Martine Barette

Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study.

The aim of this prospective study was to document the functional outcome and quality of life (QoL) over 1 year following hip fracture in elderly women. A total of 159 unselected elderly women with a first hip fracture were matched for age and residence with an equal number of control women. Functional status was measured by completing a Rapid Disability Rating Scale version 2 (RDRS-2) questionnaire [score ranging from 0 (best) to 54 (worse)], before hospital discharge and 12 months later. To examine longitudinal change in health-related QoL, fracture subjects and controls completed the Short Form 36 (SF-36) questionnaire. For the 134 women still alive at 1 year, the mean RDRS-2 score before hospital discharge was 16.2 (95% CI: 15.0–18.0) and 3.5 (2.6–4.3) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean RDRS-2 score improved to 13.0 (11.1–14.1) in hip-fracture women and worsened to 4.3 (3.3–5.0) in the control group (differences with initial scores: P<0.001 in both groups). After adjustment for potential confounders (including age and comorbidity), the estimated functional decline attributable to a hip fracture was 24% in the first year. Poor functional status upon discharge was the strongest predictor of a poor functional status at 1 year. Overall, similar trends were observed when using SF-36 scores as compared with RDRS-2 scores. However, only 51% of the study population was able to complete the SF-36 questionnaire at discharge and after 1 year, and these subjects were considerably younger (P<0.001), had less cognitive impairment (P<0.001), and had better functional status (P<0.001) than those who were unable to complete the SF-36. For those women able to complete the SF-36 questionnaires, the mean SF-36 score before hospital discharge was 56.4 (95% CI: 51.9–60.9) and 71.1 (67.5–74.8) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean SF-36 score improved significantly to 61.1 (56.5–65.7) in hip-fracture patients (P=0.03), but remained unchanged in the control group (P=0.23). Overall, the results of this study indicate that women who sustain a hip fracture continue to suffer from substantial functional impairment and loss in QoL at 1 year, despite a significant recovery during this 12-month period. Function upon hospital discharge is the strongest predictor of functional status 1 year later. Assessing QoL in hip fracture women through self-administered questionnaires is subject to considerable bias due to non-response.

The Economic Cost of Hip Fractures Among Elderly Women: A One-year, Prospective, Observational Cohort Study with Matched-pair Analysis

Background: We conducted a prospective study to assess the costs of initial hospitalization for a first hip fracture and to evaluate the excess costs attributable to the hip fracture during the one-year period following hospital discharge. Methods: This investigation was designed as a one-year prospective cohort study with matched-pair analysis. Elderly women who were receiving care for a first hip fracture at four Belgian hospitals were matched, with respect to age and residence, with women (control subjects) with no history of hip fracture who lived in the same neighborhood. The initial hospitalization costs were tabulated from the hospital invoices. To estimate the costs during the year after hospital discharge, health-care services utilized by the hip-fracture patients and by the control subjects were recorded. We used the official reimbursement rates to assign a cost to these services, and the results are reported in United States dollars. Results: The mean age of the 159 patients who had a hip fracture was 79.3 years, and that of the 159 control subjects was 78.7 years. The total mean cost of the initial hospitalization was

Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications

9534 for the hip-fracture patients. The total direct costs during the year after discharge averaged

Low Mannose-Binding Lectin Concentration Is Associated with Severe Infection in Patients with Hematological Cancer Who Are Undergoing Chemotherapy

13,470 for the hip-fracture patients and

A general chemotherapy myelotoxicity score to predict febrile neutropenia in hematological malignancies

6170 for the control subjects. Thus, the excess direct cost during the one-year period following hospital discharge averaged

Costs of care after hospital discharge among women with a femoral neck fracture.

7300 for the hip-fracture patients. The largest cost differences were attributable to nursing-home stays (31%), rehabilitation-center stays (31%), hospitalizations (16%), and home physical-therapy services (14%). Two-fifths of the excess costs were spent during the three months following hospital discharge. Moreover, we observed a shift in resource utilization after hospital discharge. Conclusions: Our one-year prospective study demonstrated that the costs of treating a hip-fracture patient are about three times greater than those of caring for a patient without a fracture. This study also highlights the savings to society if a hip fracture can be avoided.

Evaluation of a low-invasive strategy for prostate cancer screening with prostate-specific antigen.

PURPOSEnSince febrile neutropenic patients were recognized to constitute a heterogeneous population, several models have been developed for predicting the risk of serious medical complications. The Multinational Association for Supportive Care in Cancer score and its derived clinical prediction rules have been validated, but thus far there were no data about its use for simplifying therapy in predicted low-risk patients.nnnPATIENTS AND METHODSnIn a single institution, we followed all episodes of febrile neutropenia between January 1999 and November 2003. Those patients predicted at low risk for complications, who were not receiving antibacterials at fever onset and were eligible for treatment with oral antibiotics, were treated with ciprofloxacin and amoxicillin-clavulanate and were discharged if they were clinically stable or improving after an initial observation period. The primary end point of the study was the rate of resolution of the febrile neutropenic episode without complications, among these early discharged patients.nnnRESULTSnOf 383 first febrile neutropenic episodes predicted at low risk of complication, 178 patients (33 men and 145 women, mainly with solid tumors) were treated orally; they constituted the basis of our analysis. Seventy-nine patients (44%) were discharged early (with a median time to discharge of 26 hours); no complications occurred among them but three patients had to be readmitted, resulting in a success rate of 96% (95% CI, 92% to 100%).nnnCONCLUSIONnOur study shows that oral therapy followed by early discharge was feasible in a small but significant proportion of patients selected by a strategy combining predicted low risk and medical and nonmedical criteria.

Survival and functional outcome according to hip fracture type: A one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture

BACKGROUNDnMannose-binding lectin (MBL) is a serum lectin involved in innate immune response. Low serum MBL concentration may constitute a risk factor for infection in patients receiving myelosuppressive chemotherapy.nnnMETHODSnWe conducted a prospective, observational study that assessed MBL concentration as a risk factor for infection in patients with hematological malignancy who were hospitalized to undergo at least 1 chemotherapy cycle. MBL deficiency was defined using an algorithm that considered the serum MBL concentration and the MBL genotype. The primary end point was the ratio of duration of febrile neutropenia to the duration of neutropenia. Secondary end points included the incidence of severe infection (e.g., sepsis, pneumonia, bacteremia, and invasive fungal infection). Logistic regression analysis was conducted, and Fishers exact test was used to analyze binary outcomes, and Kaplan-Meier estimates and log rank tests were used for time-to-event variables.nnnRESULTSnWe analyzed 255 patients who received 569 cycles of chemotherapy. The median duration of neutropenia per cycle was 7 days (interquartile range, 0-13 days). Sixty-two patients (24%) were found to have MBL deficiency. Febrile neutropenia occurred at least once in 200 patients. No difference in the primary outcome was seen. The incidence of severe infection was higher among MBL-deficient patients than among non-MBL-deficient patients (1.96 vs. 1.34 cases per 100 days for analysis of all patients [P=.008] and 1.85 vs. 0.94 cases per 100 days excluding patients with acute leukemia [P<.001]).nnnCONCLUSIONSnMBL deficiency does not predispose adults with hematological cancer to more-frequent or more-prolonged febrile episodes during myelosuppressive chemotherapy, but MBL-deficient patients have a greater number of severe infections and experience their first severe infection earlier, compared with nondeficient patients.

The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group

BACKGROUNDnChemotherapy-induced neutropenia is the most common adverse effect of chemotherapy and is often complicated by febrile neutropenia (FN). The objective of this study is to validate a classification of aggressiveness of a chemotherapy regimen and to evaluate its usefulness in a risk prediction model of FN in patients with hematological cancer at the beginning of a chemotherapy cycle.nnnPATIENTS AND METHODSnTwo hundred and sixty-six patients were prospectively enrolled and followed during 1053 cycles. Relevant patient informations were collected at the beginning of the first cycle and the number of days of FN were counted in the follow-up [dichotomized (no FN versus >or= 1 day of FN)].nnnRESULTSnAggressive chemotherapy regimen is the major predictor of FN [odds ratio 5.2 (3.2-8.4)]. The other independent predictors are the underlying disease, an involvement of bone marrow, body surface <or= 2 m(2), a baseline monocyte count <150/microl and the interaction between the first cycle in the same treatment line and a baseline hemoglobin dosage. A rule of prediction of FN was computed with these characteristics: sensitivity 78.6%, specificity 62.3%, positive predictive value 42.7% and negative predictive value 89.1%.nnnCONCLUSIONnFurther studies are needed to validate this score.

Can we predict the duration of chemotherapy-induced neutropenia in febrile neutropenic patients, focusing on regimen-specific risk factors? A retrospective analysis

A prospective study was done among women who are postmenopausal and who had a displaced femoral neck fracture. The objective was to identify potential predictors of medical care costs during the 1-year after hospital discharge, and to examine the impact of the type of surgical procedure. The design was a 1-year prospective cohort study reflecting day-to-day clinical practice. At four hospitals, 84 women 50 years or older with a displaced femoral neck fracture were enrolled on a consecutive basis. Direct costs of medical care were documented during the 1-year after hospital discharge. Multivariate analyses were done to explore potential predictors of costs. Three fracture groups were defined by the time of surgical repair. Patients in the total hip arthroplasty group were significantly younger than those in the hemiarthroplasty and the internal fixation groups (mean age, 71 years, 81 years, and 80 years, respectively). The mean direct costs of medical care during the 1-year followup after hospital discharge were not significantly different after total hip arthroplasty, hemiarthroplasty, or internal fixation because of large cost variations among patients. A multivariate model identified increasing age and living in an institution at the time of the injury as the two significant determinants of increased medical costs during the 1-year followup after hospital discharge. Direct costs of medical care during the 1-year after hospital discharge do not seem to be associated with the type of surgical procedure. Increasing age and living in an institution at the time of the injury are strong predictors of increased costs.