Significant pain is common among hospitalized patients, even those at low risk for pain

Aims: Given the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients diagnosed with COVID-19. Methods: We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients diagnosed with SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement. Results: A total of 51 studies were retrieved from the databases. Five articles were finally included in the data extraction and qualitative and quantitative synthesis of results. The overall risk of bias in the reviewed articles was established at low-risk only in two trials. The meta-analysis suggests that there is no benefit of convalescent plasma compared with standard care or placebo in reducing the overall mortality and the ventilation requirement. However, there could be a benefit for the clinical improvement in patients treated with plasma. Conclusion: Current results led to assume that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed. The reviews of this paper are available via the supplemental material section.

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Validation of 2 Prognostic Models in Hospitalized Patients With Advanced Hematological Malignancies in Japan

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115615567 ◽

2016 ◽

Vol 34 (3) ◽

pp. 258-262 ◽

Cited By ~ 4

Author(s):

Eiji Ohno ◽

Miyuki Abe ◽

Hitohiro Sasaki ◽

Kazuki Okuhiro

Keyword(s):

Palliative Care ◽

Prognostic Model ◽

Hematological Malignancies ◽

Risk Groups ◽

Hospitalized Patients ◽

Low Risk ◽

Prognostic Models ◽

Study Objective ◽

Significant Difference ◽

Cutoff Points

Patients with advanced hematological malignancies are less likely to be referred to specialist palliative care services compared with patients having solid tumors. It has been reported that one of the most important reasons for the lack of referral is difficulties in the prognostication of terminally ill patients with hematologic malignancies. The study objective was to evaluate the predictive accuracy of the Palliative Prognostic Index (PPI) and the prognostic model developed by Kripp et al in hospitalized patients under the care of a hematologist. Using clinical charts, we retrospectively calculated the above scores. We reviewed the records of 114 patients admitted to the hematology ward. The inclusion criterion was patient with disease considered incurable using standard treatments. The prognostic models were assessed according to the original reports. Using PPI cutoff points of 2 and 4, we divided the patients into 3 groups of significantly different survival times ( P < .01). Moreover, we confirmed the usefulness of predicting survival <3 and <6 weeks using PPI scores of 6 and 4 as cutoff points, respectively. When we classified patients according to the prognostic model of Kripp et al, the high-risk group survived significantly shorter times than the intermediate- and low-risk groups ( P < .001). However, there was no significant difference in survival between the intermediate- and low-risk groups. Use of these models might enable physicians to provide more appropriate end-of-life care and to refer patients to palliative care earlier.

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De-labelling penicillin allergy in acutely hospitalized patients: a pilot study

BMC Infectious Diseases ◽

10.1186/s12879-021-06794-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Linde Steenvoorden ◽

Erik Oeglaend Bjoernestad ◽

Thor-Agne Kvesetmoen ◽

Anne Kristine Gulsvik

Keyword(s):

Antibiotic Use ◽

Hospitalized Patients ◽

Low Risk ◽

Penicillin Allergy ◽

Environmental Benefit ◽

Medical Department ◽

Norwegian Population ◽

Risk Patients ◽

History Of ◽

Clinically Significant

Abstract Background Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. Few patients undergo evaluation, which leads to overuse of broad-spectrum antibiotics. The objective of this study was to monitor prevalence and implement screening and testing of hospitalized patients. Methods All patients admitted to the medical department in a local hospital in Oslo, Norway, with a self-reported penicillin allergy were screened using an interview algorithm to categorize the reported allergy as high-risk or low-risk. Patients with a history of low-risk allergy underwent a direct graded oral amoxicillin challenge to verify absence of a true IgE-type allergy. Results 257 of 5529 inpatients (4.6%) reported a penicillin allergy. 191 (74%) of these patients underwent screening, of which 86 (45%) had an allergy categorized as low-risk. 54 (63%) of the low-risk patients consented to an oral test. 98% of these did not have an immediate reaction to the amoxicillin challenge, and their penicillin allergy label could thus be removed. 42% of the patients under treatment with antibiotics during inclusion could switch to treatment with penicillins immediately after testing, in line with the national recommendations for antibiotic use. Conclusions The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. Screening and testing of hospitalized patients with self-reported penicillin allergy is a feasible and easy measure to de-label a large proportion of patients, resulting in immediate clinical and environmental benefit. Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.

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Identification of Low-Risk Hospitalized Patients With Pneumonia

CHEST Journal ◽

10.1378/chest.105.4.1109 ◽

1994 ◽

Vol 105 (4) ◽

pp. 1109-1115 ◽

Cited By ~ 37

Author(s):

Scott R. Weingarten ◽

Mary S. Riedinger ◽

Gila Varis ◽

Mark S. Noah ◽

Michael J. Belman ◽

...

Keyword(s):

Hospitalized Patients ◽

Low Risk

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Low Risk of Clostridium difficile Infections in Hospitalized Patients with Inflammatory Bowel Disease in a German Tertiary Referral Center

Digestion ◽

10.1159/000324617 ◽

2011 ◽

Vol 84 (3) ◽

pp. 187-192 ◽

Cited By ~ 8

Author(s):

Claudia Ott ◽

Christiane Girlich ◽

Frank Klebl ◽

Annelie Plentz ◽

Igors Iesalnieks ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Bowel Disease ◽

Hospitalized Patients ◽

Low Risk ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center ◽

Inflammatory Bowel

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Improving compliance to clinical practice guidelines with a multifaceted quality improvement program for the prevention of venous thromboembolic disease in nonsurgical patients

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa037 ◽

2020 ◽

Vol 32 (5) ◽

pp. 319-324

Author(s):

Paula Ruiz-Talero ◽

Daniela Cerón-Perdomo ◽

Catalina Hernández-Flórez ◽

Santiago Gutiérrez-gómez ◽

Oscar Muñoz-Velandia

Keyword(s):

Quality Improvement ◽

Hospitalized Patients ◽

Low Risk ◽

Assessment Tools ◽

Bleeding Complications ◽

Improvement Program ◽

Vte Prophylaxis ◽

Before And After ◽

Venous Thromboembolic ◽

Risk Patients

Abstract Objective To evaluate the change in compliance to thromboprophylaxis guidelines before and after the implementation of a multifaceted patient safety program. Design Longitudinal before and after study. Setting Teaching hospital, Hospital Universitario San Ignacio, Bogotá (Colombia). Participants Adult nonsurgical hospitalized patients. Intervention A multifaceted program for the prevention of venous thromboembolic (VTE) disease among adult nonsurgical hospitalized patients. The strategies of the program included (i) update and communication of thromboprophylaxis guidelines, (ii) the implementation of risk-assessment tools in electronic medical records, (iii) nursing staff activities and (iv) education to health personnel and patients for maintenance of the program. Main Outcome Measure Appropriate use of thromboprophylaxis. Results 221 and 236 patients were evaluated in the pre- and postimplementation periods, respectively. Global appropriate thromboprophylaxis prescription went from 74.66 to 82.6% (P = 0.064). Adequate thromboprophylaxis in high-risk patients did not increase significantly (77.70 vs 80.62%, P = 0.528), but a significant reduction in inappropriate thromboprophylaxis formulation in low-risk patients was found, decreasing from 20.55 to 5.26% (P = 0.005). Conclusions Implementing a quality improvement multifaceted program improves the formulation of adequate thromboprophylaxis. Reducing the inappropriate prescription of VTE prophylaxis in patients at low risk of thrombosis can lead to a reduction in bleeding complications and a better use of economic and human resources.

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Cost-effectiveness of Telemetry for Hospitalized Patients With Low-risk Chest Pain

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2011.01008.x ◽

2011 ◽

Vol 18 (3) ◽

pp. 279-286 ◽

Cited By ~ 11

Author(s):

Michael J. Ward ◽

Mark H. Eckman ◽

Daniel P. Schauer ◽

Ali S. Raja ◽

Sean Collins

Keyword(s):

Cost Effectiveness ◽

Chest Pain ◽

Hospitalized Patients ◽

Low Risk

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Validation of a Prognostic Score to Identify Hospitalized Patients with COVID-19 at Increased Risk for Bleeding

Viruses ◽

10.3390/v13112278 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2278

Author(s):

Pablo Demelo-Rodriguez ◽

Francisco Galeano-Valle ◽

Lucía Ordieres-Ortega ◽

Carmine Siniscalchi ◽

Mar Martín Del Pozo ◽

...

Keyword(s):

Major Bleeding ◽

Prognostic Score ◽

Hospitalized Patients ◽

Low Risk ◽

Intermediate Risk ◽

Vte Prophylaxis ◽

Increased Risk ◽

Therapeutic Doses ◽

Risk For Bleeding ◽

D Dimer

Introduction: Hospitalized patients with COVID-19 are at increased risk for venous thromboembolism (VTE), but also for bleeding. We previously derived a prognostic score including four variables (elevated D-dimer, elevated ferritin, critical illness, and therapeutic-dose anticoagulation) that identified those at increased risk for major bleeding. Methods: We aimed to validate the score in a subsequent cohort of hospitalized patients with COVID-19 receiving standard-, intermediate- or therapeutic doses of VTE prophylaxis. We evaluated its capacity to predict major bleeding, non-major bleeding, and bleeding-related death. Results: The cohort included 972 patients from 29 hospitals, of whom 280 (29%) received standard-; 412 (42%) intermediate-, 157 (16%) therapeutic doses of VTE prophylaxis and 123 (13%) other drugs. Median duration of prophylaxis was 14.7 ± 10.3 days. Major bleeding occurred in 65 patients (6.7%) and non-major bleeding in 67 (6.9%). Thirty patients with major bleeding (46%) died within the first 30 days after bleeding. The prognostic score identified 203 patients (21%) at very low risk, 285 (29%) at low risk, 263 (27%) intermediate-risk and 221 (23%) at high risk for bleeding. Major bleeding occurred in 1.0%, 2.1%, 8.7% and 15.4% of the patients, respectively. Non-major bleeding occurred in 0.5%, 3.5%, 9.5% and 14.2%, respectively. The c-statistics was: 0.74 (95% confidence intervals [CI]: 0.68–0.79) for major bleeding, 0.73 (95% CI: 0.67–0.78) for non-major bleeding and 0.82 (95% CI: 0.76–0.87) for bleeding-related death. Conclusions: In hospitalized patients with COVID-19, we validated that a prognostic score including 4 easily available items may identify those at increased risk for bleeding.

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Added value of the PG-SGA in detection of malnutrition in overweight and obese hospitalized patients

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002256 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

I.M.Y. van Vliet ◽

A.W. Gomes Neto ◽

S.J.L. Bakker ◽

H. Jager-Wittenaar ◽

G.J. Navis

Keyword(s):

At Risk ◽

Screening Tool ◽

Hospitalized Patients ◽

Low Risk ◽

Added Value ◽

University Hospital ◽

Severe Malnutrition ◽

Future Research ◽

Obese Patients ◽

Critical Weight

AbstractTraditional malnutrition screening instruments, such as the Malnutrition Universal Screening Tool (MUST), strongly rely on criteria regarding low BMI and critical weight loss for risk assessment. In an increasingly overweight and obese population, this may result in underdetection of malnutrition. The Patient-Generated Subjective Global Assessment (PG-SGA) was developed in the broader context of anabolic competence and includes assessment of other aspects of malnutrition, such as nutrition impact symptoms and metabolic demand. We therefore aimed to compare MUST and PG-SGA in assessing prevalence of malnutrition in overweight and obese hospitalized patients. We measured risk for malnutrition (MUST score: 0 = low risk, 1 = medium risk, ≥ 2 = high risk) and nutritional status (PG-SGA Categories: A = well nourished, B = moderate/suspected malnutrition, C = severe malnutrition) at admission, in adult patients, on four hospital wards of a university hospital. We compared results for patients with BMI < 25 kg/m2 and overweight or obese patients (BMI ≥ 25 kg/m2). Data were obtained in 387 patients (age 59 ± 16 years, 52% male). BMI was 27.1 ± 5.6 kg/m2, 35% was overweight and 26% was obese. According to MUST, 16% of patients had risk for malnutrition (MUST score ≥ 1), while according to PG-SGA 31% of patients were malnourished (PG-SGA Stage B/C). In patients with BMI < 25 kg/m2 (N = 153), MUST identified 31% as at risk for malnutrition, while PG-SGA assessed 39% as malnourished. In patients with BMI ≥ 25 kg/m2 (N = 234), MUST identified 6% as at risk for malnutrition, while PG-SGA assessed 26% as malnourished. Of the 60 malnourished overweight or obese patients according to the PG-SGA, 52 (87%) were categorized as low risk by the MUST. According to assessment by PG-SGA, a quarter of overweight or obese patients is malnourished at hospital admission. Most of these patients are not identified as having risk for malnutrition by the screening tool MUST. Future research is needed to evaluate the current results in relation to predictive value for patient outcomes, and to further optimize hospital nutritional care policies.

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