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1.
Medicine (Baltimore) ; 100(12): e25123, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761678

RESUMEN

ABSTRACT: Human norovirus (NoV) is the leading cause of acute gastroenteritis and the rapid transmission of NoV renders infection control problematic. Our study aimed to investigate viral shedding in gastroenteritis in children caused by variants of emerging norovirus strains infections.We used RNA-dependent RNA polymerase (RdRp) sequencing to measure NoV genome copies in stool to understand the relationship between the clinical manifestations and viral shedding in hospitalized patients. The near full-length NoV genome sequence was amplified via reverse transcription-polymerase chain reaction (RT-PCR) and NoV recombination was analyzed using the Recombination Analysis Tool (RAT).From January 2015 to March 2018, 77 fecal specimens were collected from hospitalized pediatric patients with confirmed NoV gastroenteritis. The NoV genotypes were GII.4 (n = 22), non-GII.4 (n = 14), GII.4 Sydney (n = 21), and GII.P16-GII.2 (n = 20). Viral load increased from days 2 to 9 from the illness onset, resulting in an irregular plateau without peaks. After day 9, the viral load declined gradually and most viral shedding in feces ceased by day 15. The average viral load was highest in GII.4 Sydney followed by GII.P16-GII.2 infections and lowest in non-GII.4 infections. GII.4 unclassified infections showed the longest viral shedding time, followed by GII.4 Sydney infections, GII.P16-GII.2 recombinant infection resulted in the shortest duration. NoVs evolved to form a group of GII.P16-GII.2 variants during the 2017 to 2018 period.The viral load and shedding period and was different in variants of NoV infections in children. High mutation rate of emerging and re-emerging variants was observed to an enhanced epidemic risk rendering continuous surveillance.


Asunto(s)
Infecciones por Caliciviridae/virología , Gastroenteritis/virología , Variación Genética , Norovirus/genética , Esparcimiento de Virus/genética , Preescolar , Heces/virología , Femenino , Genotipo , Humanos , Lactante , Pacientes Internos/estadística & datos numéricos , Masculino , Filogenia , Reacción en Cadena en Tiempo Real de la Polimerasa , Recombinación Genética , Taiwán , Carga Viral
2.
PLoS One ; 16(3): e0248824, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33788876

RESUMEN

OBJECTIVE: To characterize the functional impairments of a cohort of patients undergoing inpatient rehabilitation after surviving severe COVID-19 illness, in order to better understand the ongoing needs of this patient population. METHODS: This study consisted of a retrospective chart review of consecutive patients hospitalized for COVID-19 and admitted to a regional inpatient rehabilitation hospital from April 29th to May 22nd, 2020. Patient demographics, clinical characteristics and complications from acute hospitalization were examined. Measures of fall risk (Berg Balance Scale), endurance (6 Minute Walk Test), gait speed (10 Meter Walk Test), mobility (transfer and ambulation independence), cognition, speech and swallowing (American Speech and Hearing Association National Outcomes Measurement System Functional Communication Measures) were assessed at rehabilitation admission and discharge. RESULTS: The study population included 29 patients and was 70% male, 58.6% white and with a mean age of 59.5. The mean length of acute hospitalization was 32.2 days with a mean of 18.7 days intubated. Patients spent a mean of 16.7 days in inpatient rehabilitation and 90% were discharged home. Patients demonstrated significant improvement from admission to discharge in measures of fall risk, endurance, gait speed, mobility, cognition, speech and swallowing, (p< 0.05). At discharge, a significant portion of the population continued to deficits in cognition (attention 37%; memory 28%; problem solving 28%), balance (55%) and gait speed (97%). CONCLUSION: Patients admitted to inpatient rehabilitation after hospitalization with COVID-19 demonstrated deficits in mobility, cognition, speech and swallowing at admission and improved significantly in all of these domains by discharge. However, a significant number of patients exhibited residual deficits at discharge highlighting the post-acute care needs of this patient population.


Asunto(s)
/fisiopatología , Pacientes Internos/estadística & datos numéricos , Recuperación de la Función , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Riesgo , Resultado del Tratamiento
3.
J Hosp Med ; 16(4): 223-226, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33734985

RESUMEN

Children's hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children's hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children's hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children's hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children's hospitals experienced a median decrease of $276 million in charges.


Asunto(s)
/economía , Prestación de Atención de Salud , Costos de la Atención en Salud , Hospitales Pediátricos/economía , Pacientes Internos/estadística & datos numéricos , Niño , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Estudios Retrospectivos
4.
J Hosp Infect ; 110: 178-183, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33571558

RESUMEN

AIM: To investigate the sources of infection among healthcare workers (HCWs) and patients in a teaching hospital in the Netherlands during the early stages of the coronavirus disease 2019 (COVID-19) pandemic using epidemiological and whole-genome sequencing data. METHODS: From 3rd April to 11th May 2020, 88 HCWs and 215 patients were diagnosed with COVID-19. Whole-genome sequences were obtained for 30 HCWs and 20 patients. RESULTS: Seven and 11 sequence types were identified in HCWs and patients, respectively. Cluster A was the most common sequence type, detected in 23 (77%) HCWs; of these, 14 (61%) had direct patient contact and nine (39%) had indirect patient contact. In addition, seven patients who were not hospitalized in the COVID-19 cohort isolation ward who became positive during their admission were infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cluster A. Following universal masking of all HCWs and emphasis on physical distancing during meals and breaks, no further evidence was found for patient-to-HCW or HCW-to-HCW transmission or vice versa. CONCLUSION: The finding that patients and HCWs were infected with SARS-CoV-2 cluster A suggests both HCW-to-HCW and HCW-to-patient transmission.


Asunto(s)
/transmisión , Personal de Salud/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pandemias/estadística & datos numéricos
5.
Am J Clin Oncol ; 44(3): 114-120, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33417323

RESUMEN

OBJECTIVES: Immune checkpoint inhibitors (ICIs) are being increasingly used across cancer types. Emergency room (ER) and inpatient (IP) care, common in patients with cancer, remain poorly defined in this specific population, and risk factors for such care are unknown. METHODS: We retrospectively reviewed charts for patients with solid tumors who received >1 ICI dose at 1 of 2 sites from January 1, 2011 to April 28, 2017. Demographics, medical history, cancer diagnosis/therapy/toxicity details, and outcomes were recorded. Descriptive data detailing ER/IP care at the 2 associated hospitals during ICI therapy (from first dose to 3 mo after last dose) were collected. The Fisher exact test and multivariate regression analysis was used to study differences between patients with versus without ER/IP care during ICI treatment. RESULTS: Among 345 patients studied, 50% had at least 1 ER visit during ICI treatment and 43% had at least 1 IP admission. Six percent of ER/IP visits eventually required intensive care. A total of 12% of ER/IP visits were associated with suspected or confirmed immune-related adverse events. Predictors of ER care were African-American race (odds ratio [OR]: 3.83, P=0.001), Hispanic ethnicity (OR: 3.12, P=0.007), and coronary artery disease (OR: 2.43, P=0.006). Predictors of IP care were African-American race (OR: 2.38, P=0.024), Hispanic ethnicity (OR: 2.29, P=0.045), chronic kidney disease (OR: 3.89, P=0.006), angiotensin converting enzyme inhibitor/angiotensin receptor blocker medication use (OR: 0.44, P=0.009), and liver metastasis (OR: 2.32, P=0.003). CONCLUSIONS: Understanding demographic and clinical risk factors for ER/IP care among patients on ICIs can help highlight disparities, prospectively identify high-risk patients, and inform preventive programs aimed at reducing such care.


Asunto(s)
Servicio de Urgencia en Hospital , /uso terapéutico , Neoplasias/terapia , Adulto , Afroamericanos , Anciano , Anciano de 80 o más Años , Comorbilidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
6.
J Infect Public Health ; 14(2): 206-213, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33486377

RESUMEN

AIMS: The emerging biliary colonization of microorganisms in patients with biliary diseases may be devastating. Recent evidence suggests that age and gender may influence changes in the microbial composition of gut microbiota. To study the relationship between these parameters on bile microbiota, we retrospectively reviewed positive bile cultures following an endoscopic retrograde cholangiopancreatography (ERCP) in a QA-certified academic surgical unit of a single institution. METHODS: 449 positive bile cultures from 172 Italian patients with diseases of the biliopancreatic system hospitalized from 2006 through 2017 were investigated for aerobic, anaerobic, and fungal organisms. The patients were stratified into four age intervals (22-66, 67-74, 75-81, and 82-93 years) and followed up for five years. RESULTS: Gram-positive bacteria (GPB) was negatively associated with age only in multivariate analysis (Rpartial = -0.114, p = 0.017), with younger patients prone to harbor GPB and older patients likely to have Gram-negative bacteria (GNB). There was a definite link with the male gender using both univariate and multivariate analysis (p < 0.001). Enterococcus spp. was the most common strain identified in patients with GPB except for patients aged 67-74 years for male (95.2%) and female (80.9%) patients. Escherichia coli and Klebsiella spp. were most frequent than others in every group analyzed. Analogous results were found for bacteria Non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas spp. and Stenotrophomonas spp. apart of the 2nd quartile. CONCLUSIONS: Our study strengthens the bond of age and gender with bile microbiota composition and suggests that further investigations may be required in targeting the aging microbiome. Other studies should also focus on Mediterranean epidemiological characteristics and antibiotic resistance surveillance system strategies.


Asunto(s)
Bilis/microbiología , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Pacientes Internos/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Envejecimiento , Colangiopancreatografia Retrógrada Endoscópica , Estudios Transversales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Adulto Joven
7.
J Am Geriatr Soc ; 69(2): 293-299, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33411332

RESUMEN

OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.


Asunto(s)
/mortalidad , Delirio/diagnóstico , Delirio/mortalidad , Pacientes Internos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Femenino , Evaluación Geriátrica , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Masculino , Prevalencia , Factores de Riesgo
8.
J Nurs Adm ; 51(2): 60-62, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449593

RESUMEN

OBJECTIVE: The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters. BACKGROUND: Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety. METHODS: A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM. RESULTS: Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM. CONCLUSIONS: Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.


Asunto(s)
Accidentes por Caídas/prevención & control , Actitud del Personal de Salud , Monitoreo Fisiológico/enfermería , Asistentes de Enfermería/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Actitud hacia los Computadores , Humanos , Pacientes Internos/estadística & datos numéricos , Grabación de Cinta de Video/métodos
9.
In Vivo ; 35(1): 653-661, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33402523

RESUMEN

BACKGROUND/AIM: To investigate the efficacy (prognosis, coagulation/inflammation biomarkers) and safety (bleeding events) of different anticoagulation dosages in COVID-19 inpatients. PATIENTS AND METHODS: COVID-19 inpatients (Athens, Greece) were included. The "Enhanced dose THRomboprophylaxis in Admissions (ETHRA)" protocol was applied in certain Departments, suggesting the use of intermediate anticoagulation dosage. The primary endpoint was a composite of intubation/venous thromboembolism/death. Inflammation/coagulation parameters were assessed. RESULTS: Among 127 admissions, 95 fulfilled the inclusion criteria. Twenty-one events (4 deaths, 17 intubations) were observed. Regression analysis demonstrated significant reduction of events with intermediate or therapeutic dosage [HR=0.16 (95%CI=0.05-0.52) p=0.002; HR=0.17 (0.04-0.71) p=0.015, respectively]. D-Dimer values were higher in those who met the composite endpoint. Intermediate dosage treatment was associated with decreased values of ferritin. Three patients (3%) had minor hemorrhagic complications. CONCLUSION: Anticoagulation treatment (particularly intermediate dosage) appears to have positive impact on COVID-19 inpatients' prognosis by inhibiting both coagulation and inflammatory cascades.


Asunto(s)
Anticoagulantes/uso terapéutico , Coagulación Sanguínea/efectos de los fármacos , Hospitalización/estadística & datos numéricos , Tromboembolia Venosa/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , /virología , Relación Dosis-Respuesta a Droga , Femenino , Grecia , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Tromboembolia Venosa/sangre
10.
Harm Reduct J ; 18(1): 9, 2021 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-33453726

RESUMEN

BACKGROUND: There is a lot of debate about the effects of smoking on COVID-19. A recent fixed-effects meta-analysis found smoking to be associated with disease severity among hospitalized patients, but other studies report an unusually low prevalence of smoking among hospitalized patients. The purpose of this study was to expand the analysis by calculating the prevalence odds ratio (POR) of smoking among hospitalized COVID-19 patients, while the association between smoking and disease severity and mortality was examined by random-effects meta-analyses considering the highly heterogeneous study populations. METHODS: The same studies as examined in the previous meta-analysis were analyzed (N = 22, 20 studies from China and 2 from USA). The POR relative to the expected smoking prevalence was calculated using gender and age-adjusted population smoking rates. Random-effects meta-analyses were used for all other associations. RESULTS: A total of 7162 patients were included, with 482 being smokers. The POR was 0.24 (95%CI 0.19-0.30). Unlike the original study, the association between smoking and disease severity was not statistically significant using random-effects meta-analysis (OR 1.40, 95%CI 0.98-1.98). In agreement with the original study, no statistically significant association was found between smoking and mortality (OR 1.86, 95%CI 0.88-3.94). CONCLUSION: An unusually low prevalence of smoking, approximately 1/4th the expected prevalence, was observed among hospitalized COVID-19 patients. Any association between smoking and COVID-19 severity cannot be generalized but should refer to the seemingly low proportion of smokers who develop severe COVID-19 that requires hospitalization. Smokers should be advised to quit due to long-term health risks, but pharmaceutical nicotine or other nicotinic cholinergic agonists should be explored as potential therapeutic options, based on a recently presented hypothesis.


Asunto(s)
/epidemiología , Pacientes Internos/estadística & datos numéricos , Fumar/epidemiología , Adulto , China/epidemiología , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/mortalidad , Estados Unidos/epidemiología
11.
Emerg Infect Dis ; 27(2): 385-395, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33496225

RESUMEN

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.


Asunto(s)
/complicaciones , Pacientes Internos/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Colorado/epidemiología , Tos/epidemiología , Tos/virología , Progresión de la Enfermedad , Disnea/epidemiología , Disnea/virología , Fatiga/epidemiología , Fatiga/virología , Femenino , Fiebre/epidemiología , Fiebre/virología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mialgia/epidemiología , Mialgia/virología , Evaluación de Síntomas , Adulto Joven
12.
Diabetes Care ; 44(2): 578-585, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323475

RESUMEN

OBJECTIVE: Diabetes and hyperglycemia are important risk factors for poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). We hypothesized that achieving glycemic control soon after admission, in both intensive care unit (ICU) and non-ICU settings, could affect outcomes in patients with COVID-19. RESEARCH DESIGN AND METHODS: We analyzed pooled data from the Glytec national database including 1,544 patients with COVID-19 from 91 hospitals in 12 states. Patients were stratified according to achieved mean glucose category in mg/dL (≤7.77, 7.83-10, 10.1-13.88, and >13.88 mmol/L; ≤140, 141-180, 181-250, and >250 mg/dL) during days 2-3 in non-ICU patients or on day 2 in ICU patients. We conducted a survival analysis to determine the association between glucose category and hospital mortality. RESULTS: Overall, 18.1% (279/1,544) of patients died in the hospital. In non-ICU patients, severe hyperglycemia (blood glucose [BG] >13.88 mmol/L [250 mg/dL]) on days 2-3 was independently associated with high mortality (adjusted hazard ratio [HR] 7.17; 95% CI 2.62-19.62) compared with patients with BG <7.77 mmol/L (140 mg/dL). This relationship was not significant for admission glucose (HR 1.465; 95% CI 0.683-3.143). In patients admitted directly to the ICU, severe hyperglycemia on admission was associated with increased mortality (adjusted HR 3.14; 95% CI 1.44-6.88). This relationship was not significant on day 2 (HR 1.40; 95% CI 0.53-3.69). Hypoglycemia (BG <70 mg/dL) was also associated with increased mortality (odds ratio 2.2; 95% CI 1.35-3.60). CONCLUSIONS: Both hyperglycemia and hypoglycemia were associated with poor outcomes in patients with COVID-19. Admission glucose was a strong predictor of death among patients directly admitted to the ICU. Severe hyperglycemia after admission was a strong predictor of death among non-ICU patients.


Asunto(s)
/epidemiología , Diabetes Mellitus/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Diabetes Mellitus/metabolismo , Femenino , Mortalidad Hospitalaria , Hospitales , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Pacientes Internos/estadística & datos numéricos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
14.
Public Health ; 190: 1-3, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33316477

RESUMEN

BACKGROUND: The mortality of the coronavirus disease 2019 (COVID-19) pandemic is high, and data regarding its prognosis are scarce. We aimed to assess the survival experience and determining factors in adult inpatients with laboratory-confirmed COVID-19. METHODS: We conducted a nationwide and retrospective cohort study. Data from 66,123 individuals were analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazard regression model was fitted. RESULTS: The 7-day survival was 72.2% and went to 47.6%, 35.0%, and 23.9% on days 15, 21, and 30 of hospital stay, respectively. In the multiple analysis, factors associated with an increased risk of dying were male gender, age, pneumonia at hospital admission, immunosuppression, and personal history of chronic non-communicable diseases. Reduced risk of a fatal outcome was observed among patients with asthma history. CONCLUSIONS: To the best of our knowledge, this is the largest study analyzing the survival probability in a large subset of Latin-American adults with COVID-19, in whom the disease burden has been high. Our results contribute to achieving a better understanding of disease evolution.


Asunto(s)
/mortalidad , Pacientes Internos/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Enfermedad Crónica/epidemiología , Estudios de Cohortes , Comorbilidad , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , México/epidemiología , Persona de Mediana Edad , Pandemias , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Adulto Joven
15.
BMC Infect Dis ; 20(1): 952, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33308159

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and outbreaks have occurred worldwide. Laboratory test results are an important basis for clinicians to determine patient condition and formulate treatment plans. METHODS: Fifty-two thousand six hundred forty-four laboratory test results with continuous values of adult inpatients who were diagnosed with COVID-19 and hospitalized in the Fifth Hospital in Wuhan between 16 January 2020 and 18 March 2020 were compiled. The first and last test results were compared between survivors and non-survivors with variance test or Welch test. Laboratory test variables with significant differences were then included in the temporal change analysis. RESULTS: Among 94 laboratory test variables in 82 survivors and 25 non-survivors with COVID-19, white blood cell count, neutrophil count/percentage, mean platelet volume, platelet distribution width, platelet-large cell percentage, hypersensitive C-reactive protein, procalcitonin, D-dimer, fibrin (ogen) degradation product, middle fluorescent reticulocyte percentage, immature reticulocyte fraction, lactate dehydrogenase were significantly increased (P < 0.05), and lymphocyte count/percentage, monocyte percentage, eosinophil percentage, prothrombin activity, low fluorescent reticulocyte percentage, plasma carbon dioxide, total calcium, prealbumin, total protein, albumin, albumin-globulin ratio, cholinesterase, total cholesterol, nonhigh-density/low-density/small-dense-low-density lipoprotein cholesterol were significantly decreased in non-survivors compared with survivors (P < 0.05), in both first and last tests. Prothrombin time, prothrombin international normalized ratio, nucleated red blood cell count/percentage, high fluorescent reticulocyte percentage, plasma uric acid, plasma urea nitrogen, cystatin C, sodium, phosphorus, magnesium, myoglobin, creatine kinase (isoenzymes), aspartate aminotransferase, alkaline phosphatase, glucose, triglyceride were significantly increased (P < 0.05), and eosinophil count, basophil percentage, platelet count, thrombocytocrit, antithrombin III, red blood cell count, haemoglobin, haematocrit, total carbon dioxide, acidity-basicity, actual bicarbonate radical, base excess in the extracellular fluid compartment, estimated glomerular filtration rate, high-density lipoprotein cholesterol, apolipoprotein A1/ B were significantly decreased in non-survivors compared with survivors (P < 0.05), only in the last tests. Temporal changes in 26 variables, such as lymphocyte count/percentage, neutrophil count/percentage, and platelet count, were obviously different between survivors and non-survivors. CONCLUSIONS: By the comprehensive usage of the laboratory markers with different temporal changes, patients with a high risk of COVID-19-associated death or progression from mild to severe disease might be identified, allowing for timely targeted treatment.


Asunto(s)
Biomarcadores/sangre , Sobrevivientes/estadística & datos numéricos , Proteína C-Reactiva/metabolismo , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Pacientes Internos/estadística & datos numéricos , Recuento de Leucocitos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Pandemias , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos , Factores de Tiempo
16.
PLoS One ; 15(12): e0243795, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33320881

RESUMEN

Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child's home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.


Asunto(s)
Hospitales Pediátricos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Infecciones/complicaciones , Pacientes Internos/estadística & datos numéricos , Leucemia Mieloide Aguda/complicaciones , Adolescente , Niño , Preescolar , República Dominicana , Femenino , Humanos , Lactante , Infecciones/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Pronóstico , Estudios Retrospectivos
17.
JAMA Netw Open ; 3(12): e2029676, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33320266

RESUMEN

Importance: Whereas outpatient treatment with medication for opioid use disorder (MOUD) is evidence based, there is a large network of inpatient facilities in the US that are reimbursed by commercial insurers and do not typically offer MOUD. Objective: To compare the rates of opioid-related overdose and all-cause hospitalization after outpatient MOUD treatment vs inpatient care. Design, Setting, and Participants: This comparative effectiveness research study used deidentified claims of commercially insured individuals in the US from the MarketScan Commercial Claims and Encounters Database from January 1, 2010, to December 31, 2017, to obtain a sample of 37 090 individuals with opioid use disorder who initiated treatment with inpatient care and/or MOUD. Data were analyzed from October 1, 2019, to May 1, 2020. To address nonrandom treatment assignment, individuals with opioid use disorder who initiated MOUD or who entered inpatient care were matched 1:1 based on propensity scores. Exposures: The independent variable of interest was the type of treatment initiated. Individuals could initiate 1 of 5 potential treatments: (1) outpatient MOUD, (2) short-term inpatient care, (3) short-term inpatient care followed by outpatient MOUD within 30 days, (4) long-term inpatient care, or (5) long-term inpatient care followed by outpatient MOUD within 30 days. Main Outcomes and Measures: Opioid-related overdose and all-cause hospitalization at any point within the 12 months after treatment of opioid use disorder. The hazard for each outcome was estimated using a time-to-event Cox proportional hazards regression model. Results: The cohort included 37 090 individuals matched 1:1 between inpatient and outpatient treatment (20 723 [56%] were younger than 30 years; 23 250 [63%] were male). After propensity score matching, compared with the inpatient treatments, initiation of outpatient MOUD alone was followed by the lowest 1-year overdose rate (2.2 [95% CI, 2.0-2.5] per 100 person-years vs 3.5 [95% CI, 2.7-4.4] to 7.0 [95% CI, 4.6-10.7] per 100 person-years) and hospitalization rate (39 [95% CI, 38-40] per 100 person-years vs 57 [95% CI, 54-61] to 74 [95% CI, 73-76] per 100 person-years). Outpatient MOUD was also associated with the lowest hazard of these events compared with inpatient care, which had hazard ratios ranging from 1.71 (95% CI, 1.35-2.17) to 2.67 (95% CI, 1.68-4.23) for overdose and 1.33 (95% CI, 1.23-1.44) to 1.90 (95% CI, 1.83-1.97) for hospitalizations. Conclusions and Relevance: The results of this comparative effectiveness research study suggest that lower rates of subsequent overdose and hospitalization are associated with outpatient MOUD compared with short- or long-term inpatient care. When patients and clinicians have a choice of treatment, outpatient MOUD treatment may be associated with lower overdose and hospitalization on balance. Future research should assess which patients benefit most from inpatient care and how best to leverage existing inpatient treatment infrastructure.


Asunto(s)
Buprenorfina , Sobredosis de Droga , Hospitalización/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Pacientes Ambulatorios/estadística & datos numéricos , Adulto , Buprenorfina/administración & dosificación , Buprenorfina/efectos adversos , Investigación sobre la Eficacia Comparativa , Sobredosis de Droga/epidemiología , Sobredosis de Droga/etiología , Sobredosis de Droga/terapia , Femenino , Humanos , Masculino , Antagonistas de Narcóticos/administración & dosificación , Antagonistas de Narcóticos/efectos adversos , Evaluación de Procesos y Resultados en Atención de Salud
20.
J Nurs Adm ; 50(12): 649-654, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33181525

RESUMEN

OBJECTIVE: The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility. BACKGROUND: Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability. METHODS: Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined. RESULTS: Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs. CONCLUSIONS: Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Servicios de Atención de Salud a Domicilio , Pacientes Internos/estadística & datos numéricos , Personal de Enfermería en Hospital/organización & administración , Caminata/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Alta del Paciente/estadística & datos numéricos , Calidad de Vida/psicología , Encuestas y Cuestionarios , Estados Unidos
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