90 research outputs found
The Laboratory-Based Intermountain Validated Exacerbation (LIVE) Score Identifies Chronic Obstructive Pulmonary Disease Patients at High Mortality Risk.
Background: Identifying COPD patients at high risk for mortality or healthcare utilization remains a challenge. A robust system for identifying high-risk COPD patients using Electronic Health Record (EHR) data would empower targeting interventions aimed at ensuring guideline compliance and multimorbidity management. The purpose of this study was to empirically derive, validate, and characterize subgroups of COPD patients based on routinely collected clinical data widely available within the EHR. Methods: Cluster analysis was used in 5,006 patients with COPD at Intermountain to identify clusters based on a large collection of clinical variables. Recursive Partitioning (RP) was then used to determine a preferred tree that assigned patients to clusters based on a parsimonious variable subset. The mortality, COPD exacerbations, and comorbidity profile of the identified groups were examined. The findings were validated in an independent Intermountain cohort and in external cohorts from the United States Veterans Affairs (VA) and University of Chicago Medicine systems. Measurements and Main Results: The RP algorithm identified five LIVE Scores based on laboratory values: albumin, creatinine, chloride, potassium, and hemoglobin. The groups were characterized by increasing risk of mortality. The lowest risk, LIVE Score 5 had 8% 4-year mortality vs. 56% in the highest risk LIVE Score 1 (p < 0.001). These findings were validated in the VA cohort (n = 83,134), an expanded Intermountain cohort (n = 48,871) and in the University of Chicago system (n = 3,236). Higher mortality groups also had higher COPD exacerbation rates and comorbidity rates. Conclusions: In large clinical datasets across different organizations, the LIVE Score utilizes existing laboratory data for COPD patients, and may be used to stratify risk for mortality and COPD exacerbations
Recommended from our members
Confirmatory Spirometry for Adults Hospitalized with a Diagnosis of Asthma or Chronic Obstructive Pulmonary Disease Exacerbation
Background: Objective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation. Methods: Multi-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations. Results: There was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007). Conclusions: Adequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients
Recommended from our members
A nurse driven care management program to engage older diabetes patients in personalized goal setting and disease management
Background and aims: Multiple diabetes care guidelines have called for the personalization of risk factor goals, medication management, and self-care plans among older patients. Study of the implementation of these recommendations is needed. This study aimed to test whether a patient survey embedded in the Electronic Healthcare Record (EHR), coupled with telephonic nurse care management, could engage patients in personalized goal setting and chronic disease management. Methods: We conducted a single-center equal-randomization delayed comparator trial at the primary care clinics of the University of Chicago Medicine from 2018.6 to 2019.12. Patients over the age of 65 years with type 2 diabetes with an active patient portal account were recruited and randomized to receive an EHR embedded goal setting and preference survey immediately in the intervention arm or after 6 months in the delayed intervention control arm. In the intervention arm, nurses reviewed American Diabetes Association recommendations for A1C goals based on health status class, established personalized goals, and provided monthly telephonic care management phone calls for a maximum of 6 months. Our primary outcome was the documentation of a personalized A1C goal in the EHR. Results: A total of 100 patients completed the trial (mean age, 72.51 [SD, 5.22] years; mean baseline A1C, 7.14% [SD, 1.06%]; 68% women). The majority were in the Healthy (59%) followed by Complex (30%) and Very Complex (11%) health status classes. Documentation of an A1C goal in the EHR increased from 42% to 90% (p Conclusions: Older patients can be engaged in personalized goal setting and disease management through an embedded EHR intervention. The clinical impact of the intervention may differ if deployed among older patients with more complex health needs and higher glucose levels. Trial registration: ClinicalTrials.gov Identifier: NCT03692208.</p
Prognostic relevance of a T-type calcium channels gene signature in solid tumours: A correlation ready for clinical validation
BackgroundT-type calcium channels (TTCCs) mediate calcium influx across the cell membrane. TTCCs regulate numerous physiological processes including cardiac pacemaking and neuronal activity. In addition, they have been implicated in the proliferation, migration and differentiation of tumour tissues. Although the signalling events downstream of TTCC-mediated calcium influx are not fully elucidated, it is clear that variations in the expression of TTCCs promote tumour formation and hinder response to treatment.MethodsWe examined the expression of TTCC genes (all three subtypes; CACNA-1G, CACNA-1H and CACNA-1I) and their prognostic value in three major solid tumours (i.e. gastric, lung and ovarian cancers) via a publicly accessible database.ResultsIn gastric cancer, expression of all the CACNA genes was associated with overall survival (OS) among stage I-IV patients (all pConclusionsAlterations in CACNA gene expression are linked to tumour prognosis. Gastric cancer represents the most promising setting for further evaluation
Deregulation of the EGFR/PI3K/PTEN/Akt/mTORC1 pathway in breast cancer: possibilities for therapeutic intervention
The EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3 pathway plays prominent roles in
malignant transformation, prevention of apoptosis, drug resistance and
metastasis. The expression of this pathway is frequently altered in
breast cancer due to mutations at or aberrant expression of: HER2,
ERalpha, BRCA1, BRCA2, EGFR1, PIK3CA, PTEN, TP53, RB as well as other
oncogenes and tumor suppressor genes. In some breast cancer cases,
mutations at certain components of this pathway (e.g., PIK3CA) are
associated with a better prognosis than breast cancers lacking these
mutations. The expression of this pathway and upstream HER2 has been
associated with breast cancer initiating cells (CICs) and in some cases
resistance to treatment. The anti-diabetes drug metformin can suppress
the growth of breast CICs and herceptin-resistant HER2+ cells. This
review will discuss the importance of the
EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3 pathway primarily in breast cancer but
will also include relevant examples from other cancer types. The
targeting of this pathway will be discussed as well as clinical trials
with novel small molecule inhibitors. The targeting of the hormone
receptor, HER2 and EGFR1 in breast cancer will be reviewed in
association with suppression of the EGFR/PI3K/PTEN/Akt/mTORC1/GSK-3
pathway.USAMRMC {[}BC022276]; Intramural RECDA Award; Italian Association for
Cancer Research (AIRC); MIUR-PRIN; Italian MIUR-FIRB Accordi di
Programma; Italian ``Ministero dell'Istruzione, dell'Universita e della
Ricerca (Ministry for Education, Universities and Research) - FIRB-MERIT
{[}RBNE08YYBM]; Italian Ministry of Economy and Finance; Italian
Ministry of Health, Ricerca Finalizzata Stemness; MIUR FIRB
{[}RBAP11ZJFA\_001]; CRO; Italian Association for Cancer Research,
(AIRC) (RM PI); Italian Association for Cancer Research, (AIRC)
{[}MCO10016]; Italian Ministry of Health; Regione Friuli Venezia-Giuli
Thermogravimetric kinetics of crude glycerol.
The pyrolysis of the crude glycerol from a biodiesel production plant was investigated by thermogravimetry coupled with Fourier transform infrared spectroscopy. The main gaseous products are discussed, and the thermogravimetric kinetics derived. There were four distinct phases in the pyrolysis process of the crude glycerol. The presence of water and methanol in the crude glycerol and responsible for the first decomposition phase, were shown to catalyse glycerol decomposition (second phase). Unlike the pure compound, crude glycerol decomposition below 500 K leaves behind a large mass fraction of pyrolysis residues (ca. 15%), which eventually partially eliminate in two phases upon reaching significantly higher temperatures (700 and 970 K, respectively). An improved iterative Coats-Redfern method was used to evaluate non-isothermal kinetic parameters in each phase. The latter were then utilised to model the decomposition behaviour in non-isothermal conditions. The power law model (first order) predicted accurately the main (second) and third phases in the pyrolysis of the crude glycerol. Differences of 10-30 kJ/mol in activation energies between crude and pure glycerol in their main decomposition phase corroborated the catalytic effect of water and methanol in the crude pyrolysis. The 3-D diffusion model more accurately reproduced the fourth (last) phase, whereas the short initial decomposition phase was poorly simulated despite correlation coefficients ca. 0.95-0.96. The kinetics of the 3rd and 4th decomposition phases, attributed to fatty acid methyl esters cracking and pyrolysis tarry residues, were sensitive to the heating rate
Recommended from our members
Association of health confidence with hospital length of stay and readmission
Background: Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations. Objective: To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population. Designs, settings and participants: We conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois. Intervention: None. Main outcome and measures: Patient-reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30- and 90-day readmission. Results: Among 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0-12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53-day lower LOS (p < .01, 95% CI [-2.11, -0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question "I am involved in decisions about me" (adjusted model: OR 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90-day readmission.</p
- …