scholarly journals Hemostasis, Hematoma Expansion, and Outcomes after Intracerebral Hemorrhage

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4886-4886
Author(s):  
Paul F Lindholm ◽  
Hau C. Kwaan ◽  
Andrew M Naidech
Keyword(s):  
Quality Of Life ◽  
Machine Learning ◽  
Intracerebral Hemorrhage ◽  
Patient Outcomes ◽  
Platelet Function ◽  
Hematoma Expansion ◽  
Platelet Activity ◽  
Coagulation Activation ◽  
Improve Patient

Background: Intracerebral hemorrhage (ICH) is a serious complication of stroke with significant morbidity and mortality. Intracerebral bleeding and hematoma expansion (HE) cause displacement and damage to brain tissue leading to disability and death. An important approach to improve patient outcomes from ICH is to prevent HE. Our ability to improve patient outcomes depends on our ability to recognize HE and the associated hemostatic mechanisms. This study is designed to evaluate biomarkers of platelet function, coagulation and fibrinolysis and relate these biomarkers to statistically powerful estimates of HE and patient outcomes. Study Design and Methods: Patients with acute ICH within the first 12 hours of the onset of symptoms will be studied to identify hemostasis biomarkers which may predict hematoma expansion. Major inclusion criteria: Spontaneous ICH within 12 hours of symptom onset; age at least 21 years; consent from the patient or a representative. Exclusion criteria: hereditary hemostasis disorders, history of malignancy, vascular malformation suspected or on imaging, sepsis, comorbid condition that is likely to be disabling or fatal, hemoglobin less than 7.5 g/dL, pregnancy. Statistical methods: We will test the hypothesis that each hemostasis biomarker predicts HE by using Mann-Whitney U (for non-parametric) or ANOVA (for normally distributed results). We will set P<0.01 given the multiple biomarkers to be assessed. The 80% power using a Mann-Whitney U to test the hypothesis that the distributions of HE are 3 mL different would require 147 patients (calculations made with PASS v.12, NCSS Inc., Kaysville, UT). Machine learning techniques will be applied to hemostasis biomarkers to predict the modified Rankin score (mRS), T Scores of HRQoL, and T Scores of NIH Toolbox outcomes. Precision-recall and receiver operating characteristic (ROC) curves will be constructed, and area under the curve will be compared. Biomarker selection or companion diagnostics: This study will measure platelet activity, coagulation activation and fibrinolysis in patients with acute onset (less than 12 hours) intracerebral hemorrhage ICH to determine hemostatic mechanisms of hematoma expansion. Global activity of platelets, coagulation factors and fibrinolysis activity are measured by thromboelastogram (TEG) and rotational thromboelastometry (ROTEM) assays. Platelet activity is also measured with Platelet Function assay, PFA-100, Platelet Aspirin Assay and the Platelet P2Y12 Assay. Coagulation activation is measured by Tissue Factor antigen and activity and Thrombin Generation Assay. Fibrinolysis is assayed by Plasmin/antiplasmin (PAP) complex, Fibrinogen, D-Dimer and PAI-1 antigen and activity. Study treatment, endpoints: The hemostatic parameters and hematoma expansion are compared to patient outcomes measured by the mRS and health related quality of life (HRQoL) and objective outcomes measures from the NIH toolbox to determine the relationship to patient outcomes. The mRS is a standard outcome measure for patients with ICH. The NIH developed and validated HRQoL measures Patient-Reported Outcomes Measurement Information System (PROMIS), Quality of Life in Neurological Disorders (Neuro-QoL), and objective function NIH Toolbox are the most sensitive and provide statistically powerful estimates of patient outcomes in survivors of ICH. Future Directions: This study is designed to identify hemostatic factor abnormalities and mechanisms of ICH hematoma expansion treatable with targeted therapies (e.g., desmopressin to counteract aspirin effect or fibrinolysis inhibitors). Machine learning algorithms will be employed for predicting patient outcomes after ICH and may illuminate when HE is most impactful and determine specific therapies which improve patient outcomes. This study is funded by a National Institutes of Health (NIH)/ The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant ID: SP0049593; R01 NS110779. Disclosures Naidech: NIH: Other: NS110779-Grant.

Ulcerative colitis

2019 ◽  
Vol 12 (9) ◽  
pp. 501-506
Author(s):  
Charlie Andrews
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Primary Care ◽  
Patient Outcomes ◽  
Colon And Rectum ◽  
Inflammatory Bowel ◽  
Primary Care Clinicians ◽  
Improve Patient ◽  
Prompt Diagnosis

Ulcerative colitis is a form of inflammatory bowel disease. It is a chronic relapsing condition affecting the colon and rectum and can cause a variety of symptoms, the commonest of which is bloody diarrhoea. Prompt diagnosis, as well as flare identification and management by primary care clinicians can improve patient outcomes such as disease progression and effects on quality of life.

scholarly journals Analysis of ergonomic and unergonomic human lifting behaviors by using Inertial Measurement Units

2017 ◽  
Vol 3 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Jan Kuschan ◽  
Henning Schmidt ◽  
Jörg Krüger
Keyword(s):  
Quality Of Life ◽  
Machine Learning ◽  
Angular Velocity ◽  
Musculoskeletal System ◽  
Occupational Diseases ◽  
Inertial Measurement Units ◽  
Inertial Measurement ◽  
Measurement Units ◽  
Main Components

Abstract:This paper presents an analysis of two distinct human lifting movements regarding acceleration and angular velocity. For the first movement, the ergonomic one, the test persons produced the lifting power by squatting down, bending at the hips and knees only. Whereas performing the unergonomic one they bent forward lifting the box mainly with their backs. The measurements were taken by using a vest equipped with five Inertial Measurement Units (IMU) with 9 Dimensions of Freedom (DOF) each. In the following the IMU data captured for these two movements will be evaluated using statistics and visualized. It will also be discussed with respect to their suitability as features for further machine learning classifications. The reason for observing these movements is that occupational diseases of the musculoskeletal system lead to a reduction of the workers’ quality of life and extra costs for companies. Therefore, a vest, called CareJack, was designed to give the worker a real-time feedback about his ergonomic state while working. The CareJack is an approach to reduce the risk of spinal and back diseases. This paper will also present the idea behind it as well as its main components.

Abstract 17: An Evaluation of Patient Disposition and Long-term Health-related Quality of Life In MISTIE III: Opportunities to Improve Decision Making for Critically Ill Intracerebral Hemorrhage Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lourdes Carhuapoma ◽  
Radhika Avadhani ◽  
Noeleen Ostapkovich ◽  
Karen Lane ◽  
Nichol McBee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Intracerebral Hemorrhage ◽  
Health Related Quality ◽  
Patient Disposition ◽  
Related Quality ◽  
Health Related ◽  
Vas Scores ◽  
Eq Vas

Introduction: Recovery in intracerebral hemorrhage (ICH) is prolonged and unpredictable, resulting in challenges in estimating health-related quality of life (HRQoL). We describe HRQoL and patient disposition for ICH survivors with similar clinical characteristics to ICH patients who had withdrawal of life-sustaining treatment (WoLST). Methods: Using MISTIE III trial data (N = 499), we performed a matched cohort analysis using a published modified severity index (mSI) to compare ICH survivors (N = 379) with WoLST patients (N = 61). We used multivariable logistic regression adjusting for age, Glasgow Coma Score, deep ICH location, stability ICH and intraventricular hemorrhage volume and ≥ 3 comorbidities to create the mSI. After matching survivors with equal mSI to WoLST patients, we compared EuroQoL (EQ) visual analog scale (VAS) scores (US norm 69-76; range 0-100) by mSI quartile and patient disposition. Results: We matched 224 survivors to WoLST patients by mSI (range 0-6.5), with data at all timepoints. Given the large mSI range, EQ VAS scores and patient disposition were evaluated by mSI quartile groups. The median (interquartile range [IQR]) EQ VAS score increase for all mSI groups from day 30 (D30) to 180 (D180) was 20 (0-35.5, p < 0.0001), and 23.5 (5-40, p < 0.0001) for D30 to 365 (D365). The highest percentage of survivors for all mSI groups were home by D365 (G1 55%, G2 88%, G3 84.5%, G4 90%). Median (IQR) EQ VAS scores by mSI quartile, patient disposition and timepoint are reported below. Conclusion: ICH survivors, matching WoLST individuals, in all mSI groups demonstrated improvement in HRQoL over time, and the majority were home by D365. This study challenges current practice of identifying poor outcomes in concert with decision making employing WoLST in ICH. If goals of care are to include return to home and HRQoL, these results strongly suggest that prognostication can be improved. Prospective studies of ICH prognostication and decision making are needed.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

scholarly journals Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis

2021 ◽  
Vol 10 (18) ◽  
pp. 4245
Author(s):  
Jörn Lötsch ◽  
Constantin A. Hintschich ◽  
Petros Petridis ◽  
Jürgen Pade ◽  
Thomas Hummel
Keyword(s):  
Quality Of Life ◽  
Machine Learning ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinus ◽  
Endoscopic Sinus Surgery ◽  
Relevant Information ◽  
Olfactory Function ◽  
Sinus Surgery ◽  
Paranasal Sinus Surgery

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

Disease-modifying therapies in advanced cancer

2021 ◽  
pp. 800-807
Author(s):  
Olav Dajani ◽  
Karin Jordan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Well Being ◽  
Patient Comfort ◽  
Optimal Care ◽  
Disease Modifying ◽  
Critical Components ◽  
Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

scholarly journals 2294 Do patient comorbidities impact the effectiveness of a COPD self-management program?

2018 ◽  
Vol 2 (S1) ◽  
pp. 41-41
Author(s):  
Emilia Galli Thurber ◽  
Hanan Aboumatar
Keyword(s):  
Quality Of Life ◽  
Patient Outcomes ◽  
The United States ◽  
Management Program ◽  
Emergency Department Visits ◽  
The Self ◽  
Self Management ◽  
Management Intervention ◽  
Comorbidity Burden

OBJECTIVES/SPECIFIC AIMS: Chronic obstructive pulmonary disease (COPD) is a leading cause of both hospitalizations and readmissions in the United States, and about 1 in 5 hospitalized patients with COPD will be readmitted within 30 days. COPD-focused self-management programs are frequently used to help patients better manage their symptoms and prevent hospitalization. However, while the majority of patients with COPD have at least one comorbidity, most trials of COPD self-management programs either excluded patients with significant comorbidities or did not analyze the impact of comorbidities on patient outcomes. Using data from the BREATHE trial of a COPD self-management program, this study aims to determine if patient post-intervention outcomes differ based on the intensity and type of patient comorbidities. METHODS/STUDY POPULATION: In total, 240 patients hospitalized for COPD were randomly assigned to either a comprehensive self-management intervention or usual transitional care. Primary outcomes for this trial were the number of COPD-related hospitalizations and emergency department visits at 6 months and changes in COPD-specific quality of life. To determine whether patient comorbidities modify the effect of the self-management intervention on readmission and quality of life outcomes, we will compare patient outcomes across groups stratified by comorbidity burden (Charlson Comorbidity Index) and type (baseline diagnosis of congestive heart failure, diabetes, and depression). In addition, we will use regression analysis with interaction terms to test for interaction between comorbidity burden/type and intervention assignment. RESULTS/ANTICIPATED RESULTS: We hypothesize that the effect of the self-management intervention will differ in patients with greater comorbidity burden due to competing medical demands for patients with multimorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of this study will help clinicians better target disease-specific self-management programs to the groups of patients with COPD who are likely to receive the greatest benefit from this type of intervention.

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