Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility (Preprint)

2018 ◽  
Author(s):  
Yanting Guo ◽  
Gang Zheng ◽  
Tianyun Fu ◽  
Shiying Hao ◽  
Chengyin Ye ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Information Exchange ◽  
Elderly Population ◽  
Validation Cohort ◽  
Health Information Exchange ◽  
Risk Group ◽  
Futile Treatment

BACKGROUND For many elderly patients, a disproportionate amount of health care resources and expenditures is spent during the last year of life, despite the discomfort and reduced quality of life associated with many aggressive medical approaches. However, few prognostic tools have focused on predicting all-cause 1-year mortality among elderly patients at a statewide level, an issue that has implications for improving quality of life while distributing scarce resources fairly. OBJECTIVE Using data from a statewide elderly population (aged ≥65 years), we sought to prospectively validate an algorithm to identify patients at risk for dying in the next year for the purpose of minimizing decision uncertainty, improving quality of life, and reducing futile treatment. METHODS Analysis was performed using electronic medical records from the Health Information Exchange in the state of Maine, which covered records of nearly 95% of the statewide population. The model was developed from 125,896 patients aged at least 65 years who were discharged from any care facility in the Health Information Exchange network from September 5, 2013, to September 4, 2015. Validation was conducted using 153,199 patients with same inclusion and exclusion criteria from September 5, 2014, to September 4, 2016. Patients were stratified into risk groups. The association between all-cause 1-year mortality and risk factors was screened by chi-squared test and manually reviewed by 2 clinicians. We calculated risk scores for individual patients using a gradient tree-based boost algorithm, which measured the probability of mortality within the next year based on the preceding 1-year clinical profile. RESULTS The development sample included 125,896 patients (72,572 women, 57.64%; mean 74.2 [SD 7.7] years). The final validation cohort included 153,199 patients (88,177 women, 57.56%; mean 74.3 [SD 7.8] years). The c-statistic for discrimination was 0.96 (95% CI 0.93-0.98) in the development group and 0.91 (95% CI 0.90-0.94) in the validation cohort. The mortality was 0.99% in the low-risk group, 16.75% in the intermediate-risk group, and 72.12% in the high-risk group. A total of 99 independent risk factors (n=99) for mortality were identified (reported as odds ratios; 95% CI). Age was on the top of list (1.41; 1.06-1.48); congestive heart failure (20.90; 15.41-28.08) and different tumor sites were also recognized as driving risk factors, such as cancer of the ovaries (14.42; 2.24-53.04), colon (14.07; 10.08-19.08), and stomach (13.64; 3.26-86.57). Disparities were also found in patients’ social determinants like respiratory hazard index (1.24; 0.92-1.40) and unemployment rate (1.18; 0.98-1.24). Among high-risk patients who expired in our dataset, cerebrovascular accident, amputation, and type 1 diabetes were the top 3 diseases in terms of average cost in the last year of life. CONCLUSIONS Our study prospectively validated an accurate 1-year risk prediction model and stratification for the elderly population (≥65 years) at risk of mortality with statewide electronic medical record datasets. It should be a valuable adjunct for helping patients to make better quality-of-life choices and alerting care givers to target high-risk elderly for appropriate care and discussions, thus cutting back on futile treatment.

How I Treat High-risk Multiple Myeloma

Blood ◽  
2021 ◽  
Author(s):  
Elena Zamagni ◽  
Simona Barbato ◽  
Michele Cavo
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
High Risk ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Specific Drug ◽  
Improve Quality

Survival of multiple myeloma (MM) has significantly improved over the last decade; however, a composed group of patients (15-20%), named high-risk (HR) MM, still experience reduced survival. Both tumor biology and suboptimal/absent responses to therapy may underlie HR definition and a clear uniform identification of risk factors is crucial for a proper management of these patients. In biologic-HRMM, MRD negativity attainment and sustain, inside and outside BM, should be the primary goal and therapy should be adapted in patients with frailty to reduce toxicity and improve quality of life. MM treatment has traditionally been tailored on age and more recently frailty or comorbidities, but very rarely on the biology of the disease, mainly because of the lack of a clear benefit derived from a specific drug/combination, inhomogeneity in HR definition and lack of data coming from prospective, properly designed clinical trials. Some attempts have been successfully made recently in this direction. In this review, we are discussing the current different definitions of HR and the need for a consensus, the results of available trials in HR patients and the way through risk-adapted treatment strategies. For this purpose, we are proposing several clinical cases of difficult-to-treat patients throughout different treatment phases.

scholarly journals Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

2018 ◽  
Vol 36 (34) ◽  
pp. 3361-3369 ◽  
Author(s):  
Anna L. Godfrey ◽  
Peter J. Campbell ◽  
Cathy MacLean ◽  
Georgina Buck ◽  
Julia Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Platelet Count ◽  
High Risk ◽  
Vascular Events ◽  
End Point ◽  
High Risk Factors ◽  
Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

scholarly journals Disorder, not just state of risk: Meta-analysis of functioning and quality of life in people at high risk of psychosis

2015 ◽  
Vol 207 (3) ◽  
pp. 198-206 ◽  
Author(s):  
Paolo Fusar-Poli ◽  
Matteo Rocchetti ◽  
Alberto Sardella ◽  
Alessia Avila ◽  
Martina Brandizzi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Psychotic Disorders ◽  
Risk Group ◽  
Clinical Syndrome ◽  
High Risk Group ◽  
Healthy Control Group ◽  
Control Group ◽  
Healthy Control

BackgroundThe nosology of the psychosis high-risk state is controversial. Traditionally conceived as an ‘at risk’ state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment.AimsTo investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.MethodThree meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).ResultsPeople at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.ConclusionsOur results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.

scholarly journals Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Huiqing Yao ◽  
Juhua Zhang ◽  
Yanmei Wang ◽  
Qingqing Wang ◽  
Fei Zhao ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Relative Risk ◽  
High Risk ◽  
Psychosocial Factors ◽  
Stroke Risk ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Stroke is a leading cause of mortality and disability worldwide. Most stroke risk studies focused on more established biological and pathophysiological risk factors such as hypertension and smoking, psychosocial factors such as quality of life are often under-investigated and thus less reported. The current study aims to estimate stroke risk and explore the impact of quality of life on stroke risk among a community sample of urban residents in Shanghai. Methods This cross-sectional study was conducted in Fengxian District of Shanghai City from December 2018 to April 2019. 4030 representative participants were recruited through a multistage, stratified, probability proportional to size sampling method and completed the study. Stroke risk was assessed using the Rapid Stroke Risk Screening Chart that included 8 risk factors for stroke. Quality of life was measured using the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Results One-third of residents were at risk for stroke, including 14.39% at high risk, and 18.68% at middle risk. The top three most commonly reported risk factors were physical inactivity (37.30%), hypertension (25.38%), and smoking (17.32%). Quality of life and its four domains were all independently and significantly associated with stroke risk. Multinominal logistic regressions showed that a one-unit increase in the quality of life was associated with a decreased relative risk for middle-risk relative to low-risk of stroke by a factor of 0.988 (95% CI:0.979, 0.997, P = 0.007), and a decreased relative risk for high-risk relative to low-risk of stroke by a factor of 0.975 (95% CI:0.966, 0.984, P < 0.001). Conclusions Our findings showed an alarmingly high prevalence of stroke risk among the sample, which may require future intervention programs to focus on improving both biological and behavioral risk factors such as increasing physical activity, early diagnosis and treatment of hypertension, and smoking cessation, as well as improving psychosocial factors such as quality of life.

scholarly journals Raising employment and quality of life among people with disadvantages – results of a Hungarian project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Noémi Meisznerné Kuklek ◽  
Máté Cséplő ◽  
Eszter Pozsonyi ◽  
Henriette Pusztafalvi
Keyword(s):  
Quality Of Life ◽  
Labor Market ◽  
High Risk ◽  
Risk Group ◽  
Critical Factor ◽  
High Risk Group ◽  
Job Seeking ◽  
Labor Market Programs

Abstract Background People with disadvantages are a high-risk group of unemployment or underemployment. Disadvantages include disability, under-education, or being a member of a minority, etc. Effective labor market programs could be a key in raising employment and quality of life among this high-risk group of society. The TOP 6.8.2.-15-NA1 project is one of the main Hungarian labor market programs. The project’s primary aims are increasing the employability of disadvantaged unemployed and supporting the efficiency of job-seeking. Methods Our goal was to analyze the effects and methodology of the TOP 6.8.2.-15-NA1 project in Hungary. The sample of our study contains participants of the project (n = 300), based in Zala County, Hungary. Results After 28 days, 53.3% of participants had a job. At the 180th day status, the rate of employed people was 47.3%. We could identify low-educated participants and older participants as higher-risk groups of long-term unemployment. Conclusions We emphasize the role of these services (job-seeking clubs, organization of job fairs, and mentorship) in the long-term individual success of participants. Improving the employment rate for people with disadvantages is a critical factor for enhancing the quality of life for individuals with disadvantages.

scholarly journals Influence of Preventive Tooth Extractions on Quality of Life in Patients with Antiresorptive Intake—A Prospective Longitudinal Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11650
Author(s):  
Thomas Rückschloß ◽  
Julius Moratin ◽  
Sven Zittel ◽  
Maximilian Pilz ◽  
Christoph Roser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Tooth Extraction ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Patient Specific ◽  
Antiresorptive Therapy ◽  
Tooth Extractions

Background: To find out whether preventive tooth extractions in patients on antiresorptive therapy have a direct impact on the patients’ overall quality of life (QoL); Methods: QoL using the five-level version of the EuroQol Group’s EQ-5D instrument (EQ-5D-5L) was longitudinally assessed in N = 114 prospectively enrolled patients with indication of preventive tooth extraction over a period of 12 months. Patients were stratified as high-risk (malignant disease with bone metastasis or multiple myeloma, with monthly high-dose antiresorptive therapy delivered intravenously [bisphosphonate] or subcutaneously [denosumab]) and low-risk/osteoporosis patients (weekly low-dose antiresorptive therapy administered orally [bisphosphonate] or half-yearly subcutaneously [denosumab]). The measurement time points were 4 weeks preoperatively (T0), 2 months (T1) and 1 year postoperatively (T2), respectively. Results: EQ-5D-5L index scores fell in a range from −0.21 to 1.00 in the low-risk group to 0.15 to 1.00 in the high-risk group. The t-test comparing the baseline index scores of both groups showed EQ-5D-5L index score in the low-risk group (0.708 ± 0.292) to be significantly smaller (p = 0.037) than in the high-risk group (0.807 ± 0.19). ANCOVA showed no significant differences in EQ-5D-5L index scores between the groups at T1 and T2. Conclusions: Preventive tooth extractions in patients undergoing antiresorptive treatment have no negative effect on QoL. Therefore, if indicated, preventive tooth extraction should not be omitted. Patient-oriented outcome measures are important to obtain a good risk–benefit balance for patient-specific treatment.

scholarly journals KUSTA DI PROVINSI LAMPUNG: STUDI EKOLOGI BERDASARKAN TREN WAKTU

2019 ◽  
Vol 18 (2) ◽  
pp. 88-98
Author(s):  
Nurhalina Sari ◽  
Eliza Eka Nurmala
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Data Analysis ◽  
Spatial Analysis ◽  
High Risk ◽  
Ecological Study ◽  
Secondary Data ◽  
Poor People ◽  
Study Designs

ABSTRACT  Leprosy is a disease that can cause pain and disability, which in the end can affect a person's quality of life. Through the 2013 Bangkok Declaration, Indonesia declared itself that 2020 was a leprosy-free country. However, until 2015, there were still reports of leprosy cases, including in Lampung Province. This study aims to analyze spatial leprosy and its risk factors to get priority areas for leprosy handling in Lampung Province. The study used ecological study designs. The sources of leprosy data and risk factors came from secondary data at the Central Statistics Agency and Health Office in Lampung for the year 2011 to 2015. Data analysis using spatial analysis. The analysis shows that leprosy cases are divided into two categories, namely paucibacillary and multibacillary. Spatial analysis results for 5 years indicate that leprosy cases are dominant in Central Lampung and East Lampung Districts. Based on population density, number of poor people, sanitation, nutritional status, and health facilities, several districts have a high risk of leprosy. The conclusion of this study is the priority in handling leprosy cases should be focused in the Central Lampung District and East Lampung District. Keywords: Leprosy, Lampung, spatial analysis, ecological study   ABSTRAK Kusta merupakan penyakit yang dapat menyebabkan kesakitan dan kecacatan,  yang pada akhirnya dapat mempengaruhi kualitas hidup seseorang. Melalui Deklarasi Bangkok 2013, Indonesia menyatakan bahwa tahun 2020 menjadi negara bebas kusta. Namun, hingga 2015 masih terdapat laporan kasus kusta, termasuk di Provinsi Lampung. Penelitian ini bertujuan menganalisis secara spasial  kusta dan faktor risikonya untuk mendapatkan prioritas penanganan kusta di Provinsi Lampung dengan desain studi ekologi. Sumber data kusta dan faktor risiko berasal dari data sekunder di Badan Pusat Statistik dan Dinas Kesehatan di Lampung 2011 sampai dengan 2015. Analisis data menggunakan analisis spasial. Hasil analisis menunjukkan bahwa kasus kusta terbagi dalam dua kategori yaitu pausibasiler (PB) dan multibasiler (MB).Hasil analisis spasial selama 5 tahun menunjukkan bahwa kasus kusta dominan di Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Berdasarkan kepadatan penduduk, jumlah orang miskin, sanitasi, status gizi, dan fasilitas kesehatan, beberapa kabupaten memiliki risiko tinggi terhadap kasus kusta. Kesimpulan penelitian ini adalah prioritas penanganan kasus kusta sebaiknya difokuskan di wilayah Kabupaten Lampung Tengah dan Kabupaten Lampung Timur. Kata kunci: Kusta, Lampung, analisis spasial, studi ekologi

scholarly journals Raising Employment and Mental Well-being Among People With Disadvantages – Results of a Hungarian Project

2021 ◽  
Author(s):  
Noemi Meisznerne Kuklek ◽  
Máté Cséplő ◽  
Eszter Pozsonyi ◽  
Henriette Pusztafalvi
Keyword(s):  
Quality Of Life ◽  
Labor Market ◽  
High Risk ◽  
Risk Group ◽  
Critical Factor ◽  
Well Being ◽  
High Risk Group ◽  
Labor Market Programs

Abstract Background: People with disadvantages are a high-risk group of unemployment or underemployment. Disadvantages include disability, under-education, being a single parent or a member of a minority, etc. Effective labor market programs could be a key in raising employment and quality of life among this high-risk group of the society. The TOP 6.8.2.-15-NA1 project is one of the main Hungarian labor market programs. Methods: The project’s primary aims are increasing the employability of disadvantaged unemployed and supporting the efficiency of job-seeking. The sample of our study contains participants of the project (n=300), based in Zala County, Hungary. Results: We could identify low educated participants and older participants as higher risk groups of long-term unemployment. Conclusions: We emphasize the role of these services in the long-term individual success of participants. Improving the employment rate for people with disadvantages is a critical factor for enhancing the quality of life for individuals with disadvantages.

Postsurgical Neuralgia

2018 ◽  
pp. 73-80
Author(s):  
John P. Kenny ◽  
Dalia Elmofty
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
High Risk ◽  
Healthcare Costs ◽  
Mechanism Of Injury ◽  
Profound Impact ◽  
Risk Patients ◽  
Collaborative Efforts ◽  
Preventative Approach

The development of post-surgical neuralgia (PSN) is multi-factorial and many questions still remain unanswered. PSN results from traumatic nerve injury during a surgical procedure. Little is known about the correlation between the mechanism of injury and the clinical presentation. PSN is often unrecogonized and misdiagnosed. It can be severely debilitating. The consequences of postsurgical neuralgia not only affect a patient’s quality of life, but also have a profound impact on healthcare costs. Identifying predisposing risk factors, utilizing a preventative approach, proper and timely detection, enhancing awareness amongst physicians and early pain management referral are imperative steps in the treatment of PSN. Surgeons and anesthesiologist have a crucial role in the prevention of PSN. Identifying high risk patients and high risk surgery types along with collaborative efforts to implement a multimodal perioperative analgesic plan is recommended.

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