Uncertainty--the other side of prognosis Smith, Alexander K; White, Douglas B; Arnold, Robert M
New England journal of medicine/The New England journal of medicine,
06/2013, Letnik:
368, Številka:
26
Journal Article
Dealing with Racist Patients Paul-Emile, Kimani; Smith, Alexander K; Lo, Bernard ...
The New England journal of medicine,
2016-Feb-25, Letnik:
374, Številka:
8
Journal Article
Rehabbed to Death Flint, Lynn A; David, Daniel J; Smith, Alexander K
The New England journal of medicine,
2019-Jan-31, Letnik:
380, Številka:
5
Journal Article
Postoperative cognitive dysfunction (POCD) is a concern after anaesthesia and surgery, but preoperative discussion of neurocognitive risks with older patients rarely occurs. Anecdotal experiences of ...POCD are common in the popular media and may inform patient perspectives. However, the degree of alignment between lay and scientific perspectives on POCD is not known.
We performed inductive qualitative thematic analysis on website user comments publicly submitted under an article entitled, ‘The hidden long-term risks of surgery: “It gives people's brains a hard time”’, published by the UK-based news source The Guardian in April 2022.
We analysed 84 comments from 67 unique users. Themes that emerged from user comments included the importance of functional impact (‘Couldn't work … even reading was a struggle’), attribution to a range of causes but particularly the use of general, rather than consciousness-preserving, anaesthesia techniques (‘side effects aren't fully understood’), and inadequate preparation and response by healthcare providers (‘I would have benefited by being warned’).
There is misalignment between professional and lay understandings of POCD. Lay people emphasise subjective and functional impact of symptoms, and express beliefs about the role of anaesthetics in causing POCD. Some patients and caregivers affected by POCD report feeling abandoned by medical providers. In 2018, new nomenclature for postoperative neurocognitive disorders was published, which better aligns with lay perspectives by including subjective complaints and functional decline. Further studies based on newer definitions and public messaging may improve concordance between different understandings of this postoperative syndrome.
Ectomycorrhizal (ECM) plants and fungi can be diverse and abundant in certain tropical ecosystems. For example, the primarily paleotropical ECM plant family Dipterocarpaceae is one of the most ...speciose and ecologically important tree families in Southeast Asia. Pakaraimaea dipterocarpacea is one of two species of dipterocarp known from the Neotropics, and is also the only known member of the monotypic Dipterocarpaceae subfamily Pakaraimoideae. This Guiana Shield endemic is only known from the sandstone highlands of Guyana and Venezuela. Despite its unique phylogenetic position and unusual geographical distribution, the ECM fungal associations of P. dipterocarpacea are understudied throughout the tree's range. In December 2010 we sampled ECM fungi on roots of P. dipterocarpacea and the co-occurring ECM tree Dicymbe jenmanii (Fabaceae subfamily Caesalpinioideae) in the Upper Mazaruni River Basin of Guyana. Based on ITS rDNA sequencing we documented 52 ECM species from 11 independent fungal lineages. Due to the phylogenetic distance between the two host tree species, we hypothesized that P. dipterocarpacea would harbor unique ECM fungi not found on the roots of D. jenmanii. Although statistical tests suggested that several ECM fungal species did exhibit host preferences for either P. dipterocarpacea or D. jenmanii, most of the ECM fungi were multi-host generalists. We also detected several ECM fungi that have never been found in long-term studies of nearby rainforests dominated by other Dicymbe species. One particular mushroom-forming fungus appears to be unique and may represent a new ECM lineage of Agaricales that is endemic to the Neotropics.
Objectives
To develop a prediction index for 1‐year mortality after hip fracture in older adults that includes predictors from a wide range of domains.
Design
Retrospective cohort study.
Settings
...Health and Retirement Study (HRS).
Participants
HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).
Measurements
Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1‐year mortality were identified, and best‐subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.
Results
Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1‐year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1‐year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c‐statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.
Conclusion
The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1‐year mortality after hip fracture.
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