scholarly journals Shift of radiotherapy use during the first wave of the COVID-19 pandemic? An analysis of German inpatient data

2022 ◽  
Author(s):  
Daniel Medenwald ◽  
Thomas Brunner ◽  
Hans Christiansen ◽  
Ulrich Kisser ◽  
Sina Mansoorian ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Head And Neck Cancer ◽  
Mixed Models ◽  
Hospital Admissions ◽  
Generalized Linear Mixed Models ◽  
Study Cohort ◽  
Inpatient Setting ◽  
University Hospitals ◽  
Normal Period ◽  
Icd 10

Abstract Objective To assess the change in inpatient radiotherapy related to COVID-19 lockdown measures during the first wave of the pandemic in 2020. Methods We included cases hospitalized between January 1 and August 31, 2018–2020, with a primary ICD-10 diagnosis of C00–C13, C32 (head and neck cancer, HNC) and C53 (cervical cancer, CC). Data collection was conducted within the Medical Informatics Initiative. Outcomes were fractions and admissions. Controlling for decreasing hospital admissions during holidays, calendar weeks of 2018/2019 were aligned to Easter 2020. A lockdown period (LP; 16/03/2020–02/08/2020) and a return-to-normal period (RNP; 04/05/2020–02/08/2020) were defined. The study sample comprised a control (admission 2018/19) and study cohort (admission 2020). We computed weekly incidence and IR ratios from generalized linear mixed models. Results We included 9365 (CC: 2040, HNC: 7325) inpatient hospital admissions from 14 German university hospitals. For CC, fractions decreased by 19.97% in 2020 compared to 2018/19 in the LP. In the RNP the reduction was 28.57% (p < 0.001 for both periods). LP fractions for HNC increased by 10.38% (RNP: 9.27%; p < 0.001 for both periods). Admissions for CC decreased in both periods (LP: 10.2%, RNP: 22.14%), whereas for HNC, admissions increased (LP: 2.25%, RNP: 1.96%) in 2020. Within LP, for CC, radiotherapy admissions without brachytherapy were reduced by 23.92%, whereas surgery-related admissions increased by 20.48%. For HNC, admissions with radiotherapy increased by 13.84%, while surgery-related admissions decreased by 11.28% in the same period. Conclusion Related to the COVID-19 lockdown in an inpatient setting, radiotherapy for HNC treatment became a more frequently applied modality, while admissions of CC cases decreased.

scholarly journals A missed opportunity: underutilization of inpatient behavioral health services to reduce injection drug use sequelae in Florida

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Austin E. Coye ◽  
Mackenzie T. Jones ◽  
Kasha J. Bornstein ◽  
Hansel E. Tookes ◽  
Joan E. St. Onge
Keyword(s):  
Substance Use ◽  
Health Services ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Hospital Admissions ◽  
Inpatient Setting ◽  
High Morbidity ◽  
Coding System ◽  
Behavioral Health Services ◽  
Icd 10

Abstract Background People who inject drugs (PWID) suffer high morbidity and mortality from injection related infections (IRI). The inpatient setting is an ideal opportunity to treat underlying substance use disorder (SUD), but it is unclear how often this occurs. Objectives To quantify the utilization of behavioral health services for PWID during inpatient admissions for IRI. Methods Data for all hospital admissions in Florida in FY2017 were obtained from the Agency for Healthcare Administration. Hospitalization for IRI were obtained using a validated ICD-10 algorithm and treatment for substance use disorder was quantified using ICD-10-Procedure Coding System (ICD-10-PCS) codes. Result Among the 20,001 IRI admissions, there were 230 patients who received behavioral health services as defined by ICD-10-PCS SAT codes for treatment for SUD. Conclusions In a state with a large number of IRI, only a very small portion of admissions received behavioral health services. Increased efforts should be directed to studying referral patterns among physicians and other providers caring for this population and increasing utilization of behavioral health services.

scholarly journals A Missed Opportunity: Underutilization of Inpatient Behavioral Health Services to Reduce Injection Drug Use Sequelae in Florida

2021 ◽  
Author(s):  
Austin Coye ◽  
Mackenzie T Jones ◽  
Kasha J. Bornstein ◽  
Hansel E. Tookes ◽  
Joan E. St. Onge
Keyword(s):  
Substance Use ◽  
Health Services ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Hospital Admissions ◽  
Inpatient Setting ◽  
High Morbidity ◽  
Coding System ◽  
Behavioral Health Services ◽  
Icd 10

Abstract Background: People who inject drugs (PWID) suffer high morbidity and mortality from injection related infections (IRI). The inpatient setting is an ideal opportunity to treat underlying substance use disorder (SUD), but it is unclear how often this occurs.Objectives: To quantify the utilization of behavioral health services for PWID during inpatient admissions for IRI.Design: Data for all hospital admissions in Florida in FY2017 were obtained from the Agency for Healthcare Administration.Subjects: Hospitalization for IRI were obtained using a validated ICD-10 algorithm and treatment for substance use disorder was quantified using ICD-10-Procedure Coding System (ICD-10-PCS) codes.Main Measure: Behavior health services associated with IRI admissionsKey Results: Among the 20,001 IRI admissions, there were 230 patients who received behavioral health services as defined by ICD-10-PCS SAT codes for treatment for SUD.Conclusions: In a state with a large number of IRI, only a very small portion of admissions received behavioral health services. Increased efforts should be directed to studying referral patterns among physicians and other providers caring for this population and increasing utilization of behavioral health services.

scholarly journals A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

2020 ◽  
Vol 41 (S1) ◽  
pp. s453-s454
Author(s):  
Hasti Mazdeyasna ◽  
Shaina Bernard ◽  
Le Kang ◽  
Emily Godbout ◽  
Kimberly Lee ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Private Insurance ◽  
Geographic Region ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Icd 10 ◽  
Tract Infections ◽  
Insurance Payer

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

scholarly journals Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011–2017) of One Midwestern City in the US

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 59
Author(s):  
Andrew Kampfschulte ◽  
Matthew Oram ◽  
Alejandra M. Escobar Vasco ◽  
Brittany Essenmacher ◽  
Amy Herbig ◽  
...  
Keyword(s):  
Local Community ◽  
Hospital Admissions ◽  
Age Groups ◽  
Care Facility ◽  
Pediatric Intensive Care ◽  
High Volume ◽  
Temporal Variables ◽  
Geographical Regions ◽  
Icd 10 ◽  
Pediatric Icu

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns emerge that associate with risk for PICU admission. Data were extracted at an urban, high-volume, quaternary care facility from January 2011 to December 2017 via ICD 10 codes associated with suicide. Clinical, socioeconomic, geographical, and temporal variables were reviewed. In total, 1036 patients over the age of 9 were included, of which n = 161 were PICU admissions. Females represented higher proportions of all suicide-related hospital admissions (67.9%). Looking at race/ethnicity, PICU admissions were largely Caucasian (83.2%); Blacks and Hispanics had lower odds of PICU admissions (OR: 0.49; 0.17, respectively). PICU-admitted patients were older (16.0 vs. 15.5; p = 0.0001), with lower basal metabolic index (23.0 vs. 22.0; p = 0.0013), and presented in summer months (OR: 1.51, p = 0.044). Time-series decomposition showed seasonal peaks in June and August. Local regions outside the city limits identified higher numbers of PICU admissions. PICUs serve discrete geographical regions and are a source of information, when paired with clinical geospatial/seasonal analyses, highlighting clinical and societal risk factors associated with PICU admissions.

l2-Penalized temporal logit-mixed models for the estimation of regional obesity prevalence over time

2021 ◽  
pp. 096228022110175
Author(s):  
Jan P Burgard ◽  
Joscha Krause ◽  
Ralf Münnich ◽  
Domingo Morales
Keyword(s):  
Parameter Estimation ◽  
Medical Treatment ◽  
Mixed Models ◽  
Generalized Linear Mixed Models ◽  
Linear Mixed Models ◽  
Obesity Prevalence ◽  
Model Parameter ◽  
Model Parameter Estimation ◽  
Public Health Reporting ◽  
Over Time

Obesity is considered to be one of the primary health risks in modern industrialized societies. Estimating the evolution of its prevalence over time is an essential element of public health reporting. This requires the application of suitable statistical methods on epidemiologic data with substantial local detail. Generalized linear-mixed models with medical treatment records as covariates mark a powerful combination for this purpose. However, the task is methodologically challenging. Disease frequencies are subject to both regional and temporal heterogeneity. Medical treatment records often show strong internal correlation due to diagnosis-related grouping. This frequently causes excessive variance in model parameter estimation due to rank-deficiency problems. Further, generalized linear-mixed models are often estimated via approximate inference methods as their likelihood functions do not have closed forms. These problems combined lead to unacceptable uncertainty in prevalence estimates over time. We propose an l2-penalized temporal logit-mixed model to solve these issues. We derive empirical best predictors and present a parametric bootstrap to estimate their mean-squared errors. A novel penalized maximum approximate likelihood algorithm for model parameter estimation is stated. With this new methodology, the regional obesity prevalence in Germany from 2009 to 2012 is estimated. We find that the national prevalence ranges between 15 and 16%, with significant regional clustering in eastern Germany.

scholarly journals National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

2021 ◽  
Author(s):  
Olena Seminog ◽  
Uy Hoang ◽  
Michael Goldacre ◽  
Anthony James
Keyword(s):  
Hospital Admissions ◽  
Population Based ◽  
Linkage Study ◽  
Incidence Rates ◽  
Childhood And Adolescence ◽  
Childhood Onset ◽  
Affective Psychosis ◽  
Health Service Provision ◽  
Childhood Onset Schizophrenia ◽  
Icd 10

Abstract Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice.

Disability in Schizophrenic Disorders

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. Wancata ◽  
M. Freidl ◽  
F. Friedrich ◽  
T. Matschnig ◽  
A. Unger ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Social Consequences ◽  
Subjective Burden ◽  
Social Contacts ◽  
Mothers And Fathers ◽  
Duration Of Illness ◽  
The Family ◽  
Different Types ◽  
Icd 10 ◽  
The Mean

Aims:The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.Methods:101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.Results:The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).Conclusions:This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.

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