scholarly journals 62. Factors Associated with 30-Day ED Readmission Following Initial ED Discharge for Suspected Sepsis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Anna E Moscowitz ◽  
Esther Y Bae ◽  
Ricardo M La Hoz ◽  
James B Cutrell ◽  
Marguerite Monogue
Keyword(s):  
Logistic Regression ◽  
Medical Center ◽  
Multivariable Analysis ◽  
P Value ◽  
Multivariable Logistic Regression Model ◽  
Suspected Sepsis ◽  
Screening Criteria ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
Increased Risk

Abstract Background Given the increased mortality associated with delayed recognition of sepsis, emergency departments (ED) often use protocols to rapidly identify and treat suspected sepsis. However, screening criteria such as systemic inflammatory response syndrome (SIRS) lack specificity and may over-diagnose sepsis in patients otherwise stable for discharge. Our study describes outcomes and identifies factors associated with ED readmission in those initially discharged directly from the ED who met sepsis criteria. Methods This retrospective cohort study evaluated adult patients (≥ 18 years) seen in the ED at UTSW Medical Center from January to June 2018 who met all the following: ≥ 2 SIRS criteria; received ≥ 1 dose of intravenous (IV) broad-spectrum antibiotic(s) in the ED; were discharged home. A multivariable logistic regression model identified factors associated with 30-day re-admission to our ED, using clinically significant variables parsimoniously. A two-sided P value < 0.05 was considered significant. Results A total of 179 patients were included. Forty-four patients (25%) returned to the ED within 30 days of their initial visit; of those 44, 63.6% (28) returned for issues related to their prior visit, and 50% (22) were admitted to the hospital. Table 1 compares baseline demographics of patients with suspected sepsis readmitted to the ED with those not readmitted within 30 days after initial ED discharge. In univariable analysis, quick Sequential Organ Failure Assessment (qSOFA), and length of antibiotic therapy (ED plus discharge antibiotics) were associated with ED re-admission (table 1). Receipt of antibiotics on discharge was not significant. In the final multivariable analysis (table 2), initial qSOFA ≥ 2 alone was associated with increased risk of ED re-admission (OR 7.5, p=0.01). Table 1. Baseline demographics of patients readmitted and not readmitted to the ED within 30 days after ED discharge with suspected sepsis Table 2. Multivariable logistic regression of risk factors for patients readmitted and not readmitted to the ED within 30 days after ED discharge with suspected sepsis Conclusion In this cohort, 25% of patients with suspected sepsis initially discharged from the ED were readmitted to our ED within 30 days. A qSOFA ≥ 2 at the initial ED visit was associated with increased risk of readmission, suggesting a potential use of qSOFA to triage those warranting admission or closer follow-up. Larger prospective studies are warranted in this understudied population of patients who meet screening sepsis criteria but are discharged from the ED. Disclosures All Authors: No reported disclosures

scholarly journals Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ehab Nooh ◽  
Colin Griesbach ◽  
Johannes Rösch ◽  
Michael Weyand ◽  
Frank Harig
Keyword(s):  
Logistic Regression ◽  
Risk Score ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
Individual Risk ◽  
Dependent Diabetes Mellitus ◽  
Analysis Model ◽  
Multivariable Logistic Regression Model ◽  
Sternal Dehiscence ◽  
Multivariable Logistic Regression

Abstract Background After sternotomy, the spectrum for sternal osteosynthesis comprises standard wiring and more complex techniques, like titanium plating. The aim of this study is to develop a predictive risk score that evaluates the risk of sternum instability individually. The surgeon may then choose an appropriate sternal osteosynthesis technique that is risk- adjusted as well as cost-effective. Methods Data from 7.173 patients operated via sternotomy for all cardiovascular indications from 2008 until 2017 were retrospectively analyzed. Sternal dehiscence occurred in 2.5% of patients (n = 176). A multivariable analysis model examined pre- and intraoperative factors. A multivariable logistic regression model and a backward elimination based on the Akaike Information Criterion (AIC) a logistic model were selected. Results The model showed good sensitivity and specificity (area under the receiver-operating characteristic curve, AUC: 0.76) and several predictors of sternal instability could be evaluated. Multivariable logistic regression showed the highest Odds Ratios (OR) for reexploration (OR 6.6, confidence interval, CI [4.5–9.5], p < 0.001), obesity (body mass index, BMI > 35 kg/m2) (OR 4.23, [CI 2.4–7.3], p < 0.001), insulin-dependent diabetes mellitus (IDDM) (OR 2.2, CI [1.5–3.2], p = 0.01), smoking (OR 2.03, [CI 1.3–3.08], p = 0.001). After weighting the probability of sternum dehiscence with each factor, a risk score model was proposed scaling from − 1 to 5 points. This resulted in a risk score ranging up to 18 points, with an estimated risk for sternum complication up to 74%. Conclusions A weighted scoring system based on individual risk factors was specifically created to predict sternal dehiscence. High-scoring patients should receive additive closure techniques.

scholarly journals Unsafe child feces disposal status in Ethiopia: what factors matter? analysis of pooled data from four demographic and health surveys

2020 ◽  
Author(s):  
Biniyam Sahiledengle
Keyword(s):  
Logistic Regression ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Multivariable Logistic Regression Model ◽  
Lower Odds ◽  
Paternal Education ◽  
Factors Associated ◽  
Pooled Data ◽  
Multivariable Logistic Regression ◽  
Toilet Facility

Abstract Background: The only safest way to dispose of a child’s feces is to help the child use a toilet or, for very young children, to put or rinse their feces into a toilet; whereas all other disposals are considered unsafe (feces put/rinsed into a drain or ditch, bush or thrown into the garbage, buried or left on the ground, and not disposed of). The study aims to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia.Methods: The study is cross-sectional in nature and based on the pooled data from the four rounds of Demographic and Health Surveys (DHS) conducted in Ethiopia (2000-16). Data on child feces disposal practice was collected for all children born during the five years preceding survey. To get detail about the disposal of children’s feces, mothers of under-five children were asked, “The last time passed stools, what was done to dispose of the stools?” with respect to the youngest child born. Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed to identify factors associated with unsafe child feces disposal. Results: The pooled dataset contains data for 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3-79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13-24 months [AOR: 0.68, 95% CI: (0.60-0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60-0.72)] were lower odds of unsafe child’s feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56-0.79)] odds of unsafe child’s feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19-0.29)] that of households lacking such facilities. Further, being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age (25-34 and ≥ 35 years) were factors associated with lower odds of unsafe child's feces disposal.Conclusions: Three in four Ethiopian children feces disposed of unsafely. Household and socio-demographic factors, such as access to improved water and toilet facility, area of a resident (urban), the child’s age (older age), and both higher maternal and paternal education levels were significantly associated with lower odds of unsafe child feces disposal.

scholarly journals Unsafe child feces disposal status in Ethiopia: what factors matter? analysis of pooled data from four demographic and health surveys

2020 ◽  
Author(s):  
Biniyam Sahiledengle
Keyword(s):  
Logistic Regression ◽  
Urban Areas ◽  
Demographic And Health Surveys ◽  
Multivariable Logistic Regression Model ◽  
Lower Odds ◽  
Paternal Education ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
Toilet Facility ◽  
High Level

Abstract Background: Unsafe child feces disposal has compounding effects on children’s wellbeing. In Ethiopia and many other countries, still, there is a common misconception that children’s feces are not harmful, and not end up in a toilet. Objective: The study aims to determine the magnitude and factors associated with unsafe child feces disposal in Ethiopia. Methods: The study is cross-sectional in nature and the analysis was based on data from 1st to 4th rounds of the population-based Ethiopian Demographic and Health Survey (EDHS) conducted between 2000 and 2016. Descriptive statistics were computed to illustrate the given data. Multivariable logistic regression was performed, adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify factors associated with unsafe child feces disposal. Results: The pooled dataset contained information on 40,520 children younger than 5 years, male accounts 20,629 (50.9%). Overall, 77.7% (95%CI: 76.3-79.0) of children feces disposed of unsafely. In the multivariable logistic regression model, those mothers whose child was 13-24 months [AOR: 0.68, 95% CI: (0.60-0.78)] and ≥ 25 months [AOR: 0.66, 95% CI: (0.60-0.72)] were lower odds of unsafe child’s feces disposal. Children born into households having two or fewer children were 33% lower [AOR: 0.67, 95% CI: (0.56-0.79)] odds of unsafe child’s feces disposal than their counterparts. The odds of disposing of feces unsafely among households having improved toilet facility was 76% lower [AOR: 0.24, 95% CI: (0.19-0.29)] that of households lacking such facilities. Being an urban resident, having improved drinking water facility, a high level of maternal and paternal education, paternal occupational status (work in non-agriculture), and maternal age were factors associated with lower odds of unsafe child's feces disposal. Conclusions: Three in four Ethiopian children feces disposed of unsafely. Unsafe child feces disposal is less prevalent among households that had improved water and toilet facility, those in urban areas, those with older children, those with a high level of maternal and paternal education, and those with a lower number of under-five children. There is a need for more attention to be paid to curtail the significant burden of unsafe child feces disposal in Ethiopia.

scholarly journals Risk for Depressive Symptoms among Hospitalized Women in High-Risk Pregnancy Units during the COVID-19 Pandemic

2020 ◽  
Vol 9 (8) ◽  
pp. 2449 ◽  
Author(s):  
Shanny Sade ◽  
Eyal Sheiner ◽  
Tamar Wainstock ◽  
Narkis Hermon ◽  
Shimrit Yaniv Salem ◽  
...  
Keyword(s):  
Logistic Regression ◽  
High Risk ◽  
Medical Center ◽  
Depression Scale ◽  
High Risk Pregnancy ◽  
Multivariable Logistic Regression ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
Isolation Period ◽  
Risk For Depression

Objective: Higher rates of mental disorders, specifically depression, were found among affected people in previous epidemiological studies taken after disasters. The aim of the current study was to assess risk for depression among pregnant women hospitalized during the “coronavirus disease 2019” (COVID-19) pandemic, as compared to women hospitalized before the COVID-19 pandemic. Study design: A cross-sectional study was performed among women hospitalized in the high-risk pregnancy units of the Soroka University Medical Center (SUMC). All participating women completed the Edinburgh Postnatal Depression Scale (EPDS), and the results were compared between women hospitalized during the COVID-19 strict isolation period (19 March 2020 and 26 May 2020) and women hospitalized before the COVID-19 pandemic. Multivariable logistic regression models were constructed to control for potential confounders. Results: Women hospitalized during the COVID-19 strict isolation period (n = 84) had a comparable risk of having a high (>10) EPDS score as compared to women hospitalized before the COVID-19 pandemic (n = 279; 25.0% vs. 29.0%, p = 0.498). These results remained similar in the multivariable logistic regression model, while controlling for maternal age, ethnicity and known mood disorder (adjusted odds ratio (OR) 1.0, 95% CI 0.52–1.93, p = 0.985). Conclusion: Women hospitalized at the high-risk pregnancy unit during the COVID-19 strict isolation period were not at increased risk for depression, as compared to women hospitalized before the COVID-19 pandemic.

MO375EPIDEMIOLOGY AND PREDICTORS OF CARDIAC BYPASS ASSOCIATED AKI IN A MIDDLE-INCOME CARIBBEAN COUNTRY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lori-Ann Fisher ◽  
Sunil Stephenson ◽  
Marshall Tulloch-Reid ◽  
Simon Anderson
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Fold Increase ◽  
University Hospital ◽  
Small Island ◽  
Multivariable Logistic Regression Model ◽  
Middle Income ◽  
Neutrophil Lymphocyte Ratio ◽  
Multivariable Logistic Regression ◽  
Increased Risk

Abstract Background and Aims AKI is a common and resource intensive complication of cardiopulmonary bypass surgery (CPB) in high income-countries occurring in up to one third of surgeries performed. However, little is known of its incidence and impact in the small island developing states of the Caribbean. We describe the incidence, risk factors and outcomes of AKI following CPB at a referral cardiac centre in Jamaica. Method A review of the Medical Records of adult patients (aged ≥ 18 years) with no prior ESRD or dialysis requirement undergoing CPB at the University Hospital of the West Indies, Mona between January 1, 2016 to June 30, 2019 inclusive was undertaken. Demographics, pre-operative status, intraoperative and post-operative data were abstracted. The primary outcome was all-cause 30-day mortality. AKI was defined as meeting the KDIGO criteria based on the peak serum creatinine measurement obtained within 72 hours post-operatively. Multivariable logistic regression was used to examine the risk factors for and impact of AKI on all-cause mortality. Results Of the 259 persons who underwent CPB in the study period, 211 (58% men, mean age 58.1±12.9 years, median± IQR Euro-score II of 1.4 ± 1.4) met inclusion criteria. AKI occurred in 37.3 % (80) of patients with 43.8% (35) KDIGO I, 32.5% (26) KDIGO II and (19) 23.7% KDIGO III. Renal replacement therapy was required in 3.2% (7) of patients. In a multivariable logistic regression model, baseline CKD (eGFR&lt;60mL/min/1.732m2; odds ratio, 95%CI: 5.32,1.72-15.90), Prolonged bypass time (1.73,1.21-2.48; per hour), intraoperative PRBC transfusion (2.33,1.08-5.03) and elevated 24-hour post-operative Neutrophil/Lymphocyte ratio&gt;18 (3.00, 1.07-8.35) were associated with an increased risk of AKI. AKI after CPB resulted in greater hospital (23.6 versus 14.6 days, p&lt;0.001) and ICU stay (8.1 versus 3.3 days, p&lt;0.001) and a 6-fold increase in 30-day mortality after adjusting for age and sex (HR, 95 CI: 6.40, 2.38-17.25). (see Figure 1 Kaplan Meier survival estimates for AKI) Conclusion The occurrence of AKI following CPB is comparable to that reported in the literature and is associated with poor short-term outcomes. Larger multicentre prospective studies to predict risk, identify interventions to reduce mortality and assess long term complications of AKI following CPB in Caribbean countries are needed.

scholarly journals Development of a New Sternal Dehiscence Prediction Scale for Decision Making in Sternal Closure Techniques After Cardiac Surgery

2020 ◽  
Author(s):  
Frank Harig ◽  
Ehab Nooh ◽  
Colin Griesbach ◽  
Michael Weyand ◽  
Johannes Rösch
Keyword(s):  
Logistic Regression ◽  
Risk Score ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
Individual Risk ◽  
Dependent Diabetes Mellitus ◽  
Analysis Model ◽  
Multivariable Logistic Regression Model ◽  
Sternal Dehiscence ◽  
Multivariable Logistic Regression

Abstract BackgroundAfter sternotomy, the spectrum for sternal osteosynthesis comprises standard wiring and more complex techniques, like titanium plating. The aim of this study is to develop a predictive risk score that evaluates the risk of sternum instability individually. The surgeon may then choose an appropriate sternal osteosynthesis technique that is risk- adjusted as well as cost-effective.MethodsData from 7.173 patients operated via sternotomy for all cardiovascular indications from 2008 until 2017 were retrospectively analyzed. Sternal dehiscence occurred in 2.5% of patients (n=176). A multivariable analysis model examined pre- and intraoperative factors. A multivariable logistic regression model and a backward elimination based on the Akaike Information Criterion (AIC) a logistic model were selected.ResultsThe model showed good sensitivity and specificity (area under the receiver-operating characteristic curve, AUC: 0.76) and several predictors of sternal instability could be evaluated. Multivariable logistic regression showed the highest Odds Ratios (OR) for reexploration (OR 6.6, confidence interval, CI [4.5-9.5], p <0.001), obesity (body mass index, BMI >35kg/m²) (OR 4.23, [CI 2.4-7.3], p<0.001), insulin-dependent diabetes mellitus (IDDM) (OR 2.2, CI [1.5-3.2], p=0.01), smoking (OR 2.03, [CI 1.3-3.08], p=0.001). After weighting the probability of sternum dehiscence with each factor, a risk score model was proposed scaling from -1 to 5 points. This resulted in a risk score ranging up to 18 points, with an estimated risk for sternum complication up to 74%.ConclusionsA weighted scoring system based on individual risk factors was specifically created to predict sternal dehiscence. High-scoring patients should receive additive closure techniques.

scholarly journals Increased Risk of Thrombosis in Patients with Myeloproliferative Neoplasms Compared with the General Population Hospitalized with COVID-19

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1508-1508
Author(s):  
Orly Leiva ◽  
Umberto Campia ◽  
Julia Snyder ◽  
Briana Barns ◽  
Samantha Rizzo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Logistic Regression ◽  
Research Funding ◽  
Myeloproliferative Neoplasms ◽  
Multivariable Analysis ◽  
Philadelphia Chromosome ◽  
Advisory Committees ◽  
Multivariable Logistic Regression ◽  
Increased Risk ◽  
Thrombotic Complications

Abstract Background: Coronavirus disease-2019 (COVID-19) is an inflammatory, multisystem infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) and is associated with increased risk of thrombosis, particularly among critically ill patients. The myeloproliferative neoplasms (MPNs) include Philadelphia chromosome-negative (Ph-negative) MPNs polycythemia vera (PV), essential thrombocytosis (ET), and primary myelofibrosis (PMF), and Philadelphia-chromosome positive chronic myeloid leukemia (CML). Patients with MPNs, especially PH-negative, have increased risk of thrombotic complications. Given the increased propensity of thrombosis and prognostic significance of thrombosis in both COVID and MPNs, defining the risk of thrombotic complications in this patient population compared to the general population is important. Methods: Using an institutional database within the Mass General Brigham integrated health network, we retrospectively analyzed 63 consecutive patients with MPN who were ≥ 18 years old and tested positive for SARS-COV-2 infection based on polymerase chain reaction (PCR) testing from March 1, 2020 to January 1, 2021. We compared patients admitted to the hospital in our "MPN cohort" with patients admitted to the hospital from a separate COVID-19 (non-MPN cohort) Mass General Brigham registry of 1114 consecutive patients who tested positive for SARS-COV-2 infection based on PCR testing from March 13, 2020 to April 3, 2020. Care was taken to ensure the cohorts were mutually exclusive. The 90-day primary outcome for MPN cohort was a composite of all-cause death, any thrombosis (composite of arterial and venous thromboembolism [VTE]), International Society on Thrombosis and Haemostasis (ISTH) defined major and clinically relevant non-major bleeding. To identify risk factors for primary outcome in MPN cohort we used a multivariable logistic regression using age, sex, hospital admission status, MPN type, cytoreduction for MPN, hypertension, smoking status, baseline anticoagulation (AC), prior thrombosis (stroke, myocardial infarction or VTE) as co-variables. The 90-day outcomes of interest in our MPN vs non-MPN cohort analysis were any thrombosis, death, ISTH major and clinically relevant non-major bleeding and readmission for any reason. To assess impact of MPN status in hospitalized patients in our MPN vs non-MPN comparison, we used a multivariable logistic regression using age, sex, race, Hispanic ethnicity, ICU admission, treatment with steroids and/or Remdesivir, baseline AC and aspirin use, prior thrombosis (stroke, myocardial infarction or VTE), diabetes, heart failure, admission hematocrit, platelet count and D-dimer as co-variables. Continuous variables were compared using student t-test and categorical variables were compared using Fischer's Exact Test with a p value of &lt; 0.05 considered significant. Results: Of the 63 patients with MPN (23 with PV, 17 ET, 4 PMF, 15 CML, 4 other), 27 (43%) were admitted to the hospital for COVID-19 and 5 (8%) required ICU admission. The mean age of all MPN patients was 66, 84% were White, 8% Black and 10% Hispanic. Primary 90-day outcome occurred in 12 (19%) of MPN patients. In multivariable analysis, only admission to hospital was associated with increased odds of composite (aOR 21.11, 95% CI 2.38 - 546.40), Figure 1A. In patients with (n = 27) and without MPN (n = 399) who were admitted to the hospital, patients with MPN were older (mean age 70 vs 61, p = 0.0076), more likely to be White (89% vs 54%, p = 0.0004) and less likely to be Hispanic (7% vs 29%, p = 0.0158), less likely to be admitted to the ICU (19% vs 43%, p = 0.0138), and more likely to be treated with corticosteroids (30% vs 14%, p = 0.025) or remdesivir (41% vs 13%, p &lt; 0.0001). After multivariable logistic regression, diagnosis of MPN was significantly associated with increased odds of thrombosis (aOR 5.38, 95% CI 1.15-25.38) and readmission (aOR 6.28, 95% CI 1.60-24.88), but not bleeding (aOR 3.51, 95% CI 0.62-18.87) or death (aOR 4.29, 95% CI 0.95-18.99), Figure 1B. Conclusions: Thrombotic complications are common in patients with MPN and COVID-19, particularly if hospitalized for COVID-19. After multivariable analysis, MPN patients admitted for COVID-19 had a significantly increased risk of thrombotic complications compared with non-MPN patients. Figure 1 Figure 1. Disclosures Al-Samkari: Dova/Sobi: Consultancy, Research Funding; Novartis: Consultancy; Argenx: Consultancy; Rigel: Consultancy; Amgen: Research Funding; Agios: Consultancy, Research Funding; Moderna: Consultancy. Rosovsky: Janssen: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Inari: Consultancy, Membership on an entity's Board of Directors or advisory committees; Dova: Consultancy, Membership on an entity's Board of Directors or advisory committees. Fathi: Agios/Servier: Consultancy, Other: Clinical Trial Support; BMS: Consultancy, Other: Clinical Trial Support; AbbVie: Consultancy, Other: Clinical Trial Support; Pfizer: Consultancy; Trillium: Consultancy; Kura: Consultancy; Blueprint Medicines Corporation: Consultancy; Genentech: Consultancy; Novartis: Consultancy; Trovagene: Consultancy; Daiichi Sankyo: Consultancy; Novartis: Consultancy; Morphosys: Consultancy; Kite: Consultancy; Foghorn: Consultancy; Takeda: Consultancy; Amgen: Consultancy; Seattle Genetics: Consultancy; NewLink Genetics: Consultancy; Forty Seven: Consultancy; Ipsen: Consultancy. Goldhaber: Bayer: Consultancy, Research Funding; Boehringer-Ingelheim: Consultancy, Research Funding; BMS: Research Funding; Boston Scientific BTG EKOS: Research Funding; Daiichi: Research Funding; Janssen: Research Funding; Pfizer: Consultancy, Research Funding; Agile: Consultancy. Piazza: Portola: Research Funding; Bayer: Research Funding; Amgen: Research Funding; BMS: Research Funding; Janssen: Research Funding; BSC: Research Funding. Hobbs: Celgene/Bristol Myers Squibb: Consultancy; Novartis: Consultancy; Merck: Research Funding; Constellation Pharmaceuticals: Consultancy, Research Funding; Bayer: Research Funding; Incyte Corporation: Research Funding; AbbVie.: Consultancy.

scholarly journals Magnitude And Associated Factors of Intraoperative Nausea And Vomiting Among parturients who gave birth with Cesarean Section under Spinal Anesthesia At Hospitals in South Gondar Zone, Ethiopia

2021 ◽  
Author(s):  
Basazinew Chekol Demilew ◽  
Fentaye Zewudu ◽  
Dinberu Dinberu Eshetie ◽  
Netsanet Temesgen Ayenew ◽  
Eshetie Molla
Keyword(s):  
Logistic Regression ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Motion Sickness ◽  
Nausea And Vomiting ◽  
Outcome Variable ◽  
P Value ◽  
Regression Result ◽  
Multivariable Logistic Regression ◽  
Increased Risk

Abstract Background Intraoperative nausea and vomiting is common intraoperative conditions by which parturient feel discomfort and disturbed after spinal anesthesia. Methods Hospital based cross-sectional study was conducted on mothers underwent cesarean section with spinal anesthesia. Descriptive analysis and chi square test were employed. Bivariable and multivariable logistic regression were used to measure the association of factors with the outcome variable intraoperative nausea and vomiting. A p-value of ≤ 0.05 was used to decide statistical significance for multivariable logistic regression. Result A total of 246 parturients were participated in this study. The incidence of intraoperative nausea and vomiting was 40.2%. According to multivariable logistic regression, age greater than 30 years (AOR, 6.26; 95%CI, 2.2-17.78; p-value 0.001), primiparous ( AOR, 3.72; 95%CI, 1.35–10.24; p-value, 0.011), having motion sickness (AOR, 7.1; 95%CI, 2.75–18.33; p-value 0.001), emergency cesarean sectin (AOR, 9.85; 95%CI, 3.19–30.38; p-value 0.001), oxygen suplimentation (AOR, 0.021; 95%CI, 0.005–0.08; p-value 0.0001) and uterotonic agent (AOR, 2.99; 95%CI 1.24–7.22; p-value 0.015) had statistically significant association with intraoperative nausea and vomiting. Conclusion In our study, the overall incidence of intraoperative nausea and vomiting after spinal anesthesia was 40.2%. Parturients with age greater than 30 years, having motion sickness, didn’t got intraoperative supplemental oxygen, oxytocin used for uterotonic purpose, emergency surgery and primiparous were at increased risk intraoperative nausea and vomiting.

scholarly journals A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database

2018 ◽  
Vol 45 (5) ◽  
pp. E9 ◽  
Author(s):  
Clinton J. Devin ◽  
Mohamad Bydon ◽  
Mohammed Ali Alvi ◽  
Panagiotis Kerezoudis ◽  
Inamullah Khan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cervical Spine ◽  
Return To Work ◽  
Spine Surgery ◽  
Multivariable Analysis ◽  
Quality Outcomes ◽  
Cervical Spine Surgery ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
Patient Reported

OBJECTIVEBack pain and neck pain are two of the most common causes of work loss due to disability, which poses an economic burden on society. Due to recent changes in healthcare policies, patient-centered outcomes including return to work have been increasingly prioritized by physicians and hospitals to optimize healthcare delivery. In this study, the authors used a national spine registry to identify clinical factors associated with return to work at 3 months among patients undergoing a cervical spine surgery.METHODSThe authors queried the Quality Outcomes Database registry for information collected from April 2013 through March 2017 for preoperatively employed patients undergoing cervical spine surgery for degenerative spine disease. Covariates included demographic, clinical, and operative variables, and baseline patient-reported outcomes. Multiple imputations were used for missing values and multivariable logistic regression analysis was used to identify factors associated with higher odds of returning to work. Bootstrap resampling (200 iterations) was used to assess the validity of the model. A nomogram was constructed using the results of the multivariable model.RESULTSA total of 4689 patients were analyzed, of whom 82.2% (n = 3854) returned to work at 3 months postoperatively. Among previously employed and working patients, 89.3% (n = 3443) returned to work compared to 52.3% (n = 411) among those who were employed but not working (e.g., were on a leave) at the time of surgery (p < 0.001). On multivariable logistic regression the authors found that patients who were less likely to return to work were older (age > 56–65 years: OR 0.69, 95% CI 0.57–0.85, p < 0.001; age > 65 years: OR 0.65, 95% CI 0.43–0.97, p = 0.02); were employed but not working (OR 0.24, 95% CI 0.20–0.29, p < 0.001); were employed part time (OR 0.56, 95% CI 0.42–0.76, p < 0.001); had a heavy-intensity (OR 0.42, 95% CI 0.32–0.54, p < 0.001) or medium-intensity (OR 0.59, 95% CI 0.46–0.76, p < 0.001) occupation compared to a sedentary occupation type; had workers’ compensation (OR 0.38, 95% CI 0.28–0.53, p < 0.001); had a higher Neck Disability Index score at baseline (OR 0.60, 95% CI 0.51–0.70, p = 0.017); were more likely to present with myelopathy (OR 0.52, 95% CI 0.42–0.63, p < 0.001); and had more levels fused (3–5 levels: OR 0.46, 95% CI 0.35–0.61, p < 0.001). Using the multivariable analysis, the authors then constructed a nomogram to predict return to work, which was found to have an area under the curve of 0.812 and good validity.CONCLUSIONSReturn to work is a crucial outcome that is being increasingly prioritized for employed patients undergoing spine surgery. The results from this study could help surgeons identify at-risk patients so that preoperative expectations could be discussed more comprehensively.

scholarly journals Sociodemographic Factors Associated with Bottle Feeding Practices in Infants Under Two Years of Age: A hospital-based study in Woldia, Ethiopia

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Yalew Mihret ◽  
Fentanesh Endalew ◽  
Hunegnaw Almaw ◽  
Melese Linger
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Sociodemographic Factors ◽  
Bottle Feeding ◽  
P Value ◽  
Multivariable Logistic Regression Analysis ◽  
Feeding Practice ◽  
Factors Associated ◽  
Multivariable Logistic Regression

Introduction: Bottle feeding should be avoided when possible in infants under the age of two to improve health outcomes. The magnitude of bottle feeding practice is currently increasing in Ethiopia, however factors associated with bottle feeding usage are rarely addressed in research. We aimed to fill this gap and assess the magnitude of bottle feeding and its association with sociodemographic factors among infants in Woldia, Ethiopia in 2019.Methods: A hospital-based cross-sectional study was conducted in Woldia General Hospital at the Immunization Clinic. A total of 255 mothers who had infants were selected by systematic random sampling method. Data was collected through face-to-face interview using a structured standardized questionnaire. The data was entered to EpiData version 3.1 and analyzed using SPSS version 20. Binary logistic regression analysis models were used to assess the association between dependent and independent variables. Variables with p-value < 0.2 in bivariable logistic regression analysis were entered to multivariable logistic regression analysis. Finally, variables with p-value < 0.05 with 95% CI in multivariable logistic regression were taken as independent predictors. COR and AOR were used to show the strength of association between the dependent and independent variables.Results: The rate of bottle feeding practice in this study was 42.7% (95%CI: 35.8,48.2). Being an infant age 0-5 months old [AOR=0.16; 95%CI: 0.06,0.4], being a mother age 35-50 years old [AOR=0.43; 95%CI: 0.22, 0.85], having 2-5 children [AOR=6.37; 95%CI: 1.33, 30.44], and being a farmer as reported mother’s occupation [AOR=2.72; 95%CI: 1.30, 5.67] showed significant association with bottle feeding practice.Conclusion: The magnitude of bottle feeding practice was significantly higher in the current study as compared to national prevalence. Several sociodemographic factors showed significant association with bottle feeding practice which need to be explored further in the future research.

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