1
|
Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
Collapse
Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
| |
Collapse
|
2
|
Paro MR, Ramanan S, McNeill IT, Bulsara KR. Predictive validity of the All Patients Refined Diagnosis Related Group modifiers for costs and outcomes from intracranial hemorrhage. J Neurosurg 2023; 139:1061-1069. [PMID: 37278739 DOI: 10.3171/2023.2.jns222255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The All Patients Refined Diagnosis Related Group (APR-DRG) modifiers-severity of illness (SOI) and risk of mortality (ROM)-inform hospital reimbursement nationally. The ubiquitous APR-DRG data bear the potential to inform public health research; however, the algorithms that generate these modifiers are proprietary and therefore should be independently verified. This study evaluated the predictive value of APR-DRG modifiers for the outcomes and costs of intracranial hemorrhage. METHODS The New York Statewide Planning and Research Cooperative System databases were accessed and searched for the intracranial hemorrhage Diagnosis Related Group in records from 2012 to 2020. Receiver operating characteristic and multiple logistic regressions characterized the predictive validity of the APR-DRG modifiers for patient outcomes. One-way ANOVA compared costs and charges between SOI and ROM designations. RESULTS Among 46,019 patients, 12,627 (27.4%) died. The mean ± SEM costs per patient were $21,342 ± $145 and the mean ± SEM charges per patient were $68,117 ± $408. For prediction of mortality, the area under the curve (AUC) was 0.74 for SOI and 0.83 for ROM. For prediction of discharge to a facility, AUC was 0.62 for SOI and 0.64 for ROM. Regression analysis showed that ROM was a strong predictor of mortality, while SOI was a weak predictor; both were modest predictors of discharge to a facility. SOI and ROM were significant predictors of costs and charges. CONCLUSIONS Compared with the prior studies, the authors identified several limitations of APR-DRG modifiers, including low specificity, modest AUC, and limited outcomes prediction. This report supports the limited use of APR-DRG modifiers in independent research on intracranial hemorrhage epidemiology and reimbursement and advocates for general caution in their use for evaluation of neurosurgical disease.
Collapse
Affiliation(s)
- Mitch R Paro
- 1UConn School of Medicine, Farmington, Connecticut; and
| | | | - Ian T McNeill
- 1UConn School of Medicine, Farmington, Connecticut; and
- 2Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut
| | - Ketan R Bulsara
- 1UConn School of Medicine, Farmington, Connecticut; and
- 2Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut
| |
Collapse
|
3
|
Zhou AX, Aczon MD, Laksana E, Ledbetter DR, Wetzel RC. Narrowing the gap: expected versus deployment performance. J Am Med Inform Assoc 2023; 30:1474-1485. [PMID: 37311708 PMCID: PMC10436142 DOI: 10.1093/jamia/ocad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Successful model development requires both an accurate a priori understanding of future performance and high performance on deployment. Optimistic estimations of model performance that are unrealized in real-world clinical settings can contribute to nonuse of predictive models. This study used 2 tasks, predicting ICU mortality and Bi-Level Positive Airway Pressure failure, to quantify: (1) how well internal test performances derived from different methods of partitioning data into development and test sets estimate future deployment performance of Recurrent Neural Network models and (2) the effects of including older data in the training set on models' performance. MATERIALS AND METHODS The cohort consisted of patients admitted between 2010 and 2020 to the Pediatric Intensive Care Unit of a large quaternary children's hospital. 2010-2018 data were partitioned into different development and test sets to measure internal test performance. Deployable models were trained on 2010-2018 data and assessed on 2019-2020 data, which was conceptualized to represent a real-world deployment scenario. Optimism, defined as the overestimation of the deployed performance by internal test performance, was measured. Performances of deployable models were also compared with each other to quantify the effect of including older data during training. RESULTS, DISCUSSION, AND CONCLUSION Longitudinal partitioning methods, where models are tested on newer data than the development set, yielded the least optimism. Including older years in the training dataset did not degrade deployable model performance. Using all available data for model development fully leveraged longitudinal partitioning by measuring year-to-year performance.
Collapse
Affiliation(s)
- Alice X Zhou
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Melissa D Aczon
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Eugene Laksana
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - David R Ledbetter
- Advanced Analytics for Healthcare, KPMG International Limited, Dallas, Texas, USA
| | - Randall C Wetzel
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
4
|
Alhasan KA, Shalaby MA, Temsah MH, Aljamaan F, Shagal R, AlFaadhel T, Alomi M, AlMatham K, AlHerbish AJ, Raina R, Sethi SK, Alsubaie S, Hakami MH, Alharbi NM, Shebeli RA, Nur HM, Kashari OF, Qari FA, Albanna AS, Kari JA. Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia. Healthcare (Basel) 2021; 9:1608. [PMID: 34946347 PMCID: PMC8701249 DOI: 10.3390/healthcare9121608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. METHODS This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. RESULTS In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). CONCLUSION In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.
Collapse
Affiliation(s)
- Khalid A Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Mohamed A Shalaby
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Reem Shagal
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Talal AlFaadhel
- Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mohammed Alomi
- Prince Mohammed bin Abdulaziz Hospital, King Salman Center for Kidney Diseases, Ministry of Health, Riyadh 14214, Saudi Arabia;
| | - Khalid AlMatham
- King Fahad Medical City, Ministry of Health, Riyadh 11525, Saudi Arabia;
| | - Adi J. AlHerbish
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Rupesh Raina
- Pediatrics Nephrology, Akron Children’s Hospital, Akron, OH 44241, USA;
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH 44241, USA
| | | | - Sarah Alsubaie
- Pediatrics Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (K.A.A.); (M.-H.T.); (R.S.); (A.J.A.); (S.A.)
| | - Marwah H Hakami
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Najla M Alharbi
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Razan A Shebeli
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Hanan Mohamed Nur
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Ohoud F Kashari
- Pediatric Department, East Jeddah General Hospital, Jeddah 636012, Saudi Arabia; (M.H.H.); (N.M.A.); (R.A.S.); (H.M.N.); (O.F.K.)
| | - Faiza A Qari
- Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia;
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| |
Collapse
|
5
|
Kuo WY, Hsu HS, Kung PT, Tsai WC. Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan. Int J Environ Res Public Health 2021; 18:12164. [PMID: 34831918 DOI: 10.3390/ijerph182212164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006-2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74-0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06-1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07-1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.
Collapse
|
6
|
Abstract
OBJECTIVES Develop, as a proof of concept, a recurrent neural network model using electronic medical records data capable of continuously assessing an individual child's risk of mortality throughout their ICU stay as a proxy measure of severity of illness. DESIGN Retrospective cohort study. SETTING PICU in a tertiary care academic children's hospital. PATIENTS/SUBJECTS Twelve thousand five hundred sixteen episodes (9,070 children) admitted to the PICU between January 2010 and February 2019, partitioned into training (50%), validation (25%), and test (25%) sets. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS On 2,475 test set episodes lasting greater than or equal to 24 hours in the PICU, the area under the receiver operating characteristic curve of the recurrent neural network's 12th hour predictions was 0.94 (CI, 0.93-0.95), higher than those of Pediatric Index of Mortality 2 (0.88; CI, [0.85-0.91]; p < 0.02), Pediatric Risk of Mortality III (12th hr) (0.89; CI, [0.86-0.92]; p < 0.05), and Pediatric Logistic Organ Dysfunction day 1 (0.85; [0.81-0.89]; p < 0.002). The recurrent neural network's discrimination increased with more acquired data and smaller lead time, achieving a 0.99 area under the receiver operating characteristic curve 24 hours prior to discharge. Despite not having diagnostic information, the recurrent neural network performed well across different primary diagnostic categories, generally achieving higher area under the receiver operating characteristic curve for these groups than the other three scores. On 692 test set episodes lasting greater than or equal to 5 days in the PICU, the recurrent neural network area under the receiver operating characteristic curves significantly outperformed their daily Pediatric Logistic Organ Dysfunction counterparts (p < 0.005). CONCLUSIONS The recurrent neural network model can process hundreds of input variables contained in a patient's electronic medical record and integrate them dynamically as measurements become available. Its high discrimination suggests the recurrent neural network's potential to provide an accurate, continuous, and real-time assessment of a child in the ICU.
Collapse
Affiliation(s)
- Melissa D Aczon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA
| | - David R Ledbetter
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA
| | - Eugene Laksana
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA
| | - Long V Ho
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA
| | - Randall C Wetzel
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, CA
| |
Collapse
|
7
|
Chen C, Peng H, Li M, Lu X, Huang M, Zeng Y, Dong G. Patients With Type 2 Diabetes Mellitus and Heart Failure Benefit More From Sodium-Glucose Cotransporter 2 Inhibitor: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:664533. [PMID: 34759887 PMCID: PMC8572881 DOI: 10.3389/fendo.2021.664533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/29/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) and heart failure (HF) are at higher risk of mortality and hospitalization for heart failure (HHF). A recent study showed that sodium-glucose cotransporter 2 (SGLT-2) inhibitors may be a promising choice. METHODS We searched the PubMed, Embase, and Cochrane databases of clinical trials for randomized controlled trials investigating the long-term effects of SGLT-2 inhibitors in patients with T2DM and HF compared with placebo. The primary outcome was cardiovascular death or HHF, and the secondary outcomes included cardiovascular death (CV death), HHF, and all-cause mortality. We also conducted an exploratory analysis and tried to identify the population, which will benefit more from the treatment. RESULTS After the study selection, a total of 5 trials, including 4 subgroup analyses, met the eligibility criteria. The results suggested that the use of SGLT-2 inhibitors was associated with a reduction in the incidence of CV death or HHF (HR, 0.69[95%CI, 0.63-0.77], P<0.00001), CV death (HR, 0.80[95%CI, 0.69-0.92], P = 0.001), HHF (HR, 0.67[95%CI, 0.60-0.76], P < 0.00001), and all-cause mortality (HR, 0.74[95%CI, 0.64-0.86], P < 0.0001). Moreover, patients with T2DM and HF may benefit more from the treatment than those with T2DM/HF. CONCLUSION The long-term use of SGLT-2 inhibitors can help reduce the risk of mortality and HHF in patients with T2DM and HF. SYSTEMATIC REVIEW REGISTRATION PROSPERO [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233156], identifier [CRD42021233156].
Collapse
Affiliation(s)
- Chengcong Chen
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Hong Peng
- Department of infectious disease, Shenzhen People’s Hospital, Shenzhen, China
| | - Mingzhu Li
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xiyan Lu
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Miao Huang
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yongmei Zeng
- Section of Gastroenterology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Guoqing Dong
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
- *Correspondence: Guoqing Dong,
| |
Collapse
|
8
|
Matas JL, Agana DFG, Germanos GJ, Hansen MA, Modak S, Tanner JP, Langlois PH, Salemi JL. Exploring classification of birth defects severity in national hospital discharge databases compared to an active surveillance program. Birth Defects Res 2019; 111:1343-1355. [PMID: 31222957 DOI: 10.1002/bdr2.1539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the extent to which the severity of birth defects could be differentiated using severity of illness (SOI) and risk of mortality (ROM) measures available in national discharge databases. METHODS Data from the 2012-14 National Inpatient Sample (NIS) was used to identify hospitalizations with one or more major birth defects reported annually to the National Birth Defects Prevention Network using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Each hospitalization also contained a 4-level SOI and 4-level ROM classification measure. For each birth defect and for each individual birth defect-related ICD-9-CM code, we calculated mean and median SOI and ROM, the proportion of hospitalizations in each level of SOI and ROM, the inpatient mortality rate, and level of agreement between various existing or derived severity proxies in the NIS and the Texas Birth Defects Registry (TBDR). RESULTS Mean SOI ranged from 1.5 (cleft lip alone) to 3.7 (single ventricle), and mean ROM ranged from 1.1 (cleft lip alone) to 3.9 (anencephaly). As a group, critical congenital heart defects had the highest average number of co-occurring defects, mean SOI, and ROM, whereas orofacial and genitourinary defects had the lowest SOI and ROM. We found strong levels of agreement between TBDR severity classifications and NIS severity classifications defined using Level 3 or 4 SOI or ROM Level 3 or 4. CONCLUSIONS This preliminary investigation demonstrated how severity indices of birth defects could be differentiated and compared to a severity algorithm of an existing surveillance program.
Collapse
Affiliation(s)
- Jennifer L Matas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Denny Fe G Agana
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - George J Germanos
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Sanjukta Modak
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jean Paul Tanner
- Birth Defects Surveillance Program, College of Public Health, University of South Florida, Tampa, Florida
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,Birth Defects Surveillance Program, College of Public Health, University of South Florida, Tampa, Florida
| |
Collapse
|
9
|
Cai W, Stewart R, Mueller C, Li YJ, Shen WD. Poststroke depression and risk of stroke recurrence and mortality: protocol of a meta-analysis and systematic review. BMJ Open 2018; 8:e026316. [PMID: 30559164 PMCID: PMC6303620 DOI: 10.1136/bmjopen-2018-026316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A number of observational studies have indicated that poststroke depression could increase the risk of stroke outcomes. There is a meta-analysis indicating that poststroke depression is a risk factor of all-cause mortality. This paper reports the protocol for a systematic review and meta-analysis to clarify the associations of poststroke depression with stroke recurrence and mortality in order to determine whether poststroke depression is a predictor of stroke outcomes according to data extracted from relevant observational studies. METHODS AND ANALYSIS MEDLINE, Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews will be used to conduct the search. Published studies written in English will be included. The risk of bias for the studies included in the systematic review or meta-analysis will be assessed by the Newcastle-Ottawa Quality Assessment Scale. HRs for stroke recurrence and mortality with 95% CIs will be included as primary outcomes. Subgroup analyses and meta-regression will be performed. ETHICS AND DISSEMINATION Ethics approval will not be needed because the data used in this systematic review will be extracted from published studies. The results of the systematic review focusing on whether depression after stroke is a predictor for stroke recurrence and mortality will be disseminated by publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018107944.
Collapse
Affiliation(s)
- Wa Cai
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Robert Stewart
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christoph Mueller
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Yi-Jing Li
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Dong Shen
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
10
|
Huang CC, Lee JD, Yang DC, Shih HI, Sun CY, Chang CM. Associations Between Geriatric Syndromes and Mortality in Community-Dwelling Elderly: Results of a National Longitudinal Study in Taiwan. J Am Med Dir Assoc 2016; 18:246-251. [PMID: 27838338 DOI: 10.1016/j.jamda.2016.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although geriatric syndromes have been studied extensively, their interactions with one another and their accumulated effects on life expectancy are less frequently discussed. This study examined whether geriatric syndromes and their cumulative effects are associated with risks of mortality in community-dwelling older adults. METHODS Data were collected from the Taiwan Longitudinal Study in Aging in 2003, and the participant survival status was followed until December 31, 2007. A total of 2744 participants aged ≥65 years were included in this retrospective cohort study; 634 died during follow-up. Demographic factors, comorbidities, health behaviors, and geriatric syndromes, including underweight, falls, functional impairment, depressive condition, and cognitive impairment, were assessed. Cox proportional hazard regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the probability of survival according to the cumulative number of geriatric syndromes. RESULTS The prevalence of geriatric syndromes increased with age. Mortality was significantly associated with age ≥75 years; male sex; ≤6 years of education; history of stroke, malignancy; smoking; not drinking alcohol; and not exercising regularly. Geriatric syndromes, such as underweight, functional disability, and depressive condition, contributed to the risk of mortality. The accumulative model of geriatric syndromes also predicted higher risks of mortality (N = 1, HR 1.50, 95% CI 1.19-1.89; N = 2, HR 1.69, 95% CI 1.25-2.29; N ≥ 3, HR 2.43, 95% CI 1.62-3.66). CONCLUSIONS Community-dwelling older adults who were male, illiterate, receiving institutional care, underweight, experiencing a depressive condition, functionally impaired, and engaging in poor health behavior were more likely to have a higher risk of mortality. The identification of geriatric syndromes might help to improve comprehensive care for community-dwelling older adults.
Collapse
Affiliation(s)
- Chi-Chang Huang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenq-Daw Lee
- Department of Economics, National Cheng Kung University, Tainan, Taiwan
| | - Deng-Chi Yang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-I Shih
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chien-Yao Sun
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chia-Ming Chang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
11
|
Cutilli T, Leocata P, Dolo V, Altobelli E. p53 as a prognostic marker associated with the risk of mortality for oral squamous cell carcinoma. Oncol Lett 2016; 12:1046-1050. [PMID: 27446392 DOI: 10.3892/ol.2016.4742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 04/22/2016] [Indexed: 11/05/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is often associated with a poor prognosis. The purpose of the present study was to investigate survival and the risk of mortality in OSCC with regard to stage, tumor site and p53 expression. A retrospective study was performed on 150 non-consecutive cases of OSCC that were observed between January 1992 and January 2012, and were selected from a total of 580 patients according to the criteria of the homogeneity of histopathological grading (G2). The medical records were reviewed for 48 cases with disease at stage I [37 males, age 64.7±5.7 years (mean age±standard deviation); 11 females, age 70.0±3.37 years]; 27 cases with stage II (15 males, age 64.5±5.6 years; 12 females, age 69.2±3.9 years); 58 cases with stage IVa (42 males, age 66.9±5.3 years; 16 females, age 64.2±6.5 years); and 17 cases with stage IVb (16 males, age 65.7±5.4 years; 1 female, age 69 years). Monoclonal p53 antibody (clone DO-7) was used to perform the p53 immunohistochemical study. A significant association was found between the site of the tumor and p53 overexpression (P<0.0001). Stage I-II cases showed a higher cumulative probability of a 24-month survival time than stage IVa-IVb cases (P<0.0001). Cheek, floor and soft palate tumors showed a worse prognosis (P<0.0001) and tumors with p53 overexpression >50% showed a poor survival rate (P<0.0001) compared with tumors of the attached gingiva, tongue and retromolar trigone. The findings allowed the quantification of the risk mortality from OSSC with regard to stage, tumor site and the p53 expression pattern of the tumor. Data supported the absolute indications for wide surgical margins (radical surgery) in cases of T1-T2 N0 tumors of the tongue, floor, retromolar trigone and attached gingiva when p53 overexpression is >50% in association with a higher risk of mortality compared with when p53 overexpression is <50%.
Collapse
Affiliation(s)
- Tommaso Cutilli
- Department of Life, Health and Environmental Sciences, Maxillofacial Surgery Unit, University of L'Aquila, I-67100 L'Aquila, Italy
| | - Pietro Leocata
- Department of Life, Health and Environmental Sciences, Pathological Anatomy Unit, University of L'Aquila, I-67100 L'Aquila, Italy
| | - Vincenza Dolo
- Department of Life, Health and Environmental Sciences, Clinical Pathology Unit, University of L'Aquila, I-67100 L'Aquila, Italy
| | - Emma Altobelli
- Department of Life, Health and Environmental Sciences, Medical Statistics and Epidemiology Unit, University of L'Aquila, I-67100 L'Aquila, Italy
| |
Collapse
|
12
|
|
13
|
Chen HF, Carlson E, Popoola T, Suzuki S. The Impact of Rurality on 30-Day Preventable Readmission, Illness Severity, and Risk of Mortality for Heart Failure Medicare Home Health Beneficiaries. J Rural Health 2015; 32:176-87. [PMID: 26348123 DOI: 10.1111/jrh.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions. METHODS We analyzed heart failure Medicare beneficiaries who received home health services for postacute care after hospital discharge in 2009. The study was a cross-sectional design with the unit of analysis as the home health episode for postacute care. Data sources included the following: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, and Area Health Resources File. The dependent variables were 30-day preventable readmission, and the extreme/major level of illness severity and of risk of mortality for a 30-day preventable readmission. The key independent variable was rurality defined as remote rural, adjacent rural, and micropolitan areas, with urban areas in the reference group. FINDINGS Home health beneficiaries in remote rural areas had 27% lower 30-day preventable readmission than those in urban areas. Home health beneficiaries in adjacent rural areas were 33% less likely to have high illness severity at readmission due to a preventable condition than those in urban areas. CONCLUSIONS Geographical location affects preventable readmission and illness severity of preventable readmission. Patients' geographic location along with patients' risk factors should be taken into consideration in the risk adjustment model for the financial incentive program that penalizes home health agencies with high preventable readmissions.
Collapse
Affiliation(s)
- Hsueh-Fen Chen
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Erin Carlson
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Taiye Popoola
- Department of Health Policy and Management, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| |
Collapse
|
14
|
Rosenbaum BP, Lorenz RR, Luther RB, Knowles-Ward L, Kelly DL, Weil RJ. Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index. Perspect Health Inf Manag 2014; 11:1c. [PMID: 25214820 PMCID: PMC4142511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.
Collapse
Affiliation(s)
- Benjamin P Rosenbaum
- Benjamin P. Rosenbaum, MD, is a neurosurgery resident at Cleveland Clinic in Cleveland, OH
| | - Robert R Lorenz
- Robert R. Lorenz, MD, MBA, FACS, is an otolaryngologist and medical director of payment reform, risk, and contracting at Cleveland Clinic in Cleveland, OH
| | - Ralph B Luther
- Ralph B. Luther, MBA, is a process improvement specialist at Cleveland Clinic in Cleveland, OH
| | - Lisa Knowles-Ward
- Lisa Knowles-Ward, RHIT, CCS, is director of coding and reimbursement at Cleveland Clinic in Cleveland, OH
| | - Dianne L Kelly
- Dianne L. Kelly, RN, is director of clinical documentation improvement at Cleveland Clinic in Cleveland, OH
| | - Robert J Weil
- Robert J. Weil, MD, MBA, FACS, is a neurosurgeon who previously worked at Cleveland Clinic in Cleveland, OH. He now works at Geisinger Health System in Danville, PA, as a neurosurgeon, chief medical executive for the northeast region, and associate chief scientific officer
| |
Collapse
|
15
|
Barocas DA, Kulahalli CS, Ehrenfeld JM, Kapu AN, Penson DF, You CC, Weavind L, Dmochowski R. Benchmarking the use of a rapid response team by surgical services at a tertiary care hospital. J Am Coll Surg 2013; 218:66-72. [PMID: 24275072 DOI: 10.1016/j.jamcollsurg.2013.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/19/2013] [Accepted: 09/18/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid response teams (RRT) are used to prevent adverse events in patients with acute clinical deterioration, and to save costs of unnecessary transfer in patients with lower-acuity problems. However, determining the optimal use of RRT services is challenging. One method of benchmarking performance is to determine whether a department's event rate is commensurate with its volume and acuity. STUDY DESIGN Using admissions between 2009 and 2011 to 18 distinct surgical services at a tertiary care center, we developed logistic regression models to predict RRT activation, accounting for days at-risk for RRT and patient acuity, using claims modifiers for risk of mortality (ROM) and severity of illness (SOI). The model was used to compute observed-to-expected (O/E) RRT use by service. RESULTS Of 45,651 admissions, 728 (1.6%, or 3.2 per 1,000 inpatient days) resulted in 1 or more RRT activations. Use varied widely across services (0.4% to 6.2% of admissions; 1.39 to 8.73 per 1,000 inpatient days, unadjusted). In the multivariable model, the greatest contributors to the likelihood of RRT were days at risk, SOI, and ROM. The O/E RRT use ranged from 0.32 to 2.82 across services, with 8 services having an observed value that was significantly higher or lower than predicted by the model. CONCLUSIONS We developed a tool for identifying outlying use of an important institutional medical resource. The O/E computation provides a starting point for further investigation into the reasons for variability among services, and a benchmark for quality and process improvement efforts in patient safety.
Collapse
Affiliation(s)
- Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN.
| | | | | | - April N Kapu
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN; Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Administration Health System, Nashville, TN
| | - Chaochen Chad You
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN
| | - Lisa Weavind
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN
| |
Collapse
|