Relationship among three common hematological premalignant conditions.
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ABSTRACT:
SUBMITTER: Boddicker NJ
PROVIDER: S-EPMC10400408 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
Publications
Relationship among three common hematological premalignant conditions.
Boddicker Nicholas J NJ Parikh Sameer A SA Norman Aaron D AD Rabe Kari G KG Griffin Rosalie R Call Timothy G TG Robinson Dennis P DP Olson Janet E JE Dispenzieri Angela A Rajkumar Vincent V Kumar Shaji S Kay Neil E NE Hanson Curtis A CA Cerhan James R JR Murray David D Braggio Esteban E Shanafelt Tait D TD Vachon Celine M CM Slager Susan L SL
Leukemia 20230505 8
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Project description:BackgroundPrivate hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals.MethodsA total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively.ResultsThe private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions.ConclusionThe public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
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Project description:BACKGROUND:Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for using 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital. METHODS:By using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18-64 years) using hierarchical models to evaluate associations between hospital 30-day, risk-standardized readmission rates in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia. RESULTS:There were 87,818, 98,315, and 103,251 admissions in younger patients for acute myocardial infarction, heart failure, and pneumonia, respectively, with overall 30-day unplanned readmission rates of 8.5%, 21.4%, and 13.7%, respectively. Readmission risk in younger patients was significantly associated with hospital 30-day risk-standardized readmission rates for elderly Medicare patients for all 3 conditions. A decrease in an average hospital's 30-day, risk-standardized readmission rates from the 75th percentile to the 25th percentile was associated with reduction in younger patients' risk of readmission from 8.8% to 8.0% (difference: 0.7%; 95% confidence interval, 0.5-0.9) for acute myocardial infarction; 21.8% to 20.0% (difference: 1.8%; 95% confidence interval, 1.4-2.2) for heart failure; and 13.9% to 13.1% (difference: 0.8%; 95% confidence interval, 0.5-1.0) for pneumonia. CONCLUSIONS:Among younger patients, readmission risk was moderately associated with hospital 30-day, risk-standardized readmission rates in elderly Medicare beneficiaries. Efforts to reduce readmissions among older patients may have important areas of overlap with younger patients, although further research may be necessary to identify specific mechanisms to tailor initiatives to younger patients.
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Project description:Concomitant multiple hematological malignancies are rare and challenging to diagnose. They represent a unique model to explore the multistep process of oncogenesis. Here, we report the unique case of 62 years-old man with cardiac tamponade as first manifestation of ALK negative anaplastic large T-cell lymphoma (ALK- ALCL). Following chemotherapy, he showed one year later ALK- ALCL concurrent with diffuse large B-cell lymphoma (DLBCL-NOS) and acute monoblastic leukemia (AML-M5) in a single excisional lymph node. Clinical, pathological and multiomics data (whole exome and targeted deep sequencing, spatial transcriptomics) were analyzed. Two somatic TET2 gene mutations at high allele burden were shared by all three neoplasms, uninvolved bone marrow and CD34+ hematopoietic stem and progenitor cells (HSPCs). Secondary hits characterized each malignancy. ALK- ALCL (pericardial and nodal) showed TP53 and LYN deleterious mutations, DLBCL-NOS disclosed KRAS, STAT6, CREBBP and ATM alterations and AML-M5 had JAK3, PPM1D, NF1 and KMT2D mutations and a complex karyotype. Furthermore we demonstrated that spatial transcriptomics can identify the specific signatures of the three neoplasms. Two TET2 mutations at high allele burden in CD34+HSPCs conferred the favorable soil and the genotoxic stress from chemotherapy likely contributed to multiple hematological malignancies oncogenesis. Our case confirms the pathogenetic link between clonal hematopoiesis and cytotoxic T-cell lymphoma, so far only suspected. Most importantly, this is the first study to document the oncogenic phylogeny of concurrent T-, B-, and myeloid neoplasms from CD34+ HSPCs clone(s) in a single specimen.
2023-03-17 | E-MTAB-12742 | biostudies-arrayexpress
Project description:BackgroundThe association between hospital volume and the death rate for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia remains unclear. It is also not known whether a volume threshold for such an association exists.MethodsWe conducted cross-sectional analyses of data from Medicare administrative claims for all fee-for-service beneficiaries who were hospitalized between 2004 and 2006 in acute care hospitals in the United States for acute myocardial infarction, heart failure, or pneumonia. Using hierarchical logistic-regression models for each condition, we estimated the change in the odds of death within 30 days associated with an increase of 100 patients in the annual hospital volume. Analyses were adjusted for patients' risk factors and hospital characteristics. Bootstrapping procedures were used to estimate 95% confidence intervals to identify the condition-specific volume thresholds above which an increased volume was not associated with reduced mortality.ResultsThere were 734,972 hospitalizations for acute myocardial infarction in 4128 hospitals, 1,324,287 for heart failure in 4679 hospitals, and 1,418,252 for pneumonia in 4673 hospitals. An increased hospital volume was associated with reduced 30-day mortality for all conditions (P<0.001 for all comparisons). For each condition, the association between volume and outcome was attenuated as the hospital's volume increased. For acute myocardial infarction, once the annual volume reached 610 patients (95% confidence interval [CI], 539 to 679), an increase in the hospital volume by 100 patients was no longer significantly associated with reduced odds of death. The volume threshold was 500 patients (95% CI, 433 to 566) for heart failure and 210 patients (95% CI, 142 to 284) for pneumonia.ConclusionsAdmission to higher-volume hospitals was associated with a reduction in mortality for acute myocardial infarction, heart failure, and pneumonia, although there was a volume threshold above which an increased condition-specific hospital volume was no longer significantly associated with reduced mortality.
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Project description:BackgroundThe cost-effectiveness of screening the U.S. population for Centers for Disease Control and Prevention (CDC) Tier 1 genomic conditions is unknown.ObjectiveTo estimate the cost-effectiveness of simultaneous genomic screening for Lynch syndrome (LS), hereditary breast and ovarian cancer syndrome (HBOC), and familial hypercholesterolemia (FH).DesignDecision analytic Markov model.Data sourcesPublished literature.Target populationSeparate age-based cohorts (ages 20 to 60 years at time of screening) of racially and ethnically representative U.S. adults.Time horizonLifetime.PerspectiveU.S. health care payer.InterventionPopulation genomic screening using clinical sequencing with a restricted panel of high-evidence genes, cascade testing of first-degree relatives, and recommended preventive interventions for identified probands.Outcome measuresIncident breast, ovarian, and colorectal cancer cases; incident cardiovascular events; quality-adjusted survival; and costs.Results of base-case analysisScreening 100 000 unselected 30-year-olds resulted in 101 (95% uncertainty interval [UI], 77 to 127) fewer overall cancer cases and 15 (95% UI, 4 to 28) fewer cardiovascular events and an increase of 495 quality-adjusted life-years (QALYs) (95% UI, 401 to 757) at an incremental cost of $33.9 million (95% UI, $27.0 million to $41.1 million). The incremental cost-effectiveness ratio was $68 600 per QALY gained (95% UI, $41 800 to $88 900).Results of sensitivity analysisScreening 30-, 40-, and 50-year-old cohorts was cost-effective in 99%, 88%, and 19% of probabilistic simulations, respectively, at a $100 000-per-QALY threshold. The test costs at which screening 30-, 40-, and 50-year-olds reached the $100 000-per-QALY threshold were $413, $290, and $166, respectively. Variant prevalence and adherence to preventive interventions were also highly influential parameters.LimitationsPopulation averages for model inputs, which were derived predominantly from European populations, vary across ancestries and health care environments.ConclusionPopulation genomic screening with a restricted panel of high-evidence genes associated with 3 CDC Tier 1 conditions is likely to be cost-effective in U.S. adults younger than 40 years if the testing cost is relatively low and probands have access to preventive interventions.Primary funding sourceNational Human Genome Research Institute.
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Project description: Not available
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