Assessment of risk-adjusted mortality ratio (RAMR) in bloodstream infections using all-patient refined diagnosis-related groups (APR-DRGs).

OBJECTIVES: To calculate a risk-adjusted mortality ratio (RAMR) for bloodstream infections (BSIs) using all-patient refined diagnosis-related groups (APR-DRGs) and compare it with the crude mortality rate (CMR). METHODS: Retrospective observational study of prevalent BSI at our institution from January 2019 to December 2022. In-hospital mortality was adjusted with a binary logistic regression model adjusting for sex, age, admission type and mortality risk for the hospitalization episode according to the four severity levels of APR DRGs. The RAMR was calculated as the ratio of observed to expected in-hospital mortality, and the CMR was calculated as the proportion of deaths among all bacteraemia episodes. RESULTS: Of 2939 BSIs, 2541 were included: Escherichia coli (n = 1310), Klebsiella pneumoniae (n = 428), Pseudomonas aeruginosa (n = 209), Staphylococcus aureus (n = 498) and candidaemia (n = 96). A total of 436 (17.2%) patients died during hospitalization and 279 died within the first 14 days after the onset of BSI. Throughout the period, all BSI cases had a mortality rate above the expected adjusted mortality (RAMR value greater than 1), except for Escherichia coli (1.03; 95% CI 0.86-1.21). The highest overall RAMR values were observed for P. aeruginosa, Candida and S. aureus with 2.06 (95% CI 1.57-2.62), 1.99 (95% CI 1.3-2.81) and 1.8 (95% CI 1.47-2.16), respectively. The temporal evolution of CMR may differ from RAMR, especially in E. coli, where it was reversed. CONCLUSIONS: RAMR showed higher than expected mortality for all BSIs studied except E. coli and provides complementary to and more clinically comprehensive information than CMR, the currently recommended antibiotic stewardship programme mortality indicator.

Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction.

INTRODUCTION AND OBJECTIVES: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.

An Exploratory Study for Assessment of Multimodal Semantic Memory in Colombian Children.

Semantic memory (SM) is a type of long-term memory associated with the storage of general information about the world. Here we assessed the characteristics of the SM battery, developed by Catricalà et al. (2013), in a sample of Colombian children. This battery was originally conceived to evaluate adults, and features six subtests that assess SM in different modalities, using a common set of 48 stimuli in both living and nonliving categories. The design of the current study is of a cross-sectional and exploratory type. The sample was composed of 111 children, 57 boys (51%) and 54 girls (49%), who were 6 (n = 68) and 7 (n = 43) years old and had no intellectual disability. Robust linear regression models and correlation networks were used. We found an effect of age on general intelligence after correcting for gender, and no differences on the six subtest scores after corrections for gender and age were performed. Furthermore, age was found to be positively associated with the naming of colored photographs (ß = .75, p = .039), naming in response to an oral description (ß = 1.81, p = .039), picture sorting at four levels (ß = 7.22, p = .029), and sentence verification (ß = 26.66, p = .01). In addition, there were differences between the results obtained in adults in the original study and in the children of our study. This exploratory study supports the feasibility of the Spanish translation of the Catricalà et al. (2013) battery to assess SM in children with a nonclinical condition. Future studies are needed to evaluate the psychometric properties of this SM battery, and to corroborate and expand our findings in a larger sample of control children, and in children with some degree of intellectual disability or suffering of some neurodegenerative or psychiatric conditions.

La memoria semántica (SM) es un tipo de memoria a largo plazo asociada con el almacenamiento de información general sobre el mundo. Aquí evaluamos las características de la batería SM, desarrollada por Catricalà et al. (2013), en una muestra de niños colombianos. Esta batería fue concebida originalmente para evaluar adultos, y presenta seis subpruebas que evalúan SM en diferentes modalidades, utilizando un conjunto común de 48 estímulos en las categorías de vida y no vida. El diseño del presente estudio es de tipo transversal y exploratorio. La muestra estaba compuesta por 111 niños, 57 niños (51%) y 54 niñas (49%), que tenían 6 (n = 68) y 7 (n = 43 ) años y no tenían discapacidad intelectual. Se utilizaron modelos de regresión lineal robustos y redes de correlación. Encontramos un efecto de la edad en la inteligencia general después de corregir por género, y no hubo diferencias en las seis puntuaciones de la subprueba después de realizar correcciones por género y edad. Además, se encontró que la edad se asociaba positivamente con el nombramiento de fotografías en color (ß = .75, p = .039), nombrando en respuesta a una descripción oral (ß = 1.81, p = .039), clasificación de imágenes en cuatro niveles (ß = 7.22, p = .029) y verificación de oraciones (ß = 26.66, p = .01). Además, hubo diferencias entre los resultados obtenidos en adultos en el estudio original y en los niños de nuestro estudio. Este estudio exploratorio respalda la viabilidad de la traducción al español de Catricalà et al. (2013) batería para evaluar SM en niños con una condición no clínica. Se necesitan estudios futuros para evaluar las propiedades psicométricas de esta batería SM, y para corroborar y expandir nuestros hallazgos en una muestra más grande de niños control, y en niños con algún grado de discapacidad intelectual o que padecen algunas condiciones neurodegenerativas o psiquiátricas.

A case report curriculum to promote scholarship.

BACKGROUND: Engaging in scholarly activity during residency can facilitate the acquisition of important skills; however, residents may encounter barriers such as unclear expectations as to what constitutes scholarship, a paucity of dedicated time and a lack of mentorship. Residents may encounter barriers such as unclear expectations as to what constitutes scholarship OBJECTIVE: In July 2013, we developed a Case Report Curriculum (CRC) for first-year residents to guide them towards creating a high-quality case report and helping them to achieve the Accreditation Council for Graduate Medical Education scholarly activity requirement. METHODS: The CRC is composed of four 1-hour educational sessions (seminars and group work) at intervals of 4-6 weeks, with specific homework assignments. Sessions are divided into four topics: (1) importance of scholarship and selecting a case; (2) defining appropriate learning objectives; (3) writing a discussion; and (4) editing and submitting. The culmination of the CRC is a poster competition at our institutional Academic Week. RESULTS: In 2012/13, the year prior to CRC implementation, six of 18 (33%) first-year residents participated in scholarly activity. During the following 2 years, 20 of 20 (100%) of the 2013/14 first-year residents and 21 of 22 (95%) of the 2014/15 first-year residents participated in the CRC and presented a case report. Furthermore, 16 of 20 (80%) of the first-year residents who completed the CRC in 2013/14 voluntarily continued to work on scholarly projects, with a total of 44 projects published or presented regionally or nationally. DISCUSSION: The CRC represents a practical structured framework for promoting scholarship, which can be easily implemented in a residency programme.

Retrospective assessment of childhood ADHD symptoms for diagnosis in adults: validity of a short 8-item version of the Wender-Utah Rating Scale.

The Wender-Utah Rating Scale (WURS) is a widely used self-report instrument for retrospective assessment of childhood ADHD. However, many WURS items are not specific to ADHD. Here, we investigated the effect of excluding these items on the performance of the WURS in predicting adult ADHD based on previous diagnosis and current clinically significant symptoms. The study was conducted on a sample of adults (n = 1014; 48 % male) participating in a family-based investigation of ADHD. Participants completed the 61-item WURS questionnaire and the 66-item Conners Adult ADHD Rating Scale. Receiver operating characteristic (ROC) curves were used to compare the performance of the eight-item WURS (WURS-8) and the longer WURS-25 in predicting previous ADHD diagnosis and current clinically significant ADHD symptoms. WURS-8 and WURS-25 have approximately the same power to predict adult ADHD, based on either previous diagnosis or current symptoms (area under the ROC curves >0.8). WURS-8 performs at least as well as the longer WURS-25 in predicting adult ADHD. This 8-item questionnaire is thus a valid instrument and is especially useful for screening for ADHD in large epidemiological samples.