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Werner C, Sturm M, Heldmann P, Fleiner T, Bauer JM, Hauer K. Predictors of 2-Year Post-Discharge Mortality in Hospitalized Older Patients. J Clin Med 2024; 13:1352. [PMID: 38592184 PMCID: PMC10931743 DOI: 10.3390/jcm13051352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Understanding prognostic factors for adverse health outcomes is clinically relevant for improving treatment decision-making processes, potentially leading to enhanced patient prognosis. This secondary analysis of a prospective observational study aimed to identify independent factors associated with 2-year post-discharge mortality in acutely hospitalized older patients. METHODS All-cause mortality and date of death of 115 patients (83.3 ± 6.3 years, females: n = 75, 65.2%) admitted to acute geriatric wards were determined two years after hospital discharge through telephone interviews. Potential prognostic factors measured at hospital admission included demographic and clinical characteristics, nutritional, cognitive, and psychological status, Fried frailty phenotype, functioning in activities of daily living, locomotor capacity, and 24 h in-hospital mobility and objectively measured physical activity (PA) behaviors. RESULTS The 2-year mortality rate was 36.7% (n = 41). Univariate and multivariate Cox proportional hazards regression models revealed that mean daily PA level (hazards ratio (HR) = 0.59, 95% confidence interval (CI) 0.90-1.00; p = 0.042), frailty (HR = 3.39, 95% CI 1.20-9.51; p = 0.020), and underweight, in contrast to overweight (HR = 3.10, 95% CI 1.07-9.01; p = 0.038), at hospital admission were independently predictive of post-discharge mortality. CONCLUSION PA, frailty, and underweight at hospital admission should be considered when evaluating long-term survival prognosis, establishing risk profiles, and developing personalized care pathways in acute hospital care of older adults.
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Affiliation(s)
- Christian Werner
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216 Heidelberg, Germany
| | - Melanie Sturm
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Tim Fleiner
- Institute for Geriatric Research, Ulm University Medical Centre, Zollernring 26, 89073 Ulm, Germany
- Department of Geriatric Psychiatry and Psychotherapy, LVR-Hospital Cologne, Wilhelm-Griesinger Straße 23, 51109 Cologne, Germany
| | - Jürgen M. Bauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216 Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany
| | - Klaus Hauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216 Heidelberg, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376 Stuttgart, Germany
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Li Y, Liu X, Kang L, Li J. Validation and Comparison of Four Mortality Prediction Models in a Geriatric Ward in China. Clin Interv Aging 2023; 18:2009-2019. [PMID: 38053653 PMCID: PMC10695131 DOI: 10.2147/cia.s429769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose The efficacy of mortality risk prediction models among older patients in China remains uncertain. We aimed to validate and compare the performances of the Walter Index, Geriatric Prognostic Index (GPI), Charlson Comorbidity Index (CCI), and FRAIL Scale in predicting 1-year all-cause mortality post-discharge in geriatric inpatients in China. Patients and Methods This study was conducted at a geriatric ward of a tertiary Hospital in Beijing, including patients aged 70 years or older with a documented comprehensive geriatric assessment, discharged between January 1, 2016, and December 31, 2021. Patients with a hospital stay ≤24 h or >60 days were excluded. All-cause mortality data within one year of discharge were collected from medical files and telephone interviews between August 2022 and February 2023. Multiple imputation, Logistic regression analysis, Brier scores, C-statistics, Hosmer-Lemeshow goodness-of-fit-test, and calibration plots were employed for statistical analysis. Results We included 832 patients with a median (interquartile range) age of 77 (74-82) years. One-hundred patients (12.0%) died within one year. After adjusting for covariates-marital status, social support, cigarette use, length of stay, number of medications, hemoglobin levels, handgrip strength, and Short Physical Performance Battery-CCI scores of 3-4 and >4, and increased Walter Index, GPI, and FRAIL Scale scores were significantly associated with 1-year mortality risk. The Brier scores varied from 0.07 (Walter Index) to 0.10 (FRAIL Scale). The C-statistic ranged from 0.74 (95% confidence interval, 0.69-0.78) for FRAIL Scale to 0.88 (95% confidence interval, 0.84-0.91) for the Walter Index. Calibration curves showed that the Walter Index, GPI, and FRAIL Scale were well calibrated, while the CCI was poor. Conclusion Combining the Brier score, discrimination and calibration, the Walter Index was confirmed for the first time to be the best model to predict the 1-year mortality risk of geriatric inpatients in China among the four models.
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Affiliation(s)
- Yuanyuan Li
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Xiaohong Liu
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Jiaojiao Li
- Department of Geriatrics, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People’s Republic of China
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Suarez-Dono J, Novo-Veleiro I, Gude-Sampedro F, Marinho R, Xavier-Pires S, Rocha D, Araújo-Correia J, Moreira C, Beires F, Pérez D, David F, Vasco-Barreto J, Del Corral-Beamonte E, Piñeiro-Fernández JC, Casariego-Vales E, Diez-Manglano J, Pose-Reino A. Atrial fibrillation as a new prognosis factor in chronic patients after hospitalization: the CHRONIBERIA index. Sci Rep 2023; 13:4068. [PMID: 36906719 PMCID: PMC10008559 DOI: 10.1038/s41598-023-30610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023] Open
Abstract
A collaborative project in different areas of Spain and Portugal was designed to find out the variables that influence the mortality after discharge and develop a prognostic model adapted to the current healthcare needs of chronic patients in an internal medicine ward. Inclusion criteria were being admitted to an Internal Medicine department and at least one chronic disease. Patients' physical dependence was measured through Barthel index (BI). Pfeiffer test (PT) was used to establish cognitive status. We conducted logistic regression and Cox proportional hazard models to analyze the influence of those variables on one-year mortality. We also developed an external validation once decided the variables included in the index. We enrolled 1406 patients. Mean age was 79.5 (SD = 11.5) and females were 56.5%. After the follow-up period, 514 patients (36.6%) died. Five variables were identified as significantly associated with 1 year mortality: age, being male, lower BI punctuation, neoplasia and atrial fibrillation. A model with such variables was created to estimate one-year mortality risk, leading to the CHRONIBERIA. A ROC curve was made to determine the reliability of this index when applied to the global sample. An AUC of 0.72 (0.7-0.75) was obtained. The external validation of the index was successful and showed an AUC of 0.73 (0.67-0.79). Atrial fibrillation along with an advanced age, being male, low BI score, or an active neoplasia in chronic patients could be critical to identify high risk multiple chronic conditions patients. Together, these variables constitute the new CHRONIBERIA index.
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Affiliation(s)
- Javier Suarez-Dono
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain
| | - Ignacio Novo-Veleiro
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain.
| | - Francisco Gude-Sampedro
- Epidemiology Unit, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ricardo Marinho
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Sara Xavier-Pires
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Diana Rocha
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - João Araújo-Correia
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
- Multidisciplinary Biomedical Research Unit (UMIB), Abel Salazar Biomedical Science Institute (ICBAS), Porto, Portugal
| | - Cecília Moreira
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Francisca Beires
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Danay Pérez
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Filipa David
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - J Vasco-Barreto
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
- Abel Salazar Biomedical Science Institute (ICBAS), Porto, Portugal
| | - Esther Del Corral-Beamonte
- Internal Medicine Department. Hospital Royo Villanova, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | | | - Jesús Diez-Manglano
- Internal Medicine Department. Hospital Royo Villanova, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Antonio Pose-Reino
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain.
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Tsui A, Tudosiu PD, Brudfors M, Jha A, Cardoso J, Ourselin S, Ashburner J, Rees G, Davis D, Nachev P. Predicting mortality in acutely hospitalised older patients: the impact of model dimensionality. BMC Med 2023; 21:10. [PMID: 36617542 PMCID: PMC9827638 DOI: 10.1186/s12916-022-02698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prediction of long-term mortality following acute illness can be unreliable for older patients, inhibiting the delivery of targeted clinical interventions. The difficulty plausibly arises from the complex, multifactorial nature of the underlying biology in this population, which flexible, multimodal models based on machine learning may overcome. Here, we test this hypothesis by quantifying the comparative predictive fidelity of such models in a large consecutive sample of older patients acutely admitted to hospital and characterise their biological support. METHODS A set of 804 admission episodes involving 616 unique patients with a mean age of 84.5 years consecutively admitted to the Acute Geriatric service at University College Hospital were identified, in whom clinical diagnoses, blood tests, cognitive status, computed tomography of the head, and mortality within 600 days after admission were available. We trained and evaluated out-of-sample an array of extreme gradient boosted trees-based predictive models of incrementally greater numbers of investigational modalities and modelled features. Both linear and non-linear associations with investigational features were quantified. RESULTS Predictive models of mortality showed progressively increasing fidelity with greater numbers of modelled modalities and dimensions. The area under the receiver operating characteristic curve rose from 0.67 (sd = 0.078) for age and sex to 0.874 (sd = 0.046) for the most comprehensive model. Extracranial bone and soft tissue features contributed more than intracranial features towards long-term mortality prediction. The anterior cingulate and angular gyri, and serum albumin, were the greatest intracranial and biochemical model contributors respectively. CONCLUSIONS High-dimensional, multimodal predictive models of mortality based on routine clinical data offer higher predictive fidelity than simpler models, facilitating individual level prognostication and interventional targeting. The joint contributions of both extracranial and intracranial features highlight the potential importance of optimising somatic as well as neural functions in healthy ageing. Our findings suggest a promising path towards a high-fidelity, multimodal index of frailty.
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Affiliation(s)
- Alex Tsui
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
| | | | - Mikael Brudfors
- School of Imaging and Biomedical Engineering, King's College London, London, UK
- Wellcome Centre for Human Neuroimaging, UCL, London, UK
| | - Ashwani Jha
- UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jorge Cardoso
- School of Imaging and Biomedical Engineering, King's College London, London, UK
| | - Sebastien Ourselin
- School of Imaging and Biomedical Engineering, King's College London, London, UK
| | | | - Geraint Rees
- UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Pierce RP, Raithel S, Brandt L, Clary KW, Craig K. A Comparison of Models Predicting One-Year Mortality at Time of Admission. J Pain Symptom Manage 2022; 63:e287-e293. [PMID: 34826545 DOI: 10.1016/j.jpainsymman.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/10/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Hospitalization provides an opportunity to address end-of-life care (EoLC) preferences if patients at risk of death can be accurately identified while in the hospital. The modified Hospital One-Year Mortality Risk (mHOMR) uses demographic and admission data in a logistic regression algorithm to identify patients at risk of death one year from admission. OBJECTIVES This project sought to validate mHOMR and identify superior models. METHODS The mHOMR model was validated using historical data from an academic health system. Alternative logistic regression and random forest (RF) models were developed using the same variables. Receiver operating characteristic (ROC) and precision recall curves were developed, and sensitivity, specificity, and positive and negative predictive values were compared over a range of model thresholds. RESULTS The RF model demonstrated higher area under the ROC curve (0.950, 95% CI 0.947 - 0.954) as compared to the logistic regression models (0.818 [95% CI 0.812 - 0.825] and 0.841 [95% CI 0.836 - 0.847]). Area under the precision recall curve was higher with the random forest model compared to the logistic regression models (0.863 vs. 0.458 and 0.494, respectively). Across a range of thresholds, the RF model demonstrated superior sensitivity, equivalent specificity, and higher positive and negative predictive values. CONCLUSION A machine learning RF model, using common demographic and utilization data available on hospital admission, identified inpatients at risk of death more effectively than logistic regression models using the same variables. Machine learning models have promise for identifying admitted patients with elevated one-year mortality risk, increasing opportunities to prompt discussion of EoLC preferences.
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Affiliation(s)
- Robert P Pierce
- Department of Family and Community Medicine (R.P.P., K.C.), University of Missouri, Columbia, Missouri, USA; Cerner Corporation (S.R.), Tiger Institute, Columbia, Missouri, USA; Center for Health Ethics (L.B.), University of Missouri, Columbia, Missouri, USA; Department of Medicine (K.W.C.), University of Missouri, Columbia, Missouri, USA.
| | - Seth Raithel
- Department of Family and Community Medicine (R.P.P., K.C.), University of Missouri, Columbia, Missouri, USA; Cerner Corporation (S.R.), Tiger Institute, Columbia, Missouri, USA; Center for Health Ethics (L.B.), University of Missouri, Columbia, Missouri, USA; Department of Medicine (K.W.C.), University of Missouri, Columbia, Missouri, USA
| | - Lea Brandt
- Department of Family and Community Medicine (R.P.P., K.C.), University of Missouri, Columbia, Missouri, USA; Cerner Corporation (S.R.), Tiger Institute, Columbia, Missouri, USA; Center for Health Ethics (L.B.), University of Missouri, Columbia, Missouri, USA; Department of Medicine (K.W.C.), University of Missouri, Columbia, Missouri, USA
| | - Kevin W Clary
- Department of Family and Community Medicine (R.P.P., K.C.), University of Missouri, Columbia, Missouri, USA; Cerner Corporation (S.R.), Tiger Institute, Columbia, Missouri, USA; Center for Health Ethics (L.B.), University of Missouri, Columbia, Missouri, USA; Department of Medicine (K.W.C.), University of Missouri, Columbia, Missouri, USA
| | - Kevin Craig
- Department of Family and Community Medicine (R.P.P., K.C.), University of Missouri, Columbia, Missouri, USA; Cerner Corporation (S.R.), Tiger Institute, Columbia, Missouri, USA; Center for Health Ethics (L.B.), University of Missouri, Columbia, Missouri, USA; Department of Medicine (K.W.C.), University of Missouri, Columbia, Missouri, USA
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Cho E, Lee S, Bae WK, Lee JR, Lee H. Prediction value of the LACE index to identify older adults at high risk for all-cause mortality in South Korea: a nationwide population-based study. BMC Geriatr 2022; 22:154. [PMID: 35209849 PMCID: PMC8876396 DOI: 10.1186/s12877-022-02848-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background As a tool to predict early hospital readmission, little is known about the association between LACE index and all-cause mortality in older adults. We aimed to validate the LACE index to predict all-cause mortality in older adults and also analyzed the LACE index outcome of all-cause mortality depending on the disease and age of the participants. Methods We used the National Health Insurance Service (NHIS) cohort, a nationwide claims database of Koreans. We enrolled 7491 patients who were hospitalized at least once between 2003 and 2004, aged ≥65 years as of the year of discharge, and subsequently followed-up until 2015. We estimated the LACE index using the NHI database. The Cox proportional hazards model was used to estimate the hazard ratio (HR) for all-cause mortality. Furthermore, we investigated all-cause mortality according to age and underlying disease when the LACE index was ≥10 and < 10, respectively. Results In populations over 65 years of age, patients with LACE index ≥10 had significantly higher risks of all-cause mortality than in those with LACE index < 10. (HR, 1.44; 95% confidence interval, 1.35–1.54). For those patients aged 65–74 years, the HR of all-cause mortality was found to be higher in patients with LACE index≥10 than in those with LACE index < 10 in almost all the diseases except CRF and mental illnesses. And those patients aged ≥75 years, the HR of all- cause mortality was found to be higher in patients with LACE index ≥10 than in those with LACE index < 10 in the diseases of pneumonia and MACE. Conclusion This is the first study to validate the predictive power of the LACE index to identify older adults at high risk for all-cause mortality using nationwide cohort data. Our findings have policy implications for selecting or managing patients who need post-discharge management. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02848-4.
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Affiliation(s)
- Eunbyul Cho
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sumi Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Woo Kyung Bae
- Health Promotion Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jae-Ryun Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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Steinmeyer Z, Piau A, Thomazeau J, Kai SHY, Nourhashemi F. Mortality in hospitalised older patients: the WHALES short-term predictive score. BMJ Support Palliat Care 2021:bmjspcare-2021-003258. [PMID: 34824134 DOI: 10.1136/bmjspcare-2021-003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate the WHALES screening tool predicting short-term mortality (3 months) in older patients hospitalised in an acute geriatric unit. METHODS Older patients transferred to an acute geriatric ward from June 2017 to December 2018 were included. The cohort was divided into two groups: derivation (n=664) and validation (n=332) cohorts. Cause for admission in emergency room, hospitalisation history within the previous year, ongoing medical conditions, cognitive impairment, frailty status, living conditions, presence of proteinuria on a urine strip or urine albumin-to-creatinine ratio and abnormalities on an ECG were collected at baseline. Multiple logistic regressions were performed to identify independent variables associated with mortality at 3 months in the derivation cohort. The prediction score was then validated in the validation cohort. RESULTS Five independent variables available from medical history and clinical data were strongly predictive of short-term mortality in older adults including age, sex, living in a nursing home, unintentional weight loss and self-reported exhaustion. The screening tool was discriminative (C-statistic=0.74 (95% CI: 0.67 to 0.82)) and had a good fit (Hosmer-Lemeshow goodness-of-fit test (X2 (3)=0.55, p=0.908)). The area under the curve value for the final model was 0.74 (95% CI: 0.67 to 0.82). CONCLUSIONS AND IMPLICATIONS The WHALES screening tool is a short and rapid tool predicting 3-month mortality among hospitalised older patients. Early identification of end of life may help appropriate timing and implementation of palliative care.
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Affiliation(s)
- Zara Steinmeyer
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
| | - Antoine Piau
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
| | | | - Samantha Huo Yung Kai
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
- Methodological Research Support Unit, CHU Toulouse, Toulouse, France
| | - Fati Nourhashemi
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
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Ueshima J, Maeda K, Ishida Y, Shimizu A, Inoue T, Nonogaki T, Matsuyama R, Yamanaka Y, Mori N. SARC-F Predicts Mortality Risk of Older Adults during Hospitalization. J Nutr Health Aging 2021; 25:914-920. [PMID: 34409971 DOI: 10.1007/s12603-021-1647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN Single-center retrospective study. SETTING A university hospital. PARTICIPANTS All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.
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Affiliation(s)
- J Ueshima
- Keisuke Maeda, M.D., Ph.D. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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Abstract
Prognostication is a vital aspect of decision making because it provides patients and families with information to establish realistic and achievable goals of care, is used in determining eligibility for certain benefits, and helps in targeting interventions to those likely to benefit. Prognostication consists of 3 components: clinicians use their clinical judgment or other tools to estimate the probability of an individual developing a particular outcome over a specific period of time; this prognostic estimate is communicated in accordance with the patient's information preferences; the prognostic estimate is interpreted by the patient or surrogate and used in clinical decision making.
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Affiliation(s)
- Emily J Martin
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, 757 Westwood Plaza Suite 7501, Los Angeles, CA 90095, USA.
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, Box 181G, San Francisco, CA 94121, USA. https://twitter.com/EWidera
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Du X, Min J, Shah CP, Bishnoi R, Hogan WR, Lemas DJ. Predicting in-hospital mortality of patients with febrile neutropenia using machine learning models. Int J Med Inform 2020; 139:104140. [PMID: 32325370 DOI: 10.1016/j.ijmedinf.2020.104140] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Febrile neutropenia (FN) has been associated with high mortality among adults with cancer. Current systems for early detection of inpatient FN mortality are based on scoring indexes that require intensive physicians' subjective evaluation. OBJECTIVE In this study, we leveraged machine learning techniques to build a FN mortality risk evaluation tool focused on FN admissions without physicians' subjective evaluation. METHODS We used the National Inpatient Sample and Nationwide Inpatient Sample (NIS) that included mortality data among adult inpatients who were diagnosed with FN during a hospital admission. Machine learning techniques that we compared included linear models (ridge logistic regression and linear support vector machine) and non-linear models (gradient boosting tree and neural network). The primary outcome for this study was death among individuals with a recorded FN admission. Model comparison was evaluated based on areas under the receiver operating characteristic curve (AUROC) and model performance was estimated using 30 % test set created via stratified split. RESULTS Our analysis detected 126,013 adult admissions within the NIS data that were diagnosed with FN, among which 5,856 were declared as deceased (4.6 %). Our machine learning results demonstrate linear models and non-linear models achieved areas under the receiver operating characteristic (AUROC) around 92 % in survival prediction. CONCLUSIONS We developed machine learning models that do not require physicians' subjective evaluation for FN mortality risk prediction.
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Affiliation(s)
- Xinsong Du
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jae Min
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Chintan P Shah
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Rohit Bishnoi
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.
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11
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Brucato A, Ferrari A, Tiraboschi M, Zucchi A, Cogliati C, Torzillo D, Dentali F, Tavecchia L, Gessi V, Squizzato A, Moretti S, Permunian ET, Carobbio A, Pasina L, De Stefano F, Tombetti E, Cumetti D, Tognoni G, Barbui T. Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study). Eur J Intern Med 2020; 72:60-66. [PMID: 31757579 DOI: 10.1016/j.ejim.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To predict the 3-months mortality in permanently bedridden medical non-oncologic inpatients. PATIENTS AND METHODS 2788 consecutive patients admitted in 5 Italian Internal Medicine units from January 2016 through January 2017 were prospectively screened; 644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-months mortality in permanently bedridden inpatients with at least 2 of: creatinine clearance <35 ml/min; albumin < 2.5 g/dl; at least 2 hospital admissions in the previous 6 months. Advanced dementia and dysphagia were also recorded. RESULTS Mean age of the 2144 patients was 73.9 (SD, 14.9) years; 374 (17%) were permanently bedridden, 435 (20%) had a creatinine clearance <35 ml/min, 217 (10%) albumin <2,5 g/dl, 112 (5%) at least 2 hospital admissions in the previous 6 months. Seventy-seven (4%) patients were permanently bedridden with at least 2 of the above mentioned items, and 48 of them died within 3 months (62%) (p < 0.001;95% CI 51-73%). Regression coefficients of the variables associated with 3-months mortality in multivariate analysis in 998 patients of unit 1 (training cohort) were used to create a simple score, which was validated in the 1146 patients of the other units (validation cohort) and performed well in predicting the 3-months mortality (https://www.ejcrim.com/beclap/). CONCLUSIONS Approximately two out of three non-oncologic medical patients permanently bedridden having 2 of the abovementioned items are dead 3 months after index admission; a simple score including bedridden status, creatinine clearance, albumin, dysphagia, age and sex may help discuss management priorities.
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Affiliation(s)
- Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alberto Ferrari
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Mara Tiraboschi
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Health Protection Agency, Bergamo, Italy
| | - Chiara Cogliati
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Daniela Torzillo
- Internal Medicine Department, L. Sacco Hospital, ASST fbf-sacco, Milan, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Tavecchia
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vera Gessi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Sara Moretti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio De Stefano
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | | | - Davide Cumetti
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Gianni Tognoni
- Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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12
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Major VJ, Aphinyanaphongs Y. Challenges in translating mortality risk to the point of care. BMJ Qual Saf 2019; 28:959-962. [DOI: 10.1136/bmjqs-2019-009858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/03/2022]
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13
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Philpotts YF, Ma X, Anderson MR, Hua M, Baldwin MR. Health Insurance and Disparities in Mortality among Older Survivors of Critical Illness: A Population Study. J Am Geriatr Soc 2019; 67:2497-2504. [PMID: 31449681 DOI: 10.1111/jgs.16138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/24/2019] [Accepted: 07/20/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The 1.5 million Medicare beneficiaries who survive intensive care each year have a high post-hospitalization mortality rate. We aimed to determine whether mortality after critical illness is higher for Medicare beneficiaries with Medicaid compared with those with commercial insurance. DESIGN A retrospective cohort study from 2010 through 2014 with 1 year of follow-up using the New York Statewide Planning and Research Cooperative System database. SETTING A New York State population-based study of older (age ≥65 y) survivors of intensive care. PARTICIPANTS Adult Medicare beneficiaries age 65 years or older who were hospitalized with intensive care at a New York State hospital and survived to discharge. INTERVENTION None. MEASUREMENT Mortality in the first year after hospital discharge. RESULTS The study included 340 969 Medicare beneficiary survivors of intensive care with a mean (standard deviation) age of 77 (8) years; 20% died within 1 year. There were 152 869 (45%) with commercial insurance, 78 577 (23%) with Medicaid, and 109 523 (32%) with Medicare alone. Compared with those with commercial insurance, those with Medicare alone had a similar 1-year mortality rate (adjusted hazard ratio [aHR] = 1.01; 95% confidence interval [CI] = .99-1.04), and those with Medicaid had a 9% higher 1-year mortality rate (aHR = 1.09; 95% CI = 1.05-1.12). Among those discharged home, the 1-year mortality rate did not vary by insurance coverage, but among those discharged to skilled-care facilities (SCFs), the 1-year mortality rate was 16% higher for Medicaid recipients (aHR = 1.16; 95% CI = 1.12-1.21; P for interaction <.001). CONCLUSIONS Older adults with Medicaid insurance have a higher 1-year post-hospitalization mortality compared with those with commercial insurance, especially among those discharged to SCFs. Future studies should investigate care disparities at SCFs that may mediate these higher mortality rates. J Am Geriatr Soc 67:2497-2504, 2019.
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Affiliation(s)
- Yoland F Philpotts
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xiaoyue Ma
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Michaela R Anderson
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - May Hua
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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14
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Nardi R, Nozzoli C, Berti F, Bonizzoni E, Fabbri LM, Frasson S, Gambacorta M, Martini M, Mazzone A, Muzzulini CL, Nobili A, Campanini M. Prognostic value for mortality of the new FADOI-COMPLIMED score(s) in patients hospitalized in medical wards. PLoS One 2019; 14:e0219767. [PMID: 31339912 PMCID: PMC6656348 DOI: 10.1371/journal.pone.0219767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Recently we defined a user-friendly tool (FADOI-COMPLIMED scores—FCS) to assess complexity of patients hospitalized in medical wards. FCS-1 is an average between the Barthel Index and the Exton-Smith score, while FCS-2 is obtained by using the Charlson score. The aim of this paper is to assess the ability of the FCS to predict mortality in-hospital and after 1-3-6-12-months. In this perspective, we performed comparisons with the validated Multidimensional Prognostic Index (MPI). Methods It is a multicenter, prospective observational study, enrolling patients aged over 40, suffering from at least two chronic diseases and consecutively admitted to Internal Medicine departments. For each patient, data from 13 questionnaires were collected. Survival follow-up was conducted at 1-3-6-12 months after discharge. The relationships between cumulative incidences of death with FCS were investigated with logistic regression analyses. ROC curve analyses were performed in order to compare the predictiveness of the logistic models based on FCS with respect to those with MPI taken as reference. Results A cohort of 541 patients was evaluated. A 10-point higher value for FCS-1 and FCS-2 leads to an increased risk of 1-year death equal to 25.0% and 27.1%, respectively. In case of in-hospital mortality, the relevant percentages were 63.1% and 15.3%. The logistic model based on FCS is significantly more predictive than the model based on MPI (which requires an almost doubled number of items) for all the time-points considered. Conclusions Assessment of prognosis of patients has the potential to guide clinical decision-making and lead to better care. We propose a new, efficient and easy-to-use instrument based on FCS, which demonstrated a good predictive power for mortality in patients hospitalized in medical wards. This tool may be of interest for clinical practice, since it well balances feasibility (requiring the compilation of 34 items, taking around 10 minutes) and performance.
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Affiliation(s)
- Roberto Nardi
- Internal Medicine, “Maggiore” Hospital, Bologna, Italy
| | - Carlo Nozzoli
- Department of Internal Medicine, Careggi Hospital, Florence, Italy
| | - Franco Berti
- Internal Medicine, San Camillo Forlanini Hospital, Rome, Italy
| | - Erminio Bonizzoni
- Institute Department of Clinical Sciences and Community, Section of Medical Statistics, Biometry and Epidemiology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Leonardo M. Fabbri
- Department of Internal and Respiratory Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | | | | | | | - Antonino Mazzone
- Department of Internal Medicine, Civile Hospital, Legnano, Italy
| | | | - Alessandro Nobili
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Mauro Campanini
- Department of Internal Medicine, Hospital ‘Maggiore della Carità’, Novara, Italy
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15
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Wegier P, Koo E, Ansari S, Kobewka D, O'Connor E, Wu P, Steinberg L, Bell C, Walton T, van Walraven C, Embuldeniya G, Costello J, Downar J. mHOMR: a feasibility study of an automated system for identifying inpatients having an elevated risk of 1-year mortality. BMJ Qual Saf 2019; 28:971-979. [PMID: 31253736 DOI: 10.1136/bmjqs-2018-009285] [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] [Received: 12/29/2018] [Revised: 05/14/2019] [Accepted: 05/24/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The need for clinical staff to reliably identify patients with a shortened life expectancy is an obstacle to improving palliative and end-of-life care. We developed and evaluated the feasibility of an automated tool to identify patients with a high risk of death in the next year to prompt treating physicians to consider a palliative approach and reduce the identification burden faced by clinical staff. METHODS Two-phase feasibility study conducted at two quaternary healthcare facilities in Toronto, Canada. We modified the Hospitalised-patient One-year Mortality Risk (HOMR) score, which identifies patients having an elevated 1-year mortality risk, to use only data available at the time of admission. An application prompted the admitting team when patients had an elevated mortality risk and suggested a palliative approach. The incidences of goals of care discussions and/or palliative care consultation were abstracted from medical records. RESULTS Our model (C-statistic=0.89) was found to be similarly accurate to the original HOMR score and identified 15.8% and 12.2% of admitted patients at Sites 1 and 2, respectively. Of 400 patients included, the most common indications for admission included a frailty condition (219, 55%), chronic organ failure (91, 23%) and cancer (78, 20%). At Site 1 (integrated notification), patients with the notification were significantly more likely to have a discussion about goals of care and/or palliative care consultation (35% vs 20%, p = 0.016). At Site 2 (electronic mail), there was no significant difference (45% vs 53%, p = 0.322). CONCLUSIONS Our application is an accurate, feasible and timely identification tool for patients at elevated risk of death in the next year and may be effective for improving palliative and end-of-life care.
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Affiliation(s)
- Pete Wegier
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada .,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Koo
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shahin Ansari
- Department of Decision Support, University Health Network, Toronto, Ontario, Canada
| | - Daniel Kobewka
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Erin O'Connor
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Medicine, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Wu
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Leah Steinberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chaim Bell
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tara Walton
- Ontario Palliative Care Network, Toronto, Ontario, Canada
| | - Carl van Walraven
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gayathri Embuldeniya
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judy Costello
- Department of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada .,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
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16
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Curtin D, Dahly DL, Smeden M, O'Donnell DP, Doyle D, Gallagher P, O'Mahony D. Predicting 1‐Year Mortality in Older Hospitalized Patients: External Validation of the HOMR Model. J Am Geriatr Soc 2019; 67:1478-1483. [DOI: 10.1111/jgs.15958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Denis Curtin
- Department of MedicineUniversity College Cork Cork Ireland
- Department of Geriatric MedicineCork University Hospital Wilton Ireland
| | - Darren L. Dahly
- HRB Clinical Research Facility Cork, School of Public HealthUniversity College Cork Cork Ireland
| | - Maarten Smeden
- Department of Clinical EpidemiologyLeiden University Medical Centre Leiden Netherlands
| | | | - David Doyle
- Department of Information and Communications TechnologyCork University Hospital Wilton Ireland
| | - Paul Gallagher
- Department of MedicineUniversity College Cork Cork Ireland
- Department of Geriatric MedicineCork University Hospital Wilton Ireland
| | - Denis O'Mahony
- Department of MedicineUniversity College Cork Cork Ireland
- Department of Geriatric MedicineCork University Hospital Wilton Ireland
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17
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Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process. Can J Aging 2018; 38:90-99. [PMID: 30404681 DOI: 10.1017/s0714980818000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.
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18
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Calsina-Berna A, Martinez-Muñoz M, Bardés Robles I, Beas Alba E, Madariaga Sánchez R, Gómez Batiste Alentorn X. Intrahospital Mortality and Survival of Patients with Advanced Chronic Illnesses in a Tertiary Hospital Identified with the NECPAL CCOMS-ICO© Tool. J Palliat Med 2018; 21:665-673. [DOI: 10.1089/jpm.2017.0339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Agnès Calsina-Berna
- Comprehensive Support Unit, Catalan Institute of Oncology, Badalona, Spain
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
| | - Marisa Martinez-Muñoz
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Elba Beas Alba
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Xavier Gómez Batiste Alentorn
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
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19
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Abe S. Prognostic Factors for the Survival of Elderly Patients Who Were Hospitalized in the Medical Ward of Our Hospital in Japan. Geriatrics (Basel) 2017; 2:geriatrics2040032. [PMID: 31011042 PMCID: PMC6371180 DOI: 10.3390/geriatrics2040032] [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: 09/28/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022] Open
Abstract
It has been a long time since there were many elderly people in Japan. The medical care and costs for the elderly are enormous, and research to lower the mortality rate of the elderly is needed. We retrospectively investigated the prognostic factors for the survival of elderly patients who were hospitalized in the medical ward of our hospital. In total, 277 patients who were hospitalized between 1 January 2014 and 31 May 2017, were included in the retrospective study. Univariate and multivariate analyses of items (vital signs, laboratory data, and so on) were performed, and significant differences between the survival group and death group were subjected to receiver operating characteristic curve analysis. Serum urea nitrogen levels and serum albumin levels provided a relatively high area under the curve (AUC). However, there was no item for which AUC exceeded 0.70, and setting the cutoff value in this study was difficult. For treating the elderly, it is important to carefully evaluate each patient’s prognostic factors, including the demented state, renal function, and nutritional state; personalized treatment of each patient is also important.
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Affiliation(s)
- Shuichi Abe
- Internal Medicine, Rehabilitation Oomiko Hospital, Oomiko19, Oohara-cho, Tokushima-City, Tokushima 770-8012, Japan.
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20
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Dooley J, Pasciuto E, Lagou V, Lampi Y, Dresselaers T, Himmelreich U, Liston A. NOD mice, susceptible to pancreatic autoimmunity, demonstrate delayed growth of pancreatic cancer. Oncotarget 2017; 8:80167-80174. [PMID: 29113292 PMCID: PMC5655187 DOI: 10.18632/oncotarget.21261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/26/2017] [Indexed: 12/26/2022] Open
Abstract
Pancreatic cancer is a high mortality form of cancer, with a median survival only six months. There are multiple associated risk factors associated, most importantly type 2 diabetes, obesity, pancreatitis and smoking. The relative rarity of the disease, however, has made it difficult to dissect causative risk factors, especially with related risk factors. A major unanswered question with important therapeutic implications is the effect of immunological responses on pancreatic cancer formation, with data from other cancers suggesting the potential for local immunological responses to either increase cancer development or increase cancer elimination. Due to the rarity and late diagnosis of pancreatic cancer direct epidemiological evidence is lacking, thus necessitating a reliance on animal models. Here we investigated the relationship between pancreatic autoimmunity and cancer by backcrossing the well characterised Ela1-Tag transgenic model of pancreatic cancer onto the pancreatic autoimmune susceptible NOD mouse strain. Through longitudinal magnetic resonance imaging we found that the NOD genetic background delayed the onset of pancreatic tumours and substantially slowed the growth rate of tumours after development. These results suggest that elevated autoimmune surveillance of the pancreas limits tumour formation and growth, identifying pancreatic cancer as a promising target for immune checkpoint blockade therapies that unleash latent autoimmunity.
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Affiliation(s)
- James Dooley
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Emanuela Pasciuto
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vasiliki Lagou
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Yulia Lampi
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Biomedical MRI/MoSAIC, Leuven, Belgium
| | - Uwe Himmelreich
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Biomedical MRI/MoSAIC, Leuven, Belgium
| | - Adrian Liston
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
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21
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Gallego González E, Ortiz Alonso FJ, Vidán Astiz MT, Soria Felix S, García Cárdenas V, Omonte Guzmán J, Abizanda P, Valadés Malagón MI, Oreja Sevilla S, Serra Rexach JA. Development and validation of a prognostic index for 6- and 12-month mortality in hospitalized older adults. Arch Gerontol Geriatr 2017; 73:269-278. [PMID: 28869885 DOI: 10.1016/j.archger.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIM Estimation of mortality in elderly patients is difficult yet very important when planning care. Previous tools are complicated or do no take into account some major determinants of mortality (i.e., frailty). We designed a simple, accurate, and non-disease-specific tool to predict individual mortality risk after hospital discharge in older adults. METHODS Patients admitted to the Acute Geriatric Unit were assessed at adission and at discharge and contacted 6 and 12 months later. Determinants of mortality were obtained. Using multivariable analysis, beta coeffcicients were calculated to build 2 scores able to predict mortality at 6 and 12 months after discharge. The scores were tested on a sample comprising 75% of the patients, who were randomly selected; they were validated using the remaining 25%. Discrimination was assessed using ROC curves. Scores were calculated for each patient and divided into tertiles. Survival analysis was performed. RESULTS Determinants of mortality at 6 months were dependent ambulation at baseline, full dependence at discharge, length of stay, pluripatology, pressure ulcers, low grip strength, malignacy, and male gender. At 12 months the determinants were: dependent amblation at baseline, full dependence at discharge, pluripatology, low BMI, low grip strength, heart failure, malignacy, and male gender. Discrimination and calibration were excellent. Survival analysis demonstrated different survival trajectories (p<0.001) for each tertile in both scores. CONCLUSIONS Our incices provide accurate prognostic information in elderly patients after discharge. They can be calculated easily, quickly and do not require technical or laboratory support, thus endorsing their value in dalily clinical practice.
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Affiliation(s)
- Eva Gallego González
- Hospital Universitario de Canarias, Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain.
| | - Francisco Javier Ortiz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Maria Teresa Vidán Astiz
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Spain.
| | - Selene Soria Felix
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | - John Omonte Guzmán
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, CIBERFES, Albacete, Spain.
| | | | - Silvia Oreja Sevilla
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - José Antonio Serra Rexach
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Spain.
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22
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Self-rated health as a predictor of mid-term and long-term mortality in older Afro-Caribbeans hospitalised via the emergency department. Qual Life Res 2017; 27:91-96. [PMID: 28864878 DOI: 10.1007/s11136-017-1693-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine whether self-rated health (SRH) is an independent predictor for mortality in older Afro-Caribbean patients hospitalised for an acute condition. METHODS Prospective cohort of patients recruited from the University Hospitals of Martinique Acute Care for Elders unit. Patients aged 75 or older and hospitalised for an acute condition were eligible. The outcome was time to death within the 36-week follow-up. SRH was the explanatory variable of interest. Cox's Proportional Hazards model was used to estimate the relationship between SRH and mortality. RESULTS The 223 patients included in the study were aged 85.1 ± 5.5 years. In total, 123 patients reported "very good to good" health, and 100 "medium to very poor" health. Crude mortality rates at six months, 1, 2, and 3 years were 30.5, 34.8, 48.4, and 57.0%, respectively. By multivariate analysis, SRH reached significant relationship for all mortality timepoints. The adjusted hazard ratios for subjects who perceived their health as medium, poor or very poor was 1.6-2.7 times greater than that of subjects who reported good or very good health. CONCLUSION Assessment of SRH could have implications for clinical practice, particularly in helping practitioners to better estimate prognosis in the acute care settings.
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23
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Villanueva A, Oller R, Martori JC, Constante C. Utility of the NECPAL CCOMS-ICO © tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. Palliat Med 2017; 31:754-763. [PMID: 27815556 DOI: 10.1177/0269216316676647] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
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Affiliation(s)
- Xavier Gómez-Batiste
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Marisa Martínez-Muñoz
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Carles Blay
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,3 Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health (DoH), Government of Catalonia, Barcelona, Spain
| | - Jordi Amblàs
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | - Laura Vila
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Xavier Costa
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Joan Espaulella
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | | | - Ramon Oller
- 7 Department of Economics and Business, University of Vic, Barcelona, Spain
| | | | - Carles Constante
- 8 Department of Health (DoH), Government of Catalonia, Barcelona, Spain
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24
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Dooley J, Lagou V, Heirman N, Dresselaers T, Himmelreich U, Liston A. Murine Pancreatic Acinar Cell Carcinoma Growth Kinetics Are Independent of Dietary Vitamin D Deficiency or Supplementation. Front Oncol 2017; 7:133. [PMID: 28702373 PMCID: PMC5488083 DOI: 10.3389/fonc.2017.00133] [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: 04/29/2017] [Accepted: 06/07/2017] [Indexed: 11/13/2022] Open
Abstract
Vitamin D has been proposed as a therapeutic strategy in pancreatic cancer, yet evidence for an effect of dietary vitamin D on pancreatic cancer is ambiguous, with conflicting data from human epidemiological and intervention studies. Here, we tested the role of dietary vitamin D in the in vivo context of the well-characterized Ela1-TAg transgenic mouse model of pancreatic acinar cell carcinoma. Through longitudinal magnetic resonance imaging of mice under conditions of either dietary vitamin D deficiency (<5 IU/kg vitamin D) or excess (76,500 IU/kg vitamin D), compared to control diet (1,500 IU/kg vitamin D), we measured the effect of variation of dietary vitamin D on tumor kinetics. No measurable impact of dietary vitamin D was found on pancreatic acinar cell carcinoma development, growth or mortality, casting further doubt on the already equivocal data supporting potential therapeutic use in humans. The lack of any detectable effect of vitamin D, within the physiological range of dietary deficiency or supplementation, in this model further erodes confidence in vitamin D as an effective antitumor therapeutic in pancreatic acinar cell carcinoma.
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Affiliation(s)
- James Dooley
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Vasiliki Lagou
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Nathalie Heirman
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Uwe Himmelreich
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Adrian Liston
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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25
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Moman RN, Loprinzi Brauer CE, Kelsey KM, Havyer RD, Lohse CM, Bellolio MF. PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool. Acad Emerg Med 2017; 24:822-831. [PMID: 28401622 DOI: 10.1111/acem.13197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions. Using a cutoff of 13 points, PREDICT had a reported 95.3% specificity and 53.9% sensitivity for 1-year mortality. We externally validated PREDICT and derived a simpler modified PREDICT tool to systematically identify high-risk patients eligible for goals-of-care discussions and palliative care consultation in the ED. METHODS This was an observational cohort study of a random sample of 927 patients aged 55+ seen in the ED in 2014. We identified advance healthcare directives (AHDs) on file. We summarized diagnostic accuracy of the clinical tool to predict 1-year mortality using sensitivity, specificity, and area under the curve (AUC). We refined PREDICT using multivariable modeling. We followed reporting guidelines including STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cohort studies and Standards for Reporting of Diagnostic Accuracy (STARD). RESULTS A total of 927 patients were included: 55.0% were male, 63 (7.0%) were nursing home residents, 389 (42.0%) patients had an AHD in their medical record at the time of ED visit, and 245 (26.4%) were deceased at 1 year. Of the 780 patients with PREDICT scores < 13, a total of 164 (21.0%; 95% confidence interval [CI] = 18.3-24.1) were deceased at 1 year, and of the 147 patients with PREDICT scores ≥ 13, a total of 81 (55.1%; 95% CI = 46.7-63.2) were deceased at 1 year. The AUC of the PREDICT score was 0.717 (95% CI = 0.680-0.754), sensitivity was 33.1% (95% CI = 27.3-39.4), and specificity was 90.3% (95% CI = 87.8-92.4) to predict 1-year mortality. The modified PREDICT tool resulted in an AUC of 0.709 (95% CI = 0.671-0.747). We decided to select this model as the preferred model, as the variable of intensive care unit (ICU) admission with multiorgan failure can be difficult to assess in the ED and may delay advanced care planning. Reweighting the score did not improve fit or the AUC, so points assigned to each variable were not adjusted. CONCLUSION PREDICT is an easy tool to administer to be able to identify patients who are at high risk of 1-year mortality and who could benefit from AHDs, goals-of-care discussion, and when appropriate in the context of an end-of-life setting, palliative medicine consultation. External validation of PREDICT was successful in our population. We simplified PREDICT and derived a new tool, the modified PREDICT minus ICU tool, without significantly altering the sensitivity, specificity, and AUC for death at 1 year. The next steps include external validation of the newly derived rule and prospective implementation.
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Affiliation(s)
- Rajat N. Moman
- Department of Emergency Medicine; Rochester MN
- Mayo Clinic, and the Mayo Clinic School of Medicine; Rochester MN
| | | | - Katherine M. Kelsey
- Department of Emergency Medicine; Rochester MN
- Mayo Clinic, and the Mayo Clinic School of Medicine; Rochester MN
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26
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Torisson G, Stavenow L, Minthon L, Londos E. Importance and added value of functional impairment to predict mortality: a cohort study in Swedish medical inpatients. BMJ Open 2017; 7:e014464. [PMID: 28566362 PMCID: PMC5730010 DOI: 10.1136/bmjopen-2016-014464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. METHODS 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall χ2, discrimination, continuous net reclassification index (NRI >0) and integrated discrimination improvement (IDI). RESULTS In the full model, GBS-ADL was the single most important predictor of mortality (χ2-df=30, p<0.001). The likelihood ratio χ2 test showed significant added value of ADL (p<0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI >0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). CONCLUSIONS Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.
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Affiliation(s)
- Gustav Torisson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Lars Stavenow
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
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27
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Dooley J, Lagou V, Pasciuto E, Linterman MA, Prosser HM, Himmelreich U, Liston A. No Functional Role for microRNA-342 in a Mouse Model of Pancreatic Acinar Carcinoma. Front Oncol 2017; 7:101. [PMID: 28573106 PMCID: PMC5435746 DOI: 10.3389/fonc.2017.00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022] Open
Abstract
The intronic microRNA (miR)-342 has been proposed as a potent tumor-suppressor gene. miR-342 is found to be downregulated or epigenetically silenced in multiple different tumor sites, and this loss of expression permits the upregulation of several key oncogenic pathways. In several different cell lines, lower miR-342 expression results in enhanced proliferation and metastasis potential, both in vitro and in xenogenic transplant conditions. Here, we sought to determine the function of miR-342 in an in vivo spontaneous cancer model, using the Ela1-TAg transgenic model of pancreatic acinar carcinoma. Through longitudinal magnetic resonance imaging monitoring of Ela1-TAg transgenic mice, either wild-type or knockout for miR-342, we found no role for miR-342 in the development, growth rate, or pathogenicity of pancreatic acinar carcinoma. These results indicate the importance of assessing miR function in the complex physiology of in vivo model systems and indicate that further functional testing of miR-342 is required before concluding it is a bona fide tumor-suppressor-miR.
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Affiliation(s)
- James Dooley
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vasiliki Lagou
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Emanuela Pasciuto
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Michelle A Linterman
- Laboratory of Lymphocyte Signaling and Development, Babraham Institute, Cambridge, UK
| | - Haydn M Prosser
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | - Uwe Himmelreich
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Adrian Liston
- Translational Immunology Laboratory, VIB, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
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28
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Dooley J, Lagou V, Garcia-Perez JE, Himmelreich U, Liston A. miR-29a-deficiency does not modify the course of murine pancreatic acinar carcinoma. Oncotarget 2017; 8:26911-26917. [PMID: 28460473 PMCID: PMC5432306 DOI: 10.18632/oncotarget.15850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
The development of cancers involves the complex dysregulation of multiple cellular processes. With key functions in simultaneous regulation of multiple pathways, microRNA (miR) are thought to have important roles in the oncogenic formation process. miR-29a is among the most abundantly expressed miR in the pancreas. Together with altered expression in pancreatic cancer cell lines and biopsies, and known oncogenic functions in leukemia, this expression data has identified miR-29a as a key candidate for miR involvement in pancreatic cancer biology. Here we used miR-29a-deficient mice and the TAg model of pancreatic acinar carcinoma to functionally test the role of miR-29a in vivo. We found no impact of miR-29a loss on the development or growth of pancreatic tumours, nor on the survival of tumour-bearing mice. These results suggest that, despite differential expression, miR-29a is oncogenically neutral in the pancreatic acinar carcinoma context. If these results are extended to other models of pancreatic cancer, they would reduce the attractiveness of miR-29a as a potential therapeutic target in pancreatic cancer.
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Affiliation(s)
- James Dooley
- VIB Center for Brain and Disease Research, Leuven, Belgium
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Vasiliki Lagou
- VIB Center for Brain and Disease Research, Leuven, Belgium
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Josselyn E. Garcia-Perez
- VIB Center for Brain and Disease Research, Leuven, Belgium
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Uwe Himmelreich
- KU Leuven-University of Leuven, Department of Imaging and Pathology, Molecular Small Animal Imaging Center (MOSAIC), Leuven, Belgium
| | - Adrian Liston
- VIB Center for Brain and Disease Research, Leuven, Belgium
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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29
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Casey G, Walraven CV. Prognosticating with the Hospitalized Patient 1-year Mortality Risk Score Using Information Abstracted from the Medical Record. J Hosp Med 2017; 12:224-230. [PMID: 28411290 DOI: 10.12788/jhm.2713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Predicting death risk in patients with diverse conditions is difficult. The Hospitalized-patient One-year Mortality Risk (HOMR) score accurately determines death risk in adults admitted to hospital using health administrative data unavailable to clinicians and most researchers. OBJECTIVE Determine if HOMR is valid when calculated using data abstracted directly from the medical record. DESIGN Medical record review linked to population-based administrative data. PARTICIPANTS 4996 adults admitted in 2011 to a nonpsychiatric service at a tertiary hospital. MAIN MEASURES From the chart, we abstracted information required to calculate the HOMR score and linked to population-based mortality data to determine vital status within 1 year of admission date. KEY RESULTS Patients had a mean age of 55.6 (standard deviation [SD], 20.7) with 563 (11.3%) dying. The mean chart HOMR score was 22 (SD, 12) and significantly predicted death risk; a 1-point increase in HOMR increased death odds by 19% (odds ratio, 1.192;, 95% confidence interval [CI], 1.175-1.210;, P < 0.0001). Chart HOMR was strongly discriminative ( C statistic 0.888) and well calibrated (Hosmer-Lemeshow goodness-of-fit test, 12.9; P = 0.11). The observed death risk was strongly associated with expected death risk (calibration slope, 1.02; 95% CI, 0.89-1.16). Notation of delirium or falls on admitting notes or dependence for at least 1 activity of daily living were each associated with 1-year death risk independent of the HOMR score. CONCLUSIONS One-year mortality risk can be accurately determined in adults admitted to hospital with the HOMR score calculated using information abstracted from the medical record. Patient functional status was independently associated with death risk. Journal of Hospital Medicine 2017;12:224-230.
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Affiliation(s)
- Genevieve Casey
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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30
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Thomazeau J, Huo Yung Kai S, Rolland Y, Sourdet S, Saffon N, Nourhashemi F. [Prognostic indices for older adults during the year following hospitalization in an acute medical ward: An update]. Presse Med 2017; 46:360-373. [PMID: 28325586 DOI: 10.1016/j.lpm.2016.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022] Open
Abstract
CONTEXT As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. OBJECTIVE This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older. SOURCES Following keywords were searched in title and abstract of articles via an advanced search in PudMed, and by searching Mesh terms: "aged", "aged, 80 and over", "mortality", "prognosis", "hospitalized", "models, statistical", "acute geriatric ward", "frailty", "outcome". STUDIES SELECTION Studies published in English between 1985 and 2015 were selected. Last article was published in June 2015. Articles that described prognostic factors of mortality without a scoring system were excluded. Articles that focus either on patients in the Emergency Department and in Intensive Care Unit, or living in institution were excluded. RESULTS Twenty-two scores are described in 17 articles. These scores use items that refer to functional status, comorbidities, cognitive status and frailty. Scores of mortality 3 or 6 months after hospitalization are not discriminative. Few of the 1-year mortality prognostic score are discriminative with AUC≥0.7. LIMITS This review is not systematic. CONCLUSION Practical use of these scores might help management of these patients, in order to initiate appropriate reflexion and palliative care if necessary.
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Affiliation(s)
- Josephine Thomazeau
- CHU Purpan, unité résonance, douleur-soins de support, pavillon des médecines, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
| | - Samantha Huo Yung Kai
- Université Paul-Sabatier, faculté de médecine, département d'épidémiologie, économie de la santé et santé publique, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Yves Rolland
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Sandrine Sourdet
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Nicolas Saffon
- CHU Purpan, unité résonance, douleur-soins de support, pavillon des médecines, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Fati Nourhashemi
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
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31
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Liu SK, Ward M, Montgomery J, Mecchella JN, Masutani R, Bartels SJ, Batsis JA. Association of Hospital Admission Risk Profile Score with Mortality in Hospitalized Older Adults. Innov Aging 2017; 1:igx007. [PMID: 30480106 PMCID: PMC6218017 DOI: 10.1093/geroni/igx007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the association of the Hospital Admission Risk Profile (HARP) score with mortality after discharge in a population of hospitalized older adults. DESIGN Retrospective cohort study. PARTICIPANTS Hospitalized patients aged 70 years or older. MEASUREMENTS Patient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living 2 weeks prior to admission were used to calculate a HARP score. The primary outcome assessed was overall mortality up to 365 days after hospital discharge. Cox proportional hazard analyses evaluated the association between HARP score and mortality adjusting for age, sex, and comorbidities associated with increased mortality. RESULTS Of the 474 patients, 165 (34.8%) had a low HARP score, 177 (37.4%) had an intermediate, and 132 (27.8%) had a high score. HARP score was not associated with differences in 30-day readmission rates. High HARP score patients had higher mortality when compared to patients with low HARP scores at all time frames (30 days: 12.9% vs 1.8%, p < .05; 90 days: 19.7% vs 4.8%, p < .05; 365 days: 34.8% vs 16.9%, p < .05). In fully adjusted Cox proportional models, patients with high HARP scores had a 3.5 times higher odds of mortality when compared to low HARP score patients. CONCLUSION The HARP score is a simple and easy to use instrument that identifies patients at increased risk for mortality after hospital discharge. Early identification of patients at increased risk for mortality has the potential to help guide treatment decisions following hospital discharge and provides additional information to providers and patients for shared decision making and may help in clarifying and achieving patient and family goals of care.
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Affiliation(s)
- Stephen K Liu
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Marshall Ward
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Justin Montgomery
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - John N Mecchella
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire
- Centers for Health and Aging, Dartmouth College, Lebanon, New Hampshire
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Centers for Health and Aging, Dartmouth College, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
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Dooley J, Lagou V, Dresselaers T, van Dongen KA, Himmelreich U, Liston A. No Effect of Dietary Aspartame or Stevia on Pancreatic Acinar Carcinoma Development, Growth, or Induced Mortality in a Murine Model. Front Oncol 2017; 7:18. [PMID: 28232906 PMCID: PMC5298959 DOI: 10.3389/fonc.2017.00018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/25/2017] [Indexed: 11/25/2022] Open
Abstract
Pancreatic cancer has an extremely poor prognosis, largely due to a poor record for early detection. Known risk factors for pancreatic cancer include obesity, diet, and diabetes, implicating glucose consumption and regulation as a key player. The role of artificial sweeteners may therefore be pertinent to disease kinetics. The oncogenic impact of artificial sweeteners is a highly controversial area. Aspartame, one of the most studied food additives, is widely recognized as being generally safe, although there are still specific areas where research is incomplete due to study limitations. Stevia, by contrast, has been the subject of relatively few studies, and the potential health benefits are based on extrapolation rather than direct testing. Here, we used longitudinal tracking of pancreatic acinar carcinoma development, growth, and lethality in a sensitized mouse model. Despite exposure to aspartame and stevia from the in utero stage onward, we found no disease modification activity, in either direction. These results contribute to the data on aspartame and stevia safety, while also reducing confidence in several of the purported health benefits.
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Affiliation(s)
- James Dooley
- Translational Immunology Laboratory, VIB, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vasiliki Lagou
- Translational Immunology Laboratory, VIB, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Biomedical MRI/MoSAIC, Department of Imaging and Pathology, KU Leuven - University of Leuven , Leuven , Belgium
| | - Katinka A van Dongen
- Translational Immunology Laboratory, VIB, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Uwe Himmelreich
- Biomedical MRI/MoSAIC, Department of Imaging and Pathology, KU Leuven - University of Leuven , Leuven , Belgium
| | - Adrian Liston
- Translational Immunology Laboratory, VIB, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
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Min H, Avramovic S, Wojtusiak J, Khosla R, Fletcher RD, Alemi F, Kheirbek R. A Comprehensive Multimorbidity Index for Predicting Mortality in Intensive Care Unit Patients. J Palliat Med 2016; 20:35-41. [PMID: 27925837 DOI: 10.1089/jpm.2015.0392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accurate prediction of mortality for patients admitted to the intensive care units (ICUs) is an important component of medical care. However, little is known about the role of multimorbidity in predicting end of life for high-risk and vulnerable patients. OBJECTIVE The aim of the study was to derive and validate a multimorbidity risk model in an attempt to predict all-cause mortality at 6 and 12 months posthospital discharge. METHODS This is a retrospective, observational, clinical cohort study. Data were collected on 442,692 ICU patients who received care through the Veterans Administration between January 2003 and December 2013. The primary outcome was all-cause mortality at 6 and 12 months posthospital discharge. We divided the data into derivation (80%) and validation (20%) sets. Using multivariable logistic regression models, we compared prognostic models based on age, principal diagnosis groups, physiological markers, immunosuppressants, comorbidity categories, and a newly developed multimorbidity index (MMI) based on 5695 comorbidities. The cross-validated area under the receiver operating characteristic curve (AUC) was used to report the accuracy of predicting all-cause mortality at 6 and 12 months of hospital discharge. RESULTS The average age of patients was 68.87 years (standard deviation = 12.1), 95.9% were males, 44.9% were widowed, divorced, or separated. The relative order of accuracy in predicting mortality was the MMI (AUC = 0.84, CI = 0.83-0.84), VA Inpatient Evaluation Center index (AUC = 0.80, CI = 0.79-0.81), principal diagnosis groups (AUC = 0.74, CI = 0.73-0.74), comorbidities (AUC = 0.69, CI = 0.68-0.70), physiological markers (AUC = 0.65, CI = 0.64-0.65), age (AUC = 0.60, CI = 0.60-0.61),and immunosuppressant use (AUC = 0.59, CI = 0.58-0.59). CONCLUSIONS The MMI improved the accuracy of predicting short- and long-term all-cause mortality for ICU patients. Further prospective studies are needed to validate the index in different clinical settings and test generalizability of results in patients outside the VA system of care.
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Affiliation(s)
- Hua Min
- 1 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
| | - Sanja Avramovic
- 1 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
| | - Janusz Wojtusiak
- 1 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
| | - Rahul Khosla
- 2 Veterans Affairs Medical Center , Washington, DC.,3 School of Medicine and Health Sciences, George Washington University , Washington, DC
| | - Ross D Fletcher
- 2 Veterans Affairs Medical Center , Washington, DC.,4 School of Medicine, Georgetown University , Washington, DC
| | - Farrokh Alemi
- 1 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia.,2 Veterans Affairs Medical Center , Washington, DC
| | - Raya Kheirbek
- 2 Veterans Affairs Medical Center , Washington, DC.,3 School of Medicine and Health Sciences, George Washington University , Washington, DC
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Suárez-Dono J, Cervantes-Pérez E, Pena-Seijo M, Formigo-Couceiro F, Ferrón-Vidán F, Novo-Veleiro I, Del Corral-Beamonte E, Díez-Manglano J, Gude-Sampedro F, Pose-Reino A. CRONIGAL: Prognostic index for chronic patients after hospital admission. Eur J Intern Med 2016; 36:25-31. [PMID: 27745854 DOI: 10.1016/j.ejim.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We have followed patients admitted to a Polypathology and Advanced Age Unit for two years in order to identify the variables that best define the mortality prognosis at medium-term (1-2years) for chronic and polypathological patients requiring admission at an Internal Medicine Department. METHODS This is an observational, prospective study in clinical practice. Polypathological, chronic or multimorbidity patients were included. The classification of the Spanish Ministry for Health was used in order to classify patients as chronic or polypathological. The Charlson Index and Barthel Index were estimated and the Pfeiffer test was administered. The Spanish PROFUND Index was also used. Logistic regression models and Cox proportional hazard model were built in order to study the influence of prognostic factors on survival. RESULTS A total of 567 patients were included: 333 met polypathological (PPP) criteria and 234 chronic criteria (CC). Mean age was 84.8+7.3years. A total of 469 were followed up, most patients belonged to category E (282), 174 to category A and 118 to category C. The prognosis at one year of our patients can be estimated with 7 variables: age, neoplasia, delirium, Barthel, Pfeiffer, presence of atrial fibrillation, and creatinine. The area under the curve is 0.74. CONCLUSION The variables dementia, neoplasia, delirium at admission, Barthel Index under 60, or deceased spouse have mortality prognosis value at one or two years. An index with 7 variables applicable to chronic and polypathological patients after admission may serve as tool to better manage complex chronic patients and follow them up.
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Affiliation(s)
- Javier Suárez-Dono
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Evelín Cervantes-Pérez
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Marta Pena-Seijo
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Francisco Formigo-Couceiro
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Fernando Ferrón-Vidán
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Ignacio Novo-Veleiro
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Esther Del Corral-Beamonte
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Jesús Díez-Manglano
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Francisco Gude-Sampedro
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain
| | - Antonio Pose-Reino
- Polypathology and Advanced Age Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Coruña, Spain.
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Alemi F, Levy C, Citron BA, Williams AR, Pracht E, Williams A. Improving Prognostic Web Calculators: Violation of Preferential Risk Independence. J Palliat Med 2016; 19:1325-1330. [PMID: 27623488 DOI: 10.1089/jpm.2016.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Web-based applications are available for prognostication of individual patients. These prognostic models were developed for groups of patients. No one is the average patient, and using these calculators to inform individual patients could provide misleading results. OBJECTIVE This article gives an example of paradoxical results that may emerge when indices used for prognosis of the average person are used for care of an individual patient. METHODS We calculated the expected mortality risks of stomach cancer and its associated comorbidities. Mortality risks were calculated using data from 140,699 Veterans Administration nursing home residents. RESULTS On average, a patient with hypertension has a higher risk of mortality than one without hypertension. Surprisingly, among patients with lung cancer, hypertension is protective and reduces risk of mortality. This paradoxical result is explained by how group-level, average prognosis could mislead individual patients. In particular, average prognosis of lung cancer patients reflects the impact of various comorbidities that co-occur in lung cancer patients. The presence of hypertension, a relatively mild comorbidity of lung cancer, indicates that more serious comorbidities have not occurred. It is not that hypertension is protective; it is the absence of more serious comorbidities that is protective. The article shows how the presence of these anomalies can be checked through the mathematical concept of preferential risk independence. CONCLUSION Instead of reporting average risk scores, web-based calculators may improve accuracy of predictions by reporting the unconfounded risks.
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Affiliation(s)
- Farrokh Alemi
- 1 The District of Columbia Veteran Administration Medical Center , Washington.,2 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia
| | - Cari Levy
- 3 Denver Veteran Administration Medical Center , Denver, Colorado
| | - Bruce A Citron
- 4 Bay Pines Veteran Administration Healthcare System , Bay Pines, Florida
| | - Arthur R Williams
- 2 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia.,5 Center of Innovation on Disability and Rehabilitation Research, James A. Haley, Veterans, Administration Medical Center , Tampa, Florida
| | - Etienne Pracht
- 6 Department of Health Care Policy and Management, University of South Florida , Tampa, Florida
| | - Allison Williams
- 4 Bay Pines Veteran Administration Healthcare System , Bay Pines, Florida
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Abstract
To determine who is dead or alive, many researchers, policy makers, and corporations have relied on the National Death Index (NDI). This study investigates the impact of using NDI information to establish mortality status upon longevity analyses. A community sample of 694 individuals, enrolled in the Ohio Longitudinal Study of Aging and Retirement in 1975, participated. The authors compared the survival of two groups of these participants: those for whom death information came from clear matches with NDI and those for whom death information was based on both NDI information and supplementary information, such as community informants. Those in the expanded group tended to have significantly shorter survival than those in the strict group. Findings suggest that using limited NDI information alone may falsely increase longevity. Use of NDI offers numerous benefits, but incomplete or inaccurate classification of mortality status may affect study results.
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Han PK, Dieckmann NF, Holt C, Gutheil C, Peters E. Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study. Med Decis Making 2016; 36:703-13. [PMID: 26985015 PMCID: PMC4930679 DOI: 10.1177/0272989x16638321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. METHODS A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. RESULTS Provision of personalized prognostic information increased prognostic communication intentions (P < 0.001, η(2) = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η(2) = 0.10), higher objective numeracy (P = 0.01, η(2) = 0.09), female sex (P = 0.01, η(2) = 0.08), and lower perceived patient distress (P = 0.02, η(2) = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η(2) = 0.09), higher subjective numeracy (P = 0.02, η(2) = 0.08), and lower ambiguity aversion (P = 0.06, η(2) = 0.04). CONCLUSIONS Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.
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Affiliation(s)
- Paul K.J. Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
- Tufts University Clinical and Translational Sciences Institute, Boston, MA
| | - Nathan F. Dieckmann
- School of Nursing & School of Medicine, Oregon Health & Science University, Portland, OR
- Decision Research, Eugene, OR
| | - Christina Holt
- Department of Family Medicine, Maine Medical Center, Portland, ME
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
| | - Ellen Peters
- Department of Psychology, Ohio State University, Columbus, OH
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Godard-Sebillotte C, Dramé M, Basileu T, Fanon JL, Godaert L. Is self-rated health an independent prognostic factor of six-week mortality in older patients hospitalized for an acute condition? Qual Life Res 2016; 25:2335-40. [PMID: 26919847 DOI: 10.1007/s11136-016-1252-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether self-rated health is a prognostic factor of six-week mortality, independently of other known objective prognostic factors. METHODS The SAFMA study was a prospective cohort, which recruited patients from the University Hospital of Martinique Acute Care for Elders unit (French West Indies) from January to June 2012. Patients aged 75 or older and hospitalized for an acute condition were eligible. The outcome was time to death within the six-week follow-up. The main explanatory variable was self-rated health. Sociodemographic and clinical characteristics were considered as covariates. Cox's proportional hazards model was used. RESULTS The mean age of the 223 patients included was 85.1 ± 5.5 years. Six-week mortality rate was 14.8 %; none were lost to follow-up. In total, 123 claimed "very good to good" health, and 100 "medium to very poor" health. Self-rated health was the only independent prognostic factor associated with 6-week mortality (hazard ratio 2.61; 95 % confidence interval 1.18-5.77; p = .02), when adjusting for known prognostic factors such as age, dimensions of the comprehensive geriatric assessment and comorbidity burden. CONCLUSION The association between self-rated health and short-term mortality could have implications for clinical practice, particularly in helping in the estimation of prognosis in acute care setting.
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Affiliation(s)
- Claire Godard-Sebillotte
- Department of Family Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Moustapha Dramé
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, Reims, France
- Department of Research and Innovation, University Hospitals of Reims, Robert Debré Hospitals, 51092, Reims, France
| | - Tatiana Basileu
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Jean-Luc Fanon
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Lidvine Godaert
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
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Chen CY, Wu CJ, Pan CF, Chen HH, Chen YW. Influence of Age on Critically Ill Patients with Cirrhosis. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
Cancer prediction tools are widely available to clinicians, and the data retrieved from these tools can assist with patient counseling sessions on risk, prognosis, treatment, and recurrence. Current tools are able to synthesize data in a concise, unbiased, and evidence-based method, allowing patients to make better-informed decisions about their treatment options. As useful as these tools can be, clinicians must understand their limitations and evaluate the tools for quality and applicability.
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Weinger MB, Slagle JM, Kuntz AH, Schildcrout JS, Banerjee A, Mercaldo ND, Bills JL, Wallston KA, Speroff T, Patterson ES, France DJ. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers. Anesth Analg 2015; 121:957-971. [DOI: 10.1213/ane.0000000000000670] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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van Walraven C, McAlister FA, Bakal JA, Hawken S, Donzé J. External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission. CMAJ 2015; 187:725-733. [PMID: 26054605 DOI: 10.1503/cmaj.150209] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study. METHODS We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003-2010) and Alberta (2011-2012), and to the Brigham and Women's Hospital in Boston (2010-2012) to calculate each patient's HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries. RESULTS The 3 validation cohorts (n = 2,862,996 in Ontario, 210 595 in Alberta and 66,683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%-2.5%). INTERPRETATION The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients.
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Affiliation(s)
- Carl van Walraven
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa (van Walraven), Ottawa, Ont.; Ottawa Hospital Research Institute (van Walraven, Hawken), Ottawa, Ont.; Department of Medicine, University of Alberta, and Alberta Innovates - Health Solutions (McAlister), Edmonton, Alta.; Health Research Methods and Analytics, Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, and Alberta Strategy for Patient Oriented Research Support Unit (Bakal), Edmonton, Alta.; Division of General Internal Medicine, Bern University, Bern, Switzerland; Brigham & Women's Hospital and Harvard Medical School (Donzé), Boston, Mass.
| | - Finlay A McAlister
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa (van Walraven), Ottawa, Ont.; Ottawa Hospital Research Institute (van Walraven, Hawken), Ottawa, Ont.; Department of Medicine, University of Alberta, and Alberta Innovates - Health Solutions (McAlister), Edmonton, Alta.; Health Research Methods and Analytics, Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, and Alberta Strategy for Patient Oriented Research Support Unit (Bakal), Edmonton, Alta.; Division of General Internal Medicine, Bern University, Bern, Switzerland; Brigham & Women's Hospital and Harvard Medical School (Donzé), Boston, Mass
| | - Jeffrey A Bakal
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa (van Walraven), Ottawa, Ont.; Ottawa Hospital Research Institute (van Walraven, Hawken), Ottawa, Ont.; Department of Medicine, University of Alberta, and Alberta Innovates - Health Solutions (McAlister), Edmonton, Alta.; Health Research Methods and Analytics, Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, and Alberta Strategy for Patient Oriented Research Support Unit (Bakal), Edmonton, Alta.; Division of General Internal Medicine, Bern University, Bern, Switzerland; Brigham & Women's Hospital and Harvard Medical School (Donzé), Boston, Mass
| | - Steven Hawken
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa (van Walraven), Ottawa, Ont.; Ottawa Hospital Research Institute (van Walraven, Hawken), Ottawa, Ont.; Department of Medicine, University of Alberta, and Alberta Innovates - Health Solutions (McAlister), Edmonton, Alta.; Health Research Methods and Analytics, Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, and Alberta Strategy for Patient Oriented Research Support Unit (Bakal), Edmonton, Alta.; Division of General Internal Medicine, Bern University, Bern, Switzerland; Brigham & Women's Hospital and Harvard Medical School (Donzé), Boston, Mass
| | - Jacques Donzé
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa (van Walraven), Ottawa, Ont.; Ottawa Hospital Research Institute (van Walraven, Hawken), Ottawa, Ont.; Department of Medicine, University of Alberta, and Alberta Innovates - Health Solutions (McAlister), Edmonton, Alta.; Health Research Methods and Analytics, Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, and Alberta Strategy for Patient Oriented Research Support Unit (Bakal), Edmonton, Alta.; Division of General Internal Medicine, Bern University, Bern, Switzerland; Brigham & Women's Hospital and Harvard Medical School (Donzé), Boston, Mass
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Pilotto A, Sancarlo D, Daragjati J, Panza F. Perspective: the challenge of clinical decision-making for drug treatment in older people. The role of multidimensional assessment and prognosis. Front Med (Lausanne) 2015; 1:61. [PMID: 25593930 PMCID: PMC4294213 DOI: 10.3389/fmed.2014.00061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/24/2014] [Indexed: 01/10/2023] Open
Abstract
A complex decision path with a careful evaluation of the risk-benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included in clinical decision-making paths to better assess the benefits and risks of different drug treatments in advanced age. We performed a scoping review of principal hospital- and community-based prognostic indices in older age. Mortality prognostic tools could help clinical decision-making in diagnostics and therapeutics, tailoring appropriate intervention for older patients. The effectiveness of drug treatments may be significantly different in older patients with different risk of mortality. Clinicians need to consider the prognostic information obtained through well-validated, accurate, and calibrated predictive tools to identify those patients who may benefit from drug treatments given with the aim of increasing survival.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova , Italy ; Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Daniele Sancarlo
- Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Julia Daragjati
- Geriatrics Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova , Italy ; Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Francesco Panza
- Geriatric Unit, Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy ; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari , Italy
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Stineman MG, Xie D, Kurichi JE, Kwong PL, Vogel WB, Ripley DC, Bates BE. Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:1143-54. [PMID: 25437017 DOI: 10.1682/jrrd.2014.03.0084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/24/2014] [Indexed: 11/05/2022]
Abstract
Comprehensive rehabilitation services postacute stroke have been shown efficacious in European trials; however, their effectiveness in everyday practices in the United States is unknown. We compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services postacute stroke using propensity scores. Outcomes included change in patients' physical and cognitive independence after rehabilitation, discharge to home as opposed to other settings, and 1-yr posthospital discharge survival. Of the 2,963 patients in the study, 683 (23.1%) received comprehensive rehabilitation while the remaining patients received consultative services. We found, after propensity adjustment, that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 (95% confidence interval [CI]: 9.1 to 16.5) more points of physical independence on a 78-point scale and gained 1.5 (95% CI: 0.8 to 2.2) more points of cognitive independence on a 30-point scale. The likelihoods of discharge to home from the hospital (odds ratio [OR] = 1.61, 95% CI: 1.07 to 2.44) and 1-yr posthospital discharge survival (OR = 1.79, 95% CI: 1.25 to 2.56) were significantly higher among those who received comprehensive rehabilitation. Among patients hospitalized for acute stroke, comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1-yr survival.
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Levy C, Kheirbek R, Alemi F, Wojtusiak J, Sutton B, Williams AR, Williams A. Predictors of six-month mortality among nursing home residents: diagnoses may be more predictive than functional disability. J Palliat Med 2014; 18:100-6. [PMID: 25380219 DOI: 10.1089/jpm.2014.0130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Loss of daily living functions can be a marker for end of life and possible hospice eligibility. Unfortunately, data on patient's functional abilities is not available in all settings. In this study we compare predictive accuracy of two indices designed to predict 6-month mortality among nursing home residents. One is based on traditional measures of functional deterioration and the other on patients' diagnoses and demography. METHODS We created the Hospice ELigibility Prediction (HELP) Index by examining mortality of 140,699 Veterans Administration (VA) nursing home residents. For these nursing home residents, the available data on history of hospital admissions were divided into training (112,897 cases) and validation (27,832 cases) sets. The training data were used to estimate the parameters of the HELP Index based on (1) diagnoses, (2) age on admission, and (3) number of diagnoses at admission. The validation data were used to assess the accuracy of predictions of the HELP Index. The cross-validated accuracy of the HELP Index was compared with the Barthel Index (BI) of functional ability obtained from 296,052 VA nursing home residents. A receiver operating characteristic curve was used to examine sensitivity and specificity of the predicted odds of mortality. RESULTS The area under the curve (AUC) for the HELP Index was 0.838. This was significantly (α <0.01) higher than the AUC for the BI of 0.692. CONCLUSIONS For nursing home residents, comorbid diagnoses predict 6-month mortality more accurately than functional status. The HELP Index can be used to estimate 6-month mortality from hospital data and can guide prognostic discussions prior to and following nursing home admission.
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Affiliation(s)
- Cari Levy
- 1 Denver Veteran Administration Medical Center , Denver, Colorado
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Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009. J Am Acad Dermatol 2014; 71:92-9. [PMID: 24704091 DOI: 10.1016/j.jaad.2014.02.030] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering disease that is associated with increased mortality. OBJECTIVE We sought to determine the incidence and mortality of patients with BP. METHODS A total of 87 residents of Olmsted County, Minnesota, were identified who had their first lifetime diagnosis of BP from January 1960 through December 2009. Incidence and mortality were compared with age- and sex-matched control patients from the same geographic area. RESULTS The adjusted incidence of BP was 2.4 per 100,000 person-years (95% confidence interval, 1.9-2.9). Incidence of BP increased significantly with age (P < .001) and over time (P = .034). Trend tests indicate increased diagnosis of localized disease (P = .006) may be a contributing factor. Survival observed in the incident BP cohort was significantly poorer than expected (P < .001). Survival was not different among patients with multisite versus localized disease (P = .90). LIMITATIONS Retrospective study design and study population from a small geographic area are limitations. CONCLUSION Incidence of BP in the United States is comparable with that found in Europe and Asia. The mortality of BP is lower in the United States than Europe, but higher than previous estimates.
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Rueda-Lara M, Lopez-Patton MR. Psychiatric and psychosocial challenges in patients undergoing haematopoietic stem cell transplants. Int Rev Psychiatry 2014; 26:74-86. [PMID: 24716502 DOI: 10.3109/09540261.2013.866075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Haematological malignancies are often treated with haematopoietic stem cell transplants (HSCT). The disease and its treatment are challenging and life threatening, as they not only affect the recipients, but also their families. This review highlights the available data on the psychological, psychiatric and social impact of these illnesses and their treatment on recipients and families. There are robust data that correlate HSCT with emotional distress, as emotional and physical functioning significantly affect quality of life. Psychiatric co-morbidity including anxiety, depression, adjustment and post-traumatic stress disorder, delirium and cognitive deficits have been reported at different stages in the transplant process. This review will highlight the psychosocial and clinical research findings relevant to HSCT patients and will summarize recommendations for future psychosocial research in this population.
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Affiliation(s)
- Maria Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center , Miami, Florida , USA
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Youngwerth J, Min SJ, Statland B, Allyn R, Fischer S. Caring about prognosis: a validation study of the caring criteria to identify hospitalized patients at high risk for death at 1 year. J Hosp Med 2013; 8:696-701. [PMID: 24227748 DOI: 10.1002/jhm.2107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Identifying patients, at the time of hospital admission, who are at high risk for 1-year mortality is an ideal opportunity to introduce palliative interventions into the hospital care plan. The CARING (C = primary diagnosis of cancer, A = ≥ 2 admissions to the hospital for a chronic illness within the last year; R = resident in a nursing home; I = intensive care unit admission with multiorgan failure, NG = noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines] criteria is a practical prognostic index developed and validated in the Veteran's Administration hospital setting that identifies patients at high risk of death within 1 year, although its effectiveness in a broader patient population is unknown. OBJECTIVE To validate the CARING criteria in a university and safety-net hospital setting. DESIGN Retrospective observational cohort study. SETTING Inpatient. PATIENTS Adults admitted to medical and surgical inpatient services during the study period of July 2005 through August 2005. MEASUREMENTS Mortality at 1 year following the index hospitalization was the primary end point. The CARING criteria were abstracted from the chart using only medical data available at time of admission. RESULTS At total of 1064 patients were admitted during the study period. Primary diagnosis of cancer (odds ratio [OR) = 7.23 [4.45-11.75]), intensive care unit admission with multiple organ failure (OR = 6.97 [2.75-17.68]), >2 noncancer hospice guidelines (OR = 15.55 [7.28-33.23]), and age (OR = 1.60 [1.32-1.93]) were predictive of 1-year mortality (C statistic = 0.79). One-year survival was significantly lower for those who met ≥ 1 of the CARING criteria. CONCLUSIONS The CARING criteria are a practical prognostic tool validated in a broad inpatient population that can be utilized on hospital admission to estimate risk of death in 1 year, with the goal of identifying patients who may benefit most from incorporating palliative interventions into their hospital plan of care. Journal of Hospital Medicine 2013;8:696-701. © 2013 Society of Hospital Medicine.
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Affiliation(s)
- Jeanie Youngwerth
- Hospital Medicine Group, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Bates BE, Xie D, Kwong PL, Kurichi JE, Ripley DC, Stineman MG. One-year all-cause mortality after stroke: a prediction model. PM R 2013; 6:473-83. [PMID: 24211696 DOI: 10.1016/j.pmrj.2013.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/30/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE By using data from Department of Veterans Affairs (VA) national databases, this article presents and internally validates a 1-year all-cause mortality prediction index after hospitalization for acute stroke. DESIGN An observational cohort. SETTING VA medical centers. PARTICIPANTS Veterans with a diagnosis of a new stroke who were discharged between October 1, 2006, and September 30, 2008. MAIN OUTCOME MEASURE Death due to any cause that occurred between the index hospital discharge date and the 1-year anniversary of that date. RESULTS Within 1-year after discharge, 1542 (12.3%) of the total 12,565 patients had died. Seventeen risk factors known at the point of hospital discharge remained in the predictive model of 1-year postdischarge mortality after backward selection, including advanced age, admission from extended care, type of stroke, 8 comorbid conditions, 4 types of procedures that occurred during the index hospitalization, hospital length of stay (longer than 3 weeks), and discharge location. We assigned a score to each variable in the final model and a risk score was determined for each patient by adding up the points for all risk factors present. According to these risk scores, the patients were divided into approximate quartiles that yielded low, moderate, high, and highest mortality likelihood strata. The risk of 1-year mortality ranged from 2.24% in the lowest quartile to 29.50% in the highest quartile in the derivation cohort and from 2.11%-30.77% in the validation cohort. Model discrimination demonstrated an area under the receiver operating characteristic curve of 0.785 in the derivation cohort and 0.787 in the validation cohort. The Hosmer-Lemeshow goodness of fit indicated that the model fit was adequate (P = .69). CONCLUSION When using readily available data, a simple index that stratifies stroke patients at hospital discharge according to low, moderate, high, and highest likelihood of all-cause 1-year mortality is feasible and can inform the postdischarge planning process, depending on level of risk.
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Affiliation(s)
- Barbara E Bates
- Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, VAMC (117), 113 Holland Avenue, Albany, NY 12208(∗).
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(†)
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(‡)
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(§)
| | - Diane Cowper Ripley
- Veterans Affairs Medical Center Gainesville, FL, Division of Health Policy and Outcomes Research, Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL(‖)
| | - Margaret G Stineman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA(¶)
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