BACKGROUNDThe aging of the population is one of the causes of the increase in healthcare costs in the past few decades. It is controversial whether chronological age alone should be used in making ...healthcare decisions.
OBJECTIVETo determine the association between age and hospital costs in patients receiving mechanical ventilation (MV).
DESIGNProspective, observational study.
SETTINGIntensive care units at a teaching hospital.
PATIENTSA total of 813 adults who received prolonged (≥48 hrs) mechanical ventilation.
INTERVENTIONNone.
MEASUREMENTSSeverity of illness, comorbidities, length of stay, hospital costs, and mortality. We evaluated the independent association of age with hospital costs using linear regression.
RESULTSMean (±sd) age of patients was 60.4 ± 18.8 yrs. Median Acute Physiology Chronic Health Evaluation III score and probability of hospital death at intensive care unit admission were 64 and 0.31, respectively. Hospital mortality was 36%. Median total hospital costs and daily costs were $ 56,056 and $2,655, respectively. Older age was associated with lower total hospital costs after controlling for sex, intensive care unit type, severity of illness, length of stay, insurance type, resuscitation status, and survival. Hospital costs were significantly less in older patients in all cost departments examined, except for respiratory care and intensive care unit room costs.
CONCLUSIONSDaily and total hospital costs were lower in older patients. Decreased hospital resource use in older patients may be related to a preference for less aggressive care by older patients and their families or by healthcare providers.
Two human immunoglobulin M (IgM) monoclonal antibodies (MoAbs), 16.88 and 28A32, which react with cytoplasmic (28A32 and 16.88) or cell surface (28A32) determinants on human colon carcinoma cells, ...were administered intravenously to 26 patients with metastatic colorectal carcinoma to determine if they could localize to sites of metastatic disease, if they had any antitumor or toxic effects, and to determine whether they would elicit an antihuman MoAb response. Serial scans showed tumor uptake of radioisotope in 12 of 16 patients receiving 131I-labeled 28A32 and in nine of 12 patients receiving 131I-labeled 16.88. No antitumor effects were seen with either antibody. No antibody-related toxic effects were observed following administration of 16.88, but two patients developed localized urticarial reactions following injection with antibody 28A32. No patient developed an antibody response to 16.88. Anti-28A32 reactivity was found in five of 12 (42%) normal sera and in seven of 23 (30%) patients before receiving any antibody. Following administration of 28A32, a low titer (1:10 dilution) of anti-28A32 developed in four patients with no preexisting antibody, a decrease in the preexisting titer was seen in three other patients, the titer remained constant in one patient, and no anti-28A32 was ever detected in six patients. In most cases, anti-28A32 activity was lost at dilutions greater than 1:10 and did not appear to affect antibody half-life in the serum or whole body retention of the antibody. We conclude that these human IgM MoAbs are capable of localizing at sites of disease in vivo, are nontoxic, and are poorly immunogenic in humans. Further studies to determine the specificity of targeting and to improve the delivery of antibody to sites of tumor are indicated.
To describe the 2-month mortality and functional status of adult patients receiving prolonged (at least 48 h) mechanical ventilation (MV), and to identify patient characteristics that are associated ...with 2-month mortality.
Prospective cohort study.
Four ICUs at a tertiary-care institution.
Eight hundred seventeen patients who received prolonged MV.
None.
Median age, sex distribution, and median Charlson comorbidity score of the 817 patients were 65 years, 45.8% women, and 1, respectively. The median scores on Katz Activities of Daily Living, Instrumental Activities of Daily Living Deficits, and Medical Outcomes Study Short-Form 36 surveys before hospitalization were 0, 1, and 50, respectively. Median APACHE (acute physiology and chronic health evaluation) III score and probability of hospital death for the cohort were 64 and 0.31, respectively. Median duration of MV was 9 days. Two-month mortality was 43%. Independent predictors of mortality at 2 months were age, comorbidities, and prehospital functional status. The adjusted odds of dying within 2 months increased 34% for each decade increase in age. Functional status deteriorated at 2 months compared to functional status prior to hospitalization, and 35% of the survivors were at risk for clinical depression. Among the 2-month survivors for whom the need for a caregiver was assessed, 78% had a caregiver.
Older age, in addition to functional status and comorbidities, was associated with increased mortality at 2 months. Functional status of survivors declined at 2 months.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Twenty melanoma patients were immunized with a whole-cell vaccine prepared from irradiated cells of the melanoma cell line SK-MEL-13. This line, derived from the melanoma of patient AH, expresses a ...differentiation antigen (initially defined by autologous antibody) which is restricted to melanomas and other cells of neural crest origin. The patients' sera were tested in rosetting assays before and after vaccination for antibodies against cell surface antigens of autologous cultured melanoma cells and SK-MEL-13, and the specificity of observed reactions was defined by absorption tests. Nine patients developed antibodies against autologous cultured melanoma cells. In only one case, patient DM, were these antibodies directed against the AH antigen. In the remaining patients, the antibodies were related to fetal bovine serum in the vaccine growth medium. All patients developed antibodies against cell surface HLA alloantigens of the immunizing cell, SK-MEL-13, as demonstrated by absorption analysis with B cells from the donor of SK-MEL-13 and by serological typing with a panel of HLA typed peripheral blood T cells and B-cell CLL cells. No specificity other than the AH antibody found in patient DM was detected after removal of alloantigens with B cells. We conclude that vaccines prepared from irradiated allogeneic melanoma cells expressing AH antigen, a demonstrably immunogenic differentiation antigen of the melanocyte lineage, are not effective in inducing AH antibody.
A comprehensive immunologic and serologic analysis was performed on 31 untreated patients with Hodgkin's disease. Immune evaluations stressed T‐cell functional activity and included traditional ...parameters (PHA responsiveness and delayed hypersensitivity skin reactivity), as well as newer functional assays (T‐cell colony formation, chemotaxis, spontaneous and antibody‐dependent cytotoxicity, and concanavalin A‐induced suppressor cell activity (CISA)). Serum factors included ferritin, prostaglandins, zinc, copper, immune complexes, and thymic hormone activity. Every patient exhibited at least one T‐cell or serum abnormality. The greatest percentage of patients exhibited T‐cell defects in chemotaxis (85%), colony formation (81%), and PHA reactivity (64%). Immune defects were more common with advanced disease but were not related to absolute T‐cell or monocyte count, skin test anergy, or abnormalities of Tμ/Tγ cell proportions. Linear relationships were identified among abnormalities in the three assays employing mononuclear cells (PHA, colony formation, CISA) which may have reflected the inhibitory influence of monocytes present in the mononuclear cell preparations. Low serum zinc correlated with marked impairment of T‐cell chemotaxis. Elevated prostaglandins were associated with high PHA reactivity and with depressed colony formation. Our results indicate that many complex factors, including intrinsic T‐cell defects, contribute to the impaired immunity associated with Hodgkin's disease.
Twenty consecutive patients with Hodgkin disease in continuous complete remission and off treatment for at least 5 yr (range 5-25 yr, median 9 yr) were studied with a battery of immunologic ...parameters. Skin test reactivity to four common antigens, sensitization to 2,4-dinitrochlorobenzene, absolute lymphocyte count, relative percentage of T cells (as measured by spontaneous rosette formation with sheep erythrocytes) and B cells (as measured by immunofluorescence with polyvalent antiserum), and absolute number of T and B cells were normal when compared with controls. However, the mean value of lymphocyte response in vitro to the mitogen phytohemagglutinin for the study population was significantly decreased (p < 0.001) when compared with the controls. This abnormality in response to mitogen could not be correlated with age, sex, stage, symptoms, histologic subclassification, or previous treatment. The data suggest the existence of a persisting cell-mediated immune defect in the circulating lymphocytes in patients with long-standing Hodgkin disease that might otherwise be considered “cured.”
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