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Meyer HJ, Mödl L, Unruh O, Xiang W, Berger S, Müller-Plathe M, Rohde G, Pletz MW, Rupp J, Suttorp N, Witzenrath M, Zoller T, Mittermaier M, Steinbeis F. Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study. Infection 2024:10.1007/s15010-024-02292-z. [PMID: 38761325 DOI: 10.1007/s15010-024-02292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management. METHODS Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment. RESULTS Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38-8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31-12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47-2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65-8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27-0.70]). CONCLUSION Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.
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Affiliation(s)
- Hans-Jakob Meyer
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pneumology, Helios Klinikum Emil Von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Lukas Mödl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | | | - Weiwei Xiang
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Berger
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Moritz Müller-Plathe
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Respiratory Medicine, Goethe University, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Mathias W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital /Friedrich Schiller University, Jena, Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mirja Mittermaier
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Hosseini-Jebeli S, Tehrani-Banihashemi A, Eshrati B, Mehrabi A, Benis MR, Nojomi M. Hospital capacities and response to COVID-19 pandemic surges in Iran: A quantitative model-based study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:75. [PMID: 38559485 PMCID: PMC10979778 DOI: 10.4103/jehp.jehp_956_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 04/04/2024]
Abstract
The coronavirus 2019 (COVID-19) pandemic resulted in serious limitations for healthcare systems, and this study aimed to investigate the impact of COVID-19 surges on in-patient care capacities in Iran employing the Adaptt tool. Using a cross-sectional study design, our study was carried out in the year 2022 using 1-year epidemiologic (polymerase chain reaction-positive COVID-19 cases) and hospital capacity (beds and human resource) data from the official declaration of the pandemic in Iran in February 2020. We populated several scenarios, and in each scenario, a proportion of hospital capacity is assumed to be allocated to the COVID-19 patients. In most of the scenarios, no significant shortage was found in terms of bed and human resources. However, considering the need for treatment of non- COVID-19 cases, in one of the scenarios, it can be observed that during the peak period, the number of required and available specialists is exactly equal, which was a challenge during surge periods and resulted in extra hours of working and workforce burnout in hospitals. The shortage of intensive care unit beds and doctors specializing in internal medicine, infectious diseases, and anesthesiology also requires more attention for planning during the peak days of COVID-19.
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Affiliation(s)
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mehrabi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Roohravan Benis
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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3
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Wood AJ, Kao RR. Empirical distributions of time intervals between COVID-19 cases and more severe outcomes in Scotland. PLoS One 2023; 18:e0287397. [PMID: 37585389 PMCID: PMC10431635 DOI: 10.1371/journal.pone.0287397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/05/2023] [Indexed: 08/18/2023] Open
Abstract
A critical factor in infectious disease control is the risk of an outbreak overwhelming local healthcare capacity. The overall demand on healthcare services will depend on disease severity, but the precise timing and size of peak demand also depends on the time interval (or clinical time delay) between initial infection, and development of severe disease. A broader distribution of intervals may draw that demand out over a longer period, but have a lower peak demand. These interval distributions are therefore important in modelling trajectories of e.g. hospital admissions, given a trajectory of incidence. Conversely, as testing rates decline, an incidence trajectory may need to be inferred through the delayed, but relatively unbiased signal of hospital admissions. Healthcare demand has been extensively modelled during the COVID-19 pandemic, where localised waves of infection have imposed severe stresses on healthcare services. While the initial acute threat posed by this disease has since subsided with immunity buildup from vaccination and prior infection, prevalence remains high and waning immunity may lead to substantial pressures for years to come. In this work, then, we present a set of interval distributions, for COVID-19 cases and subsequent severe outcomes; hospital admission, ICU admission, and death. These may be used to model more realistic scenarios of hospital admissions and occupancy, given a trajectory of infections or cases. We present a method for obtaining empirical distributions using COVID-19 outcomes data from Scotland between September 2020 and January 2022 (N = 31724 hospital admissions, N = 3514 ICU admissions, N = 8306 mortalities). We present separate distributions for individual age, sex, and deprivation of residing community. While the risk of severe disease following COVID-19 infection is substantially higher for the elderly and those residing in areas of high deprivation, the length of stay shows no strong dependence, suggesting that severe outcomes are equally severe across risk groups. As Scotland and other countries move into a phase where testing is no longer abundant, these intervals may be of use for retrospective modelling of patterns of infection, given data on severe outcomes.
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Affiliation(s)
- Anthony J. Wood
- The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rowland R. Kao
- The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
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Ruiz Galvis LM, Pérez Aguirre CA, Pérez Bedoya JP, Mendoza Cardozo OI, Barengo NC, Sánchez Escudero JP, Cardona Jiménez J, Diaz Valencia PA. Hospital length of stay throughout bed pathways and factors affecting this time: A non-concurrent cohort study of Colombia COVID-19 patients and an unCoVer network project. PLoS One 2023; 18:e0278429. [PMID: 37494381 PMCID: PMC10370719 DOI: 10.1371/journal.pone.0278429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/19/2023] [Indexed: 07/28/2023] Open
Abstract
Predictions of hospital beds occupancy depends on hospital admission rates and the length of stay (LoS) according to bed type (general ward -GW- and intensive care unit -ICU- beds). The objective of this study was to describe the LoS of COVID-19 hospital patients in Colombia during 2020-2021. Accelerated failure time models were used to estimate the LoS distribution according to each bed type and throughout each bed pathway. Acceleration factors and 95% confidence intervals were calculated to measure the effect on LoS of the outcome, sex, age, admission period during the epidemic (i.e., epidemic waves, peaks or valleys, and before/after vaccination period), and patients geographic origin. Most of the admitted COVID-19 patients occupied just a GW bed. Recovered patients spent more time in the GW and ICU beds than deceased patients. Men had longer LoS than women. In general, the LoS increased with age. Finally, the LoS varied along epidemic waves. It was lower in epidemic valleys than peaks, and decreased after vaccinations began in Colombia. Our study highlights the necessity of analyzing local data on hospital admission rates and LoS to design strategies to prioritize hospital beds resources during the current and future pandemics.
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Affiliation(s)
- Lina Marcela Ruiz Galvis
- Grupo de Fundamentos y Enseñanza de la Física y los Sistemas Dinámicos, Natural Science Department, Universidad de Antioquia, Medellín, Colombia
- Epidemiology Group at National College of Public Health, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Andrés Pérez Aguirre
- Epidemiology Group at National College of Public Health, Universidad de Antioquia, Medellín, Colombia
- Escuela de Estadística, Universidad Nacional de Colombia, Medellín, Colombia
| | - Juan Pablo Pérez Bedoya
- Epidemiology Group at National College of Public Health, Universidad de Antioquia, Medellín, Colombia
| | | | - Noël Christopher Barengo
- Herbert Wertheim College of Medicine & Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
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Hsu NC, Liao C, Hsu CH. High-Flow Nasal Oxygen vs Standard Oxygen Therapy and Length of Hospital Stay in Children With Acute Hypoxemic Respiratory Failure. JAMA 2023; 329:1610-1611. [PMID: 37159038 DOI: 10.1001/jama.2023.4584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Nin-Chieh Hsu
- National Taiwan University Hospital, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
| | - Charles Liao
- School of Medicine, Stanford University, Stanford, California
| | - Chia-Hao Hsu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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6
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Keogh RH, Diaz-Ordaz K, Jewell NP, Semple MG, de Wreede LC, Putter H. Estimating distribution of length of stay in a multi-state model conditional on the pathway, with an application to patients hospitalised with Covid-19. LIFETIME DATA ANALYSIS 2023; 29:288-317. [PMID: 36754952 PMCID: PMC9908509 DOI: 10.1007/s10985-022-09586-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/12/2022] [Indexed: 05/27/2023]
Abstract
Multi-state models are used to describe how individuals transition through different states over time. The distribution of the time spent in different states, referred to as 'length of stay', is often of interest. Methods for estimating expected length of stay in a given state are well established. The focus of this paper is on the distribution of the time spent in different states conditional on the complete pathway taken through the states, which we call 'conditional length of stay'. This work is motivated by questions about length of stay in hospital wards and intensive care units among patients hospitalised due to Covid-19. Conditional length of stay estimates are useful as a way of summarising individuals' transitions through the multi-state model, and also as inputs to mathematical models used in planning hospital capacity requirements. We describe non-parametric methods for estimating conditional length of stay distributions in a multi-state model in the presence of censoring, including conditional expected length of stay (CELOS). Methods are described for an illness-death model and then for the more complex motivating example. The methods are assessed using a simulation study and shown to give unbiased estimates of CELOS, whereas naive estimates of CELOS based on empirical averages are biased in the presence of censoring. The methods are applied to estimate conditional length of stay distributions for individuals hospitalised due to Covid-19 in the UK, using data on 42,980 individuals hospitalised from March to July 2020 from the COVID19 Clinical Information Network.
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Affiliation(s)
- Ruth H Keogh
- Department of Medical Statistics and Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Karla Diaz-Ordaz
- Department of Medical Statistics and Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas P Jewell
- Department of Medical Statistics and Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Hein Putter
- Leiden University Medical Center, Leiden, Netherlands
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7
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Liu Y, Procter SR, Pearson CAB, Montero AM, Torres-Rueda S, Asfaw E, Uzochukwu B, Drake T, Bergren E, Eggo RM, Ruiz F, Ndembi N, Nonvignon J, Jit M, Vassall A. Assessing the impacts of COVID-19 vaccination programme's timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries. BMC Med 2023; 21:85. [PMID: 36882868 PMCID: PMC9991879 DOI: 10.1186/s12916-023-02784-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. METHODS We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. RESULTS Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. CONCLUSION Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.
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Affiliation(s)
- Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK. .,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Andrés Madriz Montero
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Sergio Torres-Rueda
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Elias Asfaw
- Health Economics Programme, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Benjamin Uzochukwu
- Department of Community Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
| | - Tom Drake
- Centre for Global Development, Great Peter House, Abbey Gardens, Great College St, London, UK
| | - Eleanor Bergren
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Francis Ruiz
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD, USA.,Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Justice Nonvignon
- Health Economics Programme, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.,School of Public Health, University of Ghana, Legon, Ghana
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Anna Vassall
- Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK
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Overton CE, Pellis L, Stage HB, Scarabel F, Burton J, Fraser C, Hall I, House TA, Jewell C, Nurtay A, Pagani F, Lythgoe KA. EpiBeds: Data informed modelling of the COVID-19 hospital burden in England. PLoS Comput Biol 2022; 18:e1010406. [PMID: 36067224 PMCID: PMC9481171 DOI: 10.1371/journal.pcbi.1010406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 09/16/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
The first year of the COVID-19 pandemic put considerable strain on healthcare systems worldwide. In order to predict the effect of the local epidemic on hospital capacity in England, we used a variety of data streams to inform the construction and parameterisation of a hospital progression model, EpiBeds, which was coupled to a model of the generalised epidemic. In this model, individuals progress through different pathways (e.g. may recover, die, or progress to intensive care and recover or die) and data from a partially complete patient-pathway line-list was used to provide initial estimates of the mean duration that individuals spend in the different hospital compartments. We then fitted EpiBeds using complete data on hospital occupancy and hospital deaths, enabling estimation of the proportion of individuals that follow the different clinical pathways, the reproduction number of the generalised epidemic, and to make short-term predictions of hospital bed demand. The construction of EpiBeds makes it straightforward to adapt to different patient pathways and settings beyond England. As part of the UK response to the pandemic, EpiBeds provided weekly forecasts to the NHS for hospital bed occupancy and admissions in England, Wales, Scotland, and Northern Ireland at national and regional scales. COVID-19, the disease caused by SARS-CoV-2, leads to a high proportion of cases requiring admission to hospital. Coupled with the high burden of infections worldwide, this put substantial pressure on healthcare systems. To enable public health systems to cope with the high levels of demand, forecasting models are vital. These models enable public health managers to plan their workloads accordingly. Here, we developed EpiBeds, which combines an epidemic model with a model for patient flow through hospitals. By fitting this model to data from England, EpiBeds has been used to provide short-term forecasts of hospital admissions and bed demand weekly throughout the COVID-19 pandemic. In this paper, we describe the motivation behind the structure of EpiBeds, how the model is fitted to data, and report the estimates of the key parameters throughout the pandemic. We then evaluate the performance of EpiBeds by comparing generated forecasts to future data points, finding good agreement between the forecasts and data.
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Affiliation(s)
- Christopher E. Overton
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- Clinical Data Science Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Joint UNIversities Pandemic and Epidemiological Research, https://maths.org/juniper/. Cambridge, United Kingdom
- Infectious Disease Modelling, All Hazards Intelligence, UK Health Security Agency, London, United Kingdom
- * E-mail:
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- Joint UNIversities Pandemic and Epidemiological Research, https://maths.org/juniper/. Cambridge, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Helena B. Stage
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- The Humboldt University of Berlin, Berlin, Germany
- The University of Potsdam, Potsdam, Germany
| | - Francesca Scarabel
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- Joint UNIversities Pandemic and Epidemiological Research, https://maths.org/juniper/. Cambridge, United Kingdom
| | - Joshua Burton
- Faculty of Biology Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Ian Hall
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- Clinical Data Science Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Joint UNIversities Pandemic and Epidemiological Research, https://maths.org/juniper/. Cambridge, United Kingdom
- Alan Turing Institute, London, United Kingdom
- Emergency Preparedness, Health Protection Division, UK Health Security Agency, London, United Kingdom
| | - Thomas A. House
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- Clinical Data Science Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Joint UNIversities Pandemic and Epidemiological Research, https://maths.org/juniper/. Cambridge, United Kingdom
- Alan Turing Institute, London, United Kingdom
- Faculty of Biology Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
- IBM Research, Hartree Centre, Daresbury, United Kingdom
| | - Chris Jewell
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Anel Nurtay
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Filippo Pagani
- Department of Mathematics, University of Manchester, Manchester United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Katrina A. Lythgoe
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Biology, University of Oxford, Oxford, United Kingdom
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9
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Aziz Alimul Hidayat A, Chen WL, Nor RM, Uliyah M, Badriyah FL, Ubudiyah M. The determinants of patient care manager role and the implementation of COVID-19 clinical pathway: a cross-sectional study. PeerJ 2022; 10:e13764. [PMID: 35910779 PMCID: PMC9332306 DOI: 10.7717/peerj.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023] Open
Abstract
Objective This study aims to determine the factors associated with patient care manager role and the implementation of the clinical pathway among nurses in private hospitals. Methods This study was conducted from January-July 2021 using the cross-sectional approach. The sample consisted of 168 nurses working in a private hospital in Surabaya City, East Java, Indonesia. Meanwhile, the data were collected using the Patient Care Manager Role Scale (PCMRS) and analyzed by multiple logistic regression to find the correlation between the variables. Results A higher percentage of nurses namely 64.3% had compliance in COVID-19 clinical pathways with an average PCMRS score of 27.81 ± 2.43. Nurses with a high-level patient care manager role level had a significant compliance risk with odds ratio [OR] 440.137, 95% confidence interval [CI] [51.850-3736.184], and p-value = 0.000 compared to those with a low role. Conclusion The role of patient care manager and compliance with COVID-19 clinical pathways correlated significantly. Based on the results, several actions are needed for the early identification of patient service managers' roles to ensure compliance with COVID-19 clinical pathways and reduce the number of cases in Indonesia.
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Affiliation(s)
| | - Wen-Ling Chen
- Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung, Taiwan
| | - Rahimah Mohd Nor
- Faculty of Health & Life Sciences, Management & Science University, Selangor, Selangor, Malaysia
| | - Musrifatul Uliyah
- Nursing, University Muhammadiyah of Surabaya, Surabaya, East Jawa, Indonesia
| | | | - Masunatul Ubudiyah
- Nursing, Universitas Muhammadiyah Lamongan, Lamongan, East Java, Indonesia
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10
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Abernethy GM, Glass DH. Optimal COVID-19 lockdown strategies in an age-structured SEIR model of Northern Ireland. J R Soc Interface 2022; 19:20210896. [PMID: 35259954 PMCID: PMC8905176 DOI: 10.1098/rsif.2021.0896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022] Open
Abstract
An age-structured SEIR model simulates the propagation of COVID-19 in the population of Northern Ireland. It is used to identify optimal timings of short-term lockdowns that enable long-term pandemic exit strategies by clearing the threshold for herd immunity or achieving time for vaccine development with minimal excess deaths.
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11
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Meakin S, Abbott S, Bosse N, Munday J, Gruson H, Hellewell J, Sherratt K, Funk S. Comparative assessment of methods for short-term forecasts of COVID-19 hospital admissions in England at the local level. BMC Med 2022; 20:86. [PMID: 35184736 PMCID: PMC8858706 DOI: 10.1186/s12916-022-02271-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/20/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Forecasting healthcare demand is essential in epidemic settings, both to inform situational awareness and facilitate resource planning. Ideally, forecasts should be robust across time and locations. During the COVID-19 pandemic in England, it is an ongoing concern that demand for hospital care for COVID-19 patients in England will exceed available resources. METHODS We made weekly forecasts of daily COVID-19 hospital admissions for National Health Service (NHS) Trusts in England between August 2020 and April 2021 using three disease-agnostic forecasting models: a mean ensemble of autoregressive time series models, a linear regression model with 7-day-lagged local cases as a predictor, and a scaled convolution of local cases and a delay distribution. We compared their point and probabilistic accuracy to a mean-ensemble of them all and to a simple baseline model of no change from the last day of admissions. We measured predictive performance using the weighted interval score (WIS) and considered how this changed in different scenarios (the length of the predictive horizon, the date on which the forecast was made, and by location), as well as how much admissions forecasts improved when future cases were known. RESULTS All models outperformed the baseline in the majority of scenarios. Forecasting accuracy varied by forecast date and location, depending on the trajectory of the outbreak, and all individual models had instances where they were the top- or bottom-ranked model. Forecasts produced by the mean-ensemble were both the most accurate and most consistently accurate forecasts amongst all the models considered. Forecasting accuracy was improved when using future observed, rather than forecast, cases, especially at longer forecast horizons. CONCLUSIONS Assuming no change in current admissions is rarely better than including at least a trend. Using confirmed COVID-19 cases as a predictor can improve admissions forecasts in some scenarios, but this is variable and depends on the ability to make consistently good case forecasts. However, ensemble forecasts can make forecasts that make consistently more accurate forecasts across time and locations. Given minimal requirements on data and computation, our admissions forecasting ensemble could be used to anticipate healthcare needs in future epidemic or pandemic settings.
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Affiliation(s)
- Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Nikos Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - James Munday
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Hugo Gruson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Katharine Sherratt
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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12
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Meakin S, Abbott S, Bosse N, Munday J, Gruson H, Hellewell J, Sherratt K, Funk S. Comparative assessment of methods for short-term forecasts of COVID-19 hospital admissions in England at the local level. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.10.18.21265046. [PMID: 34704097 PMCID: PMC8547529 DOI: 10.1101/2021.10.18.21265046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Forecasting healthcare demand is essential in epidemic settings, both to inform situational awareness and facilitate resource planning. Ideally, forecasts should be robust across time and locations. During the COVID-19 pandemic in England, it is an ongoing concern that demand for hospital care for COVID-19 patients in England will exceed available resources. METHODS We made weekly forecasts of daily COVID-19 hospital admissions for National Health Service (NHS) Trusts in England between August 2020 and April 2021 using three disease-agnostic forecasting models: a mean ensemble of autoregressive time series models, a linear regression model with 7-day-lagged local cases as a predictor, and a scaled convolution of local cases and a delay distribution. We compared their point and probabilistic accuracy to a mean-ensemble of them all, and to a simple baseline model of no change from the last day of admissions. We measured predictive performance using the Weighted Interval Score (WIS) and considered how this changed in different scenarios (the length of the predictive horizon, the date on which the forecast was made, and by location), as well as how much admissions forecasts improved when future cases were known. RESULTS All models outperformed the baseline in the majority of scenarios. Forecasting accuracy varied by forecast date and location, depending on the trajectory of the outbreak, and all individual models had instances where they were the top- or bottom-ranked model. Forecasts produced by the mean-ensemble were both the most accurate and most consistently accurate forecasts amongst all the models considered. Forecasting accuracy was improved when using future observed, rather than forecast, cases, especially at longer forecast horizons. CONCLUSIONS Assuming no change in current admissions is rarely better than including at least a trend. Using confirmed COVID-19 cases as a predictor can improve admissions forecasts in some scenarios, but this is variable and depends on the ability to make consistently good case forecasts. However, ensemble forecasts can make forecasts that make consistently more accurate forecasts across time and locations. Given minimal requirements on data and computation, our admissions forecasting ensemble could be used to anticipate healthcare needs in future epidemic or pandemic settings.
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Affiliation(s)
- Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Nikos Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - James Munday
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Hugo Gruson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Katherine Sherratt
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | | | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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13
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Developing Pulmonary Rehabilitation for COVID-19: Are We Linked with the Present Literature? A Lexical and Geographical Evaluation Study Based on the Graph Theory. J Clin Med 2021; 10:jcm10245763. [PMID: 34945063 PMCID: PMC8706076 DOI: 10.3390/jcm10245763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic is a severe ongoing global emergency. Despite high rates of asymptomatic patients, in many cases, the infection causes a rapid decline in pulmonary function due to an acute respiratory distress-like syndrome, leading to multi-organ failure and death. To date, recommendations about rehabilitation on COVID-19 are based on clinical data derived from other similar lung diseases. Rehabilitation literature lacks a standard taxonomy, limiting a proper evaluation of the most effective treatments for patients after COVID-19 infection. In this study, we assessed the clinical and rehabilitative associations and the geographical area involved in interstitial lung diseases (ILD) and in COVID-19, by a mathematical analysis based on graph theory. We performed a quantitative analysis of the literature in terms of lexical analysis and on how words are connected to each other. Despite a large difference in timeframe (throughout the last 23 years for ILD and in the last 1.5 years for COVID-19), the numbers of papers included in this study were similar. Our results show a clear discrepancy between rehabilitation proposed for COVID-19 and ILD. In ILD, the term “rehabilitation” and other related words such as “exercise” and “program” resulted in lower values of centrality and higher values of eccentricity, meaning relatively less importance of the training during the process of care in rehabilitation of patients with ILD. Conversely, “rehabilitation” was one of the most cited terms in COVID-19 literature, strongly associated with terms such as “exercise”, “physical”, and “program”, entailing a multidimensional approach of the rehabilitation for these patients. This could also be due to the widespread studies conducted on rehabilitation on COVID-19, with Chinese and Italian researchers more involved. The assessment of the terms used for the description of the rehabilitation may help to program shared rehabilitation knowledge and avoid literature misunderstandings.
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