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Geographic distance is not associated with inferior outcome when using long-term transplant clinic strategy.
Ragon BK, Clifton C, Chen H, Savani BN, Engelhardt BG, Kassim AA, Vaughan LA, Lucid C, Jagasia M
(2014) Biol Blood Marrow Transplant 20: 53-7
MeSH Terms: Adult, Aged, Female, Graft vs Host Disease, Health Services Accessibility, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Humans, Long-Term Care, Male, Middle Aged, Proportional Hazards Models, Survival Analysis, Transplantation, Homologous, Treatment Outcome
Show Abstract · Added March 20, 2014
The optimal healthcare model for follow-up of allogeneic hematopoietic stem cell transplantation (HSCT) recipients after day 100 is not clear. We previously demonstrated that longitudinal follow-up at the transplant center using a multidisciplinary approach is associated with superior survival. Recent data suggest that increased distance from the transplant center is associated with inferior survival. A dedicated long-term transplant clinic (LTTC) was established in 2006 at our center. We hypothesized that geographic distance would not be associated with inferior outcome if patients are followed in the LTTC. We studied 299 consecutive patients who underwent HSCT and established care in an LTTC. The median distance from the transplant center was 118 miles (range, 1 to 1591). The 75th percentile (170 miles) was used as the cut-off to analyze the impact of distance from the center on outcome (219 patients ≤ 75th percentile; 80 patients >75th percentile). The 2 groups were balanced for pretransplant characteristics. In multivariate analyses adjusted for donor type, Center for International Blood and Marrow Transplant Research risk, and transplant regimen intensity, distance from transplant center did not impact outcome. Our study suggests that geographic distance from the transplant center is not associated with inferior outcome when follow-up care is delivered via a dedicated LTTC incorporating well-coordinated multidisciplinary care.
Published by Elsevier Inc.
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15 MeSH Terms
Medical and economic implications of cognitive and psychiatric disability of survivorship.
Hopkins RO, Girard TD
(2012) Semin Respir Crit Care Med 33: 348-56
MeSH Terms: Cost of Illness, Critical Care, Critical Illness, Disabled Persons, Humans, Long-Term Care, Mental Disorders, Prevalence, Quality of Life, Survivors
Show Abstract · Added September 23, 2015
Current research indicates that the majority of survivors of critical illness develop post-intensive care syndrome (PICS), which includes new or worsening cognitive or psychiatric disorders that persist for months to years after critical illness. These cognitive impairments and psychiatric disorders are profound and long-lasting, adversely affecting survivors' daily functioning, ability to return to work, and quality of life, as well as altering the lives of their family members. The medical effects of cognitive and psychiatric disability after critical illness translate directly into a large economic burden. A large and growing body of intensive care unit (ICU) survivors with cognitive and psychiatric morbidities presents challenges for research and identification of best practices and interventions, both during and after the ICU, including rehabilitation to prevent or remediate long-term neurological outcomes.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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10 MeSH Terms
Cancer survivorship practices, services, and delivery: a report from the Children's Oncology Group (COG) nursing discipline, adolescent/young adult, and late effects committees.
Eshelman-Kent D, Kinahan KE, Hobbie W, Landier W, Teal S, Friedman D, Nagarajan R, Freyer DR
(2011) J Cancer Surviv 5: 345-57
MeSH Terms: Adolescent, Adult, Child, Delivery of Health Care, Humans, Long-Term Care, Neoplasms, Nursing Care, Oncology Service, Hospital, Professional Practice, Survival Rate, Survivors, Young Adult
Show Abstract · Added March 27, 2014
PURPOSE - To describe survivorship services provided by the Children's Oncology Group (COG), an assessment of services was undertaken. Our overall aims were (1) to describe survivorship services, including the extent of services provided, resources (personnel, philanthropy, and research funding), billing practices, and barriers to care and 2) to describe models of care that are in use for childhood cancer survivors and adult survivors of childhood cancer.
METHODS - One hundred seventy-nine of 220 COG institutions (81%) completed an Internet survey in 2007.
RESULTS - One hundred fifty-five (87%) reported providing survivorship care. Fifty-nine percent of institutions provide care for their pediatric population in specialized late effects programs. For adult survivors, 47% of institutions chose models of care, which included transitioning to adult providers for risk-based health care, while 44% of institutions keep survivors indefinitely at the treating institution (Cancer Center Based Model without Community Referral). Sixty-eight percent provide survivors with a copy of their survivorship care plan. Only 31% of institutions provide a detailed summary of results after each clinic visit, and 41% have a database to track survivor health outcomes. Minimal time required for initial and annual survivorship visits is estimated to be approximately 120 and 90 min, respectively. The most prevalent barriers to care were the lack of dedicated time for program development and a perceived insufficient knowledge on the part of the clinician receiving the transition referral.
CONCLUSIONS - Not all COG institutions provide dedicated survivorship care, care plans, or have databases for tracking outcomes. Transitioning to adult providers is occurring within the COG. Survivorship care is time intensive.
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13 MeSH Terms
Prevalence and implications of preinjury warfarin use: an analysis of the National Trauma Databank.
Dossett LA, Riesel JN, Griffin MR, Cotton BA
(2011) Arch Surg 146: 565-70
MeSH Terms: Adult, Age Factors, Aged, Aged, 80 and over, Anticoagulants, Cause of Death, Cohort Studies, Comorbidity, Cross-Sectional Studies, Databases, Factual, Drug Utilization, Female, Hospital Mortality, Humans, Intracranial Hemorrhage, Traumatic, Long-Term Care, Male, Middle Aged, Odds Ratio, Retrospective Studies, Survival Analysis, Trauma Centers, Trauma Severity Indices, United States, Warfarin, Wounds and Injuries, Young Adult
Show Abstract · Added December 10, 2013
OBJECTIVES - To describe the prevalence of preinjury warfarin use in a large national sample of trauma patients and to define the relationship between preinjury warfarin use and mortality.
DESIGN - Retrospective cohort study.
SETTING - The National Trauma Databank (7.1).
PATIENTS - All patients admitted to eligible trauma centers during the study period; 1,230,422 patients (36,270 warfarin users) from 402 centers were eligible for analysis.
MAIN OUTCOME MEASURES - Prevalence of warfarin use and all-cause in-hospital mortality. Multivariate logistic regression was used to estimate the odds ratio (OR) for mortality associated with preinjury warfarin use.
RESULTS - Warfarin use increased among all patients from 2.3% in 2002 to 4.0% in 2006 (P < .001), and in patients older than 65 years, use increased from 7.3% in 2002 to 12.8% in 2006 (P < .001). Among all patients, 9.3% of warfarin users died compared with only 4.8% of nonusers (OR, 2.02; 95% confidence interval [CI], 1.95-2.10; P < .001). After adjusting for important covariates, warfarin use was associated with increased mortality among all patients (OR, 1.72; 95% CI, 1.63-1.81; P < .001) and patients 65 years and older (OR, 1.38; 95% CI, 1.30-1.47; P < .001).
CONCLUSIONS - Warfarin use is common among injured patients and its prevalence has increased each year since 2002. Its use is a powerful marker of mortality risk, and even after adjusting for confounding comorbidities, it is associated with a significant increase in death.
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27 MeSH Terms
Childhood cancer survivors: transition to adult-focused risk-based care.
Henderson TO, Friedman DL, Meadows AT
(2010) Pediatrics 126: 129-36
MeSH Terms: Adolescent, Adult, Age Factors, Child, Child, Preschool, Continuity of Patient Care, Disease-Free Survival, Female, Humans, Long-Term Care, Male, Neoplasms, Quality of Health Care, Quality of Life, Risk Assessment, Survivors, Treatment Outcome, United States, Young Adult
Show Abstract · Added March 27, 2014
BACKGROUND - The issues involved in transition from pediatric cancer care to adult-focused care differ from those in other childhood diseases, because malignant disease itself is no longer a problem. However, the potential for fatal outcome places a greater dependence on the pediatric oncology setting and delays this transition process, often beyond adolescence. Adverse long-term physical and psychological effects accompany survival for many of the cured children, and because these effects may not become manifest until adulthood, programs that support transition for childhood cancer survivors require the expertise of many subspecialists.
OBJECTIVES - To describe the issues and barriers to successful transition programs for childhood cancer survivors when they are ready for adult-focused care.
METHODS - We reviewed the literature and discuss the barriers to transition at the survivor, provider, and health care system levels for survivors of childhood cancer. We also critically assess the elements of successful transition programs.
RESULTS - Education of survivors and providers regarding long-term health risks is necessary for a successful transition. This process should be gradual to address the educational needs of survivors, families, and health care professionals, determine "readiness" for transition, and address financial and insurance concerns. Because little is known regarding adverse long-term health-related sequelae beyond the fourth decade of life, research is needed to quantify and reduce the consequences of these morbidities.
CONCLUSIONS - Transition programs for pediatric cancer survivors require experts who are knowledgeable regarding the long-term follow-up needs of childhood cancer survivors and who can provide a bridge between pediatric oncology and primary care that is risk based.
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19 MeSH Terms
Increasing healthcare resource utilization after coronary artery bypass graft surgery in the United States.
Swaminathan M, Phillips-Bute BG, Patel UD, Shaw AD, Stafford-Smith M, Douglas PS, Archer LE, Smith PK, Mathew JP
(2009) Circ Cardiovasc Qual Outcomes 2: 305-12
MeSH Terms: Aged, Ambulatory Care, Comorbidity, Coronary Artery Bypass, Coronary Artery Disease, Databases, Factual, Female, Heart Valve Diseases, Home Care Services, Hospital Bed Capacity, Hospital Mortality, Humans, Length of Stay, Long-Term Care, Male, Middle Aged, Multivariate Analysis, Patient Discharge, Regression Analysis, United States
Show Abstract · Added October 20, 2015
BACKGROUND - Despite declining lengths of stay, postdischarge healthcare resource utilization may be increasing because of shifts to nonacute care settings. Although changes in hospital stay after coronary artery bypass graft (CABG) surgery have been described, patterns of discharge remain unclear. Our objective was to determine patterns of discharge disposition after CABG surgery in the United States.
METHODS AND RESULTS - We examined discharge disposition after CABG procedures from 1988 to 2005 using the Nationwide Inpatient Sample. Discharges with a "nonroutine" disposition defined patients discharged with continued healthcare needs. Multivariable regression models were constructed to assess trends and factors associated with nonroutine discharge. Median length of stay among 8,398,554 discharges decreased from 11 to 8 days between 1988 and 2005 (P<0.0001). There was a simultaneous increase in nonroutine discharges from 12% in 1988 to 45% in 2005 (P<0.0001), primarily comprising home healthcare and long-term facility use. Multivariable regression models showed age, female gender, comorbidities, concurrent valve surgery, and lower-volume hospitals more likely to be associated with nonroutine discharge.
CONCLUSIONS - We found a significant increase in nonroutine discharges after CABG surgery across the United States from 1988 to 2005. The significant shortening of length of stay during CABG may be counterbalanced by the increased requirement for additional postoperative healthcare services. Nonacute care institutions are playing an increasingly significant role in providing CABG patients with postdischarge healthcare and should be considered in investigations of postoperative healthcare resource utilization. The impact of these changes on long-term outcomes and net resource utilization remain unknown.
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20 MeSH Terms
Food modification versus oral liquid nutrition supplementation.
Silver HJ
(2009) Nestle Nutr Workshop Ser Clin Perform Programme 12: 79-93
MeSH Terms: Aged, Aging, Assisted Living Facilities, Beverages, Chronic Disease, Dietary Supplements, Food Services, Food, Fortified, Hospitalization, Humans, Long-Term Care, Nutritional Requirements
Show Abstract · Added December 10, 2013
Oral liquid nutrition supplements (ONS) are widely used in community, residential and healthcare settings. ONS are intended for individuals whose nutrient requirements cannot be achieved by conventional diet or food modification, or for the management of distinctive nutrient needs resulting from specific diseases and/or conditions. ONS appear to be most effective in patients with a body mass index of Copyright (c) 2009 S. Karger AG, Basel.
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12 MeSH Terms
Management of osteoporosis among home health and long-term care patients with a prior fracture.
Warriner AH, Outman RC, Saag KG, Berry SD, Colón-Emeric C, Flood KL, Lyles KW, Tanner SB, Watts NB, Curtis JR
(2009) South Med J 102: 397-404
MeSH Terms: Accidental Falls, Aged, Algorithms, Bone Density Conservation Agents, Calcium, Fractures, Bone, Frail Elderly, Home Care Services, Humans, Long-Term Care, Osteoporosis, Risk Assessment, Vitamin D
Show Abstract · Added January 20, 2015
Osteoporosis is a growing health concern as the number of senior adults continues to increase worldwide. Falls and fractures are very common among frail older adults requiring home health and long-term care. Preventative strategies for reducing falls have been identified and many therapies (both prescription and nonprescription) with proven efficacy for reducing fracture risk are available. However, many practitioners overlook the fact that a fragility fracture is diagnostic for osteoporosis even without knowledge of bone mineral density testing. As a result, osteoporosis is infrequently diagnosed and treated in the elderly after a fracture. Based on existing literature, we have developed an algorithm for the assessment and treatment of osteoporosis among persons with known prior fracture(s) living in long-term care facilities or receiving home health care based on the data available in the literature.
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13 MeSH Terms
Oral strategies to supplement older adults' dietary intakes: comparing the evidence.
Silver HJ
(2009) Nutr Rev 67: 21-31
MeSH Terms: Aged, Aging, Beverages, Chronic Disease, Diet, Dietary Supplements, Energy Intake, Environment, Food, Food Services, Humans, Institutionalization, Long-Term Care, Malnutrition, Minerals, Nutritive Value, Satiation, Taste, Vitamins
Show Abstract · Added December 10, 2013
Despite the current global obesity crisis, undernutrition remains prevalent among older adults worldwide. This review compares the efficacy of the main oral strategies used to increase older adults' energy and nutrient intakes, i.e., meal enhancement, multivitamin/multimineral supplementation and oral liquid nutrition supplements. Well-designed long-term investigations that are adequately powered to differentiate effects on nutritional, clinical, functional, and cost outcomes are much needed before scientific and clinical consensus can be reached on where and when to implement any strategy as the optimal choice for improving dietary intakes in a specific older adult population.
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19 MeSH Terms
Talc pleurodesis for malignant effusions is preferred over the pleurx catheter (pro position).
Antevil JL, Putnam JB
(2007) Ann Surg Oncol 14: 2698-9
MeSH Terms: Chest Tubes, Combined Modality Therapy, Humans, Long-Term Care, Pleural Effusion, Malignant, Pleurodesis, Survival Rate, Talc
Added March 5, 2014
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8 MeSH Terms