5-7 years of age group had a significantly lower EQ-5D-Y-3L LSS compared with the older groups (H = 12.08, p = 0.002). The EQ-TIPS and EQ-5D-Y-3L showed moderate-to-strong associations with the PedsQL. EQ-TIPS median LSS was able to differentiate between groups on the clinical prognosis with a better health-related quality of life (HRQoL) in those where weaning from technology is possible compared with those where weaning is not possible (H = 18.98, p = 0.011). The EQ-5D-Y-3L can discriminate between breathing technology, where those with only a tracheostomy reported better HRQoL (H = 8.92, p = 0.012), and between mild and moderate clinical severity (H = 19.42, p < 0.001). Neither the PedsQL nor the PTHSI was able to discriminate between these groups across the age range. Caregiver and child HRQoL scores showed moderate-to-strong associations. CONCLUSIONS The EQ-TIPS and EQ-5D-Y-3L showed good validity in children dependent on the technology for breathing. The EQ-TIPS and EQ-5D-Y-3L LSS were all able to differentiate between children with known clinical variables and outperformed both the PedsQL and PTHSI, making them preferable for intervention research. The caregiver scores are associated with the child HRQoL scores and thus a spill-over should be accounted for in any interventions targeting this cohort. It is recommended that future studies investigate the reliability and responsiveness of these measures in children dependent on technology for breathing.
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Affiliation(s)
- Janine Verstraete
- Department of Paediatrics and Child Health, Division of Medicine, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Christopher Booth
- Department of Paediatrics and Child Health, Division of Medicine, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - Jane Booth
- Chest and Allergy Centre, Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology, Department of Surgery, H-53 OMB, Groote Schuur Hospital, Observatory, Cape Town, South Africa
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Jessica McGuire
- Division of Otorhinolaryngology, Department of Surgery, H-53 OMB, Groote Schuur Hospital, Observatory, Cape Town, South Africa
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Fiona Kritzinger
- Department of Paediatrics and Child Health, Division of Medicine, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - Taryn Gray
- Chest and Allergy Centre, Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Noluthando Zibi
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Primrose Shabangu
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, Division of Medicine, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
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Sébille V, Dubuy Y, Feuillet F, Blanchin M, Roquilly A, Cinotti R. Does Differential Item Functioning Jeopardize the Comparability of Health-Related Quality of Life Assessment Between Patients and Proxies in Patients with Moderate-to-Severe Traumatic Brain Injury? Neurocrit Care 2023; 39:339-347. [PMID: 36977961 DOI: 10.1007/s12028-023-01705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/22/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is clearly recognized as a patient-important outcome in patients with traumatic brain injury (TBI). Patient-reported outcomes are therefore often used and supposed to be directly reported by the patients without interpretation of their responses by a physician or anyone else. However, patients with TBI are often unable to self-report because of physical and/or cognitive impairments. Thus, proxy-reported measures, e.g., family members, are often used on the patient's behalf. Yet, many studies have reported that proxy and patient ratings differ and are noncomparable. However, most studies usually do not account for other potential confounding factors that may be associated with HRQoL. In addition, patients and proxies can interpret some items of the patient-reported outcomes differently. As a result, item responses may not only reflect patients' HRQoL but also the respondent's (patient or proxy) own perception of the items. This phenomenon, called differential item functioning (DIF), can lead to substantial differences between patient-reported and proxy-reported measures and compromise their comparability, leading to highly biased HRQoL estimates. Using data from the prospective multicenter continuous hyperosmolar therapy in traumatic brain-injured patients study (240 patients with HRQoL measured with the Short Form-36 (SF-36)), we assessed the comparability of patients' and proxies' reports by evaluating the extent to which items perception differs (i.e., DIF) between patients and proxies after controlling for potential confounders. METHODS Items at risk of DIF adjusting for confounders were examined on the items of the role physical and role emotional domains of the SF-36. RESULTS Differential item functioning was evidenced in three out of the four items of the role physical domain measuring role limitations due to physical health problems and in one out of the three items of the role emotional domain measuring role limitations due to personal or emotional problems. Overall, despite an expected similar level of role limitations between patients who were able to respond and those for whom proxies responded, proxies tend to give more pessimistic responses than patients in the case of major role limitations and more optimistic responses than patients in the case of minor limitations. CONCLUSIONS Patients with moderate-to-severe TBI and proxies seem to have different perceptions of the items measuring role limitations due to physical or emotional problems, questioning the comparability of patient and proxy data. Therefore, aggregating proxy and patient responses may bias HRQoL estimates and alter medical decision-making based on these patient-important outcomes.
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Affiliation(s)
- Véronique Sébille
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44200, Nantes, France.
- DRCI, Methodology and Biostatistic Department, CHU Nantes, Nantes, France.
- SPHERE, Nantes Université, IRS2 22 Boulevard Bénoni Goullin, 44200, Nantes, France.
| | - Yseulys Dubuy
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44200, Nantes, France
| | - Fanny Feuillet
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44200, Nantes, France
- DRCI, Methodology and Biostatistic Department, CHU Nantes, Nantes, France
| | - Myriam Blanchin
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44200, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- Surgical Intensive Care Unit, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Raphaël Cinotti
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44200, Nantes, France
- Surgical Intensive Care Unit, Hôtel Dieu, CHU Nantes, Nantes, France
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Chu YR, Liu CJ, Chu CC, Kung PT, Chou WY, Tsai WC. Stress on caregivers providing prolonged mechanical ventilation patient care in different facilities: A cross-sectional study. PLoS One 2022; 17:e0268884. [PMID: 35613142 PMCID: PMC9132287 DOI: 10.1371/journal.pone.0268884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Taiwan has implemented an integrated prospective payment program (IPP) for prolonged mechanical ventilation (PMV) patients that consists of four stages of care: intensive care unit (ICU), respiratory care center (RCC), respiratory care ward (RCW), and respiratory home care (RHC). We aimed to investigate the life impact on family caregivers of PMV patients opting for a payment program and compared different care units. Method A total of 610 questionnaires were recalled. Statistical analyses were conducted by using the chi-square test and multivariate logistic regression model. Results The results indicated no associations between caregivers’ stress levels and opting for a payment program. Participants in the non-IPP group spent less time with friends and family owing to caregiver responsibilities. The results of the family domain show that the RHC group (OR = 2.54) had worsened family relationships compared with the ICU group; however, there was less psychological stress in the RCC (OR = 0.54) and RCW (OR = 0.16) groups than in the ICU group. In the social domain, RHC interviewees experienced reduced friend and family interactivity (OR = 2.18) and community or religious activities (OR = 2.06) than the ICU group. The RCW group felt that leisure and work time had less effect (OR = 0.37 and 0.41) than the ICU group. Furthermore, RCW interviewees (OR = 0.43) were less influenced by the reduced family income than the ICU group in the economic domain. Conclusions RHC family caregivers had the highest level of stress, whereas family caregivers in the RCW group had the lowest level of stress.
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Affiliation(s)
- Yeong-Ruey Chu
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chin-Jung Liu
- Department of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan
- School of Nursing, China Medical University, Taichung, Taiwan
| | - Chia-Chen Chu
- Department of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail:
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Marcus EL, Jacobs JM, Stessman J. Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility. Palliat Support Care 2022; 21:429-437. [PMID: 35266449 DOI: 10.1017/s147895152200027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The number of patients treated with prolonged mechanical ventilation (PMV) is steadily rising. Traditionally treated within specialized long-term care facilities (LTCFs), healthcare providers are increasingly promoting homecare as a technologically safe, humane, and cheaper alternative. Little is known concerning their informal caregivers (ICGs), despite their crucial role in facilitating care. This study examines caregiver strain among the primary ICG of PMV patients treated at home vs. LTCF. METHOD This study was an observational cross-sectional study. The study enrolled 120/123 PMV patients ≥18 years within the study region (46 treated with homecare/74 treated at the LTCF) and 106 ICGs (34 ICGs/46 homecare patients and 72 ICGs/74 LTCF patients). Caregiver assessment included the 13-item Modified Caregiver Strain Index (Mod CSI) (0-26 maximum); patient assessment included symptom burden (the revised Edmonton Symptom Assessment System). RESULTS The mean age of ICGs was 58.9 years old; 60.4% were females; 82.1% were married; 29.2% were patient's spouses; and 40.6% were patient's children. The total Mod CSI was 13.58 (SD 6.52) and similar between home vs. LTCF (14.30 SD 7.50 vs. 13.26 SD 6.03, p = 0.50), or communicative vs. non-communicative patients (13.50 SD 7.12 vs. 13.64 SD 6.04, p = 0.93). Hierarchical analysis identified three clusters of caregiver strain, with ICGs at home vs. LTCF reporting significantly lower mood strain, higher burden, and similar levels of lifestyle disturbance. In adjusted models, homecare was significantly associated with reduced mood strain and increased burden, while increased patient symptomatology was significantly associated with total strain, mood, and burden strain clusters. SIGNIFICANCE OF RESULTS Recognizing the different patterns of caregiver strain at home or LTCF is a prerequisite for addressing their palliative care needs and improving the wellbeing and resilience of informal caregivers, who often play a critical role in deciding whether to treat the PMV patient at home or LTCF.
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Affiliation(s)
- Esther-Lee Marcus
- Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy M Jacobs
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem Home Hospital Unit, Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel
- Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Organization, Jerusalem, Israel
- Institute for Aging Research, Hadassah Medical Organization, Jerusalem, Israel
| | - Jochanan Stessman
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem Home Hospital Unit, Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel
- Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Organization, Jerusalem, Israel
- Institute for Aging Research, Hadassah Medical Organization, Jerusalem, Israel
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Takura T, Koike T, Matsuo Y, Sekimoto A, Mutou M. Proxy responses regarding quality of life of patients with terminal lung cancer: preliminary results from a prospective observational study. BMJ Open 2022; 12:e048232. [PMID: 35210333 PMCID: PMC8883223 DOI: 10.1136/bmjopen-2020-048232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This prospective study used the EQ-5D utility and Visual Analogue Scale (VAS) scores to analyse the potential usefulness of proxy responses in quality of life assessments of Japanese patients with terminal lung cancer sufficiently healthy to communicate and reply by themselves. We did not investigate the potential usefulness of using proxy responses for patients who could not respond by themselves. DESIGN A prospective observational study. SETTING Single centre. PARTICIPANTS The EQ-5D and VAS responses were gathered from 30 in-hospital patients with lung cancer for a total of three observation points. At nearly the same time, two nurses responded by providing proxy responses. PRIMARY AND SECONDARY OUTCOME MEASURES EQ-5D and VAS responses. RESULTS There were no significant differences between the patients' and nurses' responses for EQ-5D utility and VAS scores. For the five dimensions of the EQ-5D, significant differences were found between the patients' and nurses' responses for usual activities (patients' response 1.64±0.07, nurses' response 1.41±0.05, p=0.03) and anxiety/depression (patients' response: 1.40±0.05, nurses' response: 1.19±0.03, p=0.02). There was a significant weak positive correlation between patients' and nurses' responses regarding changes in responses from the first to the third observation point (Spearman's rank correlation coefficient ρ=0.228; p<0.01). CONCLUSION The results suggest that proxy responses are useful because there were no significant differences between the patients' and nurses' responses for EQ-5D utility and VAS scores at the three observation points. These findings should, however, be verified in future large-scale trials.
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Affiliation(s)
- Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tomoko Koike
- Keio University Faculty of Nursing And Medical Care Graduate School of Health Management, Fujisawa, Kanagawa, Japan
| | - Yoko Matsuo
- W. L. Gore & Associates, G.K, Minato-ku, Tokyo, Japan
| | | | - Masami Mutou
- National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
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Jacobs JM, Marcus EL, Stessman J. Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to Life. J Am Med Dir Assoc 2021; 22:1242-1247. [PMID: 32907755 PMCID: PMC7474963 DOI: 10.1016/j.jamda.2020.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although prolonged mechanical ventilation (PMV) is increasingly common, little is known concerning patient symptom burden or attitudes toward PMV. This study aims to describe the mood, well-being, distressing symptoms, and attitudes toward prolonged ventilation among PMV patients treated either at home or long-term acute care (LTAC). DESIGN An observational study. SETTING AND PARTICIPANTS 62 communicative participants treated with PMV, aged ≥18 years, insurees of a single HMO, treated at home hospital or LTAC specializing in ventilation in Jerusalem. MEASURES Sociodemographic characteristics; chronic conditions; functional status; symptom burden measured by revised Edmonton Symptomatic Assessment System (r-ESAS); attitudes toward PVM. RESULTS Participants were aged 61.7 ± 20.7 years, commonly suffered progressive neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric Depression Scale identified depression among 38% of participants, and was less at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety (16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath (9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, and 15%, respectively. Only 1 patient had advance directives concerning ventilation prior to intubation, and when asked if they had to choose again today, 85% of patients would again opt for ventilation. CONCLUSIONS AND IMPLICATIONS Few PMV patients reported distressing symptoms, and 85% would choose ventilation if asked again. These findings might be useful in clinical practice to assist in decision making concerning prolonged ventilation.
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Affiliation(s)
- Jeremy M Jacobs
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Esther-Lee Marcus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel
| | - Jochanan Stessman
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Lee YH, Wang JS, Curtis R, Huang SJ, Chang SS, Chen YC. Palliative medicine family conferences and caregiver psychological distress during prolonged mechanical ventilation. BMJ Support Palliat Care 2020; 10:443-451. [PMID: 32461221 DOI: 10.1136/bmjspcare-2019-002103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/17/2020] [Accepted: 05/02/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Little is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers. METHODS A longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys. RESULTS In total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016-2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients' death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: -44.04% and 95% CIs -75.65 to -12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: -0.35% and 95% CI -0.58 to -0.11 on IES and coefficient: -0.22% and 95% CI -0.40 to -0.05 on CES-D) among caregivers following the patients' death. Caregivers' who accepted the concept of palliative care had fewer psychological symptoms after patients' death (coefficient: -3.29% and 95% CI -6.32 to -0.25 on IES and coefficient: -3.22% and 95% CI -5.24 to -1.20 on CES-D). CONCLUSIONS Palliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death.
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Affiliation(s)
- Yi-Han Lee
- Headquarters, Taipei City Hospital, Taipei, Taiwan.,Department of Family Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
| | - Jiao-Syuan Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Randall Curtis
- Cambia Palliative Care Center of Excellence, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sheng-Jean Huang
- Headquarters, Taipei City Hospital, Taipei, Taiwan.,Surgical Department, Medical College, National Taiwan University, Taipei, Taiwan
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yang Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan .,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Liang Y, Che T, Zhang H, Shang L, Zhang Y, Xu Y, Guo L, Tan Z. Assessing the proxy response bias of EQ-5D-3 L in general population: a study based on a large-scale representative household health survey using propensity score matching. Health Qual Life Outcomes 2020; 18:75. [PMID: 32188480 PMCID: PMC7079393 DOI: 10.1186/s12955-020-01325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Proxy respondent-someone who assists the intended respondent or responds on their behalf-are widely applied in the measurement of health-related quality of life (HRQL). However, proxies may not provide the same responses as the intended respondents, which may bias the findings. Objectives To determine whether the use of proxies is related to socio-demographic characteristics of the intended respondent, and to assess the possible proxy response bias of Chinese version of EQ-5D-3 L in general population. Methods A cross-sectional study based on a provincially representative sample from 2013 National Health Service Survey (NHSS) in Shaanxi, China was performed. HRQL was measured by Chinese version of EQ-5D-3 L. Propensity score matching (PSM) was used to get matched pairs of self-reports and proxy-reports. Before and after PSM, univariate logistic and linear models including the indicator of proxy response as the only independent variable, were employed to assess the possible proxy response bias of the dimensional and overall health status of EQ-5D-3 L respectively. Results 19.9% of the responses involved a proxy. Before PSM, the proxy-report group was younger in age and reported less unhealthy lifestyle, lower prevalence of disease, and less hospitalization than the self-report group. After PSM, it showed that the proxy-report group was statistically more likely to report health problem on each dimension of EQ-5D-3 L, with odds ratios larger than one comparing with self-report group. The means of EQ-5D-3 L index and EQ VAS of proxy-report group were 0.022 and 0.834 lower than self-report group. Conclusions Significantly negative proxy response bias was found in Chinese EQ-5D-3 L in general population, and the magnitude of the bias was larger in physical dimensions than psychological dimensions after using PSM to control confounders.
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Affiliation(s)
- Ying Liang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tianle Che
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Haiyue Zhang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yuhai Zhang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yongyong Xu
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lingxia Guo
- Center of Health Statistics, Health General Office of Shaanxi Province, Xi'an, Shaanxi Province, China
| | - Zhijun Tan
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China. .,Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
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Jang CS, Wang JD. Predicting Mortality and Life Expectancy in Patients under Prolonged Mechanical Ventilation and Maintenance Dialysis. J Palliat Med 2019; 23:74-81. [PMID: 31347942 PMCID: PMC6931911 DOI: 10.1089/jpm.2018.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The number of patients receiving prolonged mechanical ventilation (PMV) or maintenance dialysis (MD) is increasing worldwide. Identification of those with a short life expectancy is useful for early referral of palliative care. Objective: To determine the survival rate, life expectancy, and major prognostic factors in patients under both PMV and MD. Design: We extracted a 1:3.4 random sample of patients treated with mechanical ventilation (MV) from the National Health Insurance (NHI) Research Database of Taiwan from 2003 to 2007. Subjects who had undergone MD and received MV for longer than 21 days were enrolled. Setting/Subjects: There were 1035 patients who received both PMV and MD. Measurements: The survival rates and life expectancy were estimated. A multivariate proportional hazards model was constructed to validate the effects of different prognostic factors, including age, gender, hospital size, and major comorbidities. Results: The median length of survival of patients under both PMV and MD was 54 days. The three-month, six-month, and one-year survival rates were 40.8%, 24.1%, and 12.6%, respectively. The life expectancies of those older than 70 years were five months; those comorbid with cancer and septicemia were 112 and 90 days, respectively. After adjustments for covariates, we found following prognostic factors were statistically significant: gangrene, peritonitis, liver cirrhosis, cancer, septicemia, hydrocephalus, having device complications, and shock. Conclusions: More than 85% of patients receiving both PMV and MD died within one year. Communication and early referral for palliative care would be indicated for those comorbid with significant prognostic factors.
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Affiliation(s)
- Chang-Sheng Jang
- Puli Christian Hospital, Nantou County, Taiwan.,Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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10
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Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Sazlina SG, Moorhouse P, Fay S, Visvanathan R, Rockwood K. The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty. Can Geriatr J 2019; 22:64-74. [PMID: 31258829 PMCID: PMC6542581 DOI: 10.5770/cgj.22.357] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. Methods In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. Results The final scale incorporated 14 domains, each conceptualized with 3–6 response levels. All domains were rated as “understood well” by most participants (range 64–94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. Conclusions The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada.,National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia
| | - Melissa Andrew
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | | | - Emma Squires
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Lisa McGarrigle
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, NS, Canada.,Department of Emergency Medicine, Division of EMS, Halifax, NS, Canada
| | | | - Judith Godin
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Glen Hougan
- Nova Scotia College of Art and Design University, Halifax, NS, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Lindsay Wallace
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shariff Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Paige Moorhouse
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Sherri Fay
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia.,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Kenneth Rockwood
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
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11
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Caiels J, Rand S, Crowther T, Collins G, Forder J. Exploring the views of being a proxy from the perspective of unpaid carers and paid carers: developing a proxy version of the Adult Social Care Outcomes Toolkit (ASCOT). BMC Health Serv Res 2019; 19:201. [PMID: 30922307 PMCID: PMC6440097 DOI: 10.1186/s12913-019-4025-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Outcomes-based policy and administration of public services present a compelling argument for the value of outcomes data. However, there are a number of challenges inherent in collecting these data from people who are unable to complete a paper-based survey or interview due to cognitive or communication impairments. In this paper, we explore the views of being a proxy from the perspective of unpaid carers and paid carers who may be asked to act as a proxy on behalf of the person(s) they care for. We consider the key issues that need to be addressed when adapting an instrument designed to measure social care outcomes, the Adult Social Care Outcomes Tool (ASCOT), into a proxy-report tool. Methods Participants took part in either a focus group (35 paid carers in eight focus groups), or a one-to-one interview (eight unpaid carers). All participants were recruited via carer organisations and care providers. Transcripts, field notes and audio data collected during focus groups and interviews were analysed using a thematic framework approach. Results Participants agreed that any person acting as a proxy would need to be very familiar with the care recipient, as well as their needs and care provision. A number of provisions for proxy respondents were proposed to improve face validity and acceptability of completing a questionnaire by proxy, and to ensure that any potential bias is reduced in the design of the questionnaire. These included: providing two sets of response options for each proxy perspective (the proxy themselves and the proxy view of how they think the care recipient would respond); a comments box to help people explain why they have selected a given response option (especially where these indicate unmet need); and providing clear guidance for the proxy respondent on how they should complete the questionnaire. Conclusions This study has shown some of the challenges involved in assessing outcomes by proxy and explored some potential ways these can be mitigated. The findings highlight the benefits of developing and testing proxy measures in a robust way to widen participation in social care research. Electronic supplementary material The online version of this article (10.1186/s12913-019-4025-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James Caiels
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK.
| | - Stacey Rand
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
| | - Tanya Crowther
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK.,NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
| | - Grace Collins
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
| | - Julien Forder
- Quality and Outcomes of person-centred care policy Research Unit (QORU), PSSRU Kent, University of Kent, Cornwallis Building, Canterbury, CT2 7NF, UK
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12
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Determinants of Receiving Palliative Care and Ventilator Withdrawal Among Patients With Prolonged Mechanical Ventilation. Crit Care Med 2017; 45:1625-1634. [PMID: 28658025 DOI: 10.1097/ccm.0000000000002569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. DESIGN Cross-sectional study. SETTING Five different hospitals of Taipei City Hospital system. PATIENTS Adult patients with ventilatory support for more than 60 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1%). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4%) with 17.3% of the family members agreeing to ventilator withdrawal currently and 67.5% terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7%). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. CONCLUSIONS During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.
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13
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Framing of mobility items: a source of poor agreement between preference-based health-related quality of life instruments in a population of individuals receiving assisted ventilation. Qual Life Res 2017; 26:1493-1505. [DOI: 10.1007/s11136-017-1510-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
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14
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Wang W, McDonald T. Patient, family, nurse perspectives on Chinese elders' quality of life. Int Nurs Rev 2016; 64:388-395. [PMID: 27859178 DOI: 10.1111/inr.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Families and nurses are important care-providers and proxies of older people. Their ability to assess the quality of life of elders in ways that align with how older people assess themselves has policy implications for allocating services and resources to older persons. AIM To investigate the alignment of perspectives of the quality of life held by older people, their families and nurses in China. METHODS Employing a survey design using concurrent EQ-5D-3L and WHOQOL-BREF surveys, responses from 72 matched stakeholder groups were compared and agreement tested using weighted kappa/one-way random intra-class correlations and paired Student's t-test. RESULTS On the more observable dimensions families and nurses were in close agreement with the older person in relation to quality of life reports. However, in the more subjective domains, family and especially nurses tended to estimate that the older person's suffering as more severe than they themselves thought. CONCLUSION The perspectives of older patients and their family are more closely aligned regarding the older person's quality of life than that of nurses caring for them, a finding inconsistent with international research. IMPLICATION FOR NURSING AND HEALTH POLICY The evidence suggests that nursing work assignment processes could influence the accuracy of nurses' perceptions of their patient's quality of life.
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Affiliation(s)
- W Wang
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | - T McDonald
- HOPE School of Nursing, Wuhan University, Wuhan, China.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
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15
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Fowler RA, Mittmann N, Geerts WH, Heels-Ansdell D, Gould MK, Guyatt G, Krahn M, Finfer S, Pinto R, Chan B, Ormanidhi O, Arabi Y, Qushmaq I, Rocha MG, Dodek P, McIntyre L, Hall R, Ferguson ND, Mehta S, Marshall JC, Doig CJ, Muscedere J, Jacka MJ, Klinger JR, Vlahakis N, Orford N, Seppelt I, Skrobik YK, Sud S, Cade JF, Cooper J, Cook D. Economic evaluation of the prophylaxis for thromboembolism in critical care trial (E-PROTECT): study protocol for a randomized controlled trial. Trials 2014; 15:502. [PMID: 25528663 PMCID: PMC4413997 DOI: 10.1186/1745-6215-15-502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a common complication of critical illness with important clinical consequences. The Prophylaxis for ThromboEmbolism in Critical Care Trial (PROTECT) is a multicenter, blinded, randomized controlled trial comparing the effectiveness of the two most common pharmocoprevention strategies, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) dalteparin, in medical-surgical patients in the intensive care unit (ICU). E-PROTECT is a prospective and concurrent economic evaluation of the PROTECT trial. Methods/Design The primary objective of E-PROTECT is to identify and quantify the total (direct and indirect, variable and fixed) costs associated with the management of critically ill patients participating in the PROTECT trial, and, to combine costs and outcome results to determine the incremental cost-effectiveness of LMWH versus UFH, from the acute healthcare system perspective, over a data-rich time horizon of ICU admission and hospital admission. We derive baseline characteristics and probabilities of in-ICU and in-hospital events from all enrolled patients. Total costs are derived from centers, proportional to the numbers of patients enrolled in each country. Direct costs include medication, physician and other personnel costs, diagnostic radiology and laboratory testing, operative and non-operative procedures, costs associated with bleeding, transfusions and treatment-related complications. Indirect costs include ICU and hospital ward overhead costs. Outcomes are the ratio of incremental costs per incremental effects of LMWH versus UFH during hospitalization; incremental cost to prevent a thrombosis at any site (primary outcome); incremental cost to prevent a pulmonary embolism, deep vein thrombosis, major bleeding event or episode of heparin-induced thrombocytopenia (secondary outcomes) and incremental cost per life-year gained (tertiary outcome). Pre-specified subgroups and sensitivity analyses will be performed and confidence intervals for the estimates of incremental cost-effectiveness will be obtained using bootstrapping. Discussion This economic evaluation employs a prospective costing methodology concurrent with a randomized controlled blinded clinical trial, with a pre-specified analytic plan, outcome measures, subgroup and sensitivity analyses. This economic evaluation has received only peer-reviewed funding and funders will not play a role in the generation, analysis or decision to submit the manuscripts for publication. Trial registration Clinicaltrials.gov Identifier: NCT00182143. Date of registration: 10 September 2005. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-502) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert A Fowler
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
| | - Nicole Mittmann
- Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Health Sciences Centre, Department of Pharmacology, University of Toronto, 2075 Bayview Avenue, E240, Toronto, ON, M4N 3M5, Canada.
| | - William H Geerts
- Department of Medicine, Room D674, Sunnybrook Health Sciences Centre, Room D674, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSC-2C12, Hamilton, ON, L8S 4K1, Canada.
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA, 91101, USA.
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSC-2C12, Hamilton, ON, L8S 4K1, Canada.
| | - Murray Krahn
- Department of Medicine, 144 College Street, Room 600, Toronto, ON, M5S 3M2, Canada.
| | - Simon Finfer
- The George Institute for Global Health, Royal North Shore Hospital, University of Sydney, Pacific Highway, St Leonards, NSW, 2065, Australia.
| | - Ruxandra Pinto
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
| | - Brian Chan
- Institute of Health Policy, Management and Evaluation University of Toronto Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Orges Ormanidhi
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 144 College Street, 6th Floor, Toronto, ON, M5S 3M2, Canada.
| | - Yaseen Arabi
- Intensive Care Department, Medical Director, Respiratory Services, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
| | - Ismael Qushmaq
- Department of Medicine, King Faisal Specialist Hospital & Research Centre-Gen. Org, PO Box 40047, Jeddah, 21499 MBC# J-46, Saudi Arabia.
| | - Marcelo G Rocha
- Department of Intensive Care, Hospitalar Santa Casa, Rua Professor Annes Dias, 295 - Centro Histórico, Porto Alegre, RS, 90020-200, Brazil.
| | - Peter Dodek
- Division of Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Center for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), Ottawa Hospital, Ottawa Hospital Research Institute, Centre for Transfusion and Critical Care Research, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.
| | - Richard Hall
- Departments of Anesthesiology, Medicine, Pharmacology and Surgery, Dalhousie University and the Capital District Health Authority, Halifax NS, Room 5452-Halifax Infirmary, 1796 Summer St, Halifax, NS, B3H 3A7, Canada.
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine and Departments of Medicine & Physiology, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. .,Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - John C Marshall
- Department of Surgery, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, 4-007 Bond Wing, St Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Christopher James Doig
- Department of Community Health Sciences, Departments of Critical Care Medicine, Attending Physician, Foothills Medical Centre Multisystem Intensive Care Unit, Alberta Health Services, University of Calgary, Room 3D39, Teaching Research and Wellness Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
| | - John Muscedere
- Department of Medicine, Angada 4 Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Michael J Jacka
- Department of Anesthesiology and Critical Care, University of Alberta Hospital, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
| | - James R Klinger
- Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, Professor of Medicine, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
| | - Nicholas Vlahakis
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Neil Orford
- Intensive Care Barwon Health, Australian and New Zealand Intensive Care Research Centre, Monash University School of Medicine, 99 Commercial Road, Geelong, VIC, 3004, Australia. .,Intensive Care Barwon Health, Australian and New Zealand Intensive Care Research Centre, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Ian Seppelt
- Critical Care Medicine, Nepean Hospital, Derby Street, Penrith, NSW, 2747, Australia.
| | - Yoanna K Skrobik
- Critical Care Medicine, Hôpital Maisonneuve-Rosemont, 5415 Blvd. De l'Assomption, Montreal, QC, H1T 2M4, Canada.
| | - Sachin Sud
- Department of Medicine, University Trillium Hospital, 100 Queensway West, Toronto, ON, L5B 1B8, Canada.
| | - John F Cade
- Intensive Care Unit, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia.
| | - Jamie Cooper
- ANZIC-RC Department of Epidemiology and Preventive Medicine Monash University, The Alfred Centre Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Deborah Cook
- Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Ceravolo F, Mascaro I, Sestito S, Pascale E, Lauricella A, Dizione E, Concolino D. Home treatment in paediatric patients with Hunter syndrome: the first Italian experience. Ital J Pediatr 2013; 39:53. [PMID: 24011228 PMCID: PMC3847888 DOI: 10.1186/1824-7288-39-53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
Hunter syndrome (mucopolysaccharidosis type II [MPS II], OMIM309900) is a rare X-linked lysosomal storage disorder caused by the deficiency of the enzyme iduronate-2-sulphatase, resulting in accumulation of glycosaminoglycans, progressive multisystem organ failure, and early death. Enzyme replacement therapy (ERT) with weekly intravenous infusions of idursulfase, a treatment for MPS II and commercially available since 2007, has been shown to improve certain symptoms and signs of the disease. The efficacy and safety data of this enzyme preparation have been widely reported and, after a change to the idursulfase Summary of Product Characteristics in March 2010, home ERT by infusion is now an option for selected patients. Previously reported experiences of home therapy in MPS II have shown increased treatment compliance and an improvement in quality of life for both patients and families. We report the results of the home therapy experience of 3 paediatric patients with MPS II in southern Italy. This pilot experience with home infusion is the first reported from Italy.
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Affiliation(s)
- Ferdinando Ceravolo
- Department of Paediatrics, University "Magna Graecia" of Catanzaro c/o Ospedale Civile A,Pugliese, Viale Pio X, 88100 Catanzaro, Italy.
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17
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Shih CY, Hung MC, Lu HM, Chen L, Huang SJ, Wang JD. Incidence, life expectancy and prognostic factors in cancer patients under prolonged mechanical ventilation: a nationwide analysis of 5,138 cases during 1998-2007. Crit Care 2013; 17:R144. [PMID: 23876301 PMCID: PMC4057492 DOI: 10.1186/cc12823] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 07/22/2013] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION This study is aimed at determining the incidence, survival rate, life expectancy, quality-adjusted life expectancy (QALE) and prognostic factors in patients with cancer in different organ systems undergoing prolonged mechanical ventilation (PMV). METHODS We used data from the National Health Insurance Research Database of Taiwan from 1998 to 2007 and linked it with the National Mortality Registry to ascertain mortality. Subjects who received PMV, defined as having undergone mechanical ventilation continuously for longer than 21 days, were enrolled. The incidence of cancer patients requiring PMV was calculated, with the exception of patients with multiple cancers. The life expectancies and QALE of patients with different types of cancer were estimated. Quality-of-life data were taken from a sample of 142 patients who received PMV. A multivariable proportional hazards model was constructed to assess the effect of different prognostic factors, including age, gender, type of cancer, metastasis, comorbidities and hospital levels. RESULTS Among 9,011 cancer patients receiving mechanical ventilation for more than 7 days, 5,138 undergoing PMV had a median survival of 1.37 months (interquartile range [IQR], 0.50 to 4.57) and a 1-yr survival rate of 14.3% (95% confidence interval [CI], 13.3% to 15.3%). The incidence of PMV was 10.4 per 100 ICU admissions. Head and neck cancer patients seemed to survive the longest. The overall life expectancy was 1.21 years, with estimated QALE ranging from 0.17 to 0.37 quality-adjusted life years for patients with poor and partial cognition, respectively. Cancer of liver (hazard ratio [HR], 1.55; 95% CI, 1.34 to 1.78), lung (HR, 1.45; 95% CI, 1.30 to 1.41) and metastasis (HR, 1.53; 95% CI, 1.42 to 1.65) were found to predict shorter survival independently. CONCLUSIONS Cancer patients requiring PMV had poor long-term outcomes. Palliative care should be considered early in these patients, especially when metastasis has occurred.
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18
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Hung MC, Lu HM, Chen L, Lin MS, Chen CR, Yu CJ, Wang JD. Cost per QALY (quality-adjusted life year) and lifetime cost of prolonged mechanical ventilation in Taiwan. PLoS One 2012; 7:e44043. [PMID: 22970160 PMCID: PMC3435371 DOI: 10.1371/journal.pone.0044043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/27/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients who require prolonged mechanical ventilation (PMV) are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-adjusted life year), out-of-pocket expenses, and lifetime costs for PMV patients stratified by underlying diseases and cognition levels. METHODS A nationwide sample of 50,481 patients with continual mechanical ventilation for more than 21 days was collected during 1997-2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA) was performed to categorise PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted using an EQ-5D utility value derived from a convenience sample of 142 PMV patients to estimate quality-adjusted life expectancies (QALE). Another convenience sample of 165 patients was used to estimate the out-of-pocket expenses. The lifetime expenditures paid by the single-payer National Health Insurance (NHI) system and patients' families were estimated by multiplying average monthly expenditures by the survival probabilities and summing the values over lifetime. RESULTS PMV therapy costs more than 100,000 U.S. dollars (USD) per QALY for all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 56,000 USD per QALY for those with liver cirrhosis, intracranial or spinal cord injuries, and 57,000-69,000 USD for patients with multiple co-morbidities under age of 65. The average lifetime cost of PMV was usually below 56,000 USD. The out-of-pocket expenses were often more than one-third of the total cost of treatment. CONCLUSIONS PMV treatment for patients with poor cognition would cost more than 5 times Taiwan's GDP (gross domestic products), or less cost-effective. The out-of-pocket expenses for PMV provision should also be considered in policy decision.
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Affiliation(s)
- Mei-Chuan Hung
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Hsin-Ming Lu
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Likwang Chen
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Shian Lin
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Ren Chen
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chong-Jen Yu
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
- Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail:
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Lu HM, Chen L, Wang JD, Hung MC, Lin MS, Yan YH, Chen CR, Fan PS, Huang LC, Kuo KN. Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data. BMC Health Serv Res 2012; 12:100. [PMID: 22531140 PMCID: PMC3375202 DOI: 10.1186/1472-6963-12-100] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 04/25/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study investigated prognosis among patients under prolonged mechanical ventilation (PMV) through exploring the following issues: (1) post-PMV survival rates, (2) factors associated with survival after PMV, and (3) the number of days alive free of hospital stays requiring mechanical ventilation (MV) care after PMV. METHODS This is a retrospective cohort study based on secondary analysis of prospectively collected data in the national health insurance system and governmental data on death registry in Taiwan. It used data for a nationally representative sample of 25,482 patients becoming under PMV (> = 21 days) during 1998-2003. We calculated survival rates for the 4 years after PMV, and adopted logistic regression to construct prediction models for 3-month, 6-month, 1-year, and 2-year survival, with data of 1998-2002 for model estimation and the 2003 data for examination of model performance. We estimated the number of days alive free of hospital stays requiring MV care in the immediate 4-year period after PMV, and contrasted patients who had low survival probability with all PMV patients. RESULTS Among these patients, the 3-month survival rate was 51.4%, and the 1-year survival rate was 31.9%. Common health conditions with significant associations with poor survival included neoplasm, acute and unspecific renal failure, chronic renal failure, non-alcoholic liver disease, shock and septicaemia (odd ratio < 0.7, p < 0.05). During a 4-year follow-up period for patients of year 2003, the mean number of days free of hospital stays requiring MV was 66.0 in those with a predicted 6-month survival rate < 10%, and 111.3 in those with a predicted 2-year survival rate < 10%. In contrast, the mean number of days was 256.9 in the whole sample of patients in 2003. CONCLUSIONS Neoplasm, acute and unspecific renal failure, shock, chronic renal failure, septicemia, and non-alcoholic liver disease are significantly associated with lower survival among PMV patients. Patients with anticipated death in a near future tend to spend most of the rest of their life staying in hospital using MV services. This calls for further research into assessing PMV care need among patients at different prognosis stages of diseases listed above.
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Affiliation(s)
- Hsin-Ming Lu
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Taiwan
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Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, Gould MK, Guyatt G, Arabi Y, Fowler RA. Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation. Am J Respir Crit Care Med 2011; 184:1289-98. [PMID: 21868500 DOI: 10.1164/rccm.201106-1059oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Venous thromboembolism is difficult to diagnose in critically ill patients and may increase morbidity and mortality. OBJECTIVES To evaluate the cost-effectiveness of strategies to reduce morbidity from venous thromboembolism in critically ill patients. METHODS A Markov decision analytic model to compare weekly compression ultrasound screening (screening) plus investigation for clinically suspected deep vein thrombosis (DVT) (case finding) versus case finding alone; and a hypothetical program to increase adherence to DVT prevention. Probabilities were derived from a systematic review of venous thromboembolism in medical-surgical intensive care unit patients. Costs (in 2010 $US) were obtained from hospitals in Canada, Australia, and the United States, and the medical literature. Analyses were conducted from a societal perspective over a lifetime horizon. Outcomes included costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios. MEASUREMENTS AND MAIN RESULTS In the base case, the rate of proximal DVT was 85 per 1,000 patients. Screening resulted in three fewer pulmonary emboli than case-finding alone but also two additional bleeding episodes, and cost $223,801 per QALY gained. In sensitivity analyses, screening cost less than $50,000 per QALY only if the probability of proximal DVT increased from a baseline of 8.5-16%. By comparison, increasing adherence to appropriate pharmacologic thromboprophylaxis by 10% resulted in 16 fewer DVTs, one fewer pulmonary emboli, and one additional heparin-induced thrombocytopenia and bleeding event, and cost $27,953 per QALY gained. Programs achieving increased adherence to best-practice venous thromboembolism prevention were cost-effective over a wide range of program costs and were robust in probabilistic sensitivity analyses. CONCLUSIONS Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening for DVT. Resources should be targeted at optimizing thromboprophylaxis.
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Affiliation(s)
- Sachin Sud
- Trillium Health Center, Mississauga, Ontario, Canada
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Hung MC, Lu HM, Chen L, Hu FC, Chan SY, Yan YH, Fan PS, Lin MS, Chen CR, Kuo LC, Yu CJ, Wang JD. Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R107. [PMID: 21457550 PMCID: PMC3219385 DOI: 10.1186/cc10128] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/21/2011] [Accepted: 04/01/2011] [Indexed: 11/29/2022]
Abstract
Introduction The present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases. Methods According to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan. Results The analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock. Conclusions PMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.
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Affiliation(s)
- Mei-Chuan Hung
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei 100, Taiwan
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Hung MC, Yan YH, Fan PS, Lin MS, Chen CR, Kuo LC, Yu CJ, Wang JD. Estimation of quality-adjusted life expectancy in patients under prolonged mechanical ventilation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:347-353. [PMID: 21402303 DOI: 10.1016/j.jval.2010.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 08/11/2010] [Accepted: 09/01/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to estimate the quality-adjusted life expectancy (QALE) and the expected lifetime utility loss of patients with prolonged mechanical ventilation (PMV). METHODS PMV was defined as more than 21 days of mechanical ventilation. A total of 633 patients fulfilled this definition and were followed for 9 years (1998-2007) to obtain their survival status. Quality of life of 142 patients was measured with the EuroQol five-dimensional (EQ-5D) questionnaire during the period 2008 to 2009. The survival probabilities for each time point were adjusted with a utility measurement of quality of life and then extrapolated to 300 months to obtain the QALE. We compared the age-, gender-matched reference populations to calculate the expected lifetime utility loss. RESULTS The average age of subjects was 76 years old. The life expectancy and loss of life expectancy were 1.95 years and 8.48 years, respectively. The QALE of 55 patients with partial cognitive ability and the ability to respond was 0.58 quality-adjusted life years (QALY), whereas the QALEs of 87 patients with poor consciousness were 0.28 and 0.29 QALY for the EQ-5D measured by family caregivers and nurses, respectively. The loss of QALE for PMV patients was 9.87 to 10.17 QALY, corresponding to a health gap of 94% to 97%. CONCLUSIONS Theses results of poor prognosis would provide stakeholders evidence for communication to facilitate clinical decisions. The estimation may be used in future studies to facilitate the cost-effectiveness and reduction of the health gap.
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Affiliation(s)
- Mei-Chuan Hung
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
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