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Löffeler S, Bertilsson H, Müller C, Aas K, Haugnes HS, Aksnessæther B, Pesonen M, Thon K, Tandstad T, Murtola T, Poulsen MH, Nordstrøm T, Vigmostad MN, Ottosson F, Holmsten K, Christiansen O, Slaaen M, Haug ES, Storås AH, Asphaug L, Rannikko A, Brasso K. Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥75 years with non-metastatic high-risk prostate cancer (SPCG 19/GRand-P). BJU Int 2024; 133:680-689. [PMID: 38469686 DOI: 10.1111/bju.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Older men (aged ≥75 years) with high risk, non-metastatic prostate cancer (PCa) are increasingly treated with curative therapy (surgery or radiotherapy). However, it is unclear if curative therapy prolongs life and improves health-related quality of life (HRQoL) in this age group compared to conservative therapy, which has evolved considerably during the last decade. STUDY DESIGN The Scandinavian Prostate Cancer Group (SPCG) 19/Norwegian Get-Randomized Research Group-Prostate (GRand-P) is a randomised, two-armed, controlled, multicentre, phase III trial carried out at study centres in Norway, Denmark, Finland, and Sweden. ENDPOINTS The primary endpoints are overall survival and HRQoL (burden of disease scale, European Organisation for the Research and Treatment of Cancer [EORTC] Elderly Cancer patients). Secondary endpoints are PCa-specific survival, metastasis-free survival, role-functioning scale (EORTC quality of life questionnaire 30-item core), urinary irritative/obstructive scale (26-item Expanded Prostate Cancer Index Composite [EPIC-26]), bowel scale (EPIC-26), intervention-free survival, PCa morbidity, use of secondary and tertiary systemic therapies, mean quality-adjusted life-years (QALYs), and mean total healthcare costs. PATIENTS AND METHODS A total of 980 men (aged ≥75 years) with non-metastatic, high-risk PCa will initially be screened with Geriatric 8 (G8) health status screening tool and Mini-COG© brief cognitive test. Participants identified by G8 as 'fit' or 'frail' will be randomised (ratio 1:1) to either immediate curative therapy (radiotherapy or prostatectomy) or conservative therapy (endocrine therapy or observation). Participants who are unable or unwilling to participate in randomisation will be enrolled in a separate observation group. Randomised patients will be followed for 10 years. TRIAL REGISTRATION Ethics approval has been granted in Norway (457593), Denmark (H-22051998), Finland (R23043) and Sweden (Dnr 2023-05296-01). The trial is registered on Clinicaltrials.org (NCT05448547).
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Affiliation(s)
- Sven Löffeler
- Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Helena Bertilsson
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Urology, St. Olav's University Hospital, Trondheim, Norway
| | - Christoph Müller
- Department of Oncology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Kirsti Aas
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Arctic University of Norway (UIT), Tromsø, Norway
| | | | - Maiju Pesonen
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kristian Thon
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Oncology, The Cancer Clinic, St Olav's University Hospital, Trondheim, Norway
| | - Teemu Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tobias Nordstrøm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Karin Holmsten
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Capio St. Göran Hospital, Stockholm, Sweden
| | | | - Marit Slaaen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | | | | | - Lars Asphaug
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Clinical Trials Unit, Oslo University Hospital, Oslo, Norway
| | - Antti Rannikko
- Department of Urology and Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Owodunni OP, Biala E, Sirisegaram L, Bettick D, Gearhart SL, Ehrlich AL. Validation of the Self-Reported Edmonton Frail Scale - Acute Care in Patients ≥ 65 Years Undergoing Surgery. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2024; 35:100383. [PMID: 38774884 PMCID: PMC11105164 DOI: 10.1016/j.pcorm.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Frailty is common in geriatric emergency surgery and associated with increased risk for poor postoperative outcomes. Frailty screening is challenging in emergency settings. The Edmonton Frail Scale (EFS) is a valid tool to screen for patients at high risk for poor postoperative outcomes. Recently, the EFS was modified to decrease dependence on staff to perform physical measures. This modification, the EFS-Acute Care (EFS-AC), has not been validated. We wish to assess the agreement between the EFS and the EFS-AC. STUDY DESIGN We performed a prospective cohort study from 10/2021 - 10/2022 screening 688 patients ≥ 65 years with both the EFS and EFS-AC preoperatively. We assessed the ability of the EFS-AC to discriminate frailty identified by the EFS and compared the association of both scales with loss of independence (LOI), hospital length of stay (LOS), ICU admissions, and ICU LOS. Receiver Operator Curves were used to estimate the discriminatory thresholds for LOI. RESULTS 688 patients with a median age 73 (IQR 68, 77) were enrolled. The EFS-AC was able to discriminate individuals' frailty status by the EFS with excellent agreement (AUC 0.971 [0.958, 0.983]). An EFS-AC threshold score of ≥ 6 points lead to 93.60% of individuals being correctly identified (77.87% sensitivity and 97.00% specificity). Both EFS and EFS-AC ≥ 6 were similarly associated with a higher risk for all clinical outcomes assessed and demonstrated similar ability to predict LOI. CONCLUSIONS The EFS-AC is a valid preoperative frailty screen, and due to its self-reported nature, can be administered in the acute care setting, during virtual visits, or through digital health apps. Real-time screening can assist with better understanding patient needs and lead to interventions to prevent poor hospital outcomes.
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Affiliation(s)
- Oluwafemi P Owodunni
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
- University of New Mexico School of Medicine, Emergency Medicine Albuquerque, NM, US
| | - Eduardo Biala
- Johns Hopkins University School of Medicine, Department of Medicine Division of Geriatric Medicine and Gerontology, Baltimore, MD
- University of Hawai'i at Mānoa John A Burns School of Medicine Honolulu, HI, US
| | - Luxey Sirisegaram
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- University of Toronto Temerty Faculty of Medicine, Department of Geriatric Medicine Toronto, ON, CA
| | - Dianne Bettick
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Susan L Gearhart
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - April L Ehrlich
- Johns Hopkins University School of Medicine, Department of Medicine Division of Geriatric Medicine and Gerontology, Baltimore, MD
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Feyzioğlu Ö, Dinçer S, Özdemir AE, Öztürk Ö. Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer. Disabil Rehabil 2024:1-8. [PMID: 38613370 DOI: 10.1080/09638288.2024.2340703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. METHODS This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. RESULTS All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. CONCLUSIONS The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.
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Affiliation(s)
- Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ayşem Ecem Özdemir
- Department of Physiotherapy and Rehabilitation, Gelisim University, Faculty of Health Sciences, Istanbul, Turkey
| | - Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
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Xu RH, Sun R, Tian L, Cheung AWL, Wong EL. Health-related quality of life in primary care patients: a comparison between EQ-5D-5L utility score and EQ-visual analogue scale. Health Qual Life Outcomes 2024; 22:2. [PMID: 38172916 PMCID: PMC10765691 DOI: 10.1186/s12955-023-02215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The EQ-VAS is an important component of the EQ-5D questionnaire. However, there is limited evidence comparing its performance to the EQ-5D utility score, which restricts its use in the population. This study aimed to EQ-5D-5L utility score and EQ-visual analogue scale (EQ-VAS) in primary care patients in Hong Kong (HK). METHODS Secondary data analysis was performed on the data collected from a cross-sectional survey to investigate patient engagement in HK. Participants were recruited through random sampling from a single general outpatient clinic. Trained investigators conducted face-to-face interviews with all eligible patients attending the clinic. Patients who were: 1) ≥ 18 years old, 2) have visited the clinic at least once in the last 6 months, 3) no cognitive problems, and 4) can speak and understand the local language. Pearson correlation was used to explore the association between EQ-5D utility and EQ-VAS score. Ordinary least squares regression and heteroscedastic Tobit regression models were adopted to analyze the EQ-VAS and EQ-5D utility data, respectively. RESULTS The analysis included data from 1,004 responses (response rate = 65%). Around 52.7% of participants were female, 25.9% completed tertiary or above education, and 75.1% living with chronic disease. The mean EQ-5D utility and EQ-VAS score were 0.92 (SD = 0.13) and 72.27 (SD = 14.69), respectively. A significant association was found between EQ-5D utility and EQ-VAS score, with coefficients ranging from 0.335 (participants who divorced) to 0.744 (participants living alone). Around 98.5% reported having no problems with 'Self-care', followed by 'Usual activities' (96.3%), 'Mobility' (91.5%) and 'Anxiety/depression' (79.9%). The correlation between EQ-VAS score and EQ-5D utility was positive for each dimension of the EQ-5D instrument (correlation coefficients ranged between 0.211 and 0.623). Age strongly influenced the magnitude and trajectory of EQ-VAS score and utility, as observed in the changes. The regression model showed that 'Mobility', 'Pain/discomfort', and 'Anxiety/depression' have considerable influence on EQ-VAS score. CONCLUSIONS This study compared the EQ-5D utility score and EQ-VAS in HK primary care setting. Although heterogeneity existed, the EQ-VAS and utility score are significantly correlated and reliable for evaluating health-related quality of life in this population.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.
| | - Ruiqi Sun
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Lidan Tian
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Annie Wai-Ling Cheung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza Laiyi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Thungathurthi K, Wei M, Othman B, Jain A, Girdlestone P, Chandra R. Outcomes in octogenarians following elective colorectal cancer surgery. J Gastrointest Oncol 2023; 14:1726-1734. [PMID: 37720453 PMCID: PMC10502545 DOI: 10.21037/jgo-22-1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/21/2023] [Indexed: 09/19/2023] Open
Abstract
Background Colorectal surgery in octogenarians is increasing in prevalence and good surgical outcomes have been demonstrated. However, functional status and independence remain the main patient consideration with limited data on the long-term functional outcomes. Methods A retrospective analysis was conducted for all patients aged above 80 undergoing surgery for colorectal cancer (CRC) from January 2018 to December 2019. Functional status assessment was made as part of pre- and post-operative allied health clinic appointments. Eastern Cooperative Oncology Group (ECOG) performance scores were recorded. Loss of independence (LOI) was defined as the reduced capacity to perform pre-morbid activities of daily living (ADL) and requiring increased supports. Results Forty-one patients aged 80 years or older had elective CRC resections with a median follow-up of 15 months [interquartile range (IQR): 8-20]. The median American Society of Anesthesiology (ASA) score was 3 and 90.2% (37/41) of patients had an ECOG score of 0 or 1. There was no 30-day mortality and 2 (4.9%) deaths occurred within 1 year. The median Clavien-Dindo score was 1, and 2 patients (4.9%) required unplanned intensive care unit (ICU) admissions. Twelve re-hospitalizations occurred with falls being the most common reason. LOI occurred in only 2 patients (4.9%) and on multivariate regression analysis, age and pre-morbid requirement of gait aids were predictive of LOI (P=0.042 and P=0.003, respectively). Gait aids were also associated with higher Clavien-Dindo scores (P=0.057) and increased length of stay (LOS) (P=0.009). Conclusions Patients with advanced age undergoing surgery for CRC surgery can still have good post-operative outcomes and adequate functional recovery with pre-operative optimization and appropriate post-operative supports.
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Affiliation(s)
- Kaushik Thungathurthi
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Matthew Wei
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Bushra Othman
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Anshini Jain
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Peter Girdlestone
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Raaj Chandra
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
- Colorectal Surgery, Division of General Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Senior Adjunct Lecturer, Monash University, Melbourne, VIC, Australia
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Liu X, Guo Y, Wang F, Yu Y, Yan Y, Wen H, Shi F, Wang Y, Wang X, Shen H, Li S, Gong Y, Ke S, Zhang W, Jin Q, Zhang G, Wu Y, Zhou M, Yu C. Disability weight measurement for the severity of different diseases in Wuhan, China. Popul Health Metr 2023; 21:5. [PMID: 37143047 PMCID: PMC10157574 DOI: 10.1186/s12963-023-00304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Measurement of the Chinese burden of disease with disability-adjusted life-years (DALYs) requires disability weight (DW) that quantify health losses for all non-fatal consequences of disease and injury. The Global Burden of Disease (GBD) 2013 DW study indicates that it is limited by lack of geographic variation in DW data and by the current measurement methodology. We aim to estimate DW for a set of health states from major diseases in the Wuhan population. METHODS We conducted the DW measurement study for 206 health states through a household survey with computer-assisted face-to-face interviews and a web-based survey. Based on GBD 2013 DW study, paired comparison (PC) and Population health equivalence (PHE) method was used and different PC/PHE questions were randomly assigned to each respondent. In statistical analysis, the PC data was analyzed by probit regression. The probit regression results will be anchored by results from the PHE data analyzed by interval regression on the DW scale units between 0 (no loss of health) and 1 (loss equivalent to death). RESULTS A total of 2610 and 3140 individuals were included in the household and web-based survey, respectively. The results from the total pooled data showed health state "mild anemia" (DW = 0.005, 95% UI 0.000-0.027) or "allergic rhinitis (hay fever)" (0.005, 95% UI 0.000-0.029) had the lowest DW and "heroin and other opioid dependence, severe" had the highest DW (0.699, 95% UI 0.579-0.827). A high correlation coefficient (Pearson's r = 0.876; P < 0.001) for DWs of same health states was observed between Wuhan's survey and GBD 2013 DW survey. Health states referred to mental symptom, fatigue, and the residual category of other physical symptoms were statistically significantly associated with a lower Wuhan's DWs than the GBD's DWs. Health states with disfigurement and substance use symptom had a higher DW in Wuhan population than the GBD 2013 study. CONCLUSIONS This set of DWs could be used to calculate local diseases burden for health policy-decision in Wuhan population. The DW differences between the GBD's survey and Wuhan's survey suggest that there might be some contextual or culture factors influencing assessment on the severity of diseases.
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Affiliation(s)
- Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
- Global Health Research Division, Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yafeng Wang
- Global Health Research Division, Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Xuyan Wang
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Hui Shen
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Shiyang Li
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yanyun Gong
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Sisi Ke
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Wei Zhang
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Qiman Jin
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Gang Zhang
- Wuhan Centers for Disease Control and Prevention, Wuhan, 430024, Hubei, China
| | - Yu Wu
- Global Health Research Division, Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, 100050, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Pubic Health, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
- Global Health Institute, Wuhan University, Wuhan, 430072, Hubei, China.
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Lindvall E, Franzon K, Lundström E, Kilander L. The impact of stroke on the ability to live an independent life at old age: a community-based cohort study of Swedish men. BMC Geriatr 2023; 23:126. [PMID: 36879184 PMCID: PMC9990268 DOI: 10.1186/s12877-023-03817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Few studies with controls from the same cohort have investigated the impact of stroke on the ability to live an independent life at old age. We aimed to analyze how great an impact being a stroke survivor would have on cognition and disability. We also analyzed the predictive value of baseline cardiovascular risk factors. METHODS We included 1147 men, free from stroke, dementia, and disability, from the Uppsala Longitudinal Study of Adult Men, between 69-74 years of age. Follow-up data were collected between the ages of 85-89 years and were available for 481 of all 509 survivors. Data on stroke diagnosis were obtained through national registries. Dementia was diagnosed through a systematic review of medical charts and in accordance with the current diagnostic criteria. The primary outcome, preserved functions, was a composite outcome comprising four criteria: no dementia, independent in personal activities of daily living, ability to walk outside unassisted, and not living in an institution. RESULTS Among 481 survivors with outcome data, 64 (13%) suffered a stroke during the follow-up. Only 31% of stroke cases, compared to 72% of non-stroke cases (adjusted OR 0.20 [95% CI 0.11-0.37]), had preserved functions. The chance of being free of dementia was 60% lower in the stroke group, OR 0.40 [95% CI 0.22-0.72]. No cardiovascular risk factors were independently able to predict preserved functions among stroke cases. CONCLUSION Stroke has long lasting consequences for many aspects of disability at very high age.
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Affiliation(s)
- Elias Lindvall
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden.
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
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Fokas E, Glynne-Jones R, Fleischmann M, Piso P, Tselis N, Ghadimi M, Hofheinz RD, Rödel C. Radiotherapy dose escalation using endorectal brachytherapy in elderly and frail patients with rectal cancer unsuitable for surgery: Lessons from studies in fit patients and future perspectives. Cancer Treat Rev 2023; 112:102490. [PMID: 36463667 DOI: 10.1016/j.ctrv.2022.102490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Epidemiological data indicate that more than 50 % of patients with newly-diagnosed rectal cancer are older than 70 years, with rising numbers expected over the next decades. Treatment decision-making is challenging in elderly and frail patients with rectal cancer, whereas standardized treatment guidelines for this patient cohort are lacking. Elderly and frail rectal cancer patients are often considered by surgeons as unfit to undergo radical surgery as the risk of surgical complications and postoperative mortality rises with increasing age and comorbidity. Furthermore, these patients often receive no treatment at all, resulting in local and/or systemic disease progression with associated symptoms and impaired quality of life (QoL). Recent data from randomized trials in young fit patients with early stage rectal cancer indicate that RT dose escalation can be safely delivered using external beam (chemo)radiotherapy (EBRT) followed by endoluminal radiotherapeutic modalities, such as contact X-ray brachytherapy (CXB) or high-dose rate endorectal brachytherapy (HDR-BT). However, prospective studies testing this therapeutic concept in elderly and frail patients remain limited. Here, we review the current evidence in the epidemiology and the management of elderly and frail patients with rectal cancer. We summarize the potential of RT dose escalation to achieve long-term local control of the primary tumour, prevent disease-related morbidity, improve QoL and even organ preservation. Future perspectives and open questions will be discussed as well.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany.
| | - Robert Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK
| | - Maximillian Fleischmann
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brüder Hospital, 93049 Regensburg, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, University Heidelberg, Heidelberg, Germany
| | - Claus Rödel
- Department of Radiotherapy of Oncology, University of Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany, German Cancer Consortium (DKTK), Partner Site, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany
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Liu X, Wang F, Yu C, Zhou M, Yu Y, Qi J, Yin P, Yu S, Zhou Y, Lin L, Liu Y, Wang Q, Zhong W, Huang S, Li Y, Liu L, Liu Y, Ma F, Zhang Y, Tian Y, Yu Q, Zeng J, Pan J, Zhou M, Kang W, Zhou JY, Yu H, Liu Y, Li S, Yu H, Wang C, Xia T, Xi J, Ren X, Xing X, Cheng Q, Fei F, Wang D, Zhang S, He Y, Wen H, Liu Y, Shi F, Wang Y, Sun P, Bai J, Wang X, Shen H, Ma Y, Yang D, Mubarik S, Cao J, Meng R, Zhang Y, Guo Y, Yan Y, Zhang W, Ke S, Zhang R, Wang D, Zhang T, Nomura S, Hay SI, Salomon JA, Haagsma JA, Murray CJ, Vos T. Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100520. [PMID: 35910433 PMCID: PMC9335373 DOI: 10.1016/j.lanwpc.2022.100520] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. METHODS In 2020-2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). FINDINGS We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. INTERPRETATION The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. FUNDING This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].
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Affiliation(s)
- Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou 221004, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
- Global Health Institute, Wuhan University, Wuhan 430072, China
- Corresponding authors.
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
- Corresponding authors.
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Jinlei Qi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuchang Zhou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Lin Lin
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Yunning Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Qiqi Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenling Zhong
- Fujian Provincial Center for Disease Control and Prevention, No. 78 Jintai Road, Gulou District, Fuzhou City 350001, Fujian province, China
| | - Shaofen Huang
- Fujian Provincial Center for Disease Control and Prevention, No. 78 Jintai Road, Gulou District, Fuzhou City 350001, Fujian province, China
| | - Yanxia Li
- Liaoning Provincial Center for Disease Control and Prevention, No. 79 Jixian Street, Heping District, Shenyang City 110005, China
| | - Li Liu
- Liaoning Provincial Center for Disease Control and Prevention, No. 79 Jixian Street, Heping District, Shenyang City 110005, China
| | - Yuan Liu
- Hunan Provincial Center for Disease Control and Prevention, No. 450 first section of Middle Furong Road, Changsha City 410005, Hunan Province, China
| | - Fang Ma
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Yine Zhang
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Yuan Tian
- Ningxia Center for Disease Control and Prevention, No. 528 Shengli Street, Xingqing District, Yinchuan City 750004, Ningxia, China
| | - Qiuli Yu
- Yunnan Center for Disease Control and Prevention, No. 158 Dongsi Street, Xishan District, Kunming City 650022, Yunnan Province, China
| | - Jing Zeng
- Sichuan Center for Disease Control and Prevention, No. 6 Middle School Road, Wuhou District, Chengdu City 610041, Sichuan Province, China
| | - Jingju Pan
- Hubei Provincial Center for Disease Control and Prevention, No. 6 Zhuodaoquan North Road, Hongshan District, Wuhan City 430079, Hubei Province, China
| | - Mengge Zhou
- Hubei Provincial Center for Disease Control and Prevention, No. 6 Zhuodaoquan North Road, Hongshan District, Wuhan City 430079, Hubei Province, China
| | - Weiwei Kang
- Inner Mongolia Integrative Center for Disease Control and Prevention, No. 50 Ordos Street, Hohhot 010031, China
| | - Jin-Yi Zhou
- Jiangsu Provincial Center for disease Control and Prevention, Public Health Research Institute of Jiangsu Province, Jiangsu Road No. 172, Gulou District, Nanjing city 210009, Jiangsu Province, China
| | - Hao Yu
- Jiangsu Provincial Center for disease Control and Prevention, Public Health Research Institute of Jiangsu Province, Jiangsu Road No. 172, Gulou District, Nanjing city 210009, Jiangsu Province, China
| | - Yuehua Liu
- Heilongjiang Provincial Center for Disease Control and Prevention, No. 40 Youfang Street, Xiangfang District, Harbin City 150030, China
| | - Shaofang Li
- Henan Provincial Center for Disease Control and Prevention, No. 105 Nongye South Street, Zhengdong New District, Zhengzhou City 450016, China
| | - Huiting Yu
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Chunfang Wang
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Tian Xia
- Shanghai Municipal Center for Disease Control and Prevention, No. 1380 Zhongshan West Street, Changning District, Shanghai City 200051, China
| | - Jinen Xi
- Gansu Provincial Center for Disease Control and Prevention, No. 230 Donggang West Street, Chengguan District, Lanzhou City 73000, China
| | - Xiaolan Ren
- Gansu Provincial Center for Disease Control and Prevention, No. 230 Donggang West Street, Chengguan District, Lanzhou City 73000, China
| | - Xiuya Xing
- Anhui Provincial Center for Disease Control and Prevention, No. 12560 Fanhua Avenue, Economic and Technological Development District, Hefei City 230601, China
| | - Qianyao Cheng
- Anhui Provincial Center for Disease Control and Prevention, No. 12560 Fanhua Avenue, Economic and Technological Development District, Hefei City 230601, China
| | - Fangrong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Street, Binjiang District, Hangzhou City 310051, China
| | - Dezheng Wang
- Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Street, Hedong District, Tianjin City 300011, China
| | - Shuang Zhang
- Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Street, Hedong District, Tianjin City 300011, China
| | - Yuling He
- Shanxi Center for Disease Control and Prevention, No. 6 Xiaonanguan Shuangta West Street, Yingze District, Taiyuan City 030012, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Panglin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Xuyan Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hui Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Yudiyang Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Donghui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, No. 115 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
| | - Runtang Meng
- Department of Preventive Medicine, School of Medicine, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Yunquan Zhang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Wei Zhang
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Sisi Ke
- Wuhan Centers for Disease Control and Prevention, Wuhan 430024, Hubei, China
| | - Runhua Zhang
- Beijing Tiantan Hospital, Capital Medical University Beijing, China
| | - Dingyi Wang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital; National Center for Respiratory Medicine, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Japan
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Joshua A. Salomon
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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10
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Niemeläinen S, Huhtala H, Jämsen E, Kössi J, Andersen J, Ehrlich A, Haukijärvi E, Koikkalainen S, Koskensalo S, Mattila A, Pinta T, Uotila-Nieminen M, Vihervaara H, Hyöty M. One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study. BJS Open 2022; 6:6668729. [PMID: 35973109 PMCID: PMC9380996 DOI: 10.1093/bjsopen/zrac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery. Methods This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes. Results A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility. Conclusion Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.
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Affiliation(s)
- Susanna Niemeläinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital , Tampere , Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University , Tampere , Finland
| | - Esa Jämsen
- Faculty of Medicine, Helsinki University , Helsinki , Finland
- Department of Surgery, Gerontology Research Center (GEREC) , Tampere , Finland
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital , Lahti , Finland
| | - Jan Andersen
- Department of Surgery, Vaasa Central Hospital , Vaasa , Finland
| | - Anu Ehrlich
- Department of Abdominal Surgery, Helsinki University Hospital , Finland
| | - Eija Haukijärvi
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital , Tampere , Finland
| | | | - Selja Koskensalo
- Faculty of Medicine, Helsinki University , Helsinki , Finland
- Department of Abdominal Surgery, Helsinki University Hospital , Finland
| | - Anne Mattila
- Department of Surgery, Central Hospital of Central Finland , Jyväskylä , Finland
| | - Tarja Pinta
- Department of Surgery, Seinäjoki Central Hospital , Seinäjoki , Finland
| | | | - Hanna Vihervaara
- Division of Digestive Surgery and Urology, Turku University Hospital , Turku , Finland
- Faculty of Medicine, Turku University , Turku , Finland
| | - Marja Hyöty
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital , Tampere , Finland
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11
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Ketelaers SHJ, Jacobs A, Verrijssen ASE, Cnossen JS, van Hellemond IEG, Creemers GJM, Schreuder RM, Scholten HJ, Tolenaar JL, Bloemen JG, Rutten HJT, Burger JWA. A Multidisciplinary Approach for the Personalised Non-Operative Management of Elderly and Frail Rectal Cancer Patients Unable to Undergo TME Surgery. Cancers (Basel) 2022; 14:2368. [PMID: 35625976 PMCID: PMC9139821 DOI: 10.3390/cancers14102368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
Despite it being the optimal curative approach, elderly and frail rectal cancer patients may not be able to undergo a total mesorectal excision. Frequently, no treatment is offered at all and the natural course of the disease is allowed to unfold. These patients are at risk for developing debilitating symptoms that impair quality of life and require palliative treatment. Recent advancements in non-operative treatment modalities have enhanced the toolbox of alternative treatment strategies in patients unable to undergo surgery. Therefore, a proposed strategy is to aim for the maximal non-operative treatment, in an effort to avoid the onset of debilitating symptoms, improve quality of life, and prolong survival. The complexity of treating elderly and frail patients requires a patient-centred approach to personalise treatment. The main challenge is to optimise the balance between local control of disease, patient preferences, and the burden of treatment. A comprehensive geriatric assessment is a crucial element within the multidisciplinary dialogue. Since limited knowledge is available on the optimal non-operative treatment strategy, these patients should be treated by dedicated multidisciplinary rectal cancer experts with special interest in the elderly and frail. The aim of this narrative review was to discuss a multidisciplinary patient-centred treatment approach and provide a practical suggestion of a successfully implemented clinical care pathway.
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Affiliation(s)
- Stijn H. J. Ketelaers
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Anne Jacobs
- Department of Gerontology and Geriatrics, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - An-Sofie E. Verrijssen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (A.-S.E.V.); (J.S.C.)
| | - Irene E. G. van Hellemond
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Geert-Jan M. Creemers
- Department of Medical Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (I.E.G.v.H.); (G.-J.M.C.)
| | - Ramon-Michel Schreuder
- Department of Gastroenterology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Harm J. Scholten
- Department of Anaesthesiology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;
| | - Jip L. Tolenaar
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Johanne G. Bloemen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
- GROW, School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; (J.L.T.); (J.G.B.); (H.J.T.R.); (J.W.A.B.)
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Ginesi M, Bingmer K, Bliggenstorfer JT, Ofshteyn A, Steinhagen E, Stein SL. Functional Not Medical Frailty Is Associated With Long-Term Disability After Surgery for Colorectal Cancer. Cureus 2022; 14:e23216. [PMID: 35449639 PMCID: PMC9012557 DOI: 10.7759/cureus.23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Frailty has been associated with increased morbidity after surgery. However, few studies investigate long-term functional outcomes. Methods: Patients ≥ 65 years old who underwent surgery for colorectal cancer were surveyed regarding their ability to perform activities of daily living, measured by Barthel Index, before and after surgery. Patients also reported time to return to their functional baseline. Results: Pre-operative moderate dependency was associated with declining function at six months (OR: 8.8; CI: 1.8-42.6) and one year post-operatively (OR: 17.5; CI: 2.8-109.8). Pre-operative functional frailty was associated with subjective failure to return to baseline (OR: 4.8 and 4.2) for slightly and moderately dependent patients and a longer time to return to baseline. Medical frailty, based on the modified Frailty Index, was not significantly associated with failure to return to baseline. Conclusions: Measures of functional frailty are better predictors of failure to return to baseline, than measures of medical frailty.
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Ng P, Lee JKD, Tan KY. Finding value with prehabilitation in older persons receiving surgery. Curr Opin Support Palliat Care 2022; 16:19-24. [PMID: 34812752 DOI: 10.1097/spc.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients presenting for surgery are increasingly older and frail. Prehabilitation offers the best hope of preemptive functional optimisation to improve postoperative outcomes. Systematic reviews and meta-analyses show signals of improved function and reduced complications and length of stay, but are hampered by small trials with heterogeneous nature of interventions. RECENT FINDINGS The value proposition for prehabilitation is strengthened by applying the following considerations to the evidence. Multimodal prehabilitation programmes incorporating elements of exercise, nutrition, and psychological preparation have a sound physiological basis and will help standardise care delivery and evidence gathering. Targeting prehabilitation resources at high-risk patients may yield higher returns. Effective prehabilitation programmes must be individualised and pragmatic to address known barriers to adherence. The evidence for functional improvement is clear and this aligns with the values of older patients. A comprehensive analysis of value incorporates functional, quality of life, and cost outcomes in addition to conventional morbidity and mortality measures. SUMMARY Multimodal prehabilitation delivered by a multidisciplinary team improves functional outcomes following surgery. Function is an integral part of multidimensional value assessment including clinical and experiential measures. Future value enhancements include addressing frailty and overcoming barriers through targeted programme design.
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Affiliation(s)
| | | | - Kok Yang Tan
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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14
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The impact of frailty in older women undergoing pelvic floor reconstructive surgery. Menopause 2020; 28:332-336. [PMID: 33177412 DOI: 10.1097/gme.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE AND OBJECTIVE Women ≥ 65 years old commonly undergo pelvic surgery but are often not screened for coexisting frailty, the presence of which increases the risk of postoperative complications. In the absence of a current consensus, the objective of this review is to discuss the incorporation of a frailty assessment into the work-up of women undergoing pelvic floor reconstructive surgery. METHODS This is a review of the literature, focusing on measurements of frailty including the Edmonton Frail Scale, FRAIL scale, Groningen Frailty Indicator, frailty phenotype, Tilburg Frailty Indicator, a 70-item frailty index, Mini-Cog score, Charlson comorbidity index, timed up and go test, and life-space assessment. Their use in the perioperative management of older women undergoing pelvic floor reconstructive surgery will be discussed. DISCUSSION AND CONCLUSION Understanding the concept of frailty and how it may affect surgical decisions and outcomes is essential. The timed up and go test, life space assessment and Mini-Cog assessment at a minimum should be considered preoperatively in patients over the age of 65 years old planning pelvic floor or elective surgery.
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Himmler S, van Exel J, Brouwer W. Estimating the monetary value of health and capability well-being applying the well-being valuation approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1235-1244. [PMID: 32939595 PMCID: PMC7561589 DOI: 10.1007/s10198-020-01231-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/26/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Quality of life measures going beyond health, like the ICECAP-A, are gaining importance in health technology assessment. The assessment of the monetary value of gains in this broader quality of life is needed to use these measurements in a cost-effectiveness framework. METHODS We applied the well-being valuation approach to calculate a first monetary value for capability well-being in comparison to health, derived by ICECAP-A and EQ-5D-5L, respectively. Data from an online survey administered in February 2018 to a representative sample of UK citizens aged 18-65 was used (N = 1512). To overcome the endogeneity of income, we applied an instrumental variable regression. Several alternative model specifications were calculated to test the robustness of the results. RESULTS The base case empirical estimate for the implied monetary value of a year in full capability well-being was £66,597. The estimate of the monetary value of a QALY, obtained from the same sample and using the same methodology amounted to £30,786, which compares well to previous estimates from the willingness to pay literature. Throughout the conducted robustness checks, the value of capability well-being was found to be between 1.7 and 2.6 times larger than the value of health. CONCLUSION While the applied approach is not without limitations, the generated insights, especially concerning the relative magnitude of valuations, may be useful for decision-makers having to decide based on economic evaluations using the ICECAP-A measure or, to a lesser extent, other (capability) well-being outcome measures.
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Affiliation(s)
- Sebastian Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Why focus on patient-reported outcome measures in older colorectal cancer patients? Eur J Surg Oncol 2020; 46:394-401. [DOI: 10.1016/j.ejso.2019.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
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GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients. J Geriatr Oncol 2020; 11:244-255. [PMID: 31492572 DOI: 10.1016/j.jgo.2019.06.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 12/27/2022]
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Ghignone F, Hernandez P, Mahmoud NN, Ugolini G. Functional recovery in senior adults undergoing surgery for colorectal cancer: Assessment tools and strategies to preserve functional status. Eur J Surg Oncol 2020; 46:387-393. [PMID: 31937431 DOI: 10.1016/j.ejso.2020.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/02/2020] [Indexed: 12/25/2022] Open
Abstract
Colorectal cancer is a widely-recognized aging-associated disease. Recent advances in the care of senior colorectal cancer patients has led to similar cancer-related life expectancy for older patients when compared to their younger counterparts. Recent data suggests that onco-geriatric patients place as much value on maintenance of functional independence and quality of life after treatment as they do on the potential improvements in survival that a treatment might offer. As a result, there has been significant interest in the geriatric literature surrounding the concept of "functional recovery," a multidimensional outcome metric that takes into account several domains, including physical, physiologic, psychological, social, and economic wellbeing. This review introduces the concept of functional recovery and highlights a number of predictors of post-treatment functional trajectory, including several office-based tools that clinicians can use to help guide informed decision making surrounding potential treatment options. This review also highlights a number of validated metrics that can be used to assess a patient's progress in functional recovery after surgery. While the timeline of each individual's functional recovery may vary, most data suggests that if patients are to return to their pre-operative functional status, this could occur up to 6 months post-surgery. For those patients identified to be at risk for post-operative functional decline this review also delineates strategies for prehabilitation and rehabilitation that may improve functional outcomes.
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Affiliation(s)
- F Ghignone
- Colorectal and General Surgery Unit, Ospedale per gli Infermi, Faenza, Italy.
| | - P Hernandez
- Division of Colorectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - N N Mahmoud
- Division of Colorectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - G Ugolini
- Colorectal and General Surgery Unit, Ospedale per gli Infermi, Faenza, Italy; University of Bologna, Bologna, Italy
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A Feasibility Study of a Social Robot Collecting Patient Reported Outcome Measurements from Older Adults. Int J Soc Robot 2020. [DOI: 10.1007/s12369-019-00561-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Viret O, Schwarz J, Senn N, Mueller Y. Discussing age-related functional decline in family medicine: a qualitative study that explores both patient and physician perceptions. Age Ageing 2019. [PMCID: PMC7047815 DOI: 10.1093/ageing/afz158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ophélie Viret
- Department of Family Medicine (DMF) , Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joëlle Schwarz
- Department of Family Medicine (DMF) , Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine (DMF) , Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine (DMF) , Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Ke JXC, MacDonald DB, McIsaac DI. Perioperative Acute Care of Older Patients Living with Frailty. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Rinaldo L, Johnson DM, Vine RL, Rabinstein AA, Lanzino G. Differences between patient- and professional-reported modified Rankin Scale score in patients with unruptured aneurysms. J Neurosurg 2019; 131:397-402. [PMID: 30095335 DOI: 10.3171/2018.3.jns18247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clinical trials forming the basis of current guidelines for the management of intracranial aneurysms have relied on patient-reported modified Rankin Scale (mRS) scores to assess functional outcome. The effect of patient demographics on perception of disability and, by extension, patient-reported mRS score, is not well understood. METHODS A consecutive series of patients with a previously treated or untreated unruptured intracranial aneurysm (UIA) prospectively underwent a structured interview with a trained nurse. At the conclusion of this interview, the patients were assigned an mRS score in accordance with their degree of disability. During the same visit, patients were also required to grade themselves on a paper sheet containing the mRS and corresponding information. Data on patient and aneurysm characteristics were also collected during the same visit. Agreement between patient- and nurse-reported mRS scores was assessed using Cohen's kappa coefficient. The effect of patient demographics on the frequency of higher patient- than nurse-reported mRS scores was assessed using the Pearson's chi-square and Fisher's exact tests. RESULTS A total of 209 patients with a UIA were included in the study, 38 of whom (18.2%) had undergone previous treatment. The majority of patients were female (161/209, 77.0%), and the mean age of the cohort was 60.2 years (SD 13.7 years). Agreement between patient- and nurse-reported mRS scores occurred in 72.7% of cases (95% CI 66.3%-78.3%), with a kappa coefficient of 0.58 (95% CI 0.49-0.67). Patients younger than 75 years were more likely to report a higher mRS score than the nurse (19.4% vs 3.4%, p = 0.034). Among female patients, those without a college degree were more likely to report a higher mRS score than the nurse (22.5% vs 9.5%, p = 0.035). CONCLUSIONS The results suggest that patient demographics may influence perception of disability. These findings should be considered when using patient-reported mRS scores to determine functional outcome.
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Franzon K, Zethelius B, Cederholm T, Kilander L. The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men. BMC Geriatr 2019; 19:153. [PMID: 31142271 PMCID: PMC6542054 DOI: 10.1186/s12877-019-1142-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background Preserved functions of daily life and cognition are cornerstones of independent aging, which is crucial for maintaining a high quality of life. The aim of this study was to examine the impact of sarcopenia, and its underlying components, on independent ageing in a cohort study of very old men. Methods The presence of sarcopenia and independent ageing at a mean age of 87 was investigated in 287 men from the Uppsala Longitudinal Study of Adult Men. Five years later 127 men were re-evaluated for independent ageing. Sarcopenia was defined by two different definitions from the European Working Group on Sarcopenia in Older People. In the first definition sarcopenia was defined as skeletal muscle index < 7.26 kg/m2 and either gait speed ≤0.8 m/s or hand grip strength < 30 kg. In the later up-dated definition, HGS < 27 kg and/or chair stand test > 15 s defines probable sarcopenia, which is confirmed by SMI < 7.0 kg/m2. Independent ageing was defined as a Mini-Mental State Examination score of ≥25 points, absence of diagnosed dementia, community-dwelling, independency in personal care and ability to walk outdoors alone. Results Sarcopenia at baseline was observed in 21% (60/287) and 20% (58/287), respectively, due to definition. The prevalence of independent ageing was 83% (239/288) at baseline and 69% (87/127) five years later. None of the sarcopenia diagnoses were associated with independent ageing. In contrast, gait speed was both in cross-sectional (odds ratio (OR) per one standard deviation increase 2.15, 95% confidence interval (CI) 1.47–3.15), and in longitudinal multivariate analyses (OR 1.84, 95% CI 1.19–2.82). In the cross-sectional analysis also higher hand grip strength was associated with independent ageing (OR 1.58, 95% CI 1.12–2.22), while a slower chair stand test was inversely associated (OR 0.61, 95% CI 0.43–0.86). Muscle mass; i.e. skeletal muscle index, was not associated with independent ageing. Conclusions For very old men, especially a higher gait speed, but also a higher hand grip strength and a faster chair stand test, were associated with independent ageing, while skeletal muscle index alone, and the composite sarcopenia phenotype measured with two different definitions, were not.
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Affiliation(s)
- Kristin Franzon
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Box 564, 751 22, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Box 564, 751 22, Uppsala, Sweden
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Maertens de Noordhout C, Devleesschauwer B, Salomon JA, Turner H, Cassini A, Colzani E, Speybroeck N, Polinder S, Kretzschmar ME, Havelaar AH, Haagsma JA. Disability weights for infectious diseases in four European countries: comparison between countries and across respondent characteristics. Eur J Public Health 2019; 28:124-133. [PMID: 29020343 PMCID: PMC5881674 DOI: 10.1093/eurpub/ckx090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background In 2015, new disability weights (DWs) for infectious diseases were constructed based on data from four European countries. In this paper, we evaluated if country, age, sex, disease experience status, income and educational levels have an impact on these DWs. Methods We analyzed paired comparison responses of the European DW study by participants’ characteristics with separate probit regression models. To evaluate the effect of participants’ characteristics, we performed correlation analyses between countries and within country by respondent characteristics and constructed seven probit regression models, including a null model and six models containing participants’ characteristics. We compared these seven models using Akaike Information Criterion (AIC). Results According to AIC, the probit model including country as covariate was the best model. We found a lower correlation of the probit coefficients between countries and income levels (range rs: 0.97–0.99, P < 0.01) than between age groups (range rs: 0.98–0.99, P < 0.01), educational level (range rs: 0.98–0.99, P < 0.01), sex (rs = 0.99, P < 0.01) and disease status (rs = 0.99, P < 0.01). Within country the lowest correlations of the probit coefficients were between low and high income level (range rs = 0.89–0.94, P < 0.01). Conclusions We observed variations in health valuation across countries and within country between income levels. These observations should be further explored in a systematic way, also in non-European countries. We recommend future researches studying the effect of other characteristics of respondents on health assessment.
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Affiliation(s)
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Heather Turner
- Department of Statistics, University of Warwick, Coventry, UK
| | - Alessandro Cassini
- European Centre for Disease Prevention and Control, Stockholm, Sweden.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edoardo Colzani
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain (Clos Chapelle-aux-Champs, 30) Brussels, Belgium
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mirjam E Kretzschmar
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arie H Havelaar
- Department of Animal Health and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.,Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Juanita A Haagsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute for Health Metrics and Evaluation, Seattle, WA, USA
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25
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Botes R, Vermeulen KM, Gerber AM, Ranchor AV, Buskens E. Health-related quality of life and well-being health state values among Dutch oldest old. Patient Prefer Adherence 2019; 13:721-728. [PMID: 31190754 PMCID: PMC6522649 DOI: 10.2147/ppa.s193171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Valuing hypothetical health states is a demanding personal process, since it involves the psychological evaluation of hypothetical health states. It seems plausible that elderly individuals will value hypothetical health states differently than the general population. It is, however, important to understand the psychological division that oldest old subgroups construct between acceptable and unacceptable health states. This information can produce important evidence regarding well-being and disability conceptualization. Objective: To investigate how Dutch oldest old, conceptualize health-related quality of life health states when compared to well-being health states. In addition, we aim to compare subgroups, based on dependency classification. Methods: Ninety-nine elderly living in the Groningen, Hoogeveen and Veendam areas of the Netherlands participated in the study. Respondents were classified into three groups based on dependency levels. The respondents were asked to value hypothetical health states, a generic preference-based HRQoL and a well-being instrument, using a visual analog scale. Results: All three groups ranked the same health states, from both questionnaires, below the average across the health states. The health-related quality of life health states was consistently ranked lower than the current well-being health states. Conclusions: Health state valuations performed by the oldest old indicate that conceptually, respondents view below average health-related and well-being health states as undesirable. The results indicated that the oldest old do view deficits in health-related health states as more important than deficits in well-being health states. Since the oldest old performed the valuations, focused interventions to improve below average health-related outcomes might be the most cost-effective way to increase oldest old well-being outcomes.
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Affiliation(s)
- Riaan Botes
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
- Correspondence: Riaan BotesDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen9700 RB, The NetherlandsTel +312 779 359 7351Email
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
| | - Anthonie M Gerber
- Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, 9700 AD, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
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A note on the relationship between age and health-related quality of life assessment. Qual Life Res 2018; 28:1201-1205. [PMID: 30523567 PMCID: PMC6470117 DOI: 10.1007/s11136-018-2071-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To extend existing analyses of whether and how the age of respondents is related to their time trade-off (TTO) valuations of hypothetical EQ-5D-3L health states, and to contribute to the existing debate about the rationale and implications for using age-specific utilities in health technology assessment (HTA). METHODS We use data from the MVH UK valuation study. For each profile, the mean TTO value-adjusted by sex, education, self-reported health and personal experience of serious illness-is pairwise compared across the different age groups. A Bonferroni correction is applied to the multiple testing of significant differences between means. Smile plots illustrate the results. A debate regarding whether there is a case for using age-specific utilities in HTAs complements the analysis. RESULTS Results show that the oldest respondents value health profiles lower than younger age groups, particularly for profiles describing problems in the mobility dimension. CONCLUSION The findings raise the possibility of using age-specific value sets in HTAs, since a technology may not be cost-effective on average but cost-effective for a sub-group whose preferences are more closely aligned to the benefits offered by the technology.
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Cubi-Molla P, Shah K, Burström K. Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:253-270. [PMID: 29305706 DOI: 10.1007/s40271-017-0292-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Whether health values should be elicited from the perspective of patients or the general public is still an open debate. The overall aim of this paper is to increase knowledge on the role of experience in health preference-based valuation research. The objectives of this paper are threefold. First, we elaborate the idea of experience-based (EB) values under the informed value or knowledge viewpoint. We think the whole scope of knowledge about the health states involved in valuation exercises is not fully integrated in the previous literature. For instance, personal knowledge based on past experiences, contemplating the health state as a likely future condition, knowing someone who is currently experiencing the state, or just receiving detailed information about the health states; all these situations capture different nuances of health-related experience which are not explicitly referred to in valuation tasks. Second, we propose a framework where the extended factor of experience is detached from other factors interwoven into the valuation exercise. Third, we examine how experience is tackled in different value sets (EB or non-EB) identified via a literature review. We identified the following elements (and items) in a value set: health state (without description, described using a multi-attribute instrument, described using other method), reference person (the respondent; other person, similar/known/hypothetical), time frame (past, present, future), raters (public, representative/convenience; vested interest, patients/other) and experience (personal experience, past/present/future; vicarious experience, affective/non-affective; no experience). Forty-nine valuation exercises were extracted from 22 reviewed papers and classified following our suggested set of elements and items. The results show that the role of experience reported in health valuation-related papers is frequently disregarded or, at most, minimised to the item of personal experience (present)-linked to self-reported health.
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Affiliation(s)
| | | | - Kristina Burström
- Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Health Outcomes and Economic Evaluation Research Group, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden.,Health Care Services, Stockholm County Council, Stockholm, Sweden
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Abstract
Introduction: Patient reported outcome measures (PROMs) have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life. Discussion: We describe innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice. We show that PROMs can show meaningful outcomes in older subjects’ patient journeys, which can at the same time serve individuals and groups of both patients and professionals. Key lesson: PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records.
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Huter K, Dubas-Jakóbczyk K, Kocot E, Kissimova-Skarbek K, Rothgang H. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:14. [PMID: 29686540 PMCID: PMC5902889 DOI: 10.1186/s12962-018-0100-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. METHODS Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. RESULTS Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. CONCLUSION There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.
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Affiliation(s)
- Kai Huter
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Katarzyna Dubas-Jakóbczyk
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Kissimova-Skarbek
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Heinz Rothgang
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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30
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Mueller YK, Monod S, Locatelli I, Büla C, Cornuz J, Senn N. Performance of a brief geriatric evaluation compared to a comprehensive geriatric assessment for detection of geriatric syndromes in family medicine: a prospective diagnostic study. BMC Geriatr 2018. [PMID: 29534680 PMCID: PMC5850979 DOI: 10.1186/s12877-018-0761-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Geriatric syndromes are rarely detected in family medicine. Within the AGE program (active geriatric evaluation), a brief assessment tool (BAT) designed for family physicians (FP) was developed and its diagnostic performance estimated by comparison to a comprehensive geriatric assessment. Methods This prospective diagnostic study was conducted in four primary care sites in Switzerland. Participants were aged at least 70 years and attending a routine appointment with their physician, without previous documented geriatric assessment. Participants were assessed by their family physicians using the BAT, and by a geriatriciant who performed a comprehensive geriatric assessment within the following two-month period (reference standard). Both the BAT and the full assessment targeted eight geriatric syndromes: cognitive impairment, mood impairment, urinary incontinence, visual impairment, hearing loss, undernutrition, osteoporosis and gait and balance impairment. Diagnostic accuracy of the BAT was estimated in terms of sensitivity, specificity, and predictive values; secondary outcomes were measures of feasibility, in terms of added consultation time and comprehensiveness in applying the BAT items. Results Prevalence of the geriatric syndromes in participants (N=85, 46 (54.1%) women, mean age 78 years (SD 6))ranged from 30.0% (malnutrition and cognitive impairment) to 71.0% (visual impairment), with a median number of 3 syndromes (IQR 2 to 4) per participant. Sensitivity of the BAT ranged from 25.0% for undernutrition (95%CI 9.8% - 46.7%) to 82.1% for hearing impairment (95%CI 66.5% - 92.5%), while specificity ranged from 45.8% for visual impairment (95%CI 25.6–67.2) to 87.7% for undernutrition (76.3% to 94.9%). Finally, most negative predictive values (NPV) were between 73.5% and 84.1%, excluding visual impairment with a NPV of 50.0%. Family physicians reported BAT use as per instructions for 76.7% of the syndromes assessed. Conclusions Although the BAT does not replace a comprehensive geriatric assessment, it is a useful and appropriate tool for the FP to screen elderly patients for most geriatric syndromes. Trial registration The study was registered on ClinicalTrials.gov on February 20, 2013 (NCT01816087). Electronic supplementary material The online version of this article (10.1186/s12877-018-0761-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yolanda K Mueller
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | - Stefanie Monod
- Public Health Office of the Canton of Vaud, Av. des casernes 2, 1014, Lausanne, Switzerland.,Department of Geriatrics, University of Lausanne, Ch. de Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Isabella Locatelli
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Institute of Social and Preventive Medicine, University of Lausanne, Rue de la Corniche 10, 1010, Lausanne, Switzerland
| | - Christophe Büla
- Department of Geriatrics, University of Lausanne, Ch. de Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Jacques Cornuz
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Nicolas Senn
- University Institute of Family Medicine, Department of Ambulatory Care and Community Medicine (DACCM), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Abstract
BACKGROUND There are difficulties in expressing the value of geriatric care in outcome measures such as recovery or mortality rates. Rather, the goal of geriatric care is to maintain quality of life and functionality. As such, patient reported outcome measures (PROMs) may be more effective in measuring the value healthcare creates in geriatric patients. In 2015 the Dutch Geriatrics Society asked their Committee Quality of Care Measurement to select a suitable PROM for the purpose of measuring the outcomes of geriatric hospital care. METHODS/RESULTS The goal of this PROM is to measure outcomes of an hospital admission in the perspective of the elderly patient who was admitted to a geriatric ward. A group of caregivers in geriatric care identified four possible PROMs in the literature and based on selection criteria the TOPICS-MDS was chosen as most suitable. To increase the feasibility of implementation in daily practice, an item reduction study was performed and this resulted in a short form: TOPICS-SF. Two pilot studies in three hospitals took place on a geriatric ward. A response of 62% was observed during the first pilot with TOPICS-MDS and a response of 37% was observed during the second pilot with TOPICS-SF. The Katz-15 improved during hospital stay and during one month at home after discharge. CONCLUSION The TOPICS-SF has been selected as PROM for the older patient receiving geriatric care and is feasible in practice. More research in different settings and with different moments of measurements is needed to evaluate the responsiveness of TOPICS-SF and the conditions for feasible implementation in daily practice.
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[SDM supports better application of EBM in geriatric patients]. Tijdschr Gerontol Geriatr 2017; 48:271-277. [PMID: 29098654 DOI: 10.1007/s12439-017-0236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidence based medicine (EBM) is the integration of the best research evidence, clinical expertise and patient values in the decision making process for patient care. However, elderly people are often excluded from participating in scientific studies and they often have multiple morbidities, which complicates the application of EBM. Shared decision making (SDM), a process where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve appropriate treatment can help to shape EBM for this group of patients.In this article, we provide tools for finding relevant literature for the geriatric patient population and for shaping the SDM process to achieve personalized care.
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Franzon K, Byberg L, Sjögren P, Zethelius B, Cederholm T, Kilander L. Predictors of Independent Aging and Survival: A 16-Year Follow-Up Report in Octogenarian Men. J Am Geriatr Soc 2017; 65:1953-1960. [DOI: 10.1111/jgs.14971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kristin Franzon
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Liisa Byberg
- Division of Orthopedics; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Per Sjögren
- Division of Clinical Nutrition and Metabolism; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Björn Zethelius
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Medical Products Agency; Uppsala Sweden
| | - Tommy Cederholm
- Division of Clinical Nutrition and Metabolism; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Lena Kilander
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Wilkinson R, Arensberg ME, Hickson M, Dwyer JT. Frailty Prevention and Treatment: Why Registered Dietitian Nutritionists Need to Take Charge. J Acad Nutr Diet 2017; 117:1001-1009. [DOI: 10.1016/j.jand.2016.06.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 12/14/2022]
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Miller PR, Chang MC, Hoth JJ, Hildreth AN, Wolfe SQ, Gross JL, Martin RS, Carter JE, Meredith JW, D'Agostino R. Predicting Mortality and Independence at Discharge in the Aging Traumatic Brain Injury Population Using Data Available at Admission. J Am Coll Surg 2017; 224:680-685. [PMID: 28263858 DOI: 10.1016/j.jamcollsurg.2016.12.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aging worsens outcome in traumatic brain injury (TBI), but available studies may not provide accurate outcomes predictions due to confounding associated injuries. Our goal was to develop a predictive tool using variables available at admission to predict outcomes related to severity of brain injury in aging patients. STUDY DESIGN Characteristics and outcomes of blunt trauma patients, aged 50 or older, with isolated TBI, in the National Trauma Data Bank (NTDB), were evaluated. Equations predicting survival and independence at discharge (IDC) were developed and validated using patients from our trauma registry, comparing predicted with actual outcomes. RESULTS Logistic regression for survival and IDC was performed in 57,588 patients using age, sex, Glasgow Coma Scale score (GCS), and Revised Trauma Score (RTS). All variables were independent predictors of outcome. Two models were developed using these data. The first included age, sex, and GCS. The second substituted RTS for GCS. C statistics from the models for survival and IDC were 0.90 and 0.82 in the GCS model. In the RTS model, C statistics were 0.80 and 0.67. The use of GCS provided better discrimination and was chosen for further examination. Using a predictive equation derived from the logistic regression model, outcome probabilities were calculated for 894 similar patients from our trauma registry (January 2012 to March 2016). The survival and IDC models both showed excellent discrimination (p < 0.0001). Survival and IDC generally decreased by decade: age 50 to 59 (80% IDC, 6.5% mortality), 60 to 69 (82% IDC, 7.0% mortality), 70 to 79 (76% IDC, 8.9% mortality), and 80 to 89 (67% IDC, 13.4% mortality). CONCLUSIONS These models can assist in predicting the probability of survival and IDC for aging patients with TBI. This provides important data for loved ones of these patients when addressing goals of care.
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Affiliation(s)
- Preston R Miller
- Department of Surgery, Wake Forest University, Winston-Salem, NC.
| | - Michael C Chang
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - J Jason Hoth
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - Amy N Hildreth
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest University, Winston-Salem, NC
| | - Jessica L Gross
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - R Shayn Martin
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - Jeffrey E Carter
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - J Wayne Meredith
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - Ralph D'Agostino
- Wake Forest Health Science Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC
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Maertens de Noordhout C, Devleesschauwer B, Gielens L, Plasmans MHD, Haagsma JA, Speybroeck N. Mapping EQ-5D utilities to GBD 2010 and GBD 2013 disability weights: results of two pilot studies in Belgium. ACTA ACUST UNITED AC 2017; 75:6. [PMID: 28191312 PMCID: PMC5292789 DOI: 10.1186/s13690-017-0174-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/03/2017] [Indexed: 11/21/2022]
Abstract
Background Utilities and disability weights (DWs) are metrics used for calculating Quality-Adjusted Life Years and Disability-Adjusted Life Years (DALYs), respectively. Utilities can be obtained with multi-attribute instruments such as the EuroQol 5 dimensions questionnaire (EQ-5D). In 2010 and 2013, Salomon et al. proposed a set of DWs for 220 and 183 health states, respectively. The objective of this study is to develop an approach for mapping EQ-5D utilities to existing GBD 2010 and GBD 2013 DWs, allowing to predict new GBD 2010/2013 DWs based on EQ-5D utilities. Methods We conducted two pilot studies including respectively four and twenty-seven health states selected from the 220 DWs of the GBD 2010 study. In the first study, each participant evaluated four health conditions using the standard written EQ-5D-5 L questionnaire. In the second study, each participant evaluated four health conditions randomly selected among the twenty-seven health states using a previously developed web-based EQ-5D-5 L questionnaire. The EQ-5D responses were translated into utilities using the model developed by Cleemput et al. A loess regression allowed to map EQ-5D utilities to logit transformed DWs. Results Overall, 81 and 393 respondents completed the first and the second survey, respectively. In the first study, a monotonic relationship between derived utilities and predicted GBD 2010/2013 DWs was observed, but not in the second study. There were some important differences in ranking of health states based on utilities versus GBD 2010/2013 DWs. The participants of the current study attributed a relatively higher severity level to musculoskeletal disorders such as ‘Amputation of both legs’ and a relatively lower severity level to non-functional disorders such as ‘Headache migraine’ compared to the participants of the GBD 2010/2013 studies. Conclusion This study suggests the possibility to translate any utility derived from EQ-5D scores into a DW, but also highlights important caveats. We observed a satisfactory result of this methodology when utilities were derived from a population of public health students, a written questionnaire and a small number of health states in the presence of a study leader. However the results were unsatisfactory when utilities were derived from a sample of the general population, using a web-based questionnaire. We recommend to repeat the study in a larger and more diverse sample to obtain a more representative distribution of educational level and age. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0174-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Maertens de Noordhout
- Institute of Health and Society (IRSS), Université catholique de Louvain Clos Chapelle-aux-Champs, 30 bte B1.30.15, Brussels, 1200 Belgium
| | - B Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Brussels, Belgium
| | - L Gielens
- Institute of Health and Society (IRSS), Université catholique de Louvain Clos Chapelle-aux-Champs, 30 bte B1.30.15, Brussels, 1200 Belgium
| | - M H D Plasmans
- National Institute for Public Health and the Environment, Centre for Health and Society, P.O. Box 1, 3720, BA Bilthoven, The Netherlands
| | - J A Haagsma
- Department of Public Health, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121 USA
| | - N Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain Clos Chapelle-aux-Champs, 30 bte B1.30.15, Brussels, 1200 Belgium
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco3Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Mihic MM, Todorovic ML, Obradovic VL, Mitrovic ZM. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia. Clin Interv Aging 2016; 11:85-96. [PMID: 26869778 PMCID: PMC4734729 DOI: 10.2147/cia.s96778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. PURPOSE This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. METHODS This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. RESULTS The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. CONCLUSION This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.
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Affiliation(s)
- Marko M Mihic
- Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia
| | - Marija Lj Todorovic
- Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia
| | - Vladimir Lj Obradovic
- Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia
| | - Zorica M Mitrovic
- Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia
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