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Risk adjustment

Ranmalee Eramudugolla, Jasmine Price, Sidhant Chopra, Xiaolan Li, Kaarin J Anstey
OBJECTIVES: To design a low-cost simulator-based driving assessment for older adults and to compare its validity with that of an on-road driving assessment and other measures of older driver risk. DESIGN: Cross-sectional observational study. SETTING: Canberra, Australia. PARTICIPANTS: Older adult drivers (N = 47; aged 65-88, mean age 75.2). MEASUREMENTS: Error rate on a simulated drive with environment and scoring procedure matched to those of an on-road test...
October 22, 2016: Journal of the American Geriatrics Society
Christel Häggström, Mieke Van Hemelrijck, Björn Zethelius, David Robinson, Birgitta Grundmark, Lars Holmberg, Soffia Gudbjörnsdottir, Hans Garmo, Pär Stattin
Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer, however, if this decrease is related to the use of anti-diabetic drugs is unknown. We prospectively studied men in the comparison cohort in the Prostate Cancer data Base Sweden (PCBaSe) 3.0, with data on T2DM, use of metformin, sulphonylurea, and insulin retrieved from national health care registers and demographic databases. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of prostate cancer, adjusted for confounders...
October 22, 2016: International Journal of Cancer. Journal International du Cancer
Joanne E Brady, Danielle K Liffmann, Anthony Yartel, Natalie Kil, Alex D Federman, Joseph Kannry, Cynthia Jordan, Omar I Massoud, David R Nerenz, Kimberly A Brown, Bryce D Smith, Claudia Vellozzi, David B Rein
BACKGROUND: From December 2012-March 2014, three randomized trials, each implementing a unique intervention in primary care settings (mail recruitment [repeated-mailing], an electronic health record best practice alert [BPA], and patient-solicitation [patient-solicitation]), evaluated HCV antibody testing, diagnosis, and costs for each of the interventions compared to standard-of-care testing. Multilevel multivariable models were used to estimate the adjusted risk ratio (aRR) for receiving an HCV antibody test, and costs were estimated using activity-based costing...
October 22, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
S Tatishvili, M Sinitsa, R Jorbendaze, G Kavtaradze
Severe infarction or its consequences are considered as triggering factors of incidental depression. The aim of our study was to reveal factors associated with depressive episode in patients hospitalized with acute coronary syndrome (acute myocardial infarction, unstable angina). The Beck Depression inventory (BDI) was used for assessment of depressive symptoms in patients with coronary disease in Emergency Cardiology Clinic Tbilisi, Georgia. The study sample included 84 patients. The clinical Information was collected from hospital recordings...
September 2016: Georgian Medical News
C V Ananth, J A Lavery, A M Friedman, R J Wapner, J D Wright
OBJECTIVE: We examined rates of serious maternal complications in relation to severe pre-eclampsia based on the delivering hospital's annualised volume. DESIGN: Retrospective cohort study. POPULATION AND SETTING: Singleton deliveries (n = 25 782 235) in 439 hospitals in the USA. METHODS: Annualised hospital volume was categorised as 25-500, 501-1000, 1001-2000 and >2000. MAIN OUTCOME MEASURES: Rates of in-hospital maternal death and serious maternal complications, including puerperal cerebrovascular disorders, pulmonary oedema, disseminated intravascular coagulation, acute renal, heart and liver failure, sepsis, haemorrhage and intubation in relation to severe pre-eclampsia...
October 21, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
U Waldenström, S Cnattingius, L Vixner, M Norman
OBJECTIVE: To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity. DESIGN: Population-based registry study. SETTING: Swedish Medical Birth Register. POPULATION: First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068). METHODS: Logistic regression analysis was used in each parity group to estimate risks of very and moderately preterm births to women at 20-24, 25-29, 30-34, 35-39, and 40 years or older, using 25-29 years as the reference group...
October 21, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Britton Trabert, Ronald C Eldridge, Ruth M Pfeiffer, Meredith S Shiels, Troy J Kemp, Chantal Guillemette, Patricia Hartge, Mark E Sherman, Louise A Brinton, Amanda Black, Anil K Chaturvedi, Allan Hildesheim, Sonja I Berndt, Mahboobeh Safaeian, Ligia Pinto, Nicolas Wentzensen
Inflammation is proposed to increase risk of developing endometrial cancer, but few prospective epidemiologic studies have investigated the relationship between circulating inflammation markers and endometrial cancer risk. In a nested case-control study within the PLCO Screening Trial we measured serum levels of 64 inflammation-related biomarkers in 284 incident endometrial cancer cases and 284 matched controls. Using multivariable logistic regression inflammation markers were evaluated individually and combined into a cross-validated inflammation score...
October 22, 2016: International Journal of Cancer. Journal International du Cancer
Andrew S Hwang, Steven J Atlas, Johan Hong, Jeffrey M Ashburner, Adrian H Zai, Richard W Grant, Clemens S Hong
BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network...
October 21, 2016: Journal of General Internal Medicine
Nils D Arvold, Matthew Cefalu, Yun Wang, Corwin Zigler, Deborah Schrag, Francesca Dominici
It is unknown whether the addition of temozolomide (TMZ) to radiotherapy (RT) is associated with improved overall survival (OS) among older glioblastoma patients. We performed a retrospective cohort SEER-Medicare analysis of 1652 patients aged ≥65 years with glioblastoma who received ≥10 fractions of RT from 2005 to 2009, or from 1995 to 1999 before TMZ was available. Three cohorts were assembled based on diagnosis year and treatment initiated within 60 days of diagnosis: (1) 2005-2009 and TMZ/RT, (2) 2005-2009 and RT only, or (3) 1995-1999 and RT only...
October 21, 2016: Journal of Neuro-oncology
Malin E M Mörner, Gustaf Edgren, Anna Martling, Ulf Gunnarsson, Monika Egenvall
PURPOSE: The hypothesis in this study was that anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent. METHODS: This is a Swedish single centre retrospective cohort study. Data on 496 consecutive radical abdominal resections stages I-III colorectal cancer performed at the Karolinska University Hospital 2007-2010 were extracted from the Swedish Colorectal Cancer Registry...
October 21, 2016: International Journal of Colorectal Disease
Marion I Boldingh, Angelina H Maniaol, Cathrine Brunborg, Harald Weedon-Fekjær, Jan J G M Verschuuren, Chantal M E Tallaksen
OBJECTIVE: To study the risk of clinical onset of myasthenia gravis (MG) in pregnancy and during the first 6 months postpartum because an association between pregnancy or the postpartum period and the onset of autoimmune MG is widely assumed but not proven. METHODS: The design was a cross-sectional population-based cohort study of 2 MG cohorts (Norway and the Netherlands) with 1,038 healthy controls from Norway. Data were obtained on 246 women with MG (age at onset 15-45 years)...
October 21, 2016: Neurology
Liya Lu, Chaoqiang Jiang, Danny F Mackay, Jill P Pell, Kar Keung Cheng, Tai Hing Lam, G Neil Thomas
OBJECTIVES: We studied the association between secondhand smoke (SHS) exposure and peripheral arterial disease (PAD) in Chinese non-smokers. METHODS: We conducted a cross-sectional study using baseline data from the Guangzhou Biobank Cohort Study: Cardiovascular Disease Sub-cohort Study (GBCS-CVD). Guangzhou residents aged ≥ 50 years were recruited between 2003 and 2008. Baseline data included measurement of ankle brachial pressure index (ABPI) and self-reported smoking status and SHS exposure...
October 20, 2016: Vascular
Elizabeth A Ellins, D Aled Rees, John E Deanfield, Andrew Steptoe, Julian P Halcox
Stress influences the risk of cardiovascular disease. Acute mental stress can induce both low-grade inflammation and endothelial dysfunction. The relationship between inflammatory responses to stress and future endothelial function is unexplored. Knowledge on the impact of other cardiovascular risk factors, such as dyslipidaemia, on such relationships is also limited We investigated the relationship between inflammatory responses to an acute mental stress challenge and endothelial function plus the influence of dyslipidaemia on the associations...
October 18, 2016: Brain, Behavior, and Immunity
Magnolia Cardona-Morrell, Amanda Chapman, Robin M Turner, Ebony Lewis, Blanca Gallego-Luxan, Michael Parr, Ken Hillman
AIM: To investigate associations between clinical parameters - beyond the evident physiological deterioration and limitations of medical treatment - with in-hospital death for patients receiving Rapid Response System (RRS) attendances. METHODS: Retrospective case-control analysis of clinical parameters for 328 patients aged 60 years and above at their last RRS call during admission to a single teaching hospital in the 2012-2013 calendar years. Generalised estimating equation modelling was used to compare the deceased with a randomly selected sample of those who had RRS calls and survived admission (controls), matched by age group, sex, and hospital ward...
October 18, 2016: Resuscitation
Robin Nance, Joseph Delaney, John W McEvoy, Michael J Blaha, Gregory Burke, Ana Navas-Acien, Joel D Kaufman, Elizabeth C Oelsner, Robyn L McClelland
OBJECTIVE: Smoking as an epidemiological exposure can be quantified in many ways including duration, intensity, pack-years, recency, and age at initiation. However it is not clear which of these are most important for cardiovascular disease (CVD), and how they should be modeled. STUDY DESIGN AND SETTING: Using the Multi-Ethnic Study of Atherosclerosis, Cox models for time to incident CVD adjusted for age, sex, race/ethnicity, education category, and income category were compared which included various characterizations of smoking history...
October 18, 2016: Journal of Clinical Epidemiology
Dario Cattaneo, Cristina Gervasoni, Valeria Cozzi, Simone Castoldi, Sara Baldelli, Emilio Clementi
Some studies have shown that adjustments to the linezolid dose guided by therapeutic drug monitoring (TDM) can reduce interindividual variability in drug exposure and improve linezolid tolerability. In this study, 6 years of linezolid TDM, a diagnostic service for our hospital and others in the Milan (Italy) area, is described. Samples were collected immediately before the morning dose intake (trough concentrations) in steady-state conditions. Linezolid concentrations were quantified by a validated high-performance liquid chromatography (HPLC) method...
October 12, 2016: International Journal of Antimicrobial Agents
Henry A Pitt, Amy J Goldberg, Abhijit S Pathak, Jonathan A Shinefeld, Sally M Hinkle, Selwyn O Rogers, Verdi J DiSesa, Larry R Kaiser
BACKGROUND: Survival of surgical inpatients is a key quality metric. Patient, surgeon, and system factors all contribute to inpatient mortality, and sophisticated risk adjustment is required to assess outcomes. When the mortality of general surgery patients was determined to be high at a safety-net hospital, a comprehensive approach was undertaken to improve patient survival. METHODS: General surgical service line mortality was measured in the database of the University HealthSystem Consortium from January 2013 through June 2015...
October 18, 2016: Surgery
Silvana B Sandbakk, Javaid Nauman, Nina Zisko, Øyvind Sandbakk, Nils Petter Aspvik, Dorthe Stensvold, Ulrik Wisløff
OBJECTIVE: To determine whether meeting physical activity (PA) recommendations and/or having high age-specific cardiorespiratory fitness (CRF) attenuate the adverse effect of prolonged sedentary time on cardiovascular risk factor (CV-RF) clustering in older adults. PATIENTS AND METHODS: We conducted a cross-sectional study of Norwegian women (495) and men (379) aged 70 to 77 years from August 22, 2012, through June 30, 2013. Sedentary time and PA were assessed by accelerometers and CRF by directly measured peak oxygen uptake (VO2peak)...
October 8, 2016: Mayo Clinic Proceedings
Omar Mahmoud, Lara Hathout, Sherif G Shaaban, Mohamed A Elshaikh, Sushil Beriwal, William Small
PURPOSE: The Gynecologic Oncology group (GOG) 0263 trial is currently exploring whether adding chemotherapy to adjuvant radiotherapy improves recurrence-free and/or overall survival in stage IB-IIA cervical cancer patients with pathologic intermediate-risk factors. Using the National Cancer Data Base, we evaluated the benefit of adjuvant chemoradiotherapy over adjuvant radiotherapy alone in the community practice setting. MATERIALS: The analysis included 869 stage IB-IIA cervical cancer patients who underwent radical hysterectomy retrieving intermediate-risk factors justifying adjuvant therapy...
October 18, 2016: Gynecologic Oncology
Hidehiro Kaneko, Michael Neuss, Jens Weissenborn, Christian Butter
Functional mitral regurgitation (MR) is common in patients with heart failure and left ventricular (LV) dysfunction. MitraClip (MC) is a novel therapeutic option for patients with high-risk MR. Similar to LV dysfunction, right ventricular dysfunction (RVD) is an important predictor of patients with heart failure. We aimed to clarify the effect of RVD on outcomes of functional MR and LV dysfunction after MC implantation. We examined 117 patients with severe functional MR and reduced LV ejection fraction (≤40%) treated with MC...
August 30, 2016: American Journal of Cardiology
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