scholarly journals Rehabilitation and In-Hospital Mortality in COVID-19 patients

2021 ◽  
Author(s):  
Anne Felicia Ambrose ◽  
Anupuma Kurra ◽  
Lana Tsirakidis ◽  
Kate Collins Hunt ◽  
Emmeline Ayers ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Randomized Clinical Trials ◽  
Evidence Base ◽  
Early Rehabilitation ◽  
Sensitivity Analyses ◽  
Disease Markers ◽  
Hospital Deaths ◽  
Group Sex ◽  
Adjusted Model ◽  
Length Of Hospitalization

Abstract Background COVID-19 guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence-base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients. Methods Single center retrospective study involving 990 COVID-19 patients (42·4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital. Association of rehabilitation during hospitalization with in-hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications. Results Over the 3-month study period, 475 (48·0%) in-patients were referred for rehabilitation. Patients who received rehabilitation were older (73·7 ± 14·0 vs. 62·3 ± 17·2). There were 61 hospital deaths (12·8%) in the rehabilitation group and 165 (32·0%) in the non-rehabilitation group. Receiving rehabilitation was associated with an 89% lower in-hospital mortality (OR 0·11, 95% CI 0·06–0·19) after adjusting for multiple confounders and COVID-19 disease markers. In sensitivity analyses, the results were significant in sub-populations defined by age group, sex, race, length of hospitalization, or pulmonary presentations. Each additional rehabilitation session was associated with a 29% lower risk of in-hospital mortality (OR per session 0·71, 95% CI 0·64-0·79) in the fully adjusted model. Conclusion Among hospitalized COVID-19 patients, receiving early rehabilitation was associated with lower in-hospital mortality. Our findings support implementation of rehabilitation services for COVID-19 patients in acute care settings, but further research from randomized clinical trials is needed.

EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

2021 ◽  
pp. 174749302110192
Author(s):  
Mahmoud H Mohammaden ◽  
Diogo C. Haussen ◽  
Leonardo Pisani ◽  
Alhamza Al-Bayati ◽  
Aaron Anderson ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Functional Independence ◽  
Stent Retriever ◽  
Sensitivity Analyses ◽  
First Line ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Guide Catheter ◽  
First Pass ◽  
Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS ≤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

scholarly journals Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoling Zhang ◽  
Jingjing Zhang ◽  
Jiamei Li ◽  
Ya Gao ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Venous Blood ◽  
Sensitivity Analyses ◽  
Icu Mortality ◽  
Logistic Regression Models ◽  
The Mean ◽  
The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

Attention Deficit Hyperactivity Disorder

2018 ◽  
Author(s):  
Steven W. Evans ◽  
Julie S. Owens ◽  
W. John Monopoli ◽  
Kari Benson
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Children And Adolescents ◽  
Attention Deficit ◽  
Randomized Clinical Trials ◽  
Evidence Base ◽  
Future Research ◽  
Hyperactivity Disorder ◽  
New Findings ◽  
Assessment And Treatment ◽  
Effective Assessment

Youth with attention deficit hyperactivity disorder experience impairment across multiple domains of functioning, with the characteristics changing with age. Thus, assessment and treatment must be appropriate for the home and school and relevant to the child’s developmental level. This chapter reviews effective assessment strategies for use with children and adolescents. Psychosocial treatments for children and adolescents are discussed separately, as the approaches with each group differ substantially. For children, strategies with a strong evidence base are described, and innovations and treatment modifications that have been examined recently are showcased. For adolescents, the results of the few randomized clinical trials conducted with this population are reviewed. A theoretical model for how to sequence treatments (i.e., intervention, medication, accommodations) for youth is referenced, and two case studies highlight this model, as well some of the new findings described in this chapter. Implications and recommendations for future research and practice are provided.

Use of Statins and Breast Cancer: A Meta-Analysis of Seven Randomized Clinical Trials and Nine Observational Studies

2005 ◽  
Vol 23 (34) ◽  
pp. 8606-8612 ◽  
Author(s):  
Stefanos Bonovas ◽  
Kalitsa Filioussi ◽  
Nikolaos Tsavaris ◽  
Nikolaos M. Sitaras
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Publication Bias ◽  
Observational Studies ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Fixed Effects Model

Purpose A growing body of evidence suggests that statins may have chemopreventive potential against breast cancer. Laboratory studies demonstrate that statins induce apoptosis and reduce cell invasiveness in various cell lines, including breast carcinoma cells. However, the clinical relevance of these data remains unclear. The nonconclusive nature of the epidemiologic data prompted us to conduct a detailed meta-analysis of the studies published on the subject in peer-reviewed literature. Patients and Methods A comprehensive search for articles published up until 2005 was performed; reviews of each study were conducted; and data were abstracted. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% CIs were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also performed. Results Seven large randomized trials and nine observational studies (five case-control and four cohort studies) contributed to the analysis. We found no evidence of publication bias or heterogeneity among the studies. Statin use did not significantly affect breast cancer risk (fixed effects model: RR = 1.03; 95% CI, 0.93 to 1.14; random effects model: RR = 1.02; 95% CI, 0.89 to 1.18). When the analyses were stratified into subgroups, there was no evidence that study design substantially influenced the estimate of effects. Furthermore, the sensitivity analysis confirmed the stability of our results. Conclusion Our meta-analysis findings do not support a protective effect of statins against breast cancer. However, this conclusion is limited by the relatively short follow-up times of the studies analyzed. Further studies are required to investigate the potential decrease in breast cancer risk among long-term statin users.

scholarly journals The role of multistraine probiotics in non-specific seasonal prevention of acute respiratory infections in children with recurrent URTI in organized teams

2021 ◽  
pp. 220-226
Author(s):  
Lyudmila D. Panova Lyudmila D. Panova Lyudmila D. Panova
Keyword(s):  
Treatment Group ◽  
High Risk ◽  
Randomized Clinical Trials ◽  
Comparison Group ◽  
Respiratory Infections ◽  
Evidence Base ◽  
Acute Respiratory Infections ◽  
Infection Period ◽  
Study Results

Introduction. A broad evidence base of numerous randomized clinical trials and meta-analyses asserts the role of intestinal microbiota dysbiosis in the development of various diseases, including those of infectious origin, in infancy and later stages of life.Purpose. Assessment of the efficacy of a multi-strain immuno-probiotic during rehabilitation of frequently ill children visiting organized groups during the period of epidemiological distress for acute respiratory diseases.Materials and methods.93 children older than 3 years of age were enrolled in an open comparative prospective clinical observation during the high-risk respiratory infection period  – November, December. Children were observed for 1.5 months during administration of the multi-strain probiotic and 1 month after discontinuation of the probiotic. The subjects were randomized into two groups: the treatment group (60 children) received the multi-strain probiotic in the maximum age-specific dosage variances (children aged 3 to 12 years old – 1 capsule, older than 12 years of age – 2 capsules) once a day in the morning for 14 days and the comparison group (33 children) did not receive the multi-probiotic for the same period.Results and discussion. It was found that the incidence of disease in children receiving the multi-probiotic (the treatment group – 60 children) was statistically lower, and the disease severity was milder than in the group of children, who did not receive the probiotic (the comparison group – 33 children). Not a single child who received the multi-probiotic in the course of disease did not require antibiotic therapy during the entire observation period. Moreover, the incidence of respiratory infections in the treatment group within a month after discontinuation of the probiotic was 4.6 times lower than in the comparison group. No side effects were reported.Conclusions. The study results allowed the author to recommend the use of a multi-strain immuno-probiotic as a nonspecific immunomodulatory supplement for the seasonal prevention of acute respiratory infections, especially in frequently ill children at a high risk of infections.

scholarly journals SARS-CoV-2 and influenza virus coinfection among patients with severe acute respiratory infection during the first wave of COVID-19 pandemic in Bangladesh: a hospital-based descriptive study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053768
Author(s):  
Zubair Akhtar ◽  
Md Ariful Islam ◽  
Mohammad Abdul Aleem ◽  
Syeda Mah-E-Muneer ◽  
M Kaousar Ahmmed ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Hospital Mortality ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Descriptive Study ◽  
Tertiary Level ◽  
Future Studies ◽  
Severe Acute Respiratory Infection ◽  
Hospital Deaths ◽  
Secondary Outcomes

ObjectiveTo estimate the proportion of SARS-CoV-2 and influenza virus coinfection among severe acute respiratory infection (SARI) cases-patients during the first wave of COVID-19 pandemic in Bangladesh.DesignDescriptive study.SettingNine tertiary level hospitals across Bangladesh.ParticipantsPatients admitted as SARI (defined as cases with subjective or measured fever of ≥38 C° and cough with onset within the last 10 days and requiring hospital admission) case-patients.Primary and secondary outcomesProportion of SARS-CoV-2 and influenza virus coinfection and proportion of mortality among SARI case-patients.ResultsWe enrolled 1986 SARI case-patients with a median age: 28 years (IQR: 1.2–53 years), and 67.6% were male. Among them, 285 (14.3%) were infected with SARS-CoV-2; 175 (8.8%) were infected with the influenza virus, and five (0.3%) were coinfected with both viruses. There was a non-appearance of influenza during the usual peak season (May to July) in Bangladesh. SARS-CoV-2 infection was significantly more associated with diabetes (14.0% vs 5.9%, p<0.001) and hypertension (26.7% vs 11.5%, p<0.001). But influenza among SARI case-patients was significantly less associated with diabetes (4.0% vs 7.4%, p=0.047) and hypertension (5.7% vs 14.4%, p=0.001). The proportion of in-hospital deaths among SARS-CoV-2 infected SARI case-patients were higher (10.9% (n=31) vs 4.4% (n=75), p<0.001) than those without SARS-CoV-2 infection; the proportion of postdischarge deaths within 30 days was also higher (9.1% (n=25) vs 4.6% (n=74), p=0.001) among SARS-CoV-2 infected SARI case-patients than those without infection. No in-hospital mortality or postdischarge mortality was registered among the five coinfected SARI case-patients.ConclusionsOur findings suggest that coinfection with SARS-CoV-2 and influenza virus was not very common and had less disease severity considering mortality in Bangladesh. There was no circulating influenza virus during the influenza peak season during the COVID-19 pandemic in 2020. Future studies are warranted for further exploration.

scholarly journals Exploring the association of hospice care on patient experience and outcomes of care

2016 ◽  
Vol 9 (1) ◽  
pp. e13-e13 ◽  
Author(s):  
Ruth Kleinpell ◽  
Eduard E Vasilevskis ◽  
Louis Fogg ◽  
E Wesley Ely
Keyword(s):  
Patient Satisfaction ◽  
Hospital Mortality ◽  
Patient Experience ◽  
Pain Control ◽  
Structural Equation ◽  
Hospice Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Outcomes Of Care ◽  
Hospital Deaths

ObjectiveTo examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised.MethodsA secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators. Structural equation modelling was used to demonstrate the effect of hospice use on patient experience, clinical and efficiency outcomes.ResultsHospice admissions in the last 6 months of life were correlated with a number of variables, including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=−0.517, p=0.01), fewer hospital deaths (r=−0.842, p=0.01) and fewer deaths occurring with an ICU admission during hospitalisation (r=−0.358, p=0.01). The structural equation model identified that use of hospice care was inversely related to hospital mortality (−0.885) and ICU mortality (−0.457).ConclusionsThe results of this investigation demonstrate that greater use of hospice care during the last 6 months of life is associated with improved patient experience, including satisfaction and pain control, as well as clinical outcomes of care, including decreased ICU and hospital mortality.

Cost-effectiveness analysis of neoadjuvant immune checkpoint inhibition (ICI) versus cisplatin-based chemotherapy (CBC) in muscle-invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 419-419
Author(s):  
Ali Raza Khaki ◽  
Yong Shan ◽  
Richard Nelson ◽  
Sapna Kaul ◽  
John L. Gore ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomized Clinical Trials ◽  
Pathologic Complete Response ◽  
Weighted Average ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Effectiveness Analysis

419 Background: Multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs in MIBC. However, ICIs remain costly. We conducted a cost-effectiveness analysis comparing neoadjuvant ICIs with CBC. Methods: We applied a decision analytic simulation model with a health care payer perspective and two-year time horizon to compare neoadjuvant ICIs vs CBC. For the primary analysis we compared pembrolizumab with dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). We performed a secondary analysis with gemcitabine/cisplatin (GC) as CBC and exploratory analyses with atezolizumab or nivolumab/ipilimumab as ICIs (vs both ddMVAC and GC). We input pCR rates from trials (ICIs) or a weighted average of prior studies (CBC) and costs from average sales price. Outcomes of interest included costs, 2-year recurrence-free survival (RFS), and incremental cost-effectiveness ratio (ICER) of cost per 2-year RFS. A threshold analysis estimated a pCR rate or price reduction for ICI to be cost-effective and one-way and probabilistic sensitivity analyses were performed. Results: Results of the cost effectiveness analysis are shown in the table. The incremental cost of pembrolizumab compared with ddMVAC was $8,042 resulting in an incremental improvement of 0.66% in 2-year RFS for an ICER of $1,218,485 per 2-year RFS. A pCR of 71% or a 26% reduction in cost of pembrolizumab would render it more cost-effective with an ICER of $100,000 per 2-year RFS. GC required a 96% pembrolizumab cost reduction to achieve an ICER of $100,000 per 2-year RFS. Atezolizumab appeared to be more cost-effective than ddMVAC, even though the 2yr RFS was 0.66% worse. Conclusions: ICIs were not cost-effective as neoadjuvant therapies, except when atezolizumab was compared with ddMVAC. Pembrolizumab would approach cost-effective thresholds with 26% or 96% reduction in cost when compared to ddMVAC and GC, respectively. Randomized clinical trials, larger sample sizes and longer follow-up are required to better understand the value of ICIs as neoadjuvant treatments. [Table: see text]

scholarly journals Patterns of comorbidities in hospitalised cancer survivors for palliative care and associated in-hospital mortality risk: A latent class analysis of a statewide all-inclusive inpatient data

2019 ◽  
Vol 33 (10) ◽  
pp. 1272-1281 ◽  
Author(s):  
Lan Luo ◽  
Wei Du ◽  
Shanley Chong ◽  
Huibo Ji ◽  
Nicholas Glasgow
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Hospital Mortality ◽  
Cancer Survivors ◽  
Latent Class Analysis ◽  
Cancer Patients ◽  
Mortality Risk ◽  
Latent Class ◽  
Class Analysis ◽  
Hospital Deaths

Background: At the end of life, cancer survivors often experience exacerbations of complex comorbidities requiring acute hospital care. Few studies consider comorbidity patterns in cancer survivors receiving palliative care. Aim: To identify patterns of comorbidities in cancer patients receiving palliative care and factors associated with in-hospital mortality risk. Design, Setting/Participants: New South Wales Admitted Patient Data Collection data were used for this retrospective cohort study with 47,265 cancer patients receiving palliative care during the period financial year 2001–2013. A latent class analysis was used to identify complex comorbidity patterns. A regression mixture model was used to identify risk factors in relation to in-hospital mortality in different latent classes. Results: Five comorbidity patterns were identified: ‘multiple comorbidities and symptoms’ (comprising 9.1% of the study population), ‘more symptoms’ (27.1%), ‘few comorbidities’ (39.4%), ‘genitourinary and infection’ (8.7%), and ‘circulatory and endocrine’ (15.6%). In-hospital mortality was the highest for ‘few comorbidities’ group and the lowest for ‘more symptoms’ group. Severe comorbidities were associated with elevated mortality in patients from ‘multiple comorbidities and symptoms’, ‘more symptoms’, and ‘genitourinary and infection’ groups. Intensive care was associated with a 37% increased risk of in-hospital deaths in those presenting with more ‘multiple comorbidities and symptoms’, but with a 22% risk reduction in those presenting with ‘more symptoms’. Conclusion: Identification of comorbidity patterns and risk factors for in-hospital deaths in cancer patients provides an avenue to further develop appropriate palliative care strategies aimed at improving outcomes in cancer survivors.

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