scholarly journals LO046: Factors associated with hospital admission following asthma exacerbations: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S46-S46 ◽  
Author(s):  
B.H. Rowe ◽  
N. Arrotta ◽  
J. Hill ◽  
E. Dennett ◽  
M. Harries
Keyword(s):  
Hospital Admissions ◽  
Data Extraction ◽  
Statistical Significance ◽  
Grey Literature ◽  
Included Study ◽  
Significance Level ◽  
Factors Associated ◽  
Admission Rates ◽  
Literature Searches ◽  
Number Of Patients

Introduction: Patients with asthma frequently present to the emergency department (ED) with exacerbations; however, a select number of patients require admission to hospital. The objective of this study was to summarize the evidence regarding asthma-related hospital admissions and factors associated with these admissions following ED presentation. Methods: Comprehensive literature searches were conducted in seven electronic databases (database inception to 2015); manual and grey literature searches were also performed. Studies reporting disposition for adults after ED presentation were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS); standardized data-collection forms were used for data extraction. Admission proportions and factors associated with admission at a statistical significance level (p<0.05) were reported. Results: Out of an initial 5865 identified articles, 37 articles met full inclusion criteria. Admission proportions were reported in 25/37 studies, ranged from 1% to 37%, and collectively demonstrated a decline of ~9% in admissions between 1993 and 2012. Studies including a >50% Caucasian ethnicity were found to have a median admission proportion of 13% (interquartile range [IQR]= 7, 20) versus studies with >50% non-Caucasian ethnicity at 22% (IQR=20, 28). Age, female sex, and previous hospitalizations for asthma exacerbation were the most individually identifiable factors associated with admission. Presenting features and medication profile were the most frequent domains associated with admission. Conclusion: Admission rates have decreased approximately 9% in a nearly 20-year span and seem to be higher in studies involving mostly non-Caucasian ethnic groups. Demographic factors, markers of severity obtained by history or at ED presentation, and medication profile could be assessed by ED clinicians to effectively discern patients at high risk for admission.

scholarly journals Association of ADRB1 gene polymorphism with dilated cardiomyopathy

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Chernova ◽  
SY Nikulina ◽  
OO Kuznecova
Keyword(s):  
Statistical Significance ◽  
Rare Allele ◽  
Public Institution ◽  
Control Group ◽  
Significance Level ◽  
Funding Sources ◽  
Idiopathic Cardiomyopathy ◽  
Homozygous Genotype ◽  
Number Of Patients ◽  
Medical University

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University Aim. To evaluate the Association of rs1801252 polymorphism of the ADRB1 gene with dilated idiopathic cardiomyopathy (DCMP) and myocardial dilation of ischemic origin (DMI). Subjects and methods. The study included patients with ICMP and MD IG in the number of 221 people. The average age of the subjects was in the range of 55.30 ± 9.69 years. We divided the patients into 2 groups: the first – patients diagnosed with idiopathic dilatation cardiomyopathy and the second-patients with myocardial dilatation of ichemic origin. The number of patients in the first group was 111, including 99 men (89.2%) and 12 women (10.8%). The average age of patients in this group is 51.73 ± 9.74 years, in men 51.00 ± 8.96 years, in women 57.75 ± 3.71 years. The second group included patients with myocardial dilatation of ischemic origin. Their number is 110 people, including 100 men (91.5%) and 10 women (8.5%). The average age of respondents is 58.68 ± 8.38 years, for men 58.29 ± 8.46 years, for women 62.90 ± 6.29 years. The control group included patients who had no manifestations of cardiovascular diseases. Their number is 121 people (average age 53.6 ± 4.8 years). The patients underwent laboratory and instrumental studies, as well as molecular and genetic studies of the A145G polymorphism of the ADRB1 gene (rs1801252 ). All patients underwent coronary angiography. Based on the anamnesis data and instrumental studies, those patients who could be said to have no risk factors for the development of dilatation of the heart cavities were identified in the first group. And those patients who were reliably diagnosed with CHD were in the second group, that is, dilatation of the heart cavities is due to a previous myocardial infarction, existing angina pectoris. Results. In the group with DCMP 70.3% of patients were carriers of the common homozygous A145A genotype, the heterozygous A145G genotype-27.0%, and the rare homozygous G145G genotype-2.7%. In the control group 71.9% of patients were identified as carriers of a homozygous genotype by a common allele, and 25.3% were carriers heterozygous genotype, and homozygous genotype for a rare allele – 2.7%. Statistical analysis showed no achievement of statistical significance level across any of the genotypes. In the group with DM IG, there was no association with the rs1801252 polymorphism of the ADRB1 gene. Conclusion. A statistically significant association of rs1801252 of the ADRB1 gene with DCMP was not found. The association of DM IG c rs1801252 could not be confirmed.

scholarly journals Multicomponent interventions for enhancing primary care: a systematic review

2020 ◽  
Vol 71 (702) ◽  
pp. e10-e21
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Choon-Huat Koh ◽  
Josip Car
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Emergency Department Visits ◽  
Narrative Form ◽  
Provider Satisfaction ◽  
Quadruple Aim ◽  
Literature Searches ◽  
Multicomponent Interventions

BackgroundMany countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.AimTo identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and settingSystematic review and narrative synthesis.MethodElectronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.ResultsFrom 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.ConclusionMost analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.

scholarly journals Musculoskeletal malignant neoplasms hospitalisation in Victoria

2015 ◽  
Vol 1 (1) ◽  
pp. 33
Author(s):  
Timothy Ore
Keyword(s):  
Rural Communities ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Hospital Admissions ◽  
Average Length ◽  
Malignant Neoplasms ◽  
Factors Associated ◽  
Admission Rates ◽  
Average Length Of Stay ◽  
Disability Support

The paper describes factors associated with 2,605 hospital admissions for musculoskeletal malignant neoplasms (MMN) over oneyear. The rates per 10,000 population increased significantly (t=5.3, p<.01) with age, with men (4.5 per 10,000 population, 95% CI 4.1-5.0) at greater risk than women (3.3 per 10,000 population, 95% CI 2.8-3.7). The 30-day readmission rate was 19%, thethird highest of all admission categories. The average length of stay was significantly (t=4.5, p<.01) shorter in the metropolitanarea (8.2 days) than in rural communities (10.8 days). The age-standardised rates varied inversely (r=-0.28) with socioeconomicstatus. Communities with high MMN admission rates had high rates of heart failure admissions (r=0.35), alcohol consumption(r=0.34) and receiving Disability Support Pension (r=0.32). There was a significant (t=13.8, p<.001) monthly variability inMMN hospitalisation rates. As a leading cause of hospital readmission and disability, the condition requires closer analysis.

scholarly journals Prevalence and factors associated with human brucellosis in livestock professionals

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Franco Cazembe Mufinda ◽  
Fernando Boinas ◽  
Carla Nunes
Keyword(s):  
Statistical Significance ◽  
Human Brucellosis ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Professional Category ◽  
Chi Square Test ◽  
Service Location

ABSTRACT OBJECTIVE The objective of this study is to estimate the seroprevalence of human brucellosis in livestock professionals and analyze the factors associated with brucellosis focusing on sociodemographic variables and the variables of knowledge and practices related to the characteristics of the activities carried out in livestock. METHODS This is a cross-sectional seroepidemiological study with a population of 131 workers of butchers, slaughter rooms, and slaughterhouse and 192 breeders sampled randomly in Namibe province, Angola. The data were obtained from the collection of blood and use of questionnaires. The laboratory tests used were rose bengal and slow agglutination. The questionnaire allowed us to collect sociodemographic information and, specifically on brucellosis, it incorporated questions about knowledge, attitudes, and behaviors of livestock professionals. In addition to the descriptive statistical approach, we used the Chi-square test of independence, Fisher’s test, and logistic regression models, using a significance level of 10%. RESULTS The general weighted prevalence of brucellosis was 15.6% (95%CI 13.61–17.50), being it 5.3% in workers and 16.7% (95%CI 11.39–21.93) in breeders. The statistical significance was observed between human seroprevalence and category (worker and breeder) (p < 0.001) and education level (p = 0.032), start of activity (p = 0079), and service location (p = 0.055). In a multivariate context, the positive factor associated with brucellosis in professionals was the professional category (OR = 3.54; 95%CI 1.57–8.30, related to breeders in relation to workers). CONCLUSIONS Human brucellosis in livestock professionals is prevalent in Namibe province (15.6%), where the professional category was the most important factor. The seroprevalence levels detected are high when compared with those found in similar studies.

The Fragility of Statistically Significant Findings From Randomized Trials in Sports Surgery: A Systematic Survey

2016 ◽  
Vol 45 (9) ◽  
pp. 2164-2170 ◽  
Author(s):  
Moin Khan ◽  
Nathan Evaniew ◽  
Mark Gichuru ◽  
Anthony Habib ◽  
Olufemi R. Ayeni ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Data Extraction ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Fisher Exact Test ◽  
Fragility Index ◽  
Exact Test ◽  
Orthopaedic Care ◽  
Bivariate Correlation ◽  
Number Of Patients

Background: High-quality, evidence-based orthopaedic care relies on the generation and translation of robust research evidence. The Fragility Index is a novel method for evaluating the robustness of statistically significant findings from randomized controlled trials (RCTs). It is defined as the minimum number of patients in 1 arm of a trial that would have to change status from a nonevent to an event to alter the results of the trial from statistically significant to nonsignificant. Purpose: To calculate the Fragility Index of statistically significant results from clinical trials in sports medicine and arthroscopic surgery to characterize the robustness of the RCTs in these fields. Methods: A search was conducted in Medline, EMBASE, and PubMed for RCTs related to sports medicine and arthroscopic surgery from January 1, 2005, to October 30, 2015. Two reviewers independently assessed titles and abstracts for study eligibility, performed data extraction, and assessed risk of bias. The Fragility Index was calculated using the Fisher exact test for all statistically significant dichotomous outcomes from parallel-group RCTs. Bivariate correlation was performed to evaluate associations between the Fragility Index and trial characteristics. Results: A total of 48 RCTs were included. The median sample size was 64 (interquartile range [IQR], 48.5-89.5), and the median total number of outcome events was 19 (IQR, 10-27). The median Fragility Index was 2 (IQR, 1-2.8), meaning that changing 2 patients from a nonevent to an event in the treatment arm changed the result to a statistically nonsignificant result, or P ≥ .05. Conclusion: Most statistically significant RCTs in sports medicine and arthroscopic surgery are not robust because their statistical significance can be reversed by changing the outcome status on only a few patients in 1 treatment group. Future work is required to determine whether routine reporting of the Fragility Index enhances clinicians’ ability to detect trial results that should be viewed cautiously.

scholarly journals Schistosomiasis among pregnant women in Njombe-Penja health district, Cameroon

2019 ◽  
Vol 13 (12) ◽  
pp. 1150-1158
Author(s):  
Calvin Tonga ◽  
Charlie Ngo Bayoi ◽  
Flore Chanceline Tchanga ◽  
Jacqueline Félicité Yengue ◽  
Godlove Bunda Wepnje ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Statistical Significance ◽  
Haemoglobin Concentration ◽  
Epidemiological Data ◽  
Blood Levels ◽  
Childbearing Age ◽  
Significance Level ◽  
Younger Women ◽  
Factors Associated ◽  
Antenatal Consultation

Introduction: Schistosomiasis is a neglected tropical disease with endemic foci in Cameroon. Epidemiological data on schistosomiasis in pregnancy are scarce in the country. This study describes the prevalence, diversity and factors associated with schistosomiasis in pregnant women in Njombe-Penja where schistosomiasis was first reported in 1968. Methodology: Two hundred and eighty-two (282) pregnant women were enrolled at first antenatal consultation between April and December 2016. A questionnaire was used to document socio-economic and obstetric information. Stool and terminal urine samples were collected and analysed using Kato-Katz/Formol-Ether concentration techniques and centrifugation methods respectively. Haemoglobin concentration was measured from finger prick blood, using an URIT®-12 electronic haemoglobinometer. Bivariate and logistic regression were used for statistical analyses with Epi-Info version 7.2.1.0. Statistical significance level was set at 0.05. Results: The overall prevalence of schistosomiasis was 31.91%. Schistosoma guineensis, S. haematobium and S. mansoni infections were found in 0.35% (n = 1), 4.96% (n = 14) and 28.01% (n = 79) of participants, respectively. Co-infection with two species of Schistosoma was found in 4.44% of these women. The prevalence of this disease was significantly higher in younger women (≤ 20 years old) and among residents of Njombe. All S. haematobium infected women were anemic and infection was associated with significantly lower haemoglobin levels (p = 0.02). Conclusion: The prevalence of schistosomiasis is high among pregnant women in Njombe-Penja, with some adverse effects on blood levels. Three Schistosoma species were found. Female of childbearing age should be considered for mass drug administration.

scholarly journals Anti-Caries Effect of Arginine-Containing Formulations in vivo: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 49 (6) ◽  
pp. 606-617 ◽  
Author(s):  
Jialing Li ◽  
Ziwei Huang ◽  
Li Mei ◽  
Guifeng Li ◽  
Huang Li
Keyword(s):  
Assessment Tool ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Research Area ◽  
Included Study ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Using Data

Objective: To assess the anti-caries effect of arginine-containing formulations in vivo on caries lesions compared with fluorides or placebo. Methods: Randomized or quasi-randomized human clinical trials wherein arginine was delivered by any method were considered. The MEDLINE, Web of Science, EMBASE, Cochrane Library, and CBM databases were searched to identify relevant articles published up to December 2014. Grey literature was also searched. Two authors performed data extraction independently and in duplicate using data collection forms. Each included study was assessed using the Cochrane risk of bias assessment tool. Results: Of the 470 studies screened, 31 full articles were scrutinized and assessed for eligibility. Ten studies (n = 15,546 participants) were selected for final inclusion. The meta-analysis results (n = 7 studies) demonstrated a synergistic effect of arginine when used in conjunction with fluoride on early coronal and root caries compared with placebo or fluoride alone. No specific side effects related to arginine usage were identified. Conclusions: When used in combination with a calcium compound and fluoride, arginine potentially provides a superior anti-caries effect compared with matched formulations of fluoride alone. However, the level of evidence was downgraded because of risks of bias and potential publication bias. In the future, more high quality, non-industry-supported clinical studies in this research area are required before any definitive recommendations can be made.

scholarly journals Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis

2021 ◽  
pp. tobaccocontrol-2021-056717
Author(s):  
Joseph G L Lee ◽  
Amanda Y Kong ◽  
Kerry B Sewell ◽  
Shelley D Golden ◽  
Todd B Combs ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Tobacco Use ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Inclusion Criteria ◽  
Data Synthesis ◽  
Literature Searches ◽  
Adult Participants ◽  
Study Selection

ObjectiveWe sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers.Data sourcesTen databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database.Study selectionIncluded studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria.Data extractionEffect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity.Data synthesisWe conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed.ConclusionsAcross studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.

scholarly journals Acute Stroke in Times of the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2224-2227 ◽  
Author(s):  
Carolin Hoyer ◽  
Anne Ebert ◽  
Hagen B. Huttner ◽  
Volker Puetz ◽  
Bernd Kallmünzer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Social Distancing ◽  
Admission Rates ◽  
Cerebrovascular Events ◽  
Number Of Patients ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. Methods: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. Results: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. Conclusions: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.

scholarly journals Is the Temporomandibular Joints’ Reciprocal Clicking Related to the Morphology and Position of the Mandible, as Well as to the Sagittal Position of Lower Incisors?—A Case-Control Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4994
Author(s):  
Marcin Derwich ◽  
Maria Mitus-Kenig ◽  
Elzbieta Pawlowska
Keyword(s):  
Orthodontic Treatment ◽  
Statistical Significance ◽  
Vertical Position ◽  
Significance Level ◽  
Skeletal Class ◽  
Number Of Patients ◽  
Lateral Cephalograms ◽  
Reciprocal Clicking ◽  
Lower Incisors ◽  
Mandibular Incisors

The number of patients diagnosed with temporomandibular joint (TMJ) internal derangements, who are seeking orthodontic treatment, is increasing. The aim of the study was to assess the relationship between the presence of TMJ reciprocal clicking and the morphology and position of the mandible, and position of lower incisors, examined on the lateral cephalograms. Fifty patients diagnosed with reciprocal clicking in at least one of the TMJs and 55 patients with no symptoms of TMJ dysfunction were included in the study. Cephalometric analysis was used for the assessment of: skeletal class, sagittal and vertical position of the mandible, angle of the mandible, inclination of the mandibular ramus and the mandibular corpus, as well as for the assessment of the position of the mandibular incisors. The statistical significance level was set at p = 0.05. There were no statistically significant differences between the examined groups regarding the sagittal and vertical position of the mandible, as well as regarding the sagittal position of the mandibular incisors. Presence of TMJ reciprocal clicking is not associated with the position and the morphology of the mandible, as well as with the sagittal position of the mandibular incisors. Patients with early stages of TMJ internal derangements do not present any significant changes in Cephalometrics. Patients diagnosed with TMJ internal derangements before orthodontic treatment require an interdisciplinary approach to the treatment, including physiotherapy.

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