Estimation of Risk of Death Attributable to Acute Gastroenteritis Not Caused by Clostridioides difficile Infection Among Hospitalized Adults in England

Introduction

The role of an infectious agent may be unclear as the primary cause of death. Furthermore, many infections go undiagnosed, particularly if identification does not affect treatment. To circumvent the limitations of individual death attribution, a population-level assessment of the role of infectious acute gastroenteritis (AGE) was performed.

Methods

Using the Clinical Practice Research Datalink and the Office for National Statistics - Mortality Statistics, covering 16 million patients in the UK, we conducted a matched case-control study to estimate the odds of having AGE not due to Clostridioides difficile infection (CDI) diagnosed in the month before death among hospitalized adults in England. To estimate the number of deaths, we first estimated the attributable fraction (AF). The population attributable fraction (PAF) was then derived by multiplying AF with the proportion of AGE hospitalizations among all hospitalizations. Finally, by multiplying the PAF with the number of deaths, the number of deaths attributable to AGE not caused by CDI among hospitalized patients was estimated.

Results

The odds of having AGE not caused by CDI was 4.6 times higher among fatal compared to non-fatal hospitalizations. The overall PAF was 1.7% for AGE not caused by CDI. The overall number of deaths attributable to AGE not caused by CDI among adults in England is estimated to be 5000 annually.

Discussion

Approximately 5000 of the 276,000 deaths that occur annually among hospitalized adults in England can be attributed to AGE not caused by CDI, which is higher than previously estimated.

Public Hospital Quality Assessment. Evidence from Greek Health Setting Using SERVQUAL Model

(1) Background: Health care service quality has been equated with preparedness to provide, accessibility, suitability, adequacy, friendliness and ongoing support and has been connected to service excellence. The main aim of this study was to investigate patients' perceptions and expectations regarding the quality of health services. (2) Materials and Methods: A cross-sectional analysis was carried out in 5 public general hospitals and convenience sampling was used as the sampling technique. Questionnaires were distributed to inpatients and outpatients and 700 valid questionnaires were returned. The SERVQUAL questionnaire was used for data collection in this survey. (3) Results: Overall, in this study, it became apparent that patients' expectations as regarding the quality of the provided services were not met. All of the five quality dimensions had a negative gap between patients' expectations and perceptions. (4) Conclusions: The findings suggested that hospital managers and health care professionals should be interested about patient expectations and subsequently they should search out ways and means to meet them. Open communication with patients, individualized attention, as well as responsiveness to their requirements, polite behavior, trustful atmosphere across the hospital and better physical facilities are the key elements that determine the patient's judgment about quality.

Vaccine effectiveness against laboratory-confirmed influenza in Europe - Results from the DRIVE network during season 2018/19

The DRIVE project aims to establish a sustainable network to estimate brand-specific influenza vaccine effectiveness (IVE) annually. DRIVE is a public-private partnership launched in response to EMA guidance that requires effectiveness evaluation from manufacturers for all individual influenza vaccine brands every season. IVE studies are conducted by public partners in DRIVE. Private partners (vaccine manufacturers from the European Federation of Pharmaceutical Industries and Association (EFPIA)) provide written feedback moderated by an independent scientific committee. Test-negative design (TND) case-control studies (4 in primary care and five in hospital) were conducted in six countries in Europe during the 2018/19 season. Site-specific confounder-adjusted vaccine effectiveness (VE) estimates for any vaccine exposure were calculated by age group (<18 years (y), 18-64y and 65 + y) and pooled by setting (primary care, hospital) through random effects meta-analysis. In addition, one population-based cohort study was conducted in Finland. TND studies included 3339 cases and 6012 controls; seven vaccine brands were reported. For ages 65 + y, pooled VE against any influenza strain was estimated at 27% (95%CI 6-44) in hospital setting. Sample size was insufficient for meaningful IVE estimates in other age groups, in the primary care setting, or by vaccine brand. The population-based cohort study included 274,077 vaccinated and 494,337 unvaccinated person-years, two vaccine brands were reported. Brand-specific IVE was estimated for Fluenz Tetra (36% [95%CI 24-45]) for ages 2-6y, Vaxigrip Tetra (54% [43-62]) for ages 6 months to 6y, and Vaxigrip Tetra (30% [25-35]) for ages 65 + y. The results presented are from the second influenza season covered by the DRIVE network. While sample size from the pooled TND studies was still too low for precise (brand-specific) IVE estimates, the network has approximately doubled in size compared to the pilot season. Taking measures to increase sample size is an important focus of DRIVE for the coming years.

Risk factors for modified vaccine effectiveness of the live attenuated zoster vaccine among the elderly in England

Background

The United Kingdom introduced routine vaccination with the live-attenuated zoster vaccine for 70 year-olds in 2013, with the vaccine also offered to 79 year-olds as part of a catch-up campaign. In the subsequent years, the catch-up campaign was extended to also include adults aged 78 years. We investigated 14 pre-identified potential risk factors for potential modified vaccine effectiveness.

Methods

This retrospective cohort study in England included subjects born in 1943-1946 (the routine cohort) and in 1934-1937 (the catch-up cohort). We used the Clinical Practice Research Datalink (CPRD) to identify herpes zoster (HZ) cases and the risk factors: age, gender, ethnicity, socio-economic status, asthma, type 2 diabetes, chronic obstructive pulmonary disease, smoking, body mass index, immunosuppression, history of HZ, co-administration with influenza or pneumococcal vaccine. We derived HZ incidence by risk groups, overall vaccine effectiveness (VE) and modified VE expressed as relative differences in VE from Poisson regression models.

Results

Overall VE was 66.8% [95% CI: 62.2; 71.0]. Two out of the 14 investigated risk factors modified the HZ VE. Notably, lower VE was observed in diabetics and in persons with a history of HZ with relative differences in VE of -22·2%, [95% CI: -39·6, -4·5] and -22·5%, [95% CI: -44·9, -0·1].

Conclusions

Live-attenuated zoster vaccine protection against HZ was lower in type 2 diabetics and in subjects with a history of HZ. Contrary to clinical trial results, age did not affect the observed VE. Further study is required to gain insights into why certain risk groups are less protected. Identifying and understanding the effect modifiers of VE is important for future vaccine development as well as vaccine recommendations.

Lanarkshire Oximetry Index as a Diagnostic Tool for Peripheral Arterial Disease in Type 2 Diabetes: A Pilot Study

We evaluated the Lanarkshire Oximetry Index (LOI) for the diagnosis of peripheral arterial disease (PAD) in type 2 diabetic patients, using the Ankle-Brachial Index (ABI) as gold standard. We included 161 patients (71 men, mean age 63.1 ± 9.8 years). Peripheral arterial disease was defined as ABI < 0.9. Two cut-off values of LOI (<0.9 and <0.8) were assessed for the diagnosis of PAD. Sensitivity and specificity for PAD were 93.3% and 89.1%, respectively, using a LOI cut-off value of 0.9, while they were 40% and 99.3%, respectively, using a LOI cut-off value of 0.8. Agreement between LOI and ABI was moderate (P < .001). There was a significant positive correlation between ABI and LOI (r = .377, P < .001). Lanarkshire Oximetry Index is a potentially useful alternative diagnostic test for PAD in type 2 diabetes. A cut-off value of 0.9 has high sensitivity and modest specificity. Agreement between LOI and ABI is moderate.