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Olasehinde O, Aderounmu A, Wuraola F, Omisore A, Akinkuolie A, Towoju A, Mohammed T, Mango V, Kingham PT, Adisa A, Alatise O. Breast Cancer Stage at Diagnosis in a Nigerian Hospital: Trend over a Decade. West Afr J Med 2023; 40:1298-1303. [PMID: 38261017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade. METHODS A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed. RESULTS There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001). CONCLUSION This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains.
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Affiliation(s)
- O Olasehinde
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - A Aderounmu
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - F Wuraola
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - A Omisore
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - A Akinkuolie
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - A Towoju
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - T Mohammed
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - V Mango
- Memorial Sloan-Kettering Cancer Center, New York, U. S. A
| | - P T Kingham
- Memorial Sloan-Kettering Cancer Center, New York, U. S. A
| | - A Adisa
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - O Alatise
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Teixeira RMP, Oliveira JC, de Andrade MAB, Pinheiro FGDMS, Vieira RDCA, Santana-Santos E. Are patient volume and care level in teaching hospitals variables affecting clinical outcomes in adult intensive care units? Einstein (Sao Paulo) 2023; 21:eAO0406. [PMID: 37820201 PMCID: PMC10519666 DOI: 10.31744/einstein_journal/2023ao0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 10/13/2023] Open
Abstract
Teixeira et al. showed that patients admitted to the intensive care unit of a teaching hospital in a non-metropolitan region needed more support, had worse prognostic indices, and had a higher nursing workload in the first 24 hours of admission. In addition, worse outcomes, including mortality, need for dialysis, pressure injury, infection, prolonged mechanical ventilation, and prolonged hospital stay, were observed in the teaching hospital. Worse outcomes were more prevalent in the teaching hospital. Understanding the importance of teaching hospitals to implement well-established care protocols is critical. OBJECTIVE To compare the clinical outcomes of patients admitted to the intensive care unit of teaching (HI) and nonteaching (without an academic affiliation; H2) hospitals. METHODS In this prospective cohort study, adult patients hospitalized between August 2018 and July 2019, with a minimum length of stay of 24 hours in the intensive care unit, were included. Patients with no essential information in their medical records to evaluate the study outcomes were excluded. Resuslts: Overall, 219 patients participated in this study. The clinical and demographic characteristics of patients in H1 and H2 were similar. The most prevalent clinical outcomes were death, need for dialysis, pressure injury, length of hospital stay, mechanical ventilation >48 hours, and infection, all of which were more prevalent in the teaching hospital. CONCLUSION Worse outcomes were more prevalent in the teaching hospital. There was no difference between the institutions concerning the survival rate of patients as a function of length of hospital stay; however, a difference was observed in intensive care unit admissions.
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Affiliation(s)
| | - Jussiely Cunha Oliveira
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
| | | | | | | | - Eduesley Santana-Santos
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
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Basso P, Negro C, Cegolon L, Larese Filon F. Risk of Vaccine Breakthrough SARS-CoV-2 Infection and Associated Factors in Healthcare Workers of Trieste Teaching Hospitals (North-Eastern Italy). Viruses 2022; 14:336. [PMID: 35215930 PMCID: PMC8875653 DOI: 10.3390/v14020336] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Healthcare workers (HCWs) are particularly exposed to biological risk, including SARS-CoV-2 infection. In order to contrast the current pandemic and alleviate the burden of the disease on the healthcare system, a mass vaccination campaign against COVID-19 has been launched worldwide. Aim To evaluate the impact of COVID-19 vaccination in HCWs exposed to SARS-CoV-2, to describe the clinical presentation of COVID-19 in infected HCWs, and to investigate clinical and occupational risk factors for breakthrough infection. Design: Retrospective cohort study. Methods: The cohort of HCWs of Trieste Hospitals were followed up from 1 March 2020, to 30 November 2021 (21 months). All HCWs were periodically screened for SARS-CoV-2 infection by real-time PCR (RT-PCR) analysis. Clinical data were obtained through routine medical surveillance records. Risk factors for SARS-CoV-2 infection were investigated by univariable as well as multivariable logistic regression analysis. Results: Among 4394 HCWs routinely screened for SARS-CoV-2 by PCR on nasopharyngeal swab, a total of 800 incident cases were identified during the entire study period (1 March 2020 to 30 November 2021). Five hundred and sixty-four cases occurred before, and 236 after the start of the vaccination campaign against COVID-19, of whom 155 received a complete vaccination scheme before SARS-CoV-2 infection. Breakthrough infection was featured by mild or no symptoms and was significantly associated with the male sex, BMI > 25, and diabetes mellitus. Some categories of HCWs (physicians and nurse aids/auxiliary personnel) were at a higher risk of breakthrough infection. Conclusions: Fully vaccinated HCWs were less likely to acquire symptomatic as well as asymptomatic SARS-CoV-2 infection. Risk factors for SARS-CoV-2 infection after a full COVID-19 vaccination scheme included the male gender, diabetes mellitus, and overweight. HCWs with higher exposure to COVID-19 patients were at higher risk of breakthrough infection.
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Affiliation(s)
- Paolo Basso
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (P.B.); (C.N.); (F.L.F.)
| | - Corrado Negro
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (P.B.); (C.N.); (F.L.F.)
- Clinical Unit of Occupational Medicine, University of Trieste, 34129 Trieste, Italy
| | - Luca Cegolon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (P.B.); (C.N.); (F.L.F.)
- Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Francesca Larese Filon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (P.B.); (C.N.); (F.L.F.)
- Clinical Unit of Occupational Medicine, University of Trieste, 34129 Trieste, Italy
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Debelo BT, Obsi RN, Dugassa W, Negasa S. The magnitude of failed induction and associated factors among women admitted to Adama hospital medical college: A cross-sectional study. PLoS One 2022; 17:e0262256. [PMID: 35085270 PMCID: PMC8794164 DOI: 10.1371/journal.pone.0262256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Induction of labor is a medical iatrogenic stimulation of uterine contraction before the spontaneous onset of labor to achieve vaginal delivery. It is an increasingly being done obstetric procedure throughout the world and associated with poorer outcomes when compared with spontaneous labor. The published evidence is limited in Ethiopia including the study area. Therefore, this study was aimed at assessing the magnitude of failed induction and associated factors among pregnant women who were admitted to the labor ward of Adama hospital medical college. Methods Institution-based cross-sectional study was conducted among 293 women who were eligible for induction using systematic random sampling. The data were collected from 1st January to 30th April 2020 by face-to-face interview using a structured questionnaire and extraction from a maternal chart. Then data was entered into Epi-data version 4.6 and analyzed using Statistical Product and Service Solution version 23. Descriptive statistics were performed to describe the study population. Logistic regression (bivariate and multivariable) analysis was conducted to identify associated factors. The association was expressed in odds ratio with 95% confidence interval and P-value <0.05 was used as cut-off points to declare significance in the final model. Results This study showed that the prevalence of failed induction was 20.5% (95% CI: (15.7–25.3%)). The odds of failed induction in unfavorable bishop score were 4.05 higher than the odds in favorable bishop [AOR = 4.05 95%CI (1.19–13.77)]. The odds of failed induction in an intact membrane were 2.05 higher than the ruptured membrane. [AOR = 2.05, 95%CI (1.06–3.98)]. The odds of failed induction in primigravida were 2.33 higher than the odds in the multiparous women [AOR = 2.33, 95%CI (1.26–4.29)]. Conclusions This study revealed that the magnitude of failed induction was higher when compared to other similar findings. Bishop scores, membrane status, and parity were significantly associated factors with failed induction. Preparation of the cervix before commencing induction is recommended to improve induction success.
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Affiliation(s)
- Bikila Tefera Debelo
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
- * E-mail:
| | - Reta Nemomsa Obsi
- Department of OBGYN, Adama Hospital Medical College, Adama, Ethiopia
| | - Worku Dugassa
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
| | - Shumi Negasa
- Department of OBGYN, Adama Hospital Medical College, Adama, Ethiopia
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Otieku E, Fenny AP, Asante FA, Bediako-Bowan A, Enemark U. Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study. BMJ Open 2022; 12:e057468. [PMID: 34980632 PMCID: PMC8724807 DOI: 10.1136/bmjopen-2021-057468] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study. DESIGN Before and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire. SETTING Korle-Bu Teaching Hospital (KBTH), Ghana. PARTICIPANTS All prospective patients who underwent surgical procedures at the general surgical unit of the KBTH. MAIN OUTCOME MEASURES The primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel. RESULTS Before-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually. CONCLUSION The intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.
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Affiliation(s)
- Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
| | - Felix Ankomah Asante
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
| | - Antoinette Bediako-Bowan
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Andrade-Silva J, Andrade-Silva LE, Paes HC, Alves L, Rosa A, Tenório BG, Ferreira MS, Felipe MSS, Teixeira MDM, Silva-Vergara ML. Molecular epidemiology of Paracoccidiodes spp. recovered from patients with paracoccidioidomycosis in a teaching hospital from Minas Gerais State of Brazil. PLoS Negl Trop Dis 2021; 15:e0009956. [PMID: 34843484 PMCID: PMC8659327 DOI: 10.1371/journal.pntd.0009956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/09/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Paracoccidioidomycosis (PCM) is caused by several species of the Paracoccidioides genus which can be differentiated by interspecific genetic variations, morphology and geographic distribution. Intraspecific variability correlation with clinical and epidemiological aspects of these species still remains unclear. This study aimed to sequence the loci GP43, exon 2 and ARF of 23 clinical isolates of Paracoccidioides spp. from patients in the Southeast Region of Brazil. Methodology and main findings GenBank was used to compare the present (23) with previous described sequences (151) that included ARF and GP43. It was identified a high polymorphism rate among the 23 isolates in comparison to the other 151. Among the isolates, 22 (95.66%) were S1/P. brasiliensis and 1 (4.34%) was identified as PS2/P. americana. A total of 45 haplotypes were found as follows: 19 from S1/P. brasiliensis (13 from the present study), 15 from P. lutzii, 6 from PS2/P. americana (1 from the present study), 3 from PS3/P. restrepiensis and 2 from PS4/P. venezuelensis. Moreover, exclusive haplotypes according to clinical origin and geographical area were found. S1/P. brasiliensis (HD = 0.655 and K = 4.613) and P. lutzii (HD = 0.649 and K = 2.906) presented the highest rate of polymorphism among all species, from which 12 isolates of the present study were clustered within S1b/P. brasiliensis. The GP43 locus showed a higher variability and was found to be the main reason for the species differentiation. Conclusions The results herein decribed show a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil. The finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. Paracoccidioidomycosis (PCM) is one of the most important systemic mycosis of Latin America. This disease can be caused by Paracoccidioides lutzii and four different phylogenetic species: S1/Paracoccidioides brasiliensis sensu stricto that harboring S1a and S1b, PS2/Paracoccidioides americana, PS3/Paracoccidioides restrepiensis and PS4/Paracoccidioides venezuelensis. Some of these species show differences in their main geographic region of predominance such as PS2/P. americana that can be found in Venezuela and Southern Brazil; PS3/P. restrepiensis and PS4/P. venezuelensis which are distributed in Colombia and Venezuela. However, and due to their wide geographical distribution, the species S1/P. brasiliensis and P. lutzii overlapping ecological niches and can be found in different regions of Brazil and other Latin American countries. Regarding eco-epidemiological aspects, the habitat is believed to be the soil due to the predominance of the disease among rural workers who become infected by inhaling infectious propagules during their farm activities. According to other authors, these species could have relation with the different PCM clinical presentation. This study aimed to describe the molecular epidemiology associated with clinical and epidemiological data of Paracoccidiodes spp. in the Minas Gerais State, located in the Southeast region, Brazil. Among the 23 isolates herein evaluated, 22 were S1/P. brasiliensis and 1 was identified as PS2/P. americana. A total of 45 haplotypes were found when these isolates were compared with other 151 deposited in the Genbank. The preliminar finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. The GP43 locus showed a higher variability and was found to be the main promotor of species differentiation. The results herein described pointed out a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil.
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Affiliation(s)
- Juliana Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
| | | | - Hugo Costa Paes
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Lucas Alves
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Adair Rosa
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | | | - Marcelo Simão Ferreira
- Infectious diseases Unit, Internal Medicine Department Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
- * E-mail:
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Affiliation(s)
- Dan Bernstein
- Fourth-year medical student, Stanford School of Medicine, Stanford University, Stanford, California; ; ORCID: https://orcid.org/0000-0002-3998-0056
| | - Isabel Beshar
- Fourth-year medical student, Stanford School of Medicine, Stanford University, Stanford, California; ORCID: http://orcid.org/0000-0002-4367-836X
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Burris HH, Passarella M, Handley SC, Srinivas SK, Lorch SA. Black-White disparities in maternal in-hospital mortality according to teaching and Black-serving hospital status. Am J Obstet Gynecol 2021; 225:83.e1-83.e9. [PMID: 33453183 PMCID: PMC8254791 DOI: 10.1016/j.ajog.2021.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Maternal mortality is higher among Black than White people in the United States. Whether Black-White disparities in maternal in-hospital mortality during the delivery hospitalization vary across hospital types (Black-serving vs nonBlack-serving and teaching vs nonteaching) and whether overall maternal mortality differs across hospital types is not known. OBJECTIVE The aims of this study were to determine whether risk-adjusted Black-White disparities in maternal mortality during the delivery hospitalization vary by hospital types (this is analysis of disparities in mortality within hospital types) and compare risk-adjusted in-hospital maternal mortality among Black-serving and nonBlack-serving teaching and nonteaching hospitals regardless of race (this is an analysis of overall mortality across hospital types). STUDY DESIGN We performed a population-based, retrospective cohort study of 5,679,044 deliveries among Black (14.2%) and White patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. A hospital discharge disposition of "death" defined maternal in-hospital mortality. Black-serving hospitals had at least 7% Black obstetrical patients (top quartile). We performed risk adjustment by calculating expected death rates using predictions from logistic regression models incorporating sociodemographics, rurality, comorbidities, multiple gestations, gestational age at delivery, year, state, and mode of delivery. We calculated risk-adjusted risk ratios of mortality by comparing observed-to-expected ratios among Black and White patients within hospital types and then examined mortality across hospital types, regardless of patient race. We quantified the proportion of Black-White disparities in mortality attributable to delivering in Black-serving hospitals using causal mediation analysis. RESULTS There were 330 maternal deaths among 5,679,044 patients (5.8 per 100,000). Black patients died more often (11.5 per 100,000) than White patients (4.8 per 100,000) (relative risk, 2.38; 95% confidence interval, 1.89-2.98). Examination of Black-White disparities revealed that after risk adjustment, Black patients had significantly greater risk of death (adjusted relative risk, 1.44; 95% confidence interval, 1.17-1.79) and that the disparity was similar within each of the hospital types. Comparison of mortality, regardless of race, across hospital types revealed that among teaching hospitals, mortality was similar in Black-serving and nonBlack-serving hospitals. However, among nonteaching hospitals, mortality was significantly higher in Black-serving vs nonBlack-serving hospitals (adjusted relative risk, 1.47; 95% confidence interval, 1.15-1.87). Notably, 53% of Black patients delivered in nonteaching, Black-serving hospitals compared with just 19% of White patients. Among nonteaching hospitals, 47% of Black-White disparities in maternal in-hospital mortality were attributable to delivering at Black-serving hospitals. CONCLUSION Maternal in-hospital mortality during the delivery hospitalization among Black patients is more than double that of White patients. Our data suggest this disparity is caused by excess mortality among Black patients within each hospital type, in addition to excess mortality in nonteaching, Black-serving hospitals where most Black patients deliver. Addressing downstream effects of racism to achieve equity in maternal in-hospital mortality will require transparent reporting of quality metrics by race to reduce differential care and outcomes within hospital types, improvements in care delivery at Black-serving hospitals, overcoming barriers to accessing high-quality care among Black patients, and eventually desegregation of healthcare.
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Affiliation(s)
- Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sara C Handley
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Sindhu K Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Ng BH, Low HJ, Nik Nuratiqah NA, Faisal AH, Soo CI, Periyasamy P, Ban AYL. Understanding of Coronavirus Disease 2019 (COVID-19) and the practice of preventive measures among doctors and nurses in a university teaching hospital- A cross-sectional study. Med J Malaysia 2021; 76:454-460. [PMID: 34305104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Knowledge and adequate practice of preventive measures among health care workers (HCWs) are important to reduce the risk of COVID-19 transmission. METHODS A cross-sectional study was conducted among doctors and nurses in the medical department in Pusat Perubatan Universiti Kebangsaan Malaysia between November 18, 2020 and December 18, 2020 during the third wave of COVID-19 epidemic in Malaysia. We studied the knowledge and practice of preventive measures of COVID-19 among doctors and nurses in the COVID-19 or sudden acute respiratory infection (SARI) wards and general medical wards. Data was collected using a validated self-designed google form online-questionnaire. RESULTS A total of 407 subjects completed the study and 80.8% were females; 55.8% were aged between 30-39 years; 46.4% were medical doctors. The main source of COVID-19 knowledge was the Ministry of Health Malaysia (MOH) website (35.1%). Majority (97%) had sufficient knowledge and 82% practiced proper preventive measures. Doctors had a higher mean knowledge score compared to nurses (p < 0.001). HCWs working in COVID-19 or SARI wards scored higher in knowledge questions compared to those in the general medical wards (p = 0.020). Nurses practiced better preventive measures (p < 0.001). Good knowledge could not be predicted based on professions (OR: 0.222, 95% CI: 0.048 - 1.028, p = 0.054). Majority were unable to recall the proper steps of donning (85.8%) and doffing (98.5%). CONCLUSIONS Although majority had good knowledge and practiced proper preventive measures, there was a poor recall in donning and doffing steps regardless of place of practice. The MOH website is a useful platform for tailored continuous medical education and regular updates on COVID-19. Regular training and retraining on donning and doffing of PPE is needed to bridge this gap.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur Malaysia
| | - N A Nik Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur Malaysia
| | - A Y L Ban
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
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Akladios C, Daraï É, Golfier F, Lecuru F, Collinet P, Uzan C, Lavoué V, Guyon F, Ferron G, Querleu D. [National certification for gynecological cancer surgery]. Bull Cancer 2021; 108:806-812. [PMID: 34217437 DOI: 10.1016/j.bulcan.2021.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of Obstetrics & Gynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.
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Affiliation(s)
- Cherif Akladios
- Hôpitaux universitaires de Strasbourg, CHU de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - Émile Daraï
- AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - François Golfier
- Hôpital Lyon Sud-Lyon, centre hospitalier Lyon Sud CHEM Grand Revoyet, 69310 Pierre-Bénite, France
| | - Fabrice Lecuru
- Institut Curie-Paris, Institut Curie Ensemble hospitalier - Site de Paris, 26, rue d'Ulm, 75005 Paris, France
| | - Pierre Collinet
- Hôpital Jeanne-de-Flandre-Lille, avenue Eugene-Avinée, 59000 Lille, France
| | - Catherine Uzan
- AP-HP, Hôpital de la Pitié Salpêtrière, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Vincent Lavoué
- Hôpital Sud Centre Eugène-Marquis, CHU de Rennes, avenue Bataille Flandres-Dunkerque C S 44229, 35042 Rennes, France
| | - Frederic Guyon
- Institut Bergonié, centre de lutte contre le cancer (CLCC) de la région Nouvelle-Aquitaine, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Gwenael Ferron
- Institut universitaire du cancer de Toulouse ONCOPOLE Iuct O, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Denis Querleu
- Société européenne d'oncologie gynécologique, 7, allée du Niger, 31000 Toulouse, France
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11
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Holmstrom AL, Ott KC, Weiss HK, Ellis RJ, Hungness ES, Shapiro MB, Yang AD. Improving trauma tertiary survey performance and missed injury identification using an education-based quality improvement initiative. J Trauma Acute Care Surg 2021; 90:1048-1053. [PMID: 34016928 DOI: 10.1097/ta.0000000000003152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance of a trauma tertiary survey (TTS) reduces rates of missed injuries, but performance has been inconsistent at trauma centers. The objectives of this study were to assess whether quality improvement (QI) efforts would increase the frequency of TTS documentation and determine if TTS documentation would increase identification of traumatic injuries. Our hypothesis was that QI efforts would improve documentation of the TTS. METHODS Before-and-after analysis of QI interventions at a level 1 trauma center was performed. The interventions included an electronic template for TTS documentation, customized educational sessions, and emphasis from trauma leadership on TTS performance. The primary outcome was documentation of the TTS. Detection of additional injuries based on tertiary evaluation was a secondary outcome. Associations between outcomes and categorical patient and encounter characteristics were assessed using χ2 tests. RESULTS Overall, 592 trauma encounters were reviewed (296 preimplementation and 296 postimplementation). Trauma tertiary survey documentation was significantly higher after implementation of the interventions (30.1% preimplementation vs. 85.1% postimplementation, p < 0.001). Preimplementation documentation of the TTS was less likely earlier in the academic year (14.3% first academic quarter vs. 46.5% last academic quarter, p < 0.001), but this temporal pattern was no longer evident postimplementation (88.5% first academic quarter vs. 77.9% last academic quarter, p = 0.126). Patients were more likely to have a missed traumatic injury diagnosed on TTS postimplementation (1.7% in preimplementation vs. 5.7% postimplementation, p = 0.009). CONCLUSION Documentation of the TTS and missed injury detection rates were significantly increased following implementation of a bundle of QI interventions. The association between time of year and documentation of the TTS was also attenuated, likely through reduction of the resident learning curve. Targeted efforts to improve TTS performance may improve outcomes for trauma patients at teaching hospitals. LEVEL OF EVIDENCE Care management, Level IV.
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Affiliation(s)
- Amy L Holmstrom
- From the Department of Surgery (A.L.H., K.C.O., H.K.W., R.J.E., E.S.H., M.B.S., A.D.Y.), Feinberg School of Medicine, and Surgical Outcomes and Quality Improvement Center (R.J.E., A.D.Y.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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12
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Ginat DT, Kenniff J. Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital. Neuroradiol J 2021; 34:238-244. [PMID: 33472535 PMCID: PMC8165903 DOI: 10.1177/1971400920988664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. METHODS Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. RESULTS Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. CONCLUSION The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.
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13
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Osman M, Balla S, Patibandla S, Kheiri B, Caccamo M, Bianco C, Sokos G. Regional Variation in the Adoption of Invasive Hemodynamic Monitoring for Cardiogenic Shock in the United States. Am J Cardiol 2021; 148:174-175. [PMID: 33667450 DOI: 10.1016/j.amjcard.2021.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia.
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Saikrishna Patibandla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Marco Caccamo
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - George Sokos
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
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Kalita JM, Aggarwal A, Yedale K, Gadepalli R, Nag VL. A 5-year study of dengue seropositivity among suspected cases attending a teaching hospital of North-Western region of India. J Med Virol 2021; 93:3338-3343. [PMID: 33038014 DOI: 10.1002/jmv.26592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/08/2022]
Abstract
Dengue virus infection is estimated to cause infection in approximately 390 million people globally each year, of which 96 million develop clinical disease. Dengue serotype 2 (DEN-2) is the most prevalent serotype over the past 50 years in India, but serotypes 3 and 4 have appeared in some epidemics as well. A retrospective study was conducted in a teaching hospital, western India, between January 2014 and December 2018. The records of dengue serological test were analyzed. In total, 40 randomly selected nonstructural protein 1 (NS1) antigen-positive samples were analyzed by a reverse transcription-polymerase chain reaction. The demographic data, that is, age and sex, along with geographic location and platelet count level, were recorded from the Serology laboratory register and Hospital Information System. In total, 14.85% (735/4948) samples tested positive for dengue serology. Most of the laboratory-confirmed dengue cases, 34.97% (257/735), were observed in the 21-30 years of age group. The most common serotype detected in the tested samples was DEN-3 in 55% cases (22/40, 13 monoinfection and 9 coinfection with DEN-1 and DEN-2). The present study gives an insight into the trend of dengue seropositivity among suspected cases in the western part of Rajasthan, India. This study showed a higher seroprevalence of dengue infection as well as a gradual increase in the seroprevalence in this part of India.
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Affiliation(s)
- Jitu M Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alisha Aggarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kavita Yedale
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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15
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Chiang JK, Kao YH. Quality of end-of-life care of home-based care with or without palliative services for patients with advanced illnesses. Medicine (Baltimore) 2021; 100:e25841. [PMID: 33950997 PMCID: PMC8104190 DOI: 10.1097/md.0000000000025841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ± 0.9 vs 1.0 ± 1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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Farahat FM, Faqih NT, Alharbi RS, Mudarris RI, Alshaikh SA, Al-Jifree HM. Epidemiological characteristics of cervical cancer in a tertiary care hospital, western Saudi Arabia: A retrospective record-based analysis from 2002-2018. Saudi Med J 2021; 42:338-341. [PMID: 33632914 PMCID: PMC7989268 DOI: 10.15537/smj.2021.42.3.20200603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: To investigate the epidemiological characteristics of cervical cancer cases reported at a tertiary care teaching hospital in western Saudi Arabia. Methods: A retrospective chart review was conducted on medical records of patients diagnosed with cervical cancer at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected on demographic characteristics, histological types and stage, treatment modalities, and disease outcomes. Results: Cervical cancer was diagnosed among 89 patients from 2002 to 2018. History of pap smear was reported among 31 cases (34.8%). Squamous cell carcinoma was the most common reported histopathological subtype. Almost one third (29.2%) of the patients were at stage III or IV at the time of diagnosis. The most frequent treatment regimen was combined radio/chemotherapy. Kaplan-Meier analysis showed an overall survival rate of 81.5%. Conclusion: The lack of an effective screening program for cervical cancer increases the likelihood of a late diagnosis and higher rates of complications and mortality. Public health programs should focus on cancer screening, screening, and reporting HPV infections, and supporting HPV vaccination activities.
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Affiliation(s)
- Fayssal M. Farahat
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
- Address correspondence and reprints request to: Dr. Fayssal M. Farahat, Infection Prevention and Control Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail: OCID ID: https://orcid.org/0000-0001-5186-2872
| | - Norah T. Faqih
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
| | - Razan S. Alharbi
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
| | - Raheed I. Mudarris
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
| | - Sahl A. Alshaikh
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
| | - Hatim M. Al-Jifree
- From the Infection Prevention and Control Department (Farahat), King Abdulaziz Medical City, Ministry of National Guard Health Affairs; from King Abdullah International Medical Research Center (Farahat, Al-Jifree); from the College of Medicine (Farahat, Alshaikh, Al-Jifree), King Saud bin Abdulaziz University for Health Sciences, Jeddah; from the College of Medicine (Faqih), Umm Al-Qura University, Makkah; from the College of Medicine (Alharbi, Mudarris), Ibn Sina National College; and from the Department of Oncology (Al-Jifree), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
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Purswani MU, Bucciarelli J, Tiburcio J, Yagudayev SM, Connell GH, Omidiran AA, Hannaway L, Zeana C, Healy M, Yu G, Reich D. SARS-CoV-2 Seroprevalence Among Healthcare Workers by Job Function and Work Location in a New York Inner-City Hospital. J Hosp Med 2021; 16:282-289. [PMID: 33929948 PMCID: PMC8086991 DOI: 10.12788/jhm.3627] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the seroprevalence and risk for SARS-CoV-2 among healthcare workers (HCWs) by job function and work location following the pandemic's first wave in New York City (NYC). METHODS A cross-sectional study conducted between May 18 and June 26, 2020, during which HCWs at a large inner-city teaching hospital in NYC received voluntary antibody testing. The main outcome was presence of SARS-CoV-2 antibodies indicating previous infection. Seroprevalence and adjusted odds ratios (aORs) for seropositivity by type and location of work were calculated using logistic regression analyses. RESULTS Of 2,749 HCWs tested, 831 tested positive, yielding a crude seroprevalence of 30.2% (95% CI, 29%-32%). Seroprevalence ranged from 11.1% for pharmacy staff to 44.0% for nonclinical HCWs comprised of patient transporters and housekeeping and security staff, with 37.5% for nurses and 20.9% for administrative staff. Compared to administrative staff, aORs (95% CIs) for seropositivity were 2.54 (1.64-3.94) for nurses; 2.51 (1.42-4.43) for nonclinical HCWs; between 1.70 and 1.83 for allied HCWs such as patient care technicians, social workers, registration clerks and therapists; and 0.80 (0.50-1.29) for physicians. Compared to office locations, aORs for the emergency department and inpatient units were 2.27 (1.53-3.37) and 1.48 (1.14-1.92), respectively. CONCLUSION One-third of hospital-based HCWs were seropositive for SARS-CoV-2 by the end of the first wave in NYC. Seroprevalence differed by job function and work location, with the highest estimated risk for nurses and the emergency department, respectively. These findings support current nationwide policy prioritizing HCWs for receipt of newly authorized COVID-19 vaccines.
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Affiliation(s)
- Murli U Purswani
- Division of Pediatric Infectious Disease, Department of Pediatrics, BronxCare Health System, Bronx, NY
- Corresponding Author: Murli U Purswani, MD; ; Telephone: 718-960-1010. Twitter: @purswani_murli
| | | | - Jose Tiburcio
- Department of Family Medicine, Bronx-Care Health System Bronx, NY
| | | | - Georgia H Connell
- Patient Care Services, Ambulatory Care, BronxCare Health System Bronx, NY
| | | | | | - Cosmina Zeana
- Division of Adult Infectious Disease, Department of Medicine, BronxCare Health System, Bronx, NY
| | - Maureen Healy
- Department of Family Medicine, Bronx-Care Health System Bronx, NY
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Doug Reich
- Department of Family Medicine, Bronx-Care Health System Bronx, NY
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Saini JS, Saroha V, Singh P, Sukhija JS, Jain AK. Keratoconus in Asian eyes at a tertiary eye care facility. Clin Exp Optom 2021; 87:97-101. [PMID: 15040776 DOI: 10.1111/j.1444-0938.2004.tb03155.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 01/08/2004] [Accepted: 01/15/2004] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the demographic variables, age at diagnosis, keratometry and slitlamp signs in keratoconus. METHODS Thirty-one patients with 61 keratoconic eyes were selected provided they met one of two criteria: 1. They had an irregular corneal surface, Vogt's striae, Fleischer's ring or apical sub-epithelial corneal scarring characteristic of keratoconus; 2. Corneal topography revealed an average simulated keratometry of more than 45.2 D, central corneal power higher than 47.2 D or infero-superior asymmetry greater than 1.4 D. The main outcome measures were demographic variables, age at diagnosis, disease severity on keratometry and biomicroscopic signs. RESULTS The patients' mean age at presentation was 20.2 +/- 6.4 years. Based on average keratometry values, 67.2 per cent of eyes had severe and 32.8 per cent had moderate keratoconus. Eyes with severe keratoconus presented at a younger average age (18.8 +/- 5.35 years) than moderate keratoconus (23.69 +/- 8.07 years). Thirty-eight eyes (92.5 per cent) with severe and 13 eyes (65 per cent) with moderate keratoconus demonstrated biomicroscopic signs of keratoconus. Twenty eyes (32.7 per cent) demonstrated apical sub-epithelial cornea scarring and 95 per cent of these eyes had severe keratoconus. CONCLUSIONS The majority of keratoconic eyes in Asian-Indian patients demonstrate the severe stage of the disease by the second decade.
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Affiliation(s)
- Jagjit S Saini
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mentias A, Sarrazin MV, Desai M, Kapadia S, Cram P, Girotra S. Expansion of transcatheter aortic valve replacement in the United States. Am Heart J 2021; 234:23-30. [PMID: 33388288 PMCID: PMC7954961 DOI: 10.1016/j.ahj.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patterns of diffusion of TAVR in the United States (U.S.) and its relation to racial disparities in TAVR utilization remain unknown. METHODS We identified TAVR hospitals in the continental U.S. from 2012-2017 using Medicare database and mapped them to Hospital Referral Regions (HRR). We calculated driving distance from each residential ZIP code to the nearest TAVR hospital and calculated the proportion of the U.S. population, in general and by race, that lived <100 miles driving distance from the nearest TAVR center. Using a discrete time hazard logistic regression model, we examined the association of hospital and HRR variables with the opening of a TAVR program. RESULTS The number of TAVR hospitals increased from 230 in 2012 to 540 in 2017. The proportion of the U.S. population living <100 miles from nearest TAVR hospital increased from 89.3% in 2012 to 94.5% in 2017. Geographic access improved for all racial and ethnic subgroups: Whites (84.1%-93.6%), Blacks (90.0%- 97.4%), and Hispanics (84.9%-93.7%). Within a HRR, the odds of opening a new TAVR program were higher among teaching hospitals (OR 1.48, 95% CI 1.16-1.88) and hospital bed size (OR 1.44, 95% CI 1.37-1.52). Market-level factors associated with new TAVR programs were proportion of Black (per 1%, OR 0.78, 95% CI 0.69-0.89) and Hispanic (per 1%, OR 0.82, 95% CI 0.75-0.90) residents, the proportion of hospitals within the HRR that already had a TAVR program (per 10%, OR 1.07, 95% CI 1.03-1.11), P <.01 for all. CONCLUSION The expansion of TAVR programs in the U.S. has been accompanied by an increase in geographic coverage for all racial subgroups. Further study is needed to determine reasons for TAVR underutilization in Blacks and Hispanics.
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Affiliation(s)
- Amgad Mentias
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
| | - Mary Vaughan Sarrazin
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA
| | - Milind Desai
- Heart and Vascular institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samir Kapadia
- Heart and Vascular institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Saket Girotra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA
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Mohy-Ud-Din N, Deyl I, Umar S, Abdul-Baki H, Morrissey S. Quality Gaps in Management of Acute Pancreatitis: A Tertiary Care Center Experience. Pancreas 2021; 50:544-548. [PMID: 33939667 DOI: 10.1097/mpa.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions. Our study compares the management of AP and adherence to guidelines among teaching medicine, nonteaching medicine, and surgical services within the same center. METHODS We performed a retrospective chart review of AP patients admitted to our center between January 2016 and January 2017 and analyzed the clinical and epidemiological data. RESULTS Of 115 patients, 65% were admitted to medicine (IM), and 35% were admitted to surgery. Mean age was 53.9 (standard deviation [SD], 15) years, and 52% were males; 38.6% (n = 29) of IM patients were prescribed lactated Ringer's solution for fluid resuscitation (mean rate of 153 [SD, 44.98] mL/h on teaching and 113 [SD, 43.56] mL/h on the nonteaching service). Antibiotics were prescribed to 22.6% (n = 17) of IM patients. On the surgical service, 77.5% of patients were prescribed lactated Ringer's solution for fluid resuscitation (mean rate of 108.25 [SD, 1.19] mL/h); 52.5% of patients received antibiotics. CONCLUSIONS Adherence to guidelines for management of AP is inadequate, and nonuniformity exists across different services within the same institution. There is a need for quality improvement initiatives.
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Affiliation(s)
| | | | - Shifa Umar
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA
| | - Heitham Abdul-Baki
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA
| | - Suzanne Morrissey
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA
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Chalmers K, Smith P, Garber J, Gopinath V, Brownlee S, Schwartz AL, Elshaug AG, Saini V. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims. JAMA Netw Open 2021; 4:e218075. [PMID: 33904912 PMCID: PMC8080218 DOI: 10.1001/jamanetworkopen.2021.8075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022] Open
Abstract
Importance Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.
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Affiliation(s)
- Kelsey Chalmers
- Lown Institute, Brookline, Massachusetts
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Aaron L. Schwartz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- University of Southern California, Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
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22
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Shin JH, Mizuno S, Okuno T, Itoshima H, Sasaki N, Kunisawa S, Kaku M, Yoshida M, Gu Y, Morii D, Shibayama K, Ohmagari N, Imanaka Y. Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals. BMC Infect Dis 2021; 21:234. [PMID: 33639873 PMCID: PMC7912490 DOI: 10.1186/s12879-021-05921-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Anti-Infective Agents/therapeutic use
- Antimicrobial Stewardship/methods
- Antimicrobial Stewardship/standards
- Catheter-Related Infections/drug therapy
- Catheter-Related Infections/epidemiology
- Catheter-Related Infections/prevention & control
- Cross Infection/drug therapy
- Cross Infection/epidemiology
- Cross Infection/prevention & control
- Drug Resistance, Bacterial
- Hand Hygiene/standards
- Hand Hygiene/statistics & numerical data
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching/standards
- Hospitals, Teaching/statistics & numerical data
- Humans
- Infection Control/methods
- Infection Control/standards
- Japan/epidemiology
- Personnel, Hospital/statistics & numerical data
- Pneumonia, Ventilator-Associated/drug therapy
- Pneumonia, Ventilator-Associated/epidemiology
- Pneumonia, Ventilator-Associated/prevention & control
- Practice Patterns, Physicians'/standards
- Surveys and Questionnaires
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Affiliation(s)
- Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Seiko Mizuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Mitsuo Kaku
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Makiko Yoshida
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Daiichi Morii
- Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, AMR Clinical Reference Center, and Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, Sinn BV, Gerhold M, Hauptmann K, Ingold-Heppner B, Miller F, Herbst H, Corman VM, Martin H, Radbruch H, Heppner FL, Horst D. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep 2021; 11:4263. [PMID: 33608563 PMCID: PMC7895917 DOI: 10.1038/s41598-021-82862-5] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Infection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.
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Affiliation(s)
- Sefer Elezkurtaj
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Selina Greuel
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jana Ihlow
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Edward Georg Michaelis
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philip Bischoff
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Catarina Alisa Kunze
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bruno Valentin Sinn
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Manuela Gerhold
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hauptmann
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Florian Miller
- Department of Pathology, Vivantes Hospitals Berlin, Berlin, Germany
| | - Hermann Herbst
- Department of Pathology, Vivantes Hospitals Berlin, Berlin, Germany
| | - Victor Max Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Infection Research, Berlin, Germany
| | - Hubert Martin
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - David Horst
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Ogar CO, Okoroiwu HU, Obeagu EI, Etura JE, Abunimye DA. Assessment of blood supply and usage pre- and during COVID-19 pandemic: A lesson from non-voluntary donation. Transfus Clin Biol 2021; 28:68-72. [PMID: 33080420 PMCID: PMC7836417 DOI: 10.1016/j.tracli.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ensuring steady stream of safe blood is the ultimate goal of blood transfusion practice. The current COVID-19 pandemic has affected almost every part of life and economy. Consequently, this study sets off to assess the effect of the pandemic on blood supply and blood transfusion in the University of Calabar Teaching Hospital. METHODS Data from the Donor Clinic and Blood Group Serology Unit of the University of Calabar Teaching Hospital were retrospectively extracted to evaluate supply and use of blood before and during COVID-19 pandemic. RESULT A total of 1638 donors were recorded within the study period. Age range 15-29 and 30-44 years constituted majority of the subjects (58.9% and 33.4%, respectively). The donor pool were male-dominated. Commercial donors (61.7%) and family replacement donors (30.6%) constituted majority of the donor pool. Most of the donor pool were students (37.1%), public servants (22.8%) and artisans (18.6%). A concomitant decrease of 26.1% and 18.9% were recorded in blood donation and request during the COVID-19 pandemic. CONCLUSION Blood supply was not significantly affected in our study center as both requests and donations decreased. Consideration for improving family replacement donation was advised.
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Affiliation(s)
- C O Ogar
- Hematology Unit, Department of Medical Laboratory Science, University of Calabar, Nigeria
| | - H U Okoroiwu
- Hematology Unit, Department of Medical Laboratory Science, University of Calabar, Nigeria.
| | - E I Obeagu
- Department of Medical Laboratory Science, Imo State University, Nigeria
| | - J E Etura
- Hematology Unit, Department of Medical Laboratory Science, University of Calabar, Nigeria
| | - D A Abunimye
- Hematology Unit, Department of Medical Laboratory Science, University of Calabar, Nigeria
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25
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Billig JI, Nasser JS, Cho HE, Chou CH, Chung KC. Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation. JAMA Netw Open 2021; 4:e2036297. [PMID: 33533928 PMCID: PMC7859845 DOI: 10.1001/jamanetworkopen.2020.36297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. OBJECTIVE To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. EXPOSURES Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. MAIN OUTCOMES AND MEASURES Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. RESULTS Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. CONCLUSIONS AND RELEVANCE In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.
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Affiliation(s)
- Jessica I. Billig
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
| | - Jacob S. Nasser
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Hoyune E. Cho
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
- Department of Plastic Surgery, University of California, Irvine
| | - Ching-Han Chou
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
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26
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Mujahid MS, Kan P, Leonard SA, Hailu EM, Wall-Wieler E, Abrams B, Main E, Profit J, Carmichael SL. Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California. Am J Obstet Gynecol 2021; 224:219.e1-219.e15. [PMID: 32798461 DOI: 10.1016/j.ajog.2020.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Birth hospital has recently emerged as a potential key contributor to disparities in severe maternal morbidity, but investigations on its contribution to racial and ethnic differences remain limited. OBJECTIVE We leveraged statewide data from California to examine whether birth hospital explained racial and ethnic differences in severe maternal morbidity. STUDY DESIGN This cohort study used data on all births at ≥20 weeks gestation in California (2007-2012). Severe maternal morbidity during birth hospitalization was measured using the Centers for Disease Control and Prevention index of having at least 1 of the 21 diagnoses and procedures (eg, eclampsia, blood transfusion, hysterectomy). Mixed-effects logistic regression models (ie, women nested within hospitals) were used to compare racial and ethnic differences in severe maternal morbidity before and after adjustment for maternal sociodemographic and pregnancy-related factors, comorbidities, and hospital characteristics. We also estimated the risk-standardized severe maternal morbidity rates for each hospital (N=245) and the percentage reduction in severe maternal morbidity if each group of racially and ethnically minoritized women gave birth at the same distribution of hospitals as non-Hispanic white women. RESULTS Of the 3,020,525 women who gave birth, 39,192 (1.3%) had severe maternal morbidity (2.1% Black; 1.3% US-born Hispanic; 1.3% foreign-born Hispanic; 1.3% Asian and Pacific Islander; 1.1% white; 1.6% American Indian and Alaska Native, and Mixed-race referred to as Other). Risk-standardized rates of severe maternal morbidity ranged from 0.3 to 4.0 per 100 births across hospitals. After adjusting for covariates, the odds of severe maternal morbidity were greater among nonwhite women than white women in a given hospital (Black: odds ratio, 1.25; 95% confidence interval, 1.19-1.31); US-born Hispanic: odds ratio, 1.25; 95% confidence interval, 1.20-1.29; foreign-born Hispanic: odds ratio, 1.17; 95% confidence interval, 1.11-1.24; Asian and Pacific Islander: odds ratio, 1.26; 95% confidence interval, 1.21-1.32; Other: odds ratio, 1.31; 95% confidence interval, 1.15-1.50). Among the studied hospital factors, only teaching status was associated with severe maternal morbidity in fully adjusted models. Although 33% of white women delivered in hospitals with the highest tertile of severe maternal morbidity rates compared with 53% of Black women, birth hospital only accounted for 7.8% of the differences in severe maternal morbidity comparing Black and white women and accounted for 16.1% to 24.2% of the differences for all other racial and ethnic groups. CONCLUSION In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.
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Affiliation(s)
- Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA.
| | - Peiyi Kan
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Leonard
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elizabeth Wall-Wieler
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elliott Main
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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Garralda Fernandez J, Molero Vilches I, Bermejo Rodríguez A, Cano Torres I, Colino Romay EI, García Arata I, Jaqueti Aroca J, Lillo Rodríguez R, López Lacomba D, Mazón Cuadrado L, Molina Esteban L, Morales García LJ, Moratilla Monzo L, Nieto-Borrajo E, Pacheco Delgado M, Prieto Menchero S, Sánchez Hernández C, Sánchez Testillano E, García-Martínez J. Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain. PLoS One 2021; 16:e0245001. [PMID: 33444392 PMCID: PMC7808590 DOI: 10.1371/journal.pone.0245001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk. METHODS AND FINDINGS This is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (p<0.01). CONCLUSIONS The global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms.
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Affiliation(s)
| | | | - Alfredo Bermejo Rodríguez
- Laboratory Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
- Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Cano Torres
- Laboratory Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | - Isabel García Arata
- Laboratory Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | | | - Luis Mazón Cuadrado
- Occupational Health Service, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | - Laura Moratilla Monzo
- Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
- Preventive Medicine Service, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Elva Nieto-Borrajo
- Laboratory Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | | | | | - Jesús García-Martínez
- Laboratory Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain
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María FM, Lorena MR, María Luz FV, Cristina RV, Dolores PD, Fernando TF. Overall management of emergency general surgery patients during the surge of the COVID-19 pandemic: an analysis of procedures and outcomes from a teaching hospital at the worst hit area in Spain. Eur J Trauma Emerg Surg 2021; 47:693-702. [PMID: 33399877 PMCID: PMC7782559 DOI: 10.1007/s00068-020-01558-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023]
Abstract
Objective To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes. Methods This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality. Results One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III–IV, ESS > 9, and SARS-CoV-2 infection. Conclusions Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.
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Affiliation(s)
- Fernández-Martínez María
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Martín-Román Lorena
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Fernández-Vázquez María Luz
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Rey-Valcarcel Cristina
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Pérez-Díaz Dolores
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Turégano-Fuentes Fernando
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
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Ali R, Qayyum F, Ahmed N, Haroon MZ, Irshad R, Sajjad S, Malik SQ, Saleem S, Hussain R, Zahid A, Farooq U. Isaric 4c Mortality Score As A Predictor Of In-Hospital Mortality In Covid-19 Patients Admitted In Ayub Teaching Hospital During First Wave Of The Pandemic. J Ayub Med Coll Abbottabad 2021; 33:20-25. [PMID: 33774948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.
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Affiliation(s)
- Rashid Ali
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | - Fatima Qayyum
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | - Nasir Ahmed
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | | | - Romana Irshad
- Department of Pathology, Ayub Medical College, Abbottabad, Pakistan
| | - Sabeen Sajjad
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | | | - Sania Saleem
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | | | - Ayesha Zahid
- Department of Medicine, Ayub Teaching Hospital, Abbottabad
| | - Umer Farooq
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
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Habonimana D, Ouedraogo L, Ndirahisha E, Misago N, Ciza R, Niyomwungere D, Niyongabo F, Irakoze JB, Nkurunziza JD, Manirakiza S. Understanding the influence of the COVID-19 pandemic on hospital-based mortality in Burundi: a cross-sectional study comparing two time periods. Epidemiol Infect 2020; 148:e280. [PMID: 33183401 PMCID: PMC7711354 DOI: 10.1017/s0950268820002770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 01/15/2023] Open
Abstract
This study used hospital records from two time periods to understand the implication of COVID-19 on hospital-based deaths in Burundi. The place of COVID-19 symptoms was sought among deaths that occurred from January to May 2020 (during the pandemic) vs. January to May 2019 (before the pandemic). First, death proportions were tested to seize differences between mortality rates for each month in 2020 vs. 2019. In the second time, we compared mean time-to-death between the two periods using the Kaplan-Meier survival curve. Finally, a logistic regression was fitted to assess the likelihood of dying from COVID-19 symptoms between the two periods. We found statistical evidence of a higher death rate in May 2020 as compared to May 2019. Moreover, death occurred faster in 2020 (mean = 6.7 days, s.d. = 8.9) than in 2019 (mean = 7.8 days, s.d. = 10.9). Unlike in 2019, being a male was significantly associated with a much lower likelihood of dying with one or more COVID-19 symptom(s) in 2020 (odds ratio 0.35, 95% confidence interval 0.14-0.87). This study yielded some evidence for a possible COVID-19-related hospital-based mortality trend for May 2020. However, considering the time-constraint of the study, further similar studies over a longer period of time need to be conducted to trace a clearer picture on COVID-19 implication on hospital-based deaths in Burundi.
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Affiliation(s)
- D. Habonimana
- Research and Innovation Unit, Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
| | - L. Ouedraogo
- Regional Adviser for Sexual and Reproductive Health, World Health Organization Regional Office for Africa, Brazaville, Congo
| | - E. Ndirahisha
- Department of Internal Medicine, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
| | - N. Misago
- Health Healing Network Burundi, Bujumbura, Burundi
| | - R. Ciza
- Health Healing Network Burundi, Bujumbura, Burundi
| | - D. Niyomwungere
- Research and Innovation Unit, Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
| | - F. Niyongabo
- National Health Institute, Ministry of Public Health and AIDS Control, Bujumbura, Burundi
| | - J. B. Irakoze
- Factulty of Medicine, University of Burundi, Bujumbura, Burundi
| | - J. D. Nkurunziza
- Department of Statistics, Higher Institute of Education, Bujumbura, Burundi
| | - S. Manirakiza
- Department of Radiology and Imaging, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
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Sareh S, Hadaya J, Sanaiha Y, Aguayo E, Dobaria V, Shemin RJ, Omari B, Benharash P. Predictors and In-Hospital Outcomes Among Patients Using a Single Versus Bilateral Mammary Arteries in Coronary Artery Bypass Grafting. Am J Cardiol 2020; 134:41-47. [PMID: 32900469 DOI: 10.1016/j.amjcard.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
The benefit of bilateral mammary artery (BIMA) use during coronary artery bypass grafting (CABG) continues to be debated. This study examined nationwide trends in BIMA use and factors influencing its utilization. Using the National Inpatient Sample, adults undergoing isolated multivessel CABG between 2005 and 2015 were identified and stratified based on the use of a single mammary artery or BIMA. Regression models were fit to identify patient and hospital level predictors of BIMA use and characterize the association of BIMA on outcomes including sternal infection, mortality, and resource utilization. An estimated 4.5% (n = 60,698) of patients underwent CABG with BIMA, with a steady increase from 3.8% to 5.0% over time (p<0.001). Younger age, male gender, and elective admission, were significant predictors of BIMA use. Moreover, private insurance was associated with higher odds of BIMA use (adjusted odds ratio 1.24) compared with Medicare. BIMA use was not a predictor of postoperative sternal infection, in-hospital mortality, or hospitalization costs. Overall, BIMA use remains uncommon in the United States despite no significant differences in acute postoperative outcomes. Several patient, hospital, and socioeconomic factors appear to be associated with BIMA utilization.
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Affiliation(s)
- Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Richard J Shemin
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Bassam Omari
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California.
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Patel A, Abdulaal A, Ariyanayagam D, Killington K, Denny SJ, Mughal N, Hughes S, Goel N, Davies GW, Moore LSP, Charani E. Investigating the association between ethnicity and health outcomes in SARS-CoV-2 in a London secondary care population. PLoS One 2020; 15:e0240960. [PMID: 33112892 PMCID: PMC7592846 DOI: 10.1371/journal.pone.0240960] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Black, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2. METHODS AND FINDINGS We conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 -April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70-63.73 versus 69.3 years, 95% CI 67.17-71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90-72.90 versus, 77.40 years, 95% CI 76.1-78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22-3.25, p<0.006). CONCLUSIONS BAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.
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Affiliation(s)
- Aatish Patel
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Ahmed Abdulaal
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | | | - Kieran Killington
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Sarah J. Denny
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Nabeela Mughal
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Imperial College London, Kensington, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Stephen Hughes
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Nupur Goel
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gary W. Davies
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Imperial College London, Kensington, London, United Kingdom
| | - Luke S. P. Moore
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Campus, London, United Kingdom
| | - Esmita Charani
- Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Campus, London, United Kingdom
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Joshi A, Beyuo T, Oppong SA, Moyer CA, Lawrence ER. Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana. BMC Pregnancy Childbirth 2020; 20:625. [PMID: 33059625 PMCID: PMC7566025 DOI: 10.1186/s12884-020-03316-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients' perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale ('Counseling Composite Score'). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points ('Preeclampsia/Eclampsia Knowledge Score' (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p < 0.001) and higher level of education (β 1.3, SE 0.48, p = 0.008). CONCLUSIONS Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01655, USA
| | - Titus Beyuo
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana.
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana.
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Brown TS, Dubowski K, Plitt M, Falci L, Lee E, Huynh M, Furuya Y, Vora NM. Erroneous Reporting of Deaths Attributed to Pneumonia and Influenza at 2 New York City Teaching Hospitals, 2013-2014. Public Health Rep 2020; 135:796-804. [PMID: 33031711 PMCID: PMC7649996 DOI: 10.1177/0033354920953209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Cause-of-death information, reported by frontline clinicians after a patient's death, is an irreplaceable source of public health data. However, systematic bias in cause-of-death reporting can lead to over- or underestimation of deaths attributable to different causes. New York City consistently reports higher rates of deaths attributable to pneumonia and influenza than many other US cities and the country. We investigated systematic erroneous reporting as a possible explanation for this phenomenon. METHODS We reviewed all deaths from 2 New York City hospitals during 2013-2014 in which pneumonia or influenza was reported as the underlying cause of death (n = 188), and we examined the association between erroneous reporting and multiple extrinsic factors that may influence cause-of-death reporting (patient demographic characteristics and medical comorbidities, time and hospital location of death, type of medical provider reporting the death, and availability of certain diagnostic information). RESULTS Pneumonia was erroneously reported as the underlying cause of death in 163 (86.7%) reports. We identified heart disease and dementia as the more likely underlying cause of death in 21% and 17% of erroneously reported deaths attributable to pneumonia, respectively. We found no significant association between erroneous reporting and the multiple extrinsic factors examined. CONCLUSIONS Our results underscore how erroneous reporting of 1 condition can lead to underreporting of other causes of death. Misapplication or misunderstanding of procedures by medical providers, rather than extrinsic factors influencing the reporting process, are key drivers of erroneous cause-of-death reporting.
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Affiliation(s)
- Tyler S. Brown
- Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn Dubowski
- Pulmonary and Critical Care Fellowship Program, Mount Sinai Hospital, New York, NY, USA
| | - Madia Plitt
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Laura Falci
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Erica Lee
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Mary Huynh
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Yoko Furuya
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY, USA
| | - Neil M. Vora
- New York City Department of Health and Mental Hygiene, New York, NY, USA
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Al-Azri M, Al-Hinai AS, Al-Ghafri MH, Panchatcharam SM. Knowledge and Awareness of Prostate Cancer Among Omani Men Attending a Teaching Hospital. J Cancer Educ 2020; 35:1002-1010. [PMID: 31154637 DOI: 10.1007/s13187-019-01556-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostate cancer is ranked as the fourth most prevalent cancer in the world and the second most common cancer affecting men. In Oman, prostate cancer is one of the most common cancers among men, with the majority of prostate cancer patients presenting in the more advanced stages of the disease. Public awareness of the risk factors, symptoms and emphasising the importance of seeking early medical attention could help to improve the outcomes and survival rates of prostate cancer patients. The aim of this study is to determine the awareness levels of the risk factors, symptoms and barriers to seeking early medical intervention among adult Omani men. A validated questionnaire measuring the knowledge of risk factors, symptoms and barriers to seeking early medical help was used to collect data from adult Omani men attending a teaching hospital in Muscat, Oman. Out of 720 men who were invited, 600 participated in the study (response rate = 83%). The most recognised risk factor was obesity (366; 61.0%), and the least was sexually transmitted diseases (204; 34.0%); the most recognised symptom was unexplained weight loss (26.5%), the least was changes in seminal fluid (13.3%); the most common barrier to seeking early intervention was "not trusting the medical knowledge of the doctors" (57.5%), the least was "difficulty in arranging transport" (19.5%). Age, education level, marital status and family history of cancer were significantly associated with the participants' knowledge of prostate cancer. Participants received a significant part of their prostate cancer awareness via the social media. National awareness campaigns using social media and information leaflets are needed to educate Omani men on prostate cancer awareness and prevention and to increase trust in the expertise of medical professionals. Further research exploring the barriers to seeking early medical intervention is needed.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
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Consonni D, Bordini L, Nava C, Todaro A, Lunghi G, Lombardi A, Magioni D, De Palo F, Guerrieri L, Gatti M, Serra D, Polonioli M, Pratò S, Muscatello A, Bandera A, Auxilia F, Castaldi S. COVID-19: What happened to the healthcare workers of a research and teaching hospital in Milan, Italy? Acta Biomed 2020; 91:e2020016. [PMID: 32921712 PMCID: PMC7716960 DOI: 10.23750/abm.v91i3.10361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Abstract
The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us the concerns about hospital acquired infections both for patients and HCWs.
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Affiliation(s)
- Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lorenzo Bordini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlo Nava
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Aldo Todaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Lunghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Andrea Lombardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Davide Magioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Francesco De Palo
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Lidia Guerrieri
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Michele Gatti
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Daniele Serra
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Marco Polonioli
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Simone Pratò
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Antonio Muscatello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Sciences (MACH), University of Milan, Italy.
| | - Francesco Auxilia
- Dept Biomedical Sciences for Health, University of Milan, Italy and ASST Fatebenefratelli e Sacco, Milan, Italy.
| | - Silvana Castaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Dept Biomedical Sciences for Health, University of Milan, Italy.
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Godat LN, Costantini TW, Doucet JJ. Emergency General Surgery and the Gallbladder: The Affordable Care Act's Impact on Practice Patterns. J Surg Res 2020; 257:356-362. [PMID: 32892131 DOI: 10.1016/j.jss.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/17/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gallbladder disease frequently requires emergency general surgery (EGS). The Affordable Care Act (ACA) mandated health insurance coverage for all with the intent to improve access to care and decrease morbidity, mortality, and costs. We hypothesize that after the ACA open-enrollment in 2014 the number of EGS cholecystectomies decreased as access to care improved with a shift in EGS cholecystectomies to teaching institutions. METHODS A retrospective review of the National Inpatient Sample Database from 2012 to quarter 3 of 2015 was performed. Patients age 18-64, with a nonelective admission for gallbladder disease based on ICD-9 codes, were collected. Outcomes measured included cholecystectomy, complications, mortality, and wage index-adjusted costs. The effect of the ACA was determined by comparing preACA to postACA years. RESULTS 189,023 patients were identified. In the postACA period the payer distribution for admissions decreased for Self-pay (19.3% to 13.6%, P < 0.001), Medicaid increased (26.3% to 34.0%, P < 0.001) and Private insurance was unchanged (48.6% to 48.7%, P = 0.946). PostACA, admissions to teaching hospitals increased across all payer types, EGS cholecystectomies decreased, while complications increased, and mortality was unchanged. Median costs increased significantly for Medicaid and Private insurance while Self-pay was unchanged. Based on adjusted DID analyses for Insured compared to Self-pay patients, EGS cholecystectomies decreased (-2.7% versus -1.21%, P = 0.033) and median cost increased more rapidly (+$625 versus +$166, P = 0.017). CONCLUSIONS The ACA has changed EGS, shifting the majority of patients to teaching institutions despite insurance type and decreasing the need for EGS cholecystectomy. The trend toward higher complication rate with increased overall cost requires attention.
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Affiliation(s)
- Laura N Godat
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego School of Medicine.
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego School of Medicine
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego School of Medicine
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Zoleo M, Della Rocca F, Tedeschi F, Zucchetto M, Maddalena G, Vettore G. Violence against health workers: findings from three emergency departments in the teaching hospital of Padua, Italy. Intern Emerg Med 2020; 15:1067-1074. [PMID: 32072369 DOI: 10.1007/s11739-020-02290-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Emergency departments (EDs) are high-risk places for Workplace Violence (WPV). In Italy, this phenomenon is scarcely investigated. The aim of this study is to evaluate the incidence, experiencing and perception of WPV in the general ED (GED), paediatric ED (PED) and obstetric-gynaecological ED (OGED) of the teaching hospital Azienda Ospedaliera in Padua (AOP). We led a cross-sectional study among the GED, OGED and PED staffs, submitting an anonymous questionnaire, regarding personal information, verbal and physical aggression experiences, risk factors and proposals for corrective actions. Our sample consists of 73 people from GED, 45 from OGED and 53 from PED. Aggressions are common. Verbal aggressions are almost never recorded, even in the case of physical aggressions, 41% did not signal the event. Both in GED and in OGED, most of the staff (68.9% and 75.0%, respectively) underwent aggression by neither psychiatric nor substance abuser patients (PSAPs). Physical aggressions are more common in GED than in OGED and in PED; most of professionals were assaulted by PSAPs. In all EDs, verbal or physical assault has been lived through by anger, resignation or fear, rarely by indifference. Professionals think there are structural characteristics and risk factors that could be corrected. They do not know how to manage assaults and would deem it useful training meetings with experts. Our results regarding how staff perceive and experience violence in the ED concern a local situation, that nevertheless reflect current evidence about the topic of WPV which plagues EDs across the globe.
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Affiliation(s)
- Miranda Zoleo
- Aulss 4 Veneto Orientale Emergency Department Portogruaro, CAP 30026, Portogruaro, Venetia, Italy.
| | - Foscarina Della Rocca
- Pronto Soccorso Azienda Ospedaliera Di Padova, Via Giustiniani 2, 35122, Padua, Italy
| | - Federico Tedeschi
- Section of Psychiatry, Department Neurosciences Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Mirka Zucchetto
- Pronto Soccorso Di San Donà Di PiaveULSS 4 Veneto, Orientale Via Nazario Sauro, 25, 30027, San Donà di Piave, Venetia, Italy
| | - Giovanna Maddalena
- Pronto Soccorso VeneziaULSS 3 Veneto, Sestiere Castello, 6777, 30122, Venice, Italy
| | - Gianna Vettore
- Coordinamento Regionale Emergenza Urgenza Regione Veneto, Via Giustiniani 2, Padua, Italy
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Dai M, Wu Y, Tan H, Deng J, Hou M, Peng W, Chen G, Li Y, Li H, Pan P, Lu J. Cross-infection of adenovirus among medical staff: A warning from the intensive care unit in a tertiary care teaching hospital in China. Int J Infect Dis 2020; 98:390-397. [PMID: 32623086 PMCID: PMC7330577 DOI: 10.1016/j.ijid.2020.06.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Abstract
Human adenovirus-55 in a single patient had strong transmission potential in ICU. This infectious event involved more than 20 medical staff members in adult ICU. Contact with patient, lack of hand hygiene or gloving adherence, were risk factors.
Rationale In 2019, a small HAdV55-associated outbreak of adenovirus infection occurred among the intensive care unit (ICU) staff in Xiangya Hospital of Central South University in Hunan Province, China, during the treatment of a patient. Objective To investigate the characteristics of a nosocomial adenovirus outbreak in an ICU. Methods We evaluated all the patients treated and the medical staff working in the ICU from August 1 to September 4, 2019. We further performed an epidemiological and molecular analysis for this outbreak from patient to healthcare workers and between healthcare workers. After the outbreak, we adopted exposure prevention and droplet prevention measures based on standard precautions. Measurements and main results Between August 1 and August 27, 2019, 27 cases of human adenovirus cross-infection were reported in our institution. Among the cases, eleven were doctors (41%), eleven were nurses (41%), three were respiratory therapists (11%), and two were caregivers (7%). The attack rate was 28.4%, and the fatality rate was 0. The results showed that contact with the index case, lack of hand hygiene or gloving adherence were risk factors for infection after adenovirus exposure. After taking specific precautions, no new cases of infection have appeared since August 27. Conclusions Our results show that HAdV55 in a single patient had strong transmission potential in an intensive care unit with adequate facilities and standardized operation. We provide convincing evidence indicating that attention could be highlighted on the role of standard and specific precautions for controlling the spread of adenovirus in ICUs.
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Affiliation(s)
- Minhui Dai
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Yanhao Wu
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Hongyi Tan
- Central Hospital, Changsha, Hunan Province, China
| | - Jing Deng
- Central South University Xiangya School of Public Health, China
| | - Maodan Hou
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Wenzhong Peng
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Guo Chen
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Yi Li
- Respiratory Department, Xiangya Hospital, Central South University, China
| | - Haitao Li
- Cancer Hospital of Hunan Province, China
| | - Pinhua Pan
- State Key Laboratory of Anti-Infective Drug Development, Dongguan 523871, China; Respiratory Department, Xiangya Hospital, Central South University, China.
| | - Jingmei Lu
- Respiratory Department, Xiangya Hospital, Central South University, China.
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Eyre DW, Lumley SF, O'Donnell D, Campbell M, Sims E, Lawson E, Warren F, James T, Cox S, Howarth A, Doherty G, Hatch SB, Kavanagh J, Chau KK, Fowler PW, Swann J, Volk D, Yang-Turner F, Stoesser N, Matthews PC, Dudareva M, Davies T, Shaw RH, Peto L, Downs LO, Vogt A, Amini A, Young BC, Drennan PG, Mentzer AJ, Skelly DT, Karpe F, Neville MJ, Andersson M, Brent AJ, Jones N, Martins Ferreira L, Christott T, Marsden BD, Hoosdally S, Cornall R, Crook DW, Stuart DI, Screaton G, Peto TEA, Holthof B, O'Donnell AM, Ebner D, Conlon CP, Jeffery K, Walker TM. Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study. eLife 2020; 9:e60675. [PMID: 32820721 PMCID: PMC7486122 DOI: 10.7554/elife.60675] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).
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Affiliation(s)
- David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health EnglandOxfordUnited Kingdom
| | - Sheila F Lumley
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Denise O'Donnell
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Mark Campbell
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Elizabeth Sims
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Elaine Lawson
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Fiona Warren
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Tim James
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Stuart Cox
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alison Howarth
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - George Doherty
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Stephanie B Hatch
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Target Discovery Institute, University of OxfordOxfordUnited Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philip W Fowler
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Jeremy Swann
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Denis Volk
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Fan Yang-Turner
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Nicole Stoesser
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health EnglandOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philippa C Matthews
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Maria Dudareva
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Timothy Davies
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Robert H Shaw
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Leon Peto
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Louise O Downs
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alexander Vogt
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Ali Amini
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Bernadette C Young
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | | | - Alexander J Mentzer
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Donal T Skelly
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Fredrik Karpe
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Radcliffe Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Matt J Neville
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Radcliffe Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Monique Andersson
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Nicola Jones
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Thomas Christott
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Brian D Marsden
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Kennedy Institute of Rheumatology Research, University of OxfordOxfordUnited Kingdom
| | - Sarah Hoosdally
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Richard Cornall
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Derrick W Crook
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - David I Stuart
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Gavin Screaton
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Timothy EA Peto
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Bruno Holthof
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Daniel Ebner
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Target Discovery Institute, University of OxfordOxfordUnited Kingdom
| | - Christopher P Conlon
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Timothy M Walker
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Oxford University Clinical Research UnitHo Chi Minh CityViet Nam
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Saida IB, Ennouri E, Nachi R, Meddeb K, Mahmoud J, Thabet N, Jerbi S, Boussarsar M. Very severe COVID-19 in the critically ill in Tunisia. Pan Afr Med J 2020; 35:136. [PMID: 33193951 PMCID: PMC7608765 DOI: 10.11604/pamj.supp.2020.35.136.24753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 is an emerging health threat outbreak. It may cause severe viral pneumonia with Acute Respiratory Distress Syndrome requiring critical care. Aim: to describe clinical features and outcomes of critically ill patients with SARS-CoV-2 infection. METHODS it was a retrospective study carried out in the medical ICU of Farhat Hached teaching hospital between March 11 and May 7, 2020. All consecutive patients with RT-PCR confirmed COVID-19 were included. Clinical characteristics and outcomes were collected by reviewing medical records. RESULTS during the study period, 10 critically ill patients with COVID-19 were enrolled. Mean age, 51.8±6.3 years; 8(80%), male. The most common comorbidities were; diabetes mellitus, 6(60%), obesity 2(20%), chronic kidney disease 2(20%) and hypertension 1(10%). Mean SAPS II, 23.2±1.8. The mean arterial oxygen partial pressure to fractional inspired oxygen ratio at admission was 136.2±79.7. Noninvasive mechanical ventilation was used in 4(40%) patients and 7(70%) received invasive mechanical ventilation. Tidal volume and PEEP were set respectively within the median [IQR] of, 5.7[5.6-6.3]ml/Kg and 10.7[6.5-11.7]cm H2O. Plateau pressure was monitored in the median [IQR] of 27.9 [25.9-28.5] cm H2O. Four patients received hydroxychloroquine alone and five hydroxychloroquine associated with an antiviral. Five patients developed respectively hyperactive (n=2), hypoactive (n=2) and mixed delirium (n=1). Mortality rate was at 70%. CONCLUSION this study demonstrated a particular profile of COVID-19 in the critically ill as a severe presentation in aged males with comorbidities presenting with an ARDS-like and neurological impairment with poor prognosis. The only survivals seem to have benefited from noninvasive ventilatory support.
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Affiliation(s)
- Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
- Research Laboratory N° LR12SP09, Heart Failure, Farhat Hached University Hospital, 4000, Sousse, Tunisia
| | - Emna Ennouri
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
| | - Rayane Nachi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
| | - Khaoula Meddeb
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
- Research Laboratory N° LR12SP09, Heart Failure, Farhat Hached University Hospital, 4000, Sousse, Tunisia
| | - Jihene Mahmoud
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
| | - Nesrine Thabet
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
| | - Salma Jerbi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
| | - Mohamed Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Faculty of medicine, University of Sousse, 4000, Sousse, Tunisia
- Research Laboratory N° LR12SP09, Heart Failure, Farhat Hached University Hospital, 4000, Sousse, Tunisia
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Ungerer M, Begli NH, Heyse M, Purrucker J, Regula J, Berberich A, Ciolli L, Nagel S, Ringleb P, Gumbinger C. Patient profiles contribute to differences in quality metrics of stroke centers. NSJ 2020; 25:292-300. [PMID: 33130810 PMCID: PMC8015612 DOI: 10.17712/nsj.2020.4.20190100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: To examine this association by comparing patient profiles in 2 closely affiliated hospitals and by examining their association with quality metrics. Methods: We performed a retrospective cohort study comparing a university level comprehensive stroke centers (CSC) with its teaching hospital and local stroke unit (LSU) using routinely collected quality assurance data over a 2 year period. Both hospitals were closely affiliated, shared important resources and medical staff rotated amongst both hospitals. We compared patient profiles as well as internationally recognized quality metrics and examined the association of profiles with quality metrics. Results: A total of 2,462 patients were treated in the CSC and 726 in the LSU. The LSU had a longer door-to-image and door-to-needle times. Rate of systemic thrombolysis was lower in the LSU. Patient profiles differed significantly and were associated with door-to-image and door-to-needle times as well as intravenous thrombolysis rates, even when adjusted for stroke service level. The diagnostic procedures for stroke work-up were similar. Discharge management differed strongly. Conclusion: Although LSUs and CSCs are the primary care providers in their respective regions, differences in patient profiles may contribute to differences in performance parameters. Adjusting for patient profiles may improve the comparability of the quality of stroke care provided by hospitals belonging to different stroke service levels.
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Affiliation(s)
- Matthias Ungerer
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Nima Haji Begli
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Miriam Heyse
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Jan Purrucker
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Jens Regula
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Anne Berberich
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Ludovico Ciolli
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Simon Nagel
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Peter Ringleb
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
| | - Christoph Gumbinger
- From the Department of Neurology (Ungerer, Begli, Heyse, Purrucker, Regula, Berberich, Nagel, Ringleb, Gumbinger), University Hospital Heidelberg, Heidelberg; from the Department of Neurology (Purrucker, Regula), GRN-Klinik Sinsheim, Sinsheim, Germany; and from the Stroke Unit, Neurology Unit, Department of Neuroscience (Ciolli), Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
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Osme SF, Almeida APS, Lemes MF, Barbosa WO, Arantes A, Mendes-Rodrigues C, Gontijo Filho PP, Ribas RM. Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case-control study. J Hosp Infect 2020; 106:303-310. [PMID: 32693085 DOI: 10.1016/j.jhin.2020.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the economic burden of healthcare-associated infections (HAIs) in Brazil. AIM To analyse the costs of hospitalization by reimbursement from the Brazilian government, via the Brazilian Unified Health System (SUS) affiliation, and direct costs in the adult Intensive Care Unit (ICU). METHODS The matched-pairs case-control study (83 patients with HAIs and 83 without HAIs) was performed at a referral tertiary-care teaching hospital in Brazil in January 2018. In order to calculate the HAI costs from the perspective of the payer, the total cost for each hospitalization was obtained through the Hospital's Billing Sector. Direct costs were calculated annually for 949 critical patients during 2018. FINDINGS The reimbursement cost per hospitalization of patients with HAIs was 75% (US$2721) higher than patients without HAIs (US$1553). When a patient has an HAI, in addition to a longer length of stay (15 days), there was an extra increase (US$996) in the reimbursement cost per hospitalization. An HAI in the ICU was associated with a total direct cost eight times higher compared with patients who did not develop infections in this unit, US$11,776 × US$1329, respectively. The direct cost of hospitalization in the ICU without HAI was 56.5% less than the reimbursement (US$1329 × US$3052, respectively), whereas for the patient with an HAI, the direct cost was 111.5% above the reimbursement (US$11,776 × US$5569, respectively). CONCLUSION HAIs contribute to a longer stay and an eight-fold increase in direct costs. It is necessary to reinforce programmes that prevent HAIs in Brazilian hospitals.
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Affiliation(s)
- S F Osme
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - A P S Almeida
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - M F Lemes
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - W O Barbosa
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - A Arantes
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - C Mendes-Rodrigues
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - P P Gontijo Filho
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil.
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Geng H, Tan F, Deng Y, Lai L, Zhang J, Wu Z, Liu P, Zhu Q. High rate of burnout among residents under standardized residency training in a tertiary teaching hospital of middle China: Results from a cross-sectional survey. Medicine (Baltimore) 2020; 99:e20901. [PMID: 32629681 PMCID: PMC7337465 DOI: 10.1097/md.0000000000020901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Burnout has been commonly observed in health care workers. Though research has been conducted involving burnout among doctors in China, few studies have focused on residents during standardized residency training (SRT). The professional status of the residents during SRT remains largely unclear. The present study was conducted in order to clarify the prevalence and potential risk factors of burnout in residents during SRT.An electronic questionnaire comprised 2 parts. The first part was designed to collect some basic characteristic information. Maslach Burnout Inventory-Human Services Survey was included in the second part.As many as 71.05% residents had at least 1 scale of burnout. Emotional exhaustion (EE) was found in 55.6% residents, depersonalization (DP) in 29.7% and reduced personal accomplishment (RPA) in 41.6%. Being older than 27, senior SRT year, working time more than 60 hours per week and poor sleeping quality was independently associated with at least on scale of burnout. Being unable to receive timely supervisor support significantly increased the probability of DP and EE. Not having friends at work or feeling cared for by the hospital were independently related to all 3 symptoms of burnout as well as overall burnout.Burnout rate is high in residents under SRT from middle part of China. Organizational, professional, and social support was demonstrated critical by the potential roles in protecting against burnout. Residents with burnout were prone to considering turnover. Strategies for managing burnout related factors among residents should be focused in future studies.
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Affiliation(s)
- Hongfang Geng
- Department of Anesthesiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City
| | - Fang Tan
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Yingqing Deng
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University
| | - Lifei Lai
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University
| | - Jiaqiang Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City
| | - Zhenlong Wu
- Comprehensive Assessment Department of Chinese medical doctor association, Beijing City, People's Republic of China
| | - Peibin Liu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University
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45
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Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191:145-147. [PMID: 32291094 PMCID: PMC7146714 DOI: 10.1016/j.thromres.2020.04.013] [Citation(s) in RCA: 3225] [Impact Index Per Article: 806.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. METHODS We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. RESULTS We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. CONCLUSION The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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Affiliation(s)
- F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - M J H A Kruip
- Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N J M van der Meer
- Department of Anesthesiology and Critical Care, Amphia Hospital Breda and Oosterhout the Netherlands and TIAS/Tilburg University, Tilburg, the Netherlands
| | - M S Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - D A M P J Gommers
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - K M Kant
- Department of Intensive Care, Amphia Hospital, Breda, the Netherlands
| | - F H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J van Paassen
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - H Endeman
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
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Jones NK, Rivett L, Sparkes D, Forrest S, Sridhar S, Young J, Pereira-Dias J, Cormie C, Gill H, Reynolds N, Wantoch M, Routledge M, Warne B, Levy J, Córdova Jiménez WD, Samad FNB, McNicholas C, Ferris M, Gray J, Gill M, Curran MD, Fuller S, Chaudhry A, Shaw A, Bradley JR, Hannon GJ, Goodfellow IG, Dougan G, Smith KGC, Lehner PJ, Wright G, Matheson NJ, Baker S, Weekes MP. Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19. eLife 2020; 9:e59391. [PMID: 32558644 PMCID: PMC7326489 DOI: 10.7554/elife.59391] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.
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MESH Headings
- Adult
- Asymptomatic Diseases
- Betacoronavirus/genetics
- Betacoronavirus/isolation & purification
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques/statistics & numerical data
- Community-Acquired Infections/transmission
- Contact Tracing
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Disease Transmission, Infectious/prevention & control
- England/epidemiology
- Family Characteristics
- Female
- Health Personnel
- Hospital Units
- Hospitals, Teaching/organization & administration
- Hospitals, Teaching/statistics & numerical data
- Hospitals, University/organization & administration
- Hospitals, University/statistics & numerical data
- Humans
- Infection Control
- Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
- Male
- Mass Screening/organization & administration
- Mass Screening/statistics & numerical data
- Middle Aged
- Nasopharynx/virology
- Occupational Diseases/epidemiology
- Occupational Diseases/prevention & control
- Pandemics/prevention & control
- Patient Admission/statistics & numerical data
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Prevalence
- Program Evaluation
- Real-Time Polymerase Chain Reaction
- SARS-CoV-2
- Symptom Assessment
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Affiliation(s)
- Nick K Jones
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Lucy Rivett
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Dominic Sparkes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Sally Forrest
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Sushmita Sridhar
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Jamie Young
- Academic Department of Medical Genetics, University of CambridgeCambridgeUnited Kingdom
| | - Joana Pereira-Dias
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Claire Cormie
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Harmeet Gill
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Nicola Reynolds
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Michelle Wantoch
- Wellcome - MRC Cambridge Stem Cell Institute, University of CambridgeCambridgeUnited Kingdom
- Department of Haematology, School of Clinical Medicine, University of CambridgeCambridgeUnited Kingdom
| | - Matthew Routledge
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Ben Warne
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Jack Levy
- Institute for Manufacturing, Department of Engineering, University of CambridgeCambridgeUnited Kingdom
| | | | - Fathima Nisha Begum Samad
- Institute for Manufacturing, Department of Engineering, University of CambridgeCambridgeUnited Kingdom
| | - Chris McNicholas
- Improvement and Transformation Team, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Mark Ferris
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Jane Gray
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Michael Gill
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Martin D Curran
- Clinical Microbiology & Public Health Laboratory, Public Health EnglandCambridgeUnited Kingdom
| | - Stewart Fuller
- National Institutes for Health Research Cambridge Biomedical Research CentreCambridgeUnited Kingdom
| | - Afzal Chaudhry
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Ashley Shaw
- Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - John R Bradley
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- National Institutes for Health Research Cambridge, Clinical Research FacilityCambridgeUnited Kingdom
| | - Gregory J Hannon
- Cancer Research United Kingdom Cambridge Institute, University of CambridgeCambridgeUnited Kingdom
| | - Ian G Goodfellow
- Division of Virology, Department of Pathology, University of CambridgeCambridgeUnited Kingdom
| | - Gordon Dougan
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Kenneth GC Smith
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Paul J Lehner
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Giles Wright
- Occupational Health and Wellbeing, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom
| | - Nicholas J Matheson
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
- NHS Blood and TransplantCambridgeUnited Kingdom
| | - Stephen Baker
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
| | - Michael P Weekes
- Department of Infectious Diseases, Cambridge University NHS Hospitals Foundation TrustCambridgeUnited Kingdom
- Department of Medicine, University of CambridgeCambridgeUnited Kingdom
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of CambridgeCambridgeUnited Kingdom
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Lahner E, Dilaghi E, Prestigiacomo C, Alessio G, Marcellini L, Simmaco M, Santino I, Orsi GB, Anibaldi P, Marcolongo A, Annibale B, Napoli C. Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy. Int J Environ Res Public Health 2020; 17:ijerph17124417. [PMID: 32575505 PMCID: PMC7345358 DOI: 10.3390/ijerph17124417] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19-69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.
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Affiliation(s)
- Edith Lahner
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (E.D.); (C.P.); (B.A.); (C.N.)
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
- Correspondence:
| | - Emanuele Dilaghi
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (E.D.); (C.P.); (B.A.); (C.N.)
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Claudio Prestigiacomo
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (E.D.); (C.P.); (B.A.); (C.N.)
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Giuliano Alessio
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Laura Marcellini
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Maurizio Simmaco
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
- Department of Neurosciences, Mental Health, and Sensory Organs, “Sapienza” University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Iolanda Santino
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Giovanni Battista Orsi
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Paolo Anibaldi
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Adriano Marcolongo
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Bruno Annibale
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (E.D.); (C.P.); (B.A.); (C.N.)
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (E.D.); (C.P.); (B.A.); (C.N.)
- Hospital Direction and Clinical Departments, Sant’Andrea University Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy; (G.A.); (L.M.); (M.S.); (I.S.); (G.B.O.); (P.A.); (A.M.)
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Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res 2020; 191:148-150. [PMID: 32381264 PMCID: PMC7192101 DOI: 10.1016/j.thromres.2020.04.041] [Citation(s) in RCA: 1132] [Impact Index Per Article: 283.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. METHODS We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. RESULTS We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8). CONCLUSION In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
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Affiliation(s)
- F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - M J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N J M van der Meer
- Department of Anesthesiology and Critical Care, Amphia Hospital Breda, Oosterhout, the Netherlands; TIAS/Tilburg University Tilburg, the Netherlands
| | - M S Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - D Gommers
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - K M Kant
- Department of Intensive Care, Amphia Hospital, Breda, the Netherlands
| | - F H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J van Paassen
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - H Endeman
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
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Mehta R, Paredes AZ, Tsilimigras DI, Moro A, Sahara K, Farooq A, Dillhoff M, Cloyd JM, Tsung A, Ejaz A, Pawlik TM. Influence of hospital teaching status on the chance to achieve a textbook outcome after hepatopancreatic surgery for cancer among Medicare beneficiaries. Surgery 2020; 168:92-100. [PMID: 32303348 DOI: 10.1016/j.surg.2020.02.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/13/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Assessing composite measures of quality such as textbook outcome may be superior to focusing on individual parameters when evaluating hospital performance. The aim of the current study was to assess the impact of teaching hospital status on the occurrence of a textbook outcome after hepatopancreatic surgery. METHODS The Medicare Inpatient Standard Analytic Files were used to identify patients undergoing hepatopancreatic surgery from 2013 to 2015 for a malignant indication. Stratified and multivariable regression analyses were performed to determine the relationship between teaching hospital status, hospital surgical volume and textbook outcome. RESULTS Among 8,035 Medicare patients (hepatectomy; 41.8%, pancreatectomy; 58.2%), 6,196 (77.1%) patients underwent surgery at a major teaching hospital, whereas 1,839 (22.9%) patients underwent surgery at a minor teaching hospital. Patients undergoing surgery for pancreatic cancer at a major teaching hospital had a greater likelihood of achieving a textbook outcome compared with patients treated at a minor teaching hospital (minor teaching hospital: 456, 40% versus major teaching hospital: 1,606, 45.4%; P = .002). The likelihood of textbook outcome was also greater among patients undergoing hepatopancreatic surgery at high-volume centers (pancreas, low volume: 875, 40.5% versus high volume: 1,187, 47.1% P < .001; liver, low volume: 608, 41.8% versus high volume: 886, 46.6%; P = .005). When examining only major teaching hospitals, patients undergoing a pancreatectomy at a high-volume center had 29% greater odds of achieving a textbook outcome (odds ratio 1.29, 95% confidence interval 1.12-1.49). In contrast, among patients undergoing pancreatic resection at high-volume centers, the odds of achieving a textbook outcome was comparable among major versus minor teaching hospital (odds ratio 1.17, 95% confidence interval 0.89-1.53). CONCLUSION The odds of achieving a textbook outcome after pancreatic and hepatic surgery was greater at major versus minor teaching hospitals; however, this effect was largely mediated by hepatopancreatic procedural volume. Patients and payers should focus on regionalization of pancreatic and liver resection to high-volume centers in an effort to optimize the chances of achieving a textbook outcome.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ayesha Farooq
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.
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Adin DB, Royal KD, Adin CA. Cross-Sectional Assessment of the Emotional Intelligence of Fourth-Year Veterinary Students and Veterinary House Officers in a Teaching Hospital. J Vet Med Educ 2020; 47:193-201. [PMID: 31194633 DOI: 10.3138/jvme.0518-065r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emotional intelligence (EI) is the recognition and management of emotions. This skill set is important to work relationships and professional success. In this cross-sectional, observational study, we investigated EI scores of 4th-year veterinary students, interns, and residents in a teaching hospital, using a psychometric tool with professional population norms. Participants' EI scores were compared with professional norms and between the sample groups. Scores were examined on the basis of demographics and residency program type. Twenty-four 4th-year students and 43 interns and residents completed the survey. Total, composite, and subscale scores for all groups were lower than professional means. We noted no statistically significant differences in EI scores between training levels, but evaluation of effect sizes showed a medium negative effect of higher training levels on Self-Perception Composite, Self-Regard, Emotional Expression, Interpersonal Composite, Flexibility, and Optimism and a medium positive effect of higher training levels on Impulse Control. Medium effects for residency type were found for Stress Tolerance, Flexibility, and Stress Management, with higher scores for residencies with heavy inpatient loads. Medium effects for residency type were found on Flexibility scores, with higher scores for residents in disciplines with a perceived high stress level. We found that baseline EI scores of 4th-year veterinary students, interns, and residents at a teaching hospital were similar to, but uniformly lower than, those of other professionals and did not increase with training level. These results may be used to build on strengths and address weaknesses associated with EI of students and house officers at this institution.
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Affiliation(s)
| | - Kenneth D Royal
- Educational Assessment and Outcomes, College of Veterinary Medicine
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