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1.
J Nerv Ment Dis ; 210(4): 257-263, 2022 04 01.
Article in English | MEDLINE | ID: mdl-35212665

ABSTRACT

ABSTRACT: We aimed to explore the prevalence and determinants of severe COVID-19 disease and mortality in patients with schizophrenia in this study. We conducted a retrospective observational study of 1620 patients with schizophrenia. Of the 1620 patients, 52 (3.2%) tested positive for SARS-CoV-19. Among SARS-CoV-2-positive patients, 40 patients were hospitalized, and 17 patients required intensive care unit admission due to COVID-19 (76.9% and 32.7%, respectively). Severe COVID-19 disease was noted in 17 patients (32.7%) requiring intubation. In the logistic regression analysis, antipsychotic dose, and comorbidity score were independently associated with a greater risk of severe COVID-19 disease in patients with schizophrenia. Our study suggests that factors such as age, sex, comorbidities, and a daily antipsychotic dose may have effects on the poor outcome of SARS-CoV-2 disease in schizophrenia patients. In addition, the current findings propose that mortality may be associated with an older age, comorbidity score, and a longer duration of psychiatric disease among the SARS-CoV-2-positive patients with schizophrenia. However, the findings of our study should be verified in prospective and larger sample studies.


Subject(s)
COVID-19 , Schizophrenia , COVID-19/epidemiology , Comorbidity , Demography , Hospitalization , Humans , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2 , Schizophrenia/epidemiology
2.
BJS Open ; 6(3)2022 05 02.
Article in English | MEDLINE | ID: mdl-35657136

ABSTRACT

BACKGROUND: Magnets and button batteries (BBs) are dangerous ingested foreign bodies in children. The scale and consequences of this public health issue in the UK are unknown. This study aims to report the current management strategies and outcomes associated with paediatric magnet and BB ingestion in the UK. METHODS: This multicentre, retrospective observational study involved 13 UK tertiary paediatric surgery centres. Children aged under 17 years, admitted between 1 October 2019 and 30 September 2020, following magnet, or BB ingestion were included. Demographics, investigations, management, and complications were recorded. RESULTS: In total, 263 patients were identified, comprising 146 (55.5 per cent) magnet, 112 (42.6 per cent) BB, and 5 (1.9 per cent) mixed magnet BB ingestions. Median (interquartile range) age was 4.8 (2.0-9.1) years and 47.5 per cent were female. In the magnet group, 38 (26.0 per cent) children swallowed single magnets, 3 of whom underwent endoscopic retrieval for oesophageal or gastric impaction. Of the 108 (74.0 per cent) children who swallowed multiple magnets, 51 (47.2 per cent) required endoscopic or surgical intervention, predominantly for failure of magnets to progress on serial imaging. Bowel perforations occurred in 10 children (9.3 per cent). Younger age and ingestion of greater numbers of multiple magnets were independently associated with surgery. BB ingestion caused morbidity in 14 children (12.5 per cent) and life-threatening injuries in two (1.8 per cent); the majority were caused by oesophageal BBs (64.3 per cent). CONCLUSION: Multiple magnet and BB ingestions are associated with significant morbidity. Action must be taken at an international level to regulate the sale of magnets and BBs, and to raise awareness of the risks that these objects pose to children.


Subject(s)
Intestinal Perforation , Specialties, Surgical , Child , Eating , Female , Hospitalization , Humans , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Magnets/adverse effects , Male
3.
Pan Afr Med J ; 41: 192, 2022.
Article in English | MEDLINE | ID: mdl-35685103

ABSTRACT

A multidisciplinary team is composed of various healthcare professionals that ensure a multifaceted approach on a group of patients. Standards for diabetes medical care note the importance of multidisciplinary diabetes care teams. We applied our model of multidisciplinary approach by structuring it in a determined five days hospitalization. The aim of this study was to determine if the interdisciplinary approach applied on a short hospitalization is of benefit in patients with poorly controlled diabetes mellitus. Sixty-seven patients were included and ensured a short hospitalization in which they received a multiple educational advice and a treatment adaptation. Sixty-one patients out of 67 (91%) were retained for evaluation with sufficient data at one year, i.e. 9% of patients with poor compliance. Evolution in glycosylated haemoglobin (HbA1c), weight and treatments was analyzed. After a 12 months follow-up, we observed significant improvement in HbA1c (-1.73%; p < 103) without weight loss (BMI=-0.42 kg/m2), p=0.28). HbA1c mean levels correlated negatively to body mass index (BMI) during the regular follow-up (r=-0.22, p=0.05). More than 90% of patients with poorly controlled diabetes mellitus responded to the multi-disciplinary approach with a decrease in HbA1c.


Subject(s)
Autoimmune Diseases , Diabetes Mellitus, Type 2 , Diabetes Mellitus, Type 2/therapy , Glycated Hemoglobin A/analysis , Hospitalization , Humans , Patient Care Team , Prospective Studies
4.
Int J Public Health ; 67: 1604761, 2022.
Article in English | MEDLINE | ID: mdl-35685336

ABSTRACT

Objectives: Develop a tool for applying various COVID-19 re-opening guidelines to the more than 120 U.S. Environmental Protection Agency (EPA) facilities. Methods: A geographic information system boundary was created for each EPA facility encompassing the county where the EPA facility is located and the counties where employees commuted from. This commuting area is used for display in the Dashboard and to summarize population and COVID-19 health data for analysis. Results: Scientists in EPA's Office of Research and Development developed the EPA Facility Status Dashboard, an easy-to-use web application that displays data and statistical analyses on COVID-19 cases, testing, hospitalizations, and vaccination rates. Conclusion: The Dashboard was designed to provide readily accessible information for EPA management and staff to view and understand the COVID-19 risk surrounding each facility. It has been modified several times based on user feedback, availability of new data sources, and updated guidance. The views expressed in this article are those of the authors and do not necessarily represent the views or the policies of the U.S. Environmental Protection Agency.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hospitalization , Humans , Pandemics/prevention & control , Policy , United States/epidemiology , United States Environmental Protection Agency
5.
Int J Clin Pract ; 2022: 3532917, 2022.
Article in English | MEDLINE | ID: mdl-35685491

ABSTRACT

Objectives: To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting "de novo" post-COVID pain. Methods: Seventy-seven (n = 77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. Results: Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score≥12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, P < 0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. Conclusion: This study found that almost 25% of previously hospitalized COVID-19 survivors with "de novo" post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.


Subject(s)
COVID-19 , Neuralgia , COVID-19/complications , COVID-19/epidemiology , Hospitalization , Humans , Neuralgia/epidemiology , Neuralgia/etiology , Prevalence , Survivors
6.
Int J Clin Pract ; 2022: 7325060, 2022.
Article in English | MEDLINE | ID: mdl-35685504

ABSTRACT

Background: Most evidence regarding anticoagulation and COVID-19 refers to the hospitalization setting, but the role of oral anticoagulation (OAC) before hospital admission has not been well explored. We compared clinical outcomes and short-term prognosis between patients with and without prior OAC therapy who were hospitalized for COVID-19. Methods: Analysis of the whole cohort of the HOPE COVID-19 Registry which included patients discharged (deceased or alive) after hospital admission for COVID-19 in 9 countries. All-cause mortality was the primary endpoint. Study outcomes were compared after adjusting variables using propensity score matching (PSM) analyses. Results: 7698 patients were suitable for the present analysis (675 (8.8%) on OAC at admission: 427 (5.6%) on VKAs and 248 (3.2%) on DOACs). After PSM, 1276 patients were analyzed (638 with OAC; 638 without OAC), without significant differences regarding the risk of thromboembolic events (OR 1.11, 95% CI 0.59-2.08). The risk of clinically relevant bleeding (OR 3.04, 95% CI 1.92-4.83), as well as the risk of mortality (HR 1.22, 95% CI 1.01-1.47; log-rank p value = 0.041), was significantly increased in previous OAC users. Amongst patients on prior OAC only, there were no differences in the risk of clinically relevant bleeding, thromboembolic events, or mortality when comparing previous VKA or DOAC users, after PSM. Conclusion: Hospitalized COVID-19 patients on prior OAC therapy had a higher risk of mortality and worse clinical outcomes compared to patients without prior OAC therapy, even after adjusting for comorbidities using a PSM. There were no differences in clinical outcomes in patients previously taking VKAs or DOACs. This trial is registered with NCT04334291/EUPAS34399.


Subject(s)
Atrial Fibrillation , COVID-19 , Thromboembolism , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/drug therapy , COVID-19/drug therapy , Hemorrhage/chemically induced , Hospitalization , Hospitals , Humans , Prognosis , Registries , Thromboembolism/prevention & control
7.
Int J Clin Pract ; 2022: 4974410, 2022.
Article in English | MEDLINE | ID: mdl-35685536

ABSTRACT

Background: The association between sarcopenia at admission and mortality in patients with sepsis has not been comprehensively evaluated. We performed a meta-analysis to systematically evaluate the above association. Methods: This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intrastudy heterogeneity was selected to pool the results. Subgroup analyses were applied to evaluate the influences of study characteristics on relationship. Results: Ten cohort studies including 2396 patients with sepsis were included, and 1496 (62.4%) of them had sarcopenia at presentation. Pooled results showed that compared to those without sarcopenia, septic patients with sarcopenia had a significantly increased early (in-hospital or 1-month) mortality risk (risk ration (RR): 2.14, 95% confidence interval (CI): 1.60-2.87, P < 0.001; I 2 = 46%). Subgroup analyses showed consistent association between sarcopenia and increased acute mortality risk in septic patients which were not affected by study characteristics such as study design, country of the study, clinical settings, diagnostic criteria for sepsis, age, gender of the patients, and methods for diagnosis of sarcopenia (P for all subgroup analyses >0.05). Further meta-analyses showed that sarcopenia was also associated with increased mortality risk in septic patients at 3-6 months (RR: 2.13, 95% CI: 1.58-2.89, P < 0.001; I 2 = 0%) and at 1 year (RR: 1.57, 95% CI: 1.09-2.24, P = 0.01; I 2 = 29%). Conclusions: Current evidence suggests that sarcopenia may be a predictor of mortality in patients with sepsis.


Subject(s)
Sarcopenia , Sepsis , Cohort Studies , Hospitalization , Humans , Observational Studies as Topic , Sarcopenia/complications , Sepsis/complications
10.
JAMA Netw Open ; 5(6): e2216260, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35679046

ABSTRACT

Importance: The pool of studies examining ethnic and racial differences in hospice use and end-of-life hospitalizations among patients with dementia is limited and results are conflicting, making it difficult to assess health care needs of underresourced racial and ethnic groups. Objective: To explore differences in end-of-life utilization of hospice and hospital services among patients with dementia by race and ethnicity. Design, Setting, and Participants: This cohort study used national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims that reflected a range of socioeconomic, health, and psychosocial characteristics. Eligible participants were Medicare fee-for-service beneficiaries aged 65 years or older diagnosed with dementia who died between 2000 and 2016. Analyses were performed from June to December 2021. Exposures: Race and ethnicity. Main Outcomes and Measures: We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end-of-life care preferences. Results: The cohort sample included 5058 beneficiaries with dementia (mean [SD] age, 85.5 [8.0] years; 3038 women [60.1%]; 809 [16.0%] non-Hispanic Black, 357 [7.1%] Hispanic, and 3892 non-Hispanic White respondents [76.9%]). In adjusted analysis, non-Hispanic Black decedents (odds ratio [OR], 0.65; 95% CI, 0.55-0.78), nursing home residents (OR, 0.81; 95% CI, 0.71-0.93), and survey respondents represented by a proxy (OR, 0.84; 95% CI, 0.71-0.99) were less likely to use hospice, whereas older decedents (age 75-84 vs 65-74 years: OR, 1.39; 95% CI, 1.12-1.72; age ≥85 vs 65-74 years: OR, 1.39; 95% CI, 1.13-1.71), women (OR, 1.19; 95% CI, 1.05-1.35), and decedents with higher education (high school vs less than high school: OR, 1.17; 95% CI, 1.01-1.36; more than high school vs less than high school: OR, 1.32; 95% CI, 1.13-1.54), more severe cognitive impairment (OR, 1.51; 95% CI, 1.02-2.23), and more instrumental activities of daily living limitations (OR, 1.07; 95% CI, 1.01-1.12) were associated with higher hospice enrollment. A higher proportion of Black and Hispanic decedents with dementia used ED (645 of 809 [79.7%] and 274 of 357 [76.8%] vs 2753 of 3892 [70.7%]; P < .001) and inpatient services (625 of 809 [77.3%] and 275 of 357 [77.0%] vs 2630 of 3892 [67.5%]; P < .001) and incurred roughly 60% higher inpatient expenditures at the end of life compared with White decedents (estimated mean: Black, $23 279; 95% CI, $20 690-$25 868; Hispanic, $23 471; 95% CI, $19 532-$27 410 vs White, $14 609; 95% CI, $13 800-$15 418). A higher proportion of Black and Hispanic than White beneficiaries with dementia who were enrolled in hospice were subsequently admitted to the ED (56 of 309 [18.1%] and 22 of 153 [14.4%] vs 191 of 1967 [9.7%]; P < .001) or hospital (48 of 309 [15.5%] and 17 of 153 [11.1%] vs 119 of 1967 [6.0%]; P < .001) before death. The proportion of dementia beneficiaries completing advance care planning was lower among Black (146 of 704 [20.7%]) and Hispanic (66 of 308 [21.4%]) beneficiaries compared with White beneficiaries (1871 of 3274 [57.1%]). A higher proportion of Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life (30 of 144 [20.8%] and 12 of 65 [18.4%] vs 72 of 1852 [3.9%]), whereas a higher proportion of White decedents preferred to limit care in certain situations (1708 of 1840 [92.8%] vs 114 of 141 [80.9%] and 51 of 64 [79.7%]), withhold treatments (1448 of 1799 [80.5%] vs 87 of 140 [62.1%] and 41 of 62 [66.1%]), and forgo extensive life-prolonging measures (1712 of 1838 [93.1%] vs 120 of 138 [87.0%] and 54 of 65 [83.1%]). Conclusions and Relevance: The results of this cohort study highlight unique end-of-life care utilization and treatment preferences across racial and ethnic groups among patients with dementia. Medicare should consider alternative payment models to promote culturally competent end-of-life care and reduce low-value interventions and costs among the population with dementia.


Subject(s)
Dementia , Hospice Care , Hospices , Activities of Daily Living , Aged , Aged, 80 and over , Cohort Studies , Death , Dementia/therapy , Female , Hospitalization , Humans , Medicare , United States/epidemiology
11.
JAMA Netw Open ; 5(6): e2216162, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35679047

ABSTRACT

Importance: Limited data are available on the clinical impact of multiplex polymerase chain reaction (PCR) point-of-care testing for respiratory pathogens in acutely ill children. Objective: To evaluate the effect of multiplex PCR point-of-care testing for respiratory pathogens on antibiotic use in acutely ill children. Design, Setting, and Participants: This unblinded, randomized clinical trial was conducted from May 6, 2019, through March 12, 2020. The participants were followed up until hospitalization or discharge from the emergency department (ED) for primary outcome. The study was conducted at the pediatric ED of Oulu University Hospital, Finland. Eligible study participants were children aged 0 to 17 years with fever and/or any respiratory signs or symptoms. Children with underlying medical conditions were included. The statistical analyses were performed between August 11, 2020, and September 14, 2021. Interventions: The participants were randomly assigned in a 2:1 ratio either to undergo multiplex PCR point-of-care testing (18 respiratory viruses and 3 bacteria with results ready within 70 minutes) upon arrival at the ED or to receive routine care. Main Outcomes and Measures: The primary outcome was the proportion of children receiving antibiotic therapy. The secondary outcomes were the numbers of diagnostic tests and radiographic imaging procedures performed and costs. Results: A total of 1417 children were assessed for eligibility. After exclusions, 1243 children (692 boys [56%]) were randomly allocated to either the intervention (829 children) or control (414 children) group. The mean (SD) age of the participants was 3.0 (3.6) years in the intervention group (median [IQR], 1.7 [0.4-4.1] years) and 3.0 (3.5) years (median [IQR], 1.9 [0.4-4.1] years) in the control group. Multiplex PCR point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (226 children [27.3%] in the intervention group vs 118 children [28.5%] in the control group; risk ratio, 0.96; 95% CI, 0.79-1.16). Targeted antibiotic therapy was started in 12 children (1.4%) tested with point-of-care multiplex PCR and 2 children (0.5%) in the control group (risk ratio, 3.0; 95% CI, 0.76-11.9). The numbers of diagnostic tests did not differ between the groups, nor did the costs. Conclusions and Relevance: In this randomized clinical trial, point-of-care testing for respiratory pathogens did not reduce the use of antibiotics at the pediatric ED. Testing for respiratory pathogens appears to have a limited impact on clinical decision-making for acutely ill children. Trial Registration: ClinicalTrials.gov Identifier: NCT03932942.


Subject(s)
Anti-Bacterial Agents , Point-of-Care Testing , Anti-Bacterial Agents/therapeutic use , Child , Fever/drug therapy , Hospitalization , Humans , Male , Point-of-Care Systems
12.
PLoS One ; 17(6): e0269548, 2022.
Article in English | MEDLINE | ID: mdl-35679226

ABSTRACT

OBJECTIVE: To analyze the spatiotemporal distribution of hospital admission rates for primary care-sensitive conditions (PCSC) in women and children in the first 1000 days of life in Brazil. METHODS: Ecological study, with spatiotemporal analyses, using secondary data from Brazilian municipalities. PCSC in women, related to prenatal care and childbirth, and in children under two years old, from 2008 to 2019 were used to characterize trends and formations of spatiotemporal clusters/outliers. Crude PCSC rates were calculated and adjusted by the local empirical Bayesian method, presented in choropleth maps. We also used Anselin Local Moran I type analyses to identify spatial clusters, and space-time cube with clustering by emerging hotspot, followed by time series clustering, for analysis of spatiotemporal trends (alpha = 5%). RESULTS: A total of 1,850,776 PCSC were registered in pregnant women, puerperae, and children under two years of age in Brazil, representing 1.7% of the total number of hospital admissions in the period. PCSC rates showed different behaviors when the groups of women and children were evaluated, with a predominant growing trend of 109% in admissions in the first group and a reduction of 34.4% in the second. The North, Northeast, and Midwest regions had larger high-risk clusters and more significant increasing trends in PCSC in the two subpopulations studied. CONCLUSIONS: Health actions and services in primary care may be reducing hospital admissions for children, but they are not being effective in reducing hospital admissions for women for causes related to prenatal care and childbirth, especially in the North, Northeast, and Midwest of Brazil. Investments in the qualification of care over the thousand days are urgent in the country.


Subject(s)
Hospitalization , Primary Health Care , Bayes Theorem , Brazil/epidemiology , Child , Female , Hospitals , Humans , Infant , Pregnancy , Spatio-Temporal Analysis
13.
PLoS One ; 17(6): e0264510, 2022.
Article in English | MEDLINE | ID: mdl-35679275

ABSTRACT

INTRODUCTION: The SARS-CoV-2 pandemic is a major challenge for patients, healthcare professionals, and populations worldwide. While initial reporting focused mainly on lung involvement, the ongoing pandemic showed that multiple organs can be involved, and prognosis is largely influenced by multi-organ involvement. Our aim was to obtain nationwide retrospective population-based data on hospitalizations with COVID-19 and AKI in Germany. MATERIALS & METHODS: We performed a query of G-DRG data for the year 2020 via the Institute for the hospital remuneration system (Institut für das Entgeltsystem im Krankenhaus GmbH, InEK) data portal and therefore included hospitalizations with a secondary diagnosis of RT-PCR proven COVID-19 infection, aged over 15 years. We included hospitalizations with acute kidney injury (AKI) stages 1 to 3. Age-specific and age-standardized hospitalization and in-hospital mortality rates (ASR) per 100.000 person years were calculated, with the German population of 2011 as the standard. RESULTS: In 2020, there were 16.776.845 hospitalizations in German hospitals. We detected 154.170 hospitalizations with RT-PCR proven COVID-19 diagnosis. The age-standardized hospitalization rate for COVID-19 in Germany was 232,8 per 100.000 person years (95% CI 231,6-233,9). The highest proportion of hospitalizations associated with COVID-19 were in the age group over 80 years. AKI was diagnosed in 16.773 (10.9%) of the hospitalizations with COVID-19. The relative risk of AKI for males was 1,49 (95%CI 1,44-1,53) compared to females. Renal replacement therapy (RRT) was performed in 3.443 hospitalizations, 20.5% of the hospitalizations with AKI. For all hospitalizations with COVID-19, the in-hospital mortality amounted to 19.7% (n = 30.300). The relative risk for in-hospital mortality was 3,87 (95%CI 3,80-3,94) when AKI occurred. The age-standardized hospitalization rates for COVID-19 took a bimodal course during the observation period. The first peak occurred in April (ASR 23,95 per 100.000 person years (95%CI 23,58-24,33)), hospitalizations peaked again in November 2020 (72,82 per 100.000 person years (95%CI 72,17-73,48)). The standardized rate ratios (SRR) for AKI and AKI-related mortality with the overall ASR for COVID-19 hospitalizations in the denominator, decreased throughout the observation period and remained lower in autumn than they were in spring. In contrast to all COVID-19 hospitalizations, the SRR for overall mortality in COVID-19 hospitalizations diverged from hospitalizations with AKI in autumn 2020. DISCUSSION: Our study for the first time provides nationwide data on COVID-19 related hospitalizations and acute kidney injury in Germany in 2020. AKI was a relevant complication and associated with high mortality. We observed a less pronounced increase in the ASR for AKI-related mortality during autumn 2020. The proportion of AKI-related mortality in comparison to the overall mortality decreased throughout the course of the pandemic.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/etiology , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Testing , Female , Hospital Mortality , Hospitalization , Hospitals , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
14.
Cardiovasc Diabetol ; 21(1): 101, 2022 Jun 09.
Article in English | MEDLINE | ID: mdl-35681209

ABSTRACT

BACKGROUND: Heart failure (HF) is a growing complication and one of the leading causes of mortality in people living with type 2 diabetes (T2D). Among the possible causes, the excess of red meat and the insufficiency of vegetables consumption are suspected. Such an alimentation is associated with nutritional biomarkers, including trimethylamine N-oxide (TMAO) and its precursors. Here, we aimed to study these biomarkers as potential prognostic factors for HF in patients with T2D. METHODS: We used the SURDIAGENE (SURvival DIAbetes and GENEtics) study, a large, prospective, monocentric cohort study including 1468 patients with T2D between 2001 and 2012. TMAO and its precursors (trimethylamine [TMA], betaine, choline, and carnitine) as well as thio-amino-acids (cysteine, homocysteine and methionine) were measured by liquid chromatography-tandem mass spectrometry. The main outcome was HF requiring Hospitalization (HFrH) defined as the first occurrence of acute HF leading to hospitalization and/or death, established by an adjudication committee, based on hospital records until 31st December 2015. The secondary outcomes were the composite event HFrH and/or cardiovascular death and all-cause death. The association between the biomarkers and the outcomes was studied using cause-specific hazard-models, adjusted for age, sex, history of coronary artery disease, NT-proBNP, CKD-EPI-derived eGFR and the urine albumin/creatinine ratio. Hazard-ratios (HR) are expressed for one standard deviation. RESULTS: The data of interest were available for 1349/1468 of SURDIAGENE participants (91.9%), including 569 (42.2%) women, with a mean age of 64.3 ± 10.7 years and a median follow-up of 7.3 years [25th-75th percentile, 4.7-10.8]. HFrH was reported in 209 patients (15.5%), HFrH and/or cardiovascular death in 341 (25.3%) and all-cause death in 447 (33.1%). In unadjusted hazard-models, carnitine (HR = 1.20, 95% CI [1.05; 1.37]), betaine (HR = 1.34, [1.20; 1.50]), choline (HR = 1.35, [1.20; 1.52]), TMAO (HR = 1.32, [1.16; 1.50]), cysteine (HR = 1.38, [1.21; 1.58]) and homocysteine (HR = 1.28, [1.17; 1.39]) were associated with HFrH, but not TMA and methionine. In the fully adjusted models, none of these associations was significant, neither for HFrH nor for HFrH and/or CV death, when homocysteine only was positively associated with all-cause death (HR = 1.16, [1.06; 1.27]). CONCLUSIONS: TMAO and its precursors do not appear to be substantial prognosis factors for HFrH, beyond usual cardiac- and kidney-related risk factors, whereas homocysteine is an independent risk factor for all-cause death in patients with T2D.


Subject(s)
Diabetes Mellitus, Type 2 , Heart Failure , Aged , Betaine , Biomarkers , Carnitine , Choline , Cohort Studies , Cysteine , Diabetes Mellitus, Type 2/diagnosis , Female , Heart Failure/diagnosis , Homocysteine , Hospitalization , Humans , Male , Methionine , Middle Aged , Prospective Studies , Risk Factors
15.
Article in English | MEDLINE | ID: mdl-35682021

ABSTRACT

Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study's primary aim was to provide insight into the extent of SDM in medication decisions in the Emergency Department (ED) and to compare how it aligns with older poly-medicated patients' preferences and needs. We applied a mixed-methods design to investigate SDM in medication decisions from two perspectives: (1) observational measurements with the observing patient involvement (OPTION 5) instrument of healthcare professionals' SDM behavior in medication decisions and (2) semi-structured interviews with older poly-medicated patients. A convergent parallel analysis was performed. Sixty-five observations and fourteen interviews revealed four overall themes: (1) a low degree of SDM about medication, (2) a variation in the pro-active and non-active patients approach to conversations about medicine, (3) no information on side effects, and (4) a preference for medication reduction. The lack of SDM with older patients in the ED may increase inequality in health. Patients with low health literacy are at risk of safety threats, nonadherence, and preventable re-admissions. Therefore, healthcare professionals should systematically investigate older poly-medicated patients' preferences and discuss the side effects and the possibility of reducing harmful medicine.


Subject(s)
Decision Making, Shared , Patient Participation , Decision Making , Emergency Service, Hospital , Hospitalization , Humans , Patient Participation/methods , Patient Preference
16.
Article in English | MEDLINE | ID: mdl-35682194

ABSTRACT

Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.


Subject(s)
Emergency Service, Hospital , Substance-Related Disorders , Ambulatory Care , Chronic Disease , Hospitalization , Humans , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy
17.
Article in English | MEDLINE | ID: mdl-35682269

ABSTRACT

BACKGROUND: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d' Evaluation du Risque de Perte d'Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. METHODS: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission. RESULTS: Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively. CONCLUSIONS: All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.


Subject(s)
Activities of Daily Living , Geriatric Assessment , Aged , Female , Geriatric Assessment/methods , Hospitalization , Humans , Longitudinal Studies , Male , Prospective Studies , Risk Assessment/methods , Risk Factors
18.
BMC Geriatr ; 22(1): 462, 2022 05 28.
Article in English | MEDLINE | ID: mdl-35643453

ABSTRACT

BACKGROUND: Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. METHODS: Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. RESULTS: Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. CONCLUSION: Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. TRIAL REGISTRATION: UMBRELLA REVIEW REGISTRATION: PROSPERO ( CRD42020145315 ).


Subject(s)
Patient Discharge , Quality of Life , Aged , Emergency Service, Hospital , Hospitalization , Humans
19.
BMC Geriatr ; 22(1): 479, 2022 06 03.
Article in English | MEDLINE | ID: mdl-35659569

ABSTRACT

BACKGROUND: Inactive behaviour is common in older adults during hospitalisation and associated with poor health outcomes. If patients at high risk of spending little time standing/walking could be identified early after admission, they could be given interventions aimed at increasing their time spent standing/walking. This study aims to identify older adults at high risk of low physical activity (PA) levels during hospitalisation. METHODS: Prospective cohort study of 165 older adults (≥ 70 years) admitted to the department of Internal Medicine of Maastricht University Medical Centre for acute medical illness. Two prediction models were developed to predict the probability of low PA levels during hospitalisation. Time spent standing/walking per day was measured with an accelerometer until discharge (≤ 12 days). The average time standing/walking per day between inclusion and discharge was dichotomized into low/high PA levels by dividing the cohort at the median (50.0%) in model 1, and lowest tertile (33.3%) in model 2. Potential predictors-Short Physical Performance Battery (SPPB), Activity Measure for Post-Acute Care (AM-PAC), age, sex, walking aid use, and disabilities in activities of daily living-were selected based on literature and analysed using logistic regression analysis. Models were internally validated using bootstrapping. Model performance was quantified using measures of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer and Lemeshow (H-L) goodness-of-fit test and calibration plots). RESULTS: Model 1 predicts a probability of spending ≤ 64.4 min standing/walking and holds the predictors SPPB, AM-PAC and sex. Model 2 predicts a probability of spending ≤ 47.2 min standing/walking and holds the predictors SPPB, AM-PAC, age and walking aid use. AUCs of models 1 and 2 were .80 (95% confidence interval (CI) = .73-.87) and .86 (95%CI = .79-.92), respectively, indicating good discriminative ability. Both models demonstrate near perfect calibration of the predicted probabilities and good overall performance, with model 2 performing slightly better. CONCLUSIONS: The developed and internally validated prediction models may enable clinicians to identify older adults at high risk of low PA levels during hospitalisation. External validation and determining the clinical impact are needed before applying the models in clinical practise.


Subject(s)
Activities of Daily Living , Hospitalization , Aged , Cohort Studies , Humans , Prospective Studies , Walking
20.
Sci Rep ; 12(1): 9581, 2022 Jun 10.
Article in English | MEDLINE | ID: mdl-35688830

ABSTRACT

Long-term sequelae of symptomatic infection caused by SARS-CoV-2 are largely undiscovered. We performed a prospective cohort study on consecutively hospitalized Sars-CoV-2 patients (March-May 2020) for evaluating COVID-19 outcomes at 6 and 12 months. After hospital discharge, patients were addressed to two follow-up pathways based on respiratory support needed during hospitalization. Outcomes were assessed by telephone consultation or ambulatory visit. Among 471 patients, 80.9% received no respiratory support during hospitalization; 19.1% received non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). 58 patients died during hospitalization, therefore 413 were enrolled for follow-up. At 6 months, among 355 patients, the 30.3% had any symptoms, 18.0% dyspnea, 6.2% neurological symptoms. Fifty-two out of 105 had major damages in interstitial computed tomography images. NIV/IMV patients had higher probability to suffer of symptoms (aOR = 4.00, 95%CI:1.99-8.05), dyspnea (aOR = 2.80, 95%CI:1.28-6.16), neurological symptoms (aOR = 9.72, 95%CI:2.78-34.00). At 12 months, among 344, the 25.3% suffered on any symptoms, 12.2% dyspnea, 10.1% neurological symptoms. Severe interstitial lesions were present in 37 out of 47 investigated patients. NIV/IMV patients in respect to no respiratory support, had higher probability of experiencing symptoms (aOR = 3.66, 95%CI:1.73-7.74), neurological symptoms (aOR = 8.96, 95%CI:3.22-24.90). COVID-19 patients showed prolonged sequelae up to 12 months, highlighting the need of follow-up pathways for post-COVID-19 syndrome.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/therapy , Dyspnea/etiology , Hospitalization , Humans , Prospective Studies , Referral and Consultation , Respiration, Artificial/methods , SARS-CoV-2 , Telephone
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