A real-world analysis of the outcome of patients with IPMN and indication for surgery according to IAP criteria in whom surgery is not performed due to advanced age and/or comorbidities

Pancreatology ◽  
2012 ◽  
Vol 12 (6) ◽  
pp. 577
Author(s):  
M. Piciucchi ◽  
G. Capurso ◽  
M. Del Chiaro ◽  
R. Valente ◽  
M. Antonelli ◽  
...  
Keyword(s):  
Real World ◽  
Advanced Age ◽  
Indication For Surgery

Approaches to Facilitating Analysis of Health and Wellness Data

2011 ◽  
pp. 92-111
Author(s):  
Lena Mamykina ◽  
Elizabeth D. Mynatt
Keyword(s):  
Chronic Diseases ◽  
Real World ◽  
Educational Level ◽  
Advanced Age ◽  
Health And Wellness ◽  
Visualization Of Data ◽  
Social Scaffolding

In the last decade novel sensing technologies enabled development of applications that help individuals with chronic diseases monitor their health and activities. These applications often generate large volumes of data that need to be processed and analyzed. At the same time, many of these applications target non-professionals and individuals of advanced age and low educational level. These users may find the data collected by the applications challenging and overwhelming, rather than helpful, and may require additional assistance in interpreting it. In this paper we discuss two different approaches to designing computing applications that not only collect the relevant health and wellness data but also find creative ways to engage individuals in the analysis and assist with interpretation of the data. These approaches include visualization of data using simple real world imagery and metaphors, and social scaffolding mechanisms that help novices learn by observing and imitating experts. We present example applications that utilize both of these approaches and discuss their relative strengths and limitations.

Interpreting Health and Wellness Information

2010 ◽  
pp. 74-90 ◽  
Author(s):  
Lena Mamykina ◽  
Elizabeth Mynatt
Keyword(s):  
Chronic Diseases ◽  
Real World ◽  
Educational Level ◽  
Advanced Age ◽  
Health And Wellness ◽  
Visualization Of Data ◽  
Social Scaffolding

In the last decade, novel sensing technologies enabled development of applications that help individuals with chronic diseases monitor their health and activities. These applications can generate large volumes of data that need to be processed and analyzed. At the same time, many of these applications are designed for non-professional use by individuals of advanced age and low educational level. These users may find the data collected by the applications challenging and overwhelming, rather than helpful, and may require additional assistance in interpreting it. In this chapter, we discuss two different approaches to designing computing applications that not only collect the relevant health and wellness data but also find creative ways to engage individuals in the analysis and assist with interpretation of the data. These approaches include visualization of data using simple real world imagery and metaphors, and social scaffolding mechanisms that help novices learn by observing and imitating experts. We present example applications that utilize both of these approaches and discuss their relative strengths and limitations.

P3615The number of coronary risk factors and mortality in patients with acute myocardial infarction from Japanese nation-wide real-world database

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Mori ◽  
K Nishihara ◽  
S Honda ◽  
S Kojima ◽  
M Takegami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Real World ◽  
Japanese Patients ◽  
Advanced Age ◽  
Coronary Risk Factors ◽  
Inverse Association ◽  
Coronary Risk

Abstract Background Hypertension, diabetes, dyslipidemia and smoking are so-called coronary risk factors for coronary heart disease, which were established by extensive epidemiological research. However, in Japanese patients with acute myocardial infarction (AMI), the impact of number of coronary risk factors on in-hospital morality has not been elucidated. Methods The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database integrated form 10 regional registries. We examined the association between number of coronary risk factors and in-hospital mortality from this JAMIR registry. Results The data were obtained from total of 20462 AMI patients (mean age, 68.8±13.3 years old; 15281 men, 5181 women). Figure 1 shows the prevalence of each coronary risk factors stratified by sex and decade. The prevalence of hypertension became higher with the advanced age while the prevalence of smoking became lower with the advanced age. Prevalence of diabetes and dyslipidemia were highest in middle age. Majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors and, 23.1% had none of them. Overall, except women under 50, number of coronary risk factor was relatively less in older age (Figure 2). In-hospital mortality by sex and decades was shown in figure 3. In-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively (Figure 4A). After adjusting age and sex, there was an inverse association between the number of coronary risk factors and in-hospital mortality (adjusted odds ratio [1.68; 95% CI, 1.20–2.35] among individuals with 0 vs. 4 risk factors, Figure 4B). Conclusion In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors. Acknowledgement/Funding Grant-in-Aid for Scientific Research

scholarly journals Balancing the Covid-19-motivated vascular access guidelines and patient-centred care of pre-dialysis candidates

2020 ◽  
Vol 21 (4) ◽  
pp. 536-538
Author(s):  
George S Georgiadis ◽  
Christos Argyriou ◽  
Selcuk Baktiroglu ◽  
Miltos K Lazarides ◽  
Alexandros Mallios ◽  
...  
Keyword(s):  
Health Care ◽  
Vascular Access ◽  
Real World ◽  
Hospital Staff ◽  
Legal Issues ◽  
Patient Specific ◽  
Clinical Judgement ◽  
Dialysis Patients ◽  
Indication For Surgery ◽  
Patient Centred Care

The recommendations recently proposed by the European and American Vascular Societies in this new ‘Covid-19’ era regarding the triage of various vascular operations into urgent, emergent and programmed based on the nature of their pathology aim at reserving health care expenses and hospital staff towards managing the current unexpected worldwide pandemic to the highest possible degree. The suggestion for implementation of these changes into real-world practice, however, does not come without a cost. In particular, the recommendation for deferral of access creation in pre-dialysis patients, ethical, socio-economic and medico-legal issues arise which should be seriously taken into consideration. At the end of the day, vascular access creation is the lifeline of haemodialysis patients and the indication for surgery warrants patient-specific clinical judgement rather than ‘group labelling’.

Effect of advanced age, elevated bilirubin, and disease extent on outcomes of unresectable pancreatic cancer (UPC) patients receiving first-line chemotherapy: A population-based study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 325-325 ◽  
Author(s):  
Hannah Marie Cherniawsky ◽  
Ying Wang ◽  
Sunita Ghosh ◽  
Winson Y. Cheung ◽  
Maria Yi Ho
Keyword(s):  
Metastatic Disease ◽  
Real World ◽  
Population Based ◽  
Advanced Age ◽  
Disease Extent ◽  
Population Based Study ◽  
The Real ◽  
Real World Setting ◽  
Elevated Bilirubin ◽  
The Impact

325 Background: Superiority of FOLFIRINOX (FFN) and nab-paclitaxel plus gemcitabine (NG) over standard gemcitabine (GEM) monotherapy for UPC was shown in the PRODIGE and MPACT trials, respectively. However, both trials either excluded or limited enrollment of patients with locally advanced disease, elevated bilirubin and advanced age. We sought to determine the impact of age, bilirubin and disease extent on treatment outcomes in the real-world setting. Methods: We identified all patients newly diagnosed with UPC who received palliative chemotherapy at any 1 of 6 British Columbia Cancer Centers and the Cross Cancer Institute in Alberta from January 2014 to April 2016. Receipt of at least one cycle of chemotherapy represented treatment with group assignment based on the initial regimen delivered. Outcomes were compared while adjusting for age, bilirubin, extent of disease, and other measured confounders. Results: A total of 292 consecutive patients were identified of whom 161 (55%) were aged > = 65 years, 164 (56%) were male, 74 (25%) had elevated bilirubin, and 205 (70%) had metastatic disease at the time of presentation. Patients who received FFN or NG had a longer median overall survival (OS) than those treated with GEM alone after adjusting for age, ECOG, bilirubin and extent of metastatic disease (11 vs 10 vs 4 months, respectively; FFN: HR 0.297, 95% CI 0.199-0.445, p < 0.0001, and NG: HR 0.338, 95% CI 0.236 – 0.485, p < 0.0001). Similarly, FFN and NG patients also had longer progression-free survival (PFS) in comparison to GEM alone (8.8 vs 6.9 vs 2.9 months, respectively; FFN: HR 0.33, 95% CI 0.22-0.499, p < 0.0001, and NG: HR 0.47, 95% CI 0.33 – 0.67, p < 0.0001). Advanced age and elevated bilirubin were not significantly associated with OS and PFS (p > 0.05). Conclusions: The efficacy of FFN and NG were superior when compared to GEM alone for patients with UPC in the real-world setting. This population-based study showed that the benefits of FFN and NG persisted regardless of advanced age and hyperbilirubinemia.

Interpreting Health and Wellness Information

2011 ◽  
pp. 510-526
Author(s):  
Lena Mamykina ◽  
Elizabeth Mynatt
Keyword(s):  
Chronic Diseases ◽  
Real World ◽  
Educational Level ◽  
Advanced Age ◽  
Health And Wellness ◽  
Visualization Of Data ◽  
Social Scaffolding

In the last decade, novel sensing technologies enabled development of applications that help individuals with chronic diseases monitor their health and activities. These applications can generate large volumes of data that need to be processed and analyzed. At the same time, many of these applications are designed for non-professional use by individuals of advanced age and low educational level. These users may find the data collected by the applications challenging and overwhelming, rather than helpful, and may require additional assistance in interpreting it. In this chapter, we discuss two different approaches to designing computing applications that not only collect the relevant health and wellness data but also find creative ways to engage individuals in the analysis and assist with interpretation of the data. These approaches include visualization of data using simple real world imagery and metaphors, and social scaffolding mechanisms that help novices learn by observing and imitating experts. We present example applications that utilize both of these approaches and discuss their relative strengths and limitations.

Abstract P57: Risk Factors for Incidentally Discovered Silent Brain Infarcts and White Matter Disease in a Real World Cohort Identified by Artificial Intelligence

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lester Y Leung ◽  
Yichen Zhou ◽  
Sunyang Fu ◽  
Chengyi Zheng ◽  
Hongfang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Language Processing ◽  
Real World ◽  
Stroke Risk ◽  
Advanced Age ◽  
White Matter Disease ◽  
Brain Infarcts ◽  
Increased Risk

Introduction: Silent brain infarcts (SBIs) and white matter disease (WMD) are highly prevalent and associated with increased risk of ischemic stroke in patients with traditional stroke risk factors (RFs) in prospective cohort studies. Their frequency and associations with stroke RFs have not been well described in real world populations. Methods: This was a cross-sectional study of patients age ≥ 50 in the Kaiser Permanente-Southern California (KPSC) health system between 2009-2019 with a head CT or MRI for non-stroke indications and no history of ischemic stroke, transient ischemic attack, or dementia. A natural language processing (NLP) algorithm developed at Mayo Clinic and Tufts Medical Center was applied to the KPSC EHR to identify individuals with reported SBIs or WMD. Multivariable Poisson regression with robust error variance was used to estimate risk ratios of demographics, stroke RFs (from the Framingham Stroke Risk Score), and scan modality on the presence of SBIs or WMD. Results: Among 262,875 individuals, the NLP identified 13,154 (5.0%) with SBIs and 78,330 (29.8%) with WMD. Stroke RFs were highly prevalent in this cohort. The majority underwent CTs (74.8%) instead of MRIs as their initial neuroimaging. After adjustment for demographics and RFs, advanced age demonstrated a strong association with increased risk of SBIs and WMD (table). MRI was associated with a reduced risk of reported SBIs (ARR: 0.87, 95% CI 0.83-0.91) and an increased risk of reported WMD (ARR 2.86, 95% CI 2.83-2.90). Despite being prevalent, traditional stroke RFs had weak associations with increased risk of SBIs or increased risk of WMD. Conclusions: Advanced age is strongly associated with incidentally discovered SBIs and WMD on neuroimaging studies obtained in routine care. The development of SBIs and WMD may not be fully attributable to traditional stroke RFs.

Replications can cause distorted belief in scientific progress

2018 ◽  
Vol 41 ◽  
Author(s):  
Michał Białek
Keyword(s):  
Real World ◽  
Scientific Progress ◽  
The Public ◽  
Psychological Science

AbstractIf we want psychological science to have a meaningful real-world impact, it has to be trusted by the public. Scientific progress is noisy; accordingly, replications sometimes fail even for true findings. We need to communicate the acceptability of uncertainty to the public and our peers, to prevent psychology from being perceived as having nothing to say about reality.

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