Background:
Predictive cancer tools focus on survival; none predict severe symptoms.
Aim:
To develop and validate a model that predicts the risk for having low performance status and severe symptoms ...in cancer patients.
Design:
Retrospective, population-based, predictive study
Setting/Participants:
We linked administrative data from cancer patients from 2008 to 2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of an outcome at 6 months following diagnosis and recalculated after each of four annual survivor marks. Model performance was assessed using discrimination and calibration plots. Outcomes included low performance status (i.e. 10–30 on Palliative Performance Scale), severe pain, dyspnea, well-being, and depression (i.e. 7–10 on Edmonton Symptom Assessment System).
Results:
We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%); and lung (13%)). At diagnosis, the predicted risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13%, and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms); the corresponding discrimination for each outcome model had high AUCs of 0.807, 0.713, 0.709, 0.790, and 0.723, respectively. Generally these covariates increased the outcome risk by >10% across all models: lung disease, dementia, diabetes; radiation treatment; hospital admission; pain; depression; transitional performance status; issues with appetite; or homecare.
Conclusions:
The model accurately predicted changing cancer risk for low performance status and severe symptoms over time.
Aims
Heart failure (HF) guidelines place patients into 3 discrete groups according to left ventricular ejection fraction (LVEF): reduced (<40%), mid‐range (40–49%), and preserved LVEF (≥50%). We ...assessed whether clinical phenogroups offer better prognostication than LVEF.
Methods and results
This was a sub‐study of the Patient‐Centered Care Transitions in HF trial. We analysed baseline characteristics of hospitalized patients in whom LVEF was recorded. We used unsupervised machine learning to identify clinical phenogroups and, thereafter, determined associations between phenogroups and outcomes. Primary outcome was the composite of all‐cause death or rehospitalization at 6 and 12 months. Secondary outcome was the composite cardiovascular death or HF rehospitalization at 6 and 12 months. Cluster analysis of 1693 patients revealed six discrete phenogroups, each characterized by a predominant comorbidity: coronary heart disease, valvular heart disease, atrial fibrillation (AF), sleep apnoea, chronic obstructive pulmonary disease (COPD), or few comorbidities. Phenogroups were LVEF independent, with each phenogroup encompassing a wide range of LVEFs. For the primary composite outcome at 6 months, the hazard ratios (HRs) for phenogroups ranged from 1.25 95% confidence interval (CI) 1.00–1.58 for AF to 2.04 (95% CI 1.62–2.57 for COPD) (log‐rank P < 0.001); and at 12 months, the HRs for phenogroups ranged from 1.15 (95% CI 0.94–1.41 for AF) to 1.87 (95% 1.52–3.20 for COPD) (P < 0.002). LVEF‐based classifications did not separate patients into different risk categories for the primary outcomes at 6 months (P = 0.69) and 12 months (P = 0.30). Phenogroups also stratified risk of the secondary composite outcome at 6 and 12 months more effectively than LVEF.
Conclusion
Among patients hospitalized for HF, clinical phenotypes generated by unsupervised machine learning provided greater prognostic information for a composite of clinical endpoints at 6 and 12 months compared with LVEF‐based categories.
Trial Registration: ClinicalTrials.gov Identifier: NCT02112227
We explored social media as a potential data source for acquiring realtime information on opioid use and perceptions in Canada. Twitter messages were collected through a social media analytics ...platform between June 15, 2017, and July 13, 2017, and analyzed to identify recurring topics mentioned in the messages. Messages concerning the medical use of opioids as well as commentary on the Canadian government's current response efforts to the opioid crisis were common. The findings of this study may help to inform public health practice and community stakeholders in their efforts to address the opioid crisis.
The opioid epidemic is currently a major public health problem in Canada. As such, knowledge of upstream risk factors associated with opioid use is needed to inform injury prevention, health ...promotion and harm reduction efforts.
We analyzed data extracted from 11 pediatric and 6 general hospital emergency departments (EDs) as part of the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from March 2011 to June 2017. We identified suspected opioid-related injuries using search strings and manually verified them. We computed age-adjusted and sex-stratified proportionate injury ratios (PIRs) and 95% confidence intervals (CIs) to compare opioid-related injuries to all injuries in eCHIRPP. Negative binomial regression was used to determine trends over time. We conducted qualitative analyses of narratives to identify common themes across life stages.
Between March 2011 and June 2017, 583 suspected opioid-related poisoning/ injury cases were identified from eCHIRPP. Most of the cases were females (55%). Many of the injuries occurred in patients' own homes (51%). Forty-five percent of the injuries were intentional self-harm. Among children (aged 1-9 years), most injuries were caused by inadvertent consumption of opioids left unattended. Among youth (aged 10-19 years) and adults (aged 20-49 years), opioid use was associated with underlying mental illness. Overall, the average annual percent change (AAPC) in the rate of injuries (per 100 000 eCHIRPP cases) has been increasing since 2012 (AAPC = 11.9%, p < .05). The increase is particularly evident for males (AAPC = 16.3%, p < .05). Compared to other injuries, people with suspected opioid-related injuries were more likely to be admitted to hospital (PIR = 5.3, 95% CI: 4.6-6.2).
The upstream determinants of opioid-related injuries are complex and likely vary by subpopulations. Therefore, continued monitoring of risk factors is important in providing the evidence necessary to prevent future overdoses and deaths.
Introduction
La crise actuelle des opioïdes est un problème de santé publique majeur au
Canada. Il est nécessaire de connaître les facteurs de risque en amont associés à la consommation
d’opioïdes ...pour éclairer les efforts de prévention des blessures, de promotion
de la santé et de réduction des méfaits.
Méthodologie
Nous avons analysé les données sur les blessures subies par des personnes
traitées dans les services d’urgence (SU) de onze hôpitaux pédiatriques et de six
hôpitaux généraux au Canada et recueillies par le Système canadien hospitalier
d’information et de recherche en prévention des traumatismes en ligne (SCHIRPTe) entre
mars 2011 et juin 2017. Nous avons identifié les blessures apparemment liées aux opioïdes
au moyen de chaînes de recherche et nous les avons vérifiées manuellement. Nous avons
calculé des rapports proportionnels de blessures (RPB) en fonction de l’âge et du sexe
ainsi que des intervalles de confiance à 95 % pour comparer les blessures liées à la consommation
d’opioïdes à l'ensemble des blessures figurant dans le SCHIRPTe. Une régression
binomiale négative a été utilisée pour déterminer les tendances au fil du temps. Nous
avons effectué des analyses qualitatives des informations descriptives afin d'en dégager
les thèmes communs spécifiques à chaque étape de vie.
Résultats
Nous avons identifié 583 cas d'intoxications ou de blessures apparemment
liées aux opioïdes dans le SCHIRPTe pour la période allant de mars 2011 à juin 2017. La
majorité concernaient des femmes (55 %) et sont survenues au domicile des patients
(51 %). Quarante-cinq pour cent des blessures étaient des automutilations intentionnelles.
Chez les enfants (1 à 9 ans), la plupart des blessures ont été causées par une consommation
accidentelle d’opioïdes laissés sans surveillance. Chez les jeunes (10 à 19 ans)
et les adultes (20 à 49 ans), la consommation d’opioïdes était associée à une maladie
mentale sous-jacente. Dans l’ensemble, on observe une augmentation de la variation
annuelle moyenne en pourcentage (VAMP) du taux de blessures (pour 100 000 cas dans le
SCHIRPTe) depuis 2012 (VAMP = 11,9 %, p $lt; 0,05), particulièrement marquée chez les
hommes (VAMP = 16,3 %, p $lt; 0,05). Les personnes victimes de blessures apparemment
liées à la consommation d’opioïdes étaient plus susceptibles d’être admises à l’hôpital
que les personnes victimes d'autres types de blessure (RPB = 5,3, IC à 95 % : 4,6 à 6,2).
Conclusion
Les déterminants en amont des blessures liées à l’utilisation d’opioïdes sont
complexes et varient probablement selon les sous-populations. La surveillance continue
des facteurs de risque est donc importante afin d'obtenir les données probantes nécessaires
à la prévention d’autres surdoses et décès.
Nous avons utilisé les médias sociaux comme source de données potentielle pour obtenir
de l’information en temps réel sur l’usage des opioïdes et sur les perceptions entourant
ces substances au ...Canada. Nous avons recueilli des messages sur Twitter au moyen d’une
plateforme d’analyse des médias sociaux entre le 15 juin et le 13 juillet 2017, puis nous
les avons analysés afin d'y déceler les thèmes récurrents. Nous avons souvent relevé des
messages concernant l’usage d’opioïdes à des fins médicales ainsi que des commentaires
sur les efforts d’intervention déployés par le gouvernement du Canada dans le cadre de la
crise des opioïdes. Les résultats de l’étude pourraient aider à orienter les pratiques en
santé publique ainsi qu'à soutenir les intervenants communautaires dans leurs efforts
pour contrer la crise.
Abstract
We compared secondary attack rates in households with B.1.1.7 variant of concern (VOC) versus non-VOC index cases in a matched cohort in Ontario, Canada. The secondary attack rate for VOC ...index cases was 1.31 times higher than non-VOC index cases. This increase was particularly accentuated for asymptomatic or presymptomatic index cases.
Results of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB).
To assess the 5-year incremental health care use and expenditures after RYGB.
This ...population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020.
RYGB procedure.
The primary outcome was total health care expenditures.
The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean SD age, 47 10.2 years) and 1587 controls (mean SD age, 47 12.2 years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars) per patient in the RYGB group increased from CAD $15 594 (95% CI, CAD $14 743 to CAD $16 614) (US $12 008 95% CI, US $11 353 to US $12 794) in the 5 years before the procedure to CAD $30 389 (95% CI, CAD $28 789 to CAD $32 232) (US $23 401 95% CI, US $22 169 to US $24 821) over the 5 years after the procedure, a difference of CAD $14 795 (95% CI, CAD $13 172 to CAD $16 480) (US $11 393 95% CI, US $10 143 to US $12 691). For the control group, mean total health care expenditures per individual increased from CAD $16 109 (95% CI, CAD $14 727 to CAD $17 591) (US $12 405 95% CI, US $11 341 to US $13 546) 5 years before the index date to CAD $20 073 (95% CI, CAD $18 147 to CAD $22 169) (US $15 457 95% CI, US $13 974 to US $17 071) 5 years after the date, a difference of CAD $3964 (95% CI, CAD $2250 to CAD $5875) (US $3053 95% CI, US $1733 to US $4524). Overall, the difference-in-differences estimate of the net cost of RYGB was CAD $10 831 (95% CI, CAD $8252 to CAD $13 283) (US $8341 95% CI, $6355 to $10 229) over the 5-year period. This amount excluded the mean (SD) cost associated with the index date: CAD $6501 (CAD $1087) (US $5006 US $837) for the RYGB cohort and CAD $9 (CAD $72) (US $7 US $55) for the controls. The cost differential was primarily associated with increased hospitalizations in the first months immediately after RYGB. Expenditures leveled off in year 3 after the index date; differences in total expenditures between the RYGB and control cohorts were not statistically significantly different in years 4 and 5.
Health care expenditures in the 3 years after publicly funded RYGB were higher in patients who underwent the procedure than in control individuals, but the costs were similar thereafter. This finding suggests the need to decrease hospital and emergency department readmissions after surgical bariatric procedures because such use is associated with increased spending.
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