Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

2019 ◽  
Vol 129 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Anthony M. Tolisano ◽  
Natalie Schauwecker ◽  
Bethany Baumgart ◽  
Johanna Whitson ◽  
Joe Walter Kutz ◽  
...  
Keyword(s):  
Marital Status ◽  
Cochlear Implantation ◽  
Older Patients ◽  
Independent Predictor ◽  
Spoken Language ◽  
Referral Rate ◽  
Disadvantaged Groups ◽  
Insurance Type ◽  
Younger Age ◽  
Qualification Rate

Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.

The neuropathogenesis of delirium

2002 ◽  
Vol 12 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Susan White
Keyword(s):  
Hospital Stay ◽  
Older Patients ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Major Surgery ◽  
Common Disorder ◽  
Disturbance Of Consciousness ◽  
Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

scholarly journals Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

2020 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Ahmed Nagy ◽  
Mona Kamal ◽  
Hesham El Halawani
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Clinical Oncology ◽  
Renal Cell ◽  
Older Patients ◽  
Treatment Options ◽  
Tumor Grade ◽  
Kaplan Meier ◽  
Younger Age

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation

2021 ◽  
Vol 42 (10S) ◽  
pp. S11-S18
Author(s):  
Ivette Cejas ◽  
Christine M. Mitchell ◽  
David H. Barker ◽  
Christina Sarangoulis ◽  
Laurie S. Eisenberg ◽  
...  
Keyword(s):  
Parenting Stress ◽  
Cochlear Implantation ◽  
Self Efficacy ◽  
Spoken Language ◽  
Language Ability

Impact of race on nonroutine discharge, length of stay, and postoperative complications after surgery for spinal metastases

2021 ◽  
pp. 1-8
Author(s):  
Bethany Hung ◽  
Zach Pennington ◽  
Andrew M. Hersh ◽  
Andrew Schilling ◽  
Jeff Ehresman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Marital Status ◽  
Functional Status ◽  
Independent Predictor ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Comprehensive Cancer Center ◽  
Insurance Status ◽  
Income Quartile

OBJECTIVE Previous studies have suggested the possibility of racial disparities in surgical outcomes for patients undergoing spine surgery, although this has not been thoroughly investigated in those with spinal metastases. Given the increasing prevalence of spinal metastases requiring intervention, knowledge about potential discrepancies in outcomes would benefit overall patient care. The objective in the present study was to investigate whether race was an independent predictor of postoperative complications, nonroutine discharge, and prolonged length of stay (LOS) after surgery for spinal metastasis. METHODS The authors retrospectively examined patients at a single comprehensive cancer center who had undergone surgery for spinal metastasis between April 2013 and April 2020. Demographic information, primary pathology, preoperative clinical characteristics, and operative outcomes were collected. Factors achieving p values < 0.15 on univariate regression were entered into a stepwise multivariable logistic regression to generate predictive models. Nonroutine discharge was defined as a nonhome discharge destination and prolonged LOS was defined as LOS greater than the 75th percentile for the entire cohort. RESULTS Three hundred twenty-eight patients who had undergone 348 operations were included: 240 (69.0%) White and 108 (31.0%) Black. On univariable analysis, cohorts significantly differed in age (p = 0.02), marital status (p < 0.001), insurance status (p = 0.03), income quartile (p = 0.02), primary tumor type (p = 0.04), and preoperative Karnofsky Performance Scale (KPS) score (p < 0.001). On multivariable analysis, race was an independent predictor for nonroutine discharge: Black patients had significantly higher odds of nonroutine discharge than White patients (adjusted odds ratio [AOR] 2.24, 95% confidence interval [CI] 1.28–3.92, p = 0.005). Older age (AOR 1.06 per year, 95% CI 1.03–1.09, p < 0.001), preoperative KPS score ≤ 70 (AOR 3.30, 95% CI 1.93–5.65, p < 0.001), preoperative Frankel grade A–C (AOR 3.48, 95% CI 1.17–10.3, p = 0.02), insurance status (p = 0.005), being unmarried (AOR 0.58, 95% CI 0.35–0.97, p = 0.04), number of levels (AOR 1.17 per level, 95% CI 1.05–1.31, p = 0.004), and thoracic involvement (AOR 1.71, 95% CI 1.02–2.88, p = 0.04) were also predictive of nonroutine discharge. However, race was not independently predictive of postoperative complications or prolonged LOS. Higher Charlson Comorbidity Index (AOR 1.22 per point, 95% CI 1.04–1.43, p = 0.01), low preoperative KPS score (AOR 1.84, 95% CI 1.16–2.92, p = 0.01), and number of levels (AOR 1.15 per level, 95% CI 1.05–1.27, p = 0.004) were predictive of complications, while insurance status (p = 0.05), income quartile (p = 0.01), low preoperative KPS score (AOR 1.64, 95% CI 1.03–2.72, p = 0.05), and number of levels (AOR 1.16 per level, 95% CI 1.05–1.30, p = 0.004) were predictive of prolonged LOS. CONCLUSIONS Race, insurance status, age, baseline functional status, and marital status were all independently associated with nonroutine discharge. This suggests that a combination of socioeconomic factors and functional status, rather than medical comorbidities, may best predict postdischarge disposition in patients treated for spinal metastases. Further investigation in a prospective cohort is merited.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

Few predictors of massive deep vein thrombosis

2005 ◽  
Vol 94 (11) ◽  
pp. 986-990 ◽  
Author(s):  
Hylton Joffe ◽  
Nils Kucher ◽  
Victor Tapson ◽  
Samuel Goldhaber
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Adjusted Odds Ratio ◽  
Independent Predictor ◽  
Multivariable Logistic Regression Analysis ◽  
Vein Thrombosis ◽  
Younger Age ◽  
Deep Vein

SummaryFactors that predispose to thrombus propagation from the femoropopliteal veins to the pelvic veins are poorly understood. Our goal was to determine whether there are characteristics that identify patients with massive deep vein thrombosis (DVT). We compared the 122 (2.5%) patients presenting with massive DVT (pelvic plus lower-extremity DVT) to the 4,674 (97.5%) patients with isolated lower-extremity DVT from a prospective United States multicenter DVT registry. Patients with massive DVT were younger (59.4±18.9 years vs. 64.3±16.8 years; p<0.01), less likely to have hypertension (40% vs. 51%; p=0.02), and more likely to smoke (21% vs. 13%; p=0.02) and have on- going radiation therapy (7% vs. 3%; p=0.02). The massive DVT group more commonly presented with extremity edema (80% vs. 69%; p<0.01) and erythema (21% vs. 12%; p<0.01) than the isolated lower-extremity DVT group. However, after multivariable logistic regression analysis, extremity erythema (adjusted odds ratio 1.86; 95% CI 1.13–3.04) was the only independent sequela of massive DVT and younger age (adjusted odds ratio 1.17 per decreasing decade of age; 95% confidence interval: 1.02-1.34) was the only independent predictor of massive DVT. Thrombus propagation from the femoropopliteal system cannot be reliably predicted using demographic or clinical characteristics.

scholarly journals Marital status, an independent predictor for survival of gastric neuroendocrine neoplasm patients: a SEER database analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu-Jie Zhou ◽  
Xiao-Fan Lu ◽  
Kenneth I. Zheng ◽  
Qi-Wen Wang ◽  
Jin-Nan Chen ◽  
...  
Keyword(s):  
Marital Status ◽  
Independent Predictor ◽  
Neuroendocrine Neoplasm ◽  
Seer Database ◽  
Database Analysis

Variations in the Seasonal Distribution of Births of Psychotic Patients in England and Wales

1978 ◽  
Vol 132 (2) ◽  
pp. 155-158 ◽  
Author(s):  
E. H. Hare
Keyword(s):  
Personality Disorder ◽  
General Population ◽  
Older Patients ◽  
Age Groups ◽  
Seasonal Distribution ◽  
Fourth Quarter ◽  
Affective Psychosis ◽  
England And Wales ◽  
Live Births ◽  
Younger Age

SummaryThe quarterly distribution of births of patients born in England and Wales 1921–60 and first admitted in 1970–75 was examined by decade of birth and by age at year of admission. For patients with schizophrenia and affective psychosis, the distribution varied: in the early decade (1921–30), and for older patients (45–54 years) the proportion of births in the fourth quarter of the year was high, compared with expectation from live births in the general population; but it became lower in succeeding decades and for younger age groups. No comparable change occurred for births of patients with neurosis or personality disorder.

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