Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

2018 ◽  
Vol 36 (10) ◽  
pp. 1009-1013 ◽  
Author(s):  
Jessica Y. Shim ◽  
Elisabeth L. Stark ◽  
Carolyn M. Ross ◽  
Emily S. Miller
Keyword(s):  
Depressive Symptomatology ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Antenatal Depression ◽  
Postpartum Visit ◽  
Patient Health ◽  
Multivariable Analyses ◽  
Publicly Insured ◽  
Racial Ethnic

Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Pre-hospital hypothermia is associated with transfusion risk after traumatic injury

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S12-S20
Author(s):  
Naheed K. Jivraj ◽  
Lilia Kaustov ◽  
Kennedy Ning Hao ◽  
Rachel Strauss ◽  
Jeannie Callum ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Traumatic Injury ◽  
Multivariable Analysis ◽  
Hospital Setting ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Injured Patients ◽  
Emergent Surgery ◽  
Rbc Transfusion

ABSTRACTObjectivesIn traumatically injured patients, excessive blood loss necessitating the transfusion of red blood cell (RBC) units is common. Indicators of early RBC transfusion in the pre-hospital setting are needed. This study aims to evaluate the association between hypothermia (<36°C) and transfusion risk within the first 24 hours after arrival to hospital for a traumatic injury.MethodsWe completed an audit of all traumatically injured patients who had emergent surgery at a single tertiary care center between 2010 and 2014. Using multivariable logistic regression analysis, we evaluated the association between pre-hospital hypothermia and transfusion of ≥1 unit of RBC within 24 hours of arrival to the trauma bay.ResultsOf the 703 patients included to evaluate the association between hypothermia and RBC transfusion, 203 patients (29%) required a transfusion within 24 hours. After controlling for important confounding variables, including age, sex, coagulopathy (platelets and INR), hemoglobin, and vital signs (blood pressure and heart rate), hypothermia was associated with a 68% increased odds of transfusion in multivariable analysis (OR: 1.68; 95% CI: 1.11-2.56).ConclusionsHypothermia is strongly associated with RBC transfusion in a cohort of trauma patients requiring emergent surgery. This finding highlights the importance of early measures of temperature after traumatic injury and the need for intervention trials to determine if strategies to mitigate the risk of hypothermia will decrease the risk of transfusion and other morbidities.

Citalopram in Children and Adolescents with Depression or Anxiety

2002 ◽  
Vol 36 (11) ◽  
pp. 1692-1697 ◽  
Author(s):  
Jennifer L Baumgartner ◽  
Graham J Emslie ◽  
M Lynn Crismon
Keyword(s):  
Anxiety Disorder ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Emotional Disorders ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Children’S Depression

OBJECTIVE: To investigate the efficacy and tolerability of citalopram in children and adolescents. METHOD: Retrospective chart review of 17 outpatients treated with citalopram at a tertiary care center. Subjects were diagnosed with a depressive or anxiety disorder with or without comorbidities and may have received concurrent medications. The primary outcome measure was the Clinical Global Impression Improvement Scale (CGI-I). Secondary outcome measures were the Children's Depression Rating Scale—Revised (CDRS-R), Inventory of Depressive Symptomatology, and Screen for Child Anxiety-Related Emotional Disorders (SCARED). Adverse effects were assessed via chart documentation. RESULTS: Patients were treated with a mean citalopram dose of 22.4 ± 7.3 mg for 12 weeks. Thirteen patients (76%) had CGI-I scores ≤2: 8 of 12 patients with depression and 5 of 5 patients with an anxiety disorder. The mean time to response was 7.6 ± 3.6 weeks. Additionally, 6 of 8 patients had ≥50% reduction from baseline CDRS-R score, with 3 patients (38%) meeting criteria for remission. Three of 4 patients had a >50% reduction for baseline SCARED-parent score. Overall, adverse effects appeared minor and transient. One patient discontinued citalopram due to intolerable adverse effects, and 1 patient required dose reduction. CONCLUSIONS: Citalopram appears to be effective and well tolerated in this group of children and adolescents with depressive or anxiety disorders and a high degree of comorbidity. Controlled studies in this patient population are indicated.

scholarly journals Do Younger Patients with Muscle-Invasive Bladder Cancer have Better Outcomes?

2019 ◽  
Vol 8 (9) ◽  
pp. 1459 ◽  
Author(s):  
Florian Janisch ◽  
Hang Yu ◽  
Malte W. Vetterlein ◽  
Roland Dahlem ◽  
Oliver Engel ◽  
...  
Keyword(s):  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Biology ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Young Patients ◽  
The Elderly ◽  
Cancer Of The Bladder ◽  
The Impact

Urothelial cancer of the bladder (UCB) is usually a disease of the elderly. The influence of age on oncological outcomes remains controversial. This study aims to investigate the impact of age on UCB outcomes in Europe focusing particularly on young and very young patients. We collected data of 669 UCB patients treated with RC at our tertiary care center. We used various categorical stratifications as well as continuous age to investigate the association of age and tumor biology as well as endpoints with descriptive statistics and Cox regression. The median age was 67 years and the mean follow-up was 52 months. Eight patients (1.2%) were ≤40 years old and 39 patients (5.8%) were aged 41–50 years, respectively. In multivariable analysis, higher continuous age and age above the median were independent predictors for disease recurrence, and cancer-specific and overall mortality (all p-values ≤ 0.018). In addition, patients with age in the oldest tertile group had inferior cancer-specific and overall survival rates compared to their younger counterparts. Young (40–50 years) and very young (≤40 years) patients had reduced hazards for all endpoints, which, however, were not statistically significant. Age remains an independent determinant for survival after RC. Young adults did, however, not have superior outcomes in our analyses. Quality of life and complications are endpoints that need further evaluation in patients undergoing RC.

Infection and Predictors of Outcome of Cirrhotic Patients after Emergency Care Hospital Admission

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Wajima Safi ◽  
Mayada Elnegouly ◽  
Raphael Schellnegger ◽  
Katrin Umgelter ◽  
Fabian Geisler ◽  
...  
Keyword(s):  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Scoring Systems ◽  
First Episode ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Cirrhotic Patients ◽  
The Impact

Introduction and aims: We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions. Material and Methods: We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike’s Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account. Results: 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26,0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure (Hazard Ratio (HR) = 0.15), albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3% vs 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients. Conclusion: Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.

scholarly journals Should ondansetron use be a reason to admit children with isolated, nondisplaced, linear skull fractures?

2020 ◽  
Vol 25 (3) ◽  
pp. 284-290
Author(s):  
Jonathan Dallas ◽  
Evan Mercer ◽  
Rebecca A. Reynolds ◽  
John C. Wellons ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Initial Presentation ◽  
Skull Fractures ◽  
Traumatic Injuries ◽  
Fracture Location ◽  
Pediatric Head Trauma ◽  
Recurrent Vomiting ◽  
Entire Patient Cohort

OBJECTIVEIsolated, nondisplaced skull fractures (ISFs) are a common result of pediatric head trauma. They rarely require surgical intervention; however, many patients with these injuries are still admitted to the hospital for observation. This retrospective study investigates predictors of vomiting and ondansetron use following pediatric ISFs and the role that these factors play in the need for admission and emergency department (ED) revisits.METHODSThe authors identified pediatric patients (< 18 years old) with a linear ISF who had presented to the ED of a single tertiary care center between 2008 and 2018. Patients with intracranial hemorrhage, significant fracture displacement, or other traumatic injuries were excluded. Outcomes included vomiting, ondansetron use, admission, and revisit following ED discharge. Both univariable and multivariable analyses were used to determine significant predictors of each outcome (p < 0.05).RESULTSOverall, 518 patients were included in this study. The median patient age was 9.98 months, and a majority of the patients (59%) were male. The most common fracture locations were parietal (n = 293 [57%]) and occipital (n = 144 [28%]). Among the entire patient cohort, 124 patients (24%) had documented vomiting, and 64 of these patients (52%) received ondansetron. In a multivariable analysis, one of the most significant predictors of vomiting was occipital fracture location (OR 4.05, p < 0.001). In turn, and as expected, both vomiting (OR 14.42, p < 0.001) and occipital fracture location (OR 2.66, p = 0.017) were associated with increased rates of ondansetron use. A total of 229 patients (44%) were admitted to the hospital, with vomiting as the most common indication for admission (n = 59 [26%]). Moreover, 4.1% of the patients had ED revisits following initial discharge, and the most common reason was vomiting (11/21 [52%]). However, in the multivariable analysis, ondansetron use at initial presentation (and not vomiting) was the sole predictor of revisit following initial ED discharge (OR 5.05, p = 0.009).CONCLUSIONSIn this study, older patients and those with occipital fractures were more likely to present with vomiting and to be treated with ondansetron. Additionally, ondansetron use at initial presentation was found to be a significant predictor of revisits following ED discharge. Ondansetron could be masking recurrent vomiting in ED patients, and this should be considered when deciding which patients to observe further or discharge.

Duration of Exposure to General Endotracheal Anesthesia during Cesarean Deliveries at Term and Perinatal Complications

2021 ◽  
Author(s):  
Kate Swanson ◽  
Luzhou Liang ◽  
William A. Grobman ◽  
Nicole Higgins ◽  
Archana Roy ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Bladder Injury ◽  
Time Interval ◽  
Perinatal Complications ◽  
Cesarean Deliveries ◽  
Endotracheal Anesthesia

Objective To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes. Study Design This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes. Results Two hundred eighteen maternal–perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ. Conclusion When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications. Key Points

Endovascular reperfusion outcomes in patients with a stroke and low ASPECTS is highly dependent on baseline infarct volumes

2021 ◽  
pp. neurintsurg-2020-017184
Author(s):  
Mehdi Bouslama ◽  
Clara M Barreira ◽  
Diogo C Haussen ◽  
Gabriel Martins Rodrigues ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Infarct Volume ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Modified Rankin Scale ◽  
Anterior Circulation ◽  
Vessel Occlusion

BackgroundPatients with large vessel occlusion stroke (LVOS) and a low Alberta Stroke Program Early CT Score (ASPECTS) are often not offered endovascular therapy (ET) as they are thought to have a poor prognosis.ObjectiveTo compare the outcomes of patients with low and high ASPECTS undergoing ET based on baseline infarct volumes.MethodsReview of a prospectively collected endovascular database at a tertiary care center between September 2010 and March 2020. All patients with anterior circulation LVOS and interpretable baseline CT perfusion (CTP) were included. Subjects were divided into groups with low ASPECTS (0–5) and high ASPECTS (6-10) and subsequently into limited and large CTP-core volumes (cerebral blood flow 30% >70 cc). The primary outcome measure was the difference in rates of 90-day good outcome as defined by a modified Rankin Scale (mRS) score of 0 to 2 across groups.Results1248 patients fit the inclusion criteria. 125 patients had low ASPECTS, of whom 16 (12.8%) had a large core (LC), whereas 1123 patients presented with high ASPECTS, including 29 (2.6%) patients with a LC. In the category with a low ASPECTS, there was a trend towards lower rates of functional independence (90-day modified Rankin Scale (mRS) score 0-2) in the LC group (18.8% vs 38.9%, p=0.12), which became significant after adjusting for potential confounders in multivariable analysis (aOR=0.12, 95% CI 0.016 to 0.912, p=0.04). Likewise, LC was associated with significantly lower rates of functional independence (31% vs 51.9%, p=0.03; aOR=0.293, 95% CI 0.095 to 0.909, p=0.04) among patients with high ASPECTS.ConclusionsOutcomes may vary significantly in the same ASPECTS category depending on infarct volume. Patients with ASPECTS ≤5 but baseline infarct volumes ≤70 cc may achieve independence in nearly 40% of the cases and thus should not be excluded from treatment.

scholarly journals Aboard the Smile Train: Outcomes of Primary Cleft Palate Repair at a Tertiary Care Center

2020 ◽  
pp. 229255032093596
Author(s):  
Daniyal A. Khan ◽  
Ayesha Farooq ◽  
Uswa Jiwani ◽  
Muhammad Asif Ahsan ◽  
Farooq Shahzad ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Asian Country ◽  
Safe Procedure ◽  
Unit Increase ◽  
Cleft Palate Repair ◽  
Palate Repair

Introduction: Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to perform cleft surgeries. Methods: The Aga Khan University medical records database was queried for pediatric patients undergoing cleft surgery between 2014 and 2017. Data were abstracted from the patient medical records, and details of the clinical, demographic factors, and postoperative outcomes were assessed. Results: Among 142 patients with orofacial clefts, 102 (72%) underwent primary cleft palate repair, one-third (n = 36, 35%) of whom were operated as part of the Smile Train. The median preoperative hemoglobin was 11.4 g/dL (interquartile range: 10.7-12.0 g/dL), whereas the median weight was 8.3 kg (7.7-11.4 kg). Nearly two-thirds (n = 64, 63%) of the cohort underwent preoperative cardiology screening, with only a minority undergoing orthodontic treatment (n = 6, 6%). Approximately 15% (n = 15) of patients experienced a postoperative complication, most often a fistula (n = 11, 73%). On multivariable analysis, with each unit increase in hemoglobin levels, there was a 50% reduction in the odds of experiencing a complication (odds ratio: 0.51, 95% CI: 0.28-0.87). There were no in-patient deaths among the cohort. Conclusion: The results of the current study provide useful information to key stakeholders including patients, plastic surgeons, and policy makers on the outcomes of cleft palate repair in a developing country.

A prospective cohort study of predictors of upper extremity arteriovenous fistula maturation

2020 ◽  
Vol 21 (5) ◽  
pp. 746-752
Author(s):  
Aiza Waheed ◽  
Agnes Masengu ◽  
Tomas Skala ◽  
Guiyun Li ◽  
Jacek Jastrzebski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Arteriovenous Fistula ◽  
Prospective Cohort Study ◽  
Vascular Access ◽  
Prospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Nursing Assessment ◽  
Arteriovenous Fistulas

Background: A substantial proportion of arteriovenous fistulas fail to function adequately for hemodialysis. Existing studies on arteriovenous fistula failure prediction assess patency rather than the more clinically relevant outcome of arteriovenous fistula function. We hypothesized that preoperative demographic and ultrasound characteristics, and postoperative assessment by an experienced vascular access nurse would predict which arteriovenous fistulas will not function adequately for hemodialysis. Methods: Prospective cohort study of chronic kidney disease patients at a tertiary care center in Vancouver, Canada, with arteriovenous fistula creation between 2009 and 2013. Pre and postoperative clinical assessment and ultrasound blood vessel mapping were performed by an experienced vascular access nurse. The primary outcome was failure to achieve a fistula used successfully for hemodialysis (FUSH). Results: Outcomes were assessed in 200 patients; 123 (61.5%) arteriovenous fistulas were radiocephalic. Overall, 26.5% of arteriovenous fistulas had FUSH failure (34.1% of lower arm vs 14.3% of upper arm, p = 0.002). Univariate predictors of FUSH failure included older age (p = 0.03), female sex (p = 0.05), smaller arterial diameter (p ⩽ 0.001), lower artery volume flow (p = 0.04), and smaller vein diameter (p = 0.01). In multivariable analysis, artery diameter (odds ratio: 0.44, 95% confidence interval: 0.28–0.68) most significantly predicted FUSH failure. Vascular access nurse assessment 6 weeks postoperatively correctly predicted outcome in 83.8% of FUSH and 65.0% of FUSH failure. Conclusion: Smaller artery diameter most strongly predicted FUSH failure. Early postoperative nursing assessment was more useful to predict FUSH than FUSH failure, and as such was insufficient in determining which arteriovenous fistulas should be abandoned as many predicted to fail could be salvaged with further intervention.

Sign in / Sign up

Export Citation Format

Share Document