Old Patients and Uremia: Rates of Acceptance to and Withdrawal from Dialysis

1987 ◽  
Vol 10 (3) ◽  
pp. 166-172 ◽  
Author(s):  
D.G. Husebye ◽  
C.M. Kjellstrand
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Age Groups ◽  
The United States ◽  
Living Situation ◽  
Term Survival ◽  
Old Patients ◽  
Hennepin County ◽  
Number Of Patients ◽  
Patients At Risk

We studied the entry of elderly uremic patients to chronic dialysis in the U.S. in 1979. We also reviewed long-term survival, causes of death, and risk factors for death in old patients on dialysis at one center for the period 1966 to 1983. A comparison of the number of patients at risk with the number entering dialysis in the United States in 1979 indicates that 80% of the patients aged 25-45 years, 30% of patients over the age of 65 years, and 6% of those over the age of 75 years entered dialysis during that period. Of 239 patients over the age of 70 years followed at the Regional Kidney Disease Program at Hennepin County Medical Center in Minneapolis, the seven-year cumulative survival was 17%. In this program withdrawal from dialysis was the commonest cause of death, accounting for 40% of all deaths. Age groups over 75 years, sex, time period, duration of dialysis, eight pre-existing degenerative diseases, living situation, family support, and site and type of dialysis were not risk factors for termination of dialysis, but living in a nursing home was. When compared to the young, total deaths and deaths from discontinuation were much higher, and this decision was made earlier. Half of the patients who died because dialysis was discontinued were competent and decided for themselves; the other half were incompetent and families and physicians made the decision. Thus, old patients do not live as long, and they withdraw from dialysis more frequently than the young. Qualitatively, though, the decisions to stop dialysis are no different from those decisions made by or for younger patients.

Excellent Outcome In Infants below One Year of Age with AML – Results of Studies AML-BFM -98 and -2004

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 17-17 ◽  
Author(s):  
Ursula Creutzig ◽  
Zimmermann Martin ◽  
Michael Dworzak ◽  
Jean-Pierre Bourquin ◽  
Christine Neuhoff ◽  
...  
Keyword(s):  
Death Rate ◽  
Age Groups ◽  
Interquartile Range ◽  
Term Survival ◽  
Old Patients ◽  
Liposomal Daunorubicin ◽  
Total Group ◽  
Off Label ◽  
Number Of Patients ◽  
Pediatric Aml

Abstract Abstract 17 Infants <1 year of age with AML are very vulnerable patients who may not tolerate intensive treatment, which is however required to achieve complete remission (CR) and long-term survival. In several pediatric AML studies, outcome of this age group is described as unfavorable. Here we report the improved outcome of 108 infants with AML (Down syndromes excluded) who were treated within the studies AML-BFM 98 and -2004 until end of 2008. Treatment regimens of study AML-BFM 98 (see Creutzig, J Clin Oncol 24, 2006) and AML-BFM 2004 were largely similar. AML-BFM 2004: Induction with AIE (cytarabine, idarubicin and etoposide) or ADxE (Dx=liposomal daunorubicin) - exclusively in high-risk (HR) patients supplemented by HAM (high-dose cytarabine [HD-Ara-C] and mitoxantrone) - continued by two short therapy cycles with medium and HD-Ara-C and anthracyclines, followed by intensification with HAE (HD-Ara-C and etoposide) and maintenance. Allogeneic stem cell-transplantation (SCT) in 1st CR from a family donor was restricted to HR patients. Drug dosage was generally calculated according to bodyweight instead of bodysurface in this age cohort; HD-Ara-C was dose adjusted for age (from 20% in the <3-month- to 60% in >11-month-olds). Patients' age was 0.6 years in median (interquartile range 0.3 –0.7 years) and white blood cell count 26,000μ /L (interquartile range 8,500 – 106,250μ /L). Most infants (103/108) were HR patients according to morphology, cytogenetics, molecular genetics, and therapy response. Four of the 5 standard risk patients had favorable cytogenetics with inv(16) and t(15;17); 47/90 (52%) patients with data showed a MLL rearrangement. Results in this cohort of infants were similar compared to older HR patients. Early death rate was higher by trend compared to 1–3 year old patients: 6/108 (5.6%) vs. 3/156 (1.9%), px2 0.12; non-response rates were similar: 11/108 (10.2%) vs. 14/154 (9.1%), px2 0.77. Overall survival (OS) in the total group (n=108) was 68%+5%. OS improved from study -98 to -2004 from 60%+6% (n=59) to 78%+6% (n=49), plogrank 0.07. Event-free survival (EFS) in the total group was 45%+5%; EFS results in study -98 vs. -2004 were similar: 43%+7% vs. 47%+8%, plogrank 0.98. There was no difference in OS, EFS and cumulative incidence for relapse in infants aged 1–3, 4–6, 7–9 or 10–12 months, regardless of whether presenting with or without initial CNS involvement, MLL rearrangement or other molecular-/cytogenetic features (the number of patients with favorable cytogenetic was too low). Results for HR infants (95% of the patients) were similar to those in older age groups (1-2 or 2–10 year olds, plogrank 0.75). All 8 patients receiving allogeneic (SCT) in 1st remission survived although 2 children relapsed. Five of 10 patients transplanted after initial non-/partial response and 19/30 patients transplanted after relapse are still alive. Survival after relapse (n=37) was 50±8%. The rate of grade III/IV toxicities after induction was highest in infants <1 year of age and decreased in the age groups of 1–2 and 2–3 years (general condition 52% vs. 44% vs. 30%, (px2 <1 vs. 2–3 years 0.07); infection 47% vs.49% vs. 23% (px2 <1 vs. 2–3 year olds 0.06); lung problems, e.g. artificial respirator needed 31% vs. 18% vs. 0% (px2 <1 vs. 2–3 years 0.01); whereas the treatment related death rate was in the same range as in older patients (4%). Conclusion: Our data show that intensive AML treatment is feasible in infants. Toxicities can be managed, and outcome is excellent, which is partly due to salvage therapy after relapse, with a present 5-year OS rate of 78%. *Supported by the Deutsche Krebshilfe e.V. Disclosures: Off Label Use: liposomal daunorubicin is used, which is off label for pediatric AML. It was used because it offers a possibility to increase cumulative dosages of anthracyclines with lower cardiotoxicity.

scholarly journals Increasing Incidence of Blastomycosis Infection in Vermont

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S84-S85 ◽  
Author(s):  
Porntip Kiatsimkul
Keyword(s):  
Medical Center ◽  
The United States ◽  
Common Disease ◽  
Invasive Infection ◽  
Fungal Culture ◽  
Disseminated Infection ◽  
South Central ◽  
Urine Antigen ◽  
Number Of Patients ◽  
Disseminated Disease

Abstract Background Blastomycosis is an invasive infection caused by the ubiquitous fungus Blastomyces. The clinical presentation ranges from limited cutanenous infections to pneumonia and disseminated disease. Endemic areas in the United States include: midwestern, south-central, and southeastern states; yearly incidence is &lt;0.3 cases per 100,000. Diagnosis is based on recovery of the organism on fungal culture. A urine antigen test is available for the detection of blastomycosis which has a sensitivity of 92.9% and specificity of 79.3%. Anecdotally, an increasing number of patients are presenting to the University of Vermont Medical Center (UVMMC) with disseminated blastomycosis – an area in which the fungus is rare. We hoped to determine the incidence of blastomycosis in Vermont over a 10-year period and examine the sensitivity of the urine antigen in our patient population. Methods After IRB approval, medical record numbers of all patients who had BD-glucan, blastomyces urine antigen, culture, or pathology positive for blastomyces during a 10-year period (2006–2016) were obtained. Chart review completed for all patients with diagnosis of blastomycosis. Data collected on demographic characteristics: zip code, comorbidities, site of infection, HIV, BD-glucan, blastomyces urine antigen, fungal culture, and treatment duration. Results Forty-one blastomycosis cases were found; 39 cases in Vermont residents. The incidence rate Vermont was 0.7 cases per 100,000. Mean age was 49 years, 60% of patients were male. Most patients had pulmonary (37%) or disseminated infection (37%). 17% of patients had localized cutaneous disease, bone and joint infection (7%) or CNS disease (2%). Urine antigen was positive in 78% overall, and in 90% with disseminated infection. Three deaths, none attributed to blastomycosis. Conclusion Vermont appears to have a higher incidence than what has been reported in the US overall. This increase may have to do with better reporting and testing rather than a true increase in disease. Most common disease presentation was localized pulmonary or disseminated disease. Urine antigen sensitivity ranged from 78% (overall) to 90% (disseminated disease). This appears consistent with what has been reported in other studies, but is lower than the overall reported sensitivity. Disclosures All authors: No reported disclosures.

Effect of young age (<50) on clinical, pathologic features and survival of patients with colorectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14025-e14025
Author(s):  
Jamal Zidan ◽  
Jehad Abu Salah ◽  
Adi Sharabi-Nov
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Medical Center ◽  
Young Patients ◽  
Young Group ◽  
Old Patients ◽  
Pathological Characteristics ◽  
Pathologic Features ◽  
Number Of Patients ◽  
Significant Difference

e14025 Background: Colorectal cancer is one of the most common malignancies in both men and women in Israel. Most patients with colon cancer are older than 50 years of age. However young patients are not rare. There is no consensus in the literature regarding the behavior of this disease in young patients. Clinical and pathological characteristics of colon cancer patients treated at Oncology Institute in Ziv Medical Center were retrospectively analyzed. The aim of the present study is to compare clinical and pathological features of colon cancer between young and old patients. Methods: A total of 200 patients with colon cancer were treated at our institute during 8 years. Twenty five (12.5%) of them were <50 years age (young patients) at diagnosis. All clinical and pathological characteristics were taken retrospectively from the hospital files. In situations where the pathological findings were not noted in the chart, review of the stored tumor was requested from the pathology department. Acceptable statistical methods were used for statistical calculations. Results: Among the 200 patients 25 (12.5%) were <50 years age at diagnosis (mean age 41 years) and 175 were >50 years (mean age 70 years). Males were 56% of the young group and 60.1% of the old one. Arab patients were 52% of the young and only 12.6% of the old group although total number of Arabs was 35 of 200 patients. No significant difference was found in stage of tumor at diagnosis between the young group (YG) and the old group (OG). Twenty percent of YG had distant metastases compared to 26.5% in the OG. Histopathological grade 3 tumors were found in 33.3% of the YG versus 7.7% in the OG. Surgery and chemotherapy were done in 96% and 88% in YG versus 95.4% and 69.7% in the OG respectively. In a median follow up period of 96 months 35% of young patients died of their disease compared to 33.1% of the old patients. Conclusions: Young patients with colon cancer were diagnosed at the same stage of the disease as old patients. More tumors were high grade in YG. More patients were candidates for chemotherapy in the YG. Significantly more Arab patients were young at the time of diagnosis than Jewish patients. Further studies with higher number of patients are suggested to clarify our findings.

Social Security

2012 ◽  
Author(s):  
Larry DeWitt ◽  
Edward D. Berkowitz
Keyword(s):  
United States ◽  
Social Security ◽  
Older People ◽  
Age Groups ◽  
The United States ◽  
Critical Question ◽  
Term Survival ◽  
History Of ◽  
Government Benefits

This chapter considers the history of Social Security, arguing that the 1950 amendments represented the fundamental adjustment that allowed the program’s long-term survival. It analyzes current issues in Social Security related to gender, race, and the program’s long-term solvency. It concludes that Social Security has legitimized the receipt of government benefits among many Americans and changed the nature of old age in the United States by providing older people with a guaranteed means of support. A large and costly program, Social Security has evolved into the United States’ major antipoverty program. Nonetheless it faces the criticism of those who argue that it favors older people over other age groups and that it represents an inefficient form of government coercion. Whether the program will be sustained in the future or modified in a significant way remains a critical question.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

2004 ◽  
Vol 8 (5) ◽  
pp. 303-309 ◽  
Author(s):  
Anatoli Freiman ◽  
John Yu ◽  
Antoine Loutfi ◽  
Beatrice Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
High Risk Population ◽  
Awareness Campaigns ◽  
Number Of Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
And Behavior ◽  
Attitudes And Behavior

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

scholarly journals 464. Structural Vulnerability among Patients with HIV and SARS-CoV-2 Coinfection: Descriptive Case Series from the U.S. Midwest

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S334-S335
Author(s):  
Natasha E Hongsermeier-Graves ◽  
Rohan Khazanchi ◽  
Nada Fadul
Keyword(s):  
Risk Factors ◽  
Disease Progression ◽  
Legal Status ◽  
Medical Center ◽  
Disease Incidence ◽  
Demographic Data ◽  
Case Series ◽  
Retrospective Chart Review ◽  
The United States ◽  
Hiv Disease

Abstract Background It is well known that the HIV epidemic and COVID-19 pandemic have both disproportionately harmed marginalized minority and immigrant communities in the United States. The risk factors associated with disease incidence and outcomes reaffirm that structural vulnerabilities—sociopolitically imposed risk factors like discrimination, legal status, poverty, and beyond which impact a patient’s opportunity to achieve optimal health—play a key role in facilitating the inequitable harms of COVID-19 and HIV alike. This study explores the role of structural forces in increasing the risk of SARS-CoV-2 coinfection among people with HIV (PWH). Methods We performed a retrospective chart review of PWH receiving care at the University of Nebraska Medical Center HIV clinic in Omaha, Nebraska, to collect patient demographics, comorbidities, HIV outcomes, and COVID-19 outcomes for 37 patients with HIV and SARS-CoV-2 coinfection as of August 27, 2020. As a comparison group, we obtained demographic data from a registry of all patients seen at the HIV clinic. We used R Statistical Software to perform descriptive statistical analysis. Results Relative to our overall HIV clinic population, over twice as many Hispanic patients (35.1% vs. 16.0%), three times as many undocumented patients (13.5% vs. 4.2%), and four times as many refugee patients (16.2% vs. 4.0%) had COVID-19. The majority (67.6%) of coinfected patients reported working in “essential” jobs during the pandemic. Thirty-four of the 37 people with HIV and COVID-19 (PWHC) had at least one comorbidity, including increased BMI (83.7%), hypertension (64.9%), or hyperlipidemia (48.6%). All 37 PWHC remained alive as of October 4, 2020. Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry (continued) Conclusion The disproportionate burden of SARS-CoV-2 coinfection on Hispanic, undocumented, and refugee PWH may be a product of structural vulnerabilities contributing to greater risk of exposure. Although all 37 PWHC had well-controlled HIV and relatively mild COVID-19 courses, the broader theme of disproportionate COVID-19 incidence among vulnerable sub-populations of people with HIV reaffirms the importance of structural interventions to mitigate current and downstream harms. Disclosures All Authors: No reported disclosures

scholarly journals Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

2021 ◽  
Author(s):  
Celia Stafford ◽  
Wesley Marrero ◽  
Rebecca B. Naumann ◽  
Kristen Hassmiller Lich ◽  
Sarah Wakeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Geographic Region ◽  
Influential Factors ◽  
Opioid Use ◽  
Living Situation ◽  
Data Set ◽  
Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

scholarly journals Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

Kidney360 ◽  
2020 ◽  
Vol 1 (6) ◽  
pp. 569-579 ◽  
Author(s):  
Masood Ahmad ◽  
Eric L. Wallace ◽  
Gaurav Jain
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
The United States ◽  
Absolute Number ◽  
Team Approach ◽  
Home Dialysis ◽  
Education Of Patients ◽  
Number Of Patients ◽  
Experienced Nurse

Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.

Presentation of Wegener's Granulomatosis in Young Patients

1986 ◽  
Vol 94 (3) ◽  
pp. 368-371 ◽  
Author(s):  
Lucinda A. Halstead ◽  
Collin S. Karmody ◽  
Sheldon M. Wolff
Keyword(s):  
Head And Neck ◽  
Wegener’S Granulomatosis ◽  
Medical Center ◽  
Nasal Congestion ◽  
Age Groups ◽  
Young Patients ◽  
Wegener's Granulomatosis ◽  
Upper Respiratory Tract ◽  
Presenting Symptoms ◽  
Number Of Patients

We have reviewed 50 cases of Wegener's granulomatosis, seen at the New England Medical Center Hospital between 1970 and 1984, and were impressed that 10 (20%) of these patients were under 25 years of age, with ages ranging from 13 to 23 years. Closer examination of this younger group revealed striking differences in their presenting symptoms and organ Involvement when compared to the older group of patients. The presentation of these young patients was varied, with no single predominant symptom. Patients presented with otalgia and otitis media or hearing loss, fulminant sinusitis, arthralgias, and even corneal ulcers. Only one patient had “typical” rhinitis and nasal congestion. This group also had a disproportionate number of patients with involvement of the oral cavity, skin, and trachea. Biopsy of these sites frequently demonstrated necrotizing vasculitis. Three of our 50 patients had intracranial involvement, leading to transient hemiplegia in the first, permanent hemiplegia in the second, and a seizure disorder in the third. Two of these patients were in the younger age group. The proportion of patients with limited and generalized Wegener's granulomatosis was the same in both the younger and older age groups. All the younger patients, however, had manifestations of the disease in the head and neck, while four of the older patients had no symptoms in the upper respiratory tract. The number of young patients in our study emphasizes the fact that Wegener's granulomatosis, indeed, occurs in the younger patient and with a greater frequency than previously supposed. This study suggests that in the teenager and young adult, with an unusual constellation of symptoms of the head and neck and accompanying systemic problems, a diagnosis of Wegener's granulomatosis should be seriously considered.

Epidemiology and primary prevention of feeding and eating disorders

2020 ◽  
pp. 1059-1064
Author(s):  
Katherine A. Halmi
Keyword(s):  
United States ◽  
Risk Factors ◽  
Eating Disorder ◽  
Mortality Rate ◽  
Age Groups ◽  
The United States ◽  
Lifetime Prevalence ◽  
The Past ◽  
Prevention Programmes ◽  
Standardized Mortality Rate

In the past 20 years, the incidence of anorexia nervosa (AN) in industrialized countries has remained stable at 4.2–7.7 new cases per 100,000 per year. During this period, the incidence of bulimia nervosa (BN) has decreased from 12.2 to 6.1 per 100,000. The lifetime prevalence of AN in females in the United States in the past decade was 0.9% and 0.3% in males, and that of BN was 0.88% in females and 0.12% in males in a European study. Binge eating disorder (BED) is the most common eating disorder (ED), with a lifetime prevalence of 3.5% in women in the United States and 2.0% in men. AN has the highest standardized mortality rate of 5.86, followed by BN with a standardized mortality rate of 2.29. Less than half of AN patients have a full recovery, compared to two-thirds of BN patients who recover. The prevalence of EDs is increasing in the Middle East and Asian countries, as well as among Latinos, African-Americans, and Asians in the United States. Body dissatisfaction and a family history of ED are consistent risk factors across all EDs. Perfectionism is a greater risk factor for restricting AN and conduct disorders, and substance abuse and sexual abuse are risk factors for BN and BED. ED prevention programmes have mainly targeted at-risk persons in specific age groups and environments. Both Internet-based and group session programmes have reduced ED-related symptoms. There are multiple issues concerning the implementation and maintenance of prevention programmes, including clinician training, costs, attrition rate, and effectiveness over time.

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