Nasopharyngeal Microbiota as an early severity biomarker in COVID-19 hospitalised patients: a retrospective cohort study in a Mediterranean area.

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

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P181 Cytomegalovirus infections are rare in hospitalised patients with flares of inflammatory bowel disease—a monocentre retrospective cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy222.305 ◽

2019 ◽

Vol 13 (Supplement_1) ◽

pp. S180-S181

Author(s):

L-V Lorenz ◽

C Monasterio ◽

A-M Globig ◽

P Hasselblatt

Keyword(s):

Inflammatory Bowel Disease ◽

Cohort Study ◽

Bowel Disease ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospitalised Patients ◽

Inflammatory Bowel ◽

Cytomegalovirus Infections

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Unintended discontinuation of medication following hospitalisation: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-024747 ◽

2019 ◽

Vol 9 (6) ◽

pp. e024747 ◽

Cited By ~ 3

Author(s):

Patrick Redmond ◽

Ronald McDowell ◽

Tamasine C Grimes ◽

Fiona Boland ◽

Ronan McDonnell ◽

...

Keyword(s):

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Discharge Summary ◽

Lipid Lowering ◽

Evidence Based ◽

Hospitalised Patients ◽

Hospital Discharge Summary

ObjectivesWhether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice.DesignRetrospective cohort study between 2012 and 2015.SettingElectronic records and hospital supplied discharge notifications in 44 Irish general practices.Participants20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions.Primary and secondary outcomesDiscontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient’s general practitioner (GP) prescribing record at 6 months follow-up.ResultsIn patients admitted to hospital, medication discontinuity ranged from 6%–11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01).ConclusionDiscontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.

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Stress Hyperglycaemia in Hospitalised Patients and Their 3-Year Risk of Diabetes: A Scottish Retrospective Cohort Study

PLoS Medicine ◽

10.1371/journal.pmed.1001708 ◽

2014 ◽

Vol 11 (8) ◽

pp. e1001708 ◽

Cited By ~ 24

Author(s):

David A. McAllister ◽

Katherine A. Hughes ◽

Nazir Lone ◽

Nicholas L. Mills ◽

Naveed Sattar ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stress Hyperglycaemia ◽

Hospitalised Patients

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Do premorbid characteristics of home care clients predict delayed discharges in acute care hospitals: a retrospective cohort study in Ontario and British Columbia, Canada

BMJ Open ◽

10.1136/bmjopen-2020-038484 ◽

2021 ◽

Vol 11 (2) ◽

pp. e038484

Author(s):

Stella A Arthur ◽

John P Hirdes ◽

George Heckman ◽

Anne Morinville ◽

Andrew P Costa ◽

...

Keyword(s):

Cohort Study ◽

Home Care ◽

Activities Of Daily Living ◽

Retrospective Cohort Study ◽

Daily Living ◽

Retrospective Cohort ◽

Term Care ◽

Delayed Discharge ◽

Hospitalised Patients ◽

Care Assessment

BackgroundImproved identification of patients with complex needs early during hospitalisation may help target individuals at risk of delayed discharge with interventions to prevent iatrogenic complications, reduce length of stay and increase the likelihood of a successful discharge home.MethodsIn this retrospective cohort study, we linked home care assessment records based on the Resident Assessment Instrument for Home Care (RAI-HC) of 210 931 hospitalised patients with their Discharge Abstract Database records. We then undertook multivariable logistic regression analyses to identify preadmission predictive factors for delayed discharge from hospital.ResultsCharacteristics that predicted delayed discharge included advanced age (OR: 2.72, 95% CI 2.55 to 2.90), social vulnerability (OR: 1.27, 95% CI 1.08 to 1.49), Parkinsonism (OR: 1.34, 95% CI 1.28 to 1.41) Alzheimer’s disease and related dementias (OR: 1.27, 95% CI 1.23 to 1.31), need for long-term care facility services (OR: 2.08, 95% CI 1.96 to 2.21), difficulty in performing activities of daily living and instrumental activities of daily living, falls (OR: 1.16, 95% CI 1.12 to 1.19) and problematic behaviours such as wandering (OR: 1.29, 95% CI 1.22 to 1.38).ConclusionPredicting delayed discharge prior to or on admission is possible. Characteristics associated with delayed discharge and inability to return home are easily identified using existing interRAI home care assessments, which can then facilitate the targeting of pre-emptive interventions immediately on hospital admission.

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Effects of a Medication Review on Delirium in Older Hospitalised Patients: A Comparative Retrospective Cohort Study

Drugs & Aging ◽

10.1007/s40266-018-0523-9 ◽

2018 ◽

Vol 35 (2) ◽

pp. 153-161 ◽

Cited By ~ 4

Author(s):

Eveline L. van Velthuijsen ◽

Sandra M. G. Zwakhalen ◽

Evelien Pijpers ◽

Liesbeth I. van de Ven ◽

Ton Ambergen ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Medication Review ◽

Retrospective Cohort ◽

Hospitalised Patients

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Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010675 ◽

2020 ◽

pp. bmjqs-2019-010675 ◽

Cited By ~ 1

Author(s):

Rachel Kohn ◽

Michael O Harhay ◽

Brian Bayes ◽

Hummy Song ◽

Scott D Halpern ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

General Medicine ◽

Adverse Outcomes ◽

Referral Centre ◽

Tertiary Referral Centre ◽

Medicine Service ◽

Hospitalised Patients

BackgroundSpecialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services.MethodsWe performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home.ResultsAmong 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses.ConclusionBedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.

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External validation of the Hospital Frailty Risk Score and comparison with the Hospital-patient One-year Mortality Risk Score to predict outcomes in elderly hospitalised patients: a retrospective cohort study

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-008661 ◽

2018 ◽

Vol 28 (4) ◽

pp. 284-288 ◽

Cited By ~ 14

Author(s):

Finlay McAlister ◽

Carl van Walraven

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Risk Score ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Patient ◽

Prolonged Length ◽

C Statistic ◽

Hospitalised Patients ◽

One Year

ObjectiveFrailty is an important prognostic factor in hospitalised patients but typically requires face-to-face assessment by trained observers to detect. Thus, frail patients are not readily apparent from a systems perspective for those interested in implementing quality improvement measures to optimise their outcomes. This study was designed to externally validate and compare two recently described tools using administrative data as potential markers for frailty: the Hospital Frailty Risk Score (HFRS) and the Hospital-patient One-year Mortality Risk (HOMR) Score.DesignRetrospective cohort study.SettingOntario, Canada.ParticipantsAll patients over 75 with at least one urgent non-psychiatric hospitalisation between 2004 and 2010.Main outcome measuresProlonged hospital length of stay (>10 days), 30-day mortality after admission and 30-day postdischarge rates of urgent readmission or emergency department (ED) visits.ResultsIn 452 785 patients (25.9% with intermediate or high-risk HFRS), increased HFRS was associated with higher Charlson scores, older age and decreased likelihood of baseline independence. Patients with high or intermediate HFRS had significantly increased risks of prolonged hospitalisation (70.0% (OR 8.64, 95% CI 8.30 to 8.99) or 49.7% (OR 3.66, 95% CI 3.60 to 3.71) vs 21.3% in low-risk HFRS group) and 30-day mortality (15.5% (OR 1.27, 95% CI 1.20 to 1.33) or 16.8% (OR 1.39, 95% CI 1.36 to 1.41) vs 12.7% in low-risk), but decreased risks of 30-day readmission (10.0% (OR 0.74, 95% CI 0.69 to 0.79) and 11.2% (OR 0.84, 95% CI 0.82 to 0.86) vs 13.1%) or ED visit (7.3% (OR 0.41, 95% CI 0.38 to 0.45) and 11.1% (OR 0.66, 95% CI 0.38 to 0.45) vs 16.0%). Although only loosely associated (Pearson correlation coefficient 0.265, p<0.0001), both the HFRS and HOMR Score were independently associated with each outcome—HFRS was more strongly associated with prolonged length of stay (C-statistic 0.71) and HOMR Score was more strongly associated with 30-day mortality (C-statistic 0.71). Both poorly predicted 30-day readmissions (C-statistics 0.52 for HFRS and 0.54 for HOMR Score).ConclusionsThe HFRS best identified hospitalised older patients at higher risk of prolonged length of stay and the HOMR score better predicted 30-day mortality. However, neither score was suitable for predicting risk of readmission or ED visit in the 30 days after discharge. Thus, a single score is inadequate to prognosticate for all outcomes associated with frailty.

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