Post-operative delirium in older patients following cancer related and other high-risk surgeries.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24024-e24024
Author(s):  
Rawad Elias ◽  
Ilene Staff ◽  
Stephen Thompson ◽  
Christine Waszynski ◽  
Jennifer Zanchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Logistic Regression ◽  
High Risk ◽  
Tertiary Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Chi Square ◽  
Targeted Interventions ◽  
Increased Risk

e24024 Background: Older adults are at increased risk for postoperative delirium (POD). This risk might be higher in patients with cancer as underlying malignancy and its complications predispose individuals to develop delirium. Therefore, it is important to evaluate the onset of delirium in this patient population especially as POD is associated with increased risk of rehospitalization, decline in cognitive function, morbidity and mortality. Methods: We performed a retrospective review of patients aged ≥ 70 years admitted January 2017 through July 2019 to a tertiary care referral center for a high-risk surgery, defined as associated with a mortality risk greater than 1%. Cancer related surgeries (CRS) were identified through cross matching with Cancer Registry. Patients who had delirium assessment in the postoperative setting using the Confusion Assessment Method (CAM) were included. Chi-square tests of proportion, Wilcoxon Ranked Sum and multivariate logistic regression analyses were conducted. Results: A total of 2340 patients were included in this analysis, 315 of whom had (CRS). Overall, the age (median, IQR) of patients at surgery was 76 years (72-80) and the length of stay (LOS) was 7 (4-11) days. Patients receiving CRS were younger (75, 72-79) than those with non-CRS (76, 72-81) (p = 0.022); had a shorter post-operative LOS (4, 2-7 vs. 5, 3-8; p > 0.001), and were less likely to develop POD (7.6% vs. 16.1%; p < 0.001). Among patients receiving CSR, those who developed POD were older (78 vs. 74; p = 0.008) and had longer post-operative LOS (14.0 vs. 4.0; p < 0.001). Those having experienced radiotherapy (RT) for cancer within the year before the surgery, were more likely to develop POD (40.0% vs. 6.6% p. < 0.001). Chemotherapy in the year prior to surgery did not increase the risk of POD (6.1% vs. 7.8%; p = 0.721). Among those having non-CRS, a cancer diagnosis did not affect POD. A logistic regression predicting POD indicated that the lower likelihood of POD following CRS was independent of age or gender (OR = 0.40; p < .001); RT within one year prior was independent predictor of higher POD (OR = 5.48; p = 0.003). Our data presentation will include further analysis of POD risk factors. Conclusions: Although older adults receiving CRS were significantly less likely to develop delirium than patients with other high-risk surgeries, it is still important to evaluate POD in this population due to its impact of patients’ outcomes. Further understanding of POD risk factors, such as preoperative RT, would allow the development of targeted interventions that might lessen the risk.

scholarly journals Clinical profile and factors determining outcome of intramural very low birth weight babies in a tertiary care centre: a retrospective study

2017 ◽  
Vol 5 (2) ◽  
pp. 520
Author(s):  
Devi Meenakshi K. ◽  
Arasar Seeralar A. T. ◽  
Srinivasan Padmanaban
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Logistic Regression Analysis ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
P Value ◽  
Increased Risk

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.

Delirium in Hospitalized Older Patients: Recognition and Risk Factors

1998 ◽  
Vol 11 (3) ◽  
pp. 118-125 ◽  
Author(s):  
Sharon K. Inouye
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Older Patients ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Precipitating Factors ◽  
Acute Confusional State ◽  
Confusional State ◽  
Confusion Assessment ◽  
Simplified Algorithm

Delirium, or acute confusional state, represents a common, serious, potentially preventable and increasing problem for older hospitalized patients. This study is intended to improve overall understanding of the problem of delirium and thus to lessen its adverse impact on the older population. The specific aims of this study are (1) to examine the epidemiology of delirium in older patients; (2) to evaluate barriers to recognition; (3) to present the Confusion Assessment Method (CAM) simplified algorithm to improve recognition; (4) to elucidate predisposing and precipitating factors for delirium; and (5) to propose preventive strategies. Delirium occurs in 10-60% of the older hospitalized population and is unrecognized in 32-66% of cases. The CAM algorithm provides a sensitive (94-100%), specific (90-95%), reliable, and easy to use means for identification of delirium. Four predisposing and five precipitating factors were identified and validated to identify patients at high risk for development of delirium. Primary prevention of delirium should address important delirium risk factors and target patients at intermediate to high risk for delirium at admission.

scholarly journals Self-reported sleep disturbances are associated with poorer cognitive performance in older adults with hypertension: a multi-parameter risk factor investigation

2019 ◽  
Vol 32 (7) ◽  
pp. 815-825 ◽  
Author(s):  
Jordan N. Kohn ◽  
Emily Troyer ◽  
Robert N. Guay-Ross ◽  
Kathleen Wilson ◽  
Amanda Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Sleep Disturbances ◽  
Depressive Symptomatology ◽  
Cognitive Outcomes ◽  
Cognitive Domain ◽  
Increased Risk

ABSTRACTObjectives:Given the evidence of multi-parameter risk factors in shaping cognitive outcomes in aging, including sleep, inflammation, cardiometabolism, and mood disorders, multidimensional investigations of their impact on cognition are warranted. We sought to determine the extent to which self-reported sleep disturbances, metabolic syndrome (MetS) factors, cellular inflammation, depressive symptomatology, and diminished physical mobility were associated with cognitive impairment and poorer cognitive performance.Design:This is a cross-sectional study.Setting:Participants with elevated, well-controlled blood pressure were recruited from the local community for a Tai Chi and healthy-aging intervention study.Participants:One hundred forty-five older adults (72.7 ± 7.9 years old; 66% female), 54 (37%) with evidence of cognitive impairment (CI) based on Montreal Cognitive Assessment (MoCA) score ≤24, underwent medical, psychological, and mood assessments.Measurements:CI and cognitive domain performance were assessed using the MoCA. Univariate correlations were computed to determine relationships between risk factors and cognitive outcomes. Bootstrapped logistic regression was used to determine significant predictors of CI risk and linear regression to explore cognitive domains affected by risk factors.Results:The CI group were slower on the mobility task, satisfied more MetS criteria, and reported poorer sleep than normocognitive individuals (all p < 0.05). Multivariate logistic regression indicated that sleep disturbances, but no other risk factors, predicted increased risk of evidence of CI (OR = 2.00, 95% CI: 1.26–4.87, 99% CI: 1.08–7.48). Further examination of MoCA cognitive subdomains revealed that sleep disturbances predicted poorer executive function (β = –0.26, 95% CI: –0.51 to –0.06, 99% CI: –0.61 to –0.02), with lesser effects on visuospatial performance (β = –0.20, 95% CI: –0.35 to –0.02, 99% CI: –0.39 to 0.03), and memory (β = –0.29, 95% CI: –0.66 to –0.01, 99% CI: –0.76 to 0.08).Conclusions:Our results indicate that the deleterious impact of self-reported sleep disturbances on cognitive performance was prominent over other risk factors and illustrate the importance of clinician evaluation of sleep in patients with or at risk of diminished cognitive performance. Future, longitudinal studies implementing a comprehensive neuropsychological battery and objective sleep measurement are warranted to further explore these associations.

scholarly journals Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering

2021 ◽  
Vol 18 (15) ◽  
pp. 7941
Author(s):  
Ying Ying Chan ◽  
Norhafizah Sahril ◽  
Muhammad Solihin Rezali ◽  
Lim Kuang Kuay ◽  
Azli Baharudin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Logistic Regression ◽  
Modifiable Risk Factors ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Multivariable Logistic Regression

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60–69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.

scholarly journals A retrospective study of serious adverse drug reactions and associated risk factors in a tertiary care hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 101
Author(s):  
Smita Shenoy ◽  
Mohit Gupta ◽  
Sadhana Holla ◽  
Madhurima Home ◽  
Harish Thanusubramanian
Keyword(s):  
Risk Factors ◽  
Adverse Drug Reactions ◽  
Anticancer Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Concomitant Disease ◽  
Care Hospital ◽  
Drug Reactions ◽  
Chi Square ◽  
Increased Risk

Background: Serious adverse drug reactions (ADRs) cause physical, psychological and economic harm to patients and society. This study was undertaken to understand serious ADRs in a tertiary care hospital and risk factors associated with it.Methods: The serious adverse reactions that occurred over a one-year period were assessed. The serious adverse drug reactions, action taken, outcome, predictability, suspect drug, causality, patient demographics and risk factors for the reaction was collected. Chi-square test was applied for observing relationships of predisposing factors for serious ADRs.Results: Out of a total of 984 reported adverse drug reactions, 94 (9.55%) were serious. Hematological disorders (41.05%) were the common serious ADRs followed by electrolyte disturbances (18.94%). Anticancer agents were the suspect drugs for majority of serious ADRs. Serious ADRs contributed to 39 (0.05%) admissions in the hospital. Recovery occurred in 97.87% of the patients. The causality was possible in 91.48% (n=86) and probable in 8.51% (n=8) of the serious adverse drug reactions. Males, patients even with a single concomitant disease and those with more than 2 concomitant medications were at increased risk (p<0.05) for developing serious ADRs.Conclusions: Serious ADRs are a significant problem in health care. Measures should be taken to detect and treat them at the earliest to reduce suffering of the patient.

scholarly journals Investigation on risk factors of haemorrhagic fever with renal syndrome (HFRS) in Xuancheng City in Anhui Province, Mainland China

2020 ◽  
Vol 148 ◽  
Author(s):  
Guangjian Wu ◽  
Zhicai Xia ◽  
Fengtian Wang ◽  
Jiabing Wu ◽  
Deman Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Statistical Significance ◽  
Mainland China ◽  
Multivariate Logistic Regression Analysis ◽  
Health Concern ◽  
Haemorrhagic Fever ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Test

Abstract Haemorrhagic fever with renal syndrome (HFRS), a rodent-borne disease, is a major public health concern in both developed and developing countries. China is the most severe endemic country in the world, constituting 90% of the cases. Although the incidence of HFRS has substantively decreased in most areas of China, HFRS has rebounded remarkably in some epidemic areas. Xuancheng is one of these areas. In this study, we collected the case data reported recently in Xuancheng and designed a 1:3 case−control study. The Chi-square test, univariate and multivariate logistic regression analysis were performed. In all cases, farmers made up the highest proportion of occupations. And there were 20 variables with statistical significance including indoor hygienic conditions; the surrounding environment; whether bitten by rats at work and other criteria. In addition, exposure to rodents and rats bites is a high-risk factor for HFRS. Rodent density was calculated at 20.9% (159/760), the virus carrier rate was 9.4% (15/159) and the index of rats with a virus was about 2.0%. Exposure to rodents and insect bites is also high-risk factors for HFRS among local residents in Xuancheng. More importantly, during the flood years, the increased density of rodents led to an increased risk of human exposure to rodents. As our statistical analysis proves, targeted strategies should be developed and implemented to reduce the incidence of local diseases in the future.

scholarly journals Health Disparities in Delirium

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 148-148
Author(s):  
Robert Dicks ◽  
Jimmy Choi ◽  
Christine Waszynski ◽  
Kadesha Collins-Fletcher ◽  
Beth Taylor ◽  
...  
Keyword(s):  
Health Disparities ◽  
Acute Care ◽  
Health Disparity ◽  
Age Groups ◽  
High Specificity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Mitigation Strategies ◽  
Chi Square ◽  
Increased Risk

Abstract Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; &lt;65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.

scholarly journals Sexual Experience, Suicidal Behaviors and Depression Association, and Its Tendency to Lead to Smoking and Alcohol Consumption among Korean Adolescents

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Baby Doll Bana ◽  
Jinsoo Jason Kim ◽  
Jerre Mae Tamanal ◽  
Sun Hee Kim
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Logistic Regression ◽  
Alcohol Drinking ◽  
Sexual Experience ◽  
P Value ◽  
Suicidal Behaviors ◽  
Chi Square ◽  
Korean Adolescents ◽  
Increased Risk

In numerous published findings, the cohesion was they have treated sexual experience, suicidal behaviors and depression, as the outcome variables and regard substance use as the core factors. In this study, we aim to do the opposite. We seek to make sense of the linkage by inversing the analytical direction. We intend to examine the association and the likelihood, and observe the levels to which sexual experience, suicidal behaviors, and depression may play a part in the odds of smoking and alcohol drinking among middle school and high school Korean students. The data obtained were cross-sectional from the 2019 Korean Youth Risk Behavior Web-Based Survey, participated by 57, 303 Korean adolescents. Among which are male 52.1%, female 47.9%, ages 15 below 59.2 % and 15 above 40.4%. This study utilized descriptive, Chi-square, and logistic regression analyses. Our basic findings signified that sexual experience and mental health problems doubled the odds of motivation. Chi-square analyses asserted that the association was statistically significant. All variables were notably correlated to substance use at 0.01 level, that is, when sexual experience, suicidal behaviors, and depression tend to increase, there was a high risk of using substances. The results for logistic regression on alcohol drinking, the -2LL statistic is 73157.25, the Cox & Snell R2 is 0.057, and Nagelkerke R2 is 0.078 having the df of 1, with the p value of 0.000l, and the -2LL statistic is 39022.46, the Cox & Snell R2 is 0.064, and Nagelkerke R2 is 0.122 having the df of 1, with the p value of 0.000 for smoking, predicted the maximum likelihood and considerably identified as positive significant indicators in the onset of substance initiation. This study also found that sexual experience had remained robustly substantial with the odds of smoking and drinking, that is, participants with higher sexual experience had the strongest likelihood of substance use motivation. Our overall results contribute to the debate by treating sexual experience, suicidal behaviors, and depression as precedent significant risk factors for developing substance use behaviors among Korean adolescents. For efficient and effective management of sexual experience, suicidal behaviors and depression on teenagers, findings underscore the need for early detection on adolescents at risk. A comprehensive prevention and protective efforts is required along with continuous parental guidance. Intervention programs with coping skills to handle emotional and behavioral problems is essential to help reduce the probability of an increased risk factors and subsequently lessen the threat for developing cigarette smoking and alcohol drinking behaviors among teenagers. School-based programs that can create synergy by embedding teenagers in an academic environment that is equally supportive, beneficial and can help promote a positive mindset is recommended.

Geriatric assessment (GA) predictors of 1y mortality in older adults with gastrointestinal (GI) malignancies: Results from the CARE study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12047-12047
Author(s):  
Grant Richard Williams ◽  
Chen Dai ◽  
Mustafa Al Obaidi ◽  
Smith Giri ◽  
Kelly Kenzik ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Older Patients ◽  
Cancer Stage ◽  
Newly Diagnosed ◽  
Cox Regression Analysis ◽  
Targeted Interventions ◽  
C Statistic ◽  
Increased Risk ◽  
Patient Reported

12047 Background: Chronologic age is an imperfect predictor of morbidity and mortality in older patients with newly-diagnosed GI malignancies. Identifying patients with GI malignancies that are at increased risk of mortality within the 1st year remains challenging given no prior studies have focused on this population, yet is critical to developing personalized treatment plans. To fill this gap, we examined predictors of 1y mortality using variables from a patient-reported GA in a prospective cohort of older adults with GI malignancies. Methods: Cancer and Aging Resilience Evaluation (CARE) is a prospective registry of older adults (≥60y) with cancer seen at UAB (J Geri Onc 2019; PMID 31005648). Patients with GI malignancies with GA completed within the timeframe of 3 mo. before and up to 6 mo. after diagnosis were included. Vital status (up to 12/7/2019) was ascertained by linking participants to LexisNexis. Multivariable Cox regression analysis was used to estimate associations between GA variables and 1y mortality, adjusting for age at cancer diagnosis, race, cancer stage (IV vs. I-III), cancer group (high risk: pancreatic, hepatobiliary, esophageal vs. low risk: colorectal, GIST, neuroendocrine, etc.), and planned chemotherapy (yes/no). Results: A total of 356 participants met eligibility criteria. Mean age at enrollment was 70y; 56.4% were females; 25% black; 47.1% had high-risk cancers. In unadjusted analysis, high-risk cancers, cancer stage, malnutrition, impaired performance status, limitations in social activities, impaired instrumental activities of daily living (IADL), physical health, mental health, anxiety, and ≥3 comorbidities were associated with higher 1y mortality. Our base model (demographic and clinical variables) demonstrated good discrimination (c statistic 0.758), but was improved with the addition of all significant GA variables (c-statistic 0.810). Fatigue and malnutrition were identified as the strongest predictors among the GA variables, and a model adding those to the base model retained high discrimination (c-statistic 0.804). The estimated 1yr survival was 53.1% for those with both fatigue and malnutrition compared to 88.1% in those with neither. Conclusions: Among older adults with GI malignancies, malnutrition and fatigue were the strongest GA predictors of 1yr mortality after adjusting for age and clinical factors. These findings provide evidence for developing targeted interventions in older patients with newly-diagnosed GI malignancies to reduce 1y mortality.

scholarly journals Prevalence and Risk Factors ofToxoplasma gondiiin Fattening Pigs Farm from Yucatan, Mexico

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
A. Ortega-Pacheco ◽  
K. Y. Acosta Viana ◽  
E. Guzmán-Marín ◽  
J. C. Segura-Correa ◽  
M. Álvarez-Fleites ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Protective Factor ◽  
Herd Size ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Fattening Pigs

The objective of this study was to estimate the prevalence and identify risk factors associated with the presence ofToxoplasma gondiiin pig-fattening farms from Yucatan, Mexico. A cross-sectional study was conducted with a two-stage sampling. There were 429 pigs sampled from 39 farms randomly selected. Blood samples were collected to obtain DNA and serum. The presence of IgM and IgG antibodies was determined by indirect ELISA. Prevalence was estimated by diagnostic test. Potential risk factors to be included in a marginal logistic regression were tested by chi-square or Fisher. The prevalence of IgM and IgG was 92.5% (397/429) (CI 89.9–95.1%) and 95.8% (411/429) (CI 93.7–97.8%), respectively. Regarding PCR, a prevalence of 50.8% (218/429) (CI 45.9–55.6%) was found. The logistic regression showed an association with herd size and type of feeder (). The risk of a case in farms with ≤400 pigs was 27.9 times higher than in farms with >400 pigs. The manual feeder was a significant protective factor associated with the seropositive againstT. gondii. Results indicate a high circulation ofT. gondiiin pig-fattening farms from Yucatan, finding an increased risk of infection for those farms with less than 400 animals and automatic feeders.

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