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Mendlovic J, Mimouni FB. Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study. Interact J Med Res 2024; 13:e41749. [PMID: 38981116 PMCID: PMC11267089 DOI: 10.2196/41749] [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: 08/07/2022] [Revised: 12/06/2023] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting. OBJECTIVE This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel. METHODS We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients. RESULTS During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)-backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001). CONCLUSIONS Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy.
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Affiliation(s)
- Joseph Mendlovic
- Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
- Associate Director General Office, Israel Ministry of Health, Jerusalem, Israel
| | - Francis B Mimouni
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Leumit Health Service, Tel Aviv, Israel
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Salaj D, Schultz T, Strang P. Nursing Home Residents With Dementia at End of Life: Emergency Department Visits, Hospitalizations, and Acute Hospital Deaths. J Palliat Med 2024; 27:24-30. [PMID: 37504957 DOI: 10.1089/jpm.2023.0201] [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] [Indexed: 07/29/2023] Open
Abstract
Background: Most nursing home (NH) residents do not benefit from health care at an emergency room (ER) or inpatient care at an emergency hospital during the end-of-life period. Therefore, a low number of unplanned admissions during the last month of life are considered good quality of care. Objectives: This study examined ER visits, hospital admissions, and place of death in NH residents with and without dementia in the last month of life, with the aim of answering the question, "Are NH residents with dementia provided with equal health care in their last stage of life?" Design: An observational retrospective study of registry data from all NH residents who died during the years 2015-2019, using health care consumption data from the Stockholm Regional Council, Sweden. Results: Dementia was associated with a higher adjusted odds ratio (aOR) for ER visits (aOR 1.32, p < 0.0001) and acute admissions (aOR 1.30, p < 0.0001) (logistic regression, including sensitivity analysis). Being male, young, and having multiple comorbidities (Charlson Comorbidity Index) and frailty (Hospital Frailty Risk Score) were all independently associated with higher aORs for the same outcomes and also with hospital deaths. Conclusion: Dementia is associated with increased ER referrals and acute in-hospital care. Comorbidities and frailty were strongly associated with an increase in hospital deaths. In addition, men are sent to emergency hospitals more frequently than women, and older residents are sent to the hospital to a lesser extent than younger residents, which cannot be explained by the factors studied.
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Affiliation(s)
- Dag Salaj
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Schultz
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Ojelade E, Koris J, Van-Hove M, Gray WK, Briggs TWR, Hutton M. Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England: Retrospective Analysis of an Administrative Dataset. Global Spine J 2023:21925682231203651. [PMID: 37791603 DOI: 10.1177/21925682231203651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of an administrative dataset. OBJECTIVE This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England. METHODS Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within one year of the first. The exposure of interest was two injections within 180 days or three within one year. Patients aged <17 years and where the body site was listed as cervical, thoracic or sacral were excluded. RESULTS Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180 days or three injections within one year. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the five years, enough to power 2,575 average UK homes for 1 year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20. CONCLUSIONS The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.
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Affiliation(s)
- Elizabeth Ojelade
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jacob Koris
- Getting It Right First Time Programme, NHS England, London, UK
- FMLM National Medical Director's Clinical Fellow, NHS England, London, UK
- Orthopaedic Surgery, John Radcliffe Hospital, Oxford, UK
| | - Maria Van-Hove
- Getting It Right First Time Programme, NHS England, London, UK
- Clinical Fellow, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK
| | - Tim W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mike Hutton
- Getting It Right First Time Programme, NHS England, London, UK
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Capraru ID, Vulcanescu DD, Bagiu IC, Horhat FG, Popescu IM, Baditoiu LM, Muntean D, Licker M, Radulescu M, Mot IC, Diaconu MM, Marian C. COVID-19 Biomarkers Comparison: Children, Adults and Elders. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050877. [PMID: 37241109 DOI: 10.3390/medicina59050877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: this study aimed to research links between C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinekinase (CK), 25-OH vitamin D (25-OHD), ferritin (FER), high-density lipoprotein cholesterol (HDL)cholesterol and clinical severity in patients from the western part of Romania, and compare their potential use as biomarkers for intensive care units (ICU) admission and death in children, adults and elders. Materials and Methods: this study is a retrospective cohort study, performed on patients positively diagnosed with COVID-19. Available CRP, LDH, CK 25-OH vitamin D, ferritin, HDL cholesterol and clinical severity were recorded. The following were assessed: median group differences, association, correlation and receiver operating characteristic. Results: 381 children, 614 adults and 381 elders were studied between 1 March 2021 and 1 March 2022. Most children and adults presented mild symptomatology (53.28%, 35.02%, respectively), while most elders presented severe symptomatology (30.04%). ICU admission was 3.67% for children, 13.19% for adults and 46.09% for elders, while mortality was 0.79% for children, 8.63% for adults and 25.1% for elders. With the exception of CK, all other biomarkers showed some significant associations with clinical severity, ICU admission and death. Conclusions: CRP, LDH, 25-OH vitamin D, ferritin and HDL are important biomarkers for COVID-19 positive patients, especially in the pediatric population, while CK was mostly within normal ranges.
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Affiliation(s)
- Ionut Dragos Capraru
- Department of Epidemiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
| | - Dan Dumitru Vulcanescu
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
- Clinical Laboratory, Emergency Hospital for Children "Louis Turcanu", 300011 Timișoara, Romania
| | - Iulia Cristina Bagiu
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
- Clinical Laboratory, Emergency Hospital for Children "Louis Turcanu", 300011 Timișoara, Romania
| | - Florin George Horhat
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
- Clinical Laboratory, Emergency Hospital for Children "Louis Turcanu", 300011 Timișoara, Romania
| | - Irina Maria Popescu
- Department of Epidemiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
| | - Luminita Mirela Baditoiu
- Department of Epidemiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
| | - Delia Muntean
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
- Microbiology Laboratory, "Pius Brinzeu" County Clinical Emergency Hospital, No. 156 L. Rebreanu, 300723 Timisoara, Romania
| | - Monica Licker
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
- Microbiology Laboratory, "Pius Brinzeu" County Clinical Emergency Hospital, No. 156 L. Rebreanu, 300723 Timisoara, Romania
| | - Matilda Radulescu
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
| | - Ion Cristian Mot
- ENT Department, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Mircea Mihai Diaconu
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Marian
- Department of Biochemistry, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timisoara, Romania
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