Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre

2019 ◽  
Vol 29 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Igor V. Polivenok ◽  
Frank J. Molloy ◽  
Christian L. Gilbert ◽  
Mark Danton ◽  
Ali Dodge-Khatami ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Case Volume ◽  
Standardised Mortality Ratio ◽  
Case Complexity ◽  
International Team ◽  
Assistance Programme ◽  
Mortality Ratio ◽  
The Impact

AbstractBackgroundSurgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.Material and methodsThe international paediatric assistance programme included five main components – intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000–2007; era B: 2008–2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.ResultsA total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3–24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1–137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.ConclusionsThe model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.

Clinical and Seasonal Variations of Nutritional Risk Screening in Patients Scheduled for Rehabilitation after Heart Surgery

2013 ◽  
Vol 16 (6) ◽  
pp. 336
Author(s):  
Marko Boban ◽  
Viktor Persic ◽  
Zeljko Jovanovic ◽  
Niksa Drinkovic ◽  
Milan Milosevic ◽  
...  
Keyword(s):  
Weight Loss ◽  
Heart Surgery ◽  
Nutritional Risk ◽  
Risk Scores ◽  
Risk Screening ◽  
Climate Effects ◽  
Seasonal Climate ◽  
Nrs 2002 ◽  
The Impact ◽  
Nutritional Risk Screening

<p><b>Background:</b> Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics.</p><p><b>Methods:</b> The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia.</p><p><b>Results:</b> Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 � 1.0, with a percentage weight loss history of 11.7% � 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 � 0.7 versus 4.8 � 1.1 (<i>P</i> = 0.136) and greater loss of weight of 13.0% � 3.2% versus 10.6% � 3% (<i>P</i> = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; <i>P</i> = 0.034 versus 0.584; <i>P</i> = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; <i>P</i> = 0.009), the increase in glucose concentrations (cc = 0.600; <i>P</i> < 0.001), and the decrease in erythrocyte counts (cc = -0.520; <i>P</i> = 0.001) during the colder season.</p><p><b>Conclusion:</b> Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment.</p>

The impact of craniotomy for brain tumor case volume on patient safety indicators and in-hospital mortality

2020 ◽  
Vol 196 ◽  
pp. 106043
Author(s):  
Paul R. Clark ◽  
Robert J. Dambrino ◽  
Sean M. Himel ◽  
Zachary S. Smalley ◽  
Wondwosen K. Yimer ◽  
...  
Keyword(s):  
Patient Safety ◽  
Brain Tumor ◽  
Hospital Mortality ◽  
Case Volume ◽  
Patient Safety Indicators ◽  
The Impact

scholarly journals Onchocerciasis control in Ghana (1974–2016)

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nana-Kwadwo Biritwum ◽  
Dziedzom K. de Souza ◽  
Odame Asiedu ◽  
Benjamin Marfo ◽  
Uche Veronica Amazigo ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Vector Control ◽  
Control Strategy ◽  
Financial Support ◽  
Control Programme ◽  
Ivermectin Treatment ◽  
Mobile Community ◽  
The Mean ◽  
The Impact ◽  
Onchocerciasis Control

Abstract Background The control of onchocerciasis in Ghana started in 1974 under the auspices of the Onchocerciasis Control Programme (OCP). Between 1974 and 2002, a combination of approaches including vector control, mobile community ivermectin treatment, and community-directed treatment with ivermectin (CDTI) were employed. From 1997, CDTI became the main control strategy employed by the Ghana OCP (GOCP). This review was undertaken to assess the impact of the control interventions on onchocerciasis in Ghana between 1974 and 2016, since which time the focus has changed from control to elimination. Methods In this paper, we review programme data from 1974 to 2016 to assess the impact of control activities on prevalence indicators of onchocerciasis. This review includes an evaluation of CDTI implementation, microfilaria (Mf) prevalence assessments and rapid epidemiological mapping of onchocerciasis results. Results This review indicates that the control of onchocerciasis in Ghana has been very successful, with a significant decrease in the prevalence of infection from 69.13% [95% confidence interval) CI 60.24–78.01] in 1975 to 0.72% (95% CI 0.19–1.26) in 2015. Similarly, the mean community Mf load decreased from 14.48 MF/skin snip in 1975 to 0.07 MF/skin snip (95% CI 0.00–0.19) in 2015. Between 1997 and 2016, the therapeutic coverage increased from 58.50 to 83.80%, with nearly 100 million ivermectin tablets distributed. Conclusions Despite the significant reduction in the prevalence of onchocerciasis in Ghana, there are still communities with MF prevalence above 1%. As the focus of the GOCP has changed from the control of onchocerciasis to its elimination, both guidance and financial support are required to ensure that the latter goal is met.

scholarly journals Decreased Medical Care During the COVID-19 Pandemic – A Comprehensive Analysis of Radiological Examinations

2021 ◽  
Author(s):  
Annette Aigner ◽  
Bernd Hamm ◽  
Florian Nima Fleckenstein ◽  
Tazio Maleitzke ◽  
Georg Böning ◽  
...  
Keyword(s):  
Medical Care ◽  
Control Period ◽  
Surrogate Marker ◽  
Medical Specialty ◽  
Case Volume ◽  
Medical Specialties ◽  
Key Points ◽  
Depth Analysis ◽  
The Impact ◽  
Radiological Examinations

Objectives As a cross-section discipline within the hospital infrastructure, radiological departments might be able to provide important information regarding the impact of the COVID-19 pandemic on healthcare. The goal of this study was to quantify changes in medical care during the first wave of the pandemic using radiological examinations as a comprehensive surrogate marker and to determine potential future workload. Methods A retrospective analysis of all radiological examinations during the first wave of the pandemic was performed. The number of examinations was compared to time-matched control periods. Furthermore, an in-depth analysis of radiological examinations attributed to various medical specialties was conducted and postponed examinations were extrapolated to calculate additional workload in the near future. Results A total of 596,760 examinations were analyzed. Overall case volumes decreased by an average of 41 % during the shutdown compared to the control period. The most affected radiological modalities were sonography (–54 %), X-ray (–47 %) followed by MRI (–42 %). The most affected medical specialty was trauma and orthopedics (–60 % case volume) followed by general surgery (–49 %). Examination numbers increased during the post-shutdown period leading to a predicted additional workload of up to 22 %. Conclusion This study shows a marked decrease in radiological examinations in total and among several core medical specialties, indicating a significant reduction in medical care during the first COVID-19 shutdown. Key Points: Citation Format

scholarly journals Mortality Associated with Idiopathic Pulmonary Fibrosis in Northeastern Italy, 2008–2020: A Multiple Cause of Death Analysis

2021 ◽  
Vol 18 (14) ◽  
pp. 7249
Author(s):  
Alessandro Marcon ◽  
Elena Schievano ◽  
Ugo Fedeli
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Cause Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Annual Percent Change ◽  
Northeastern Italy ◽  
Mortality Ratio ◽  
The Impact ◽  
Related Mortality

Mortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008–2019, to compare results of underlying vs. multiple cause of death analyses, and to describe the impact of the COVID-19 epidemic in 2020. We identified IPF (ICD-10 code J84.1) among the causes of death registered in 557,932 certificates in the Veneto region. We assessed time trends in annual age-standardized mortality rates by gender and age (40–74, 75–84, and ≥85 years). IPF was the underlying cause of 1310 deaths in the 2251 certificates mentioning IPF. For all age groups combined, the age-standardized mortality rate from IPF identified as the underlying cause of death was close to the European median (males and females: 3.1 and 1.3 per 100,000/year, respectively). During 2008–2019, mortality rates increased in men aged ≥85 years (annual percent change of 6.5%, 95% CI: 2.0, 11.2%), but not among women or for the younger age groups. A 72% excess of IPF-related deaths was registered in March–April 2020 (mortality ratio 1.72, 95% CI: 1.29, 2.24). IPF mortality was increasing among older men in northeastern Italy. The burden of IPF was heavier than assessed by routine statistics, since less than two out of three IPF-related deaths were directly attributed to this condition. COVID-19 was accompanied by a remarkable increase in IPF-related mortality.

Mortality of Public Mental Health Patients: A Singapore Experience

1993 ◽  
Vol 27 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Lionel Chee-Chong Lim ◽  
Li-Ping Sim ◽  
Peak-Chiang Chiam
Keyword(s):  
Mental Health ◽  
General Population ◽  
Older Patients ◽  
Public Mental Health ◽  
Younger Patients ◽  
Standardised Mortality Ratio ◽  
Common Diagnosis ◽  
Mental Health Patients ◽  
Mortality Ratio ◽  
Age And Sex

This study reports the Standardised Mortality Ratio (SMR) by age and sex among public mental health patients in Singapore. The authors also examine the differences between those who were classified as “inpatient deaths” and those who were classified as “outpatient deaths”. Mortality was 5.1 times that of the general population and the SMR was most accentuated in the younger, female patients. Of the 217 deaths documented over two years, schizophrenia was the most common diagnosis. Inpatient deaths (N = 120) occurred in older patients with prior physical illness who died of natural causes. In contrast, outpatient deaths (N = 97) involved younger patients with no previous illness and the majority jumped to their deaths. Mortality studies are necessary in monitoring the efficacy of mental health provisions.

scholarly journals POS0774 INFLUENZA INFECTION AS A TRIGGER FOR SYSTEMIC LUPUS ERYTHEMATOSUS FLARES RESULTING IN HOSPITALIZATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 641.1-641
Author(s):  
Y. B. Joo ◽  
Y. J. Park
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Influenza Infection ◽  
Age Groups ◽  
Case Series ◽  
Incidence Rates ◽  
Systemic Lupus ◽  
Control Interval ◽  
The Impact

Background:Infections have been associated with a higher risk of systemic lupus erythematosus (SLE) flares, but the impact of influenza infection on SLE flares has not been evaluated.Objectives:We evaluated the association between influenza infection and SLE flares resulting in hospitalization.Methods:SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model.Results:We identified 1,624 influenza infections among the 1,455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63 – 37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00 – 37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively).Conclusion:We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.References:[1]Kwong, J. C. et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018:378;345-353.Table 1.Incidence ratios for SLE flares resulting in hospitalization after influenza infectionRisk intervalIncidence ratio95% CIDuring risk interval for 7 days / control interval25.7517.63 – 37.59Days 1-3 / control interval21.8114.71 – 32.35Days 4-7 / control interval7.563.69 – 15.47SLE, systemic lupus erythematosus; CI, confidence intervalDisclosure of Interests:None declared

Abstract 5857: Low Operative Mortality with implantation of a Continuous Flow LVAD and Impact of Concurrent Cardiac Procedures

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jay D Pal ◽  
Charles T Klodell ◽  
Ranjit John ◽  
Francis Pagani ◽  
Joseph G Rogers ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Continuous Flow ◽  
Operative Mortality ◽  
Negative Impact ◽  
Venous Pressure ◽  
Heartmate Ii ◽  
Cardiac Procedures ◽  
Increased Risk ◽  
The Impact ◽  
Tricuspid Repair

Objective: Our goal was to determine the operative mortality of isolated implantation of the HeartMate II continuous flow LVAD and the impact of additional concurrent cardiac procedures on patient outcomes. Methods: In a multicenter trial, 279 patients at 33 clinical sites underwent implantation of the HeartMate II continuous flow LVAD as a bridge to transplantation from March 2005 to March 2007. HeartMate II implantation (HM II) was the only procedure required in 172 patients while 80 patients required concurrent cardiac procedures in conjunction with LVAD implantation (HM II+CCP). Results: Preoperative characteristics were similar, but central venous pressure (14.5 vs 11.6 mmHg) was greater for patients requiring concurrent cardiac procedures, suggesting worse right heart dysfunction. Mean cardiopulmonary bypass times increased from 97 to 120 minutes when a concurrent cardiac procedure was performed (p<0.001). Length of stay slightly increased from 23 to 26 days (p=0.17). Overall 30- and 180-day mortality was 5.8% and 13.3% for the HM II group, and 11.3% and 20.0% for the HM II+CCP group. Concurrent valvular procedures increased the risk to 8.5% and 19.1%. Patients who underwent an aortic valve replacement with cardioplegic arrest had a 30-day mortality of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Other cardiac procedures were associated with a 30-day mortality of 27.8%. Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. Conclusion: There is a low 5.8% operative mortality for patients requiring uncomplicated HeartMate II implantation, with no apparent increased risk for concurrent PFO closure, mitral or tricuspid repair. However, concurrent aortic valve and other cardiac procedures are associated with a significantly decreased survival. The increased risk of these procedures must be balanced against the negative impact of uncorrected aortic insufficiency during VAD support.

Abstract 18020: Identifying Hospitalizations Related to Heart Failure in Dronedarone Users Who Are Supplementary Medicare Beneficiaries

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chuntao Wu ◽  
Andrew Koren ◽  
Jane Thammakhoune ◽  
Jasmanda Wu ◽  
Hayet Kechemir ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Claims Data ◽  
Search Algorithm ◽  
Medicare Beneficiaries ◽  
Current Procedural Terminology ◽  
Diagnosis Codes ◽  
Medicare Database ◽  
The Impact

Background: When using inpatient claims data to identify hospitalizations in supplemental Medicare beneficiaries, e.g., in the MarketScan database, there is a concern that the coverage of hospitalizations in such inpatient claims may be incomplete. However, whether hospitalizations are covered by inpatient claims or not, they incur professional charges that are recorded in the professional claims data in the MarketScan Medicare database. In the context of identifying hospitalizations that might be related to heart failure (HF) in dronedarone users, we compared different approaches to identify such hospitalizations. Objective: To assess the impact of using professional claims in addition to inpatient claims on identifying hospitalizations that might be related to HF. Methods: A total of 20,834 dronedarone users who were supplemental Medicare beneficiaries between July 2009 (launch date in US) and December 2012 were identified in the MarketScan database. The hospitalizations that might be related to HF within 30 days prior to initiating dronedarone were identified by searching (1) inpatient claims and (2) both inpatient and professional claims using related ICD-9-CM diagnosis codes for HF and Current Procedural Terminology codes for hospitalizations. Results: A total of 1,162 patients who had HF hospitalizations within 30 days prior to initiating dronedarone were identified by searching inpatient claims between July 2009 and December 2012. Supplementing with professional claims identified an additional 177 patients who had HF hospitalizations, increasing the total number to 1,339. Therefore, 13.2% (177/1,399) of the patients who had HF hospitalizations could only be identified in professional claims. Thus, the prevalence of hospitalizations that might be related to HF within 30 days prior to initiating dronedarone was 5.6% (1,162/20,834; 95% confidence interval (CI): 5.3 - 5.9%) when hospitalizations were identified using inpatient claims alone. Adding professional claims in the search algorithm, the prevalence of HF hospitalizations was 6.4% (1,339/20,834, 95% CI: 6.1 - 6.8%). Conclusions: Using professional claims, in addition to inpatient claims, can improve the identification of hospitalizations that might be related to HF.

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