scholarly journals Risk of adverse events associated with upper and lower endoscopic ultrasound: a population-based cohort study

2021 ◽  
Vol 09 (09) ◽  
pp. E1427-E1434
Author(s):  
Roshan Razik ◽  
Paul D. James ◽  
Rishad Khan ◽  
Courtney Maxwell ◽  
Yibing Ruan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Needle Aspiration ◽  
Population Based ◽  
Emergency Department Visits ◽  
Therapeutic Interventions ◽  
Increased Risk

Abstract Background and study aim Endoscopic ultrasound (EUS) enables diagnostic evaluation and therapeutic interventions but is associated with adverse events. We conducted a population-based cohort study to determine the risk of adverse events for upper and lower EUS with and without fine-needle aspiration (FNA). Patients and methods All adults who underwent EUS and resided in Calgary in 2007–2013 were included. Endoscopy and provincial databases were used to identify EUS procedures, unplanned emergency department visits, and hospital admissions within 30 days of the procedures, which were then characterized through formal chart review. Adverse events were defined a priori and classified as definitely, possibly, or not related to EUS. The primary outcome was 30-day risk of adverse events classified as definitely or possibly related to EUS. Univariable and multivariable analyses were conducted with risk factors known to be associated with EUS adverse events. Results 2895 patients underwent 3552 EUS procedures: 3034 (85 %) upper EUS, of which 710 (23 %) included FNA, and 518 (15 %) lower EUS, of which 23 (4 %) involved FNA. Overall, 69 procedures (2 %) involved an adverse event that was either definitely or possibly related to EUS, with 33 (1 %) requiring hospitalization. None of the adverse events required intensive care or resulted in death. On multivariable analysis, only FNA was associated with increased risk of adverse events (odds ratio 6.43, 95 % confidence interval 3.92–10.55; P < 0.001). Conclusion Upper and lower EUS were generally safe but FNA substantially increased the risk of adverse events. EUS-related complications requiring hospitalization were rare.

1107 Risk of Adverse Events Following Endoscopic Ultrasound in a Population-Based Cohort Study

2017 ◽  
Vol 85 (5) ◽  
pp. AB141
Author(s):  
Roshan A. Razik ◽  
Paul D. James ◽  
Robert Hilsden ◽  
Courtney Maxwell ◽  
Divine Tanyingoh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Population Based

scholarly journals Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England

BMJ ◽  
2021 ◽  
pp. n628 ◽  
Author(s):  
Harriet Forbes ◽  
Caroline E Morton ◽  
Seb Bacon ◽  
Helen I McDonald ◽  
Caroline Minassian ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Admissions ◽  
Absolute Risk ◽  
Population Based ◽  
Intensive Care Admission ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Uk

Abstract Objective To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic. Design Population based cohort study, on behalf of NHS England. Setting Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). Participants Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020. Main outcome measures Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household. Results Among 9 334 392 adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions. Conclusions In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.

scholarly journals Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5497
Author(s):  
Jaehoon Lee ◽  
Yuntae Kim ◽  
Hyunji Park ◽  
Changsoo Kim ◽  
Sihyun Cho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Multivariable Analysis ◽  
National Sample ◽  
Population Based ◽  
Increased Risk

Individuals with atrial fibrillation (AF), especially women, have an increased risk of stroke and death. Although hormone replacement therapy (HRT) is widely used in postmenopausal women, the association between HRT use and AF risk is unclear. We aimed to investigate the association between various types of HRT and AF. This was a population-based retrospective cohort study from The Korean National Health Insurance Service-National Sample Cohort (2004–2015). Participants were aged 45–60 years and were free from cardiovascular disease and AF at baseline. Overall, 13,452 (64.03%) women had never received HRT, 5671 (26.99%) had received HRT, and 1885 (8.98%) were currently receiving HRT. In multivariable analysis, the relative hazards for AF were significantly higher among current users (p < 0.001) and lower among past users (p = 0.069). Current users—except those using estradiol-only HRT—had significantly elevated AF risk. Among past users, only estradiol plus progestin HRT users had a reduced AF risk after adjusting for covariates (p = 0.027). Ongoing HRT posed an increased risk of AF. The degree of risk varied based on the specific type of estrogen and progestins co-administration. These findings indicate that, with respect to AF risk, oral estradiol-containing HRT is superior to HRT containing oral conjugated equine estrogen or tibolone.

scholarly journals Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Alexander Kutz ◽  
Fahim Ebrahimi ◽  
Soheila Aghlmandi ◽  
Ulrich Wagner ◽  
Miluska Bromley ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Population Based ◽  
Control Group ◽  
Short Term ◽  
Patient Disposition ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Context Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design and Setting A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017 Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main Outcome Measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P &lt; .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P &lt; .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P &lt; .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P &lt; .001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

scholarly journals The association between psoriatic arthritis and venous thromboembolism: a population-based cohort study

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Tal Gazitt ◽  
Jacob Pesachov ◽  
Idit Lavi ◽  
Muna Elias ◽  
Amir Haddad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psoriatic Arthritis ◽  
Large Population ◽  
Multivariable Analysis ◽  
Previous History ◽  
Population Based ◽  
Janus Kinase ◽  
Control Group ◽  
Increased Risk ◽  
History Of

Abstract Background Although the risk of cardiovascular disease has been discussed extensively in both psoriasis (PsO) and psoriatic arthritis (PsA), very few studies have addressed the occurrence of venous thromboembolic (VTE) events among PsO patients, and even fewer in PsA. Thus, our goal was to assess the association between PsA and VTE events using a large population-based database. Methods This retrospective cohort study includes all 5,275 patients with newly diagnosed PsA from the largest health care provider in Israel between January 2003 and December 2018. Identified PsA patients were matched by age, sex, ethnicity, and index date with 21,011 controls without PsA from the same database. Both groups were followed through June 30, 2019 for the occurrence of VTE event. Cox proportional hazard regression models were used to assess the association between PsA and VTE. Results PsA cohort consisted of 53.2% females with mean age of 51.7±15.4 Sixty-two patients (1.2%) were diagnosed with VTE in the PsA group and 176 patients (0.8%) in the control group (p=0.023, HR=1.40, 95% CI 1.05-1.87). However, there was no increased risk of VTE among PsA patients on multivariable analysis (p=0.16, HR=1.27, 95% CI 0.91-1.80). Within the PsA group, patients with VTE were more often of older age and with history of VTE. Conclusions This study suggests that the increased risk of VTE in PsA patients appears to be related to the underlying comorbidities and not independently associated with PsA. Age and previous history of VTE were the only risk factors associated with increased risk of VTE in patients with PsA. Addressing VTE risk is recommended especially in the era of Janus kinase inhibitors.

scholarly journals Death and readmissions after hospital discharge during the December holiday period: cohort study

BMJ ◽  
2018 ◽  
pp. k4481 ◽  
Author(s):  
Lauren Lapointe-Shaw ◽  
Peter C Austin ◽  
Noah M Ivers ◽  
Jin Luo ◽  
Donald A Redelmeier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Population Based ◽  
Emergency Department Visits ◽  
Risk Of Death ◽  
Holiday Period

Abstract Objective To determine whether patients discharged from hospital during the December holiday period have fewer outpatient follow-ups and higher rates of death or readmission than patients discharged at other times. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, 1 April 2002 to 31 January 2016. Participants 217 305 children and adults discharged home after an urgent admission, during the two week December holiday period, compared with 453 641 children and adults discharged during two control periods in late November and January. Main outcome measures The primary outcome was death or readmission, defined as a visit to an emergency department or urgent rehospitalisation, within 30 days. Secondary outcomes were death or readmission and outpatient follow-up with a physician within seven and 14 days after discharge. Multivariable logistic regression with generalised estimating equations was used to adjust for characteristics of patients, admissions, and hospital. Results 217 305 (32.4%) patients discharged during the holiday period and 453 641 (67.6%) discharged during control periods had similar baseline characteristics and previous healthcare utilisation. Patients who were discharged during the holiday period were less likely to have follow-up with a physician within seven days (36.3% v 47.8%, adjusted odds ratio 0.61, 95% confidence interval 0.60 to 0.62) and 14 days (59.5% v 68.7%, 0.65, 0.64 to 0.66) after discharge. Patients discharged during the holiday period were also at higher risk of 30 day death or readmission (25.9% v 24.7%, 1.09, 1.07 to 1.10). This relative increase was also seen at seven days (13.2% v 11.7%, 1.16, 1.14 to 1.18) and 14 days (18.6% v 17.0%, 1.14, 1.12 to 1.15). Per 100 000 patients, there were 2999 fewer follow-up appointments within 14 days, 26 excess deaths, 188 excess hospital admissions, and 483 excess emergency department visits attributable to hospital discharge during the holiday period. Conclusions Patients discharged from hospital during the December holiday period are less likely to have prompt outpatient follow-up and are at higher risk of death or readmission within 30 days.

scholarly journals Perinatal factors and hospitalisations for severe childhood infections: a population-based cohort study in Sweden

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e054083
Author(s):  
Samuel Videholm ◽  
Urban Kostenniemi ◽  
Torbjörn Lind ◽  
Sven-Arne Silfverdal
Keyword(s):  
Cohort Study ◽  
Young Children ◽  
Bacterial Meningitis ◽  
Gestational Age ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Population Based ◽  
Perinatal Factors ◽  
Increased Risk ◽  
Severe Infections

ObjectiveTo examine the association between perinatal factors and hospitalisations for sepsis and bacterial meningitis in early childhood (from 28 days to 2 years of age).DesignA population‐based cohort study. The Swedish Medical Birth Register was combined with the National Inpatient Register, the Cause of Death Register, the Total Population Register and the Longitudinal integration database for health insurance and labour market studies. Associations between perinatal factors and hospitalisations were examined using negative binomial regression models.SettingSweden.Participants1 406 547 children born in Sweden between 1997 and 2013.Main outcome measuresHospital admissions for sepsis and bacterial meningitis recorded between 28 days and 2 years of life.ResultsGestational age was inversely associated with severe infections, that is, extreme prematurity was strongly associated with an increased risk of sepsis, adjusted incidence rate ratio (aIRR) 10.37 (95% CI 6.78 to 15.86) and meningitis aIRR 6.22 (95% CI 2.28 to 16.94). The presence of congenital malformation was associated with sepsis aIRR 3.89 (95% CI 3.17 to 4.77) and meningitis aIRR 1.69 (95% CI 1.09 to 2.62). Moreover, children born small or large for gestational age were more likely to be hospitalised for sepsis and children exposed to maternal smoking were more likely to be hospitalised for meningitis.ConclusionsPrematurity and several other perinatal factors were associated with an increased risk of severe infections in young children. Therefore, clinical guidelines for risk assessment of infections in young children should consider perinatal factors.

scholarly journals Increased risk of death in COVID-19 hospital admissions during the second wave as compared to the first epidemic wave: a prospective, single-centre cohort study in London, UK

Infection ◽  
2021 ◽  
Author(s):  
Martina Cusinato ◽  
Jessica Gates ◽  
Danyal Jajbhay ◽  
Timothy Planche ◽  
Yee Ean Ong
Keyword(s):  
Cohort Study ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Resource Planning ◽  
Risk Of Death ◽  
Crude Mortality ◽  
Increased Risk ◽  
The Impact ◽  
Second Wave ◽  
Epidemic Wave

Abstract Background The second coronavirus disease (COVID-19) epidemic wave in the UK progressed aggressively and was characterised by the emergence and circulation of variant of concern alpha (VOC 202012/01). The impact of this variant on in-hospital COVID-19-specific mortality has not been widely studied. We aimed to compare mortality, clinical characteristics, and management of COVID-19 patients across epidemic waves to better understand the progression of the epidemic at a hospital level and support resource planning. Methods We conducted an analytical, dynamic cohort study in a large hospital in South London. We included all adults (≥ 18 years) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission to COVID-19-specific wards between January 2020 and March 2021 (n = 2701). Outcome was COVID-19-specific in-hospital mortality ascertained through Medical Certificate Cause of Death. Results In the second wave, the number of COVID-19 admissions doubled, and the crude mortality rate dropped 25% (1.66 versus 2.23 per 100 person-days in second and first wave, respectively). After accounting for age, sex, dexamethasone, oxygen requirements, symptoms at admission and Charlson Comorbidity Index, mortality hazard ratio associated with COVID-19 admissions was 1.62 (95% CI 1.26, 2.08) times higher in the second wave. Conclusions Although crude mortality rates dropped during the second wave, the multivariable analysis suggests a higher underlying risk of death for COVID-19 admissions in the second wave. These findings are ecologically correlated with an increased circulation of SARS-CoV-2 variant of concern 202012/1 (alpha). Availability of improved management, particularly dexamethasone, was important in reducing risk of death.

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