Risk Factors Associated With Unplanned Acute Care in Outpatient Chemotherapy With Oral Anticancer Drugs as Monotherapy or Combination Therapy With Injectable Anticancer Drugs

2021 ◽  
Vol 41 (11) ◽  
pp. 5827-5834
Author(s):  
KENJI KAWASUMI ◽  
YOHEI KAWANO ◽  
AZUSA KUJIRAI ◽  
YASUNARI MANO ◽  
REIKO MATSUI ◽  
...  
Keyword(s):  
Risk Factors ◽  
Combination Therapy ◽  
Acute Care ◽  
Anticancer Drugs ◽  
Factors Associated ◽  
Outpatient Chemotherapy

Risk factors for ED visits and admissions during outpatient chemotherapy in head and neck cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 223-223
Author(s):  
Navika Shukla ◽  
Anirudh Saraswathula ◽  
Saad A. Khan ◽  
Vasu Divi
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Acute Care ◽  
Neck Cancer ◽  
Care Utilization ◽  
Factors Associated ◽  
Outpatient Chemotherapy ◽  
Acute Care Utilization ◽  
Ed Visits

223 Background: Despite the recent introduction of the CMS metric, OP-35, which tracks 30-day inpatient admissions and ED visits after outpatient chemotherapy administration, the risk factors driving acute care utilization (ACU) in the head and neck cancer treatment setting are not yet well understood. Further characterization of these risk factors could allow for improved care quality and reduce preventable inpatient and ED admissions. Methods: This was a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked cancer registry-claims database. The study cohort consisted of patients aged 66 years or older diagnosed with head and neck cancer between 2004-2015 who received outpatient chemotherapy within the first two years after diagnosis. Multivariable logistic regression modeling was utilized to characterize the risk factors associated with an inpatient or ED admission within 30 days after receiving chemotherapy. Results: Of the 2,236 eligible patients, 735 (32.9%) had at least one inpatient or ED admission within 30 days of receiving outpatient chemotherapy. On multivariable analysis, cancer of the oral cavity [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.04-1.96] and oropharynx/hypopharynx [OR 1.34; 95% CI 1.06-1.70] were associated with an increased odds of ACU. Other factors associated with ACU included NCI comorbidity index [OR 1.10; 95% CI 1.03-1.18], prior ACU [OR 1.06; 95% CI 1.02-1.09], second cycle of chemotherapy relative to the first cycle [OR 0.38, 95% CI 0.29-0.50], and third or greater cycle of chemotherapy [OR 0.17; 95% CI 0.13-0.21]. Certain chemotherapeutic agents also modified risk: use of an angiogenesis inhibitor [OR 0.18; 95% CI 0.06-0.45], alkylating agent [OR 1.24; 95% 1.01-1.53], plant alkaloid [OR 1.63; 95% CI 1.25-2.10], or antimetabolite [OR 2.69; 95% CI 1.78-4.09]. The most common admission diagnosis was pain (n = 243; 33.1%) followed by dehydration (n = 167; 22.7%). Conclusions: Multiple clinical variables modify risk of acute care utilization after outpatient chemotherapy in the head and neck cancer setting, providing several potential avenues of intervention for providers.

Two Sides to Every Fall: Patient and Nurse Perspectives

2020 ◽  
Vol 40 (6) ◽  
pp. 33-41
Author(s):  
Linda M. Hoke ◽  
Rachel T. Zekany
Keyword(s):  
Risk Factors ◽  
Content Analysis ◽  
Acute Care ◽  
Fall Prevention ◽  
Analysis Approach ◽  
Cardiac Care ◽  
Prevention Strategies ◽  
Factors Associated ◽  
Two Sides ◽  
Cardiac Care Unit

Background Despite vast evidence describing risk factors associated with falls and fall prevention strategies, falls continue to present challenges in acute care settings. Objective To describe and categorize patient and nurse perspectives on falls and nurses’ suggestions for preventing falls. Methods To improve transparency about the causes of falls, nurses interviewed patients in a 48-bed progressive cardiac care unit who had experienced a fall. A content analysis approach was used to examine responses to 3 open-ended items: why patients said they fell, why nurses said the patients fell, and nurses’ reflections on how each fall could have been prevented. Results Over a 2-year period, 67 falls occurred. Main themes regarding causes of falls were activity (41 falls, 61%), coordination (16 falls, 24%), and environment (10 falls, 15%). Patients said they fell because they slipped, had a medical issue, were dizzy, or had weak legs. Nurses said patients fell because they had a medical issue or did not call for assistance. Conclusions Nurses and patients agreed on the causes of assisted falls but disagreed on the causes of unassisted falls. Nurses frequently said that the use of a bed alarm could have prevented the fall.

641 Incidence and risk factors for stroke associated with immune checkpoint inhibitor therapy in cancer patients using real-world clinical data

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A677-A678
Author(s):  
Prantesh Jain ◽  
Jahir Gutierrez ◽  
Avirup Guha ◽  
Chhavi Jain ◽  
Nirav Patil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Malignant Melanoma ◽  
Combination Therapy ◽  
Cancer Patients ◽  
Real World ◽  
Cumulative Incidence ◽  
Claims Data ◽  
Cytotoxic Chemotherapy ◽  
University Hospitals ◽  
Factors Associated

BackgroundImmune checkpoint inhibitors (ICIs) can cause unique, high-grade immune-related adverse events. Although rare, ICI related stroke events can have high morbidity and mortality. Neurological monitoring is not routinely performed in patients on ICI treatment, thus risk factors remain unknown. Characterisation of such rare, but fatal adverse events requires integration of real-world data.MethodsU.S claims data (IBM MarketScan) of over 30 million commercially insured individuals was leveraged to identify 2,687,301 cancer patients between 2011–2018. Patients ≥18 years of age, treated with ICIs (targeting CTLA4 (ipilimumab) and/or the PD1 (nivolumab, pembrolizumab)/PDL1 (atezolizumab, avelumab, durvalumab) alone or in combination with ICI and/or chemotherapy were identified and followed until disenrollment. All strokes (ischemic or haemorrhagic), comorbidities, and treatment details were identified using diagnosis and billing codes. Patients from the ICI cohort were matched 1:1 to those in the chemotherapy cohort according to age, gender, NCI comorbidity score, and primary cancer as presented in the study design (figure 1). The matched cohorts were split by the specific type of chemotherapy (targeted or cytotoxic) used in the control patients. This yielded a total of 2,177 pairs of matched patients where the control arm received targeted chemotherapy, and 3,550 pairs of matched patients where the control arm received cytotoxic chemotherapy. Analyses included descriptive statistics and Cox proportional hazards regression.ResultsA total of 16,574 patients received at least one dose of ICI therapy for any advanced cancer. Overall 9,496 patients who were treated with ICI met the study eligibility criteria. Stroke was identified in 489 (5.14%) patients. Mean age (±standard deviation, SD) was 60 (±12), male 62%, mean (±SD) NCI comorbidity index 2.3 (±2.12), median time to stroke was 168 days. 51.3% patients received anti-PD1 monotherapy, 37.6% received anti-CTLA4, 3.3.% anti-PD-L1 and 7.8% received combination therapy (anti-PD1 plus anti-CTLA4). One-year cumulative incidence (CI) in the matched ICI vs. targeted and ICI vs. cytotoxic chemotherapy were 6.3% vs. 5.7% (p=0.07) and 4.95% vs. 4.08% (p=0.90) respectively (table 1). Within the ICI cohort, CI of stroke events with anti-CTLA4 monotherapy vs. anti-PD1/PD-L1 and anti-CTLA-4 plus anti-PD-1 combination vs. PD1/PD-L1 monotherapy were 9.89% vs. 4.54% and 6.69% vs. 3.73%, respectively (table 2). On multivariable regression analyses, patients with malignant melanoma, and those receiving anti-CTLA-4 monotherapy were associated with higher risk of stroke events, while the risk was lower in patients with head and neck cancer and those who received anti-PD-1 monotherapy (table 3 and 4).Abstract 641 Figure 1Study designAbstract 641 Table 1Cumulative Incidence of Stroke in ICI cohort vs. non-ICI cohortAbstract 641 Table 2Cumulative incidence of stroke across ICI typeAbstract 641 Table 3Risk factors associated with stroke events (Univariate analysis)Abstract 641 Table 4Risk factors associated with stroke events (Multivariate analysis)ConclusionsTo the best of our knowledge, this is the largest and comprehensive real-world longitudinal study for stroke events in advanced cancer patients treated with ICI. Cumulative incidence of stroke was significantly higher in patients on anti-CTLA-4 monotherapy and anti-CTLA-4 plus anti-PD-1 combination therapy in comparison to anti-PD-1/PD-L1 monotherapy. Malignant melanoma and anti CTLA-4 therapy were independent risk factors for stroke.AcknowledgementsThis work was funded by pilot award in Big Data/Cancer Informatics to Prantesh Jain, MD from University Hospitals Research & Education InstituteEthics ApprovalThe IBM MarketScan national database contains de-identified linked inpatient, outpatient, and pharmacy claims data. University Hospitals’ Institutional Review Board determined this study to be exempt from review and requirement of an informed consent.

scholarly journals Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals: Results of the third national survey

2019 ◽  
Vol 58 (2) ◽  
pp. 62-69 ◽  
Author(s):  
Irena Klavs ◽  
Mojca Serdt ◽  
Aleš Korošec ◽  
Tatjana Lejko Zupanc ◽  
Blaž Pečavar
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Prevention And Control ◽  
Acute Care Hospitals ◽  
Healthcare Associated Infections ◽  
Prevalence Survey ◽  
Factors Associated ◽  
The Third ◽  
Healthcare Associated ◽  
And Control

Abstract Introduction In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them. Methods Patients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. Results Among 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.1; 95% confidence intervals [CI]: 3.1–5.4), peripheral vascular catheter (aOR 3.0; 95% CI: 2.3–3.9), urinary catheter (aOR 1.8; 95% CI: 1.4–2.3). Conclusions The prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

Poster 254 Risk Factors Associated With Transfer From Inpatient Rehabilitation to Acute Care in the Burn Population

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S259-S259 ◽  
Author(s):  
Paul Gerrard ◽  
Margaret A. DiVita ◽  
Karen J. Kowalske ◽  
Paulette Niewczyk ◽  
Colleen M. Ryan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Factors Associated

Risk factors associated with substance use

2014 ◽  
Author(s):  
Ariel M. Barber ◽  
Alexandra Crouch ◽  
Stephen Campbell
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Factors Associated

A Six Year Prospective Study of Fibrinogen and Other Risk Factors Associated with Mortality in Stable Claudicants

1992 ◽  
Vol 68 (03) ◽  
pp. 261-263 ◽  
Author(s):  
A K Banerjee ◽  
J Pearson ◽  
E L Gilliland ◽  
D Goss ◽  
J D Lewis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intermittent Claudication ◽  
Fibrinogen Level ◽  
Past History ◽  
Fold Increase ◽  
Arterial Disease ◽  
Plasma Fibrinogen ◽  
Plasma Fibrinogen Level ◽  
Factors Associated ◽  
Probability Of Death

SummaryA total of 333 patients with stable intermittent claudication at recruitment were followed up for 6 years to determine risk factors associated with subsequent mortality. Cardiovascular diseases were the underlying cause of death in 78% of the 114 patients who died. The strongest independent predictor of death during the follow-up period was the plasma fibrinogen level, an increase of 1 g/l being associated with a nearly two-fold increase in the probability of death within the next 6 years. Age, low ankle/brachial pressure index and a past history of myocardial infarction also increased the probability of death during the study period. The plasma fibrinogen level is a valuable index of those patients with stable intermittent claudication at high risk of early mortality. The results also provide further evidence for the involvement of fibrinogen in the pathogenesis of arterial disease.

Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction

2013 ◽  
Author(s):  
Giovanni Corona ◽  
Giulia Rastrelli ◽  
Emmanuele Jannini ◽  
Linda Vignozzi ◽  
Edoardo Mannucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sexual Dysfunction ◽  
Factors Associated ◽  
Male Patients
Sign in / Sign up

Export Citation Format

Share Document