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Minerva Urology and Nephrology Jun 2024The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa)...
The impact of venous thromboembolism before open or minimally-invasive radical cystectomy in the USA: insurance claims data on perioperative outcomes and healthcare costs.
BACKGROUND
The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).
METHODS
Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.
RESULTS
Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.
CONCLUSIONS
Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.
Topics: Humans; Cystectomy; Venous Thromboembolism; Male; Female; United States; Aged; Middle Aged; Postoperative Complications; Urinary Bladder Neoplasms; Health Care Costs; Minimally Invasive Surgical Procedures; Patient Readmission; Retrospective Studies; Preoperative Period
PubMed: 38920012
DOI: 10.23736/S2724-6051.24.05699-4 -
Canadian Oncology Nursing Journal =... 2022Characteristics, including age, educational level, economics, and geographical setting during care provision significantly affect quality of life (QoL) among cancer...
BACKGROUND
Characteristics, including age, educational level, economics, and geographical setting during care provision significantly affect quality of life (QoL) among cancer patient caregivers in high-income countries. Investigation in middle/low income countries is limited.
OBJECTIVE
To explore the factors associated with QoL among family caregivers (FCG's) of cancer patients in Kenya.
METHODOLOGY
This was a correlational study conducted at the largest teaching and referral hospital in Kenya. The study enrolled 164 family caregivers of cancer patients. The QoL (Family Version) was used to measure Quality of Life. Data collection was done using interviewer-administered questionnaires. A student t-test and Pearson chi-square were used to determine the association between personal, social, and disease characteristics and family caregiver quality of life.
RESULTS
The average mean score of family caregiver QoL was 55.8 (SD±10.12) percent, which is lower than in other countries.
CONCLUSION
There was a significant association between family caregiver quality of life (QoL) and level of education, relationship to the patient, caregivers' ability to carry out normal activities, and caregiver knowledge of the stage of cancer.
PubMed: 38919787
DOI: 10.5737/23688076324542 -
Frontiers in Psychiatry 2024The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups.
PURPOSE
The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups.
METHODS
Data were derived from a prospective multicenter cohort study conducted in primary care - the AgeCoDe/AgeQualiDe study. In total, 2,436 patients 75 years and older were followed from baseline to ninth follow-up. To assess depressive symptoms, the short version of the Geriatric Depression Scale (GDS-15, cutoff score 6) was used. Age-specific competing risk regressions were performed to analyze risk factors for incident depressive symptoms in different age groups (75 to 79, 80 to 84, 85+ years), taking into account the accumulated mortality.
RESULTS
The age-specific incidence rate of depression was 33 (95% CI 29-38), 46 (95% CI 40-52) and 63 (95% CI 45-87) per 1,000 person years for the initial age groups 75 to 79, 80 to 84 and 85+ years, respectively. In competing risk regression models, female sex, mobility as well as vision impairment, and subjective cognitive decline (SCD) were found to be risk factors for incident depression for age group 75 to 79, female sex, single/separated marital status, mobility as well as hearing impairment, and SCD for age group 80 to 84, and mobility impairment for age group 85+.
CONCLUSION
Depressive symptoms in latest life are common and the incidence increases with increasing age. Modifiable and differing risk factors across the highest age groups open up the possibility of specifically tailored prevention concepts.
PubMed: 38919640
DOI: 10.3389/fpsyt.2024.1367225 -
Frontiers in Endocrinology 2024The prevalence of diabetes has risen fast with a considerable weighted prevalence of undiagnosed diabetes or uncontrolled diabetes. Then it becomes more necessary to...
BACKGROUND
The prevalence of diabetes has risen fast with a considerable weighted prevalence of undiagnosed diabetes or uncontrolled diabetes. Then it becomes more necessary to timely screen out and monitor high-risk populations who are likely to be ignored during the COVID-19 pandemic. To classify and find the common risks of undiagnosed diabetes and uncontrolled diabetes, it's beneficial to put specific risk control measures into effect for comprehensive primary care. Especially, there is a need for accurate yet accessible prediction models.
OBJECTIVE
Based on a cross-sectional study and secondary analysis on the health examination held in Changchun City (2016), we aimed to evaluate the factors associated with hyperglycemia, analyze the management status of T2DM, and determine the best cutoff value of incidence of diabetes in the first-degree relatives to suggest the necessity of early diagnosis of diabetes after first screening.
RESULTS
A total of 5658 volunteers were analyzed. Prevalence of T2DM and impaired fasting glucose were 8.4% (n=477) and 11.5% (n=648), respectively. There were 925 participants (16.3%) with a family history of T2DM in their first-degree relatives. Multivariable analysis demonstrated that family history was associated with hyperglycemia. Among the 477 patients with T2DM, 40.9% had not been previously diagnosed. The predictive equation was calculated with the following logistic regression parameters with 0.71 (95% CI: 0.67-0.76) of the area under the ROC curve, 64.0% of sensitivity and 29% of specificity ( < 0.001): = \frac{1}{1 + e^{-z}}, where z = -3.08 + [0.89 (Family history-group) + 0.69 (age-group)+ 0.25 (BMI-group)]. Positive family history was associated with the diagnosis of T2DM, but not glucose level in the diagnosed patients. The best cutoff value of incidence of diabetes in the first-degree relatives was 9.55% ( < 0.001).
CONCLUSIONS
Family history of diabetes was independently associated with glucose dysfunction. Classification by the first-degree relatives with diabetes is prominent for targeting high-risk population. Meanwhile, positive family history of diabetes was associated with diabetes being diagnosed rather than the glycemic control in patients who had been diagnosed. It's necessary to emphasize the linkage between early diagnosis and positive family history for high proportions of undiagnosed T2DM.
Topics: Humans; Female; Male; China; Middle Aged; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Risk Factors; Adult; Prevalence; COVID-19; Blood Glucose; Family; Aged; Hyperglycemia; Incidence
PubMed: 38919473
DOI: 10.3389/fendo.2024.1385583 -
Iranian Journal of Public Health Mar 2024A significant share of medical care, primary health care, and health-related education and research in Iran is provided by the Ministry of Health and its affiliated...
BACKGROUND
A significant share of medical care, primary health care, and health-related education and research in Iran is provided by the Ministry of Health and its affiliated universities of medical sciences. We aimed to identify a set of key metrics for monitoring their efficiency in the four areas of medical care, primary health care, education and research.
METHODS
A combination of scoping review, expert panel and Delphi method was used. First, the relevant keywords were searched in the appropriate databases between 2000 and 2020. The final extracted indicators then reviewed, reduced and refined through the expert panel meetings. The last metrics were established following a three-stage Delphi study.
RESULTS
Out of 2327 studies, 155 were selected following the different screening stages of scoping review. After summarizing and refining the indicators via several expert panel meetings and the Delphi method, a total of 36 key indicators were considered appropriate for measuring efficiency of the health system, 23 of which were for the sub-systems of public health (4 indicators), medical services (10 indicators), education (4 indicators) and research (5 indicators) and 13 indicators for the whole system efficiency.
CONCLUSION
The set of indicators presented representing both the technical and allocative efficiency, might be a reliable basis for designing information systems and management dashboards for periodic monitoring of health system efficiency at national, regional and local levels.
PubMed: 38919299
DOI: 10.18502/ijph.v53i3.15152 -
International Journal of Public Health 2024
Topics: Humans; Refugees
PubMed: 38919278
DOI: 10.3389/ijph.2024.1607306 -
BMC Geriatrics Jun 2024Surgery in geriatric patients often poses risk of major postoperative complications. Acute kidney injury (AKI) is a common complication following noncardiac surgery and...
BACKGROUND
Surgery in geriatric patients often poses risk of major postoperative complications. Acute kidney injury (AKI) is a common complication following noncardiac surgery and is associated with increased mortality. Early identification of geriatric patients at high risk of AKI could facilitate preventive measures and improve patient prognosis. This study used machine learning methods to identify important features and predict AKI following noncardiac surgery in geriatric patients.
METHODS
The data for this study were obtained from a prospective cohort. Patients aged ≥ 65 years who received noncardiac surgery from June 2019 to December 2021 were enrolled. Data were split into training set (from June 2019 to March 2021) and internal validation set (from April 2021 to December 2021) by time. The least absolute shrinkage and selection operator (LASSO) regularization algorithm and the random forest recursive feature elimination algorithm (RF-RFE) were used to screen important predictors. Models were trained through extreme gradient boosting (XGBoost), random forest, and LASSO. The SHapley Additive exPlanations (SHAP) package was used to interpret the machine learning model.
RESULTS
The training set included 6753 geriatric patients. Of these, 250 (3.70%) patients developed AKI. The XGBoost model with RF-RFE selected features outperformed other models with an area under the precision-recall curve (AUPRC) of 0.505 (95% confidence interval [CI]: 0.369-0.626) and an area under the receiver operating characteristic curve (AUROC) of 0.806 (95%CI: 0.733-0.875). The model incorporated ten predictors, including operation site and hypertension. The internal validation set included 3808 geriatric patients, and 96 (2.52%) patients developed AKI. The model maintained good predictive performance with an AUPRC of 0.431 (95%CI: 0.331-0.524) and an AUROC of 0.845 (95%CI: 0.796-0.888) in the internal validation.
CONCLUSIONS
This study developed a simple machine learning model and a web calculator for predicting AKI following noncardiac surgery in geriatric patients. This model may be a valuable tool for guiding preventive measures and improving patient prognosis.
TRIAL REGISTRATION
The protocol of this study was approved by the Committee of Ethics from West China Hospital of Sichuan University (2019-473) with a waiver of informed consent and registered at www.chictr.org.cn (ChiCTR1900025160, 15/08/2019).
Topics: Humans; Acute Kidney Injury; Aged; Machine Learning; Female; Male; Prospective Studies; Postoperative Complications; Aged, 80 and over; Risk Assessment; Surgical Procedures, Operative; Risk Factors
PubMed: 38918723
DOI: 10.1186/s12877-024-05148-1 -
Nature Aging Jun 2024Adenoviral and mRNA vaccines encoding the viral spike (S) protein have been deployed globally to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)....
Adenoviral and mRNA vaccines encoding the viral spike (S) protein have been deployed globally to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older individuals are particularly vulnerable to severe infection, probably reflecting age-related changes in the immune system, which can also compromise vaccine efficacy. It is nonetheless unclear to what extent different vaccine platforms are impacted by immunosenescence. Here, we evaluated S protein-specific immune responses elicited by vaccination with two doses of BNT162b2 or ChAdOx1-S and subsequently boosted with a single dose of BNT162b2 or mRNA-1273, comparing age-stratified participants with no evidence of previous infection with SARS-CoV-2. We found that aging profoundly compromised S protein-specific IgG titers and further limited S protein-specific CD4 and CD8 T cell immunity as a probable function of progressive erosion of the naive lymphocyte pool in individuals vaccinated initially with BNT162b2. Our results demonstrate that primary vaccination with ChAdOx1-S and subsequent boosting with BNT162b2 or mRNA-1273 promotes sustained immunological memory in older adults and potentially confers optimal protection against coronavirus disease 2019.
PubMed: 38918602
DOI: 10.1038/s43587-024-00644-w -
Scientific Reports Jun 2024The precise delineation of urban aquatic features is of paramount importance in scrutinizing water resources, monitoring floods, and devising water management...
The precise delineation of urban aquatic features is of paramount importance in scrutinizing water resources, monitoring floods, and devising water management strategies. Addressing the challenge of indistinct boundaries and the erroneous classification of shadowed regions as water in high-resolution remote sensing imagery, we introduce WaterDeep, which is a novel deep learning framework inspired by the DeepLabV3 + architecture and an innovative fusion mechanism for high- and low-level features. This methodology first creates a comprehensive dataset of high-resolution remote sensing images, then progresses through the Xception baseline network for low-level feature extraction, and harnesses densely connected Atrous Spatial Pyramid Pooling (ASPP) modules to assimilate multi-scale data into sophisticated high-level features. Subsequently, the network decoder amalgamates the elemental and intricate features and applies dual-line interpolation to the amalgamated dataset to extract aqueous formations from the remote images. Experimental evidence substantiates that WaterDeep outperforms its existing deep learning counterparts, achieving a stellar overall accuracy of 99.284%, FWIoU of 95.58%, precision of 97.562%, recall of 95.486%, and F1 score of 96.513%. It also excels in the precise demarcation of edges and the discernment of shadows cast by urban infrastructure. The superior efficacy of the proposed method in differentiating water bodies in complex urban environments has significant practical applications in real-world contexts.
PubMed: 38918493
DOI: 10.1038/s41598-024-65430-5 -
The Journal of Maternal-fetal &... Dec 2024To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes.
OBJECTIVE
To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes.
METHODS
We performed a 2017-2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs.
RESULTS
A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance.
CONCLUSION
Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance.
Topics: Humans; Female; Pregnancy; Cost-Benefit Analysis; Diabetes, Gestational; Retrospective Studies; Adult; Gestational Age; Prenatal Diagnosis; Stillbirth; Prenatal Care
PubMed: 38918175
DOI: 10.1080/14767058.2024.2369209