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Dean JA, Eldering MJ, Schoevers RA, van Driel CMG. Identifying predictors of a favourable outcome for outpatients with a persistent depressive disorder treated with Cognitive Behavioural Analysis System of Psychotherapy: A prospective cohort study. Br J Clin Psychol 2024; 63:244-257. [PMID: 38312067 DOI: 10.1111/bjc.12454] [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: 03/30/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the first therapy specifically developed for persistent depressive disorder (PDD). This study aimed to identify predictors of favourable treatment outcome after group CBASP and assess change in depression severity over 24 weeks. DESIGN A prospective cohort study was conducted in patients with PDD treated with group-CBASP. METHODS Outcomes were depression severity measured by the Inventory of Depression Severity-self-report (IDS-SR) after 6 and 12 months. Potential predictors investigated were baseline depression severity, prior antidepressant use, age, family status, income source, age of onset and childhood trauma. Multivariate logistic regression was performed to assess their effects with a ≥25% IDS-SR score decrease as the dependent variable. RESULTS The IDS-SR score (range 0-84) significantly decreased from 37.78 at start to 33.45 at 6 months, an improvement which was maintained at 12 months. Having paid work and no axis I comorbidity significantly predicted favourable response. In the groups without a favourable outcome predictor a substantial percentage still showed at least partial response (16.7% and 19.2%). CONCLUSIONS Source of income and axis I comorbidity were predictors of response to group-CBASP. Within the group without favourable outcome predictors, a subgroup showed at least partial response. These results suggest that group-CBASP has promise for patients who do not respond to standard treatments. Future studies should include outcome measures that take into account comorbidity and other clinically relevant changes, such as social functioning.
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Affiliation(s)
- Juliana A Dean
- University Centre Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke J Eldering
- University Centre Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Schoevers
- University Centre Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Ye Y, Ma H, Dong J, Wang J. Association between short-term ambient air pollutants and type 2 diabetes outpatient visits: a time series study in Lanzhou, China. Environ Sci Process Impacts 2024; 26:778-790. [PMID: 38546508 DOI: 10.1039/d3em00464c] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Diabetes is a global public health problem, and the impact of air pollutants on type 2 diabetes mellitus (T2DM) has attracted people's attention. This study aimed to assess the association of short-term exposure to six criteria air pollutants with T2DM outpatient visits in Lanzhou, China. We collected data on daily outpatient visits for T2DM, daily meteorological data and hourly concentrations of air pollutants in Lanzhou from 2013 to 2019. An over-dispersed passion generalized addictive model combined with a distributed lag non-linear model was applied to estimate the associations and stratified analyses were performed by gender, age, and season. The models were fitted with different lag structures, including single lag days from the current to the previous seven days (lag0 to lag7) and moving average concentrations over seven lag days (lag01 to lag07). A positive association between multiple air pollutants, especially PM2.5, NO2, O38h and CO and hospital outpatient visits for T2DM was observed. The largest association between T2DM outpatient visits and PM2.5 was observed at lag06 (RR 1.013, 95% CI: 1.001, 1.027), NO2 at lag03 (RR 1.034, 95% CI: 1.018, 1.050), O38h at lag05 (RR 1.012, 95% CI: 1.001, 1.023) for an increase of 10 μg m-3 and CO at lag03 (RR 1.084, 95% CI: 1.029, 1.142) for an increase of 1 mg m-3 in the concentrations. In addition, people aged <65 and males are more susceptible, and air pollutants have a greater impact on the cold season. This study showed that although the air pollution in Lanzhou was improved, there was still a statistical correlation between air pollution exposure and T2DM outpatient visits. Therefore, the local government still needs to strengthen the control of air pollution and enhance the protection awareness of the diabetic population through education and publicity.
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Affiliation(s)
- Yilin Ye
- School of Public Health, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Hongran Ma
- School of Public Health, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Jiancheng Wang
- Gansu Health Vocational College, Lanzhou 730050, People's Republic of China
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Elmahallawy EK, Gareh A, Ghallab MMI, Köster PC, Dashti A, Aboelsoued D, Toaleb NI, Alzaylaee H, Gonzálvez M, Saleh AA, Alhegaili AS, Eldehn AF, Hernández-Castro C, Bailo B, González-Barrio D, Carmena D. Microscopy detection and molecular characterisation of Giardia duodenalis infection in outpatients seeking medical care in Egypt. Front Public Health 2024; 12:1377123. [PMID: 38645455 PMCID: PMC11026549 DOI: 10.3389/fpubh.2024.1377123] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Giardiosis remains one of the most prevalent enteric parasitic infections globally. Earlier molecular-based studies conducted in Egypt have primarily focused on paediatric clinical populations and most were based on single genotyping markers. As a result, there is limited information on the frequency and genetic diversity of G. duodenalis infections in individuals of all age groups. Methods Individual stool samples (n = 460) from outpatients seeking medical care were collected during January-December 2021 in Kafr El-Sheikh governorate, northern Egypt. Initial screening for the presence of G. duodenalis was conducted by coprological examination. Microscopy-positive samples were further confirmed by real-time PCR. A multilocus sequence typing approach targeted amplification of the glutamate dehydrogenase (gdh), beta-giardin (bg), and triose phosphate isomerase (tpi) genes was used for genotyping purposes. A standardised epidemiological questionnaire was used to gather basic sociodemographic and clinical features of the recruited patients. Results Giardia duodenalis cysts were observed in 5.4% (25/460, 95% CI: 3.6-7.9) of the stool samples examined by conventional microscopy. The infection was more frequent in children under the age of 10 years and in individuals presenting with diarrhoea but without reaching statistical significance. Stool samples collected during the winter period were more likely to harbour G. duodenalis. All 25 microscopy-positive samples were confirmed by real-time PCR, but genotyping data was only available for 56.0% (14/25) of the isolates. Sequence analyses revealed the presence of assemblages A (78.6%, 11/14) and B (21.4%, 3/14). All assemblage A isolates were identified as sub-assemblage AII, whereas the three assemblage B sequences belonged to the sub-assemblage BIII. Patients with giardiosis presenting with diarrhoea were more frequently infected by the assemblage A of the parasite. Conclusion This is one of the largest epidemiological studies evaluating G. duodenalis infection in individuals of all age groups in Egypt. Our molecular data suggest that G. duodenalis infections in the surveyed population are primarily of anthropic origin. However, because assemblages A and B are zoonotic, some of the infections identified can have an animal origin. Additional investigations targeting animal (domestic and free-living) and environmental (water) samples are warranted to better understand the epidemiology of giardiosis in Egypt.
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Affiliation(s)
- Ehab Kotb Elmahallawy
- Department of Zoonoses, Faculty of Veterinary Medicine, Sohag University, Sohag, Egypt
- Departamento de Sanidad Animal, Grupo de Investigación en Sanidad Animal y Zoonosis (GISAZ), Universidad de Córdoba, Córdoba, Spain
| | - Ahmed Gareh
- Department of Parasitology, Faculty of Veterinary Medicine, Aswan University, Aswan, Egypt
| | - Marwa M. I. Ghallab
- Department of Medical Parasitology, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Pamela C. Köster
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
- Faculty of Health Sciences, Alfonso X El Sabio University (UAX), Villanueva de la Cañada, Madrid, Spain
- Faculty of Medicine, Alfonso X El Sabio University (UAX), Villanueva de la Cañada, Madrid, Spain
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
| | - Dina Aboelsoued
- Department of Parasitology and Animal Diseases, Veterinary Research Institute, National Research Centre, Cairo, Egypt
| | - Nagwa Ibrahim Toaleb
- Department of Parasitology and Animal Diseases, Veterinary Research Institute, National Research Centre, Cairo, Egypt
| | - Hind Alzaylaee
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Moisés Gonzálvez
- Departamento de Sanidad Animal, Grupo de Investigación en Sanidad Animal y Zoonosis (GISAZ), Universidad de Córdoba, Córdoba, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Campus de Excelencia Internacional Regional “Campus Mare Nostrum”, Universidad de Murcia, Murcia, Spain
| | - Amira A. Saleh
- Department of Medical Parasitology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa S. Alhegaili
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdul Aziz University, Alkharj, Saudi Arabia
| | - Ahmed Fathy Eldehn
- Department of Otorhinolaryngology, Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Carolina Hernández-Castro
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
- Parasitology Group, Faculty of Medicine, Academic Corporation for the Study of Tropical Pathologies, University of Antioquia, Medellín, Colombia
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Majadahonda, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBER), Carlos III Health Institute (ISCIII), Madrid, Spain
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Firnhaber C, Simoncini G, Mayer C, Armon C, Ewing AC, Tedaldi E, Battalora L, Carlson K, Chagaris K, Buchacz K, Li J. Mammogram and Pap Smear Uptake Among Women in the HIV Outpatient Study USA, 2010-2021. AIDS Patient Care STDS 2024; 38:151-154. [PMID: 38656216 DOI: 10.1089/apc.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- Cynthia Firnhaber
- Vivent Health, Department of Research, Denver, Colorado, USA
- University of Colorado, Department of Medicine, Division of Infectious Disease, Anschutz Medical Center, Aurora, Colorado, USA
| | - Gina Simoncini
- Department of Internal Medicine, AIDS Healthcare Foundation, Philadelphia, Pennsylvania, USA
| | - Cynthia Mayer
- Department of Internal Medicine, Division of Infectious Disease, St. Joseph's Comprehensive Research Institute, Tampa, Florida, USA
| | - Carl Armon
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Alexander C Ewing
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Linda Battalora
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
- Petroleum Engineering Department, Colorado School of Mines, Golden, Colorado, USA
| | - Kimberly Carlson
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kalliope Chagaris
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Desmet M, Fillon A, Thivel D, Tanghe A, Braet C. Attrition rate and predictors of a monitoring mHealth application in adolescents with obesity. Pediatr Obes 2023; 18:e13071. [PMID: 37680003 DOI: 10.1111/ijpo.13071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Integrating mobile health (mHealth) into paediatric obesity treatment can provide opportunities for more personalized and lifetime treatment. However, high attrition rates pose a significant challenge. The current study attempts to better understand attrition by exploring (1) attrition rates of a monitoring mHealth application for usage over 14 days and (2) testing predictors of attrition in adolescents with obesity. METHODS Participants were 69 adolescents between 12 and 16 years old who engaged in a multidisciplinary obesity treatment centre (either outpatient or inpatient) in two countries (Belgium and France). To assess the attrition rates, frequency distributions were used. To test the predictors of attrition, zero-inflated negative binomial regression was performed. RESULTS Attrition rates were high, in the outpatient group, more than half of the participants (53.3%) used the app for only 0-7 days. In the inpatient group, this percentage was 24.1%. Only deficits in initiating (a component of executive functions) were a negative predictor of attrition, indicating that deficits in initiating lead to lower attrition rates. CONCLUSIONS This study provides evidence for high attrition rates in mHealth interventions for adolescents with obesity and was the first to investigate psychological predictors of attrition to an mHealth monitoring tool in adolescents with obesity in treatment. Findings regarding predictors of attrition should be approached with caution due to the small sample size.
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Affiliation(s)
- Maurane Desmet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Alicia Fillon
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont Auvergne University, Clermont-Ferrand, France
- National Observatory for Physical Activity and Sedentary behaviors (ONAPS), Clermont-Ferrand, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), EA 3533, Clermont Auvergne University, Clermont-Ferrand, France
- National Observatory for Physical Activity and Sedentary behaviors (ONAPS), Clermont-Ferrand, France
| | | | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Glebov OO, Mueller C, Stewart R, Aarsland D, Perera G. Antidepressant drug prescription and incidence of COVID-19 in mental health outpatients: a retrospective cohort study. BMC Med 2023; 21:209. [PMID: 37340474 PMCID: PMC10283271 DOI: 10.1186/s12916-023-02877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Currently, the main pharmaceutical intervention for COVID-19 is vaccination. While antidepressant (AD) drugs have shown some efficacy in treatment of symptomatic COVID-19, their preventative potential remains largely unexplored. Analysis of association between prescription of ADs and COVID-19 incidence in the population would be beneficial for assessing the utility of ADs in COVID-19 prevention. METHODS Retrospective study of association between AD prescription and COVID-19 diagnosis was performed in a cohort of community-dwelling adult mental health outpatients during the 1st wave of COVID-19 pandemic in the UK. Clinical record interactive search (CRIS) was performed for mentions of ADs within 3 months preceding admission to inpatient care of the South London and Maudsley (SLaM) NHS Foundation Trust. Incidence of positive COVID-19 tests upon admission and during inpatient treatment was the primary outcome measure. RESULTS AD mention was associated with approximately 40% lower incidence of positive COVID-19 test results when adjusted for socioeconomic parameters and physical health. This association was also observed for prescription of ADs of the selective serotonin reuptake inhibitor (SSRI) class. CONCLUSIONS This preliminary study suggests that ADs, and SSRIs in particular, may be of benefit for preventing COVID-19 infection spread in the community. The key limitations of the study are its retrospective nature and the focus on a mental health patient cohort. A more definitive assessment of AD and SSRI preventative potential warrants prospective studies in the wider demographic.
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Affiliation(s)
- Oleg O Glebov
- Institute of Neuroregeneration and Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Shandong, China.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Byun H, Kang D, Go SI, Kim HI, Hahm JR, Kim RB. The impact of the COVID-19 pandemic on outpatients of internal medicine and pediatrics: A descriptive study. Medicine (Baltimore) 2022; 101:e28884. [PMID: 35212289 PMCID: PMC8878857 DOI: 10.1097/md.0000000000028884] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions.
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Affiliation(s)
- Hayoung Byun
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dawon Kang
- Department of Physiology and Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Se-Il Go
- College of Medicine, Gyeongsang National University, Institute of Health Sciences and Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jong Ryeal Hahm
- College of Medicine, Gyeongsang National University, Institute of Health Sciences and Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Republic of Korea
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Molla M, Sisay W, Andargie Y, Kefale B, Singh P. Patients' satisfaction with outpatient pharmacy services and associated factors in Debre Tabor comprehensive specialized hospital, Northwest Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0262300. [PMID: 34986179 PMCID: PMC8730437 DOI: 10.1371/journal.pone.0262300] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION By measuring patients' satisfaction, providers can gain insight into several elements of health care services, including the effectiveness of their care and the level of empathy they exhibit. The aim of this study was to assess patient satisfaction with pharmaceutical services and associated factors in public hospitals located in Northwestern Ethiopia. METHODS An institution-based quantitative cross-sectional study was used. The study was carried out in an outpatient pharmacy from January 1-June 30, 2021. Participants were selected by a systematic sampling technique. The IBM SPSS statistical package (version 23) was used to enter and analyze the collected data. The findings were presented using descriptive statistical methods. To find factors linked to satisfaction, binary logistic regression was used. RESULTS The final analysis included a total of 401 samples. More than half of the participants (229, or 55.1%) were female. The overall mean score of satisfaction was 30.6 out of a maximum of 100 scores. By taking this mean score as a cut-off point, 204 (50.9%) of the study participants had satisfaction with the outpatient pharmacists' service. Participants' responses scored on the uncomfortable and inconvenient waiting areas [AOR = 0.31; 95%CI, (0.13, 0.49)] were found to be negatively associated with the level of patients' satisfaction. Also, the unavailability of medications [AOR = 0.12; 95%CI, (0.02, 0.37)] was negatively associated with the respondent satisfaction. Uncomfortable and inconvenient private counseling areas [AOR = 1.37; 95%CI, (0.79, 4.42)] showed a negative association with their satisfaction. CONCLUSION Patients' satisfaction levels with pharmacy service were found to be greater than 50%. The socio-demographic characteristics of patients have no association with their level of satisfaction, but their perception of uncomfortable private counseling areas and waiting areas was negatively associated with their satisfaction.
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Affiliation(s)
- Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Woretaw Sisay
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yared Andargie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Belayneh Kefale
- Clinical Pharmacy Unit, Department of Pharmacy, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Pradeep Singh
- Pharmaceutical Chemistry Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Solomon D, Bekele K, Atlaw D, Mamo A, Gezahegn H, Regasa T, Negash G, Nigussie E, Zenbaba D, Teferu Z, Nugusu F, Atlie G. Prevalence of anemia and associated factors among adult diabetic patients attending Bale zone hospitals, South-East Ethiopia. PLoS One 2022; 17:e0264007. [PMID: 35180254 PMCID: PMC8856574 DOI: 10.1371/journal.pone.0264007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/28/2021] [Accepted: 01/31/2022] [Indexed: 01/13/2023] Open
Abstract
Background Anemia found in diabetes patients is often unrecognized like many other chronic diseases. The occurrence of anemia is also an additional burden to the micro vascular complications of patients with diabetes. In the selected study structure no published data were found on the prevalence of anemia and associated factors in diabetic patients. Hence, the findings of this study are very fruitful as an input for further studies and after the repetition of similar studies in different frameworks. It is helpful as input for the development of guidelines at diabetes clinics to request the laboratory assessment of hemoglobin as a routine activity. Objective This study aimed to assess the prevalence of anemia and its associated factors among diabetic patients who attended Bale zone hospitals. Methods A cross-sectional study design was conducted from September 2020–to January 2021 GC among adult diabetic patients who had follow-up at Bale zone hospitals. A total of 238 study participants were determined by single population proportion sample size calculation formula taking prevalence of anemia among adult diabetic patients 19.0%. Systematic random sampling technique was used to select the study participants. Information on demographic and associated factors of anemia in diabetic patients was collected using an interviewer-administered questionnaire. Blood sample collection was performed under aseptic conditions by a licensed medical laboratory professional. Data were entered into EpiData version 3.1, cleaned and exported to statistical package for the social sciences (SPSS) version 25 software tools. Logistic regression was used to assess factors associated with anemia in diabetic patients. P-value less than 0.05 and 95% CI were considered as statistically significant. The odds ratios were reported to indicate the strength of associations. Frequencies, percentages, charts and tables were used to summarize the characteristics of study participants. Results In this study anemia among adult diabetic patients is 18.1% (95% CI (13.2, 23.0%). Multivariable logistic regression analysis revealed that the sex of the study participants and the type of diabetes mellitus were found to be statistically significant to associate with anemia. The odds of having anemia among females are nearly three times higher when compared with males (AOR 2.78, 95% CI 1.40–5.52). In addition, the odds of having anemia among adult diabetic patients who had type II diabetes mellitus (AOR 2.18, 95%CI 1.04–4.54) were 2.18 times higher than those who had type I diabetes mellitus patients. Conclusion Nearly one out of five adult diabetic patients had anemia. Sex of the patients and the type of diabetes are associated with anemia among adult diabetic patients.
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Affiliation(s)
- Damtew Solomon
- Anatomy Department, Madda Walabu University, Goba, Oromia, Ethiopia
- * E-mail:
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Daniel Atlaw
- Anatomy Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Habtamu Gezahegn
- Physiology Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Tadele Regasa
- Biochemistry Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Getahun Negash
- Medical Laboratory Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Eshetu Nigussie
- Medical Laboratory Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Demissu Zenbaba
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Fikadu Nugusu
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Gela Atlie
- Internal Medicine Department, Madda Walabu University, Goba, Oromia, Ethiopia
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Kebede T, Taddese Z, Girma A. Knowledge, attitude and practices of lifestyle modification and associated factors among hypertensive patients on-treatment follow up at Yekatit 12 General Hospital in the largest city of East Africa: A prospective cross-sectional study. PLoS One 2022; 17:e0262780. [PMID: 35085323 PMCID: PMC8794133 DOI: 10.1371/journal.pone.0262780] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertension is a devastating global public health challenge; studies indicated that Ethiopia has been affected by the burden of hypertension especially in urban areas. The overall prevalence of hypertension in Ethiopia was estimated to be 19.6% (23.5% in urban and 14.7% in rural population). Along with medical management of hypertension, appropriate lifestyle modification is a crucial and inexpensive means of hypertension control. The main purpose of the study was therefore to assess knowledge, attitude and practice of lifestyle modification among patients on follow up for hypertension treatment at Yekatit 12 General Hospital. METHODS A prospective cross-sectional study design was applied in Yekatit 12 General Hospital from October 28, 2018, to February 28, 2019, by allotting proportionate samples from the two chronic outpatients departments (OPD). Using single proportion sampling techniques, the study participants were selected and the total sample size calculated was 405. Primarily, clinical measurements were made according to the international standard set to verify true hypertensive patient's inclusions. Then, data about socio-demographic characteristics, lifestyle modification related to knowledge, attitude and practices were comprehensively collected using an interviewer-administered structured questionnaire. The collected data was entered into Epi-data exported to SPSS Window version of 22 for analysis. All variables with ρ-value less than 0.05 in the final model were considered as independently associated with knowledge, attitude and practices of patients' lifestyle modification. The strength of association was described by Odds Ratio (OR) at the corresponding CI of 95%. RESULTS The overall sampled hypertensive patients as compared to the planned sample size was 95.5% (n = 387), out of which 53.5% (n = 207) was male patients. The mean age was 50 years with a standard deviation of 14.4. The study revealed that 67.7% [95% CI (65.32%, 70.08%)] were knowledgeable; and 54.0% [95% CI (51.34%, 56.6%)] were reported to have favorable attitude towards lifestyle modification. Regarding their practices, 38% [95% CI (19.91%, 57.49%] of the respondents had good practices. Their monthly income [AOR = 2.39, 95% CI (1.12, 5.11)] and duration on-treatment follow up since diagnosed with hypertension [AOR = 4.39, 95% CI (1.20, 16.03)] were independently associated with knowledge. Concerning their damned practices, age [AOR = 7.71, 95% CI (2.4, 24.8)] and knowledge [AOR = 3.94, 95% CI (2.01, 7.72)] were independently associated with the practices. CONCLUSION Though the encouraging high knowledge status and favourable attitudes towards lifestyle modification among hypertensive patients, the practices are among the lowest findings report in all standards. Hence, older patients, jobless patients, and low-income patients and patients on long-term treatment follow up who were diagnosed with hypertension before 10 years needs special attention and interventions by the country NCDs policy formulators to rise their non-pharmacological practices to control high blood pressure and its consequences.
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Affiliation(s)
- Taye Kebede
- Department of Biomedical Sciences and Immunology, Natural Sciences College, Madda Walabu University, Bale-Robe, Ethiopia
| | - Zaid Taddese
- ICAP Ethiopia (International Center for AIDS Care and Treatment Programs), The Non-Governmental and Development Organization Home-Based in Ethiopia, Addis Ababa, Ethiopia
| | - Abiot Girma
- Department of Public Health, College of Health Sciences and Medicine, Jimma University, Jimma, Ethiopia
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Oliveira J E Silva L, Gerberi DJ, Cummins NW, Shah AS, Bellolio F. Representativeness of Racial and Ethnic Groups in COVID-19 Outpatient Trials in the United States. Mayo Clin Proc 2022; 97:184-186. [PMID: 34996551 PMCID: PMC8554176 DOI: 10.1016/j.mayocp.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Lucas Oliveira J E Silva
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN; Research Fellow and Assistant Professor of Emergency Medicine.
| | | | - Nathan W Cummins
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Aditya S Shah
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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Clemency BM, Varughese R, Gonzalez-Rojas Y, Morse CG, Phipatanakul W, Koster DJ, Blaiss MS. Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:42-49. [PMID: 34807241 PMCID: PMC8609464 DOI: 10.1001/jamainternmed.2021.6759] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [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: 08/09/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
Importance Systemic corticosteroids are commonly used in treating severe COVID-19. However, the role of inhaled corticosteroids in the treatment of patients with mild to moderate disease is less clear. Objective To determine the efficacy of the inhaled steroid ciclesonide in reducing the time to alleviation of all COVID-19-related symptoms among nonhospitalized participants with symptomatic COVID-19 infection. Design, Setting, and Participants This phase 3, multicenter, double-blind, randomized clinical trial was conducted at 10 centers throughout the US and assessed the safety and efficacy of a ciclesonide metered-dose inhaler (MDI) for treating nonhospitalized participants with symptomatic COVID-19 infection who were screened from June 11, 2020, to November 3, 2020. Interventions Participants were randomly assigned to receive ciclesonide MDI, 160 μg per actuation, for a total of 2 actuations twice a day (total daily dose, 640 μg) or placebo for 30 days. Main Outcomes and Measures The primary end point was time to alleviation of all COVID-19-related symptoms (cough, dyspnea, chills, feeling feverish, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell) by day 30. Secondary end points included subsequent emergency department visits or hospital admissions for reasons attributable to COVID-19. Results A total of 413 participants were screened and 400 (96.9%) were enrolled and randomized (197 [49.3%] in the ciclesonide arm and 203 [50.7%] in the placebo arm; mean [SD] age, 43.3 [16.9] years; 221 [55.3%] female; 2 [0.5%] Asian, 47 [11.8%] Black or African American, 3 [0.8%] Native Hawaiian or other Pacific Islander, 345 [86.3%] White, and 1 multiracial individuals [0.3%]; 172 Hispanic or Latino individuals [43.0%]). The median time to alleviation of all COVID-19-related symptoms was 19.0 days (95% CI, 14.0-21.0) in the ciclesonide arm and 19.0 days (95% CI, 16.0-23.0) in the placebo arm. There was no difference in resolution of all symptoms by day 30 (odds ratio, 1.28; 95% CI, 0.84-1.97). Participants who were treated with ciclesonide had fewer subsequent emergency department visits or hospital admissions for reasons related to COVID-19 (odds ratio, 0.18; 95% CI, 0.04-0.85). No participants died during the study. Conclusions and Relevance The results of this randomized clinical trial demonstrated that ciclesonide did not achieve the primary efficacy end point of reduced time to alleviation of all COVID-19-related symptoms. Trial Registration ClinicalTrials.gov Identifier: NCT04377711.
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Affiliation(s)
- Brian M. Clemency
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Renoj Varughese
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | | | - Caryn G. Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wanda Phipatanakul
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Qian H, Lu W, Zhang D. Empirical Investigation on the Characteristics and Perceived Value of Patients in Medical Treatment Seeking: In-Depth Research in Zhejiang Province of China. Biomed Res Int 2021; 2021:5245041. [PMID: 34977240 PMCID: PMC8720011 DOI: 10.1155/2021/5245041] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient Perceived Value (PPV) provides a valuable perspective to explain why the government reforms on health system in terms of functional medical treatment performance improvement did not decrease the crowded waiting line or increased patient satisfaction in China. METHODS Questionnaires comprising seven constructs were sent to patients from seven highly recognized hospitals in Zhejiang Province of China. It was collected via face-by-face in a twelve-month period (2019), and 2586 valid data were collected for SPSS statistic accordingly. RESULTS Besides the significance of the functional medical treatment values (such as the treatment effectiveness, accurate price, standardization, and normalization), the emotional values (reasonable waiting time, convenient accessibility, communication with doctors/nurses) were significant in patients' consciousness. Patient medical treatment seeking preferences were affected by patients' background characteristics and perceived value, which consequently produced differentiated patients' satisfaction. Patients' characteristics, which related to the age, gender, illness conditions, educational, and income level, would have different demanding in medical treatment seeking. These young female patients in outpatient or in mild illness conditions with higher educational and income levels tend to be relatively high in timing and convenience demanding. CONCLUSION This result would change the policy maker and hospitals to considerate the patients' emotional value as well as functional value in providing medical treatment. Classified patients' time arrangement tactics consistent with distinguished characteristics, equipped up with convenient accessibility and interconnected medical treatment environment design, can create valuable patients' satisfaction in China.
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Affiliation(s)
- Hui Qian
- Zhejiang University City College, Hangzhou 310000, China
| | - Wu Lu
- Zhejiang University City College, Hangzhou 310000, China
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Lemma A, Mulat H, Nigussie K, Getinet W. Prevalence of unrecognized depression and associated factors among medical outpatient department attendees; a cross sectional study. PLoS One 2021; 16:e0261064. [PMID: 34932584 PMCID: PMC8691632 DOI: 10.1371/journal.pone.0261064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia. METHODS An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance. RESULTS A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1-20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67-0.84)), secondary education (AOR = 0.34, 95% CI (0.12-0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13-0.78)), poor social support (AOR = 7.78, 95% CI (2.74-22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79-89.14)) were associated with depression. CONCLUSION The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.
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Affiliation(s)
- Alemu Lemma
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Haregewoyin Mulat
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Wondale Getinet
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Agbalajobi OM, Gmelin T, Moon AM, Alexandre W, Zhang G, Gellad WF, Jonassaint N, Rogal SS. Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action. PLoS One 2021; 16:e0261377. [PMID: 34919585 PMCID: PMC8682904 DOI: 10.1371/journal.pone.0261377] [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: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. Methods This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Results Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14–1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36–2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04–1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94–4.01), depression (AIRR = 1.93, 95% CI = 1.60–2.32), anxiety (AIRR = 1.84, 95% CI = 1.53–2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67–2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22–1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47–0.66). Conclusion Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.
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Affiliation(s)
- Olufunso M. Agbalajobi
- Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Theresa Gmelin
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Andrew M. Moon
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Wheytnie Alexandre
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Grace Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, United States of America
| | - Naudia Jonassaint
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail: ,
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Franchi C, Mandelli S, Fortino I, Nobili A. Antibiotic use and associated factors in adult outpatients from 2000 to 2019. Pharmacol Res Perspect 2021; 9:e00878. [PMID: 34664793 PMCID: PMC8524672 DOI: 10.1002/prp2.878] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of the study were to assess the changes in 19-years use of antibiotics (overall, by age, sex and geographical area) and of those classes deemed to be quality indicators for their consumption and to evaluate factors associated to antibiotic use. We analyzed drug prescription data collected in the administrative database of the Lombardy Region (Northern Italy) for outpatients aged 40+ years from 2000 to 2019. Logistic regression analyses were performed to evaluate the association between receiving at least one antibiotic prescription and year of observation, gender, age groups, area of residence, polypharmacy and hospitalizations in the index year. The prevalence of patients prescribed with antibiotics remained high from 2000 (33.8%) to 2019 (32.6%). Prevalence of use of second-line choice antibiotics (penicillin combinations with beta-lactamase inhibitors, third and fourth generation cephalosporins, macrolides) continued to increase, only fluoroquinolones decreased in 2019 (19%) comparing to 2018 (26%), at the time when the Italian Medicines Agency promulgated safety warnings. Females (OR 1.28, 95%CI 1.27-1.28), people living in Brescia (OR 1.24, 95%CI 1.24-1.25), those exposed to polypharmacy (OR 2.57, 95%CI 2.56-2.57) and those hospitalized 1 to 3 (OR 1.86, 95%CI 1.85-1.86) or more than 3 (OR 2.02, 95%CI 2.01-2.03) times a year had a statistically significant higher risk of receiving antibiotics. The high use of antibiotics over the study period further reinforces the need of impactful interventions, in order to improve the rational use of antibiotics and to reduce the risks of antimicrobial resistance. The differences outlined should be considered when monitoring and planning these interventions.
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Affiliation(s)
- Carlotta Franchi
- Department of Health Policy, Laboratory of Pharmacoepidemiology and Human NutritionIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanoItaly
| | - Sara Mandelli
- Department of Health Policy, Laboratory of Pharmacoepidemiology and Human NutritionIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanoItaly
| | | | - Alessandro Nobili
- Department of Health Policy, Laboratory of Pharmacoepidemiology and Human NutritionIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanoItaly
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Nomura K, Tarumi R, Yoshida K, Sado M, Suzuki T, Mimura M, Uchida H. Cancellation of outpatient appointments in patients with attention-deficit/hyperactivity disorder. PLoS One 2021; 16:e0260431. [PMID: 34797891 PMCID: PMC8604341 DOI: 10.1371/journal.pone.0260431] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Regular visit to psychiatric clinic is essential for successful treatment of any psychiatric condition including attention-deficit/hyperactivity disorder (AD/HD). However, cancellation of outpatient appointments in patients with AD/HD, which represents a significant medical loss, has not been systematically investigated to our knowledge. METHODS A systematic chart review was conducted for patients visiting the Shimada Ryoiku medical Center for Challenged Children in Japan at the age of ≤15 years from January to December 2013. The primary outcome measure was the cancellation rate, defined as the number of missed visits divided by the number of scheduled visits. The cancellation rates during 24 months after the first visit were compared between outpatients with AD/HD and other psychiatric disorders, including pervasive developmental disorders (PDD), and developmental coordination disorders and/or communication disorders (DCD-CD). A generalized linear model with binomial distribution was used to examine factors associated with cancellation rates exclusively in the AD/HD group. RESULTS We included 589 patients (mean ± SD age, 5.6 ± 3.4 years; 432 males) in the analysis. The cancellation rate in patients with AD/HD was 12.3% (95% confidence interval [CI]: 10.0-15.1), which was significantly higher than in those with PDD (5.6%, 95% CI: 3.8-8.3) and DCD-CD (5.3%, 95% CI: 3.6-7.8). Prescriptions of osmotic-release oral system-methylphenidate (OROS-MPH) and antipsychotics were associated with fewer cancellations in AD/HD patients (odds ratios: 0.61, 95% CI: 0.39-0.95 and 0.49, 95% CI: 0.25-0.95, respectively), although these significances did not find in the subgroup analysis including only patients with ≥ 6 years old. CONCLUSIONS Patients with AD/HD were more likely to miss appointments compared to those with other psychiatric disorders. The impact of AD/HD medications as well as potential psychiatric symptoms of their parents or caregivers on appointment cancellations needs to be evaluated in more detail in future investigations.
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Affiliation(s)
- Kensuke Nomura
- Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan
| | - Ryosuke Tarumi
- Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
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Amboko B, Stepniewska K, Malla L, Machini B, Bejon P, Snow RW, Zurovac D. Determinants of improvement trends in health workers' compliance with outpatient malaria case-management guidelines at health facilities with available "test and treat" commodities in Kenya. PLoS One 2021; 16:e0259020. [PMID: 34739519 PMCID: PMC8570506 DOI: 10.1371/journal.pone.0259020] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health workers' compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. METHODS Data from 11 national, cross-sectional health facility surveys undertaken from 2010-2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). RESULTS Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite "test and treat" performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the "test and treat" policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers' gender, correct health workers' knowledge about the targeted malaria treatment policy, and patients' main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. CONCLUSIONS Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers' knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.
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Affiliation(s)
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Beatrice Machini
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dejan Zurovac
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Coleman A, Vohra Y, Rascati K, Kubes S, Moffett B. Antibiotic Utilization and Efficacy Associated With Treating Pediatric Urinary Tract Infections in Texas Medicaid Patients in the First Year of Life. Pediatr Infect Dis J 2021; 40:993-996. [PMID: 34321440 DOI: 10.1097/inf.0000000000003272] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Historically, amoxicillin (Amoxil) has been used as a first-line agent to treat pediatric urinary tract infections (UTIs). However, emerging antibiotic resistance in urinary pathogens has led to broader treatment options, such as cefdinir (Omnicef). This shift in prescribing practices is predicted to vary among place of service and gender due to differing institutional protocols and antimicrobial stewardship practices. OBJECTIVE This study aimed to describe the antibiotic utilization patterns associated with treating pediatric UTIs in Texas Medicaid patients and to assess the real-world efficacy of the antibiotics that were prescribed. METHODS Texas Medicaid prescription and medical claims data for patients under 1 year of age were included in the analysis if they presented with a UTI to the healthcare practitioner’s office or the emergency department (ED) and were treated with an outpatient antibiotic. Treatment efficacy was assessed by whether a patient received a second (different) antibiotic within 7 days of their initial antibiotic fill. RESULTS A total of 12,795 visits met inclusion criteria; 12,561 visits included prescriptions for the top 4 antibiotics prescribed: cefdinir (50%), amoxicillin (25%), cephalexin (Keflex; 13%), and amoxicillin-clavulanate (Augmentin; 12%). Cefdinir utilization predominated in both places of service [office (50%) and ED (55%)], and gender [males (47%) and females (52%)]. Controlling for gender and place of service, initial treatment with amoxicillin when compared with cefdinir (OR = 2.54; 95% confidence intervals: 1.84–3.54; P < 0.001) was associated with a greater rate of treatment failure. CONCLUSIONS In this study of Texas Medicaid patients, the widespread utilization of cefdinir may be appropriate for the empiric treatment of uncomplicated UTIs because of its low rate of treatment failure compared to other commonly used antibiotics.
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Affiliation(s)
- Alana Coleman
- From the College of Pharmacy, The University of Texas at Austin, Austin, TX
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Yogesh Vohra
- From the College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Karen Rascati
- From the College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Sarah Kubes
- From the College of Pharmacy, The University of Texas at Austin, Austin, TX
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
- University Health System, San Antonio, TX
| | - Brady Moffett
- Texas Children's Hospital, Houston, TX
- Baylor College of Medicine, Houston, TX
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20
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Zhu W, Wei X, Zhang L, Shi Q, Shi G, Zhang X, Wang M, Yin C, Kang F, Bai Y, Nie Y, Zheng S. The effect and prediction of diurnal temperature range in high altitude area on outpatient and emergency room admissions for cardiovascular diseases. Int Arch Occup Environ Health 2021; 94:1783-1795. [PMID: 33900441 DOI: 10.1007/s00420-021-01699-7] [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] [Received: 11/24/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Diurnal temperature range (DTR) is a meteorological indicator closely associated with global climate change. Thus, we aim to explore the effects of DTR on the outpatient and emergency room (O&ER) admissions for cardiovascular diseases (CVDs), and related predictive research. METHODS The O&ER admissions data for CVDs from three general hospitals in Jinchang of Gansu Province were collected from 2013 to 2016. A generalized additive model (GAM) with Poisson regression was employed to analyze the effect of DTR on the O&ER admissions for all cardiovascular diseases, hypertension, ischemic heart disease (IHD) and stoke. GAM was also used to preform predictive research of the effect of DTR on the O&ER admissions for CVDs. RESULTS There were similar positive linear relationships between DTR and the O&ER visits with the four cardiovascular diseases. And the cumulative lag effects were higher than the single lag effects. A 1 °C increase in DTR corresponded to a 1.30% (0.99-1.62%) increase in O&ER admissions for all cardiovascular diseases. Males and elderly were more sensitivity to DTR. The estimates in non-heating season were higher than in heating season. The trial prediction accuracy rate of CVDs based on DTR was between 59.32 and 74.40%. CONCLUSIONS DTR has significantly positive association with O&ER admissions for CVDs, which can be used as a prediction index of the admissions of O&ER with CVDs.
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Affiliation(s)
- Wenzhi Zhu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xingfu Wei
- Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, 730000, China
| | - Li Zhang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Qin Shi
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Guoxiu Shi
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xiaofei Zhang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Minzhen Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Chun Yin
- Workers' Hospital of Jinchuan Group Co., Ltd., Jinchang, 737102, China
| | - Feng Kang
- Workers' Hospital of Jinchuan Group Co., Ltd., Jinchang, 737102, China
| | - Yana Bai
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yonghong Nie
- Jinchang Center for Disease Prevention and Control, Jinchang, 737100, China.
| | - Shan Zheng
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
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21
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O'Neill B, Kalia S, Gill P, Hum S, Moran-Venegas C, Stoller R, Greiver M, Agarwal P, Kirubarajan A, DeKoven S, Eisen D, Pinto A, Dunn S. Association between new-onset anosmia and positive SARS-CoV-2 tests among people accessing outpatient testing in Toronto, Ontario: a retrospective cross-sectional study. CMAJ Open 2021; 9:E1134-E1140. [PMID: 34876415 PMCID: PMC8673484 DOI: 10.9778/cmajo.20210085] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Reports have suggested that anosmia is strongly associated with SARS-CoV-2 infection, but patients were often asked about this symptom after their diagnosis. This study assessed associations between prospectively reported anosmia and other symptoms related to SARS-CoV-2 infection, and SARS-CoV-2 positivity in community testing centres in Toronto, Ontario. METHODS We conducted a retrospective cross-sectional study in which data were collected from 2 COVID-19 assessment centres affiliated with 2 hospitals in Toronto, Ontario, from Apr. 5 to Sept. 30, 2020. We included symptomatic profiles of all people who underwent a SARS-CoV-2 test at either clinic within the study period. We used generalized estimating equations to account for repeat visits and to assess associations between anosmia and other symptoms and SARS-CoV-2 positivity. RESULTS A total of 83 443 SARS-CoV-2 tests were conducted across the 2 sites for 72 692 participants during the study period. Of all tests, 1640 (2.0%) were positive; 837 (51.0%) of people who tested positive were asymptomatic. The adjusted odds ratio for the association between anosmia and test positivity was 5.29 (95% confidence interval [CI] 4.50-6.22), with sensitivity of 0.138 (95% CI 0.121-0.154), specificity of 0.980 (95% CI 0.979-0.981), a positive predictive value of 0.120 (95% CI 0.106-0.135) and a negative predictive value of 0.983 (95% CI 0.982-0.984). INTERPRETATION Anosmia had high specificity and a positive predictive value of 12% for SARS-CoV-2 infection in this community population with low prevalence of SARS-CoV-2 positivity. The presence of anosmia should increase clinical suspicion of SARS-CoV-2 infection, and our findings suggest that people presenting with this symptom should be tested.
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Affiliation(s)
- Braden O'Neill
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Sumeet Kalia
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Peter Gill
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Susan Hum
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Carla Moran-Venegas
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Rebecca Stoller
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Michelle Greiver
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Payal Agarwal
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Abirami Kirubarajan
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Samuel DeKoven
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - David Eisen
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Andrew Pinto
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sheila Dunn
- MAP Centre for Urban Health Solutions (O'Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O'Neill, Pinto), St. Michael's Hospital, Unity Health; Department of Family and Community Medicine (O'Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women's College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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22
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Golabi S, Adelipour M, Mobarak S, Piri M, Seyedtabib M, Bagheri R, Suzuki K, Ashtary-Larky D, Maghsoudi F, Naghashpour M. The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study. Nutrients 2021; 13:nu13103368. [PMID: 34684369 PMCID: PMC8537338 DOI: 10.3390/nu13103368] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Vitamin D and zinc are important components of nutritional immunity. This study compared the serum concentrations of 25-hydroxyvitamin D (25(OH)D) and zinc in COVID-19 outpatients with those of potentially non-infected participants. The association of clinical symptoms with vitamin D and zinc status was also examined. A checklist and laboratory examination were applied to collect data in a cross-sectional study conducted on 53 infected outpatients with COVID-19 and 53 potentially non-infected participants. Serum concentration of 25(OH)D were not significantly lower in patients with moderate illness (19 ± 12 ng/mL) than patients with asymptomatic or mild illness (29 ± 18 ng/mL), with a trend noted for a lower serum concentration of 25(OH)D in moderate than asymptomatic or mild illness patients (p = 0.054). Infected patients (101 ± 18 µg/dL) showed a lower serum concentration of zinc than potentially non-infected participants (114 ± 13 µg/dL) (p = 0.01). Patients with normal (odds ratio (OR), 0.19; p ≤ 0.001) and insufficient (OR, 0.3; p = 0.007) vitamin D status at the second to seventh days of disease had decreased OR of general symptoms compared to patients with vitamin D deficiency. This study revealed the importance of 25(OH)D measurement to predict the progression of general and pulmonary symptoms and showed that infected patients had significantly lower zinc concentrations than potentially non-infected participants.
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Affiliation(s)
- Sahar Golabi
- Department of Medical Physiology, School of Medicine, Abadan University of Medical Sciences, Abadan 6313833177, Iran;
| | - Maryam Adelipour
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran;
| | - Sara Mobarak
- Department of Infectious Diseases, School of Medicine, Abadan University of Medical Sciences, Abadan 6313833177, Iran;
| | - Maghsud Piri
- Vice Chancellor for Health, Abadan University of Medical Sciences, Abadan 6313833177, Iran;
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran;
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan 8174673441, Iran;
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa 359-1192, Japan;
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran;
| | - Fatemeh Maghsoudi
- Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan 6313833177, Iran;
| | - Mahshid Naghashpour
- Department of Nutrition, School of Medicine, Abadan University of Medical Sciences, Abadan 6313833177, Iran
- Correspondence: ; Tel.: +98-9166157338
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23
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Nguyen MH, Pham TTM, Vu DN, Do BN, Nguyen HC, Duong TH, Pham KM, Pham LV, Nguyen TTP, Tran CQ, Nguyen QH, Hoang TM, Tran KV, Duong TT, Yang SH, Bai CH, Duong TV. Single and Combinative Impacts of Healthy Eating Behavior and Physical Activity on COVID-19-like Symptoms among Outpatients: A Multi-Hospital and Health Center Survey. Nutrients 2021; 13:nu13093258. [PMID: 34579134 PMCID: PMC8465237 DOI: 10.3390/nu13093258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Healthy eating and physical activity are effective non-pharmacological approaches to boost immune function and contain the pandemic. We aimed to explore the associations and interactions between physical activity and healthy eating behavior with COVID-19-like symptoms (Slike-CV19S). Methods: A cross-sectional study was conducted on 3947 outpatients, from 14 February to 2 March 2020, at nine health facilities in Vietnam. Data collection included sociodemographic characteristics, healthy eating behavior (using the healthy eating score (HES) questionnaire), physical activity (using the short form international physical activity questionnaire), and Slike-CV19S. The associations and interactions were tested using logistic regression models. Results: Frequent intake of fruits (OR = 0.84; p = 0.016), vegetables (OR = 0.72; p = 0.036), and fish (OR = 0.43; p < 0.001) were associated with a lower Slike-CV19S likelihood, as compared with infrequent intake. Patients with higher HES levels (OR = 0.84; p = 0.033 for medium HES; OR = 0.77; p = 0.006 for high HES) or being physically active (OR = 0.69; p < 0.001) had a lower Slike-CV19S likelihood, as compared to those with low HES or physical inactivity, respectively. Patients with medium HES who were physically active (OR = 0.69; p = 0.005), or with high HES and physically active (OR = 0.58; p < 0.001), had a lower Slike-CV19S likelihood, as compared to those with low HES and physical inactivity. Conclusions: Healthy eating behavior and physical activity showed single and combinative impacts on protecting people from Slike-CV19S. Strategic approaches are encouraged to improve healthy behaviors, which may further contribute to containing the pandemic.
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Affiliation(s)
- Minh H. Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (T.T.M.P.); (K.M.P.)
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Dinh N. Vu
- Director Office, Military Hospital 103, Hanoi 121-08, Vietnam;
- Department of Trauma and Orthopedic Surgery, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam;
- Division of Military Science, Military Hospital 103, Hanoi 121-08, Vietnam
| | - Hoang C. Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (T.H.D.)
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Thai H. Duong
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (T.H.D.)
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (T.T.M.P.); (K.M.P.)
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Linh V. Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam;
- Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam
| | - Thao T. P. Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue 491-20, Vietnam;
| | - Cuong Q. Tran
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam;
- Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
| | - Quyen H. Nguyen
- Department of Anesthesiology, Thu Duc City Hospital, Ho Chi Minh City 713-11, Vietnam; (Q.H.N.); (T.M.H.)
| | - Thanh M. Hoang
- Department of Anesthesiology, Thu Duc City Hospital, Ho Chi Minh City 713-11, Vietnam; (Q.H.N.); (T.M.H.)
| | - Khanh V. Tran
- Director Office, Le Van Thinh Hospital (Previously Hospital District 2), Ho Chi Minh City 711-13, Vietnam;
| | - Trang T. Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City 720-16, Vietnam;
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan;
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
| | - Chyi-Huey Bai
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- Correspondence: (C.-H.B.); (T.V.D.)
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan;
- Correspondence: (C.-H.B.); (T.V.D.)
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24
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Mälberg J, Hadziosmanovic N, Smekal D. Physiological respiratory parameters in pre-hospital patients with suspected COVID-19: A prospective cohort study. PLoS One 2021; 16:e0257018. [PMID: 34473782 PMCID: PMC8412304 DOI: 10.1371/journal.pone.0257018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023] Open
Abstract
Background The COVID-19 pandemic has presented emergency medical services (EMS) worldwide with the difficult task of identifying patients with COVID-19 and predicting the severity of their illness. The aim of this study was to investigate whether physiological respiratory parameters in pre-hospital patients with COVID-19 differed from those without COVID-19 and if they could be used to aid EMS personnel in the prediction of illness severity. Methods Patients with suspected COVID-19 were included by EMS personnel in Uppsala, Sweden. A portable respiratory monitor based on pneumotachography was used to sample the included patient’s physiological respiratory parameters. A questionnaire with information about present symptoms and background data was completed. COVID-19 diagnoses and hospital admissions were gathered from the electronic medical record system. The physiological respiratory parameters of patients with and without COVID-19 were then analyzed using descriptive statistical analysis and logistic regression. Results Between May 2020 and January 2021, 95 patients were included, and their physiological respiratory parameters analyzed. Of these patients, 53 had COVID-19. Using adjusted logistic regression, the odds of having COVID-19 increased with respiratory rate (95% CI 1.000–1.118), tidal volume (95% CI 0.996–0.999) and negative inspiratory pressure (95% CI 1.017–1.152). Patients admitted to hospital had higher respiratory rates (p<0.001) and lower tidal volume (p = 0.010) compared to the patients who were not admitted. Using adjusted logistic regression, the odds of hospital admission increased with respiratory rate (95% CI 1.081–1.324), rapid shallow breathing index (95% CI 1.006–1.040) and dead space percentage of tidal volume (95% CI 1.027–1.159). Conclusion Patients taking smaller, faster breaths with less pressure had higher odds of having COVID-19 in this study. Smaller, faster breaths and higher dead space percentage also increased the odds of hospital admission. Physiological respiratory parameters could be a useful tool in detecting COVID-19 and predicting hospital admissions, although more research is needed.
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Affiliation(s)
- Johan Mälberg
- Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Center for Prehospital Research, Uppsala University Hospital, Uppsala, Sweden
- Uppsala Emergency Medical Service, Uppsala University Hospital, Uppsala, Sweden
- * E-mail:
| | | | - David Smekal
- Department of Surgical Sciences-Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Center for Prehospital Research, Uppsala University Hospital, Uppsala, Sweden
- Uppsala Emergency Medical Service, Uppsala University Hospital, Uppsala, Sweden
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Teigell Muñoz FJ, García-Guijarro E, García-Domingo P, Pérez-Nieto G, Roque Rojas F, García-Peña M, Nieto Gallo MA, Melero Bermejo JA, de Guzman García-Monge MT, Granizo JJ. A safe protocol to identify low-risk patients with COVID-19 pneumonia for outpatient management. Intern Emerg Med 2021; 16:1663-1671. [PMID: 33620681 PMCID: PMC7900647 DOI: 10.1007/s11739-021-02660-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/01/2021] [Indexed: 10/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has made it necessary to rationalize health-care resources, but there is little published data at this moment regarding ambulatory management of patients with COVID-19 pneumonia. The objective of the study is to evaluate the performance of a protocol for ambulatory management of patients with COVID-19 pneumonia regarding readmissions, admission into the Intensive Care Unit (ICU) and deaths. Also, to identify unfavorable prognostic factors that increase the risk of readmission. This is a prospective cohort study of patients with COVID-19 pneumonia discharged from the emergency ward of Infanta Cristina Hospital (Madrid, Spain) that met the criteria of the hospital protocol for outpatient management. We describe outcomes of those patients and compare those who needed readmission versus those who did not. We use logistic regression to explore factors associated with readmissions. A total of 314 patients were included, of which 20 (6.4%) needed readmission, and none needed ICU admission nor died. At least one comorbidity was present in 29.9% of patients. Hypertension, leukopenia, lymphocytopenia, increased lactate dehydrogenase (LDH) and increased aminotransferases were all associated with a higher risk of readmission. A clinical course of 10 days or longer, and an absolute eosinophil count over 200/µL were associated with a lower risk. After the multivariate analysis, only hypertension (OR 4.99, CI 1.54-16.02), temperature over 38 °C in the emergency ward (OR 9.03, CI 1.89-45.77), leukopenia (OR 4.92, CI 1.42-17.11) and increased LDH (OR 6.62, CI 2.82-19.26) remained significantly associated with readmission. Outpatient management of patients with low-risk COVID-19 pneumonia is safe, if adequately selected. The protocol presented here has allowed avoiding 30% of the admissions for COVID-19 pneumonia in our hospital, with a very low readmission rate and no mortality.
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Affiliation(s)
- Francisco Javier Teigell Muñoz
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain.
- Department of Medicine, Complutense University, Madrid, Spain.
| | - Elena García-Guijarro
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Paula García-Domingo
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Guadalupe Pérez-Nieto
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Fernando Roque Rojas
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - María García-Peña
- Department of Pathology, Infanta Cristina University Hospital, Madrid, Spain
| | | | - José Antonio Melero Bermejo
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - María Teresa de Guzman García-Monge
- Department of Emergency Medicine and Internal Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Juan José Granizo
- Preventive Medicine Unit, Infanta Cristina University Hospital, Madrid, Spain
- Institute of Investigations Puerta de Hierro-Segovia de Arana, Madrid, Spain
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White HD, O’Brien SM, Alexander KP, Boden WE, Bangalore S, Li J, Manjunath CN, Lopez-Sendon JL, Peteiro J, Gosselin G, Berger JS, Maggioni AP, Reynolds HR, Hochman JS, Maron DJ. Comparison of Days Alive Out of Hospital With Initial Invasive vs Conservative Management: A Prespecified Analysis of the ISCHEMIA Trial. JAMA Cardiol 2021; 6:1023-1031. [PMID: 33938917 PMCID: PMC8094032 DOI: 10.1001/jamacardio.2021.1651] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/29/2022]
Abstract
Importance Traditional time-to-event analyses rate events occurring early as more important than later events, even if later events are more severe, eg, death. Days alive out of hospital (DAOH) adds a patient-focused perspective beyond trial end points. Objective To compare DAOH between invasive management and conservative management, including invasive protocol-assigned stays, in the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) randomized clinical trial. Design, Setting, and Participants In this prespecified analysis of the ISCHEMIA trial, DAOH was compared between 5179 patients with stable coronary disease and moderate or severe ischemia randomized to invasive management or conservative management. Participants were recruited from 320 sites in 37 countries. Stays included overnight stays in hospital or extended care facility (skilled nursing facility, rehabilitation, or nursing home). DAOH was separately analyzed excluding invasive protocol-assigned procedures. Data were collected from July 2012 to June 2019, and data were analyzed from July 2020 to April 2021. Interventions Invasive management with angiography and revascularization if feasible or conservative management, with both groups receiving optimal medical therapy. Main Outcomes and Measures The hypothesis was formulated before data lock in July 2020. The primary end point was mean DAOH per patient between randomization and 4 years. Initial stays for invasive protocol-assigned procedures were prespecified to be excluded. Results Of 5179 included patients, 1168 (22.6%) were female, and the median (interquartile range) age was 64 (58-70) years. The average DAOH was higher in the conservative management group compared with the invasive management group at 1 month (30.8 vs 28.4 days; P < .001), 1 year (362.2 vs 355.9 days; P < .001), and 2 years (718.4 vs 712.1 days; P = .001). At 4 years, the 2 groups' DAOH were not significantly different (1415.0 vs 1412.2 days; P = .65). In the invasive management group, 2434 of 4002 stays (60.8%) were for protocol-assigned procedures. There were no clear differences at any time point in DAOH when protocol-assigned procedures were excluded from the invasive management group. There were more hospital and extended care stays in the invasive management vs conservative management group during follow-up (4002 vs 1897; P < .001). Excluding protocol-assigned procedures, there were fewer stays in the invasive vs conservative group (1568 vs 1897; P = .001). Cardiovascular stays following the initial assigned procedures were lower in the invasive management group (685 of 4002 [17.1%] vs 1095 of 1897 [57.8%]; P < .001) due to decreased spontaneous myocardial infarction stays (65 [1.6%] vs 123 [6.5%]; P < .001) and unstable angina stays (119 [3.0%] vs 216 [11.4%]; P < .001). Conclusions and Relevance DAOH was higher for patients in the conservative management group in the first 2 years but not different at 4 years. DAOH was decreased early in the invasive management group due to protocol-assigned procedures. Hospital stays for myocardial infarction and unstable angina during follow-up were lower in the invasive management group. DAOH provides a patient-focused metric that can be used by clinicians and patients in shared decision-making for management of stable coronary artery disease. Trial Registration ClinicalTrials.gov Identifier: NCT01471522.
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Affiliation(s)
- Harvey D. White
- Green Lane Cardiovascular Services, Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - Sean M. O’Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - William E. Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, Massachusetts
| | | | - Jianghao Li
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Jose Luis Lopez-Sendon
- Hospital Universitario La Paz, Idipaz, Universidad Autonoma de Madrid, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jesus Peteiro
- Hospital Universitario A Coruña, Universidad de A Coruña, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), A Coruña, Spain
| | | | | | | | | | | | - David J. Maron
- Department of Medicine, Stanford University, Stanford, California
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Johnson DM, Junarta J, Gerace C, Frisch DR. Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits. Am J Cardiol 2021; 153:125-128. [PMID: 34229856 DOI: 10.1016/j.amjcard.2021.05.027] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/15/2022]
Abstract
Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device. Mobile technology is available for heart rhythm monitoring and can give feedback to the user. This study showed a reduction of in-person, healthcare utilization with mECG device use. In conclusion, this strategy would be expected to decrease the risk of exposure to patients and providers and would avoid overwhelming emergency and inpatient services.
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Affiliation(s)
- Drew M Johnson
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA.
| | - Joey Junarta
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
| | - Christopher Gerace
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Daniel R Frisch
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
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Getie Mekonnen E, Yeshita HY, Bishaw Geremew A. Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors. PLoS One 2021; 16:e0256015. [PMID: 34379695 PMCID: PMC8357135 DOI: 10.1371/journal.pone.0256015] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/28/2021] [Indexed: 01/23/2023] Open
Abstract
Background Sexual dysfunction is the commonest reproductive health problem observed among men with diabetes mellitus affecting their quality of life. Previous studies conducted in this area were concentrated on the specific domains of sexual dysfunction, and factors were not well-addressed. Therefore, this study was aimed to determine the prevalence of all forms of sexual dysfunction and to identify its associated factors among diabetic men patients attending at the three hospitals of the Amhara region, Ethiopia. Method An institutional-based cross-sectional study was conducted involving 462 men diabetic patients at the three hospitals of the northwest Amhara region. A systemic random sampling technique was employed. A face-to-face interviewer-administered change in the sexual functioning questionnaire was used to collect the required data from the 20th of February to the 15th of April 2020. The binary logistic regression was employed and a multivariable logistic regressions model was used to control the effect of confounders. Variables that had an independent correlation with the sexual dysfunction were identified based on a p-value≤ 0.05. Likewise, the direction and strength of association were interpreted using Adjusted Odds Ratio (AOR) with its corresponding 95% CI. Results The prevalence of sexual dysfunction was found to be 69.5% (95%CI: (65.1–73.9)). The magnitude of sexual dysfunction was prevalently observed among participants who were older (> 50 years) (AOR = 8.7, 95%CI: (3.3–23.1)). Likewise, the odds of sexual dysfunction was significantly higher among men who have lived with diabetes for a longer duration (AOR = 10.8, 95%CI: (5.3–21.9)), with poor metabolic control (AOR = 3.57, 95%CI: (1.81–7.05)), with comorbid illnesses (AOR = 5.07, 95%CI: (2.16–11.9)), and diabetic-related complications (AOR = 3.01, 95%CI: 1.31–6.92). On the other hand, participants who were physically active (AOR = 0.41, 95%CI: (0.12–0.7)) and satisfied with their relationship (AOR = 0.15, 95%CI: (0.03–0.7)) showed a lesser risk of experiencing sexual dysfunction. Conclusion Well over two-thirds of men with diabetes mellitus have experienced sexual dysfunction, implying a public health pressing problem. Older age, lack of physical activity, living longer duration with diabetes, having diabetic complications, experiencing co-morbid illnesses, being unsatisfied with couple relationship, and poor metabolic control increased the risk of developing SD. Therefore, promoting physical exercise, preventing co-morbid illnesses, and couples counseling to build up a good couple relationship are recommended to promote the sexual and reproductive health of men with diabetes.
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Affiliation(s)
- Eskedar Getie Mekonnen
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Hedija Yenus Yeshita
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alehegn Bishaw Geremew
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ceccato F, Voltan G, Sabbadin C, Camozzi V, Merante Boschin I, Mian C, Zanotto V, Donato D, Bordignon G, Capizzi A, Carretta G, Scaroni C. Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period. J Endocrinol Invest 2021; 44:1689-1698. [PMID: 33355915 PMCID: PMC7757080 DOI: 10.1007/s40618-020-01476-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit. OBJECTIVE We have developed and applied an emergency plan, tailored for Outpatients with endocrine diseases. DESIGN Cross-sectional study from March to May 2020. SETTING Referral University-Hospital center. PATIENTS 1262 patients in 8 weeks. INTERVENTIONS The emergency plan is based upon the endocrine triage, the stay-safe procedures and the tele-Endo. During endocrine triage every patient was contacted by phone to assess health status and define if the visit will be performed face-to-face (F2F) or by tele-Medicine (tele-Endo). In case of F2F, targeted stay-safe procedures have been adopted. Tele-Endo, performed by phone and email, is dedicated to COVID-19-infected patients, to elderly or frail people, or to those with a stable disease. MAIN OUTCOME MEASURE To assess efficacy of the emergency plan to continue the follow-up of Outpatients. RESULTS The number of visits cancelled after endocrine triage (9%) is lower than that cancelled independently by the patients (37%, p < 0.001); the latter reduced from 47 to 19% during the weeks of lockdown (p = 0.032). 86% of patients contacted by endocrine-triage received a clinical response (F2F and tele-Endo visits). F2F visit was offered especially to young patients; tele-Endo was applied to 63% of geriatric patients (p < 0.001), visits' outcome was similar between young and aged patients. CONCLUSIONS The emergency plan respects the WHO recommendations to limit viral spread and is useful to continue follow-up for outpatients with endocrine diseases.
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Affiliation(s)
- F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy.
- Department of Neuroscience DNS, University of Padova, Padova, Italy.
| | - G Voltan
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - C Sabbadin
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - V Camozzi
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - I Merante Boschin
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
- Department of Surgical Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Padova, Italy
| | - C Mian
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - V Zanotto
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - D Donato
- Department of Directional Hospital Management, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Padova, Italy
| | - G Bordignon
- Department of Directional Hospital Management, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Padova, Italy
| | - A Capizzi
- Department of Directional Hospital Management, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Padova, Italy
| | - G Carretta
- Department of Directional Hospital Management, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Padova, Italy
| | - C Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, European Reference Network On Rare Endocrine Conditions (endoERN) Center of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
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Bongiovanni T, Parzynski C, Ranasinghe I, Steinman MA, Ross JS. Unplanned hospital visits after ambulatory surgical care. PLoS One 2021; 16:e0254039. [PMID: 34283840 PMCID: PMC8291649 DOI: 10.1371/journal.pone.0254039] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives We sought to assess the rate of unplanned hospital visits among patients undergoing ambulatory surgery. Summary background data The majority of surgeries performed in the United States now take place in outpatient settings. Post-discharge hospital visit rates have been shown to vary widely, suggesting variation in surgical or discharge care quality. Complicating efforts to address quality, most facilities and surgeons are unaware of their patients’ hospital visits after surgery since patients may present to a different hospital. Methods We used state-level, administrative data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project from California to assess unplanned hospital visits after ambulatory surgery. To compare rates across centers, we determined the age, sex, and procedure-adjusted rates of hospital visits for each facility using 2-level, hierarchical, generalized linear models using methods similar to existing Centers for Medicare and Medicaid Services measures. Results Among a total of 1,260,619 ambulatory same-day surgeries from 440 surgical facilities, the risk adjusted 30-day rate of unplanned hospital visits was 4.8%, with emergency department visits of 3.1% and hospital admissions of 1.7%. Several patient characteristics were associated with increased risk of unplanned hospitals visits, including increased age, increased number of comorbidities (using the Elixhauser score), and type of procedure (p<0.001). Conclusions The overall rate unplanned hospital visits within 30 days after same-day surgery is low but variable, suggesting a difference in the quality of care provided. Further, these rates are higher among specific patient populations and procedure types, suggesting areas for targeted improvement.
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Affiliation(s)
- Tasce Bongiovanni
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, United States of America
- * E-mail:
| | - Craig Parzynski
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut, United States of America
| | - Isuru Ranasinghe
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Michael A. Steinman
- Division of Geriatrics, University of California San Francisco School of Medicine and San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut, United States of America
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, United States of America
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Abstract
Outpatient total shoulder arthroplasty (TSA) is an alternative to surgery with inpatient admission for appropriate patients. Controlled studies assessing differences in perioperative outcomes between inpatient and outpatient TSA are lacking. In this study, the primary outcome was 30-day all-cause hospital readmission following inpatient vs outpatient TSA. The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing both primary and revision TSA from 2010 to 2017. Patients were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was used to create two groups of patients, those who underwent outpatient surgery and those who underwent inpatient surgery, while matching for age, sex, American Society of Anesthesiologists classification, primary vs revision surgery, smoking, diabetes, chronic obstructive pulmonary disease, and congestive heart failure. This study had a power of 85% to detect a difference of 1% in 30-day readmission. Following 1:1 propensity score matching, 1714 patients who underwent inpatient TSA and 1714 patients who underwent outpatient TSA were analyzed. All-cause 30-day readmission rates were 3.4% in the outpatient group and 1.7% in the inpatient group (P<.01). A total of 1.9% of patients who underwent outpatient surgery had a 30-day readmission for a surgical complication compared with 1.4% of patients who underwent inpatient surgery (P=.32). Although patients who underwent outpatient TSA had an increased risk of all-cause 30-day readmission compared with equally matched controls who underwent inpatient TSA, readmission for surgical complications was equivalent between the two groups. Careful patient selection for outpatient TSA should be emphasized to minimize the potential for postoperative hospital admission. [Orthopedics. 2021;44(2):e173-e178.].
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Reidy-Lagunes D, Saltz L, Postow ,M, Scordo ,M, Moskowitz A, Tew W, Zamarin D, Redelman-Sidi G. Recommendations for Testing and Treating Outpatient Cancer Patients in the Era of COVID-19. J Natl Cancer Inst 2021; 113:820-822. [PMID: 32797188 PMCID: PMC7454724 DOI: 10.1093/jnci/djaa111] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023] Open
Abstract
The clinical spectrum of coronavirus disease 2019 (COVID-19) is still not fully understood. Cancer patients are uniquely vulnerable to COVID-19, and many have been or will be infected. Although an unfortunate minority will die from the infection, most will recover. This poses a challenge in which clinicians must weigh the benefits of initiation or resumption of antineoplastic therapy against the risks that antineoplastic treatment may worsen outcomes related to COVID-19 infection. A recent study of 423 patients at our institution found that patients in active cancer treatment who develop COVID-19 infection did not fare any worse than other hospitalized patients, yet guidance as to who requires testing prior to antineoplastic therapy and when to resume therapy post-COVID-19 diagnosis remains unknown. Our institution, therefore, commissioned a task force to help create guidelines for treating oncologists using available published literature. The task force focused on the ambulatory care testing guidelines only, because all inpatients receiving antineoplastic therapy are tested for COVID-19 prior to hospital admission. The guidelines focus solely on the safety and well-being of the individual patient undergoing antineoplastic therapy and are not designed to address infection control issues.
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Affiliation(s)
- Diane Reidy-Lagunes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - , Michael Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - , Michael Scordo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dmitriy Zamarin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gil Redelman-Sidi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Barbar R, Hayden R, Sun Y, Tang L, Hakim H. Epidemiologic and Clinical Characteristics of Clostridioides difficile Infections in Hospitalized and Outpatient Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients. Pediatr Infect Dis J 2021; 40:655-662. [PMID: 34097657 DOI: 10.1097/inf.0000000000003126] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology and clinical course of Clostridioides difficile infection (CDI) in children, especially with cancer, are poorly defined. We aim to describe the epidemiology, clinical features and outcomes of CDI and to identify risk factors for recurrence in a pediatric oncology center. METHODS This is a retrospective cohort study of CDI in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients in 2016 and 2017. CDI cases were identified by positive C. difficile test in symptomatic patients. CDI episodes were classified as incident, duplicate or recurrent and community-onset, hospital-onset or community-onset healthcare facility-associated. Data about clinical course and outcomes were abstracted. Risk factors for CDI recurrence were assessed by logistic regression. RESULTS One hundred seventy-eight patients 1 year of age and older developed 291 CDI episodes; 78% were incident and 22% recurrent. Underlying diagnoses were leukemia/lymphoma (57%) and solid/brain tumors (41%); 30% were HSCT recipients. Antibiotics, chemotherapy, antacids, steroids and laxatives were received by 96%, 82%, 70%, 47% and 15%, respectively. Half of the patients were neutropenic. Twenty-two percent of outpatients with CDI required hospitalization. Chemotherapy was delayed in 25%. There were no intensive care unit admissions nor deaths due to CDI. Exposure to H2-antagonists was identified as an independent risk factor for CDI recurrence. CONCLUSIONS Although CDI in pediatric oncology and HSCT patients was associated with chemotherapy delay and hospitalization in approximately a quarter of patients, it was not associated with morbidity or mortality because patients had no attributable intensive care unit admission nor death. H2-antagonists are independent risk factors for CDI recurrence.
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Affiliation(s)
| | | | - Yilun Sun
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hana Hakim
- From the Department of Infectious Diseases
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Abstract
IMPORTANCE There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy. OBJECTIVE To measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at Oregon Health & Science University, a large academic medical center. Participants included clinicians and staff who wrote outpatient progress notes between 2009 and 2018 for a random sample of 200 000 patients. Statistical analysis was performed from March to August 2020. EXPOSURES Use of a comprehensive electronic health record to document patient care. MAIN OUTCOMES AND MEASURES Note length, note redundancy (ie, the proportion of text identical to the patient's last note), and percentage of templated, copied, or directly typed note text. RESULTS A total of 2 704 800 notes written by 6228 primary authors across 46 specialties were included in this study. Median note length increased 60.1% (99% CI, 46.7%-75.2%) from a median of 401 words (interquartile range [IQR], 225-660 words) in 2009 to 642 words (IQR, 399-1007 words) in 2018. Median note redundancy increased 10.9 percentage points (99% CI, 7.5-14.3 percentage points) from 47.9% in 2009 to 58.8% in 2018. Notes written in 2018 had a mean value of just 29.4% (99% CI, 28.2%-30.7%) directly typed text with the remaining 70.6% of text being templated or copied. Mixed-effect linear models found that notes with higher proportions of templated or copied text were significantly longer and more redundant (eg, in the 2-year model, each 1% increase in the proportion of copied or templated note text was associated with 1.5% [95% CI, 1.5%-1.5%] and 1.6% [95% CI, 1.6%-1.6%] increases in note length, respectively). Residents and fellows also wrote significantly (26.3% [95% CI, 25.8%-26.7%]) longer notes than more senior authors, as did more recent hires (1.8% for each year later [95% CI, 1.3%-2.4%]). CONCLUSIONS AND RELEVANCE In this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.
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Affiliation(s)
- Adam Rule
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Steven Bedrick
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Michelle R. Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Hamo CE, Abdelmoneim SS, Han SY, Chandy E, Muntean C, Khan SA, Sunkesula P, Meykler M, Ramachandran V, Rosenberg E, Klem I, Sacchi TJ, Heitner JF. OUTpatient intravenous LASix Trial in reducing hospitalization for acute decompensated heart failure (OUTLAST). PLoS One 2021; 16:e0253014. [PMID: 34170908 PMCID: PMC8232441 DOI: 10.1371/journal.pone.0253014] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. The current study aimed to investigate the feasibility, safety, and efficacy of outpatient furosemide intravenous (IV) infusion following hospitalization for ADHF. METHODS In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3h, biweekly for a one-month period following ADHF hospitalization. Patients in Groups 2/3 also received a comprehensive HF-care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment and education. Echocardiography, quality of life and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. RESULTS Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American). There were a total of 14 (15%) hospitalizations for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p = 0.11; p = 0.037 comparing Groups 2 and 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. CONCLUSION The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.
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Affiliation(s)
- Carine E. Hamo
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sahar S. Abdelmoneim
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Seol Young Han
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Elizabeth Chandy
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Cornelia Muntean
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Saadat A. Khan
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Prasanthi Sunkesula
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Marcella Meykler
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Vidhya Ramachandran
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Emelie Rosenberg
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Igor Klem
- The Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Terrence J. Sacchi
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - John F. Heitner
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
- * E-mail:
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Bhullar H, County B, Barnard S, Anderson A, Seddon ME. Reducing the MRI outpatient waiting list through a capacity and demand time series improvement programme. N Z Med J 2021; 134:27-35. [PMID: 34239159] [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 A capacity and demand improvement initiative commenced in January 2019 with the goal of reducing the growing outpatient waiting list for magnetic resonance imaging (MRI) at Counties Manukau District Health Board (CMDHB). Initial work showed that the capacity (MRI machines and staff) actually outstripped demand, which challenged pre-existing assumptions. This became the basis for interventions to improve efficiency in the department. Interventions undertaken can be split into three distinct categories: (1) matching capacity to demand, (2) waiting list segmentation and (3) redesigning operational systems. METHODS A capacity and demand time series during 2019 and 2020 was used as the basis for improving waiting list and operational systems. A combination of the Model for Improvement and Lean principles were used to embed operational improvements. Multiple small tests of change were implemented to various aspects of the MRI waiting list process. Staff engagement was central to the success of the quality improvement (QI) initiatives. The radiological information system (RIS) provided the bulk of the data, and this was supplemented with manual data collection. RESULTS The number of people waiting for an MRI scan decreased from 1,954 at the start of the project to 413 at its conclusion-an overall reduction of 75%. Moreover, the average waiting time reduced from 96.4 days to 23.1. Achieving the Ministry of Health's (MoH) Priority 2 (P2) target increased from 23% to 87.5%. CONCLUSION A partnership between Ko Awatea and the radiology department at CMDHB, examining capacity and demand for MRI and using multiple QI techniques, successfully and sustainably reduced the MRI waiting list over a two-year period. The innovative solutions to match capacity to demand may be instructive for other radiology departments, and other waiting list scenarios.
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Affiliation(s)
- Heera Bhullar
- Improvement Advisor, Ko Awatea, Counties Manukau District Health Board, Auckland
| | - Bernadette County
- Portfolio Manager, Ko Awatea, Counties Manukau District Health Board, Auckland
| | - Stuart Barnard
- Clinical Director of Central Clinical Services, Counties Manukau District Health Board, Auckland
| | - Anne Anderson
- Service Manager, Radiology, Counties Manukau District Health Board, Auckland
| | - Mary E Seddon
- Director Ko Awatea, Counties Manukau District Health Board, Auckland
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Palella FJ, Armon C, Cole SR, Hart R, Tedaldi E, Novak R, Battalora L, Purinton S, Li J, Buchacz K. HIV viral exposure and mortality in a multicenter ambulatory HIV adult cohort, United States, 1995-2016. Medicine (Baltimore) 2021; 100:e26285. [PMID: 34160393 PMCID: PMC8238313 DOI: 10.1097/md.0000000000026285] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to identify viral exposure (VE) measures and their relationship to mortality risk among persons with HIV.Prospective multicenter observational study to compare VE formulae.Eligible participants initiated first combination antiretroviral therapy (cART) between March 1, 1995 and June 30, 2015. We included 1645 participants followed for ≥6 months after starting first cART, with cART prescribed ≥75% of time, who underwent ≥2 plasma viral load (VL) and ≥1 CD4+ T-lymphocyte cell (CD4) measurement during observation. We evaluated all-cause mortality from 6 months after cART initiation until June 30, 2016. VE was quantified using 2 time-updated variables: viremia copy-years and percent of person-years (%PY) spent >200 or 50 copies/mL. Cox models were fit to estimate associations between VE and mortality.Participants contributed 10,453 person years [py], with median 14 VLs per patient. Median %PY >200 or >50 were 10% (interquartile range: 1%-47%) and 26% (interquartile range: 6%-72%), respectively. There were 115 deaths, for an overall mortality rate of 1.19 per 100 person years. In univariate models, each measure of VE was significantly associated with mortality risk, as were older age, public insurance, injection drug use HIV risk history, and lower pre-cART CD4. Based on model fit, most recent viral load and %PY >200 copies/mL provided the best combination of VE factors to predict mortality, although all VE combinations evaluated performed well.The combination of most recent VL and %PY >200 copies/mL best predicted mortality, although all evaluated VE measures performed well.
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Affiliation(s)
- Frank J. Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | | - Linda Battalora
- Cerner Corporation, Kansas City, MO
- Colorado School of Mines, Golden, CO
| | | | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Abate M, Debie A, Tsehay CT, Amare T. Compassionate and respectful care among outpatient clients at public health facilities in Northwest Ethiopia: A mixed-methods study. PLoS One 2021; 16:e0252444. [PMID: 34115772 PMCID: PMC8195428 DOI: 10.1371/journal.pone.0252444] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Compassionate and respectful care is a pillar for improving health-seeking behaviour. It has given much attention globally, following the concerns that healthcare often falls significantly; however, less research emphasis was paid in the last decade. Therefore, this study aims to assess compassionate and respectful care and associated factors among outpatient clients at public health facilities in Northwest Ethiopia, 2020. Methods A facility-based quantitative cross-sectional study supplemented with the qualitative findings was conducted from 30 February to 30 March 2020. A semi-structured interviewer-administered questionnaire was used to collect the quantitative data among 593 participants. Systematic and purposive sampling techniques were used to select the quantitative and qualitative participants, respectively. A semi-structured interview guide was also employed for the qualitative data collection. Epi-Data version 4.6 and SPSS version 25 were used for data entry and analysis, respectively. The bi-variable and multivariable logistic regression model was fitted to identify the factors associated with each outcome variable (compassionate and respectful care separately). Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 were used to declare the strength and factors statistically associated with the outcome variables. Results Overall, 72.8% and 82.6% of the respondents experienced compassionate and respectful care, respectively. Patients attending primary or above education (AOR: 0.35; 95% CI: 0.21–0.59), attending at the hospital (AOR: 0.59; 95% CI: 0.39–0.88), new clients (AOR: 0.33; 95% CI: 0.16–0.70) and service users who had three or more visits (AOR: 0.34; 95% CI: 0.17–0.71) were negatively associated with compassionate care. On the other hand, female patients (AOR = 0.53; 95% CI: 0.32–0.87), aged over 36 years (AOR = 0.43; 95% CI: 0.20–0.90), primary or above school attended clients (AOR = 0.18; 95% CI: 0.09–0.36), waiting two or more hours (AOR = 0.28; 95% CI: 0.13–0.62), and use public or private transport access (AOR: 0.49; 95% CI: 0.29–0.83) were negatively associated with a respectful care. Conclusion Compassionate and respectful care provided to the outpatient clients in public health facilities of northwest Ethiopia was high. However, our result suggests that immediate actions are necessary to address respectful and compassionate care at hospitals, and hospital management should adopt mitigation measures. Consideration should be given to foster patient-centric services and educate the health care workers about compassionate and respectful care.
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Affiliation(s)
- Manaye Abate
- Maternal and Child Health, Motta Health Office, Motta, Ethiopia
| | - Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Zhao H, Wei L, Li H, Zhang M, Cao B, Bian J, Zhan S. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis 2021; 21:847-857. [PMID: 33515511 DOI: 10.1016/s1473-3099(20)30596-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 07/10/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. METHODS We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. FINDINGS Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). INTERPRETATION Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. FUNDING The National Natural Science Foundation of China.
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Affiliation(s)
- Houyu Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Mei Zhang
- Department of Pharmacology, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jiaming Bian
- Department of Pharmacology, 7th Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
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Lee J, Joo H, Maskery BA, Alpern JD, Park C, Weinberg M, Stauffer WM. Increases in Anti-infective Drug Prices, Subsequent Prescribing, and Outpatient Costs. JAMA Netw Open 2021; 4:e2113963. [PMID: 34143194 PMCID: PMC8214158 DOI: 10.1001/jamanetworkopen.2021.13963] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines the association of prices for drugs to treat hookworm and pinworm with prescribing and prescription-filling behaviors and total outpatient treatment costs.
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Affiliation(s)
- Junsoo Lee
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Economics, University at Albany, State University of New York, Albany
| | - Heesoo Joo
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A. Maskery
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan D. Alpern
- Center for Global Health and Social Responsibility, Department of Medicine, University of Minnesota, Minneapolis
| | - Chanhyun Park
- Department of Pharmacy and Health Systems Science, Northeastern University, Boston, Massachusetts
- Now with Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William M. Stauffer
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Center for Global Health and Social Responsibility, Department of Medicine, University of Minnesota, Minneapolis
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Abstract
Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (β = 0.364, p < 0.001), expertise (β = 0.319, p < 0.001), communication by doctors (β = 0.224, p < 0.001), and tangibility (β = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (β = 0.258, p < 0.001), tangibility (β = 0.192, p < 0.001), communication by doctors (β = 0.163, p < 0.001), and expertise (β = 0.122, p < 0.01). Further, service value (β = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (β = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients’ intention to revisit through patient-oriented communication.
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Affiliation(s)
- Sewon Park
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong, South Korea
| | - Mankyu Choi
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- * E-mail: (MC); (ML)
| | - Munjae Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
- Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea
- * E-mail: (MC); (ML)
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Zhou YM, An SJ, Tang EJ, Xu C, Cao Y, Liu XL, Yao CY, Xiao H, Zhang Q, Liu F, Li YF, Ji AL, Cai TJ. Association between short-term ambient air pollution exposure and depression outpatient visits in cold seasons: a time-series analysis in northwestern China. J Toxicol Environ Health A 2021; 84:389-398. [PMID: 33622183 DOI: 10.1080/15287394.2021.1880507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/12/2023]
Abstract
Depression is known to be one of the most common mental disorders raising global concerns. However, evidence regarding the association between short-term air pollution exposure and risk of development of depression is limited. The aim of this was to assess the relationship between short-term ambient air pollution exposure and depression in outpatient visits in Xi'an, a northwestern Chinese metropolis. Data for air pollutants including particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) levels from October 1, 2010 to December 31, 2013 and number of daily depression outpatient visits (92,387 in total) were collected. A time-series quasi-Poisson regression model was adopted to determine the association between short-term air pollutant concentrations and frequency of outpatient visits for depression with different lag models. Consequently, 10 μg/m3 increase of SO2 and NO2 levels corresponded to significant elevation in number of outpatient-visits for depression on concurrent days (lag 0), and this relationship appeared stronger in cool seasons (October to March). However, the association of PM10 was only significant in males aged 30-50 at lag 0. Evidence indicated that short-term exposure to ambient air pollutants especially in cool seasons might be associated with increased risk of outpatient visits for depression.
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Affiliation(s)
- Yu-Meng Zhou
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shu-Jie An
- Medical Department, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - En-Jie Tang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen Xu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Hepatobiliary Surgery, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yi Cao
- Department of Health Economics Management, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xiao-Ling Liu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chun-Yan Yao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hua Xiao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qian Zhang
- Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Feng Liu
- Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Ya-Fei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ai-Ling Ji
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Tong-Jian Cai
- Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, China
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Nutarelli S, Delahunt E, Cuzzolin M, Delcogliano M, Candrian C, Filardo G. Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2111582. [PMID: 34037730 PMCID: PMC8155825 DOI: 10.1001/jamanetworkopen.2021.11582] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated. OBJECTIVE To compare outcomes associated with home-based rehabilitation programs (HBP) vs standard inpatient and/or outpatient supervised physical therapy (IOP) following arthroscopic isolated meniscectomy (AM). DATA SOURCES A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on March 15, 2021. The included studies were published from 1982 to 2019. STUDY SELECTION Randomized clinical trials of patients treated with HBP vs IOP after AM were included. DATA EXTRACTION AND SYNTHESIS Data were independently screened and extracted by 2 authors according to the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guideline. The meta-analysis was performed using a random-effect model; when an I2 < 25% was observed, the fixed-effect model was used. The Hartung-Knapp correction was applied. MAIN OUTCOMES AND MEASURES The primary outcome was the Lysholm score (scale of 0-100 with higher scores indicating better knee function) and secondary outcomes were subjective International Knee Documentation Committee (IKDC) score, knee extension and flexion, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the PROSPERO registration. Outcomes were measured in the short-term (ranging from 28 to 50 days) and the midterm (6 months). RESULTS In this meta-analysis of 8 RCTs including 434 patients, IOP was associated with a greater short-term improvement in Lysholm score compared with HBP, with a mean difference of -8.64 points (95% CI, -15.14 to -2.13 points; P = .02) between the 2 approached, but the sensitivity analysis showed no difference. Similarly, no statistically significant difference was detected at midterm for Lysholm score, with a mean difference between groups of -4.78 points (95% CI, -9.98 to 0.42 points; P = .07). HBP was associated with a greater short-term improvement in thigh girth, with a mean difference between groups of 1.38 cm (95% CI, 0.27 to 2.48 cm; P = .01), whereas IOP was associated with a better short-term vertical hop score, with a mean difference between groups of -3.25 cm (95% CI, -6.20 to -0.29 cm; P = .03). No differences were found for all the other secondary outcomes. CONCLUSIONS AND RELEVANCE No intervention was found to be superior in terms of physical and functional outcomes as well as work-related and patient-reported outcomes, both at short-term and midterm follow-up. Overall, these results suggest that HBP may be an effective management approach after AM in the general population.
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Affiliation(s)
- Sebastiano Nutarelli
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Marco Cuzzolin
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Marco Delcogliano
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- USI-Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
| | - Christian Candrian
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- USI-Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
| | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- USI-Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Bernhardt M, Schwert C, Aschenbrenner S, Weisbrod M, Schröder A. Longitudinal Changes of Cognitive Deficits and Treatment Outcome of Cognitive Behavioral Therapy for Major Depression. J Nerv Ment Dis 2021; 209:336-342. [PMID: 33555821 DOI: 10.1097/nmd.0000000000001301] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The current study examined neuropsychological changes over the course of cognitive behavioral therapy (CBT) in outpatients with major depressive disorder and the influence of cognitive deficits as predictors of clinical outcome in depression. A neuropsychological test battery was carried out on depressed outpatients (N = 54) at the beginning and at the end of CBT. Small improvements were found in divided attention, figural memory, and processing speed from pre- to posttreatment. Cognitive deficits in executive functions before treatment predicted the clinical outcome at the end of CBT. The present study reveals that attention and memory deficits are most likely to improve over the course of treatment, whereas executive functions remain stable in the long term. Depressed patients with worse executive functions at the beginning of treatment seem to benefit more from long-term CBT therapy.
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Affiliation(s)
- Maren Bernhardt
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Christine Schwert
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
| | | | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
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Smith TB, Workman C, Andrews C, Barton B, Cook M, Layton R, Morrey A, Petersen D, Holt-Lunstad J. Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials. PLoS Med 2021; 18:e1003595. [PMID: 34003832 PMCID: PMC8130925 DOI: 10.1371/journal.pmed.1003595] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. METHODS AND FINDINGS We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. CONCLUSIONS In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.
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Affiliation(s)
- Timothy B. Smith
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Connor Workman
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Caleb Andrews
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Bonnie Barton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Matthew Cook
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Ryan Layton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Alexandra Morrey
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Devin Petersen
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Julianne Holt-Lunstad
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
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Crisan C, Cainap C, Deac A, Havasi A, Balacescu O, Balacescu L, Bochis O, Vlad C, Cainap S. Decrease of oncological patients' hospital visits during Covid-19 pandemic; the experience of a tertiary Romanian centre. J BUON 2021; 26:1121-1126. [PMID: 34268980] [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
PURPOSE The outbreak of COVID-19 pandemic has changed the provision of medical services worldwide. We assessed the impact of the pandemic on the oncological patients' visits to a tertiary cancer centre. METHODS We analysed registrations from the administrative data system of in- and outpatients in all of the departments of the Cluj-Napoca Oncology Institute, during March-October 2020, and compared to the same 7-month period of the previous year. RESULTS The decrease during March-October 2020 was 40.2% for new referrals overall (with the most significant drop in April, of 80%), 52.5% for medical oncology inpatients, 39% for paediatric oncology department inpatients, 69% for radiotherapy inpatients, 34.9% for surgical interventions and 31% decrease of issued pathology reports. The decrease was less important for outpatients: only 10% for medical oncology outpatient department, 33% for radiotherapy and 27% for breast cancer unit outpatients. Imaging investigations were only slightly influenced by the pandemic (reduction of 5% for MRI scans, 19% for mammograms,whereas performed CT scans were even more after the outbreak of COVID-19). CONCLUSION Our results show a decrease in the number of patients during the period after the outbreak of the COVID-19 pandemic, more for inpatients and less significant for outpatient departments, probably because of the internal circuits reorganization but also because of health care measures taken nationally and locally to limit the spread of the pandemic.
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Affiliation(s)
- Cristina Crisan
- "Prof. Dr. Ion Chiricuta" Oncology Institute of Cluj-Napoca, Romania
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Nakash O, Nagar M, Razon L, Westen D. Association Between Attachment Patterns and Personality Disorders: A Multimethod Multi-Informant Study Using a Clinical Sample. J Nerv Ment Dis 2021; 209:386-394. [PMID: 33625070 DOI: 10.1097/nmd.0000000000001310] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We investigated the association between personality disorders (PDs) and attachment patterns, and examined the construct validity of attachment patterns against adaptive functioning. We used a multimeasure multi-informant approach, which allowed us to disentangle the effects of the methods and to examine the utility of the various methods for measuring these constructs. The participants included 80 clinicians and 170 clinical outpatients, recruited via convenience sampling. Results showed that secure attachment was positively associated with adaptive functioning, whereas insecure patterns were negatively associated with adaptive functioning. Both categorical and dimensional PD diagnoses were associated with insecure attachment patterns. However, after controlling for comorbidity among the PD diagnoses, only some findings remained significant, most notably the association between borderline PD and the clinicians' assessment of preoccupied and incoherent/disorganized attachment, and the patients' self-reported attachment anxiety. Our findings underscore the importance of controlling for comorbidity in examining the associations between attachment patterns and PDs.
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Affiliation(s)
| | | | - Liat Razon
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
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Ahmed SM, Shah RU, Fernandez V, Grineski S, Brintz B, Samore MH, Ferrari MJ, Leung DT, Keegan LT. Robust Testing in Outpatient Settings to Explore COVID-19 Epidemiology: Disparities in Race/Ethnicity and Age, Salt Lake County, Utah, 2020. Public Health Rep 2021; 136:345-353. [PMID: 33541222 PMCID: PMC8580386 DOI: 10.1177/0033354920988612] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE US-based descriptions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on patients with severe disease. Our objective was to describe characteristics of a predominantly outpatient population tested for SARS-CoV-2 in an area receiving comprehensive testing. METHODS We extracted data on demographic characteristics and clinical data for all patients (91% outpatient) tested for SARS-CoV-2 at University of Utah Health clinics in Salt Lake County, Utah, from March 10 through April 24, 2020. We manually extracted data on symptoms and exposures from a subset of patients, and we calculated the adjusted odds of receiving a positive test result by demographic characteristics and clinical risk factors. RESULTS Of 17 662 people tested, 1006 (5.7%) received a positive test result for SARS-CoV-2. Hispanic/Latinx people were twice as likely as non-Hispanic White people to receive a positive test result (adjusted odds ratio [aOR] = 2.0; 95% CI, 1.3-3.1), although the severity at presentation did not explain this discrepancy. Young people aged 0-19 years had the lowest rates of receiving a positive test result for SARS-CoV-2 (<4 cases per 10 000 population), and adults aged 70-79 and 40-49 had the highest rates of hospitalization per 100 000 population among people who received a positive test result (16 and 11, respectively). CONCLUSIONS We found disparities by race/ethnicity and age in access to testing and in receiving a positive test result among outpatients tested for SARS-CoV-2. Further research and public health outreach on addressing racial/ethnic and age disparities will be needed to effectively combat the coronavirus disease 2019 pandemic in the United States.
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Affiliation(s)
- Sharia M. Ahmed
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rashmee U. Shah
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Valerie Fernandez
- College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
| | - Sara Grineski
- Center for Natural & Technological Hazards, University of Utah, Salt Lake City, UT, USA
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Brintz
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew H. Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Matthew J. Ferrari
- Department of Biology, Pennsylvania State University, State College, PA, USA
| | - Daniel T. Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lindsay T. Keegan
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT, USA
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Kibret AA, Oumer M, Moges AM. Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One 2021; 16:e0249736. [PMID: 33878128 PMCID: PMC8057569 DOI: 10.1371/journal.pone.0249736] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Hemorrhoidal disease is a very common benign anorectal disease. It affects millions of people around the world, and represent a major medical and socioeconomic problem. However, studies that determine the magnitude and risk factors are limited. Therefore, the aim this study is to assess the prevalence and associated factors of hemorrhoid among adult patients visiting the surgical outpatient department at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from February to May 2020. A systematic random sampling technique was used to select a total of 403 participants. The data were collected then entered using EPI DATA version 3.1 and exported to the STATA 14 for analysis. Bivariable and multivariable logistic regression analysis were performed. Adjusted odds ratio (AOR) with 95% confidence interval was used as a measure of association. Variables having P-value < 0.05 from the multivariable analysis were considered to have a significant association with the outcome. Result Out of the 403 study participants, 13.1% (95%CI; 10.1, 16.8) had hemorrhoids. Constipation (AOR = 4.32, 95% CI; 2.20, 8.48) and BMI ≥25kg/m2 (AOR = 2.6, 95% CI; 1.08, 6.23) had a statistically significant association with hemorrhoid. Conclusion The overall prevalence of hemorrhoid was high and its prevalence was higher in male subjects. Constipation and being overweight were found to increase the odds of having hemorrhoids. Screening for early identification and intervention of hemorrhoids, especially for risk groups is better to be practiced by health professionals.
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Affiliation(s)
- Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Muche Moges
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ashagrie D, Genet C, Abera B. Vancomycin-resistant enterococci and coagulase-negative staphylococci prevalence among patients attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia. PLoS One 2021; 16:e0249823. [PMID: 33831089 PMCID: PMC8031390 DOI: 10.1371/journal.pone.0249823] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/04/2020] [Accepted: 03/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background Vancomycin resistant enterococci (VRE) and vancomycin resistance coagulase negative staphylococci (VRCoNS) are common pathogens causing difficult to treat health care associated infections (HAI). Hence, the World Health Organization listed VRE as one of the high priority pathogens for new antibiotic discovery and antimicrobial resistance surveillance. Despite this, data on the prevalence of VRE and VRCoNS in Ethiopia is scarce. Thus, the present study determined prevalence of VRE and VRCoNS among patients attending Felege-Hiwot comprehensive specialized hospital, Ethiopia. Methods A hospital based cross-sectional study was conducted on 384 patients selected conveniently from February to March 2020. Data on demographic and clinical variables were collected using a structured questionnaire by face-to-face interview. Simultaneously urine, venous blood and wound swab were collected and processed following standard bacteriological technique. Antimicrobial susceptibility test was performed by minimum inhibitory concentration method using E-test for vancomycin and Kirby-Bauer disc diffusion method for other classes of antibiotics. Data was entered and analyzed using SPSS version 23. Logistic regression was performed to identify factors associated with VRE infection. P. value < 0.05 was considered as statistically significant. Results The prevalence of enterococci and CoNS were 6.8% and 12% respectively. The prevalence of VRE was 34.61% (9/26), while all CoNS (46 isolates) were susceptible to vancomycin. The majority (66.7%) of VRE was isolated from blood samples. Furthermore all VRE (100%), 58.8% of vancomycin susceptible enterococci and 45.7% of CoNS were multidrug resistant (MDR). Having educational level of secondary school and below (AOR = 12.80, CI = 1.149–142.5), previous exposure to catheterization (AOR = 56.0, CI = 4.331–724.0) and previous antibiotic use practice (AOR = 26.25, CI = 3.041–226.2) were a significant associated explanatory factor for VRE infection. Conclusions The prevalence of vancomycin resistance enterococci, which is also multidrug resistant, was significantly high. Though no vancomycin resistance CoNS detected, the MDR level of CoNS was high. Thus to limit enterococci and CoNS infections and MDR development, focused infection prevention measures should be implemented.
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Affiliation(s)
- Degu Ashagrie
- Diagnostic Medical Laboratory Unit, Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Bayeh Abera
- Department of Medical Laboratory Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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