Time Spent in Hospital in the Last Six Months of Life in Patients Who Died of Cancer in Ontario

2002 ◽  
Vol 20 (6) ◽  
pp. 1584-1592 ◽  
Author(s):  
J. Huang ◽  
C. Boyd ◽  
S. Tyldesley ◽  
J. Zhang-Salomons ◽  
P. A. Groome ◽  
...  
Keyword(s):  
Acute Care ◽  
Inverse Correlation ◽  
Palliative Radiotherapy ◽  
Population Based ◽  
Hospitalization Rates ◽  
Hospital Bed ◽  
The Common ◽  
The Mean ◽  
Mean Time ◽  
Hospital Separation

PURPOSE: To describe hospital bed utilization in the final 6 months of life in patients dying of cancer in Ontario, Canada. PATIENTS AND METHODS: Hospital separation records were linked to a population-based cancer registry to identify factors associated with hospitalization in the 203,713 patients who died of cancer in Ontario between 1986 and 1998. RESULTS: Between 1986 and 1998, 5.3% of all acute care beds in Ontario were devoted to the care of cancer patients in the last 6 months of life. The mean time spent in hospital in the last 6 months of life decreased from 34.3 days in 1986 to 22.7 days in 1998. Hospitalization rates increased exponentially during the last month of life. Patients younger than 50 years of age, women, and residents of poorer communities spent significantly longer in hospital than others. Hospitalization rates differed very little among the common solid tumors, but patients with CNS malignancies, the lymphomas, and the leukemias spent significantly longer in hospital than the other groups. There was significant interregional variations in hospitalization that were not explained by differences in case mix. There was a statistically significant inverse correlation between the rate of use of palliative radiotherapy and the hospital bed use in the county in which the patient resided. CONCLUSION: The total time spent in hospital in the last 6 months of life has decreased over the last decade, but acute care hospitals continue to play a large role in the care of patients who are dying of cancer.

scholarly journals Remission from Depression among Adults with Arthritis: A 12-Year Followup of a Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Esme Fuller-Thomson ◽  
Marla Battiston ◽  
Tahany M. Gadalla ◽  
Yael Shaked ◽  
Ferrah Raza
Keyword(s):  
Chronic Pain ◽  
Panel Study ◽  
Secondary Analysis ◽  
Population Based ◽  
National Population Health Survey ◽  
Community Based ◽  
Population Based Study ◽  
Kaplan Meier ◽  
The Mean ◽  
Mean Time

Individuals with arthritis are vulnerable to depression. In this study, we calculated time to remission from depression in a representative community-based sample of depressed Canadians with arthritis who were followed for 12 years. We conducted secondary analysis of a longitudinal panel study, the National Population Health Survey, which was begun in 1994/95 and has included biennial assessment of depression since that time. Our analysis focused on a total of 216 respondents with arthritis who were depressed at baseline. The mean time to remission from depression was calculated using the Kaplan-Meier procedure and compared across categories of each of the potential predictors. The percentage of those no longer screening positive for depression was calculated at two years after baseline. At two years after baseline, 71% of the sample had achieved remission from depression. Time to remission was significantly longer for those depressed adults who were under the age of 55, those who reported more chronic pain at baseline, those with comorbid migraine, and those who experienced childhood physical abuse or parental addictions. These findings highlight the importance of screening for these factors to improve the targeting of interventions to depressed patients with arthritis.

scholarly journals Sagittal diffusion-weighted imaging in preventing the false-negative diagnosis of acute brainstem infarction: Confirmation of the benefit by anatomical characterization of false-negative lesions

2019 ◽  
Vol 10 ◽  
pp. 180 ◽  
Author(s):  
Nobuyuki Takeshige ◽  
Takachika Aoki ◽  
Kiyohiko Sakata ◽  
Soushou Kajiwara ◽  
Tetsuya Negoto ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
False Negative ◽  
Inverse Correlation ◽  
Brainstem Infarction ◽  
Diffusion Weighted ◽  
Lateral Width ◽  
The Mean ◽  
Mean Time ◽  
Anatomical Characterization

Background: In some cases of acute brainstem infarction (BI), standard axial diffusion-weighted imaging (DWI) does not show a lesion, leading to false-negative (FN) diagnoses. It is important to recognize acute BI accurately and promptly to initiate therapy as soon as possible. Methods: Of the 171 patients with acute cerebral infarctions in our institution who were examined, 16 were diagnosed with true-positive BI (TP-BI) and six with FN-BI. We evaluated the effectiveness of sagittal DWI in accurately diagnosing acute BI and sought to find the cause of its effectiveness by the anatomical characterization of FN-BIs. Results: Considering the direction of the brainstem perforating arteries, we supposed that sagittal DWI might more effectively detect BIs than axial DWI. We found that sagittal DWI detected all FN-BIs more clearly than axial DWI. The mean time between the onset of symptoms and initial DWI was significantly longer in the TP group (17.6 ± 5.5 h) than in the FN group (5.0 ± 1.2 h; P < 0.0001). The lesion volumes were much smaller in FN-BIs (259 ± 82 mm3) than in TP-BIs (2779 ± 767 mm3; P = 0.0007). FN-BIs had a significant inverse correlation with the ventrodorsal length of infarcts (FN 3.5 ± 1.1 mm, TP 11.4 ± 3.6 mm; P < 0.0004) and no correlation with other size parameters such as rostrocaudal thickness and lateral width. Conclusion: Anatomical characterization clearly confirmed that the addition of sagittal DWI to the initial axial DWI in suspected cases of BI ensures its accurate diagnosis and improves the patient’s prognosis.

scholarly journals Disposition of intravenous metronidazole in Asian surgical patients.

1996 ◽  
Vol 40 (10) ◽  
pp. 2248-2251 ◽  
Author(s):  
T Y Ti ◽  
H S Lee ◽  
Y M Khoo
Keyword(s):  
Half Life ◽  
Inverse Correlation ◽  
Volume Of Distribution ◽  
Population Based ◽  
Surgical Patients ◽  
Pharmacokinetic Analysis ◽  
Elimination Half Life ◽  
Elimination Half ◽  
The Mean ◽  
Total Body

Steady-state peak and trough concentrations of metronidazole and its metabolites were measured in the sera of 54 surgical patients who were on intravenous metronidazole, 500 mg every 8 h. These patients had no significant renal or hepatic impairment. High-pressure liquid chromatography was used to determine the concentrations of metronidazole and its metabolites. The mean peak and trough metronidazole concentrations were 28.9 +/- 11.0 and 18.0 +/- 9.9 micrograms/ml, respectively. The acid metabolite was not detectable in all the blood specimens. The mean peak concentration of the hydroxy metabolite (MH) was 6.6 +/- 4.3 micrograms/ml, the mean trough concentration of MH was 6.2 +/- 4.2 micrograms/ml, and the MH concentration/metronidazole concentration ratio was 0.4 +/- 0.24. Using a population-based method for the pharmacokinetic analysis and stepwise regression between parameters and covariables (sex, age, and weight), we found that weight showed the highest correlation with the total body clearance (CL). The mean CL was 0.89 +/- 0.3 ml min-1 kg-1 (3.029 liters/h), the mean volume of distribution was 0.73 +/- 0.14 liter/kg, and the mean elimination half-life was 10.6 +/- 4.5 h. For the patients in our study, the CL was lower and the elimination half-life was longer compared with those for healthy volunteers, but the values of these parameters were comparable to those found for hospitalized patients. There was an inverse correlation between age and CL.

Salinity Tolerance in Pelobates Fuscus (Laurenti, 1768) Tadpoles (Amphibia: Pelobatidae)

2013 ◽  
Vol 56 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Florina Stănescu ◽  
Ruben Iosif ◽  
Diana Székely ◽  
Paul Székely ◽  
Daniela Roşioru ◽  
...  
Keyword(s):  
Survival Rate ◽  
Deionized Water ◽  
Salinity Treatment ◽  
Spadefoot Toad ◽  
Pelobates Fuscus ◽  
Size At Metamorphosis ◽  
Salinity Levels ◽  
The Common ◽  
The Mean ◽  
Mean Time

Abstract We investigated the effect of salinity on larval development and survival rate to metamorphosis in the common spadefoot toad Pelobates fuscus (Laurenti, 1768). Our hypothesis was that higher salinity would decrease tadpole survival rate and body size at metamorphosis, and delay metamorphosis. The response of the tadpoles was evaluated through an experimental design with three salinity treatments of 2, 4, and 8‰ compared to a control (deionized water). Survival varied across the treatments: neither of the tadpoles in 8‰ salinity treatment survived the experiment, nor achieved metamorphosis. Salinity levels of 2 and 4‰ had no significant influence on the mean time to metamorphosis, body mass and SVL at metamorphosis. Our results suggest that P. fuscus tadpoles have a tolerance threshold for brackish water up to 4‰, above which survival is impaired.

scholarly journals Population based hospitalization burden of laboratory-confirmed hand, foot and mouth disease caused by multiple enterovirus serotypes in southern China

2018 ◽  
Author(s):  
Shuanbao Yu ◽  
Qiaohong Liao ◽  
Yonghong Zhou ◽  
Shixiong Hu ◽  
Qi Chen ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Southern China ◽  
Foot And Mouth Disease ◽  
Population Based ◽  
Mouth Disease ◽  
Rural County ◽  
Hospitalization Rates ◽  
Foot And Mouth ◽  
The Mean ◽  
Enterovirus Serotypes

AbstractBackgroundHand, foot and mouth disease (HFMD) is spread widely across Asia, and the hospitalization burden is as yet not well understood. Here, we estimated serotype-specific and age-specific hospitalization rates of HFMD in Southern China.MethodsWe enrolled pediatric patients admitted to 3/3 county-level hospitals and 3/23 township level hospitals in Anhua county, Hunan (CN) with HFMD, and collected samples to identify enterovirus serotypes by RT-PCRs between October 2013 and September 2016. The information of other eligible but un-enrolled patients were retrospectively collected from the same six hospitals. Monthly number of hospitalizations for all causes was collected from each of 23 township level hospitals to extrapolate hospitalizations associated with HFMD among these.ResultsDuring the three years, an estimated 3,236 pediatric patients were hospitalized with lab-confirmed HFMD, and among these only one patient was severe. The mean hospitalization rates were 660 (95% CI: 638-684) per 100,000 person-years for lab-confirmed HFMD, with higher rates among CV-A16 and CV-A6 associated HFMD (213 vs 209 per 100,000 person-years), and lower among EV-A71, CV-A10 and other enteroviruses associated HFMD (134, 39 and 66 per 100,000 person-years, p<0.001). Children aged 12-23 months had the highest hospitalization rates (3,594/100,000 person-years), followed by those aged 24-35 months (1,828/100,000 person-years) and 6-11 months (1,572/100,000 person-years). Compared with other serotypes, CV-A6-associated hospitalizations were evident at younger ages.ConclusionsOur study indicates a substantial hospitalization burden associated with non-severe HFMD in a rural county in southern China. Future mitigation policies should take into account the disease burden identified, and optimize interventions for HFMD.

scholarly journals Phosphatidylethanol Levels, As a Marker of Alcohol Consumption, Are Associated With Risk of Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2148-2152 ◽  
Author(s):  
Kristina Johansson ◽  
Lars Johansson ◽  
Johanna Pennlert ◽  
Stefan Söderberg ◽  
Jan-Håkan Jansson ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Intracerebral Hemorrhage ◽  
Population Based ◽  
Health Examination ◽  
Blood Concentrations ◽  
Increased Risk ◽  
Health And Disease ◽  
The Mean ◽  
Reported Data ◽  
Mean Time

Background and Purpose: Previous observational studies have shown a moderately increased risk of intracerebral hemorrhage (ICH) with high self-reported alcohol consumption. However, self-reported data tend to underestimate alcohol consumption. Phosphatidylethanol is a specific biomarker reflecting alcohol intake during the last month and correlates with the amount of alcohol consumed. The present study aimed to investigate the association between phosphatidylethanol levels and the risk of future ICH. Methods: This population-based nested case-referent study was conducted within the Northern Sweden Health and Disease Cohort. At baseline, all participants underwent a health examination, including a questionnaire with questions about alcohol consumption. A blood sample was collected and stored at −80°C, and phosphatidylethanol 16:0/18:1 levels were measured in packed erythrocytes. Cases (n=97) were diagnosed with a first-ever ICH between 1985 and 2007. Two referents (n=180) were matched to each case. Results: The mean age at baseline was 55 years, 39% of participants were women, and the mean time from blood sampling to ICH was 7.3 years. Only phosphatidylethanol and hypertension remained independently associated with ICH in a multivariable model. Participants with phosphatidylethanol >0.30 μmol/L had an increased risk of ICH compared with those with phosphatidylethanol <0.01 μmol/L (odds ratio, 4.64 [95% CI, 1.49–14.40]). Conclusions: High blood concentrations of phosphatidylethanol were associated with an increased risk of future ICH. This association was independent of hypertension and other risk factors for ICH. Our findings suggest that phosphatidylethanol, as a marker of alcohol consumption, may be used as a risk marker of future ICH.

scholarly journals Early detection and preliminary susceptibility testing of positive pediatric blood cultures with the Steers replicator

1977 ◽  
Vol 6 (4) ◽  
pp. 367-372
Author(s):  
J W Paisley ◽  
J K Todd ◽  
M H Roe
Keyword(s):  
Early Detection ◽  
Susceptibility Testing ◽  
Rapid Identification ◽  
Haemophilus Influenzae Type ◽  
Type B ◽  
The Common ◽  
The Mean ◽  
Time To Detection ◽  
Blood Specimens ◽  
Mean Time

Early replicator subculturing of blood specimens after 4 to 16 h of incubation detected 135 of 217 (59%) of all positive cultures, including 56 of 64 (87%) Haemophilus influenzae type b, 7 of 22 (32%) Staphylococcus aureus, 19 of 20 (95%) pathogenic streptococci, and 20 of 24 (83%) Enterobacteriaceae. The mean time to detection of the common pediatric pathogens (36 h) was significantly less than that of contaminants (85 h) (P less than 0.001). Blind subculturing to differential media aided in the rapid identification of isolates and the detection of mixed cultures. In addition, a method of obtaining rapid susceptibilities of blood and body fluid isolates to selected antibiotics by blind subculturing to antibiotic-containing media was evaluated. Immediate susceptibility information was obtained for 214 of the 245 (87.3%) isolate-antibiotic combinations. There was complete correlation with a standard Kirby-Bauer reading for 94.9% of these observations. Replicator blood subculturing before 24 h of incubation results in early detection of the majority of pediatric pathogens. The inoculation of additional differential and antibiotic-containing media with each blind subculture aids in rapid identification of isolates and may give limited, but clinically important, immediate susceptibility information.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

2015 ◽  
Vol 24 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Petra A. Golovics ◽  
Laszlo Lakatos ◽  
Michael D. Mandel ◽  
Barbara D. Lovasz ◽  
Zsuzsanna Vegh ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cox Regression ◽  
Diagnostic Procedures ◽  
Population Based ◽  
Disease Course ◽  
Inception Cohort ◽  
Disease Extent ◽  
Cox Regression Analysis ◽  
Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

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