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Kim SJ, Kim T, Choi H, Shin TR, Kim HI, Jang SH, Hong JY, Lee CY, Chung S, Choi JH, Sim YS. Respiratory pathogen and clinical features of hospitalized patients in acute exacerbation of chronic obstructive pulmonary disease after COVID 19 pandemic. Sci Rep 2024; 14:10462. [PMID: 38714885 PMCID: PMC11076476 DOI: 10.1038/s41598-024-61360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
Respiratory infections are common causes of acute exacerbation of chronic obstructive lung disease (AECOPD). We explored whether the pathogens causing AECOPD and clinical features changed from before to after the coronavirus disease 2019 (COVID-19) outbreak. We reviewed the medical records of patients hospitalized with AECOPD at four university hospitals between January 2017 and December 2018 and between January 2021 and December. We evaluated 1180 patients with AECOPD for whom medication histories were available. After the outbreak, the number of patients hospitalized with AECOPD was almost 44% lower compared with before the outbreak. Patients hospitalized with AECOPD after the outbreak were younger (75 vs. 77 years, p = 0.003) and more often stayed at home (96.6% vs. 88.6%, p < 0.001) than patients of AECOPD before the outbreak. Hospital stay was longer after the outbreak than before the outbreak (10 vs. 8 days. p < 0.001). After the COVID-19 outbreak, the identification rates of S. pneumoniae (15.3 vs. 6.2%, p < 0.001) and Hemophilus influenzae (6.4 vs. 2.4%, p = 0.002) decreased, whereas the identification rates of P. aeruginosa (9.4 vs. 13.7%, p = 0.023), Klebsiella pneumoniae (5.3 vs. 9.8%, p = 0.004), and methicillin-resistant Staphylococcus aureus (1.0 vs. 2.8%, p = 0.023) increased. After the outbreak, the identification rate of influenza A decreased (10.4 vs. 1.0%, p = 0.023). After the outbreak, the number of patients hospitalized with AECOPD was lower and the identification rates of community-transmitted pathogens tended to decrease, whereas the rates of pathogens capable of chronic colonization tended to increase. During the period of large-scale viral outbreaks that require quarantine, patients with AECOPD might be given more consideration for treatment against strains that can colonize chronic respiratory disease rather than community acquired pathogens.
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Affiliation(s)
- Soo Jung Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Taehee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Tae Rim Shin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Hwan Il Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Ji Young Hong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Soojie Chung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong-Hee Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan-si, Korea
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Yun Su Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
- Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea.
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Ferro S, Riganti A. The hidden toll of the pandemic on nonrespiratory patients. Health Policy 2024; 143:105035. [PMID: 38461618 DOI: 10.1016/j.healthpol.2024.105035] [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: 09/13/2023] [Revised: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
While many empirical studies have focused on the health consequences of COVID-19 for infected individuals, little attention has been given to its consequences for patients with nonrespiratory medical conditions. In this study, we apply machine learning and regression analysis techniques to complete-coverage administrative records of inpatient hospitalizations in Italy in 2012-2021 to investigate how the outbreak has impacted on the treatment of nonrespiratory patients in one of the countries most acutely affected by the pandemic. A comparison of hospital- and population-level excess deaths suggests that 53.7% of COVID-19 deaths occurred outside of hospitals. We interpret this as evidence of limited hospital resources, and we show that a higher number of hospital beds per capita is associated with a greater proportion of in-hospital deaths. We also document a 22.6% decrease in hospitalizations of nonrespiratory patients, more pronounced for patients in less severe conditions, and a conditional decrease of 0.5 days in the average length of stay for nonrespiratory patients. We attribute these changes to fear of infection and hospital resource limitations, and we show that the drop in admissions is more pronounced in areas that were more impacted by COVID-19 and had fewer hospital beds per capita. Our findings suggested that the pandemic's direct impact on infected individuals is just a fraction of the broader health losses in the population.
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Affiliation(s)
- Simone Ferro
- Department of Economics, Management and Quantitative Methods, University of Milan, Italy
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Decker SL, Zuvekas SH. A Nationally Representative Summary of 2020 Changes in the Use of Health Care in the United States. J Ambul Care Manage 2024; 47:64-83. [PMID: 38345888 DOI: 10.1097/jac.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The COVID-19 pandemic produced an unprecedented shock to the U.S. health care system. Prior literature documenting 2020 changes has been limited to certain types of care or subsets of patients. We use the nationally representative Medical Expenditure Panel Survey to summarize changes in all types of health care from 2018 through 2020. Outpatient visits, emergency department visits, and inpatient admissions each fell about 35% in April 2020. Dental visits fell over 80%. Ophthalmology visits declined 71% and mammograms 82%. Psychiatric visits rose slightly (1.6%). By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than 2019.
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Affiliation(s)
- Sandra L Decker
- Author Affiliations: U.S. Agency for Healthcare Research and Quality, Rockville, MD (Drs Decker and Zuvekas)
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Razimoghadam M, Yaseri M, Rezaee M, Fazaeli A, Daroudi R. Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022. BMC Public Health 2024; 24:380. [PMID: 38317148 PMCID: PMC10840276 DOI: 10.1186/s12889-024-17819-0] [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: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. METHOD This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. RESULTS During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. CONCLUSIONS In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Aliakbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Hartman M, Martin AB, Whittle L, Catlin A. National Health Care Spending In 2022: Growth Similar To Prepandemic Rates. Health Aff (Millwood) 2024; 43:6-17. [PMID: 38091522 DOI: 10.1377/hlthaff.2023.01360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Health care spending in the US grew 4.1 percent to reach $4.5 trillion in 2022, which was still a faster rate of growth than the increase of 3.2 percent in 2021 but was much slower than the rate of 10.6 percent seen in 2020. In 2022, strong Medicaid and private health insurance spending growth, including a turnaround in the net cost of insurance, was somewhat offset by continued declines in federal spending associated with the COVID-19 pandemic. The insured share of the population reached a historic high of 92.0 percent in 2022 as enrollment in private health insurance increased at a faster rate relative to 2021 and Medicaid enrollment continued to experience strong growth. The share of the economy accounted for by the health sector was 17.3 percent in 2022, which was down from a peak of 19.5 percent in 2020 but was more consistent with the average share of 17.5 percent during 2016-19.
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Affiliation(s)
- Micah Hartman
- Micah Hartman , Centers for Medicare and Medicaid Services (CMS), Baltimore, Maryland
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Meille G, Decker SL, Owens PL, Selden TM. COVID-19 Admission Rates and Changes in US Hospital Inpatient and Intensive Care Unit Occupancy. JAMA HEALTH FORUM 2023; 4:e234206. [PMID: 38038986 PMCID: PMC10692846 DOI: 10.1001/jamahealthforum.2023.4206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023] Open
Abstract
Importance The COVID-19 pandemic had unprecedented effects on hospital occupancy, with consequences for hospital operations and patient care. Previous studies of occupancy during COVID-19 have been limited to small samples of hospitals. Objective To measure the association between COVID-19 admission rates and hospital occupancy in different US areas and at different time periods during 2020. Design, Setting, and Participants This cross-sectional study used data from the Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for patients in nonfederal acute care hospitals in 45 US states, including the District of Columbia. Data analysis was performed between September 1, 2022, and April 30, 2023. Exposures Each hospital and week in 2020 was categorized based on the number of COVID-19 admissions per 100 beds (<1 [low], 1-4.9, 5-9.9, 10-14.9, or ≥15 [high]). Main Outcomes and Measures The main outcomes were inpatient and intensive care unit (ICU) occupancy. We used regression analysis to estimate the average change in occupancy for each hospital-week in 2020 relative to the same hospital week in 2019. Results This study included 3960 hospitals and 54 355 916 admissions. Of the admissions in the 40 states used for race and ethnicity analyses, 15.7% were for Black patients, 12.9% were for Hispanic patients, 62.5% were for White patients, and 7.2% were for patients of other race or ethnicity; 1.7% of patients were missing these data. Weekly COVID-19 admission rates in 2020 were less than 4 per 100 beds for 63.9% of hospital-weeks and at least 10 in only 15.9% of hospital-weeks. Inpatient occupancy decreased by 12.7% (95% CI, 12.1% to 13.4%) during weeks with low COVID-19 admission rates and increased by 7.9% (95% CI, 6.8% to 9.0%) during weeks with high COVID-19 admission rates. Intensive care unit occupancy rates increased by 67.8% (95% CI, 60.5% to 75.3%) during weeks with high COVID-19 admissions. Increases in ICU occupancy were greatest when weighted to reflect the experience of Hispanic patients. Changes in occupancy were most pronounced early in the pandemic. During weeks with high COVID-19 admissions, occupancy decreased for many service lines, with occupancy by surgical patients declining by 43.1% (95% CI, 38.6% to 47.2%) early in the pandemic. Conclusions and Relevance In this cross-sectional study of US hospital discharges in 45 states in 2020, hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions, with the largest changes occurring early in the pandemic. These findings suggest that surges in COVID-19 strained ICUs and were associated with large decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.
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Affiliation(s)
- Giacomo Meille
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Sandra L. Decker
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Pamela L. Owens
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Thomas M. Selden
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
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Pina H, Martins JD, Guerra S, Aragüés JM, Valadas C. The silent diabetic decompensation epidemic during the SARS-CoV2 pandemic - The role of primary care in early diagnosis and prevention of severe diabetic decompensation. Prim Care Diabetes 2023; 17:524-525. [PMID: 37353465 PMCID: PMC10266494 DOI: 10.1016/j.pcd.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
AIM/HYPOTHESIS Efficiency in controlling chronic diseases, especially in the primary care setting, is associated with reduced rates of hospitalizations. Poorly controlled diabetes is associated with severe diabetic decompensation, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It is hypothesized that, in addition to the SARS-CoV2 pandemic, there was a parallel increase in decompensation of previously controlled chronic diseases, such as diabetes. In this work, the impact of the SARS-CoV2 pandemic on hospitalizations for severe diabetic decompensation in a Portuguese hospital was assessed. METHODS A retrospective study by hospital clinical file consultation was performed and a cohort of 177 patients admitted to a Portuguese hospital with a diagnosis of DKA or hyperosmolar hyperglycemic state HHS, excluding SARS-CoV2 infected patients, between 2019 and 2020 was analysed. RESULTS In the population not infected by SARS-CoV2, statistically significant differences were found in the relative number of hospitalizations (5.59 vs 3.79 hospitalizations for DKA/HHS per 1000 patients not infected with SARS-CoV2, p = 0.0093) and lethality due to DKA/HHS (0941 vs 0337 deaths from DKA/HHS per 1000 patients not infected with SARS-CoV2, p = 0.0251). This increase in hospitalizations and lethality was accompanied by a statistically significant increase in newly type 2 diabetes diagnosis in DKA/HHS hospital admissions (p = 0.0156) and by a statistically significant increase in average age of patients (56.3 ± 22.4 vs 69.1 ± 17.6, p < 0.001). DISCUSSION AND CONCLUSIONS These results show the empirical perspective that the consequences of the pandemic also had a considerable impact on the control of chronic diseases such as diabetes, with a higher percentage of hospitalizations due to severe decompensation, especially in the elderly population.
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Affiliation(s)
- Henrique Pina
- Endocrinology department, Hospital Beatriz Ângelo, Lisbon, Portugal.
| | | | - Sílvia Guerra
- Endocrinology department, Hospital Beatriz Ângelo, Lisbon, Portugal
| | | | - Cristina Valadas
- Endocrinology department, Hospital Beatriz Ângelo, Lisbon, Portugal
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Vieira Filho JF, Ribeiro VN, do Nascimento ÁMA, Maria Alves de Melo M. Infections in Children with Cancer Admitted in an Oncology Reference Hospital: A Cross-sectional Study. Curr Microbiol 2023; 80:315. [PMID: 37544971 DOI: 10.1007/s00284-023-03420-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Pediatric oncology patients are usually immunosuppressed due to factors such as the neoplasm and its treatment, making them more susceptible to infections. This article aims to determine the infection profile of pediatric oncology patients admitted to an oncology reference hospital in Natal, Rio Grande do Norte, Brazil. A retrospective and cross-sectional study was conducted, collecting data from patients hospitalized due to infection in a pediatric oncology unit exclusively for the Brazilian public health system, spanning from 2018 to 2021. A total of 168 episodes of infections were identified in 96 patients, resulting in 157 hospitalizations. Among the patients with infections, 62.4% had hematological malignancies, and out of these cases, 74.6% specifically had Acute Lymphoid Leukemia. The Escherichia coli (31.9%) was the most prevalent microorganism isolated from the samples. Multidrug-resistant microorganisms accounted for 52% of all identified microorganisms. Fluoroquinolones and beta-lactam were the most prevalent antibiotic classes in the analyzed antibiograms. Factors such as Sex, type of cancer, chemotherapy in the last 30 days, were found to be associated with the occurrence of infection (p < 0.05). Conducting epidemiological studies regarding infections in pediatric oncology is crucial to development of empirical protocols, and the implementation of strategies to better control future infections.
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Affiliation(s)
- Jonas Fernandes Vieira Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | - Viviane Nunes Ribeiro
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | | | - Menilla Maria Alves de Melo
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil.
- Department of Pharmacy, Pesquisa e Inovação, Instituto de Ensino, Liga Norte Riograndense Contra o Câncer Hospital, Av. Miguel Castro, Nossa Senhora de Nazaré, Natal, 1355, CEP 59062-000, Rio Grande do Norte, Brazil.
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Mahroo OA, Xing W, Lazarevic S, Zekite A, Flanagan D. Monthly certifications of vision impairment in England and Wales in 2020 and 2021: comparison with years prior to the COVID-19 pandemic. Eye (Lond) 2023; 37:2154-2156. [PMID: 36335204 PMCID: PMC9638396 DOI: 10.1038/s41433-022-02300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Omar A Mahroo
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK.
- Institute of Ophthalmology, University College London, Bath Street, London, UK.
- Section of Ophthalmology, King's College London, St Thomas' Hospital Campus, London, UK.
| | - Wen Xing
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
| | - Snezana Lazarevic
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
| | - Antra Zekite
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
| | - Declan Flanagan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
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Bhalla NS, Fawcett J. Frailty Trends in an Older Veteran Subpopulation 1 Year Prior and Into the COVID-19 Pandemic Using CAN Scores. Fed Pract 2023; 40:194-198a. [PMID: 37860074 PMCID: PMC10584405 DOI: 10.12788/fp.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background We studied the effects of the first year of the COVID-19 pandemic on frailty trends in a subset of older veterans at the Phoenix Veterans Affairs Health Care System. Methods We identified 3538 and 6103 veterans aged 70 to 75 years as of February 8, 2019, with a calculated Care Assessment Need (CAN) score of ≥ 75 for 1-year mortality and hospitalization, respectively. After excluding veterans with insufficient 2020 and 2021 data, we compared the difference in 1-year mortality and hospitalization CAN scores from 2019 to 2020 with 2020 to 2021 using a paired t test. Results The difference in mean (SD) 1-year mortality CAN scores from 2020 to 2021 was 0.2 (13.4) when compared with the previous year's -4.9 (12.5) (P < .0001), indicating increased frailty. The difference in 1-year hospitalization CAN scores from 2020 to 2021 was -1.5 (12.0) when compared with the previous year's -2.8 (9.9) (P < .0001). Conclusions Frailty in our veteran subpopulation as calculated by 1-year mortality CAN scores increased in the first year of the COVID-19 pandemic when compared with a recovering trend the previous year.
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Affiliation(s)
- Nalini S Bhalla
- Phoenix Veterans Affairs Health Care System, Arizona
- University of Arizona College of Medicine, Phoenix
| | - Janet Fawcett
- Phoenix Veterans Affairs Health Care System, Arizona
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Manolitsis I, Feretzakis G, Katsimperis S, Angelopoulos P, Loupelis E, Skarmoutsou N, Tzelves L, Skolarikos A. A 2-Year Audit on Antibiotic Resistance Patterns from a Urology Department in Greece. J Clin Med 2023; 12:jcm12093180. [PMID: 37176622 PMCID: PMC10178956 DOI: 10.3390/jcm12093180] [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: 03/01/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The high incidence of urinary tract infections (UTIs), often in nosocomial environments, is a major cause of antimicrobial resistance (AMR). The dissemination of antibiotic-resistant infections results in very high health and economic burdens for patients and healthcare systems, respectively. This study aims to determine and present the antibiotic resistance profiles of the most common pathogens in a urology department in Greece. METHODS During the period 2019-2020, we included 12,215 clinical samples of blood and urine specimens that tested positive for the following pathogens: Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, or Pseudomonas aeruginosa, as these are the most commonly encountered microbes in a urology department. RESULTS The analysis revealed a 22.30% mean resistance rate of E. coli strains with a 76.42% resistance to ampicillin and a 54.76% resistance rate to ciprofloxacin in the two-year period. It also showed an approximately 19% resistance rate of P. mirabilis strains and a mean resistance rate of 46.205% of K. pneumoniae strains, with a decreasing trend during the four semesters (p-value < 0.001), which presented an 80% resistance rate to ampicillin/sulbactam and 73.33% to ciprofloxacin. The resistance to carbapenems was reported to be 39.82%. The analysis revealed a 24.17% mean resistance rate of P. aeruginosa with a declining rate over the two-year period (p-value < 0.001). The P. aeruginosa strains were 38% resistant to fluoroquinolones and presented varying resistance against carbapenems (31.58% against doripenem and 19.79% against meropenem). Regarding the Enteroccocal strains, a 46.91% mean resistance was noted for E. faecium with 100% resistance to ampicillin, and a 24.247% mean resistance rate for E. faecalis strains that were 41% resistant to ciprofloxacin. Both types showed 100% sensitivity to linezolid. CONCLUSIONS The dissemination of antibiotic-resistant pathogens poses the need to implement surveillance programs and, consequently, to develop strategies to prevent the emergence of such pathogens in order to optimize patient outcomes.
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Affiliation(s)
- Ioannis Manolitsis
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, 26335 Patras, Greece
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, 15126 Marousi, Greece
| | | | | | | | | | - Lazaros Tzelves
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
| | - Andreas Skolarikos
- Second Department of Urology, Sismanogleio General Hospital, 15126 Marousi, Greece
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Semprini J. Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States. Int J Dent 2023; 2023:5601447. [PMID: 37143852 PMCID: PMC10154088 DOI: 10.1155/2023/5601447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/01/2023] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
Background American adults delay dental care more than any other healthcare service. Unfortunately, the COVID-19 pandemic may have stalled efforts to address dental service delays. Early evidence has suggested substantial declines in dental service visits in the early phase of the pandemic; however, our study is among the first to measure within-person changes from 2019 to 2020 and conduct subgroup analyses to examine if changing dental patterns were mediated by exposure to the pandemic, risk of adverse COVID-19 outcomes, or dental insurance. Methods We analyzed a National Health Interview Survey panel of individuals initially surveyed in 2019, with subsequent follow-up in 2020. The outcomes included dental service access measures and the interval of a most recent dental visit. By constructing a probability-weighted linear regression model with fixed-effects, we estimated the average within-person change from 2019 to 2020. Robust standard errors were clustered within each respondent. Results From 2019 to 2020, adults reported a 4.6%-point reduction in the probability of visiting the dentist (p < 0.001). Significantly higher declines were found in Northeast and West regions compared to Midwest and South regions. We find no evidence that declining dental services in 2020 were associated with more chronic diseases, older age, or lack of dental insurance coverage. Adults did not report more financial or nonfinancial access barriers to dental care in 2020 compared to 2019. Conclusions The long-term effects of the COVID-19 pandemic on delayed dental care warrant continued monitoring as policymakers aim to mitigate the pandemic's negative consequences on oral health equity.
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Affiliation(s)
- Jason Semprini
- University of Iowa College of Public Health, Iowa City, USA
- University of Iowa College of Dentistry, Iowa City, USA
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13
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Endaryanto A, Dewi A, Kusbaryanto, Nugraha RA. Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in surabaya, Indonesia. Heliyon 2023; 9:e15122. [PMID: 37035376 PMCID: PMC10065813 DOI: 10.1016/j.heliyon.2023.e15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/11/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background COVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms. Objective To determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances. Methods A retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9. Results There was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (β = 0.132, P < 0.001), as well as clinical outcomes (β = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (β = -0.020, P < 0.001), as well as clinical outcomes (β = -0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with β = 0.135, P < 0.001; and in the adult patients with β = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (β = -0.093, P < 0.001) and adult patient (β = -0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (β = -0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q2 = 0.215) and financial outcomes (Q2 = 0.462). The adult structural model effectively predicted clinical outcomes (Q2 = 0.06) and financial outcomes (Q2 = 0.472). Conclusion The conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.
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14
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Aksamit T, Wu J, Hassan M, Achter E, Chatterjee A. Impact of initiation of amikacin liposome inhalation suspension on hospitalizations and other healthcare resource utilization measures: a retrospective cohort study in real-world settings. BMC Pulm Med 2022; 22:461. [PMID: 36463137 PMCID: PMC9719199 DOI: 10.1186/s12890-022-02257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mycobacterium avium complex lung disease (MAC-LD) is an infection that is increasing in frequency, associated with substantial disease burden, and often refractory to treatment. Amikacin liposome inhalation suspension (ALIS) is the first therapy approved for refractory MAC-LD. In the CONVERT study of adult patients with refractory MAC-LD, adding ALIS to a multidrug background regimen showed evidence of MAC infection elimination in sputum by month 6, which was maintained in most patients through the end of treatment (≤ 12 months post-conversion). This study assessed changes in healthcare resource utilization (HCRU) among patients initiating ALIS in real-world settings. METHODS This retrospective cohort study of the All-Payer Claims Database (October 2018-April 2020) included patients aged ≥ 18 years with ≥ 1 pharmacy claim for ALIS and ≥ 12 months of continuous health plan enrollment pre- and post-ALIS initiation. Respiratory disease-related (and all-cause) HCRU (hospitalizations, length of stay [LOS], emergency department [ED] visits, and outpatient office visits) were compared 12 months pre- and post-ALIS initiation. Outcomes were reported at 6-month intervals; 0-6 months pre-ALIS initiation was the reference period for statistical comparisons. RESULTS A total of 331 patients received ALIS, with HCRU highest in the 6 months pre-ALIS initiation. Compared with 26.9% during the reference period, respiratory-related hospitalizations decreased to 19.3% (P < 0.01) and 15.4% (P < 0.0001) during 0-6 and 7-12 months post-ALIS initiation, respectively. Mean number of respiratory disease-related hospitalizations per patient/6-month period decreased from 1.0 (reference period) to 0.6 (P < 0.0005) at both timepoints post-ALIS initiation. A similar pattern was observed for all-cause hospitalizations and hospitalizations per patient/6-month period (both P < 0.005). Reductions in all-cause and respiratory disease-related LOS post-ALIS initiation were significant (both P < 0.05). ED visits were few and unchanged during the study. Significant reductions per patient/6-month period in all-cause and respiratory-related outpatient office visits were observed post-ALIS initiation (all P < 0.01). CONCLUSIONS In this first real-world study of ALIS, respiratory disease-related (and all-cause) hospitalizations and outpatient visits were reduced in the 12 months following ALIS initiation. The results of this study provide HCRU-related information to better understand the impact of initiating ALIS treatment. TRIAL REGISTRATION Not appliable.
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Affiliation(s)
- Timothy Aksamit
- grid.66875.3a0000 0004 0459 167XPulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN USA
| | - Jasmanda Wu
- grid.418728.00000 0004 0409 8797Insmed Incorporated, Bridgewater, NJ USA
| | - Mariam Hassan
- grid.418728.00000 0004 0409 8797Insmed Incorporated, Bridgewater, NJ USA
| | | | - Anjan Chatterjee
- grid.418728.00000 0004 0409 8797Insmed Incorporated, Bridgewater, NJ USA
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15
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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16
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Cassell K, Zipfel CM, Bansal S, Weinberger DM. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017-2021. Nat Commun 2022; 13:5930. [PMID: 36209210 PMCID: PMC9546751 DOI: 10.1038/s41467-022-33686-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
COVID-19 pandemic-related shifts in healthcare utilization, in combination with trends in non-COVID-19 disease transmission and non-pharmaceutical intervention use, had clear impacts on rates of hospitalization for infectious and chronic diseases. Using a U.S. national healthcare billing database, we estimated the monthly incidence rate ratio of hospitalizations between March 2020 and June 2021 according to 19 ICD-10 diagnostic chapters and 189 subchapters. The majority of primary diagnoses for hospitalization showed an immediate decline in incidence during March 2020. Hospitalizations for reproductive neoplasms, hypertension, and diabetes returned to pre-pandemic levels during late 2020 and early 2021, while others, like those for infectious respiratory disease, did not return to pre-pandemic levels during this period. Our assessment of subchapter-level primary hospitalization codes offers insight into trends among less frequent causes of hospitalization during the COVID-19 pandemic in the U.S.
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Affiliation(s)
- Kelsie Cassell
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Casey M Zipfel
- Department of Biology, Georgetown University, Washington, DC, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington, DC, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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17
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Na L. Characteristics of community-dwelling older individuals who delayed care during the COVID-19 pandemic. Arch Gerontol Geriatr 2022; 101:104710. [PMID: 35500472 PMCID: PMC9044630 DOI: 10.1016/j.archger.2022.104710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Ling Na
- School of Population Health, University of Toledo, Toledo, OH 43606, USA.
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18
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Hangartner N, Di Gangi S, Elbl C, Senn O, Bisatz F, Fehr T. Impact of the COVID-19 pandemic on emergency outpatient consultations and admissions of non-COVID-19 patients (ECCO)—A cross-sectional study. PLoS One 2022; 17:e0269724. [PMID: 35687575 PMCID: PMC9187104 DOI: 10.1371/journal.pone.0269724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
During the first year of the COVID-19 pandemic, healthcare facilities worldwide struggled to adequately care for the increasing number of COVID-19 patients while maintaining quality of care for all other patients. The aim of this study was to investigate the displacement and underuse of non-COVID-19 patient care in a medical department of a tertiary hospital in Switzerland. In this retrospective cross-sectional study, internal medicine admissions from 2017 to 2020, emergency outpatient visits from 2019 to 2020 and COVID-19 admissions in 2020 were analyzed and compared using a regression model. Internal medicine admissions were also stratified by diagnosis. A questionnaire was used to assess the pandemic experience of local general practitioners, referring hospitals, and nursing homes. The total number of admissions decreased during the 1st and 2nd waves of the pandemic but increased between the two waves. Elective admissions decreased in 2020 compared to pre-pandemic years: they represented 25% of total admissions in 2020 versus 30% of the total admissions during 2017–2019, p <0.001. Admissions for emergency reasons increased: 71% in 2020 versus 65% in 2017–2019, p < 0.001. Emergency outpatient consultations decreased in 2020 compared to 2019, 62.77 (14.70), mean (SD), weekly visits in 2020 versus 74.13 (13.98) in 2019, p<0.001. Most general practitioners and heads of referring hospitals also reported a decrease in consultations, especially during the 1st wave of the pandemic. Mental illnesses, anxiety or burn-out were perceived in both patients and staff in general practices and nursing homes. In conclusion, the COVID-19 pandemic negatively affected the care of non-COVID-19 patients, particularly those with chronic illnesses. A shift of health care resources from non-COVID patients to COVID patients was observed. These findings could help institutions better manage such a situation in the future.
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Affiliation(s)
- Nina Hangartner
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Elbl
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Oliver Senn
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Fadri Bisatz
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
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19
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Tang W, Inzerillo S, Weiner J, Khalili L, Barasch J, Gartshteyn Y, Dall'Era M, Aranow C, Mackay M, Askanase A. The Impact of Telemedicine on Rheumatology Care. Front Med (Lausanne) 2022; 9:876835. [PMID: 35669922 PMCID: PMC9163385 DOI: 10.3389/fmed.2022.876835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background The pandemic disrupted the care of patients with rheumatic diseases; difficulties in access to care and its psychological impact affected quality of life. Telemedicine as an alternative to traditional face-to-face office visits has the potential to mitigate this impact. Objective To evaluate patient and provider experience with telemedicine and its effect on care. Methods We surveyed patients with rheumatic diseases and their rheumatology providers. The surveys were conducted in 2020 and repeated in 2021. We assessed data on quality of care and health-related quality of life. Results Hundred patients and 17 providers responded to the survey. Patients reported higher satisfaction with telemedicine in 2021 compared to 2020 (94 vs. 84%), felt more comfortable with (96 vs. 86%), expressed a stronger preference for (22 vs. 16%), and higher intention to use telemedicine in the future (83 vs. 77%); patients thought physicians were able to address their concerns. While providers' satisfaction with telemedicine increased (18–76%), 14/17 providers believed that telemedicine visits were worse than in-person visits. There were no differences in annualized office visits and admissions. Mean EQ-5D score was 0.74, lower than general population (0.87) but equivalent to a subset of patients with SLE (0.74). Conclusion Our data showed a high level of satisfaction with telemedicine. The lower rheumatology provider satisfaction raises concern if telemedicine constitutes an acceptable alternative to in-person care. The stable number of office visits, admissions, and the similar quality of life to pre-pandemic level suggest effective management of rheumatic diseases using telemedicine/in-person hybrid care.
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Affiliation(s)
- Wei Tang
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Sean Inzerillo
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Julia Weiner
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Leila Khalili
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Julia Barasch
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Yevgeniya Gartshteyn
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Maria Dall'Era
- Lupus Clinic and Rheumatology Clinical Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Cynthia Aranow
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Meggan Mackay
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Anca Askanase
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Anca Askanase
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20
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Serapide F, Quirino A, Scaglione V, Morrone HL, Longhini F, Bruni A, Garofalo E, Matera G, Marascio N, Scarlata GGM, Cicino C, Russo A, Trecarichi EM, Torti C. Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19? Microorganisms 2022; 10:microorganisms10050957. [PMID: 35630400 PMCID: PMC9146770 DOI: 10.3390/microorganisms10050957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic may have had an effect on antimicrobial resistance. We compared the prevalence of ESKAPE multidrug-resistant (MDR) bacterial infections in COVID-19 affected/unaffected patients admitted to intensive care units (ICU) or infectious disease units at the “Mater Domini” University Hospital of Catanzaro between 1 March 2020 and 31 July 2021. Moreover, an analysis of MDR rates in ICU comparing the pre-pandemic period with the pandemic period was performed, and the possible consequence on in-hospital mortality was explored. One hundred and eighty-four ESKAPE isolates were analyzed from 362 SARS-CoV-2 positive and 199 negative patients. In total, 116 out of 171 Gram-negative isolates were classified as MDR, and a higher frequency was observed in COVID-19 compared with non-COVID-19 patients (74.2% vs. 60.3%; p = 0.052). A higher rate of MDR ESKAPE bacteria was observed in COVID-19 patients admitted to the ICU compared with COVID-19 unaffected patients admitted to the same ward in 2019 (88% vs. 80.4%; p = 0.186). Acinetobacter baumannii was the main pathogen in COVID-19 patients (58.7%), where it was the most frequent cause of bloodstream infection with the highest mortality rate (68.7%). Increase in MDR appeared to be associated with COVID-19 but only in the ICU setting. Acinetobacter baumannii was associated with the risk of death, indicating the importance of implementing infection control measures urgently.
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Affiliation(s)
- Francesca Serapide
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University, 88110 Catanzaro, Italy; (A.Q.); (G.M.); (N.M.); (G.G.M.S.); (C.C.)
| | - Vincenzo Scaglione
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Correspondence: ; Tel.: +39-0961-364-7833
| | - Helen Linda Morrone
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Federico Longhini
- Unit of Intensive Care, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.L.); (A.B.); (E.G.)
| | - Andrea Bruni
- Unit of Intensive Care, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.L.); (A.B.); (E.G.)
| | - Eugenio Garofalo
- Unit of Intensive Care, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.L.); (A.B.); (E.G.)
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University, 88110 Catanzaro, Italy; (A.Q.); (G.M.); (N.M.); (G.G.M.S.); (C.C.)
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University, 88110 Catanzaro, Italy; (A.Q.); (G.M.); (N.M.); (G.G.M.S.); (C.C.)
| | - Giuseppe Guido Maria Scarlata
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University, 88110 Catanzaro, Italy; (A.Q.); (G.M.); (N.M.); (G.G.M.S.); (C.C.)
| | - Claudia Cicino
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University, 88110 Catanzaro, Italy; (A.Q.); (G.M.); (N.M.); (G.G.M.S.); (C.C.)
| | - Alessandro Russo
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (F.S.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
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21
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Cassell K, Zipfel CM, Bansal S, Weinberger DM. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017 â€" 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.04.26.22274301. [PMID: 35547844 PMCID: PMC9094108 DOI: 10.1101/2022.04.26.22274301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
COVID-19 pandemic-related shifts in healthcare utilization, in combination with trends in non-COVID-19 disease transmission and NPI use, had clear impacts on infectious and chronic disease hospitalization rates. Using a national healthcare billing database (C19RDB), we estimated the monthly incidence rate ratio of hospitalizations between March 2020 and June 2021 according to 19 ICD-10 diagnostic chapters and 189 subchapters. The majority of hospitalization causes showed an immediate decline in incidence during March 2020. Hospitalizations for diagnoses such as reproductive neoplasms, hypertension, and diabetes returned to pre-pandemic norms in incidence during late 2020 and early 2021, while others, like those for infectious respiratory disease, never returned to pre-pandemic norms. These results are crucial for contextualizing future research, particularly time series analyses, utilizing surveillance and hospitalization data for non-COVID-19 disease. Our assessment of subchapter level primary hospitalization codes offers new insight into trends among less frequent causes of hospitalization during the COVID-19 pandemic.
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Affiliation(s)
- Kelsie Cassell
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
| | - Casey M Zipfel
- Department of Biology, Georgetown University, Washington DC, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington DC, USA
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
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22
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Aykent K, Kirolos G, Khan M, Moza A. Fear of COVID-19 leading to late presenting myocardial infarction complicated by cardiogenic shock due to ventricular septal rupture. BMJ Case Rep 2022; 15:15/4/e248592. [PMID: 35414580 PMCID: PMC9006830 DOI: 10.1136/bcr-2021-248592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Post myocardial ventricular septal rupture (VSR) is one of the most fatal complications of acute myocardial infarction (AMI) in spite of percutaneous and surgical closure. With the advancement of percutaneous coronary interventions in a timely manner, incidence of post MI VSR has declined remarkably. However, the COVID-19) pandemic-related late hospital presentations with AMI increases the possibilities of a potential upward shift in the incidence of post MI VSR. This case report aimed to increase awareness of negative contributions of the current pandemic to AMI and its fatal complications.
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Affiliation(s)
- Kazim Aykent
- Michigan State University/McLaren Flint, Department of Cardiovascular Medicine, McLaren Health Care Corp, Flint, Michigan, USA
| | - Gergis Kirolos
- Michigan State University/McLaren Flint, Department of Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA
| | - Mahin Khan
- Michigan State University/McLaren Flint, Department of Cardiovascular Medicine, McLaren Health Care Corp, Flint, Michigan, USA
| | - Ankush Moza
- Michigan State University/McLaren Flint, Department of Cardiovascular Medicine, McLaren Health Care Corp, Flint, Michigan, USA
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