Trends and Utilization of Inpatient Palliative Care Among Patients With Metastatic Bladder Cancer

2020 ◽  
pp. 082585972092493 ◽  
Author(s):  
Hedong Han ◽  
Feifei Yu ◽  
Cheng Wu ◽  
Lihe Dai ◽  
Yiming Ruan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Bladder Cancer ◽  
Mortality Risk ◽  
International Classification Of Diseases ◽  
The United States ◽  
Related Factors ◽  
Cross Sectional ◽  
Metastatic Bladder Cancer ◽  
Using Data ◽  
Hospital Characteristics

Objective: To explore the trends and utilization of palliative care (PC) service among inpatients with metastatic bladder cancer (MBC). Methods: A retrospective, cross-sectional analysis was performed using data from the 2003 to 2014 National Inpatient Sample. Palliative care was identified through International Classification of Diseases, Ninth Revision code V66.7. Demographics, comorbidities, hospital characteristics, tumor-related, and treatment-related factors were compared between patients with and without PC. Multivariable logistic regression was used to explore predictors of PC use. Results: Among 131 852 patients with MBC, 13 224 (10.03%) received PC. Rate of PC increased from 2.49% in 2003 to 28.39% in 2014 ( P < .0001). Similarly, rate of PC in decedents increased from 7.02% in 2003 to 54.86% in 2014 ( P < .0001). Patients receiving PC were older, tendered to be white, had more comorbidities, and higher all-patient refined diagnosis-related group mortality risk. Predictors of PC included age (odds ratio [OR]: 1.02; 95% CI: 1.01-1.02; P < .0001), Medicaid (OR: 1.87; 95%.CI: 1.54-2.26; P < .0001), and private (OR: 1.61; 95% CI: 1.40-1.84; P < .0001) insurance, hospitals in the West (OR: 1.33; 95% CI: 1.10-1.61; P = .0032), and Mid-west (OR: 1.46; 95% CI: 1.22-1.75; P = .0032), major (OR: 1.32; 95% CI: 1.11-1.49; P < .0001), and extreme (OR: 2.37; 95% CI: 2.04-2.76; P < .0001) mortality risk. Chemotherapy and mechanical ventilation were related with lower odds of PC use. Palliative care predictors in the decedents were similar to those in overall patients with bladder cancer. Conclusions: Palliative care encounter in MBC shows an increasing trend. However, it still remains very low. Disparities in PC use covered age, insurance, and hospital characteristics among metastatic bladder cancer in the United States.

scholarly journals COVID-19-Related Changes in Perceived Household Food Waste in the United States: A Cross-Sectional Descriptive Study

2021 ◽  
Vol 18 (3) ◽  
pp. 1104
Author(s):  
Kelly Cosgrove ◽  
Maricarmen Vizcaino ◽  
Christopher Wharton
Keyword(s):  
Logistic Regression ◽  
Food Waste ◽  
The United States ◽  
Food Groups ◽  
Related Factors ◽  
Cross Sectional ◽  
Household Level ◽  
Binomial Logistic Regression ◽  
Household Food ◽  
Fresh Vegetables

Food waste contributes to adverse environmental and economic outcomes, and substantial food waste occurs at the household level in the US. This study explored perceived household food waste changes during the COVID-19 pandemic and related factors. A total of 946 survey responses from primary household food purchasers were analyzed. Demographic, COVID-19-related household change, and household food waste data were collected in October 2020. Wilcoxon signed-rank was used to assess differences in perceived food waste. A hierarchical binomial logistic regression analysis was conducted to examine whether COVID-19-related lifestyle disruptions and food-related behavior changes increased the likelihood of household food waste. A binomial logistic regression was conducted to explore the contribution of different food groups to the likelihood of increased food waste. Perceived food waste, assessed as the estimated percent of food wasted, decreased significantly during the pandemic (z = −7.47, p < 0.001). Food stockpiling was identified as a predictor of increased overall food waste during the pandemic, and wasting fresh vegetables and frozen foods increased the odds of increased food waste. The results indicate the need to provide education and resources related to food stockpiling and the management of specific food groups during periods of disruption to reduce food waste.

The influence of prescriber and patient gender on the prescription of benzodiazepines: results from the Florida Medicaid Dataset

CNS Spectrums ◽  
2021 ◽  
pp. 1-5
Author(s):  
Leanna M. W. Lui ◽  
Yena Lee ◽  
Orly Lipsitz ◽  
Nelson B. Rodrigues ◽  
Hartej Gill ◽  
...  
Keyword(s):  
The United States ◽  
Sociodemographic Factors ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Assistance Program ◽  
Patient Gender ◽  
Prescription Rates ◽  
Male Patients ◽  
Using Data ◽  
Main Effects

Abstract Background Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription. Methods Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety. Results Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively. Conclusions Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.

Increasing Sepsis Rates in the United States: Results From National Inpatient Sample, 2005 to 2014

2018 ◽  
Vol 35 (9) ◽  
pp. 858-868 ◽  
Author(s):  
Muni Rubens ◽  
Anshul Saxena ◽  
Venkataraghavan Ramamoorthy ◽  
Sankalp Das ◽  
Rohan Khera ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
The United States ◽  
Relative Increase ◽  
National Inpatient Sample ◽  
Readmission Rates ◽  
Cross Sectional ◽  
Hospitalization Cost ◽  
Classification Of Diseases ◽  
Coding Rules ◽  
Age And Sex

Objectives:To examine the trends in hospitalization rates, mortality, and costs for sepsis during the years 2005 to 2014.Methods:This was a retrospective serial cross-sectional analysis of patients ≥18 years admitted for sepsis in National Inpatient Sample. Trends in sepsis hospitalizations were estimated, and age- and sex-adjusted rates were calculated for the years 2005 to 2014.Results:There were 541 694 sepsis admissions in 2005 and increased to 1 338 905 in 2014. Sepsis rates increased significantly from 1.2% to 2.7% during the years 2005 to 2014 (relative increase: 123.8%; Ptrend< .001). However, the relative increase changed by 105.8% ( Ptrend< .001) after adjusting for age and sex and maintained significance. Although total cost of hospitalization due to sepsis increased significantly from US$22.2 to US$38.1 billion ( Ptrend< .001), the mean hospitalization cost decreased significantly from US$46,470 to US$29,290 ( Ptrend< .001).Conclusions:Hospitalizations for sepsis increased during the years 2005 to 2014. Our study paradoxically found declining rates of in-hospital mortality, length of stay, and mean hospitalization cost for sepsis. These findings could be due to biases introduced by International Classification of Diseases, Ninth Revision, Clinical Modification coding rules and increased readmission rates or alternatively due to increased awareness and surveillance and changing disposition status. Standardized epidemiologic registries should be developed to overcome these biases.

Trends in metastatic bladder cancer incidence and prognosis by histologic subtypes.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 322-322 ◽  
Author(s):  
Thuy Koll ◽  
Xiang Fang ◽  
Shanmuga Subbiah
Keyword(s):  
Bladder Cancer ◽  
Survival Data ◽  
Transitional Cell ◽  
Palliative Surgery ◽  
Common Type ◽  
Metastatic Bladder Cancer ◽  
Common Grade ◽  
Poorly Differentiated ◽  
Using Data ◽  
Signet Cell

322 Background: Approximately 5% of patients present with metastatic bladder cancer (MBC) at diagnosis.We aim to assess the trends of MBC at presentation over the last two decades using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Retrospective analysis of MBC patients at presentation was done using data from SEER for 1988-2003. Age, Sex, Histology, Race, use of palliative surgery and survival data was extracted. Results: 9357 patients with MBC were identified. Incidence of MBC remained same in the last 2 decades (6.05% vs 6.34%). The most common histology was (TCC) transitional cell with least common being Signet cell. Squamous cell carcinoma (SCC) was common in African Americans and in females. Common grade at presentation was poorly differentiated. Palliative surgery was done in 18.15% patients with radical cystectomy being the common type of surgery. Median survival was better in TCC with the worst outcomes in patients with SCC (Table). Conclusions: Incidence of MBC at presentation hasn’t changed over the last two decades with TCC being the most common type. Clinical trials integrating targeted therpy with chemotherapy is needed to improve outcomes of MBC patients. [Table: see text] 

A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States

2018 ◽  
Vol 17 (03) ◽  
pp. 269-275 ◽  
Author(s):  
Samuel M. Kase ◽  
Elisha D. Waldman ◽  
Andrea S. Weintraub
Keyword(s):  
United States ◽  
Palliative Care ◽  
Pilot Study ◽  
Compassion Fatigue ◽  
Compassion Satisfaction ◽  
Clinical Situation ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Care Providers ◽  
Cross Sectional

AbstractObjectiveCompassion fatigue (CF) is secondary traumatic distress experienced by providers from contact with patients' suffering. Burnout (BO) is job-related distress resulting from uncontrollable workplace factors that manifest in career dissatisfaction. Compassion satisfaction (CS) is emotional fulfillment derived from caring for others. The literature on BO in healthcare providers is extensive, whereas CF and CS have not been comprehensively studied. Because of ongoing exposure to patient and family distress, pediatric palliative care (PPC) providers may be at particular risk for CF. We conducted a cross-sectional pilot study of CF, BO, and CS among PPC providers across the United States.MethodThe Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of professional and personal characteristics were distributed electronically and anonymously to PPC physicians and nurses. Logistic and linear regression models for CF, BO, and CS as a function of potential risk factors were constructed.ResultsThe survey response rate was 39%, primarily consisting of female, Caucasian providers. The prevalence of CF, BO, and CS was 18%, 12%, and 25%, respectively. Distress about a “clinical situation,” physical exhaustion, and personal loss were identified as significant determinants of CF. Distress about “coworkers,” emotional depletion, social isolation, and “recent involvement in a clinical situation in which life-prolonging activities were not introduced” were significant determinants of BO. Physical exhaustion, personal history of trauma, “recent involvement in a clinical situation in which life-prolonging activities were not introduced,” and not discussing distressing issues were significant predictors of lower CS scores.Significance of resultsCF and BO directly influence the well-being and professional performance of PPC providers. To provide effective compassionate care to patients, PPC providers must be attentive to predictors of these phenomena. Further work is needed to explore additional causes of CF, BO, and CS in PPC providers as well as potential interventions.

scholarly journals Exploring the Association Between Electronic Wearable Device Use and Levels of Physical Activity Among Individuals With Depression and Anxiety: A Population Level Study

2021 ◽  
Vol 3 ◽  
Author(s):  
Henry Onyeaka ◽  
Joe Firth ◽  
Valentine Enemuo ◽  
Chioma Muoghalu ◽  
John Naslund ◽  
...  
Keyword(s):  
Physical Activity ◽  
United States ◽  
Large Scale ◽  
Population Level ◽  
The United States ◽  
Individual Characteristics ◽  
Activity Levels ◽  
Depression And Anxiety ◽  
Related Factors ◽  
Cross Sectional

Aim: The present study aimed to investigate the cross-sectional association between self-reported use of electronic wearable devices (EWDs) and the levels of physical activity among a representative sample of adults with depression and anxiety in the United States.Methods: For this cross-sectional study, data were pooled from the Health Information National Trends Survey 2019. A sample of 1,139 adults with self-reported depression and anxiety (60.9% women; mean age of 52.5 years) was analyzed. The levels of physical activity and prevalence of EWD utilization were self-reported. The chi-square tests were used to compare individual characteristics through the use of EWDs. Multivariable logistic regression was employed to investigate the association between EWDs and physical activity levels while adjusting for sociodemographic and health-related factors.Results: From the 1,139 adults with self-reported depression and anxiety, 261 (weighted percentage 28.1%) endorsed using EWD in the last year. After adjusting for covariates, the use of EWDs was only significantly associated with a higher odds of reporting intention to lose weight (OR 2.12; 95% CI 1.04, 4.35; p = 0.04). We found no association between the use of EWDs and meeting the national weekly recommendation for physical activity or resistance/strength exercise training.Conclusion: About three in 10 adults suffering from depression and anxiety in the United States reported using EWDs in the last year. The current study findings indicate that among people living with mental illness, EWD use is associated with higher odds of weight loss intent suggesting that EWDs may serve as an opening for the clinical interactions around physical health through identifying patients primed for behavior change. Further large-scale studies using randomized trial designs are needed to examine the causal relationships between EWDs and the physical activity of people with mental health conditions.

Hearing Impairment and Loneliness in Older Adults in the United States

2020 ◽  
pp. 073346482094408
Author(s):  
Alison R. Huang ◽  
Jennifer A. Deal ◽  
George W. Rebok ◽  
Jayant M. Pinto ◽  
Linda Waite ◽  
...  
Keyword(s):  
Social Interactions ◽  
Hearing Impairment ◽  
Social Life ◽  
The United States ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Comorbidity Index ◽  
Reported Health ◽  
Using Data ◽  
Fair Poor

Hearing impairment impacts fluidity of communication and social interactions and thus may contribute to loneliness. We investigated the cross-sectional association between hearing impairment and loneliness in community-dwelling older U.S. adults using data from the National Social Life, Health, and Aging Project ( N = 3,196). Individuals reporting fair/poor hearing had 50% (95% confidence interval [CI] = [1.09–2.05]) higher odds of any loneliness compared with those reporting excellent hearing after adjusting for comorbidity index, functional and cognitive ability, self-reported health, and demographic characteristics. Test for trend suggests a dose–response relationship over levels of hearing impairment. Hearing impairment is highly prevalent and may be an important target for consideration in interventions to reduce loneliness. Further investigation of whether treatment of hearing impairment alleviates loneliness and its disabling effects is also needed.

scholarly journals Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Kathryn E Marqueen ◽  
Nikhil Waingankar ◽  
John P Sfakianos ◽  
Reza Mehrazin ◽  
Scot A Niglio ◽  
...  
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
High Risk ◽  
Mortality Risk ◽  
Cross Validation ◽  
The United States ◽  
Early Mortality ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Quality Adjusted Life

Abstract Background Although radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), for many patients the risks versus benefits of RC may favor other approaches. We sought to define the landscape of early postcystectomy mortality in the United States and identify patients at high risk using pretreatment variables. Methods We identified patients with MIBC (cT2-T4aN0M0) who underwent RC without perioperative chemotherapy within the National Cancer Database (2003–2012). Using multistate multivariable modeling, we calculated time spent in three health states: hospitalized, discharged, and death more than 90 days postcystectomy. Cross-validation was performed by geographic region. Time spent in each state was weighted by utility to determine 90-day quality-adjusted life days (QALDs). Results Among 7922 patients, 90-day mortality was 7.6% (8.0% for lower and 6.7% for higher volume hospitals). Increasing age, clinical T stage, Charlson Comorbidity Index, and lower volume were associated with higher 90-day mortality and were included in the model. Cross-validation revealed appropriate performance (C-statistics of 0.53–0.74; calibration slopes of 0.50–1.67). The model predicted 25% of patients had a 90-day mortality risk higher than 10%, and observed 90-day mortality in this group was 14.0% (95% CI = 12.5% to 15.6%). Mean quality-adjusted life days (QALDs) was 63 (range = 44–68). Conclusions RC is associated with relatively high early mortality risk. Pretreatment variables may identify patients at particularly high risk, which may inform clinical trial design, facilitate shared decision making, and enhance quality improvement initiatives.

scholarly journals The Role of Imaging in Bladder Cancer Diagnosis and Staging

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 703
Author(s):  
Samuel J. Galgano ◽  
Kristin K. Porter ◽  
Constantine Burgan ◽  
Soroush Rais-Bahrami
Keyword(s):  
Bladder Cancer ◽  
Metastatic Disease ◽  
Fdg Pet ◽  
Imaging Modality ◽  
Treatment Decision ◽  
The United States ◽  
Imaging Evaluation ◽  
Cross Sectional ◽  
Locoregional Staging

Bladder cancer (BC) is the most common cancer of the urinary tract in the United States. Imaging plays a significant role in the management of patients with BC, including the locoregional staging and evaluation for distant metastatic disease, which cannot be assessed at the time of cystoscopy and biopsy/resection. We aim to review the current role of cross-sectional and molecular imaging modalities for the staging and restaging of BC and the potential advantages and limitations of each imaging modality. CT is the most widely available and frequently utilized imaging modality for BC and demonstrates good performance for the detection of nodal and visceral metastatic disease. MRI offers potential value for the locoregional staging and evaluation of muscular invasion of BC, which is critically important for prognostication and treatment decision-making. FDG-PET/MRI is a novel hybrid imaging modality combining the advantages of both MRI and FDG-PET/CT in a single-setting comprehensive staging examination and may represent the future of BC imaging evaluation.

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