scholarly journals The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

2019 ◽  
Author(s):  
Peter Raubenheimer ◽  
Cascia Day ◽  
Faried Abdullah ◽  
Katherine Manning ◽  
Clint Cupido ◽  
...  
Keyword(s):  
Predictive Value ◽  
Screening Tool ◽  
Communicable Disease ◽  
Demographic Data ◽  
Young Patients ◽  
Public Hospitals ◽  
Mortality Data ◽  
Western Cape ◽  
Hospitalised Patients ◽  
Identification Tool

Abstract Background: Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards FrameworkPrognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South AfricaMethods: Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospectiveobservational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic recordsResults: 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68-81%), specificity of 85% (83-88%), a positive predictive value of 56% (49-63%) and a negative predictive value of 93% (91-95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87 – 16.9; p < 0.001).Conclusions:The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.

scholarly journals The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

2019 ◽  
Author(s):  
Peter Raubenheimer ◽  
Cascia Day ◽  
Faried Abdullah ◽  
Katherine Manning ◽  
Clint Cupido ◽  
...  
Keyword(s):  
Predictive Value ◽  
Screening Tool ◽  
Communicable Disease ◽  
Demographic Data ◽  
Young Patients ◽  
Public Hospitals ◽  
Mortality Data ◽  
Western Cape ◽  
Hospitalised Patients ◽  
Identification Tool

Abstract Background: Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards FrameworkPrognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South AfricaMethods: Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospectiveobservational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic recordsResults: 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68-81%), specificity of 85% (83-88%), a positive predictive value of 56% (49-63%) and a negative predictive value of 93% (91-95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87 – 16.9; p < 0.001).Conclusions:The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.

scholarly journals The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two south African hospitals with a high HIV burden

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Peter J. Raubenheimer ◽  
Cascia Day ◽  
Faried Abdullah ◽  
Katherine Manning ◽  
Clint Cupido ◽  
...  
Keyword(s):  
South Africa ◽  
Observational Study ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Screening Tool ◽  
Young Patients ◽  
Public Hospitals ◽  
Mortality Data ◽  
Hospitalised Patients ◽  
Identification Tool

Abstract Background Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. We aimed to evaluate the performance of a identification tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa. Methods Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa were enrolled in a prospective observational study. Demographic data were collected from patients and patient notes. Patients were assessed within two days of admission by two trained clinicians who were not the primary care givers, using the identification tool. Outcome mortality data were obtained from patient folders, the hospital electronic patient management system and the Western Cape Provincial death registry which links a unique patient identification number with national death certificate records and system wide electronic records. Results 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68–81%), specificity of 85% (83–88%), a positive predictive value of 56% (49–63%) and a negative predictive value of 93% (91–95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87–16.9, p < 0.001). Conclusions The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.

scholarly journals The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

2019 ◽  
Author(s):  
Peter Raubenheimer ◽  
Cascia Day ◽  
Faried Abdullah ◽  
Katherine Manning ◽  
Clint Cupido ◽  
...  
Keyword(s):  
Observational Study ◽  
South African ◽  
Predictive Value ◽  
Screening Tool ◽  
Communicable Disease ◽  
Young Patients ◽  
Prognostic Indicator ◽  
Public Hospitals ◽  
Middle Income ◽  
Hospitalised Patients

Abstract Background: Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process.Aim: To evaluate the performance of a screening tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South AfricaDesign: Prospective cohort observational study using linkage analysis of hospitalised patients to death certification records.Setting/participants: Patients admitted to the acute medical services in two public hospitals in Cape Town, South AfricaResults: 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified using the screening tool as being in the last year of their lives. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68-81%), specificity of 85% (83-88%), a positive predictive value of 56% (49-63%) and a negative predictive value of 93% (91-95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87 – 16.9; p < 0.001). Conclusions:The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst young patients, the majority under age 60.

scholarly journals The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

2019 ◽  
Author(s):  
Peter Raubenheimer ◽  
Cascia Day ◽  
Faried Abdullah ◽  
Katherine Manning ◽  
Clint Cupido ◽  
...  
Keyword(s):  
South Africa ◽  
Observational Study ◽  
Predictive Value ◽  
Screening Tool ◽  
Communicable Disease ◽  
Young Patients ◽  
Prognostic Indicator ◽  
Public Hospitals ◽  
Middle Income ◽  
Hospitalised Patients

Abstract Background Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process. Aim To evaluate the performance of a screening tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa Design Prospective cohort observational study using linkage analysis of hospitalised patients to death certification records. Setting/participants Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa Results 822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified as meeting one of the specific indicators. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68-81%), specificity of 85% (83-88%), a positive predictive value of 56% (49-63%) and a negative predictive value of 93% (91-95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87 – 16.9; p < 0.001). Conclusions The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst relatively young patients.

Calculated globulin as a screening tool for hypogammaglobulinaemia or paraproteins in hospitalized patients

2021 ◽  
pp. 000456322198973
Author(s):  
Teng Hoo ◽  
Ee Mun Lim ◽  
Mina John ◽  
Lloyd D’Orsogna ◽  
Andrew McLean-Tooke
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Screening Tool ◽  
Haematological Malignancy ◽  
Laboratory Data ◽  
Liver Function Tests ◽  
Serum Globulin ◽  
Tertiary Hospitals ◽  
Low Sensitivity ◽  
Diagnostic Delays

Background Calculated globulin fraction is derived from the liver function tests by subtracting albumin from the total protein. Since immunoglobulins comprise the largest component of the serum globulin concentration, increased or decreased calculated globulins and may identify patients with hypogammaglobulinaemia or hypergammaglobulinaemia, respectively. Methods A retrospective study of laboratory data over 2.5 years from inpatients at three tertiary hospitals was performed. Patients with paired calculated globulins and immunoglobulin results were identified and clinical details reviewed. The results of serum electrophoresis testing were also assessed where available. Results A total of 4035 patients had paired laboratory data available. A calculated globulin ≤20 g/L (<2nd percentile) had a low sensitivity (5.8%) but good positive predictive value (82.5%) for hypogammaglobulinaemia (IgG ≤5.7 g/L), with a positive predictive value of 37.5% for severe hypogammaglobulinaemia (IgG ≤3 g/L). Paraproteins were identified in 123/291 (42.3%) of patients with increased calculated globulins (≥42 g/L) who also had a serum electrophoresis performed. Significantly elevated calculated globulin ≥50 g/L (>4th percentile) were seen in patients with either liver disease (37%), haematological malignancy (36%), autoimmune disease (13%) or infections (9%). Conclusions Calculated globulin is an inexpensive and easily available test that assists in the identification of hypogammaglobulinaemia or hypergammaglobulinaemia which may prompt further investigation and reduce diagnostic delays.

scholarly journals NESTROFT—A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden

2021 ◽  
Author(s):  
Manasi Gosavi ◽  
Ramesh Chavan ◽  
M. B. Bellad
Keyword(s):  
Pregnant Women ◽  
Effective Mass ◽  
Mass Screening ◽  
Predictive Value ◽  
Screening Tool ◽  
Hematological Parameters ◽  
False Negative ◽  
Cost Effective ◽  
Mean Corpuscular Hemoglobin ◽  
Carrier Status

Abstract Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective. Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated. Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC). Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students’ “t” test were used to identify differences between the groups. Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests. Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.

scholarly journals New screening tool for neonatal nutritional risk in China: a validation study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042467
Author(s):  
Mei Zhou ◽  
Yuwei Li ◽  
Huaying Yin ◽  
Xianhong Zhang ◽  
Yan Hu
Keyword(s):  
Validation Study ◽  
Head Circumference ◽  
Predictive Value ◽  
Screening Tool ◽  
Nutritional Risk ◽  
Risk Level ◽  
Spearman Correlation ◽  
Nutrition Risk ◽  
Sensitivity Specificity ◽  
Nutritional Risk Screening

ObjectiveA neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.DesignProspective validation study.Setting and participantsIn total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.Main outcome measuresWe evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.ResultsThe sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.ConclusionThe validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.Trial registration numberChiCTR2000033743.

scholarly journals Using the Multidimensional Prognostic Index to Predict Clinical Outcomes of Hospitalized Older Persons: A Prospective, Multicenter, International Study

2018 ◽  
Vol 74 (10) ◽  
pp. 1643-1649 ◽  
Author(s):  
Alberto Pilotto ◽  
Nicola Veronese ◽  
Julia Daragjati ◽  
Alfonso J Cruz-Jentoft ◽  
Maria Cristina Polidori ◽  
...  
Keyword(s):  
Home Care ◽  
Older Patients ◽  
Risk Group ◽  
Prognostic Index ◽  
Home Care Services ◽  
Cognitive Status ◽  
Public Hospitals ◽  
Mortality Data ◽  
Care Services ◽  
Overall Mortality

Abstract Background Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. Methods This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Results Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79–6.17; p &lt; .001) and severe risk (OR = 10.72, 95% CI: 5.70–20.18, p &lt; .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. Conclusions In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.

scholarly journals Backstreet abortion: Women’s experiences

Curationis ◽  
1997 ◽  
Vol 20 (2) ◽  
Author(s):  
F. Makorah ◽  
K. Wood ◽  
R. Jewkes
Keyword(s):  
Descriptive Study ◽  
Induced Abortion ◽  
Public Hospitals ◽  
Western Cape ◽  
Eastern Cape ◽  
Personal Experiences ◽  
Induced Abortions ◽  
Experiences Of Women ◽  
Depth Interviews ◽  
Induce Abortion

This was a descriptive study aimed at exploring the personal experiences of women who induce abortion and the circumstances surrounding induced abortion. The study was conducted in six public hospitals in four different provinces: Baragwanath (Gauteng), Groote Schuur and Tygerberg (Western Cape), King Edward and R.K. Khan (Kwa-Zulu/Natal) and Livingstone (Eastern Cape). In-depth interviews were conducted with 25 African, Indian and Coloured women admitted to the hospitals following backstreet abortions. The study gave women the opportunity to "speak for themselves" about "why" and "how" and the context in which the unscfe induced abortions occurred

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