42 research outputs found
The association of polypharmacy with functional decline in elderly patients undergoing cardiac surgery
Aims: Identifying preoperative risk factors in older patients becomes more important to reduce adverse functional outcome. This study investigated the association between preoperative medication use and functional decline in elderly cardiac surgery patients and compared polypharmacy as a preoperative screening tool to a clinical frailty assessment.Methods: This sub-study of the Anaesthesia Geriatric Evaluation study included 518 patients aged ≥70 years undergoing elective cardiac surgery. The primary outcome was functional decline, defined as a worse health-related quality of life or disability 1 year after surgery. The association between polypharmacy (i.e. ≥5 prescriptions and Results: Functional decline was reported in 284 patients (55%) and preoperative polypharmacy and excessive polypharmacy showed higher risks (adjusted relative risk 1.57, 95% confidence interval [CI] 1.23-1.98 and 1.93, 95% CI 1.48-2.50, respectively). Besides cardiovascular medication, proton-pump inhibitors and central nervous system medication were significantly associated with functional decline. Discrimination between models with polypharmacy or frailty was similar (area under the curve 0.67, 95% CI 0.61-0.72). The net reclassification index improved when including polypharmacy to the basic model (17%, 95% CI 0.06-0.27).Conclusion: Polypharmacy is associated with functional decline in elderly cardiac surgery patients. A preoperative medication review is easily performed and could be used as screening tool to identify patients at risk for adverse outcome after cardiac surgery.Pharmacolog
Results of the standard set forpulmonary sarcoidosis: Feasibility and multicentre outcomes
Our study presents findings on a previously developed standard set of clinical outcome data for pulmonary sarcoidosis patients. We aimed to assess whether changes in outcome varied between the different centres and to evaluate the feasibility of collecting the standard set retrospectively. This retrospective observational comparative benchmark study included six interstitial lung disease expert centres based in the Netherlands, Belgium, the UK and the USA. The standard set of outcome measures included 1) mortality, 2) changes in pulmonary function (forced vital capacity (FVC), forced expiratory volume in 1 s, diffusing capacity of the lung for carbon monoxide), 3) soluble interleukin-2 receptor (sIL-2R) change, 4) weight changes, 5) quality-of-life (QoL) measures, 6) osteoporosis and 7) clinical outcome status (COS). Data collection was considered feasible if the data were collected in ⩾80% of all patients. 509 patients were included in the retrospective cohort. In total six patients died, with a mean survival of 38±23.4 months after the diagnosis. Centres varied in mean baseline FVC, ranging from 110 (95% CI 92–124)% predicted to 99 (95% CI 97–123)% pred. Mean baseline body mass index (BMI) of patients in the different centres varied between 27 (95% CI 23.6–29.4) kg·m−2 and 31.8 (95% CI 28.1–35.6) kg·m−2. 310 (60.9%) patients were still on systemic therapy 2 years after the diagnosis. It was feasible to measure mortality, changes in pulmonary function, weight changes and COS. It is not (yet) feasible to retrospectively collect sIL-2R, osteoporosis and QoL data internationally. This study shows that data collection for the standard set of outcome measures for pulmonary sarcoidosis was feasible for four out of seven outcome measures. Trends in pulmonary function and BMI were similar for different hospitals when comparing different practices
Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma
We examined the feasibility of achieving a rapid response in patients with previously untreated multiple myeloma by administering vincristine 0.4 mR and doxorubicin 9 mg/m2 as a rapid intravenous infusion for 4 d together with intermittent high-dose dexamethasone 40 mg (VAD) for remission induction treatment in patients who were scheduled to receive high-dose therapy. 139 patients (86 male, 53 female; median age 53 years, range 32-65 years; Durie and Salmon stage IIA: 42, IIB: one, IIIA: 89, IIIB: seven) were included in a prospective multicentre study in which VAD was administered as remission induction treatment and was followed by intensified treatment. The response was evaluated according to the criteria of the Eastern Cooperative Oncology Group (ECOG). The results of treatment were evaluable in 134 patients. Five patients died before evaluation. 86 patients (62%) achieved a partial response (PR) and seven patients (5%) achieved a complete response (CR), which equates to a response rate of 67%. The main side-effect was mild neurotoxicity, which was observed in 18% of the patients. Fever or infections were reported in 27% of the patients. VAD administered as an outpatient regimen, based on rapid intravenous infusion, is an effective induction regimen for untreated myeloma with a 67% response rate and acceptable toxicity
First patient-centred set of outcomes for pulmonary sarcoidosis: a multicentre initiative
Introduction Routine and international comparison of
clinical outcomes enabling identification of best practices
for patients with pulmonary sarcoidosis is lacking. The aim
of this study was to develop a standard set of outcome
measures for pulmonary sarcoidosis, using the valuebased healthcare principles.
Methods Six expert clinics for interstitial lung diseases in
four countries participated in a consensus-driven RANDmodified Delphi study. A mixed-method approach was
applied for the identification of an outcome measures
set and initial conditions for patients with pulmonary
sarcoidosis. The expert team consisted of multidisciplinary
professionals (n=14) from Cleveland Clinic, Cincinnati MC,
Erasmus MC, Leuven UZ, Royal Brompton and St. Antonius
Hospital. During a ranking process, participants were
instructed to rank variables on a scale from 1 to 10 based
on whether it has (1) impact of the outcome on quality of
life, (2) impact of quality of care on the outcome and (3) the
number of patients negatively affected by the outcome.
Results An outcome measures set was defined consisting
of seven outcome measures: mortality, pulmonary function,
soluble interleukin-2 receptor change as an activity
biomarker, weight gain, quality of life, osteoporosis and
clinical outcome status.
Discussion Collecting outcomes in pulmonary sarcoidosis
internationally and the use of a broadly accepted set can
enable international comparison. Differences in outcomes
can potentially be used as a starting point for quality
improvement initiatives
De schijf van vijf : over vijf basis-ingrediënten voor goede patiëntenzorg
Mijn “schijf van vijf ” bestaat uit vijf “O’s”: opvang, opleiding, onderzoek, organisatie en omgeving. Ik bedoel dan opvang van patiënten, opleiding en onderwijs en nascholing, wetenschappelijk onderzoek, organisatie van de zorg en oog voor de omgeving. Mijn “schijf van vijf ” is van toepassing op alle artsen. Op huisartsen en medisch specialisten. Op artsen in opleiding tot specialist (de aios) en voor de gevestigde orde. Als ik hierna spreek over “specialist” of “internist”, bedoel ik al deze groepen. Ik voorzie ook dat de komende jaren een verdere tweedeling onder medisch specialisten gaat ontstaan: zij die om allerlei redenen kiezen voor een beperkt pakket werkzaamheden en zij die voor het volledige pakket gaan. Het is de kunst om binnen één organisatie ruimte en waardering voor beide groepen te bieden en om te kunnen switchen van de ene naar de andere vorm van beroepsuitoefening. Levensloopregelingen voor medici staan echter nog in de kinderschoenen. We moeten op dit gebied veel meer maatwerk leveren. Zo kunnen niet individuen, maar vakgroepen afgerekend worden op hun gezamenlijke output op gebied van onderwijs, patiëntenzorg en wetenschap in een UMC. Zo kan men binnen maatschappen besluiten om te komen tot een systeem van gedifferentieerde beloning, waarbij mijn “schijf van vijf ” een goede meetlat kan zijn
214 THROMBIN AND PLASMIN ARE ABLE TO INDUCE PROTEOGLYCAN RELEASE IN A PAR-INDEPENDENT MANNER IN HUMAN CARTILAGE
Repeated NT-proBNP testing and risk for adverse outcome after acute pulmonary embolism
Clinical epidemiolog