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Gebresillassie BM, Attia JR, Mersha AG, Harris ML. Prognostic models and factors identifying end-of-life in non-cancer chronic diseases: a systematic review. BMJ Support Palliat Care 2024:spcare-2023-004656. [PMID: 38580395 DOI: 10.1136/spcare-2023-004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Precise prognostic information, if available, is very helpful for guiding treatment decisions and resource allocation in patients with non-cancer non-communicable chronic diseases (NCDs). This study aimed to systematically review the existing evidence, examining prognostic models and factors for identifying end-of-life non-cancer NCD patients. METHODS Electronic databases, including Medline, Embase, CINAHL, Cochrane Library, PsychINFO and other sources, were searched from the inception of these databases up until June 2023. Studies published in English with findings mentioning prognostic models or factors related to identifying end-of-life in non-cancer NCD patients were included. The quality of studies was assessed using the Quality in Prognosis Studies tool. RESULTS The analysis included data from 41 studies, with 16 focusing on chronic obstructive pulmonary diseases (COPD), 10 on dementia, 6 on heart failure and 9 on mixed NCDs. Traditional statistical modelling was predominantly used for the identified prognostic models. Common predictors in COPD models included dyspnoea, forced expiratory volume in 1 s, functional status, exacerbation history and body mass index. Models for dementia and heart failure frequently included comorbidity, age, gender, blood tests and nutritional status. Similarly, mixed NCD models commonly included functional status, age, dyspnoea, the presence of skin pressure ulcers, oral intake and level of consciousness. The identified prognostic models exhibited varying predictive accuracy, with the majority demonstrating weak to moderate discriminatory performance (area under the curve: 0.5-0.8). Additionally, most of these models lacked independent external validation, and only a few underwent internal validation. CONCLUSION Our review summarised the most relevant predictors for identifying end-of-life in non-cancer NCDs. However, the predictive accuracy of identified models was generally inconsistent and low, and lacked external validation. Although efforts to improve these prognostic models should continue, clinicians should recognise the possibility that disease heterogeneity may limit the utility of these models for individual prognostication; they may be more useful for population level health planning.
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Affiliation(s)
- Begashaw Melaku Gebresillassie
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Centre for Women's Health Research, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - John Richard Attia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Melissa L Harris
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Centre for Women's Health Research, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Zhou M, Zha F, Liu F, Zhou J, Liu X, Li J, Yang Q, Zhang Z, Xiong F, Hou D, Weng H, Wang Y. Long-term care status for the elderly with different levels of physical ability: a cross-sectional survey in first-tier cities of China. BMC Health Serv Res 2023; 23:953. [PMID: 37674190 PMCID: PMC10481569 DOI: 10.1186/s12913-023-09987-3] [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: 01/05/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Long term care (LTC) services for functionally impaired senior citizens are crucial for addressing the challenges of aging. However, research on eligibility criteria and coverage of LTC in China is lacking. Our objective is to assess the current status of LTC and explore eligibility criteria and coverage for the elderly. METHODS This is a cross-sectional study conducted in two first-tier cities in China. Residents aged 65 or over were recruited from a nursing home and four primary hospitals. Participants were divided into three groups (bedridden, domestic, and community), then six grades (grade one to six) according to the Longshi Scale, and their functional ability was assessed using the Modified Barthel Index. Information such as diseases, complications, and daily care needs were collected. Nursing staff were invited to indicate patients' needs for care. A one-way ANOVA test, Kruskal Wallis H test and Mann-Whitney U test were used to explore the differences of variables in three Longshi groups or Longshi grades. RESULTS Among all 1157 participants, with an average age of 80.54, 69.3% were in the bedridden group. The most common diagnosis was stroke (71.4%), with the most prevalent complication being pulmonary infection (25.2%). In the nursing assessment, basic health care, disease care, activity care, complication prevention care and psychosocial care were summarized as the five main aspects of LTC for the elderly. Feeding, bathing, drinking, bowel management and bladder management were identified as the basic care which fulfills participants' basic physical needs in each Longshi group. Mouth care, artificial airway management, and body reposition, which can prevent immobility complications, were highly demanded by bedridden elderly. CONCLUSIONS The elderly in grade one to three are the ones in need of LTC most. The content of LTC for elderly should include basic care which fulfills their basic physical needs and complication care which can prevent immobility complications. The evidence of this research may contribute to the design of LTC in China. TRIAL REGISTRATION The study design was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registered 22 Jun 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).
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Affiliation(s)
- Mingchao Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fubing Zha
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jing Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Xiangxiang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Feng Xiong
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Dianrui Hou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Hongyun Weng
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China.
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3
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Sganga F, Salerno A, Frizza A, Turriziani A, Barillaroa C, Bernabei R. The role of geriatricians in hospital palliative care units for elderly patients affected by end stage diseases. Int J Palliat Nurs 2022; 28:202-207. [PMID: 35648681 DOI: 10.12968/ijpn.2022.28.5.202] [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: 11/11/2022]
Abstract
OBJECTIVE To show the importance of geriatricians in the assessment and treatment of patients with terminal illnesses requiring palliative care. METHODS This was a retrospective epidemiological study, in which the authors used data relating to 229 patients with terminal stage cancer/advanced chronic diseases, which were evaluated by a palliative care team and collected from January to December 2018. RESULTS The average age of the sample was 72 years. The sample was divided into two groups, called 'advanced cancer' (N=161, 70.3%) and 'advanced chronic diseases' (N=68, 29.6%). The authors found that patients with advanced chronic diseases had the highest age, highest number of comorbidities and higher indicators of complex care. The authors also showed that, in advanced chronic diseases, the factors that are associated with increased hospital death are: bedridden (OR=3,778; 95% CI=1,371-10,409), dysphagia (OR=2,038; 95% CI=1,005-4,133) and a higher number of diseases (OR=1,446; 95% CI=1,179-1,774). DISCUSSION Given these findings, there is a high prevalence of elderly hospitalised patients with advanced chronic end-stage disease, a classic geriatric condition, who need access to palliative care services. CONCLUSION The authors believe that an increase in geriatricians dedicated to palliative care services is needed to ensure that these patients have equal access to continuity of care services and optimal treatment.
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Affiliation(s)
- Federica Sganga
- Doctor, UOSA Palliative Care, Gemelli University Hospital Geriatric and Orthogeriatric Unit, S. Anna University Hospital, Italy
| | | | | | | | | | - Roberto Bernabei
- Professor, UOSA Palliative Care, Gemelli University Hospital; Sacred Heart Catholic University, Italy
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Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, D’Andrea A, Garofalo U, De Lucia F, Testa C, Cuomo G, Iannuzzo G, Gentile M, Nugara C, Sarullo FM, Marinus N, Hansen D, Vigorito C. Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation. J Clin Med 2021; 10:1696. [PMID: 33920796 PMCID: PMC8071180 DOI: 10.3390/jcm10081696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual's clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina (LI), Italy;
| | - Mario Pacileo
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
| | - Antonello D’Andrea
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
- Division of Cardiology, “Luigi Vanvitelli” University of Naples, 80131 Naples, Italy
| | - Umberto Garofalo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Felice De Lucia
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Crescenzo Testa
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Marco Gentile
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Cinzia Nugara
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Filippo M Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
- Heart Centre Hasselt, Jessa Hospital, BE3500 Hasselt, Belgium
| | - Carlo Vigorito
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
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Brucato A, Ferrari A, Tiraboschi M, Zucchi A, Cogliati C, Torzillo D, Dentali F, Tavecchia L, Gessi V, Squizzato A, Moretti S, Permunian ET, Carobbio A, Pasina L, De Stefano F, Tombetti E, Cumetti D, Tognoni G, Barbui T. Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study). Eur J Intern Med 2020; 72:60-66. [PMID: 31757579 DOI: 10.1016/j.ejim.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
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Affiliation(s)
- Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alberto Ferrari
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Mara Tiraboschi
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Health Protection Agency, Bergamo, Italy
| | - Chiara Cogliati
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Daniela Torzillo
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Tavecchia
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vera Gessi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Sara Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio De Stefano
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | | | - Davide Cumetti
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Gianni Tognoni
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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Cao J, Wang T, Li Z, Liu G, Liu Y, Zhu C, Jiao J, Li J, Li F, Liu H, Liu H, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X, Wu X. Factors associated with death in bedridden patients in China: A longitudinal study. PLoS One 2020; 15:e0228423. [PMID: 31995622 PMCID: PMC6988962 DOI: 10.1371/journal.pone.0228423] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Immobility is common and associated with adverse outcomes in hospitalized patients, especially older people. However, the factors contributing to mortality in bedridden patients are not well known. This study aimed to estimate short-term mortality and analyze risk factors that affect the prognosis of bedridden patients. METHODS This was a multicenter study in China involving 23,738 patients admitted to 25 hospitals between November 2015 and June 2016. All-cause mortality was recorded for 90 days after enrollment regardless of whether death occurred before or after discharge. Socio-demographic and clinical information was obtained from an electronic database. Univariate and multivariate Cox regression analysis was used to identify factors associated with mortality. RESULTS In total, 23,738 hospitalized bedridden patients, there were 1,114 (4.7%) observed deaths. The overall mortality rate was therefore 4.7%. Of these, 318 (1.4%) died while hospitalized and 796 (3.4%) after discharge. The univariate Cox regression analysis showed that variables significantly associated with 90-day mortality included total time spent bedridden, urinary tract infection and pulmonary infection (p<0.05). The multivariate Cox regression analysis showed that the independent risk factors for death were age (adjusted hazard ratio [aHR] 1.006, 95% CI 1.000-1.011), and pulmonary infection (aHR 1.439, 95% CI 1.266-1.635). The hazard ratios for mortality were reduced with urinary tract infection and more time spent bedridden. CONCLUSIONS The mortality after discharge was significantly higher than mortality in hospital. The factors affecting short-term mortality in bedridden patients included age, time spent bedridden, urinary tract infection and pulmonary infection. This suggests these factors may be potential predictors of mortality in bedridden patients. It is essential for medical staff to improve health education of patients and family members, pay more attention to follow up after discharge and meet care needs at home.
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Affiliation(s)
- Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Tiantian Wang
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ge Liu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jiaqian Li
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- * E-mail:
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Abstract
AIMS The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. METHODS A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. RESULTS A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. CONCLUSIONS Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
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Martín-Escalante MD, Quirós-López R, Martos-Pérez F, Olalla-Sierra J, Rivas-Ruiz F, Aguilar-García JA, Jiménez-Puente A, García-Alegría J. Validation of the PROFUND index to predict early post-hospital discharge mortality. QJM 2019; 112:854-860. [PMID: 31297526 DOI: 10.1093/qjmed/hcz179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/21/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The PROFUND index (PI) is a prognostic scale for polypathological patients at 12 months. The objective of the study was to validate the PI as a predictor of 1-year mortality in a current cohort of polypathological patients and analyse its prognostic usefulness in the short-term (1 month and 3 months) after discharge from Internal Medicine. DESIGN We conducted a prospective observational study and all polypathological patients discharged from an Internal Medicine Department between 01 March 2016 and 28 February 2017 were enrolled. METHODS The variables recorded for each patient were age, sex, diseases and diagnostic categories defining patients as polypathological patients, PI at discharge, number of hospital admissions, length of stay, vital status at 1 year, and date and place of death if applicable. Follow-up lasted 1 year from the time of enrolment. RESULTS Six hundred and ten polypathological patients were enrolled. Mortality was 41% and the patients who died were older, their length of stay was longer and their PI was higher compared with those who survived. The discrimination of the PI for predicting mortality was good, with a C-statistic of 0.718 [95% confidence interval (CI) 0.67-0.76]. In addition, a subgroup of patients with early mortality after discharge was identified, with a C-statistic of 0.74 (95% CI 0.67-0.80) at 30 days and 0.73 (95% CI 0.68-0.78) at 90 days. CONCLUSIONS The PI is a valid tool for predicting early and 1-year mortality in polypathological patients after discharge from Internal Medicine.
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Affiliation(s)
- M D Martín-Escalante
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - R Quirós-López
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
- Research Network for Health Services in Chronic Diseases (REDISSEC), Marbella, Málaga, Spain
| | - F Martos-Pérez
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J Olalla-Sierra
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - F Rivas-Ruiz
- Research Network for Health Services in Chronic Diseases (REDISSEC), Marbella, Málaga, Spain
- Research Unit, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J A Aguilar-García
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - A Jiménez-Puente
- Research Network for Health Services in Chronic Diseases (REDISSEC), Marbella, Málaga, Spain
- Assessment Unit, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J García-Alegría
- From the Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
- Research Network for Health Services in Chronic Diseases (REDISSEC), Marbella, Málaga, Spain
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9
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Costa G, Frezza B, Fransvea P, Massa G, Ferri M, Mercantini P, Balducci G, Buondonno A, Rocca A, Ceccarelli G. Clinico-pathological Features of Colon Cancer Patients Undergoing Emergency Surgery: A Comparison Between Elderly and Non-elderly Patients. Open Med (Wars) 2019; 14:726-734. [PMID: 31637303 PMCID: PMC6778396 DOI: 10.1515/med-2019-0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery. METHOD We retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant'Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality. RESULTS Of a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tumor site between the two groups. Comorbidities were significantly higher in elderly patients (73.4% vs 41.4%, p<0.001). No significant differences were observed between the two groups in surgical approach and the rate of one-stage procedures. Elderly patients were more frequently treated by Hartmann's procedure compared to non-elderly patients (20.2% vs 6.9%). Left colorectal resection with protective ileostomy was most frequent in the non-elderly group (27.6% vs 11.7%). No significant differences were found in the pT and pN categories of the TNM system between the two groups. However, a higher number of T3 in non-elderly patients was observed. A consistent number of non-oncologically adequate resections were observed in the elderly (21.3% vs 3.5%; p<0.03). The morbidity rate was significantly higher in the elderly group (31.9 % vs 3.4%, p<0.001). No significant difference was found in the mortality rate between the two groups, being 13.8% in the elderly and 6.9% in the non-elderly. CONCLUSIONS Emergency colorectal surgery for cancer still presents significant morbidity and mortality rates, especially in elderly patients. More aggressive tumors and advanced stages were more frequent in the non-elderly group and as a matter it should be taken into account when treating such patients in the emergency setting in order to perform a radical procedure as much as possible.
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Affiliation(s)
- Gianluca Costa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Barbara Frezza
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
| | - Pietro Fransvea
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Giulia Massa
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Genoveffa Balducci
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
| | - Antonio Buondonno
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189Rome, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Aldo Rocca
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale” IRCCS, Naples, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- Department of Surgery, Division of General Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100Arezzo, Italy
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10
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Cózar A, Ramos-Martínez A, Merino E, Martínez-García C, Shaw E, Marrodán T, Calbo E, Bereciartúa E, Sánchez-Muñoz LA, Salavert M, Pérez-Rodríguez MT, García D, Bravo-Ferrer JM, Gálvez-Acebal J, Henríquez C, Cuquet J, Gil-Campesino H, Torres L, Sánchez-Porto A, Royuela A, Cobo J. High delayed mortality after the first episode of Clostridium difficile infection. Anaerobe 2019; 57:93-98. [PMID: 30959165 DOI: 10.1016/j.anaerobe.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Clostridium difficile infection (CDI) is characterized by a high delayed and unrelated mortality. Predicting delayed mortality in CDI patients could allow the implementation of interventions that could reduce these events. A prospective multicentric study was carried out to investigate prognostic factors associated with mortality. It was based on a cohort (July 2015 to February 2016) of 295 patients presenting with CDI. Logistic regression was used and the model was calibrated using the Hosmer-Lemeshow test. The mortality rate at 75 days in our series was 18%. Age (>65 years), comorbidity (defined by heart failure, diabetes mellitus with any organ lesion, renal failure, active neoplasia or immunosuppression) and fecal incontinence at clinical presentation were associated with delayed (75-day) mortality. When present, each of the aforementioned variables added one point to the score. Mortalities with 0, 1, 2 and 3 points were 0%, 9.4%, 18.5% and 38.2%, respectively. The area under the ROC curve was 0.743, and the Hosmer-Lemeshow goodness-of-fit test p value was 0.875. Therefore, the prediction of high delayed mortality in CDI patients by our scoring system could promote measures for increasing survival in suitable cases.
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Affiliation(s)
- Alberto Cózar
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Spain.
| | - Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro-Majadahonda, Spain.
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Alicante, Spain.
| | | | - Evelyn Shaw
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Epidemiologia de Les Infeccions Bacterianes, Patologia Infecciosa I Transplantament, Institut D'Investigació Biomèdica de Bellvitge, IDIBELL, Spain.
| | | | - Esther Calbo
- Servicio de Medicina Interna, Unidad de Control de La Infección, Hospital Universitario Mútua Terrasssa, Spain.
| | - Elena Bereciartúa
- Unidad de Enfermedades Infecciosas, Hospital Universitario Cruces, Spain.
| | - Luis A Sánchez-Muñoz
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Spain.
| | - Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe (Valencia), Spain.
| | - M Teresa Pérez-Rodríguez
- Unidad de Patología Infecciosa (Servicio de Medicina Interna), Complejo Universitario de Vigo, Spain.
| | - Dácil García
- Sección de Infecciones, Servicio de Medicina Interna Hospital Universitario de Canarias, La Laguna (Tenerife), Spain.
| | | | - Juan Gálvez-Acebal
- Servicio de Enfermedades Infecciosas, Hospital Virgen Macarena, Sevilla, Spain.
| | - César Henríquez
- Servicio de Medicina Interna, Hospital Fundación Alcorcón, Spain.
| | - Jordi Cuquet
- Proceso de Infecciones, Servicio de Medicina Interna, Hospital General de Granollers, Spain.
| | - Helena Gil-Campesino
- Servicio de Microbiología, Hospital Nuestra Señora de Candelaria. Sta. Cruz de Tenerife, Spain.
| | - Luis Torres
- Servicio de Microbiología, Hospital San Jorge de Huesca, Spain.
| | - Antonio Sánchez-Porto
- Servicio de Microbiología, Hospital SAS, La Línea (La Línea de La Concepción), Spain.
| | - Ana Royuela
- Servicio de Bioestadística Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Spain.
| | - Javier Cobo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Spain.
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11
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Mannucci PM, Nobili A, Pasina L. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13:1191-1200. [PMID: 30171585 DOI: 10.1007/s11739-018-1941-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/27/2018] [Indexed: 01/24/2023]
Abstract
As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, Via Pace, 9, 20122, Milan, Italy.
| | - Alessandro Nobili
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
| | - Luca Pasina
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
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