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El Alami El Hassani N, Akrichi MA, Bajit H, Alem C. Investigation of accordance between nutritional assessment tools, and bio-electrical impedance-derived phase angle, with the global leadership initiative on malnutrition criteria in hemodialysis patients. Clin Nutr ESPEN 2024; 62:260-269. [PMID: 38865238 DOI: 10.1016/j.clnesp.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Malnutrition (MN) is a major health concern for patients with chronic kidney disease (CKD) who receive maintenance hemodialysis (MHD). These patients are particularly vulnerable to MN due to their compromised health status, which in turn increases the risk of morbidity and mortality. However, there is limited evidence on the use of reliable and effective tools for assessing MN in this population. This lack of sufficient data highlights the crucial need to assess MN within these patients, considering the significant mortality risk it poses. The first aim of this study was to compare the concurrent validity of three nutritional methods: the 7-point Subjective Global Assessment (7p-SGA), the Nutritional Risk Index (NRI), and the Nutritional Risk Screening from 2002 (NRS-2002) with the Global Leadership Initiative on Malnutrition (GLIM) criteria in MHD patients. The second aim was to investigate the advantage of the bio-electrical impedance-derived phase angle (PhA) in predicting MN. METHODS one hundred sixty-eight outpatients (31% women) with a mean age of 56.9 ± 14.7 years and a median dialysis vintage of 48 months were included in this retrospective study. Nutritional scores, anthropometric measurements, biological markers, and body composition parameters were collected. RESULTS According to GLIM standards, MN was identified in 80% of these patients. Using logistic regression (LR) analysis, all nutritional scores were significantly associated with GLIM criteria, with optimal sensitivity (94.4%) and specificity (85.7%) for 7p-SGA and NRI, respectively. For discriminating the nutritional risk, the GLIM criteria demonstrated a good agreement with 7p-SGA (Kappa concordance coefficient (κ) = 0.677, p-value<0.001) with a good level of accuracy (Area Under the Curve (AUC) = 0.841; 95% Confidence Interval (CI) = 0.705-0.977; p-value <0.001) when compared to the NRI and NRS-2002 (κ = 0.522, p-value<0.001 and κ = 0.411, p-value = 0.006, respectively). An excellent accuracy was found between PhA and the GLIM-defined MN, with an optimal cut-off value of 5.5° for males and 4.5° for females. The LR showed that arm circumference is the parameter that most influences the decrease of PhA (odds ratio 2.710, 95% CI = 1.597-4.597, p-value <0.001). CONCLUSION Based on the results of the present study, 7p-SGA is the most sensitive score in identifying MN diagnosed by GLIM criteria. Nonetheless, NRI exhibits greater specificity. PhA is a valuable marker for MN in MHD patients.
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Affiliation(s)
- Nadia El Alami El Hassani
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco.
| | | | - Habiba Bajit
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco; Department of Pharmacology, Faculty of Medicine, University of Granada, Spain
| | - Chakib Alem
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco
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Jimenez EY, Lamers-Johnson E, Long JM, Mordarski BA, Ma X, Steiber A. Completion of a Nutrition-Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study. Nutr Clin Pract 2024; 39:888-902. [PMID: 38372592 DOI: 10.1002/ncp.11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. METHODS Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RESULTS RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. CONCLUSION RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Beth A Mordarski
- Lifelong Learning and Engagement, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Alison Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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Biniek JP, Schwab F, Graf K, Vonberg RP. Adherence to Antibiotic Prescription Guidelines in Four Community Hospitals in Germany. Antibiotics (Basel) 2024; 13:635. [PMID: 39061317 PMCID: PMC11274007 DOI: 10.3390/antibiotics13070635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
This retrospective study aimed to assess and compare guideline adherence and treatment costs in the management of urinary tract infections (UTIs) and bloodstream infections (BSIs) in German tertiary hospitals from January 2019 to December 2020. The study analyzed 586 patient records, with 65% diagnosed with UTIs and 35% with BSIs. Antibiotic treatment was given to 98% of patients, but only 65% received microbiological diagnostics. Bacterial growth was observed in 86% of patients with cultures taken, with Escherichia coli being the leading pathogen. The treatment was intravenous in 63% of cases, with Ceftriaxone as the leading antibiotic agent. The guideline adherence was found to be low, at 33%. Multivariable logistic regression analysis revealed that patients with urogenital risk factors (OR = 1.589; p < 0.001) and increasing age (OR = 1.01; p = 0.007) were significantly more likely to receive guideline-concordant treatment for UTIs and BSIs. Additionally, complicating factors such as diabetes and renal dysfunction were associated with higher adherence rates, underscoring the importance of targeted antibiotic stewardship interventions.
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Affiliation(s)
- Joachim Peter Biniek
- Department of Hospital Hygiene, Paracelsus-Hospital am Silbersee, 30851 Langenhagen, Germany; (J.P.B.)
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany
| | - Karolin Graf
- Department of Hospital Hygiene, Paracelsus-Hospital am Silbersee, 30851 Langenhagen, Germany; (J.P.B.)
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany
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Fahmy JN, Kong L, Wang L, Chung KC. Postoperative hand therapy and the 2018 Medicare therapy cap repeal: Appraising cost and use changes. J Hand Ther 2024:S0894-1130(24)00048-6. [PMID: 38942653 DOI: 10.1016/j.jht.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/15/2024] [Accepted: 05/16/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Therapy use is common following carpal tunnel release (CTR), trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture, open reduction internal fixation or percutaneous pinning (DRF). Policy that improves coverage influences the cost and use of health care services. PURPOSE This study aims to evaluate changes to the cost and use of postoperative hand therapy by race and procedure following the repeal of a longstanding annual Medicare outpatient therapy cap. STUDY DESIGN Retrospective cohort study. METHODS This is a longitudinal retrospective cohort study using a quasi-experimental interrupted time series design, including patients who underwent common hand surgeries from January 1, 2016-December 31, 2019. RESULTS This study included 203,672 patients with a mean age of 71.4 years. Neither White (1.00, 95% confidence interval [CI]: 0.999-1.007, p = 0.45) nor non-White (1.00, 95% CI: 1.00-1.01, p = 0.06) patients experienced monthly changes in therapy use before policy implementation. Therapy frequency increased following CTR (odds ratio [OR] 1.12, 95% CI: 1.11-1.14, p < 0.001), trigger finger release (OR 1.09, 95% CI: 1.07-1.10, p < 0.001), and DRF (OR 1.05, 95% CI: 1.03-1.06, p < 0.001) following implementation. CONCLUSIONS This study found that improved coverage was associated with increased postoperative therapy use among some subsets, including CTR and DRF, suggesting the need to optimize coverage by means such as prior authorization or bundled payments, rather than only increasing coverage benefits.
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Affiliation(s)
- Joseph N Fahmy
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lingxuan Kong
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Bloom DA, Bieganowski T, Robin JX, Arshi A, Schwarzkopf R, Rozell JC. Evaluation of Preoperative Variables that Improve the Predictive Accuracy of the Risk Assessment and Prediction Tool in Primary Total Hip Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-00987. [PMID: 38754131 DOI: 10.5435/jaaos-d-23-00784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Discharge disposition after total joint arthroplasty may be predictable. Previous literature has attempted to improve upon models such as the Risk Assessment and Prediction Tool (RAPT) in an effort to optimize postoperative planning. The purpose of this study was to determine whether preoperative laboratory values and other previously unstudied demographic factors could improve the predictive accuracy of the RAPT. METHODS All patients included had RAPT scores in addition to the following preoperative laboratory values: red blood cell count, albumin, and vitamin D. All values were recorded within 90 days of surgery. Demographic variables including marital status, American Society of Anesthesiologists (ASA) scores, body mass index, Charlson Comorbidity Index, and depression were also evaluated. Binary logistic regression was used to determine the significance of each factor in association with discharge disposition. RESULTS Univariate logistic regression found significant associations between discharge disposition and all original RAPT factors as well as nonmarried patients (P < 0.001), ASA class 3 to 4 (P < 0.001), body mass index >30 kg/m2 (P = 0.065), red blood cell count <4 million/mm3 (P < 0.001), albumin <3.5 g/dL (P < 0.001), Charlson Comorbidity Index (P < 0.001), and a history of depression (P < 0.001). All notable univariate models were used to create a multivariate model with an overall predictive accuracy of 90.1%. CONCLUSIONS The addition of preoperative laboratory values and additional demographic data to the RAPT may improve its PA. Orthopaedic surgeons could benefit from incorporating these values as part of their discharge planning in THA. Machine learning may be able to identify other factors to make the model even more predictive.
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Affiliation(s)
- David A Bloom
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Jimenez EY, Lamers-Johnson E, Long JM, McCabe G, Ma X, Woodcock L, Bliss C, Abram JK, Steiber AL. Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study. Am J Clin Nutr 2024; 119:779-787. [PMID: 38432715 DOI: 10.1016/j.ajcnut.2023.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment. OBJECTIVES This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified. METHODS A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes. RESULTS After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake. CONCLUSIONS Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic. CLINICALTRIALS gov/ct2/show/NCT03928548).
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States; Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; College of Population Health, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - George McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, United States
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States
| | - Lindsay Woodcock
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Courtney Bliss
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Jenica K Abram
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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Bian H, Liu M, Liu J, Dong M, Hong G, Agrafiotis AC, Patel AJ, Ding L, Wu J, Chen J. Seven preoperative factors have strong predictive value for postoperative pneumonia in patients undergoing thoracoscopic lung cancer surgery. Transl Lung Cancer Res 2023; 12:2193-2208. [PMID: 38090511 PMCID: PMC10713263 DOI: 10.21037/tlcr-23-512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 09/13/2024]
Abstract
Background Postoperative pneumonia (POP) is a hospital acquired pneumonia that occurs >48 hours after tracheal intubation. The diagnosis of POP should be based on clinical and radiological findings within 30 days after surgery. It is a common complication after thoracoscopic surgery for lung cancer patients. However, the specific impact of preoperative comorbidities on the incidence of POP remains unclear. This study aimed to analyze the preoperative data of patients with lung cancer to help surgeons predict the risk of incidence of POP after thoracoscopic lung resection. Methods This study is a prospective study that included patients with lung cancer who were scheduled for thoracoscopic surgery in 1 year. All cases came from two medical centers. Preoperative demographic information, tumor information, preoperative comorbidities, quality of life scores, and incidence of POP were collected. Variables were screened by univariate analysis and multivariate regression. Finally, a prediction model was constructed. A total of 53 preoperative factors were included as candidate predictors. The binary outcome variable was defined as the presence or absence of POP. The incidence of POP was the primary outcome variable. The predictive performance of the model was verified internally through 1,000 iterations of bootstrap resampling. Results A total of 1,229 patients with lung cancer who underwent thoracoscopic surgery were enrolled. In addition, 196 cases (15.95%) had POP; 1,025 (83.40%) patients had comorbid conditions. The total number of comorbidity diagnosed in all samples was 2,929. The prediction model suggested that patients with advanced age, high body mass index (BMI), smoking, poor physical condition, respiratory diseases, diabetes, and neurological diseases were more likely to develop POP. The area under the curve (AUC) and Brier scores were 0.851 and 0.091, respectively. The expected and observed results were in strong agreement, according to the likelihood of POP calibration curve. Conclusions The constructed model is capable of evaluating the probability of POP occurrence in patients with lung cancer. Seven preoperative factors in patients with lung cancer were found to be associated with increased probability of having pneumonia after thoracoscopic lung resection. This model can help predict the incidence of POP after surgery.
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Affiliation(s)
- Hongliang Bian
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Thoracic Surgery, Affiliated Hospital of Chifeng University & Institute of Thoracic Trauma and Tumor of Chifeng University, Chifeng, China
| | - Minghui Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Dong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Goohyeon Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Apostolos C. Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Akshay J. Patel
- Institute of Immunology and Immunotherapy (III), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Lei Ding
- Department of Thoracic Surgery, Affiliated Hospital of Chifeng University & Institute of Thoracic Trauma and Tumor of Chifeng University, Chifeng, China
| | - Jingbo Wu
- Department of Thoracic Surgery, Affiliated Hospital of Chifeng University & Institute of Thoracic Trauma and Tumor of Chifeng University, Chifeng, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Ashman Kröönström L, Lundgren-Nilsson Å, Kjellby-Wendt G, Stibrant Sunnerhagen K. Symptoms, care consumption, and healthcare costs in hospitalized patients during the first wave of the COVID-19 pandemic. PLoS One 2023; 18:e0291548. [PMID: 37708157 PMCID: PMC10501636 DOI: 10.1371/journal.pone.0291548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND We aimed to assess symptomatology post discharge from the hospital in patients with COVID-19 treated during the first wave of the COVID-19 pandemic, and to follow care consumption and healthcare costs six months post discharge. METHODS This study was a descriptive observational study over time. Data were retrieved from the Sahlgrenska University (SU) hospital registry for patients admitted to an SU hospital during March 2020 to August 2020. Of these, 1014 received a questionnaire approximately six weeks post discharge regarding symptoms. Data regarding care consumption were retrieved from the registry in the Region Västra Götaland for 529 (52.2%) patients who completed the questionnaire. Of these, 466 patients were included in the analysis of care consumption. RESULTS There was a reported decrease in mobility from admission to discharge in both men (p = 0.02) and women (p = 0.01). The costs of inpatient care amounted to a total of 9 601 459.20 Euro (EUR). Symptoms were reported in 436 (93.6%) patients post discharge, of which weight loss during COVID-19 was most common in both men (n = 220, 77.5%) and women (n = 107, 58.8%). During six-month follow-up, 409 (87%) patients consumed care. Of the registered visits, 868 (27.1%) were related to a COVID-19 diagnosis. The total sum of outpatient care (i.e. visits with a registered COVID-19 diagnosis) was 77 311.30 EUR. CONCLUSIONS At discharge from the hospital, there was a decrease in mobility. Most patients had remaining sequelae post discharge. At six months post discharge, nearly 90% of patients had consumed care, with approximately 20% related to COVID-19. This indicates a persisting need for rehabilitation post discharge from hospital in patients treated for COVID-19.
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Affiliation(s)
- Linda Ashman Kröönström
- Institute of Neuroscience and Physiology, Section of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Section of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Institute of Neuroscience and Physiology, Section of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Institute of Neuroscience and Physiology, Section of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sipos M, Farcas A, Leucuta DC, Bulik NB, Huruba M, Dumitrascu D, Mogosan C. Prevalence and Risk Factors Associated with Potentially Inappropriate Prescribing According to STOPP-2 Criteria among Discharged Older Patients-An Observational Retrospective Study. Pharmaceuticals (Basel) 2023; 16:852. [PMID: 37375799 PMCID: PMC10304400 DOI: 10.3390/ph16060852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Pharmacokinetic and pharmacodynamic changes associated with old age, along with multimorbidity and polypharmacy might lead to inappropriate prescribing and adverse reactions. Explicit criteria such as the Screening tool of older people's prescribing (STOPP) are useful to identify potential inappropriate prescribing's (PIPs). Our retrospective study included discharge papers from patients aged ≥65 years, from an internal medicine department in Romania (January-June 2018). A subset of the STOPP-2 criteria was used to assess the prevalence and characteristics of PIPs. Regression analysis was performed to evaluate the impact of associated risk factors (i.e., age, gender, polypharmacy and specific disease). Out of the 516 discharge papers analyzed, 417 were further assessed for PIPs. Patients' mean age was 75 years, 61.63% were female and 55.16% had at least one PIP, with 81.30% having one or two PIPs. Antithrombotic agents in patients with significant bleeding risk was the most prevalent PIP (23.98%), followed by the use of benzodiazepines (9.11%). Polypharmacy, extreme (>10 drugs) polypharmacy, hypertension and congestive heart failure were found as independent risk factors. PIP was prevalent and increased with (extreme) polypharmacy and specific cardiac disease. Comprehensive criteria like STOPP should be regularly used in clinical practice to identify PIPs to prevent potential harm.
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Affiliation(s)
- Mariana Sipos
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania; (M.S.); (C.M.)
| | - Andreea Farcas
- Pharmacovigilance Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Noémi-Beátrix Bulik
- Pharmacovigilance Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Madalina Huruba
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania; (M.S.); (C.M.)
| | - Dan Dumitrascu
- Department of Internal Medicine, Medical Clinic 2, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 40000 Cluj-Napoca, Romania;
| | - Cristina Mogosan
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400010 Cluj-Napoca, Romania; (M.S.); (C.M.)
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Kim DD, DeSnyder SM, Dougherty PM, Cata JP. Effect of neoadjuvant chemotherapy on intraoperative core temperature in patients with breast cancer: a retrospective cohort study. BJA OPEN 2023; 5:100119. [PMID: 37587989 PMCID: PMC10430839 DOI: 10.1016/j.bjao.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 08/18/2023]
Abstract
Background Clinical evidence suggests that chemotherapeutic agents are associated with neuropathy and peripheral autonomic dysfunction. However, the possible effects of neoadjuvant chemotherapy on intraoperative temperature remain poorly characterised. Methods We evaluated patients who underwent a mastectomy for breast cancer between April 2016 and July 2020. Propensity scores were used to match patients who received neoadjuvant chemotherapy with those who did not, and intraoperative core temperature patterns were analysed in the matched cohort. The independent associations between vasopressor use and heart rate during general anaesthesia in the matched cohort were also analysed. Results Data from 1764 patients were analysed (882 patients in each group). Both groups presented a similar pattern of heat redistribution and subsequent rewarming; however, the neoadjuvant chemotherapy group did not reach the same intraoperative plateau temperature as the group that did not receive prior chemotherapy, with differences of up to 0.4°C (95% confidence interval: 0.11-0.63°C; P=0.005). In a subgroup analysis, neuropathy in patients who received neoadjuvant chemotherapy was associated with increased use of vasopressors and higher heart rate. Conclusions In patients with breast cancer, neoadjuvant chemotherapy is associated with lower plateau core temperatures, increased vasopressor use, and higher heart rates during general anaesthesia, which is more severe in the presence of neuropathy.
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Affiliation(s)
- Daniel D. Kim
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Sarah M. DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick M. Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
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11
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Christensen TH, Bieganowski T, Malarchuk AW, Davidovitch RI, Bosco JA, Schwarzkopf R, Macaulay WB, Slover JD, Lajam CM. Hospital Revenue, Cost, and Contribution Margin in Inpatient Versus Outpatient Primary Total Joint Arthroplasty. J Arthroplasty 2023; 38:203-208. [PMID: 35987495 DOI: 10.1016/j.arth.2022.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Removal of primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA) from the inpatient-only list has financial implications for both patients and institutions. The aim of this study was to evaluate and compare financial parameters between patients designated for inpatient versus outpatient total joint arthroplasty. METHODS We reviewed all patients who underwent TKA or THA after these procedures were removed from the inpatient-only list. Patients were statistical significance into cohorts based on inpatient or outpatient status, procedure type, and insurance type. This included 5,284 patients, of which 4,279 were designated inpatient while 1,005 were designated outpatient. Patient demographic, perioperative, and financial data including per patient revenues, total and direct costs, and contribution margins (CMs) were collected. Data were compared using t-tests and Chi-squared tests. RESULTS Among Medicare patients receiving THA, CM was 89.1% lower for the inpatient cohort when compared to outpatient (P < .001), although there was no statistical significance difference between cohorts for TKA (P = .501). Among patients covered by Medicaid or Government-managed plans, CM was 120.8% higher for inpatients receiving THA (P < .001) when compared to outpatients and 136.3% higher for inpatients receiving TKA (P < .001). CONCLUSION Our analyses showed that recent costs associated with inpatient stay inconsistently match or outpace additional revenue, causing CM to vary drastically depending on insurance and procedure type. For Medicare patients receiving THA, inpatient surgery is financially disincentivized leaving this vulnerable patient population at a risk of losing access to care. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Alex W Malarchuk
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - William B Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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12
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Paiva CE, Preto DD, de Lima C, Paiva BSR. To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers. Cancer Control 2023; 30:10732748231176639. [PMID: 37178323 PMCID: PMC10184254 DOI: 10.1177/10732748231176639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/16/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with advanced cancers and their oncologists are often faced with difficult treatment decisions, especially when there are borderline situations of expected benefit or increased risk of complications. In this narrative review, we will explore the decision-making process for patients with advanced cancers and provide insights on how to approach this complex task, while didactically dividing the oncologist's assessments according to a mnemonic rule of the ABCDE of therapeutic decision-making. Part A (advanced cancer) recalls that the rule is to be used specifically for advanced cancers. Parts B (potential benefits) and C (clinical conditions and risks) represents the traditional risk vs benefit scale. In Part D, we discuss ways to identify and understand patients' desires, values, preferences, and beliefs. The prognostic estimation, from Part E, may function as an "adjust" for the antineoplastic treatment decision-making. Treatment decisions need to be conducted by skilled oncologists, in a patient-centered care, aiming to promote valuable oncology with lower rates of aggressive care.
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Affiliation(s)
- Carlos Eduardo Paiva
- Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Daniel D’Almeida Preto
- Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Crislaine de Lima
- Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil
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13
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Prommik P, Tootsi K, Veske K, Strauss E, Saluse T, Kolk H, Märtson A. Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet Disord 2022; 23:394. [PMID: 35477499 PMCID: PMC9044808 DOI: 10.1186/s12891-022-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT’s effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009–2017. The fracture populations’ acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients’ acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients’ mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients’ survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration Retrospectively registered.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Karin Veske
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
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