Search

Background: Using the ‘surprise’ question ‘Would you be surprised if this patient died in the next year?’ may improve physicians’ prognostic accuracy and identify people appropriate for palliative care. Aim: Determine the prognostic accuracy of general practitioners asking the ‘surprise’ question about their patients with advanced (stage IV) cancer. Design: Prospective cohort study. Setting/participants: Between December 2011 and February 2012, 42 of 50 randomly selected general practitioners (Bologna area, Italy) prospectively classified 231 patients diagnosed with advanced cancer according to the ‘surprise’ question and supplied the status of each patient 1 year later. Results: Of the 231 patients, general practitioners responded ‘No’ to the ‘surprise’ question for 126 (54.5%) and ‘Yes’ for 105 (45.5%). After 12 months, 104 (45.0%) patients had died; 87 (83.7%) were in the ‘No’ group. The sensitivity of the ‘surprise’ question was 69.3%; the specificity was 83.6%. Positive predictive value was 83.8%; negative predictive value was 69.0%. The answer to the ‘surprise’ question was significantly correlated with survival at 1 year. Patients in the ‘No’ group had an odds ratio of 11.55 (95% confidence interval: 5.83–23.28) and a hazard ratio of 6.99 (95% confidence interval: 3.75–13.03) of being dead in the next year compared to patients in the ‘Yes’ group ( p = 0.000 for both odds ratio and hazard ratio). Conclusion: When general practitioners used the ‘surprise’ question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care.

To evaluate the stability and reproducibility of selected peripheral oxidative stress markers and their possible relation to cognitive performance, three different blood samples were taken at 7- to 10-day intervals from 11 patients with probable Alzheimer disease (AD) and 11 nondemented controls. Blood samples were also collected once from 6 patients with vascular dementia (VT). alpha -1-Antichymotrypsin (ACT), C-reactive protein (CRP), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), lactoferrin (LTF), and total lipid peroxidation (LPO) were then measured. Blood levels of ACT and GSH-Px were increased in AD patients but not in patients with VD. Levels of LTF, CRP, and LPO were comparable between AD patients and controls. Erythrocyte SOD activity was increased in AD patients. Blood levels of ACT negatively correlated with LPO levels and positively correlated with scores of the Global Deterioration Scale of AD patients. ACT might be implicated in controlling oxidative damage of blood lipids and their turnover during the progression of AD.

This study evaluated various outcomes of home care in a group of 121 chronically ill and frail elderly subjects followed for 24 months, starting from September 2001. The scheduled times of follow up were baseline, 6, 12, and 24 months. Subjects of both sexes were assigned to one of two groups. Control group (CG) (60 subjects: mean age 85.4 years, home care provided by the Social Health Service of the Emilia Romagna Region) and Intervention group (IG) (61 subjects, mean age 82.0 years), for whom the institutional home care was empowered providing a home care attendant. The home care attendant was a person trained in the care of the frail elderly. He/she served from 4 to 24 h daily, according to a program established by a Geriatric Evaluation Unit, considering the needs of the subject and of his/her family members. The cost of the additional home care attendance (HCA) was sponsored (totally or in part), by the “Fondazione del Monte di Bologna e di Ravenna”, a non profit foundation. This report takes into consideration the data coming from the first 24 months of follow-up. The two groups were homogenous at baseline. Genetic/molecular pattern including interleukine-1-beta (IL-1b), alfa1-antichimotrypsine (a1ACT), apolipoprotein E4 (APOE4), interleukine-6 (IL-6), tumor necrosis factor-alfa (TNFa), and progression of frailty and disability were considered and discussed. Mortality was lower in the IG than in the CG at 6, 12, and 24 months. Depressive symptoms and disability increased more in IG than in CG; a decrease of the stress of the family members was observed in the IG. The number of drugs used was higher in the CG than in the IG. These outcomes can be related to the additional program of home attendance. The correlation between pro-inflammatory cytokine levels and degree of frailty are observed in both groups without statistically significant difference.

SUMMARY This controlled study evaluated various outcomes in a group of 127 chronically ill and frail elderly patients when discharged from a hospital ward, and cared at home, enrolled during 12 months starting from September 2001. The observation of patients is programmed to be of two years from enrollment, with a scheduled program of follow up at baseline, 6, 12, and 24 months. Patients (of both sexes) were randomly assigned to one of two groups: (i) Control group (61 patients: mean age 85.2 years) having a usual home care program of assistance, guaranteed by the Social Health Care Service. (ii) Intervention group (66 patients: mean age 83.2 years), for whom the program of care mentioned above was integrated providing collaboration of a home care attendant. This was a lay-working person who has attended a specializing course about care of the elderly and of the very frail. The home attendance was provided for 4-10 hrs daily, according to a program established by a Geriatric Evaluation Unit. The team evaluated the patients at their home, deciding the amount of hours of attendance in the presence of the caregiver. The financial cost of the additional home care attendance was sponsored, totally or in part, according to the financial situation of the patient’s family, by the “Fondazione del Monte di Bologna e di Ravenna”. This report takes into consideration only few preliminary data, coming from the first 6 months of observation of all the patients included. The two groups were homogeneous when compared statistically at baseline. Data coming form laboratory and biological analysis will be available only at the end of the project as they are recorded in a blind methodology. A lower degree of mortality and of dropouts in the intervention group was observed, compared to the control group, already at 6 months. These outcomes can be considered favorable, and perhaps can be related to the various benefits gained by additional program of home attendance.