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Howard DH, David G. Hospital ownership and admission rates from the emergency department, evidence from Florida. Health Serv Res 2024; 59:e14254. [PMID: 37875259 PMCID: PMC10915481 DOI: 10.1111/1475-6773.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department. DATA SOURCES We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019. STUDY DESIGN We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument. DATA COLLECTION/EXTRACTION METHODS Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults. PRINCIPAL FINDINGS Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009. CONCLUSION Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.
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Affiliation(s)
- David H. Howard
- Department of Health Policy and ManagementEmory UniversityAtlantaGeorgiaUSA
| | - Guy David
- Department of Health Care ManagementUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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2
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Harris E. "Safe" Levels of Air Pollution Tied to More Hospitalizations, Diseases. JAMA 2024; 331:1002. [PMID: 38446443 DOI: 10.1001/jama.2024.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Papaioannu Borjesson R, Galli L, Lolatto R, Menzaghi B, Feasi M, Gulminetti R, Fornabaio C, Cattelan AM, Bonora S, Lagi F, Zazzi M, Castagna A, Spagnuolo V. Lower aids-related hospitalizations in women living with HIV multidrug resistance. AIDS 2024; 38:435-438. [PMID: 38300163 DOI: 10.1097/qad.0000000000003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | - Laura Galli
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Riccardo Lolatto
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio
| | | | - Roberto Gulminetti
- Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Torino
| | - Filippo Lagi
- Infectious and Tropical diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Vincenzo Spagnuolo
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
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McCormick N, Yokose C, Challener GJ, Joshi AD, Tanikella S, Choi HK. Serum Urate and Recurrent Gout. JAMA 2024; 331:417-424. [PMID: 38319333 PMCID: PMC10848075 DOI: 10.1001/jama.2023.26640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
Importance Approximately 12 million adults in the US have a history of gout, but whether serum urate levels can help predict recurrence is unclear. Objective To assess associations of a single serum urate measurement with subsequent risk of acute gout flares and subsequent risk of hospitalizations for gout among patients in the UK with a history of gout. Design, Setting, and Participants This retrospective study included patients with a history of gout identified from the UK between 2006 and 2010 who were followed up through Primary Care Linked Data medical record linkage until 2017 and through the Hospital Episode Statistics database until 2020. Exposures Serum urate levels at enrollment. Main Outcome and Measure Rate of recurrent acute gout, ascertained by hospitalization, outpatient, and prescription/procedure records, and adjusted rate ratios using negative binomial regressions. Results Among 3613 patients with gout (mean age, 60 years; 3104 [86%] men), 1773 gout flares occurred over a mean follow-up of 8.3 years. Of these, 1679 acute gout flares (95%) occurred in people with baseline serum urate greater than or equal to 6 mg/dL and 1731 (98%) occurred in people with baseline serum urate greater than or equal to 5 mg/dL. Rates of acute gout flares per 1000 person-years were 10.6 for participants with baseline urate levels less than 6 mg/dL, 40.1 for levels of 6.0 to 6.9 mg/dL, 82.0 for levels of 7.0 to 7.9 mg/dL, 101.3 for levels of 8.0 to 8.9 mg/dL, 125.3 for urate levels of 9.0 to 9.9 mg/dL, and 132.8 for levels greater than or equal to 10 mg/dL. Rate ratio of flares were 1.0, 3.37, 6.93, 8.67, 10.81, and 11.42, respectively, over 10 years (1.61 [1.54-1.68] per mg/dL). Rates of hospitalization per 1000 person-years during follow-up were 0.18 for those with baseline serum urate less than 6 mg/dL, 0.97 for serum urate of 6.0 to 6.9 mg/dL, 1.8 for serum urate of 7.0 to 7.9 mg/dL, 2.2 for serum urate of 8.0 to 8.9 mg/dL, 6.7 for serum urate of 9.0 to 9.9 mg/dL, and 9.7 for serum urate greater than or equal to 10 mg/dL. Rate ratios of hospitalization for gout, adjusting for age, sex, and race were 1.0, 4.70, 8.94, 10.37, 33.92, and 45.29, respectively (1.87 [1.57-2.23] per mg/dL). Conclusions and Relevance In this retrospective study of patients with a history of gout, serum urate levels at baseline were associated with the risk of subsequent gout flares and rates of hospitalization for recurrent gout. These findings support using a baseline serum urate level to assess risk of recurrent gout over nearly 10 years of follow-up.
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Affiliation(s)
- Natalie McCormick
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Chio Yokose
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gregory J. Challener
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Amit D. Joshi
- Channing Division of Network Medicine, Boston, Massachusetts
| | - Sruthi Tanikella
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Hyon K. Choi
- Rheumatology & Allergy Clinical Epidemiology Research Center, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia, Canada
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [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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Kannan S, Bruch JD, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA 2023; 330:2365-2375. [PMID: 38147093 PMCID: PMC10751598 DOI: 10.1001/jama.2023.23147] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/22/2023] [Indexed: 12/27/2023]
Abstract
Importance The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. Objective To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Design, Setting, and Participants Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes. Main Outcomes and Measures Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions). Results Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge. Conclusions and Relevance Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
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Affiliation(s)
- Sneha Kannan
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Joseph Dov Bruch
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Center for Primary Care, Harvard Medical School, Harvard University, Boston, Massachusetts
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Menezes-Filho N, Komatsu BK, Villares L. The impacts of COVID-19 hospitalizations on non-COVID-19 deaths and hospitalizations: A panel data analysis using Brazilian municipalities. PLoS One 2023; 18:e0295572. [PMID: 38096258 PMCID: PMC10721066 DOI: 10.1371/journal.pone.0295572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity, and a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases. We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level. Our estimates imply that 100 more hospitalizations by COVID-19 is associated with a drop of 49 non-COVID-19 hospitalizations and an additional four deaths for other reasons (all measured per 100,000 pop.). The impact of intensive care units COVID-19 hospitalizations on mortality is larger. The groups most affected are the African Brazilians, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were diseases related to the circulatory and endocrine system. The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population. Our results highlight the importance of promoting the awareness of heightened risk of non-communicable chronic diseases during a health emergency context. This should be done preferably through already established channels with community outreach, such as the Family Health Program in Brazil.
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Affiliation(s)
- Naercio Menezes-Filho
- Ruth Cardoso Chair, Insper, São Paulo, São Paulo, Brazil
- School of Economics, Business, and Accounting, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luana Villares
- Ruth Cardoso Chair, Insper, São Paulo, São Paulo, Brazil
- School of Economics, Business, and Accounting, University of São Paulo, São Paulo, São Paulo, Brazil
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Rubens M, Ramamoorthy V, Saxena A, Zevallos JC, Pelaez JGR, Ahmed MA, Zhang Z, McGranaghan P, Chaparro S, Jimenez J. Racial difference in mortality among COVID-19 hospitalizations in California. Sci Rep 2023; 13:21378. [PMID: 38049452 PMCID: PMC10696031 DOI: 10.1038/s41598-023-47124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
In the US, racial disparities in hospital outcomes are well documented. We explored whether race was associated with all-cause in-hospital mortality and intensive care unit (ICU) admission among COVID-19 patients in California. This was a retrospective analysis of California State Inpatient Database during 2020. Hospitalizations ≥ 18 years of age for COVID-19 were included. Cox proportional hazards with mixed effects were used for associations between race and in-hospital mortality. Logistic regression was used for the association between race and ICU admission. Among 87,934 COVID-19 hospitalizations, majority were Hispanics (56.5%), followed by White (27.3%), Asian, Pacific Islander, Native American (9.9%), and Black (6.3%). Cox regression showed higher mortality risk among Hispanics, compared to Whites (hazard ratio, 0.91; 95% CI 0.87-0.96), Blacks (hazard ratio, 0.87; 95% CI 0.79-0.94), and Asian, Pacific Islander, Native American (hazard ratio, 0.89; 95% CI 0.83-0.95). Logistic regression showed that the odds of ICU admission were significantly higher among Hispanics, compared to Whites (OR, 1.70; 95% CI 1.67-1.74), Blacks (OR, 1.70; 95% CI 1.64-1.78), and Asian, Pacific Islander, Native American (OR, 1.82; 95% CI 1.76-1.89). We found significant disparities in mortality among COVID-19 hospitalizations in California. Hispanics were the worst affected with the highest mortality and ICU admission rates.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA
| | - Juan Carlos Zevallos
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA
| | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Germany.
- Advance Heart Failure and Pulmonary Hypertension, South Miami Hospital, Baptist Health South, Miami, FL, USA.
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Sandra Chaparro
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 10117, Berlin, Germany.
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Horon I. Characteristics of Mothers Admitted to Intensive Care Units During Hospitalization for Delivery of a Live-born Infant: United States, 2020-2022. NCHS Data Brief 2023:1-7. [PMID: 38085529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Although admission of a mother to an intensive care unit (ICU) during hospitalization for delivery is a relatively rare event, rates of mortality and severe morbidity are high for both mother and child when ICU care is necessary (1-4). Studies on maternal ICU admissions have generally focused on medical diagnoses related to admission, and most have been conducted using international data or data for a hospital or group of hospitals (4-10). Information on demographic characteristics of mothers admitted to ICUs is lacking at the national level. This report describes ICU admissions overall and by race and Hispanic origin, maternal age, live birth order, and plurality for mothers delivering live-born infants in the United States in 2020-2022.
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10
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Danis DO, Palmer WJ, Bachrach K, Tracy LF, Levi JR. Racial Disparity in Tympanostomy Tube Placement in Inpatient Pediatric Admissions. Clin Pediatr (Phila) 2023; 62:1531-1536. [PMID: 37060287 DOI: 10.1177/00099228231167685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This study aims to evaluate if race and ethnicity affect rates of tympanostomy tube (TT) placement during inpatient pediatric admissions in children with otologic conditions. A review of the 2016 Kids' Inpatient Database was conducted based on the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for common otologic conditions. Among 85 827 weighted pediatric inpatient discharges with ICD-10-CM codes for common otologic conditions, 213 underwent TT placement. Odds ratios (ORs) for children of Hispanic ethnicity and Asian or Pacific Islander race undergoing TT placement when compared to other ethnicities and races were 0.60 (P = .011) and 0.21 (P = .040), respectively. Multiple logistic regression showed Hispanic ethnicity was associated with lower rates of TT placement when compared to non-Hispanic white children (OR = 0.62; 95% confidence interval = 0.40-0.96). Future studies should assess why these differences exist and if these differences are associated with racial/ethnic bias or attributed to patient/family preference.
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Affiliation(s)
- David O'Neil Danis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Kevin Bachrach
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Lauren F Tracy
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- School of Medicine, Boston University, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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11
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Owen HE, Wyeth EH, Maclennan B, Barson D, McBride P, Gabbe BJ, Civil I, Derrett S. Cohort profile: The Trauma Outcomes Project, a prospective study of New Zealanders experiencing major trauma. BMJ Open 2023; 13:e075480. [PMID: 38011969 PMCID: PMC10685924 DOI: 10.1136/bmjopen-2023-075480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are useful for trauma registries interested in monitoring patient outcomes and trauma care quality. PROMs had not previously been collected by the New Zealand Trauma Registry (NZTR). More than 2500 New Zealanders are admitted to hospital for major trauma annually. The Trauma Outcomes Project (TOP) collected PROMs postinjury from three of New Zealand's (NZ's) major trauma regions. This cohort profile paper aims to provide a thorough description of preinjury and 6 month postinjury characteristics of the TOP cohort, including specifically for Māori (Indigenous population in Aotearoa me Te Waipounamu/NZ). PARTICIPANTS Between July 2019 and June 2020, 2533 NZ trauma patients were admitted to one of 22 hospitals nationwide for major trauma and included on the NZTR. TOP invited trauma patients (aged ≥16 years) to be interviewed from three regions; one region (Midlands) declined to participate. Interviews included questions about health-related quality of life, disability, injury recovery, healthcare access and household income adequacy. FINDINGS TO DATE TOP recruited 870 participants, including 119 Māori. At 6 months postinjury, most (85%) reported that the injury still affected them, 88% reported problems with≥1 of five EQ-5D-5L dimensions (eg, 75% reported problems with pain or discomfort, 71% reported problems with usual activities and 52% reported problems with mobility). Considerable disability (World Health Organization Disability Assessment Schedule, WHODAS II, score ≥10) was reported by 45% of participants. The prevalence of disability among Māori participants was 53%; for non-Māori it was 44%. Over a quarter of participants (28%) reported trouble accessing healthcare services for their injury. Participation in paid work decreased from 63% preinjury to 45% 6 months postinjury. FUTURE PLANS The 12 and 24 month postinjury data collection has recently been completed; analyses of 12 month outcomes are underway. There is potential for longer-term follow-up interviews with the existing cohort in future. TOP findings are intended to inform the National Trauma Network's quality improvement processes. TOP will identify key aspects that aid in improving postinjury outcomes for people experiencing serious injury, including importantly for Māori.
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Affiliation(s)
- Helen E Owen
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - David Barson
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Paul McBride
- New Zealand Health Quality and Safety Commission, Wellington, New Zealand
| | - Belinda J Gabbe
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian Civil
- New Zealand National Trauma Network, Wellington, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Harris E. Antiseptic Soap, Nasal Spray Reduced Nursing Home Hospitalizations. JAMA 2023; 330:1723. [PMID: 37878336 DOI: 10.1001/jama.2023.20631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
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Miller LG, McKinnell JA, Singh RD, Gussin GM, Kleinman K, Saavedra R, Mendez J, Catuna TD, Felix J, Chang J, Heim L, Franco R, Tjoa T, Stone ND, Steinberg K, Beecham N, Montgomery J, Walters D, Park S, Tam S, Gohil SK, Robinson PA, Estevez M, Lewis B, Shimabukuro JA, Tchakalian G, Miner A, Torres C, Evans KD, Bittencourt CE, He J, Lee E, Nedelcu C, Lu J, Agrawal S, Sturdevant SG, Peterson E, Huang SS. Decolonization in Nursing Homes to Prevent Infection and Hospitalization. N Engl J Med 2023; 389:1766-1777. [PMID: 37815935 DOI: 10.1056/nejmoa2215254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms. METHODS We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone-iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups. RESULTS Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason. CONCLUSIONS In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.).
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Affiliation(s)
- Loren G Miller
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - James A McKinnell
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Raveena D Singh
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Gabrielle M Gussin
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ken Kleinman
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Raheeb Saavedra
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Job Mendez
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Tabitha D Catuna
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - James Felix
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Justin Chang
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Lauren Heim
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ryan Franco
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Thomas Tjoa
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Nimalie D Stone
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Karl Steinberg
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Nancy Beecham
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Jocelyn Montgomery
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - DeAnn Walters
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Steven Park
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Steven Tam
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Shruti K Gohil
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Philip A Robinson
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Marlene Estevez
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Brian Lewis
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Julie A Shimabukuro
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Gregory Tchakalian
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Aaron Miner
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Crystal Torres
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Kaye D Evans
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Cassiana E Bittencourt
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Jiayi He
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Eunjung Lee
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Christine Nedelcu
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Julia Lu
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Shalini Agrawal
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - S Gwynn Sturdevant
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ellena Peterson
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Susan S Huang
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
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14
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Harris E. COVID-19 Hospitalizations Up Among Older Adults. JAMA 2023; 330:1611. [PMID: 37851487 DOI: 10.1001/jama.2023.19796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
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15
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Rosario E, Sharma E, Patel A, Guvensen G, Ashroff R, McClenaghan F, Hariri A, Joseph J. Use of tranexamic acid-soaked NasoPore® in the emergency department, to reduce epistaxis admissions. Clin Otolaryngol 2023; 48:909-914. [PMID: 37614122 DOI: 10.1111/coa.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES The aim of this study was to assess the efficacy of a new emergency department (ED) intervention for the management of non-traumatic, anterior epistaxis in adult patients, aiming to reduce epistaxis admissions. DESIGN A new epistaxis pathway was introduced for use by ED practitioners. This was disseminated in ED through an educational campaign by the ear, nose and throat team. A tranexamic acid (500 mg/5 mL)-soaked NasoPore® packing step was introduced for epistaxis which did not terminate following 10 min of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation periods were defined, and all adults attending ED with non-traumatic, anterior epistaxis were included. Pre- and post-implementation epistaxis treatment interventions, admission rates and re-attendance rates were recorded by retrospective audit and compared. RESULTS In the post-implementation group, epistaxis admissions were 51.7% (p < .05) lower than in the pre-implementation group, as a proportion of the total number attending ED with epistaxis during these periods. CONCLUSIONS The significant reduction in epistaxis admissions demonstrates that this ED intervention is beneficial for patient outcomes.
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Affiliation(s)
- Eleanor Rosario
- Department of Otolaryngology, University College London Hospitals, UK
| | - Ekta Sharma
- Department of Otolaryngology, University College London Hospitals, UK
| | - Ankit Patel
- Department of Otolaryngology, University College London Hospitals, UK
| | | | - Rizal Ashroff
- Accident & Emergency Department, University College London Hospitals, UK
| | - Fiona McClenaghan
- Department of Otolaryngology, University College London Hospitals, UK
| | - Ahmad Hariri
- Department of Otolaryngology, University College London Hospitals, UK
| | - Jonathan Joseph
- Department of Otolaryngology, University College London Hospitals, UK
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16
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Hayashida S, Nagano N, Morohashi T, Momoki E, Nezu K, Shimozawa K, Ishii W, Okahashi A, Morioka I. Clinical factors associated with extended hospitalization in pediatric patients ≥3 years of age with respiratory syncytial virus or human metapneumovirus infection: A Japanese single-center, retrospective study. Medicine (Baltimore) 2023; 102:e35565. [PMID: 37861549 PMCID: PMC10589578 DOI: 10.1097/md.0000000000035565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections are common in children worldwide. However, the clinical factors related to extended hospitalization in Japanese patients aged ≥3 years remain elusive. We aimed to elucidate the clinical risk factors contributing to hospital stays ≥7 days in patients with RSV and hMPV infections. Patients ≥3 years of age who were hospitalized due to RSV or hMPV infection between 2014 to 2020 were included. Twenty-one RSV- and 27 hMPV-infected patients were enrolled. Patients were divided into 2 groups: hospitalization for ≥ and <7 days. Univariate and multivariate analyses determined the clinical risk factors contributing to hospital stay ≥7 days. The RSV- and hMPV-infected patients had similar clinical characteristics. The clinical risk factors contributing to extended hospitalization were analyzed in the 48 infected patients of the 2 groups. The presence of prophylactic antibiotics usage, co-bacterial colonization, and underlying diseases were extracted by univariate analysis (P < .05). In multivariate analysis, underlying diseases were determined as an independent clinical risk factor (odds ratio 8.09, P = .005). Underlying diseases contributed to extended hospitalization in RSV- or hMPV-infected patients ≥3 years of age.
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Affiliation(s)
- Shingo Hayashida
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tamaki Morohashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Emiko Momoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Keiko Nezu
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuyoshi Shimozawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Wakako Ishii
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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17
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Vriz O, Mushtaq AH, Elshaer AN, Shaik A, Landi I, Alzahrani T. Takotsubo Syndrome in Black Americans: Insights From the National Inpatient Sample. Tex Heart Inst J 2023; 50:e228055. [PMID: 37853912 PMCID: PMC10658156 DOI: 10.14503/thij-22-8055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Data on race-related differences in the clinical outcomes of Takotsubo syndrome are limited, particularly for Black patients. This study aimed to assess whether race and sex may have an additional impact on the inpatient mortality of patients with Takotsubo syndrome. METHODS A total of 4,628 patients from the United States' National Inpatient Sample from 2012 to 2016 were identified; propensity score analysis revealed a similar propensity score between Black patients (n = 2,314) and White patients (n = 2,314), which was used to balance observed covariates. Sex and age distributions were identical between the 2 groups. The groups were also similar in baseline characteristics, including cardiovascular risk factors. White patients were compared with Black patients on in-hospital outcomes and inpatient mortality. A logistic regression analysis was conducted to measure the difference in mortality based on race and sex. RESULTS Compared with White patients, Black patients had a higher percentage of in-hospital complications, including cerebrovascular accidents (4.9% vs 2.5%, P ≤ .01), acute kidney injury (25% vs 19%, P ≤ .01); longer lengths of stay (8 vs 7 days, P ≤ .01); and higher inpatient mortality (6.1% vs 4.5%, P < .01). When analysis was conducted with race and sex combined, inpatient mortality was higher among Black men than among White women (odds ratio, 2.7 [95% CI, 1.80-3.95]; P ≤ .01). CONCLUSION This study showed that Black patients with Takotsubo syndrome have higher in-hospital complications and inpatient mortality rates. When race and sex were combined, inpatient mortality was significantly higher among Black men than among either White men and women or Black women.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Cardiology and Sport Medicine, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Ali Hassan Mushtaq
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed Nahid Elshaer
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Talal Alzahrani
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
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18
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Zhang R, Zhang W, Ling J, Dong J, Zhang L, Ruan Y. Association between air temperature and risk of hospitalization for genitourinary disorders: An environmental epidemiological study in Lanzhou, China. PLoS One 2023; 18:e0292530. [PMID: 37819991 PMCID: PMC10566730 DOI: 10.1371/journal.pone.0292530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between air temperature and the risk of hospitalization for genitourinary disorders. METHODS Distributed lag non-linear models (DLNM) were used to estimate the association between air temperature and the risk of hospitalization for genitourinary disorders, with subgroup analysis by gender and age to identify the susceptible population of temperature-sensitive genitourinary system diseases. RESULTS Low mean temperature (MT) (RR = 2.001, 95% CI: 1.856~2.159), high MT (RR = 2.884, 95% CI: 2.621~3.173) and low diurnal temperature range (DTR) (RR = 1.619, 95% CI: 1.508~1.737) were all associated with the increased risk of hospitalization for genitourinary disorders in the total population analysis, and the high MT effect was stronger than the low MT effect. Subgroup analysis found that high MT was more strongly correlated in male (RR = 2.998, 95% CI: 2.623~3.427) and those <65 years (RR = 3.003, 95% CI: 2.670~3.344), and low DTR was more strongly correlated in female (RR = 1.669, 95% CI: 1.510~1.846) and those <65 years (RR = 1.643, 95% CI: 1.518~1.780). CONCLUSIONS The effect of high MT on the risk of hospitalization for genitourinary disorders is more significant than that of low MT. DTR was independently associated with the risk of hospitalization for genitourinary disorders.
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Affiliation(s)
- Runping Zhang
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Wancheng Zhang
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jianglong Ling
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Li Zhang
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Ye Ruan
- School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
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Wu XC, Yu Q, Yi Y, Maniscalco LS, Hsieh MC, Gruber D, Mendoza L, Subbiah S, Sokol T, Shrestha P, Chen VW, Mederos ET, Ochoa A. Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients. J Natl Cancer Inst 2023; 115:1204-1212. [PMID: 37697664 PMCID: PMC10560601 DOI: 10.1093/jnci/djad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients. METHODS We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases. RESULTS Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively. CONCLUSION Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.
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Affiliation(s)
- Xiao-Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health, LSU Health, New Orleans, LA, USA
| | - Yong Yi
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Lauren S Maniscalco
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - DeAnn Gruber
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Lee Mendoza
- Bureau of Health Informatics, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Suki Subbiah
- Section of Hematology-Oncology, School of Medicine, LSU Health, New Orleans, LA, USA
| | - Theresa Sokol
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Pratibha Shrestha
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Vivien W Chen
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Eileen T Mederos
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
| | - Augusto Ochoa
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
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20
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Teixeira RMP, Oliveira JC, de Andrade MAB, Pinheiro FGDMS, Vieira RDCA, Santana-Santos E. Are patient volume and care level in teaching hospitals variables affecting clinical outcomes in adult intensive care units? Einstein (Sao Paulo) 2023; 21:eAO0406. [PMID: 37820201 PMCID: PMC10519666 DOI: 10.31744/einstein_journal/2023ao0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 10/13/2023] Open
Abstract
Teixeira et al. showed that patients admitted to the intensive care unit of a teaching hospital in a non-metropolitan region needed more support, had worse prognostic indices, and had a higher nursing workload in the first 24 hours of admission. In addition, worse outcomes, including mortality, need for dialysis, pressure injury, infection, prolonged mechanical ventilation, and prolonged hospital stay, were observed in the teaching hospital. Worse outcomes were more prevalent in the teaching hospital. Understanding the importance of teaching hospitals to implement well-established care protocols is critical. OBJECTIVE To compare the clinical outcomes of patients admitted to the intensive care unit of teaching (HI) and nonteaching (without an academic affiliation; H2) hospitals. METHODS In this prospective cohort study, adult patients hospitalized between August 2018 and July 2019, with a minimum length of stay of 24 hours in the intensive care unit, were included. Patients with no essential information in their medical records to evaluate the study outcomes were excluded. Resuslts: Overall, 219 patients participated in this study. The clinical and demographic characteristics of patients in H1 and H2 were similar. The most prevalent clinical outcomes were death, need for dialysis, pressure injury, length of hospital stay, mechanical ventilation >48 hours, and infection, all of which were more prevalent in the teaching hospital. CONCLUSION Worse outcomes were more prevalent in the teaching hospital. There was no difference between the institutions concerning the survival rate of patients as a function of length of hospital stay; however, a difference was observed in intensive care unit admissions.
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Affiliation(s)
| | - Jussiely Cunha Oliveira
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
| | | | | | | | - Eduesley Santana-Santos
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
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21
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Yan C, Zhang X, Yang Y, Kang K, Were MC, Embí P, Patel MB, Malin BA, Kho AN, Chen Y. Differences in Health Professionals' Engagement With Electronic Health Records Based on Inpatient Race and Ethnicity. JAMA Netw Open 2023; 6:e2336383. [PMID: 37812421 PMCID: PMC10562942 DOI: 10.1001/jamanetworkopen.2023.36383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Importance US health professionals devote a large amount of effort to engaging with patients' electronic health records (EHRs) to deliver care. It is unknown whether patients with different racial and ethnic backgrounds receive equal EHR engagement. Objective To investigate whether there are differences in the level of health professionals' EHR engagement for hospitalized patients according to race or ethnicity during inpatient care. Design, Setting, and Participants This cross-sectional study analyzed EHR access log data from 2 major medical institutions, Vanderbilt University Medical Center (VUMC) and Northwestern Medicine (NW Medicine), over a 3-year period from January 1, 2018, to December 31, 2020. The study included all adult patients (aged ≥18 years) who were discharged alive after hospitalization for at least 24 hours. The data were analyzed between August 15, 2022, and March 15, 2023. Exposures The actions of health professionals in each patient's EHR were based on EHR access log data. Covariates included patients' demographic information, socioeconomic characteristics, and comorbidities. Main Outcomes and Measures The primary outcome was the quantity of EHR engagement, as defined by the average number of EHR actions performed by health professionals within a patient's EHR per hour during the patient's hospital stay. Proportional odds logistic regression was applied based on outcome quartiles. Results A total of 243 416 adult patients were included from VUMC (mean [SD] age, 51.7 [19.2] years; 54.9% female and 45.1% male; 14.8% Black, 4.9% Hispanic, 77.7% White, and 2.6% other races and ethnicities) and NW Medicine (mean [SD] age, 52.8 [20.6] years; 65.2% female and 34.8% male; 11.7% Black, 12.1% Hispanic, 69.2% White, and 7.0% other races and ethnicities). When combining Black, Hispanic, or other race and ethnicity patients into 1 group, these patients were significantly less likely to receive a higher amount of EHR engagement compared with White patients (adjusted odds ratios, 0.86 [95% CI, 0.83-0.88; P < .001] for VUMC and 0.90 [95% CI, 0.88-0.92; P < .001] for NW Medicine). However, a reduction in this difference was observed from 2018 to 2020. Conclusions and Relevance In this cross-sectional study of inpatient EHR engagement, the findings highlight differences in how health professionals distribute their efforts to patients' EHRs, as well as a method to measure these differences. Further investigations are needed to determine whether and how EHR engagement differences are correlated with health care outcomes.
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Affiliation(s)
- Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yuyang Yang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter Embí
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mayur B. Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research and Education Clinical Center, Veterans Affairs, Tennessee Valley Healthcare System, Nashville
- Division of Acute Care Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley A. Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abel N. Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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22
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Zhang X, Wilkinson A, Storer M, Epton MJ. Impact of COVID-19 and lockdown on COPD admissions to Christchurch Hospital, New Zealand 2020-2021: a combined quantitative and qualitative study. Intern Med J 2023; 53:1768-1775. [PMID: 37548338 DOI: 10.1111/imj.16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND During the year following New Zealand's first COVID-19 lockdown, a 33% reduction in chronic obstructive pulmonary disease (COPD)-related admissions occurred and persisted beyond this period at Christchurch Hospital. AIM To identify contributing factors which may have resulted in a persistent decrease in COPD hospitalisation rates at Christchurch Hospital following the 2020 COVID-19 lockdown. METHODS Using an explanatory sequential mixed-methods research design, we (i) retrospectively analysed hospital admissions and primary healthcare access by people with COPD (n = 1358) in Canterbury before, during and after COVID lockdown (24 March 2019 to 2021) and (ii) undertook individual interviews from a sample of patients (n = 14). RESULTS Patients who were not re-admitted following the COVID-19 lockdown had fewer general practice encounters, acute primary care access, antibiotic and prednisone prescriptions. Proportionally fewer Māori and more Pacific patients were admitted with COPD following lockdown. Positive contributing factors at a primary care level included improvements in primary care interactions and medication management. At a patient and community level, there were improvements in lifestyle, self-management practices, social support and contact precautions. However, a subgroup of patients described negative effects such as social isolation. CONCLUSION A combination of patient, primary care and community-level factors led to an overall persistent decrease in COPD admissions following the COVID-19 lockdown. Future targeted and individualised measures focusing on these modifiable factors may decrease future COPD-related hospital admissions. The study design facilitated further explanation about factors that contributed to the persistent decrease in hospital admissions among people living with COPD and has underscored the importance of social support, patient empowerment and reduction in barriers in accessing care in admission reduction.
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Affiliation(s)
- Xianzhi Zhang
- Respiratory Services, Te Whatu Ora, Waitaha Canterbury, New Zealand
| | - Amanda Wilkinson
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Malina Storer
- Respiratory Services, Te Whatu Ora, Waitaha Canterbury, New Zealand
| | - Michael J Epton
- Respiratory Services, Te Whatu Ora, Waitaha Canterbury, New Zealand
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Ahn HJ. Potential Errors in Health Disparities Research Resulting from Lack of Unique Patient Identifiers: Analysis of Diabetes-related Preventable Hospitalizations. Hawaii J Health Soc Welf 2023; 82:111-116. [PMID: 37901669 PMCID: PMC10612426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
All-payer, population-level hospital discharge data have been used to identify health disparities across racial/ethnic and other demographic groups. However, researchers are often unable to identify unique patients in the data sets if a unique patient identifier is not provided. The lack of the unique patient identifier can result in biased estimates of research outcomes using discharge data. This could then mislead the researchers, public, or policy-makers who utilize such biased results. This study examined estimation bias of health disparities due to rehospitalizations considering diabetes-related preventable hospitalizations using 6 years of state-level data from Hawai'i Health Information Corporation. Different analyses methods showed different probabilities of having multiple visits by age, race/ethnicity and payer subgroups. Charge analysis results also showed that ignoring the multiple visits could result in significance error. For a patient with multiple hospitalizations, rehospitalizations are often dependent upon the discharge status of previous visits, and the independence assumption of the multiple visits may not be appropriate. Ignoring the multiple visits in population-level analyses could result in severe health disparities significance errors. In this hospitalization charge analysis, the Chinese group was not significantly different than the White group (relative risk ratio - RR: [95% CI]: 0.93 [0.80, 1.08]), while the difference was signficant (RR [95% CI]: 0.86 [0.77,0.96]) when the multiple visits were ignored.
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Affiliation(s)
- Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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Hanchate AD, Abdelfattah L, Lin MY, Lasser KE, Paasche-Orlow MK. Affordable Care Act Medicaid Expansion was Associated With Reductions in the Proportion of Hospitalizations That are Potentially Preventable Among Hispanic and White Adults. Med Care 2023; 61:627-635. [PMID: 37582292 PMCID: PMC10894451 DOI: 10.1097/mlr.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Using data on 5 years of postexpansion experience, we examined whether the coverage gains from Affordable Care Act Medicaid expansion among Black, Hispanic, and White individuals led to improvements in objective indicators of outpatient care adequacy and quality. RESEARCH DESIGN For the population of adults aged 45-64 with no insurance or Medicaid coverage, we obtained data on census population and hospitalizations for ambulatory care sensitive conditions (ACSCs) during 2010-2018 in 14 expansion and 7 nonexpansion states. Our primary outcome was the percentage share of hospitalizations due to ACSC out of all hospitalizations ("ACSC share") among uninsured and Medicaid-covered patients. Secondary outcomes were the population rate of ACSC and all hospitalizations. We used multivariate regression models with an event-study difference-in-differences specification to estimate the change in the outcome measures associated with expansion in each of the 5 postexpansion years among Hispanic, Black, and White adults. PRINCIPAL FINDINGS At baseline, ACSC share in the expansion states was 19.0%, 14.5%, and 14.3% among Black, Hispanic, and White adults. Over the 5 years after expansion, Medicaid expansion was associated with an annual reduction in ACSC share of 5.3% (95% CI, -7.4% to -3.1%) among Hispanic and 8.0% (95% CI, -11.3% to -4.5%) among White adults. Among Black adults, estimates were mixed and indicated either no change or a reduction in ACSC share. CONCLUSIONS After Medicaid expansion, low-income Hispanic and White adults experienced a decrease in the proportion of potentially preventable hospitalizations out of all hospitalizations.
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Affiliation(s)
- Amresh D. Hanchate
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Lindsey Abdelfattah
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Karen E. Lasser
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Michael K. Paasche-Orlow
- Division of General Internal Medicine, Department of Medicine, Tufts University School of Medicine, Boston, MA
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25
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Dursun Ergezen F, Çiftçi B, Yalın H, Geçkil E, Korkmaz Doğdu A, İlter SM, Terzi B, Kol E, Kaşıkçı M, Ecevit Alpar Ş. Missed nursing care: A cross-sectional and multi-centric study from Turkey. Int J Nurs Pract 2023; 29:e13187. [PMID: 37604179 DOI: 10.1111/ijn.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
AIM The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors. DESIGN This was a descriptive, cross-sectional, multicentre study. METHODS A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey. RESULTS The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05). CONCLUSION This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.
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Affiliation(s)
- Fatma Dursun Ergezen
- Nursing Faculty, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey
| | - Bahar Çiftçi
- Nursing Faculty, Fundamentals of Nursing Department, Atatürk University, Erzurum, Turkey
| | - Hayat Yalın
- Faculty of Health Sciences, Department of Nursing, Bahçeşehir University, İstanbul, Turkey
| | - Emine Geçkil
- Nursing Faculty, Child Health Nursing Department, Necmettin Erbakan University, Konya, Turkey
| | - Ayşegül Korkmaz Doğdu
- Nursing Faculty, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey
| | - Sümeyra Mihrap İlter
- Faculty of Health Sciences, Nursing, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Banu Terzi
- Nursing Faculty, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey
| | - Emine Kol
- Nursing Faculty, Fundamentals of Nursing Department, Akdeniz University, Antalya, Turkey
| | - Mağfiret Kaşıkçı
- Nursing Faculty, Fundamentals of Nursing Department, Atatürk University, Erzurum, Turkey
| | - Şule Ecevit Alpar
- Faculty of Health Sciences, Nursing, Marmara University, İstanbul, Turkey
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26
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Boustany A, Rahhal R, Mitri J, Onwuzo S, Abou Zeid HK, Baffy G, Martel M, Barkun AN, Asaad I. The impact of nonalcoholic fatty liver disease on inflammatory bowel disease-related hospitalization outcomes: a systematic review. Eur J Gastroenterol Hepatol 2023; 35:1067-1074. [PMID: 37577829 DOI: 10.1097/meg.0000000000002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Evidence suggests that patients with inflammatory bowel disease are at higher risk of developing nonalcoholic fatty liver disease (NAFLD). However, there is limited information currently available on how NAFLD may affect the clinical course of IBD. Thus, we conducted a systematic review to evaluate the impact of NAFLD on IBD-related hospitalization outcomes. All observational studies assessing IBD-related hospitalization outcomes in patients with NAFLD were included. Exclusion criteria were studies published in languages other than English or French, or those involving pediatric population. Outcomes included IBD-related hospitalization and readmission rates, need for surgery, length of stay, inpatient mortality, and costs. Overall, 3252 citations were retrieved and seven studies met the inclusion criteria (1 574 937 patients); all were observational, of high quality, and originated in the United States. Measurable outcomes reported in these studies were few and with insufficient similarity across studies to complete a quantitative assessment. Only one study reports NAFLD severity. Two studies suggested a higher rate of hospitalization for patients with both NAFLD and IBD compared to IBD alone (incidence rate ratio of 1.54; 95% confidence interval: 1.33-1.79). This is the first systematic review to date that evaluates any possible association of NAFLD with IBD-related hospitalization outcomes. Despite the paucity and low quality of available data, our findings indicate that NAFLD may be associated with worse outcomes amongst IBD patients (especially Crohn's disease). Further and higher certainty of evidence is needed for better characterization of such clinical impact.
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Affiliation(s)
- Antoine Boustany
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Romy Rahhal
- Department of Emergency Medicine, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Jad Mitri
- Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | | | | | - György Baffy
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School
- Section of Gastroenterology, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Myriam Martel
- Research Institute of the McGill University Health Center
| | - Alan N Barkun
- Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Imad Asaad
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kohrman A, Lynfield R, Rudin D, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, Swain A, Havers FP, Taylor CA. Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022. Clin Infect Dis 2023; 77:827-838. [PMID: 37132204 DOI: 10.1093/cid/ciad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination. METHODS Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons. RESULTS Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9). CONCLUSIONS Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.
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Affiliation(s)
- Jean Y Ko
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Huong Pham
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Onika Anglin
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Department of Public Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Alexander Kohrman
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Dominic Rudin
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Fiona P Havers
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Christopher A Taylor
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
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Duong KNC, Le LM, Veettil SK, Saidoung P, Wannaadisai W, Nelson RE, Friedrichs M, Jones BE, Pavia AT, Jones MM, Samore MH, Chaiyakunapruk N. Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses. Front Public Health 2023; 11:1206988. [PMID: 37744476 PMCID: PMC10513444 DOI: 10.3389/fpubh.2023.1206988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Background Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. Methods In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805. Results Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Conclusion Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.
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Affiliation(s)
- Khanh N. C. Duong
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Lan M. Le
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Sajesh K. Veettil
- International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia
| | - Pantakarn Saidoung
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | | | - Richard E. Nelson
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Mike Friedrichs
- Utah Department of Health, Salt Lake City, UT, United States
| | - Barbara E. Jones
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Pulmonary & Critical Care, University of Utah, Salt Lake City, UT, United States
| | - Andrew T. Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, UT, United States
| | - Makoto M. Jones
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Matthew H. Samore
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
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29
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Haskell H, Khan A, Landrigan CP. Family-Centered Hospital Admissions. Pediatrics 2023; 152:e2023062108. [PMID: 37584112 DOI: 10.1542/peds.2023-062108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Hosseini-Moghaddam SM, Shepherd FA, Swayze S, Kwong JC, Chan KKW. SARS-CoV-2 Infection, Hospitalization, and Mortality in Adults With and Without Cancer. JAMA Netw Open 2023; 6:e2331617. [PMID: 37651139 PMCID: PMC10472189 DOI: 10.1001/jamanetworkopen.2023.31617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Patients with cancer are at increased risk of SARS-CoV-2-associated adverse outcomes. Objective To determine the associations of tumor type with SARS-CoV-2 infection, hospitalization, intensive care unit (ICU) admission, and death. Design, Setting, and Participants This retrospective, population-based cohort study included community-dwelling adults aged at least 18 years in Ontario, Canada, ICES-linked provincial health databases from January 1, 2020, to November 30, 2021. Data were analyzed from December 1, 2021, to November 1, 2022. Exposures Cancer diagnosis. Main Outcomes and Measures The primary outcome was SARS-CoV-2 infection, and secondary outcomes included all-cause 14-day hospitalization, 21-day ICU admission, and 28-day death following SARS-CoV-2 infection. Cox proportional hazards models were used to obtain adjusted hazard ratios (aHRs) and 95% CIs. Results Of 11 732 108 people in the ICES-linked health databases, 279 287 had cancer (57.2% female; mean [SD] age, 65.9 [16.1] years) and 11 452 821 people did not have cancer (45.7% female; mean [SD] age, 65.9 [16.0] years). Overall, 464 574 individuals (4.1%) developed SARS-CoV-2 infection. Individuals with hematologic malignant neoplasms (33 901 individuals) were at increased risk of SARS-CoV-2 infection (aHR, 1.19; 95% CI, 1.13-1.25), 14-day hospitalization (aHR, 1.75; 95% CI, 1.57-1.96), and 28-day mortality (aHR, 2.03; 95% CI, 1.74-2.38) compared with the overall population, while individuals with solid tumors (245 386 individuals) were at lower risk of SARS-CoV-2 infection (aHR, 0.93; 95% CI, 0.91-0.95) but increased risk of 14-day hospitalization (aHR, 1.11; 95% CI, 1.05-1.18) and 28-day mortality (aHR, 1.31; 95% CI, 1.19-1.44). The 28-day mortality rate was high in hospitalized patients with hematologic malignant neoplasms (163 of 321 hospitalized patients [50.7%]) or solid tumors (486 of 1060 hospitalized patients [45.8%]). However, the risk of 21-day ICU admission in patients with hematologic malignant neoplasms (aHR, 1.14; 95% CI, 0.93-1.40) or solid tumors (aHR, 0.93; 95% CI, 0.82-1.05) was not significantly different from that among individuals without cancer. The SARS-CoV-2 infection risk decreased stepwise with increasing numbers of COVID-19 vaccine doses received (1 dose: aHR, 0.63; 95% CI, 0.62-0.63; 2 doses: aHR, 0.16; 95% CI, 0.16-0.16; 3 doses: aHR, 0.05; 95% CI, 0.04-0.06). Conclusions and Relevance These findings highlight the importance of prioritization strategies regarding ICU access to reduce the mortality risk in increased-risk populations, such as patients with cancer.
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Affiliation(s)
- Seyed M. Hosseini-Moghaddam
- ICES, Toronto, Ontario, Canada
- Transplant-Oncology Infectious Diseases, Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frances A. Shepherd
- Divisions of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Caner Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- ICES, Toronto, Ontario, Canada
- Divisions of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Caner Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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31
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Tan PC, Zhang PQ, Zhou SB, He J, Qian J, Huang RL, Zhang ZY, Cheng C, Li Q, Xie Y. Racial Disparities in the Cost of Unplanned Hospitalizations after Breast Reconstruction. Plast Reconstr Surg 2023; 152:281-290. [PMID: 36728197 PMCID: PMC10368219 DOI: 10.1097/prs.0000000000010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Given the national attention to disparities in health care, understanding variation provided to minorities becomes increasingly important. This study will examine the effect of race on the rate and cost of unplanned hospitalizations after breast reconstruction procedures. METHODS The authors performed an analysis comparing patients undergoing implant-based and autologous breast reconstruction in the Healthcare Cost and Utilization Project. The authors evaluated the rate of unplanned hospitalizations and associated expenditures among patients of different races. Multivariable analyses were performed to determine the association among race and readmissions and health care expenditures. RESULTS The cohort included 17,042 patients. The rate of an unplanned visit was 5%. The rates of readmissions among black patients (6%) and Hispanic patients (7%) in this study are higher compared with white patients (5%). However, after controlling for patient-level characteristics, race was not an independent predictor of an unplanned visit. In our expenditure model, black patients [adjusted cost ratio, 1.35 (95% CI, 1.11 to 1.66)] and Hispanic patients [adjusted cost ratio, 1.34 (95% CI, 1.08 to 1.65)] experienced greater cost for their readmission compared with white patients. CONCLUSIONS Although race is not an independent predictor of an unplanned hospital visit after surgery, racial minorities bear a higher cost burden after controlling for insurance status, further stimulating health care disparities. Adjusted payment models may be a strategy to reduce disparities in surgical care. In addition, direct and indirect measures of disparities should be used when examining health care disparities to identify consequences of inequities more robustly.
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Affiliation(s)
- Poh-Ching Tan
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Pei-Qi Zhang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Shuang-Bai Zhou
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jizhou He
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jia Qian
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Ru-Lin Huang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhi-Yue Zhang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Chen Cheng
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Qingfeng Li
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
| | - Yun Xie
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine
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Campbell JI, Shanahan KH, Bartick M, Ali M, Goldmann D, Shaikh N, Allende-Richter S. Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis. J Pediatr 2023; 259:113424. [PMID: 37084849 PMCID: PMC10527861 DOI: 10.1016/j.jpeds.2023.113424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis. STUDY DESIGN Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile). RESULTS We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11). CONCLUSIONS Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | | | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Mohsin Ali
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
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Bekheit M, Rajan S, Wohlgemut JM, Watson AJM, Ramsay G. Comprehensive assessment of the management of acute cholecystitis in Scotland: population-wide cohort study. BJS Open 2023; 7:zrad073. [PMID: 37578027 PMCID: PMC10424165 DOI: 10.1093/bjsopen/zrad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis aimed to describe the current clinical management and outcomes of patients with acute cholecystitis across Scotland, UK. METHODS This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for acute cholecystitis were included. Data were used to identify all patients admitted to Scottish hospitals between 1997 and 2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was linked to death data, including date of death. RESULTS A total of 47 558 patients were diagnosed with 58 824 episodes of acute cholecystitis (with 27.2 per cent of patients experiencing more than one episode) in 46 Scottish hospitals. Median age was 58 years (interquartile range (i.q.r.) 43-71), 64.4 per cent were female, and most (76.1 per cent) had no comorbidities. A total of 28 741 (60.4 per cent) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared with non-operative management (OR 0.62, 95% c.i. 0.55-0.70). CONCLUSION In this study, 60 per cent of patients had an index cholecystectomy. Patients who underwent surgery had a better survival rate compared with those managed conservatively, further advocating for an operative approach in this cohort.
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Affiliation(s)
- Mohamed Bekheit
- Department of General Surgery, NHS Grampian, Aberdeen, UK
- HPB Surgery Unit, Integrated Centres of Excellence, Elite Healthcare, Alexandria, Egypt
| | - Sendhil Rajan
- Department of General Surgery, NHS Grampian, Aberdeen, UK
| | - Jared M Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - George Ramsay
- Department of General Surgery, NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Mounie M, Fabre D, Rapp T, Rolland Y, Blain H, Tchalla A, Carcaillon-Bentata L, Beltzer N, Assous L, Apparitio S, Caby D, Reina N, Andre L, Molinier L, Costa N. Costs and Survival of Patients having Experienced a Hospitalized Fall-Related Injury in France: A Population-Based Study. J Am Med Dir Assoc 2023; 24:951-957.e4. [PMID: 36934774 DOI: 10.1016/j.jamda.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old. DESIGN We performed a population-based, retrospective cohort study using the French national health insurance claims database. SETTING AND PARTICIPANTS Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted. METHODS Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities. RESULTS A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs. CONCLUSIONS AND IMPLICATIONS We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.
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Affiliation(s)
- Michael Mounie
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France.
| | - Didier Fabre
- Department of Medical Information, University Hospital of Toulouse, Toulouse, France
| | - Thomas Rapp
- LIRAES (URP 4470), Chaire AgingUP!, LIEPP Sciences Po, Paris, France
| | - Yves Rolland
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Hubert Blain
- Department of Geriatrics, University Hospital of Montpellier, Montpellier, France
| | - Achille Tchalla
- Clinical Geriatric, University Hospital of Limoges, Limoges, France
| | | | - Nathalie Beltzer
- Directorate of Non-Communicable Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France
| | | | | | | | - Nicolas Reina
- Locomotor Institute, University Hospital of Toulouse, Toulouse, France
| | - Laurine Andre
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Laurent Molinier
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France
| | - Nadège Costa
- Health Economic Unit, University Hospital of Toulouse, Toulouse, France
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Yoo JW, Reed PS, Shen JJ, Carson J, Kang M, Reeves J, Kim Y, Choe I, Kim P, Kim L, Kang HT, Tabrizi M. Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study. Int J Environ Res Public Health 2023; 20:6157. [PMID: 37372743 PMCID: PMC10298291 DOI: 10.3390/ijerph20126157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.
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Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Peter S. Reed
- Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
- School of Public Health, University of Nevada, Reno, NV 89557, USA
| | - Jay J. Shen
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Jennifer Carson
- Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
- School of Public Health, University of Nevada, Reno, NV 89557, USA
| | - Mingon Kang
- Department of Computer Science, Howard Hughes College of Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | | | - Yonsu Kim
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Ian Choe
- Telehealth Divison, Optum Care Network of Nevada, Las Vegas, NV 89128, USA;
| | - Pearl Kim
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Laurie Kim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Hee-Taik Kang
- Department of Family Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Maryam Tabrizi
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV 89154, USA
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Yokose C, McCormick N, Lu N, Joshi AD, Jackson L, Kohler MJ, Yinh J, Zhang Y, Hsu J, Dalbeth N, Saag KG, Choi HK. Nationwide racial/ethnic disparities in US emergency department visits and hospitalizations for gout. Rheumatology (Oxford) 2023; 62:2247-2251. [PMID: 36218483 PMCID: PMC10234199 DOI: 10.1093/rheumatology/keac590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Gout prevalence is reportedly ∼20% higher in US Black adults than Whites, but racial differences in emergency department (ED) visits and hospitalizations for gout are unknown. We evaluated the latest US national utilization datasets according to racial/ethnic groups. METHODS Using 2019 US National Emergency Department Sample and National Inpatient Sample databases, we compared racial/ethnic differences in annual population rates of ED visits and hospitalizations for gout (primary discharge diagnosis) per 100 000 US adults (using 2019 age- and sex-specific US census data). We also examined rates of ED visits and hospitalizations for gout among all US ED visits/hospitalizations and mean costs for each gout encounter. RESULTS Compared with White patients, the per capita age- and sex-adjusted rate ratio (RR) of gout primary ED visits for Black patients was 5.01 (95% CI 4.96, 5.06), for Asian patients 1.29 (1.26, 1.31) and for Hispanic patients 1.12 (1.10, 1.13). RRs for gout primary hospitalizations were 4.07 (95% CI 3.90, 4.24), 1.46 (1.34, 1.58) and 1.06 (0.99, 1.13), respectively. Corresponding RRs among total US hospitalizations were 3.17 (95% CI 2.86, 3.50), 3.23 (2.71, 3.85) and 1.43 (1.21, 1.68) and among total ED visits were 2.66 (95% CI, 2.50, 2.82), 3.28 (2.64, 4.08), and 1.14 (1.05, 1.24), respectively. RRs were largest among Black women. Costs for ED visits and hospitalizations experienced by race/ethnicity showed similar disparities. CONCLUSIONS These first nationwide data found a substantial excess in both gout primary ED visits and hospitalizations experienced by all underserved racial/ethnic groups, particularly by Black women, revealing an urgent need for improved care to eliminate inequities in gout outcomes.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie McCormick
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, BC, Canada
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Amit D Joshi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lesley Jackson
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Minna J Kohler
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John Hsu
- Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hyon K Choi
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Arthritis Research Canada, Vancouver, BC, Canada
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Joseph P, Roy A, Lonn E, Störk S, Floras J, Mielniczuk L, Rouleau JL, Zhu J, Dzudie A, Balasubramanian K, Karaye K, AlHabib KF, Gómez-Mesa JE, Branch KR, Makubi A, Budaj A, Avezum A, Wittlinger T, Ertl G, Mondo C, Pogosova N, Maggioni AP, Orlandini A, Parkhomenko A, ElSayed A, López-Jaramillo P, Grinvalds A, Temizhan A, Hage C, Lund LH, Kazmi K, Lanas F, Sharma SK, Fox K, McMurray JJV, Leong D, Dokainish H, Khetan A, Yonga G, Kragholm K, Wagdy Shaker K, Mwita JC, Al-Mulla AA, Alla F, Damasceno A, Silva-Cardoso J, Dans AL, Sliwa K, O'Donnell M, Bazargani N, Bayés-Genís A, McCready T, Probstfield J, Yusuf S. Global Variations in Heart Failure Etiology, Management, and Outcomes. JAMA 2023; 329:1650-1661. [PMID: 37191704 PMCID: PMC10189564 DOI: 10.1001/jama.2023.5942] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Importance Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures HF cause, HF medication use, hospitalization, and death. Results Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Eva Lonn
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | - John Floras
- Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Jun Zhu
- FuWai Hospital, Beijing, China
| | - Anastase Dzudie
- Department of Global Health and Population, Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kamilu Karaye
- Bayero University and Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abel Makubi
- Community Development, Gender, Elderly, and Children, Ministry of Health, Dodoma, Tanzania
| | - Andrzej Budaj
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital Goslar, Goslar, Germany
| | - Georg Ertl
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | | | - Nana Pogosova
- Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia
| | | | - Andres Orlandini
- Estudios Clínicos Latino America Collaborative Group, Rosario, Argentina
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Centre, Strazhesko Institute of Cardiology, Kiev, Ukraine
| | | | | | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ahmet Temizhan
- Clinic of Cardiology, University of Health Science, Ankara City Hospital, Ankara, Türkiye
| | - Camilla Hage
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Lars H Lund
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Khawar Kazmi
- Department of Cardiology, Aga Khan University, Karachi, Pakistan
| | | | | | - Keith Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hisham Dokainish
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Aditya Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gerald Yonga
- University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Nairobi City County, Kenya
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kerolos Wagdy Shaker
- Aswan Heart Center, Magdi Yacoub Foundation, Department of Cardiology, Aswan, Egypt
| | | | | | - François Alla
- Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France
| | | | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Porto, Portugal
- São João University Hospital Centre, Porto, Portugal
| | - Antonio L Dans
- University of the Philippines, Medicine, Quezon City, National Capital Region, Philippines
| | - Karen Sliwa
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Martin O'Donnell
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | | | - Antoni Bayés-Genís
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, CIBERCV, Spain
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Bohrmann B, Massa MS, Ross S, Lewington S, Lacey B. Body Mass Index and Risk of Hospitalization or Death Due to Lower or Upper Respiratory Tract Infection. JAMA 2023; 329:1512-1514. [PMID: 37129662 PMCID: PMC10155062 DOI: 10.1001/jama.2023.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study assesses the associations between body mass index and risk of hospitalization for or death due to COVID-19, lower respiratory tract infections, and upper respiratory tract infections.
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Affiliation(s)
- Bastian Bohrmann
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - M Sofia Massa
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Stephanie Ross
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Sarah Lewington
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, England
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Bauernfreund Y, Launders N, Favarato G, Hayes JF, Osborn D, Sampson EL. Incidence and associations of hospital delirium diagnoses in 85,979 people with severe mental illness: A data linkage study. Acta Psychiatr Scand 2023; 147:516-526. [PMID: 35869544 PMCID: PMC10952251 DOI: 10.1111/acps.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Delirium is an acute neuro-psychiatric disturbance precipitated by a range of physical stressors, with high morbidity and mortality. Little is known about its relationship with severe mental illness (SMI). METHODS We conducted a retrospective cohort study using linked data analyses of the UK Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. We ascertained yearly hospital delirium incidence from 2000 to 2017 and used logistic regression to identify associations with delirium diagnosis in a population with SMI. RESULTS The cohort included 249,047 people with SMI with median follow-up time in CPRD of 6.4 years. A total of 85,979 patients were eligible for linkage to HES. Delirium incidence increased from 0.04 (95% CI 0.02-0.07) delirium associated admissions per 100 person-years in 2000 to 1.05 (95% CI 0.93-1.17) per 100 person-years in 2017, increasing most notably from 2010 onwards. Delirium was associated with older age at study entry (OR 1.05 per year, 95% CI 1.05-1.06), SMI diagnosis of bipolar affective disorder (OR 1.66, 95% CI 1.44-1.93) or other psychosis (OR 1.56, 95% CI 1.35-1.80) relative to schizophrenia, and more physical comorbidities (OR 1.08 per additional comorbidity of the Charlson Comorbidity Index, 95% CI 1.02-1.14). Patients with delirium received more antipsychotic medication during follow-up (1-2 antipsychotics OR 1.65, 95% CI 1.44-1.90; >2 antipsychotics OR 2.49, 95% CI 2.12-2.92). CONCLUSIONS The incidence of recorded delirium diagnoses in people with SMI has increased in recent years. Older people prescribed more antipsychotics and with more comorbidities have a higher incidence. Linked electronic health records are feasible for exploring hospital diagnoses such as delirium in SMI.
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Affiliation(s)
- Yehudit Bauernfreund
- Division of PsychiatryUniversity College LondonLondonUK
- Camden & Islington NHS Foundation TrustLondonUK
| | | | | | - Joseph F. Hayes
- Division of PsychiatryUniversity College LondonLondonUK
- Camden & Islington NHS Foundation TrustLondonUK
| | - David Osborn
- Division of PsychiatryUniversity College LondonLondonUK
- Camden & Islington NHS Foundation TrustLondonUK
| | - Elizabeth L. Sampson
- Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychological MedicineEast London NHS Foundation Trust, Royal London HospitalLondonUK
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Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. JAMA 2023; 329:1088-1097. [PMID: 37014339 PMCID: PMC10074220 DOI: 10.1001/jama.2023.1699] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 04/05/2023]
Abstract
Importance Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.
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Affiliation(s)
- Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura A. Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, England
- Department of Cardiology, University College London Hospitals, London, England
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Dennis T. Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, England
| | - Feng Qiu
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Peter Cram
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Texas Medical Branch, Galveston
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Blossey AM, Brückner S, May M, Parzmair GP, Sharma H, Shaligram U, Grode L, Kaufmann SHE, Netea MG, Schindler C. VPM1002 as Prophylaxis Against Severe Respiratory Tract Infections Including Coronavirus Disease 2019 in the Elderly: A Phase 3 Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Study. Clin Infect Dis 2023; 76:1304-1310. [PMID: 36358012 DOI: 10.1093/cid/ciac881] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) vaccination can potentially reduce the rate of respiratory infections in vulnerable populations. This study evaluates the safety and efficacy of VPM1002 (a genetically modified BCG) as prophylaxis against severe respiratory tract infections including coronavirus disease 2019 (COVID-19) in an elderly population. METHODS In this phase 3, randomized, double-blind, placebo-controlled, multicenter clinical trial, healthy elderly volunteers (N = 2064) were enrolled, randomized (1:1) to receive either VPM1002 or placebo, and followed up remotely for 240 days. The primary outcome was the mean number of days with severe respiratory infections at hospital and/or at home. Secondary endpoints included the incidence of self-reported fever, number of hospital and intensive care unit (ICU) admissions, and number of adverse events. RESULTS A total of 31 participants in the VPM1002 group reported at least 1 day with severe respiratory disease and a mean number of days with severe respiratory disease of 9.39 ± 9.28 while in the placebo group; 38 participants reported a mean of 14.29 ± 16.25 days with severe respiratory disease. The incidence of self-reported fever was lower in the VPM1002 group (odds ratio, 0.46 [95% confidence interval, .28-.74]; P = .001), and consistent trends to fewer hospitalization and ICU admissions due to COVID-19 were observed after VPM1002 vaccination. Local reactions typical for BCG were observed in the VPM1002-vaccinated group, which were mostly of mild intensity. CONCLUSIONS Vaccination with VPM1002 is well tolerated and seems to have a prophylactic effect against severe respiratory disease in the elderly. CLINICAL TRIALS REGISTRATION NCT04435379.
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Affiliation(s)
| | | | - Marcus May
- Vakzine Projekt Management GmbH, Hannover, Germany
| | | | - Hitt Sharma
- Serum Institute of India Private Limited, Pune, India
| | | | | | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany
- Hagler Institute for Advanced Study, Texas A&M University, College Station, Texas, USA
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Department for Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Christoph Schindler
- Clinical Research Center Core Facility, Hannover Medical School, Hannover, Germany
- Center for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany
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Trochet C. [Immobilization syndrome and iatrogenic dependence of hospitalized elderly people]. Rev Infirm 2023; 72:18-21. [PMID: 37088489 DOI: 10.1016/j.revinf.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
In the hospital, the geriatric missions of nurses and paramedical and medical teams are essential in order to benefit elderly patients and to fight against the immobilization syndrome through responsiveness and quality care. This care takes place in parallel with the specific medical care of the medical pathologies treated. In 2017, the High Authority for Health advocated good professional practices to avoid iatrogenic dependence of hospitalized elderly people. Through this article, we carry out a focus on the immobilization syndrome and its deleterious consequences: we must not do in the place of the elderly subject!
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Affiliation(s)
- Claire Trochet
- Centre hospitalier universitaire Grenoble Alpes, CS 10217 Grenoble, 38700 La Tronche, France.
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Arakelyan M, Freyleue S, Avula D, McLaren JL, O’Malley AJ, Leyenaar JK. Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019. JAMA 2023; 329:1000-1011. [PMID: 36976279 PMCID: PMC10051095 DOI: 10.1001/jama.2023.1992] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
Importance Approximately 1 in 6 youth in the US have a mental health condition, and suicide is a leading cause of death among this population. Recent national statistics describing acute care hospitalizations for mental health conditions are lacking. Objectives To describe national trends in pediatric mental health hospitalizations between 2009 and 2019, to compare utilization among mental health and non-mental health hospitalizations, and to characterize variation in utilization across hospitals. Design, Setting, and Participants Retrospective analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative database of US acute care hospital discharges. Analysis included 4 767 840 weighted hospitalizations among children 3 to 17 years of age. Exposures Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified mental health diagnoses into 30 mutually exclusive disorder types. Main Outcomes and Measures Measures included number and proportion of hospitalizations with a primary mental health diagnosis and with attempted suicide, suicidal ideation, or self-injury; number and proportion of hospital days and interfacility transfers attributable to mental health hospitalizations; mean lengths of stay (days) and transfer rates among mental health and non-mental health hospitalizations; and variation in these measures across hospitals. Results Of 201 932 pediatric mental health hospitalizations in 2019, 123 342 (61.1% [95% CI, 60.3%-61.9%]) were in females, 100 038 (49.5% [95% CI, 48.3%-50.7%]) were in adolescents aged 15 to 17 years, and 103 456 (51.3% [95% CI, 48.6%-53.9%]) were covered by Medicaid. Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8%, and these hospitalizations accounted for a significantly higher proportion of pediatric hospitalizations (11.5% [95% CI, 10.2%-12.8%] vs 19.8% [95% CI, 17.7%-21.9%]), hospital days (22.2% [95% CI, 19.1%-25.3%] vs 28.7% [95% CI, 24.4%-33.0%]), and interfacility transfers (36.9% [95% CI, 33.2%-40.5%] vs 49.3% [95% CI, 45.9%-52.7%]). The percentage of mental health hospitalizations with attempted suicide, suicidal ideation, or self-injury diagnoses increased significantly from 30.7% (95% CI, 28.6%-32.8%) in 2009 to 64.2% (95% CI, 62.3%-66.2%) in 2019. Length of stay and interfacility transfer rates varied significantly across hospitals. Across all years, mental health hospitalizations had significantly longer mean lengths of stay and higher transfer rates compared with non-mental health hospitalizations. Conclusions and Relevance Between 2009 and 2019, the number and proportion of pediatric acute care hospitalizations due to mental health diagnoses increased significantly. The majority of mental health hospitalizations in 2019 included a diagnosis of attempted suicide, suicidal ideation, or self-injury, underscoring the increasing importance of this concern.
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Affiliation(s)
- Mary Arakelyan
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
| | - Seneca Freyleue
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Divya Avula
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky
| | - Jennifer L. McLaren
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Department of Psychiatry, Dartmouth Health, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - JoAnna K. Leyenaar
- Department of Pediatrics, Dartmouth Health Children’s, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Tenforde MW, Patel MM, Lewis NM, Adams K, Gaglani M, Steingrub JS, Shapiro NI, Duggal A, Prekker ME, Peltan ID, Hager DN, Gong MN, Exline MC, Ginde AA, Mohr NM, Mallow C, Martin ET, Talbot HK, Gibbs KW, Kwon JH, Chappell JD, Halasa N, Lauring AS, Lindsell CJ, Swan SA, Hart KW, Womack KN, Baughman A, Grijalva CG, Self WH. Vaccine Effectiveness Against Influenza A(H3N2)-Associated Hospitalized Illness: United States, 2022. Clin Infect Dis 2023; 76:1030-1037. [PMID: 36327388 PMCID: PMC10226741 DOI: 10.1093/cid/ciac869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with historically low influenza circulation during the 2020-2021 season, followed by an increase in influenza circulation during the 2021-2022 US season. The 2a.2 subgroup of the influenza A(H3N2) 3C.2a1b subclade that predominated was antigenically different from the vaccine strain. METHODS To understand the effectiveness of the 2021-2022 vaccine against hospitalized influenza illness, a multistate sentinel surveillance network enrolled adults aged ≥18 years hospitalized with acute respiratory illness and tested for influenza by a molecular assay. Using the test-negative design, vaccine effectiveness (VE) was measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative controls, adjusting for confounders. A separate analysis was performed to illustrate bias introduced by including SARS-CoV-2-positive controls. RESULTS A total of 2334 patients, including 295 influenza cases (47% vaccinated), 1175 influenza- and SARS-CoV-2-negative controls (53% vaccinated), and 864 influenza-negative and SARS-CoV-2-positive controls (49% vaccinated), were analyzed. Influenza VE was 26% (95% CI: -14% to 52%) among adults aged 18-64 years, -3% (-54% to 31%) among adults aged ≥65 years, and 50% (15-71%) among adults aged 18-64 years without immunocompromising conditions. Estimated VE decreased with inclusion of SARS-CoV-2-positive controls. CONCLUSIONS During a season where influenza A(H3N2) was antigenically different from the vaccine virus, vaccination was associated with a reduced risk of influenza hospitalization in younger immunocompetent adults. However, vaccination did not provide protection in adults ≥65 years of age. Improvements in vaccines, antivirals, and prevention strategies are warranted.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nathaniel M Lewis
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew E Prekker
- Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Chopra A, Tillu G, Chuadhary K, Reddy G, Srivastava A, Lakdawala M, Gode D, Reddy H, Tamboli S, Saluja M, Sarmukaddam S, Gundeti M, Raut AK, Rao BCS, Yadav B, Srikanth N, Patwardhan B. Co-administration of AYUSH 64 as an adjunct to standard of care in mild and moderate COVID-19: A randomized, controlled, multicentric clinical trial. PLoS One 2023; 18:e0282688. [PMID: 36928877 PMCID: PMC10019690 DOI: 10.1371/journal.pone.0282688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/28/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Evaluate the efficacy of AYUSH 64, a standard polyherbal Ayurvedic drug in COVID-19. METHODS During the first pandemic wave, 140 consenting and eligible hospitalized adult participants with mild-moderate symptomatic disease (specific standard RT-PCR assay positive) were selected as per a convenience sample, and randomized (1:1 ratio) to an open-label (assessor blind) two-arm multicentric drug trial; standard of care (SOC as per Indian guidelines) versus AYUSH 64 combined with SOC (AYUSH plus). Participants were assessed daily and discharged once clinical recovery (CR, primary efficacy) was achieved which was based on a predetermined set of criteria (resolution of symptoms, normal peripheral oximetry, and negative specific RT-PCR assay). Each participant was followed using an indigenous software program(mobile phone) and completed a 12-week study period. The dose of AYUSH 64 was 2 tablets oral, 500 mg each, bid for 12 weeks (AYUSH plus only). Significant P was <0.05 (two-sided). On randomization, the groups were found well matched. RESULTS The mean interval time from randomization to CR was significantly superior in the AYUSH plus group [mean 6.45 days versus 8.26 days, 95% Confidence Interval of the difference -3.02 to -0.59 (P = 0.003, Student's 't test] as per-protocol analysis (134 participants); significant (P = 0.002) on an intention to treat analysis. 70% of the participants in AYUSH plus recovered during the first week (P = 0.046, Chi-square) and showed a significantly better change in physical health, fatigue, and quality of life measures. 48 adverse events, mostly mild and gut related, were reported by each group. There were 20 patient withdrawals (8 in AYUSH plus) but none due to an AE. There were no deaths. Daily assessment (hospitalization) and supervised drug intake ensured robust efficacy data. The open-label design was a concern (study outcome). CONCLUSIONS AYUSH 64 in combination with SOC hastened recovery, reduced hospitalization, and improved health in COVID-19. It was considered safe and well-tolerated. Further clinical validation (Phase III) is required. TRIAL REGISTRATION CTRI/2020/06/025557.
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Affiliation(s)
| | - Girish Tillu
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | | | - Govind Reddy
- Regional Ayurveda Research Institute, Nagpur, India
| | | | | | - Dilip Gode
- Datta Meghe Institute of Medical Sciences, Nagpur, India
| | | | - Sanjay Tamboli
- Target Institute of Medical Education & Research, Mumbai, India
| | | | | | | | | | - B. C. S. Rao
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Babita Yadav
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | | | - Bhushan Patwardhan
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
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Abdelatif N, Naidoo I, Dunn S, Mazinu M, Essack Z, Groenewald C, Maharaj P, Msomi N, Reddy T, Roberts B, Zuma K. Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data. Front Public Health 2023; 11:1009309. [PMID: 37006523 PMCID: PMC10061133 DOI: 10.3389/fpubh.2023.1009309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThe 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons.ObjectiveRecognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50–59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged.MethodsUsing a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated.ResultsAverage numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50–59- and 60–69-years. However, average age-specific infection rates showed that people aged 50–59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50–59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups.DiscussionHealth promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inbarani Naidoo
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- *Correspondence: Inbarani Naidoo
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Mikateko Mazinu
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, and Honorary Research Associate, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- Honorary Research Associate, Rhodes University, Grahamstown, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, University of KwaZulu-Natal and National Health Laboratory Services, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Benjamin Roberts
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Ou W, Zhang Q, He J, Shao X, Yang Y, Wang X. Hospitalization costs of injury in elderly population in China: a quantile regression analysis. BMC Geriatr 2023; 23:143. [PMID: 36918769 PMCID: PMC10013238 DOI: 10.1186/s12877-023-03729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Trauma in the elderly is gradually growing more prevalent as the aging population increases over time. The purpose of this study is to assess hospitalization costs of the elderly trauma population and analyze the association between those costs and the features of the elderly trauma population. METHODS In a retrospective analysis, data on trauma patients over 65 who were admitted to the hospital for the first time due to trauma between January 2017 and March 2022 was collected from a tertiary comprehensive hospital in Baotou. We calculated and analyzed the hospitalization cost components. According to various therapeutic approaches, trauma patients were divided into two subgroups: non-surgical patients (1320 cases) and surgical patients (387 cases). Quantile regression was used to evaluate the relationship between trauma patients and hospitalization costs. RESULTS This study comprised 1707 trauma patients in total. Mean total hospitalization costs per patient were ¥20,741. Patients with transportation accidents incurred the highest expenditures among those with external causes of trauma, with a mean hospitalization cost of ¥24,918, followed by patients with falls at ¥19,809 on average. Hospitalization costs were dominated by medicine costs (¥7,182 per capita). According to the quantile regression results, all trauma patients' hospitalization costs were considerably increased by length of stay, surgery, the injury severity score (16-24), multimorbidity, thorax injury, and blood transfusion. For non-surgical patients, length of stay, multimorbidity, and the injury severity score (16-24) were all substantially linked to higher hospitalization costs. For surgical patients, length of stay, injury severity score (16-24), and hip and thigh injuries were significantly associated with greater hospitalization costs. CONCLUSIONS Using quantile regression to identify factors associated with hospitalization costs could be helpful for addressing the burden of injury in the elderly population. Policymakers may find these findings to be insightful in lowering hospitalization costs related to injury in the elderly population.
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Affiliation(s)
- Wenjing Ou
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
- Baotou Central Hospital, Baotou, 014040, Inner Mongolia, China
| | - Qin Zhang
- Shengjing Hospital of China Medical University, Shenyang, 110001, China
| | - Junlin He
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xinye Shao
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang Yang
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China.
- Research Center for Health Development-Liaoning New Type Think Tank for University, China Medical University, Shenyang, 110122, Liaoning, China.
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Orandi BJ, McLeod MC, MacLennan PA, Lee WM, Fontana RJ, Karvellas CJ, McGuire BM, Lewis CE, Terrault NM, Locke JE. Association of FDA Mandate Limiting Acetaminophen (Paracetamol) in Prescription Combination Opioid Products and Subsequent Hospitalizations and Acute Liver Failure. JAMA 2023; 329:735-744. [PMID: 36881033 PMCID: PMC9993184 DOI: 10.1001/jama.2023.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023]
Abstract
Importance In January 2011, the US Food and Drug Administration (FDA) announced a mandate to limit acetaminophen (paracetamol) to 325 mg/tablet in combination acetaminophen and opioid medications, with manufacturer compliance required by March 2014. Objective To assess the odds of hospitalization and the proportion of acute liver failure (ALF) cases with acetaminophen and opioid toxicity prior to and after the mandate. Design, Setting, and Participants This interrupted time-series analysis used hospitalization data from 2007-2019 involving ICD-9/ICD-10 codes consistent with both acetaminophen and opioid toxicity from the National Inpatient Sample (NIS), a large US hospitalization database, and ALF cases from 1998-2019 involving acetaminophen and opioid products from the Acute Liver Failure Study Group (ALFSG), a cohort of 32 US medical centers. For comparison, hospitalizations and ALF cases consistent with acetaminophen toxicity alone were extracted from the NIS and ALFSG. Exposures Time prior to and after the FDA mandate limiting acetaminophen to 325 mg in combination acetaminophen and opioid products. Main Outcomes and Measures Odds of hospitalization involving acetaminophen and opioid toxicity and percentage of ALF cases from acetaminophen and opioid products prior to and after the mandate. Results In the NIS, among 474 047 585 hospitalizations from Q1 2007 through Q4 2019, there were 39 606 hospitalizations involving acetaminophen and opioid toxicity; 66.8% of cases were among women; median age, 42.2 (IQR, 28.4-54.1). In the ALFSG, from Q1 1998 through Q3 2019, there were a total of 2631 ALF cases, of which 465 involved acetaminophen and opioid toxicity; 85.4% women; median age, 39.0 (IQR, 32.0-47.0). The predicted incidence of hospitalizations 1 day prior to the FDA announcement was 12.2 cases/100 000 hospitalizations (95% CI, 11.0-13.4); by Q4 2019, it was 4.4/100 000 hospitalizations (95% CI, 4.1-4.7) (absolute difference, 7.8/100 000 [95% CI, 6.6-9.0]; P < .001). The odds of hospitalizations with acetaminophen and opioid toxicity increased 11%/y prior to the announcement (odds ratio [OR], 1.11 [95% CI, 1.06-1.15]) and decreased 11%/y after the announcement (OR, 0.89 [95% CI, 0.88-0.90]). The predicted percentage of ALF cases involving acetaminophen and opioid toxicity 1 day prior to the FDA announcement was 27.4% (95% CI, 23.3%-31.9%); by Q3 2019, it was 5.3% (95% CI, 3.1%-8.8%) (absolute difference, 21.8% [95% CI, 15.5%-32.4%]; P < .001). The percentage of ALF cases involving acetaminophen and opioid toxicity increased 7% per year prior to the announcement (OR, 1.07 [95% CI, 1.03-1.1]; P < .001) and decreased 16% per year after the announcement (OR, 0.84 [95% CI, 0.77-0.92]; P < .001). Sensitivity analyses confirmed these findings. Conclusions and Relevance The FDA mandate limiting acetaminophen dosage to 325 mg/tablet in prescription acetaminophen and opioid products was associated with a statistically significant decrease in the yearly rate of hospitalizations and proportion per year of ALF cases involving acetaminophen and opioid toxicity.
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Affiliation(s)
- Babak J. Orandi
- University of Alabama at Birmingham Heersink School of Medicine
- Joan & Sanford Weill Medical College of Cornell University, New York, New York
| | | | | | - William M. Lee
- University of Texas Southwestern Medical Center at Dallas
| | | | | | | | - Cora E. Lewis
- University of Alabama at Birmingham School of Public Health
| | - Norah M. Terrault
- University of Southern California Keck School of Medicine, Los Angeles
| | - Jayme E. Locke
- University of Alabama at Birmingham Heersink School of Medicine
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Yu Q, Cao W, Hamer D, Urbanek N, Straif-Bourgeois S, Cormier SA, Ferguson T, Richmond-Bryant J. Associations of COVID-19 Hospitalizations, ICU Admissions, and Mortality with Black and White Race and Their Mediation by Air Pollution and Other Risk Factors in the Louisiana Industrial Corridor, March 2020-August 2021. Int J Environ Res Public Health 2023; 20:4611. [PMID: 36901619 PMCID: PMC10001987 DOI: 10.3390/ijerph20054611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.
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Affiliation(s)
- Qingzhao Yu
- Biostatistics Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Wentao Cao
- Biostatistics Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Diana Hamer
- Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
| | - Norman Urbanek
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC 27695, USA
| | - Susanne Straif-Bourgeois
- Epidemiology Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Stephania A. Cormier
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Tekeda Ferguson
- Epidemiology Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Jennifer Richmond-Bryant
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC 27695, USA
- Center for Geospatial Analytics, North Carolina State University, Raleigh, NC 27695, USA
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50
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Harris E. Medicaid Expansion Tied to Reduction in Postpartum Hospitalizations. JAMA 2023; 329:458. [PMID: 36696140 DOI: 10.1001/jama.2023.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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