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Rahouma M, Khairallah S, Lau C, Al Zghari T, Girardi L, Mick S. The impact of comorbidities on outcomes of concomitant mitral valve intervention with ascending aortic surgery. Int J Cardiol 2024; 413:132398. [PMID: 39069093 DOI: 10.1016/j.ijcard.2024.132398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION The Charlson Comorbidity Index (CCI) is widely utilized for risk stratification for non-cardiac surgical patients, yet it has not been broadly validated in patients undergoing cardiac surgery. We aim to assess its ability to predict early and late outcomes of concomitant mitral valve intervention with ascending aortic surgery. METHODS Patients who underwent surgery between 1997 and 2022 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at a time of index operation. The primary endpoint was all causes mortality while secondary outcomes were major adverse events (MAE) that included combined perioperative mortality, dialysis, myocardial infarction, and stroke in addition to the individual outcomes and take back for bleeding and tracheostomy. Chi-square test, Logistic and Cox regression analysis, and Kaplan-Meier curves were used. Maximally selected rank statistics were used to identify best cutoff of CCI for late mortality. RESULTS 186 patients (median age 65 [interquartile range (IQR): 54-76] and 69% males) were included with a median CCI of 4 [IQR: 3-6]. Five and ten-years overall survival were 95.9% and 67.1% vs 59.7%, and 19.9% in CCI ≤ 5 vs >5 (P < 0.001). On multivariate Cox regression analysis, higher CCI (HR 1.60 [1.17;2.18], P = 0.00), and lower EF (HR 0.89 [0.83;0.96], P = 0.002) were associated with late mortality. There was a trend to lower mortality in recent surgery years (HR 0.91 [0.83;1.01], P = 0.070)). Perioperative MAE was higher in CCI >5 (11.0% vs 2.1%, P = 0.017), and postoperative need for tracheostomy and CVA had a trend to be higher in CCI > 5 (P = 0.055). Logistic regression revealed that higher CCI, as a continuous variable, was associated with significantly higher odds of MAE, postoperative dialysis, and need for tracheostomy. CONCLUSIONS The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America.
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America; National Cancer Institute, Cairo University, Egypt
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America
| | - Talal Al Zghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America
| | - Stephanie Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine / New York-Presbyterian Hospital, New York, NY, United States of America
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Eves C, Omland LH, Gerstoft J, Kronborg G, Johansen IS, Larsen CS, Porskrog A, Dalager-Pedersen M, Lunding S, Leth S, Nielsen LN, Tetens MM, Obel N. Survival among people with HIV and their families in Denmark 1995-2021: a nationwide population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:100956. [PMID: 38966335 PMCID: PMC11223088 DOI: 10.1016/j.lanepe.2024.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
Background Survival among people with HIV (PWH) has vastly improved globally over the last few decades but remains lower than among the general population. We aimed to estimate time trends of survival among PWH and their families from 1995 to 2021. Methods We conducted a registry-based, nationwide, population-based, matched cohort study. We included all Danish-born PWH from 1995 to 2021 who had been on antiretroviral therapy for 90 days, did not report intravenous drug use, and were not co-infected with hepatitis C (n = 4168). We matched population controls from the general population 10:1 to PWH by date of birth and sex (n = 41,680). For family cohorts, we identified siblings, mothers, and fathers of PWH and population controls. From Kaplan-Meier tables with age as time scale, we estimated survival from age 25. We compared PWH with population controls and families of PWH with families of population controls to calculate mortality rate ratios adjusted for sex, age, comorbidities, and education (aMRR). Findings The median age of death among PWH increased from 27.5 years in 1995-1997 to 73.9 years (2010-2014), but thereafter survival increased only marginally. From 2015 to 2021, mortality was increased among PWH (aMRR 1.87 (95% CI: 1.65-2.11)) and siblings (aMRR: 1.25 (95% CI: 1.07-1.47)), mothers (aMRR: 1.30 (95% CI: 1.17-1.43)), and fathers (aMRR: 1.15 (95% CI: 1.03-1.29)) of PWH compared to their respective control cohorts. Mortality among siblings of PWH who reported heterosexual route of HIV transmission (aMRR: 1.51 (95% CI: 1.16-1.96)) was higher than for siblings of PWH who reported men who have sex with men as route of HIV transmission (aMRR 1.19 (95% CI: 0.98-1.46)). Interpretation Survival among PWH improved substantially until 2010, after which it increased only marginally. This may partly be due to social and behavioural factors as PWH families also had higher mortality. Funding Preben and Anna Simonsen's Foundation and Independent Research Fund Denmark.
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Affiliation(s)
- Caroline Eves
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 7, 2100, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 7, 2100, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
- Research Center of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Sønder Boulevard 29, 5000, Odense, Denmark
| | - Carsten Schade Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Anders Porskrog
- Department of Infectious Diseases, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Suzanne Lunding
- Department of Internal Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Steffen Leth
- Department of Infectious Diseases & Internal Medicine, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Lars Nørregaard Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Malte Mose Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 7, 2100, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 7, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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Coaston A, Lee SJ, Johnson JK, Weiss S, Hoffmann T, Stephens C. Factors associated with mobile medical clinic use: a retrospective cohort study. Int J Equity Health 2023; 22:195. [PMID: 37749529 PMCID: PMC10521435 DOI: 10.1186/s12939-023-02004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension. METHODS We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen's Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors. RESULTS Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36-1.92; 1.22, 95% CI, 1.02-1.45). CONCLUSIONS Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.
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Affiliation(s)
- Angela Coaston
- California Baptist University, College of Nursing, 8432 Magnolia Ave, Riverside, Ca, 92504, USA.
| | - Soo-Jeong Lee
- University of California, San Francisco, CA, 94143, USA
| | | | - Sandra Weiss
- University of California, San Francisco, CA, 94143, USA
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Hanna JJ, Geresu LB, Diaz MI, Ho M, Casazza JA, Pickering MA, Lanier HD, Radunsky AP, Cooper LN, Saleh SN, Bedimo RJ, Most ZM, Perl TM, Lehmann CU, Turer RW, Chow JY, Medford RJ. Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study. Open Forum Infect Dis 2023; 10:ofad400. [PMID: 37577110 PMCID: PMC10416813 DOI: 10.1093/ofid/ofad400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Background Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed. Methods This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates. Results Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes. Conclusions This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.
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Affiliation(s)
- John J Hanna
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liyu B Geresu
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Healthcare Informatics, Children’s Health Hospitals and Health Care, Dallas, Texas, USA
| | - Marlon I Diaz
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Milan Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Julia A Casazza
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison A Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heather D Lanier
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander P Radunsky
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger J Bedimo
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary M Most
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert W Turer
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeremy Y Chow
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Yoo-Jeong M, Nguyen AL, Waldrop D. Social network size and its relationship to domains of quality-of-life among older persons living with HIV. AIDS Care 2023; 35:600-607. [PMID: 35357192 PMCID: PMC9522889 DOI: 10.1080/09540121.2022.2057907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Gerontological research suggests that social network characteristics are key elements of successful aging as they are related to a positive quality-of-life (QoL). Less is known about the social networks of persons aging with HIV. To describe social network characteristics and assess the effect of social network size on QoL, a sample of 146 OPWH (age ≥50) was recruited from an outpatient HIV clinic in Atlanta, GA. Social network size was assessed using Cohen's social network index (SNI). Domains of QoL (physical, emotional, and social) were assessed using the RAND-36. Descriptive analyses were used to determine the frequency of contact within social networks and multivariable regression models were used to assess the relationship between SNI and three domains of QoL controlling for potential covariates. Participants were predominantly male (60%), heterosexual (63%), and African American (86%). Regular contact occurred most frequently with friends (82%) and relatives (77%). Multivariable modeling revealed that SNI explained 58% of the variance in emotional QoL (R2 = 0.58, F(8, 137) = 25.48, p < .001). Findings provide basis for potential interventions focused on the specific social network to improve emotional QoL of this vulnerable population.
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Affiliation(s)
- Moka Yoo-Jeong
- Northeastern University, Bouvé College of Health Sciences, School of Nursing
| | - Annie L. Nguyen
- University of Southern California, Keck School of Medicine, Department of Family Medicine
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Golsorkhtabaramiri M, Mckenzie J, Potter J. Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for post-operative short-term complications: a retrospective study. BMC Musculoskelet Disord 2023; 24:227. [PMID: 36966301 PMCID: PMC10039504 DOI: 10.1186/s12891-023-06211-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
PURPOSE Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory response. We investigated predictability of NLR for early adverse outcome after surgery for hip fracture in elderly population. METHODS We reviewed a total of 971 elderly patients with hip fracture who underwent emergency surgery between January 2017 and July 2020 in the Department of Orthopaedics Surgery at the Wollongong Hospital. After considering exclusion criteria, data from a total of 834 patients included in our study. Socio-demographic data, NLR in admission, updated Charlson comorbidity index (uCCI), biochemical markers, mortality rate and 15 short term post-operative complications were collected to determine predictability of NLR for post-operative complications and mortality. RESULTS After hip surgery, Hospital in-patient case fatality rate was 3.7% (31). In addition, 63.1% (511) of the patients had at least one complication or more. Logistic regression demonstrated that raised NLR (P-value < 0.001, OR 1.05) and uCCI≥4 (P-Value < 0.001, OR 1.75) are associated with post-operative complications. Moreover, decreased haemoglobin was associated with adverse effects (P-value < 0.001, OR 0.97). No association was found for any of these variables with in-patient mortality except for albumin (P-value: 0.03). In addition, despite significant association, ROC analyses showed a low predictability for each of the above variables including NLR (AUC 0.59) for post-operative complications. CONCLUSIONS Despite significant association, NLR was unable to prognosticate early adverse outcomes. However, it can be considered as a risk factor in admission for postoperative complications in combination with other risk factors and clinical context.
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Affiliation(s)
- Mohammad Golsorkhtabaramiri
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.
| | - John Mckenzie
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Jan Potter
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
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Lee CC, Tey J, Cheo T, Lee CH, Wong A, Kumar N, Vellayappan B. Outcomes of Patients With Spinal Metastases From Prostate Cancer Treated With Conventionally-Fractionated External Beam Radiation Therapy. Global Spine J 2023; 13:284-294. [PMID: 33648366 PMCID: PMC9972278 DOI: 10.1177/2192568221994798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the outcomes of conventionally-fractionated external beam radiation therapy (cEBRT) in the treatment of prostate cancer spinal metastases (PCSM). METHODS Patients who received palliative cEBRT for PCSM in our institution between 2008 and 2018 were included. Our outcomes were local progression-free survival (LPFS), overall survival (OS), pain response and toxicities graded using CTCAE version 4.03. Univariable and multivariable Cox proportional hazard regressions were performed to identify predictors for LPFS and OS. RESULTS A total of 100 patients with 132 sites of PCSM were identified, with a median follow-up of 54 months. Fourteen-percent of patients underwent surgical intervention before receiving cEBRT. Eighteen spinal segments (13.6%) had local progression, with a median time to local progression of 8 months. The median LPFS and OS were 7.8 and 9.0 months, respectively. The complete and partial pain response rates were 57% and 39% respectively. The incidence of grade ≥3 acute toxicities was 11%. Better ECOG performance status (0 to 1), castration-sensitive disease, spinal surgery and use of novel antiandrogen agent were identified as significant predictors for improved OS on multivariable analysis. CONCLUSIONS In our prostate cancer cohort, cEBRT is an effective treatment modality for local palliation of spinal metastases. More aggressive treatment approach should be considered for patients with excellent performance status and castration-sensitive disease in light of their expected longer survival. Further studies are warranted to identify the predictors for radiotherapy response in this population.
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Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Jeremy Tey
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Timothy Cheo
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng
Hospital, Singapore, Singapore
| | - Alvin Wong
- Department of Haematology-Oncology,
National University Cancer Institute, National University Hospital, Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery,
National University Hospital, National University Health System, National University
of Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
- Balamurugan Vellayappan, Department of
Radiation Oncology, National University Cancer Institute, National University
Hospital, National University Health System, National University of Singapore,
1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore, Singapore.
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Greene M, Shi Y, Boscardin J, Sudore R, Gandhi M, Covinsky K. Geriatric conditions and healthcare utilisation in older adults living with HIV. Age Ageing 2022; 51:6577097. [PMID: 35511728 PMCID: PMC9271234 DOI: 10.1093/ageing/afac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population. SETTING outpatient safety-net HIV clinic in San Francisco. METHODS in 2013, HIV-positive adults ≥50 years of age underwent geriatric assessment including functional impairment, fall(s)in past year, cognitive impairment (MOCA <26) and low social support (Lubben social network scale ≤12). We reviewed medical records from 2013 through 2017 to capture healthcare utilisation (emergency room (ER) visits and hospitalisations) and used Poisson models to examine the association between geriatric conditions and utilisation events over 4 years. RESULTS among 192 participants, 81% were male, 51% were white, the median age was 56 (range 50-74), and the median CD4 count was 508 (IQR 338-688) cells/mm3. Sixteen percent of participants had ≥1 activities of daily living (ADL) dependency, 58% had ≥1 instrumental activities of daily living IADL dependency, 43% reported ≥1 falls, 31% had cognitive impairment, and 58% had low social support. Over 4 years, 90 participants (46%) had ≥1 ER visit (total of 289 ER visits), 39 (20%) had ≥1 hospitalisation (total of 68 hospitalisations), and 15 (8%) died. In unadjusted and adjusted analyses, IADL dependency and falls were associated with healthcare utilisation (adjusted incidence rate ratios IADL (95%CI): 1.73 (1.33-2.25); falls: 1.51 (1.21-1.87)). CONCLUSION IADL dependency and history of falls were associated with healthcare utilisation among older HIV-positive adults. Although our results are limited by sample size, improved understanding of the association between geriatric conditions and healthcare utilisation could build support for geriatric HIV care models.
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Affiliation(s)
- Meredith Greene
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,Address correspondence to: Meredith Greene, 490 Illinois Street, Floor 08 San Francisco, CA 94143, USA. Tel: 415-502-3626;
| | - Ying Shi
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - John Boscardin
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Rebecca Sudore
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth Covinsky
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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The Charlson Comorbidity Index: problems with use in epidemiological research. J Clin Epidemiol 2022; 148:174-177. [PMID: 35395393 DOI: 10.1016/j.jclinepi.2022.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
The Charlson Comorbidity Index (CCI) is a highly cited and well established tool for measuring comorbidity in clinical research, but there are problems with its use in practice. Like most comorbidity summary measures, the CCI was developed to adjust for prognostic comorbidities in statistical models, particularly those exploring associations between risk of death or survival time and other patient- and disease-related factors. Despite this, the CCI is often used in cancer research to measure all comorbidity, or as a multimorbidity measure, and CCI scores are often used to assess the prognostic importance of multiple health conditions. In the latter case, it is not at all surprising that researchers report a significant association between CCI scores and risk of death or survival times because CCI scores provide a summary of the presence or absence of a set of prognostic comorbidities. Advances in multimorbidity research require specific attention to the methods used to develop relevant indices. Published literature on the association between comorbidity and risk of death or survival time should be interpreted with caution, especially if the CCI was used to provide a measure of comorbidities.
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Mukundan M, Kashyap K, Dhar M, Muralidharan A, Agarwal D, Saxena Y. Nutritional and Functional Status as a Predictor of Short-Term Mortality in Hospitalized Elderly Patients in a Tertiary Care Hospital. Cureus 2022; 14:e22576. [PMID: 35371632 PMCID: PMC8958128 DOI: 10.7759/cureus.22576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Context Elderly people are at a high risk of malnutrition leading to poor outcomes and quality of life. Aims We aimed to find an association between the nutritional and functional status of hospitalized elderly patients and the three-month all-cause mortality among them. Settings and design A cross-sectional study was carried out at a tertiary care hospital in North India from July 2018 to December 2019. Methods and material A total of 177 patients were recruited for the study, and their demographic and clinical data were collected on a preformed questionnaire. Comorbidity, nutritional status, functional status, and depression were calculated using the Charlson Comorbidity Index (CCI), Mini Nutritional Assessment (MNA) form, Katz Index of Independence in Activities of Daily Living (Katz ADL), and Geriatric Depression Scale (GDS), respectively. Statistical analysis A Chi-square test was used to find the association between different qualitative variables. A regression model was used to find out the odds for mortality. Statistical significance was set at p<0.05. Results According to the MNA score, 49.7% (88) were at risk of malnutrition, and 22.6%(40) were malnourished. Malnutrition, Charlson Comorbidity Index, and the functional status of the patients were found to be associated with three-month mortality, with a p value of 0.005, 0.017, and 0.021, respectively. On regression analysis, malnutrition (odds ratio (OR): 3.796; 95% confidence interval (CI): 1.178-12.234; p=0.025) and the functional status (OR: 3.160; 95% CI: 1.256-7.952; p=0.015) of the study participants were found to have higher odds for three-month all-cause mortality. Conclusions Nutritional status and ADL assessed at the time of discharge are good prognostic markers of health outcomes in the elderly population. Key message ADL and nutritional assessment at admission and discharge should be routinely incorporated in the geriatric assessment of hospitalized patients to triage and prognosticate.
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Hirsch EA, Barón AE, Risendal B, Studts JL, New ML, Malkoski SP. Determinants Associated With Longitudinal Adherence to Annual Lung Cancer Screening: A Retrospective Analysis of Claims Data. J Am Coll Radiol 2021; 18:1084-1094. [PMID: 33798496 PMCID: PMC8349785 DOI: 10.1016/j.jacr.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Lung cancer screening (LCS) efficacy is highly dependent on adherence to annual screening, but little is known about real-world adherence determinants. We used insurance claims data to examine associations between LCS annual adherence and demographic, comorbidity, health care usage, and geographic factors. MATERIALS AND METHODS Insurance claims data for all individuals with an LCS low-dose CT scan were obtained from the Colorado All Payer Claims Dataset. Adherence was defined as a second claim for a screening CT 10 to 18 months after the index claim. Cox proportional hazards regression was used to define the relationship between annual adherence and age, gender, insurance type, residence location, outpatient health care usage, and comorbidity burden. RESULTS After exclusions, the final data set consisted of 9,056 records with 3,072 adherent, 3,570 nonadherent, and 2,414 censored (unclassifiable) individuals. Less adherence was associated with ages 55 to 59 (hazard ratio [HR] = 0.80, 99% confidence interval [CI] = 0.67-0.94), 60 to 64 (HR = 0.83, 99% CI = 0.71-0.97), and 75 to 79 (HR = 0.79, 99% CI = 0.65-0.97); rural residence (HR = 0.56, 99% CI = 0.43-0.73); Medicare fee-for-service (HR = 0.45, 99% CI = 0.39-0.51), and Medicaid (HR = 0.50, 99% CI = 0.40-0.62). A significant interaction between outpatient health care usage and comorbidity was also observed. Increased outpatient usage was associated with increased adherence and was most pronounced for individuals without comorbidities. CONCLUSIONS This population-based description of LCS adherence determinants provides insight into populations that might benefit from specific interventions targeted toward improving adherence and maximizing LCS benefit. Quantifying population-based adherence rates and understanding factors associated with annual adherence are critical to improving screening adherence and reducing lung cancer death.
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Affiliation(s)
- Erin A Hirsch
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna E Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jamie L Studts
- Division of Medical Oncology and Cancer Prevention and Control Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melissa L New
- Pulmonary Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen P Malkoski
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Medicine, University of Washington, WWAMI-Spokane, Spokane, Washington; Sound Critical Care, Sacred Heart Medical Center, Spokane, Washington.
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Jenkins NW, Parrish JM, Nolte MT, Jadczak CN, Geoghegan CE, Mohan S, Hrynewycz NM, Singh K. Charlson Comorbidity Index: An Inaccurate Predictor of Minimally Invasive Lumbar Spinal Fusion Outcomes. Int J Spine Surg 2021; 15:770-779. [PMID: 34266930 DOI: 10.14444/8099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is a scarcity of research on the Charlson Comorbidity Index (CCI) and its influence on minimum clinically important difference (MCID) achievement after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). The objective of this study is to detail the association between the CCI and attaining MCID after MIS TLIF. METHODS A prospective surgical registry was retrospectively reviewed for spine surgeries between May 2015 and February 2019. Inclusion criteria were primary or revision, 1- or 2-level MIS TLIF procedures. Patients were stratified based on CCI score: 0 points (no comorbidities), 1-2 points (mild CCI), ≥3 points (moderate CCI). Preoperative, intraoperative, and postoperative variables were assessed by subgroup using appropriate statistical analysis. Subgroups were analyzed with linear regression or χ2 tests for continuous or categorical variables, respectively. Subgroup scores, improvement, and MCID achievement were assessed at postoperative timepoints (eg, 6 weeks, 12 weeks, 6 months, and 1 year) for back and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Composite Score (PCS), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF). RESULTS A total of 171 patients were included (n = 51 [no comorbidities], n = 73 [mild CCI], and n = 47 [moderate CCI]). Higher CCI patients were older and more likely to be smokers, diabetic, arthritic, hypertensive, or have a malignancy history (P < 0.003). Preoperatively, ODI and PROMIS PF were the only patient-reported outcomes with a significant association by CCI group (P = 0.015 and 0.014). Back pain was the only measure that had a significant association with the CCI subgroup at 1 year for score (P = 0.002) or MCID (P = 0.028). CONCLUSIONS By 1 year, regardless of the number of comorbidities, a similar proportion of patients undergoing MIS TLIF were able to achieve MCID for visual analog scale leg, SF-12 PCS, and PROMIS PF. Patients with higher comorbidities are not likely to experience a significant difference in symptom improvement. Regardless of CCI score, MIS TLIF can have a significant benefit for patients. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Text.
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Affiliation(s)
- Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Alternatives to free flap surgery for maxillofacial reconstruction: focus on the submental island flap and the pectoralis major myocutaneous flap. BMC Oral Health 2021; 21:198. [PMID: 33874923 PMCID: PMC8056673 DOI: 10.1186/s12903-021-01563-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF). Methods This retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics. Results 24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group. Conclusions The pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction.
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Chen E, Bazargan-Hejazi S, Ani C, Hindman D, Pan D, Ebrahim G, Shirazi A, Banta JE. Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost. Medicine (Baltimore) 2021; 100:e25206. [PMID: 33847618 PMCID: PMC8052007 DOI: 10.1097/md.0000000000025206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.
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Affiliation(s)
- Ethan Chen
- Charles Drew University of Medicine and Science and David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Chizobam Ani
- Department of Internal Medicine, Charles Drew University of Medicine and. Science & University
| | - David Hindman
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Deyu Pan
- Charles Drew University of Medicine and Science
| | - Gul Ebrahim
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Anaheed Shirazi
- Department of Psychiatry, University of California at San Diego
| | - Jim E. Banta
- Health Policy and Leadership, School of Public Health, Loma Linda University, Los Angeles CA
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Artiles-Armas M, Roque-Castellano C, Fariña-Castro R, Conde-Martel A, Acosta-Mérida MA, Marchena-Gómez J. Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer. World J Surg Oncol 2021; 19:106. [PMID: 33838668 PMCID: PMC8037830 DOI: 10.1186/s12957-021-02221-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients. METHODS A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival. RESULTS Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72-80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10-1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16-3.67) were the only independent risk factors for survival at 5 years. CONCLUSIONS Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival.
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Affiliation(s)
- Manuel Artiles-Armas
- Department of General Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Cristina Roque-Castellano
- Department of General Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Roberto Fariña-Castro
- Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain
| | - Alicia Conde-Martel
- Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Department of Internal Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain
| | - María Asunción Acosta-Mérida
- Department of General Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Joaquín Marchena-Gómez
- Department of General Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain. .,Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Mouton JP, Jobanputra N, Njuguna C, Gunter H, Stewart A, Mehta U, Lahri S, Court R, Igumbor E, Maartens G, Cohen K. Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence. Afr J Emerg Med 2021; 11:46-52. [PMID: 33437593 PMCID: PMC7787921 DOI: 10.1016/j.afjem.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 10/19/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION South Africa has the world's largest antiretroviral treatment programme, which may contribute to the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according to HIV status, to determine the contribution of drugs used in management of HIV and its complications to ADR-related EU presentations, and identify factors associated with ADR-related EU presentation. METHODS We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and preventability. RESULTS We included 1010 EU presentations and assessed 80/1010 (7.9%) as ADR-related, including 20/239 (8.4%) presentations among HIV-positive attendees. Among HIV-positive EU attendees with ADRs 17/20 (85%) were admitted, versus 22/60 (37%) of HIV-negative/unknown EU attendees. Only 5/21 (24%) ADRs in HIV-positive EU attendees were preventable, versus 24/63 (38%) in HIV-negative/unknown EU attendees. On multivariate analysis, only increasing drug count was associated with ADR-related EU presentation (adjusted odds ratio 1.10 per additional drug, 95% confidence interval 1.03 to 1.18), adjusted for age, sex, HIV status, comorbidity, and hospital. CONCLUSIONS ADRs caused a significant proportion of EU presentations, similar to findings from other resource-limited settings. The spectrum of ADR manifestations in our EUs reflects South Africa's colliding epidemics of infectious and non-communicable diseases. ADRs among HIV-positive EU attendees were more severe and less likely to be preventable.
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Bahlis LF, Diogo LP, Fuchs SC. Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia. ACTA ACUST UNITED AC 2021; 47:e20200257. [PMID: 33656092 PMCID: PMC8332672 DOI: 10.36416/1806-3756/e20200257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Objective: To compare the performance of Charlson Comorbidity Index (CCI) with those of the mental Confusion, Urea, Respiratory rate, Blood pressure, and age = 65 years (CURB-65) score and the Pneumonia Severity Index (PSI) as predictors of all-cause in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods: This was a cohort study involving hospitalized patients with CAP between April of 2014 and March of 2015. Clinical, laboratory, and radiological data were obtained in the ER, and the scores of CCI, CURB-65, and PSI were calculated. The performance of the models was compared using ROC curves and AUCs (95% CI). Results: Of the 459 patients evaluated, 304 met the eligibility criteria. The all-cause in-hospital mortality rate was 15.5%, and 89 (29.3%) of the patients were admitted to the ICU. The AUC for the CCI was significantly greater than those for CURB-65 and PSI (0.83 vs. 0.73 and 0.75, respectively). Conclusions: In this sample of hospitalized patients with CAP, CCI was a better predictor of all-cause in-hospital mortality than were the PSI and CURB-65.
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Affiliation(s)
- Laura Fuchs Bahlis
- . Faculdade de Medicina, Universidade do Vale do Rio dos Sinos - UNISINOS - São Leopoldo (RS) Brasil.,. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Luciano Passamani Diogo
- . Faculdade de Medicina, Universidade do Vale do Rio dos Sinos - UNISINOS - São Leopoldo (RS) Brasil.,. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Sandra Costa Fuchs
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
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Payne RA, Mendonca SC, Elliott MN, Saunders CL, Edwards DA, Marshall M, Roland M. Development and validation of the Cambridge Multimorbidity Score. CMAJ 2020; 192:E107-E114. [PMID: 32015079 DOI: 10.1503/cmaj.190757] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health services have failed to respond to the pressures of multimorbidity. Improved measures of multimorbidity are needed for conducting research, planning services and allocating resources. METHODS We modelled the association between 37 morbidities and 3 key outcomes (primary care consultations, unplanned hospital admission, death) at 1 and 5 years. We extracted development (n = 300 000) and validation (n = 150 000) samples from the UK Clinical Practice Research Datalink. We constructed a general-outcome multimorbidity score by averaging the standardized weights of the separate outcome scores. We compared performance with the Charlson Comorbidity Index. RESULTS Models that included all 37 conditions were acceptable predictors of general practitioner consultations (C-index 0.732, 95% confidence interval [CI] 0.731-0.734), unplanned hospital admission (C-index 0.742, 95% CI 0.737-0.747) and death at 1 year (C-index 0.912, 95% CI 0.905-0.918). Models reduced to the 20 conditions with the greatest combined prevalence/weight showed similar predictive ability (C-indices 0.727, 95% CI 0.725-0.728; 0.738, 95% CI 0.732-0.743; and 0.910, 95% CI 0.904-0.917, respectively). They also predicted 5-year outcomes similarly for consultations and death (C-indices 0.735, 95% CI 0.734-0.736, and 0.889, 95% CI 0.885-0.892, respectively) but performed less well for admissions (C-index 0.708, 95% CI 0.705-0.712). The performance of the general-outcome score was similar to that of the outcome-specific models. These models performed significantly better than those based on the Charlson Comorbidity Index for consultations (C-index 0.691, 95% CI 0.690-0.693) and admissions (C-index 0.703, 95% CI 0.697-0.709) and similarly for mortality (C-index 0.907, 95% CI 0.900-0.914). INTERPRETATION The Cambridge Multimorbidity Score is robust and can be either tailored or not tailored to specific health outcomes. It will be valuable to those planning clinical services, policymakers allocating resources and researchers seeking to account for the effect of multimorbidity.
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Affiliation(s)
- Rupert A Payne
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Silvia C Mendonca
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Marc N Elliott
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Catherine L Saunders
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Duncan A Edwards
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Martin Marshall
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
| | - Martin Roland
- Centre for Academic Primary Care (Payne), Population Health Sciences, University of Bristol, Bristol, UK; Primary Care Unit (Mendonca, Saunders, Edwards, Roland), Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK; RAND Corporation (Elliott), Santa Monica, Calif.; Research Department of Primary Care and Population Health (Marshall), University College London Medical School, Royal Free Campus, London, UK
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Roque-Castellano C, Fariña-Castro R, Nogués-Ramia EM, Artiles-Armas M, Marchena-Gómez J. Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study. World J Surg Oncol 2020; 18:120. [PMID: 32493351 PMCID: PMC7271489 DOI: 10.1186/s12957-020-01895-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Advanced age is a risk factor for colorectal cancer, and very elderly patients often need to be surgically treated. This study aimed to analyze the outcomes of a cohort of nonagenarian patients operated on for colorectal cancer. Methods Observational study conducted on a cohort of 40 nonagenarian patients, who were treated surgically for colorectal cancer between 2000 and 2018 in our institution. Clinical data, ASA score, Charlson Comorbidity Index, Surgical Mortality Probability Model, tumor characteristics, and nature and technical features of the surgical procedure, were recorded. The Comprehensive Complication Index (CCI) and survival time after the procedure were recorded as outcome variables. Univariate and multivariate analyses were performed in order to define risk factors for postoperative complications and long-term survival. Results Out of the 40 patients, 13 (32.5%) were men, 27 (67.5%) women, and mean age 91.6 years (SD ± 1.5). In 24 patients (60%), surgery was elective, and in 16 patients (40%), surgery was emergent. Curative surgery with intestinal resection was performed in 34 patients (85%). In 22 patients (55%), intestinal continuity was restored by performing an anastomosis. The median CCI was 22.6 (IRQ 0.0–42.6). Operative mortality was 10% (4 patients). Cumulative survival at 1, 3, and 5 years was 70%, 47%, and 29%, respectively. In multivariate analysis, only the need for transfusion remained as an independent prognostic factor for complications (p = 0.021) and TNM tumor stage as a significant predictor of survival (HR 3.0, CI95% 1.3–7.2). Conclusions Colorectal cancer surgery is relatively safe in selected nonagenarian patients and may achieve long-term survival.
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Affiliation(s)
- Cristina Roque-Castellano
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Roberto Fariña-Castro
- Department of Anesthesiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva María Nogués-Ramia
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Artiles-Armas
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Joaquín Marchena-Gómez
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. .,Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Lee CC, Tey JCS, Cheo T, Lee CH, Wong A, Kumar N, Vellayappan B. Outcomes of patients with spinal metastases from renal cell carcinoma treated with conventionally-fractionated external beam radiation therapy. Medicine (Baltimore) 2020; 99:e19838. [PMID: 32312006 PMCID: PMC7220059 DOI: 10.1097/md.0000000000019838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Renal cell carcinoma (RCC) has been traditionally thought to be radioresistant. This retrospective cohort study aims to assess the outcomes of patients with spinal metastases from RCC treated with conventionally-fractionated external beam radiation therapy (cEBRT) in our institution.Patients diagnosed with histologically or radiologically-proven RCC who received palliative cEBRT to spinal metastases, using 3-dimensional conformal technique between 2009 and 2018 were reviewed. Local progression-free survival (PFS), overall survival (OS) and common terminology criteria for adverse events version 4.0-graded toxicity were assessed. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate for predictors associated with survivals.Thirty-five eligible patients with forty spinal segments were identified, with a median follow-up of 7 months (range, 0-47). The median equivalent dose in 2 Gy fractions (EQD2) was 32.5 Gy 10 (range, 12-39). Thirty-seven percent of patients underwent surgical intervention. At the time of last follow-up, all but 1 patient had died. Seven patients developed local progression, with the median time to local progression of 10.2 months. The median local PFS and OS were 3.3 and 4.8 months. There was no grade 3 or higher toxicity. A higher radiation dose (equivalent dose to 2 Gy fraction <32.5 Gy 10 vs ≥32.5Gy 10) (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.17-3.18; P-value (P) = .68) and spinal surgery (HR, 2.35; 95% CI, 0.53-10.29; P = .26) were not significantly associated with local PFS on univariable analysis. Multivariable analysis showed that higher Tokuhashi score (HR, 0.41; 95% CI, 0.19-0.88; P = .02), lower number of spinal segments irradiated (HR, 1.18; 95% CI, 1.01-1.37; P = .04) and use of targeted therapy (HR, 0.41; 95% CI, 0.18-0.96; P = .04) were independent predictors for improved OS.For an unselected group of patients with RCC, there is no significant association between higher radiation dose and improved local control following cEBRT. This may be due to their short survivals. With the use of more effective systemic therapy, including targeted therapy and immunotherapy, survival will likely be prolonged. A tailored-approach is needed to identify patients with good prognosis who may still benefit from aggressive local treatments.
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Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore
| | - Jeremy Chee Seong Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - Alvin Wong
- Department of Medical Oncology, National University Cancer Institute
| | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore; National University Hospital, Singapore; National University Health System, Singapore; National University of Singapore
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The Comprehensive Complication Index is Related to Frailty in Elderly Surgical Patients. J Surg Res 2019; 244:218-224. [DOI: 10.1016/j.jss.2019.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023]
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Yoo-Jeong M, Hepburn K, Holstad M, Haardörfer R, Waldrop-Valverde D. Correlates of loneliness in older persons living with HIV. AIDS Care 2019; 32:869-876. [PMID: 31462066 DOI: 10.1080/09540121.2019.1659919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Loneliness poses a significant risk for morbidity and mortality in the context of older adulthood. Research shows that older persons living with HIV (PLWH) often face increased and complex vulnerability in terms of physical and psychosocial needs which may promote loneliness. The current study sought to identify correlates of loneliness in a sample of 146 older PLWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA. Participants completed a survey on loneliness, depression, HIV-related stigma, social network size, HIV-disclosure status, disease burden, and demographics. HIV biomarkers were abstracted from electronic medical records. Participants were predominantly male (60%) and African American (86%). Twelve percent (n = 17) reported past homelessness/unstable housing. Multivariable modeling revealed that depression and HIV-related stigma explained 41% of the variance in loneliness, above and beyond the effects of past homelessness/unstable housing and disease burden (R 2 = 0.41, F(7, 138) = 13.76, p < .001). Findings suggest that targeting HIV-related stigma and depression may reduce loneliness in older PLWH, but more studies are needed to elucidate causal pathways. A greater understanding of the mechanisms by which loneliness affects health among older PLWH could help better inform efforts to improve health in this patient population.
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Affiliation(s)
- Moka Yoo-Jeong
- School of Nursing, Columbia University, New York, NY, USA
| | - Kenneth Hepburn
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Marcia Holstad
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Wyss K, Wångdahl A, Vesterlund M, Hammar U, Dashti S, Naucler P, Färnert A. Obesity and Diabetes as Risk Factors for Severe Plasmodium falciparum Malaria: Results From a Swedish Nationwide Study. Clin Infect Dis 2017; 65:949-958. [PMID: 28510633 PMCID: PMC5848256 DOI: 10.1093/cid/cix437] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable diseases and obesity are increasing in prevalence globally, also in populations at risk of malaria. We sought to investigate if comorbidity, in terms of chronic diseases and obesity, is associated with severe Plasmodium falciparum malaria. METHODS We performed a retrospective observational study in adults (≥18 years of age) diagnosed with malaria in Sweden between January 1995 and May 2015. We identified cases through the surveillance database at the Public Health Agency of Sweden and reviewed clinical data from 18 hospitals. Multivariable logistic regression was used to assess associations between comorbidities and severe malaria. RESULTS Among 937 adults (median age, 37 years; 66.5% were male), patients with severe malaria had higher prevalence of chronic diseases (28/92 [30.4%]) compared with nonsevere cases (151/845 [17.9%]) (P = .004). Charlson comorbidity score ≥1 was associated with severe malaria (adjusted odds ratio [aOR], 2.63 [95% confidence interval {CI}, 1.45-4.77), as was diabetes among individual diagnoses (aOR, 2.98 [95% CI, 1.25-7.09]). Median body mass index was higher among severe (29.3 kg/m2) than nonsevere cases (24.7 kg/m2) (P < .001). Obesity was strongly associated with severe malaria, both independently (aOR, 5.58 [95% CI, 2.03-15.36]) and in combination with an additional metabolic risk factor (hypertension, dyslipidemia, or diabetes) (aOR, 6.54 [95% CI, 1.87-22.88]). The associations were observed among nonimmune travelers as well as immigrants from endemic areas. CONCLUSIONS Comorbidities, specifically obesity and diabetes, are previously unidentified risk factors for severe malaria in adults diagnosed with P. falciparum. Noncommunicable diseases should be considered in the acute management and prevention of malaria.
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Affiliation(s)
- Katja Wyss
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Emergency Medicine and
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Andreas Wångdahl
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Department of Infectious Diseases, Västerås Central Hospital, and
| | - Maria Vesterlund
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Ulf Hammar
- Unit of Biostatistics, Department of Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saduddin Dashti
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Pontus Naucler
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
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Lesourd A, Leporrier J, Delbos V, Unal G, Honoré P, Etienne M, Bouchaud O, Caron F. Antiretroviral Therapy as Prevention of … Pneumococcal Infections? Open Forum Infect Dis 2016; 3:ofw228. [PMID: 28018929 PMCID: PMC5170497 DOI: 10.1093/ofid/ofw228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/21/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV. METHODS The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI. RESULTS Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients). CONCLUSIONS Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.
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Affiliation(s)
- Anaïs Lesourd
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Jérémie Leporrier
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Valérie Delbos
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Guillemette Unal
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Patricia Honoré
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - Manuel Etienne
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Olivier Bouchaud
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - François Caron
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
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Bernard S, Inderjeeth C, Raymond W. Higher Charlson Comorbidity Index scores do not influence Functional Independence Measure score gains in older rehabilitation patients. Australas J Ageing 2016; 35:236-241. [DOI: 10.1111/ajag.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Bernard
- Department of Rehabilitation and Aged Care; Sir Charles Gairdner Hospital; Perth Western Australia Australia
- Department of Rehabilitation and Aged Care; Osborne Park Hospital; Perth Western Australia Australia
| | - Charles Inderjeeth
- Department of Rehabilitation and Aged Care; Sir Charles Gairdner Hospital; Perth Western Australia Australia
- Department of Rehabilitation and Aged Care; Osborne Park Hospital; Perth Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
| | - Warren Raymond
- Department of Rehabilitation and Aged Care; Sir Charles Gairdner Hospital; Perth Western Australia Australia
- University of Western Australia; Perth Western Australia Australia
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Yang H, Chen YH, Hsieh TF, Chuang SY, Wu MJ. Prediction of Mortality in Incident Hemodialysis Patients: A Validation and Comparison of CHADS2, CHA2DS2, and CCI Scores. PLoS One 2016; 11:e0154627. [PMID: 27148867 PMCID: PMC4858249 DOI: 10.1371/journal.pone.0154627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background The CHADS2 and CHA2DS2 scores are usually applied for stroke prediction in atrial fibrillation patients, and the Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity. The role in assessing mortality with score system in hemodialysis is not clear and comparisons are lacking. We aimed at evaluating CHADS2, CHA2DS2, and CCI scores to predict mortality in incident hemodialysis patients. Methods Using data from the Nation Health Insurance system of Taiwan (NHIRD) from 1 January 2005 to 31 December 2009, individuals ≧20 y/o who began hemodialysis identified by procedure code and receiving dialysis for > 3 months were included for our study. Renal transplantation patients after dialysis or PD patients were excluded. We calculated the CHADS2, CHA2DS2, and CCI score according to the ICD-9 code and categorized the patients into three groups in each system: 0–1, 2–3, over 4. A total of 3046 incident hemodialysis patients enrolled from NHIRD were examined for an association between the separate scoring systems (CHADS2, CHA2DS2, and CCI score) and mortality. Results CHADS2 and CHA2DS2 scores revealed good predictive value for total mortality (CHADS2 AUC = 0.805; CHA2DS2 AUC = 0.790). However, the CCI score did not reveal a similarly satisfying result (AUC = 0.576). Conclusions Our results show that CHADS2 and CHA2DS2 scores can be applied for mortality prediction in incident hemodialysis patients.
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Affiliation(s)
- Hsun Yang
- Department of Nephrology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yi-Hsin Chen
- Department of Nephrology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- * E-mail:
| | - Teng-Fu Hsieh
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Medical Research, Taichung Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Shiun-Yang Chuang
- Department of Medical Research, Taichung Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Mouton JP, Njuguna C, Kramer N, Stewart A, Mehta U, Blockman M, Fortuin-De Smidt M, De Waal R, Parrish AG, Wilson DPK, Igumbor EU, Aynalem G, Dheda M, Maartens G, Cohen K. Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa. Medicine (Baltimore) 2016; 95:e3437. [PMID: 27175644 PMCID: PMC4902486 DOI: 10.1097/md.0000000000003437] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
Abstract
Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions.We prospectively followed patients admitted to 4 hospitals' medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission.There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34-65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06-2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09-1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07-1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17-3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable.In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect South Africa's high HIV and tuberculosis burden. Identification and management of these ADRs should be considered in HIV and tuberculosis care and treatment programs and should be emphasized in health care worker training programmes.
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Affiliation(s)
- Johannes P Mouton
- From the Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town (JPM, CN, NK, AS, UM, MB, MFDS, RDW, GM, KC); Department of Medicine, East London Hospital Complex and Walter Sisulu University, East London (AGP); Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa (DPKW), US Centers for Disease Control and Prevention, Pretoria (EUI, GA); National Department of Health, Pretoria (MD); and Pharmaceutical Services, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa (MD)
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Gomez AT, Kiberd BA, Royston JP, Alfaadhel T, Soroka SD, Hemmelgarn BR, Tennankore KK. Comorbidity burden at dialysis initiation and mortality: A cohort study. Can J Kidney Health Dis 2015; 2:34. [PMID: 26351568 PMCID: PMC4562341 DOI: 10.1186/s40697-015-0068-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/24/2015] [Indexed: 11/14/2022] Open
Abstract
Background A high level of comorbidity at dialysis initiation is associated with an increased risk of death. However, contemporary assessments of the validity and prognostic value of comorbidity indices are lacking. Objectives To assess the validity of two comorbidity indices and to determine if a high degree of comorbidity is associated with mortality among dialysis patients. Design Cohort study. Setting QEII Health Sciences Centre (Halifax, Nova Scotia, Canada). Patients Incident, chronic dialysis patients between 01 Jan 2006 and 01 Jul 2013. Measurements Exposure: The Charlson Comorbidity Index (CCI) and End-Stage Renal Disease Comorbidity Index (ESRD-CI) were used to classify individual comorbid conditions into an overall score. Comorbidities were classified using patient charts and electronic records. Outcome: All-cause mortality. Confounders: Patient demographics, dialysis access, cause of ESRD and baseline laboratory data. Methods Regression coefficients were estimated on the CCI and ESRD-CI. Discrimination for death was assessed using Harrell’s c-index. Adjusted Cox proportional hazard models were used to calculate relative hazards and 95 % confidence intervals for each category of the CCI and ESRD-CI. Results The cohort consisted of 771 ESRD patients from 01 Jan 2006 to 01 Jul 2013. Most were male (62 %) and Caucasian (91 %). The cohort had a high proportion of diabetes (48 %), history of previous myocardial infarction (31 %) and heart failure (22 %). Regression coefficients on the CCI and ESRD-CI were 0.55 and 0.52, respectively. The c-index, for the prediction of death, was 0.61 for the CCI and 0.63 for the ESRD-CI. ESRD-CI scores of 4, 5 and ≥6 were associated with a similar mortality risk (adjusted relative hazard of 1.95, 1.89 and 1.99, respectively). There was a small increased mortality risk for CCI scores of 4, 5 and ≥6 (adjusted relative hazard of 1.86, 2.38 and 2.71, respectively). Limitations Classification of comorbidities for each patient was determined by clinical impression. Conclusions The CCI and ESRD-CI have a limited ability to discriminate mortality risk for incident dialysis patients. Acknowledging the frequency with which they are used, this study emphasizes the need to re-examine the usefulness of previously derived comorbidity indices in contemporary dialysis cohorts.
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Affiliation(s)
- Alwyn T Gomez
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Bryce A Kiberd
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
| | | | - Talal Alfaadhel
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada
| | - Steven D Soroka
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, AB Canada ; Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
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Cope R, Berkowitz L, Arcebido R, Yeh JY, Trustman N, Cha A. Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities. AIDS Patient Care STDS 2015; 29:445-53. [PMID: 26125093 DOI: 10.1089/apc.2015.0018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Treatment of HIV now occurs largely within the primary care setting, and the principal focus of most visits has become the management of chronic disease states. The clinical pharmacist's potential role in improving chronic disease outcomes for HIV patients is unknown. A retrospective cohort study was performed for HIV-positive patients also diagnosed with diabetes, hypertension, or hyperlipidemia. Characteristics and outcomes in 96 patients treated by an interdisciplinary team that included a clinical pharmacist (i.e., the intervention group) were compared to those in 50 patients treated by an individual healthcare provider (i.e., the control group). Primary outcomes were changes from baseline over 18 months of HbA1c, low density lipoprotein (LDL), and blood pressure, respectively. Secondary outcomes included number of drug-drug interactions, HIV viral load, CD4 count, percent change in smoking status, and percent of patients treated to cardiovascular guideline recommendations. The interdisciplinary team had a significant improvement in lipid management over the control group (LDL: -8.8 vs. +8.4 mg/dL; p=0.014), and the smoking cessation rate over the study period was doubled in the interdisciplinary group (20.4% vs. 11.8%). Among those with an indication for aspirin, a significantly higher percentage of patients were prescribed the medication in the interdisciplinary group compared to the control group (85.5% vs. 64.9%; p=0.014). An informal cost analysis estimated savings of more than $3000 per patient treated by the interdisciplinary team. Based on these results, pharmacist involvement in an HIV primary care clinic appears to lead to more appropriate management of chronic co-morbidities in a cost-effective manner.
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Affiliation(s)
| | - Leonard Berkowitz
- Division of Infectious Diseases, The Brooklyn Hospital Center, Brooklyn, New York
| | - Rebecca Arcebido
- Pharmacotherapy Services, The Brooklyn Hospital Center, Brooklyn, New York
| | - Jun-Yen Yeh
- College of Pharmacy, Long Island University, Brooklyn, New York
| | - Nathan Trustman
- College of Pharmacy, Long Island University, Brooklyn, New York
| | - Agnes Cha
- College of Pharmacy, Long Island University, Brooklyn, New York
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Mouton JP, Mehta U, Parrish AG, Wilson DPK, Stewart A, Njuguna CW, Kramer N, Maartens G, Blockman M, Cohen K. Mortality from adverse drug reactions in adult medical inpatients at four hospitals in South Africa: a cross-sectional survey. Br J Clin Pharmacol 2015; 80:818-26. [PMID: 25475751 DOI: 10.1111/bcp.12567] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS Fatal adverse drug reactions (ADRs) are important causes of death, but data from resource-limited settings are scarce. We determined the proportion of deaths in South African medical inpatients attributable to ADRs, and their preventability, stratified by human immunodeficiency virus (HIV) status. METHODS We reviewed the folders of all patients who died over a 30 day period in the medical wards of four hospitals. We identified ADR-related deaths (deaths where an ADR was 'possible', 'probable' or 'certain' using WHO-UMC criteria and where the ADR contributed to death). We determined preventability according to previously published criteria. RESULTS ADRs contributed to the death of 2.9% of medical admissions and 56 of 357 deaths (16%) were ADR-related. Tenofovir, rifampicin and co-trimoxazole were the most commonly implicated drugs. 43% of ADRs were considered preventable. The following factors were independently associated with ADR-related death: HIV-infected patients on antiretroviral therapy (adjusted odds ratio (aOR) 4.4, 95% confidence interval (CI) 1.6, 12), exposure to more than seven drugs (aOR 2.5, 95% CI 1.3, 4.8) and increasing comorbidity score (aOR 1.3, 95% CI 1.1, 1.7). CONCLUSIONS In our setting, where HIV and tuberculosis are highly prevalent, fatal in-hospital ADRs were more common than reported in high income settings. Most deaths were attributed to drugs used in managing HIV and tuberculosis. A large proportion of the ADRs were preventable, highlighting the need to strengthen systems for health care worker training and support.
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Affiliation(s)
- Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Ushma Mehta
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town.,Independent Pharmacovigilance Consultant, Cape Town
| | - Andy G Parrish
- Department of Medicine, Cecilia Makiwane Hospital and Walter Sisulu University, East London
| | - Douglas P K Wilson
- Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa
| | - Annemie Stewart
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Christine W Njuguna
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Nicole Kramer
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town
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Abstract
PURPOSE OF REVIEW The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. RECENT FINDINGS Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. SUMMARY Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa.
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Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:155-75. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Munier AL, de Lastours V, Porcher R, Donay JL, Pons JL, Molina JM. Risk factors for invasive pneumococcal disease in HIV-infected adults in France in the highly active antiretroviral therapy era. Int J STD AIDS 2014; 25:1022-8. [DOI: 10.1177/0956462414528316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Invasive pneumococcal diseases remain frequent and severe in HIV-infected subjects. To identify opportunities for prevention, we assessed risk factors of invasive pneumococcal diseases (IPD) in HIV-infected patients over a 10-year period in France. We performed a retrospective case-control study in a reference centre of HIV management in Paris. All HIV-infected patients having suffered from IPD between 2000 and 2011 were included. Control subjects were HIV-infected with no history of IPD or pneumonia, matched by date of diagnosis of HIV with controls. Two controls were randomly selected for each subject. In all, 42 HIV-infected patients presented 44 IPD episodes during the study period and were compared to 84 controls. In the multivariate analysis, patients with IPD were more likely than controls to have a Charlson Comorbidity Index ≥2 (adjusted OR = 7.07, 95% CI 1.99–25.1, p = 0.003), CD4-cell count <200/cells/µL (aOR = 6.93, 95% CI 1.80–26.7, p = 0.005), HIV-RNA viral load >400 copies/mL (aOR = 5.56, 95% CI 1.58–19.5, p = 0.007) and a non-European origin (aOR = 4.26, 95% CI 1.02–17.9, p = 0.047). HIV-infected patients with a higher burden of comorbidities, uncontrolled HIV replication, low CD4-cell counts and/or of non-European origin are at higher risk of developing IPD. Better screening for and management of HIV infection is necessary to reduce the risk of IPD.
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Affiliation(s)
- Anne-Lise Munier
- Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - Victoire de Lastours
- Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - Raphaël Porcher
- Department of Biostatistics, St Louis Hospital, APHP, Paris, France
| | - Jean-Luc Donay
- Microbiology Department, St Louis Hospital, APHP, Paris, France
| | - Jean-Louis Pons
- Microbiology Department, St Louis Hospital, APHP, Paris, France
| | - Jean-Michel Molina
- Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
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Whitmore RG, Stephen JH, Vernick C, Campbell PG, Yadla S, Ghobrial GM, Maltenfort MG, Ratliff JK. ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs. Spine J 2014; 14:31-8. [PMID: 23602377 DOI: 10.1016/j.spinee.2013.03.011] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 10/28/2012] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes. PURPOSE To evaluate CCI and ASA grade as predictors of complications after spinal surgery and examine the correlation between these comorbidity indices and the cost of care. STUDY DESIGN/SETTING Prospective observational study. PATIENT SAMPLE All patients undergoing any spine surgery at a single academic tertiary center over a 6-month period. OUTCOME MEASURES Direct health-care costs estimated from diagnosis related group and Current Procedural Terminology (CPT) codes. METHODS Demographic data, including all patient comorbidities, procedural data, and all complications, occurring within 30 days of the index procedure were prospectively recorded. Charlson Comorbidity Index was calculated from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ASA grades determined from the operative record. Diagnosis related group and CPT codes were captured for each patient. Direct costs were estimated from a societal perspective using Medicare rates of reimbursement. A multivariable analysis was performed to assess the association of the CCI and ASA grade to the rate of complication and direct health-care costs. RESULTS Two hundred twenty-six cases were analyzed. The average CCI score for the patient cohort was 0.92, and the average ASA grade was 2.65. The CCI and ASA grade were significantly correlated, with Spearman ρ of 0.458 (p<.001). Both CCI and ASA grade were associated with increasing body mass index (p<.01) and increasing patient age (p<.0001). Increasing CCI was associated with an increasing likelihood of occurrence of any complication (p=.0093) and of minor complications (p=.0032). Increasing ASA grade was significantly associated with an increasing likelihood of occurrence of a major complication (p=.0035). Increasing ASA grade showed a significant association with increasing direct costs (p=.0062). CONCLUSIONS American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention.
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Affiliation(s)
- Robert G Whitmore
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - James H Stephen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Coleen Vernick
- Department of Anesthesiology, Thomas Jefferson University, 3400 Spruce Street, Philadelphia, PA 19107, USA
| | - Peter G Campbell
- Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA
| | - Sanjay Yadla
- Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA
| | - George M Ghobrial
- Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA
| | - Mitchell G Maltenfort
- Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA
| | - John K Ratliff
- Department of Neurosurgery, Thomas Jefferson University, 111 S 11th Street, Philadelphia, PA 19107, USA.
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Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, Grant I, Woods, and The HIV Neurobehavioral SP. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDS 2013; 27:5-16. [PMID: 23305257 DOI: 10.1089/apc.2012.0329] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study sought to determine the synergistic effects of age and HIV infection on medical co-morbidity burden, along with its clinical correlates and impact on health-related quality of life (HRQoL) across the lifespan in HIV. Participants included 262 individuals across four groups stratified by age (≤40 and ≥50 years) and HIV serostatus. Medical co-morbidity burden was assessed using a modified version of the Charlson Co-morbidity Index (CCI). Multiple regression accounting for potentially confounding demographic, psychiatric, and medical factors revealed an interaction between age and HIV infection on the CCI, with the highest medical co-morbidity burden in the older HIV+cohort. Nearly half of the older HIV+group had at least one major medical co-morbidity, with the most prevalent being diabetes (17.8%), syndromic neurocognitive impairment (15.4%), and malignancy (12.2%). Affective distress and detectable plasma viral load were significantly associated with the CCI in the younger and older HIV-infected groups, respectively. Greater co-morbidity burden was uniquely associated with lower physical HRQoL across the lifespan. These findings highlight the prevalence and clinical impact of co-morbidities in older HIV-infected adults and underscore the importance of early detection and treatment efforts that might enhance HIV disease outcomes.
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Affiliation(s)
| | | | - Patricia K. Riggs
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Katie Doyle
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, San Diego, California
| | - Scott L. Letendre
- Department of Medicine, University of California San Diego, San Diego, California
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, California
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Hindmarsh D, Loh M, Finch CF, Hayen A, Close JCT. Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people. Australas J Ageing 2012; 33:E1-7. [DOI: 10.1111/j.1741-6612.2012.00638.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Diane Hindmarsh
- School of Mathematics and Applied Statistics; University of Wollongong; Sydney New South Wales Australia
| | - Ming Loh
- Department of Geriatric Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Caroline F Finch
- Accident Research Centre; Monash University; Melbourne Victoria Australia
| | - Andrew Hayen
- Screening and Test Evaluation Program; Sydney School of Public Health; University of Sydney; Sydney New South Wales Australia
| | - Jacqueline CT Close
- Falls & Injury Prevention Group, Neuroscience Research Australia; University of New South Wales; Sydney New South Wales Australia
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
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Federico CA, Hsu PC, Krajden M, Yoshida EM, Bremner KE, Weiss AA, Anderson FH, Krahn MD. Patient time costs and out-of-pocket costs in hepatitis C. Liver Int 2012; 32:815-25. [PMID: 22221745 DOI: 10.1111/j.1478-3231.2011.02722.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 11/11/2011] [Indexed: 02/13/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with substantial costs to patients, their caregivers and society. AIMS We evaluated time costs (time spent seeking healthcare) and out-of-pocket (OOP) costs for patients with HCV and their caregivers. METHODS We measured costs for 738 HCV outpatients in a tertiary-care clinic using a patient-completed questionnaire. Time and OOP costs were compared across disease stages and sociodemographic categories. We examined the association between cost and disease stage using linear regression adjusting for age, gender, marital status, education, income and Index of Coexistent Disease (ICED) comorbidity score. Costs were expressed in 2007 Canadian dollars. RESULTS The mean annual time cost per patient was $2136 (98 h), and ranged from $281 (18 h) in individuals who had cleared the virus to $9416 in transplant recipients (420 h). Caregiver costs were reported in 10% of patients. The mean annual OOP cost per patient was $1326. Patients receiving active treatment and those with late-stage disease spent $2500-2800 per year on HCV-related healthcare, approximately 7% of their annual income. Patients who had cleared the virus had the lowest time and OOP costs. Low income and unemployed patients had higher costs. CONCLUSIONS In HCV-infected individuals, OOP and time costs represent a significant economic burden and fall disproportionately upon those least able to afford them. The lower cost burden among those who were successfully treated suggests that wider use of antiviral therapy may reduce economic burden in addition to improving health outcomes.
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Diederichs C, Bartels DB, Berger K. [Methodological challenges concerning the selection of diseases for a standardized multimorbidity index]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 54:972-8. [PMID: 21800246 DOI: 10.1007/s00103-011-1323-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Multimorbidity is defined as the coexistence of two or more chronic diseases. However, this complex health status, which primarily affects elderly, is still insufficiently understood. One reason is the underrepresentation of older, multimorbid people in studies. Another reason is that there is no agreement on the number and type of diseases, which have to be considered in the assessment of multimorbidity. Therefore, this article provides an overview on the status quo of research on multimorbidity indices and describes in detail, what kind of methodological challenges have to be faced regarding the development of a standardized index. Finally, recommendations are made for criteria, which can be used for the selection of diseases relevant for multimorbidity.
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Affiliation(s)
- C Diederichs
- Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Domagkstrasse 3, Münster, Germany.
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Rattanasompattikul M, Feroze U, Molnar MZ, Dukkipati R, Kovesdy CP, Nissenson AR, Norris KC, Kopple JD, Kalantar-Zadeh K. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 2011; 44:1813-23. [PMID: 22134841 DOI: 10.1007/s11255-011-0085-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/02/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity, but its role in assessing mortality in hemodialysis patients is not clear. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with comorbidities. We hypothesized that the Charlson comorbidity index without age is a strong predictor of mortality in hemodialysis patients. METHODS A 6-year cohort of 893 hemodialysis patients was examined for an association between a modified CCI (without age and kidney disease) (mCCI) and mortality. RESULTS Patients were 53±15 years old (mean±SD), had a median mCCI score of 2, and included 47% women, 31% African Americans and 55% diabetics. After adjusting for case-mix and nutritional and inflammatory markers including C-reactive protein and interleukin-6, 2nd (mCCI: 1-2), 3rd (mCCI=3), and 4th (mCCI: 4-9) quartiles compared to 1st (mCCI=0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92-2.23), 1.70 (1.06-2.72), and 2.33 (1.43-3.78), respectively. The mCCI-death association was robust in non-African Americans. The CCI-death association linearity was verified in cubic splines. Each 1 unit higher mCCI score was associated with a death hazard ratio of 1.16 (1.07-1.27). CONCLUSIONS CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients, in particular in non-African Americans.
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Affiliation(s)
- Manoch Rattanasompattikul
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90502, USA
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Obel N, Omland LH, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Sørensen HT, Gerstoft J. Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study. PLoS One 2011; 6:e22698. [PMID: 21799935 PMCID: PMC3143183 DOI: 10.1371/journal.pone.0022698] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 07/05/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population. METHODOLOGY/PRINCIPAL FINDINGS In a Danish nationwide, population-based cohort study, we used population based registries to identify (1) all Danish HIV-infected patients who started HAART in the period 1 January 1998-1 July 2009, and (2) a comparison cohort of individuals matched on date of birth and gender (N = 2,267 and 9,068, respectively). Study inclusion began 1 year after start of HAART. Patients were categorised hierarchically in four groups according to the three risk factors, which were identified before study inclusion. The main outcome measure was probability of survival from age 25 to 65 years. The probability of survival from age 25 to age 65 was substantially lower in HIV patients [0.48 (95% confidence interval (CI) 0.42-0.55)] compared to the comparison cohort [0.88 (0.86 to 0.90)]. However, in HIV patients with no risk factors (N = 871) the probability of survival was equivalent to that of the general population [0.86 (95% CI 0.77-0.92)]. In contrast, the probability of survival was 0.58 in patients with HIV risk factors (N = 704), 0.30 in patients with comorbidities (N = 479), and 0.03 in patients with drug or alcohol abuse (N = 313). CONCLUSIONS The increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment. Mortality in patients without risk factors on a successful HAART is almost identical to that of the non-HIV-infected population.
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Affiliation(s)
- Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Carsten S. Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus Sygehus, Aarhus N, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aarhus University Hospital, Aalborg Sygehus, Aalborg, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus Sygehus, Aarhus N, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Khan NF, Perera R, Harper S, Rose PW. Adaptation and validation of the Charlson Index for Read/OXMIS coded databases. BMC FAMILY PRACTICE 2010; 11:1. [PMID: 20051110 PMCID: PMC2820468 DOI: 10.1186/1471-2296-11-1] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 01/05/2010] [Indexed: 11/21/2022]
Abstract
Background The Charlson comorbidity index is widely used in ICD-9 administrative data, however, there is no translation for Read/OXMIS coded data despite increasing use of the General Practice Research Database (GPRD). Our main objective was to translate the Charlson index for use with Read/OXMIS coded data such as the GPRD and test its association with mortality. We also aimed to provide a version of the comorbidity index for other researchers using similar datasets. Methods Two clinicians translated the Charlson index into Read/OXMIS codes. We tested the association between comorbidity score and increased mortality in 146 441 patients from the GPRD using proportional hazards models. Results This Read/OXMIS translation of the Charlson index contains 3156 codes. Our validation showed a strong positive association between Charlson score and age. Cox proportional models show a positive increasing association with mortality and Charlson score. The discrimination of the logistic regression model for mortality was good (AUC = 0.853). Conclusion We have translated a commonly used comorbidity index into Read/OXMIS for use in UK primary care databases. The translated index showed a good discrimination in our study population. This is the first study to develop a co-morbidity index for use with the Read/OXMIS coding system and the GPRD. A copy of the co-morbidity index is provided for other researchers using similar databases.
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Affiliation(s)
- Nada F Khan
- Department of Primary Health Care, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
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Hsu PC, Krajden M, Yoshida EM, Anderson FH, Tomlinson GA, Krahn MD. Does cirrhosis affect quality of life in hepatitis C virus-infected patients? Liver Int 2009; 29:449-58. [PMID: 19267865 DOI: 10.1111/j.1478-3231.2008.01865.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health-related quality of life. AIMS To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non-cirrhotic patients with chronic HCV infection, using preference-based (utilities) and non-preference-based methods of evaluating QOL. METHODS In a tertiary care setting, 271 patients completed a self-administered time trade-off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method. RESULTS Mean utilities were lower than general population norms (0.81-0.92) and ranged from 0.62 to 0.82 in non-cirrhotic patients (n=197), 0.56-0.84 in compensated cirrhotic patients (n=17) and 0.55-0.76 for decompensated cirrhotic patients (n=57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common-law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching. CONCLUSIONS Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.
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Affiliation(s)
- Priscilla C Hsu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Kim KH, Ahn LS. A Comparative Study on Comorbidity Measurements with Lookback Period using Health Insurance Database: Focused on Patients Who Underwent Percutaneous Coronary Intervention. J Prev Med Public Health 2009; 42:267-73. [DOI: 10.3961/jpmph.2009.42.4.267] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kyoung Hoon Kim
- Review & Assessment Policy Institute, Health Insurance Review & Assessment Service, Korea
| | - Lee Su Ahn
- Review & Assessment Policy Institute, Health Insurance Review & Assessment Service, Korea
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