12 research outputs found
The performance of the Dutch Safety Management System frailty tool to predict the risk of readmission or mortality in older hospitalised cardiac patients
Background: Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown.
Aim: To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients.
Methods: An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p-values (PHL) to describe predictive performance in terms of discrimination and calibration.
Results: The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56-0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63-0.73; PHL was 0.658).
Discussion: The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored.
Keywords: Aged; Cardiovascular diseases; Frailty; Mortality; Patient readmission; Predictive value of tests; Risk assessment
Real-time PCR for determining capsular serotypes of Haemophilus influenzae.
A two-step real-time PCR assay targeting all six capsulation loci of Haemophilus influenzae (i.e. serotypes a to f) was developed and compared with a previously published qualitative PCR assay by using 131 H. influenzae clinical isolates. There was a 98.5% concordance between the two tests. The sensitivity of detection of capsular type-specific reference strains of H. influenzae a to c (10(1) CFU/PCR) was higher than that for type e (10(3) CFU/PCR) and types d and f (10(4) CFU/PCR), and a broader dynamic range was obtained (5 to 8 log(10) units). No cross-reaction was observed with bacteria commonly isolated from the respiratory tract. We showed that both PCR assays are more reliable than slide agglutination serotyping. The real-time PCR-based assay seems to be an alternative of choice for the epidemiological follow-up of H. influenzae invasive infections.Journal Articleinfo:eu-repo/semantics/publishe
In vitro evaluation of various antifungal agents alone and in combination by using an automatic turbidimetric system combined with viable count determinations
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Circulating concentrations of interleukin-6 in cancer patients and their pathogenic role in tumor-induced hypercalcemia
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Disseminated infection due to Cylindrocarpon (Fusarium) lichenicola in a neutropenic patient with acute leukaemia: Report of a case and review of the literature
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Rapid detection of Candida albicans in clinical blood samples by using a Taqman-based PCR assay
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Cross reaction between a pan-Candida genus probe and Fusarium spp. in a fatal case of Fusarium oxysporum pneumonia.
Case ReportsJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe
Pilot study of amphotericin B entrapped in sonicated liposomes in cancer patients with fungal infections
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Inaugural bilateral aspergillus endophthalmitis in a seriously immunocompromised patient.
Case ReportsLetterFLWINSCOPUS: le.jinfo:eu-repo/semantics/publishe
In-vitro evaluation of the antifungal activity of amphotericin B entrapped into liposomes during storage for one year
SCOPUS: ar.jinfo:eu-repo/semantics/publishe