scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

scholarly journals Iron Administration and Clinical Outcomes in Hemodialysis Patients

2002 ◽  
Vol 13 (3) ◽  
pp. 734-744
Author(s):  
Harold I. Feldman ◽  
Jill Santanna ◽  
Wensheng Guo ◽  
Howard Furst ◽  
Eunice Franklin ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
The United States ◽  
Hemodialysis Patients ◽  
Elevated Risk ◽  
Adjusted Relative Risk ◽  
Risk Of Death ◽  
Iron Administration ◽  
Parenteral Iron ◽  
Elevated Rate ◽  
The Impact

ABSTRACT. To evaluate the impact of parenteral iron administration on the survival and rate of hospitalization of US hemodialysis patients, a nonconcurrent cohort study of 10,169 hemodialysis patients in the United States in 1994 was conducted. The main outcome measures were patient survival and rate of hospitalization. After adjusting for 23 demographic and comorbidity characteristics among 5833 patients included in multivariable analysis, bills for ≤10 vials of iron over 6 mo showed no adverse effect on survival (adjusted relative risk [RR] = 0.93; 95% confidence interval [CI], 0.84 to 1.02; P = 0.14) when compared with none, but bills for >10 vials showed a statistically significant elevated rate of death (adjusted RR = 1.11; 95% CI, 1.00 to 1.24; P = 0.05). Bills for ≤10 vials of iron over 6 mo also showed no significant association with hospitalization (adjusted RR = 0.92; 95% CI, 0.83 to 1.03; P = 0.15), but bills for >10 vials showed statistically significant elevated risk (adjusted RR = 1.12; 95% CI, 1.01 to 1.25; P = 0.03). Prescribing iron in quantities of ≤10 vials over 6 mo had no association with an elevated risk of death or rate of hospitalization. More intensive dosing was associated with diminished survival and higher rates of hospitalization, even after extensive adjustment for baseline comorbidity. Although these potential risks may be offset by the known elevations in morbidity and mortality associated with anemia, these findings indicate that caution is warranted when prescribing >10 vials (1000 mg) of iron dextran over a period of 6 mo.

scholarly journals The Effect of Chronic and Inhospital Exposure to Renin-Angiotensin System Inhibitors on the Outcome and Inflammatory State of Coronavirus Disease 2019 Adult Inpatients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Pedro Gaspar ◽  
Inês Parreira ◽  
Pedro Antunes Meireles ◽  
Filipe Bessa ◽  
Virgílio Dias Silva ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Icu Admission ◽  
Risk Of Death ◽  
Asymptomatic Patients ◽  
The Impact

Background. Controversies exist about the effect of renin-angiotensin system inhibitors (RASi) on coronavirus disease 2019 (COVID-19) outcome. The inhospital use of RASi and its effect on inflammatory sate are still poorly studied during the COVID-19 pandemic. Objectives. We aimed to compare the impact of previous and inhospital RASi exposure on the outcome and inflammatory response of COVID-19 patients. Methods. Single-centre, ambispective analysis of hospitalized adult COVID-19 patients at Hospital de Santa Maria, Lisbon, between March and August 2020 was performed. We excluded asymptomatic patients and those admitted due to another disease. The primary outcome was inhospital all-cause mortality. Illness severity was assessed based on the development of acute respiratory distress syndrome/acute lung injury (ARDS/ALI), intensive care unit (ICU) admission, and need for invasive mechanical ventilation (IMV). We used C-reactive protein (CRP), ferritin, and interleukin 6 (IL-6) as surrogate markers of the inflammatory response. Results. From a total of 432 patients, 279 were selected, among whom 133 (47.7%) were receiving a RASi. Chronic treatment with RASi was not associated with the risk of death (OR 1.24, 95% CI 0.66–2.31, p = 0.500 ), ARDS/ALI development (OR 1.12, 95% CI 0.67–1.86, p = 0.676 ), ICU admission (OR 1.11, 95% CI 0.67–1.84, p = 0.686), and IMV need (OR 1.03, 95% CI 0.58–1.84, p = 0.917 ) in a univariable and multivariable analysis. Inhospital RASi withdrawing was associated with the risk of death (OR 4.38, 95% CI 1.11–17.21, p = 0.035 ) and ARDS/ALI development (OR 4.33, 95% CI 1.49–12.6, p = 0.007 ), the latter remaining significant after adjustment. Previous exposure to RASi was associated with lower CRP levels at admission ( p = 0.018 ). IL-6 levels were significantly higher in those patients whose RASi were stopped ( p = 0.024 ). Conclusion. Previous and inhospital exposure to RASi was not associated with mortality nor severity of COVID-19. This study supports current guidance on RASi management during the COVID-19 pandemic.

State Medical Boards' Perceptions of a Minimum Data Set and Current Practices for Collecting Physician Information

2013 ◽  
Vol 99 (4) ◽  
pp. 40-45 ◽  
Author(s):  
Aaron Young ◽  
Philip Davignon ◽  
Margaret B. Hansen ◽  
Mark A. Eggen
Keyword(s):  
Media Coverage ◽  
The United States ◽  
Minimum Data Set ◽  
Direct Patient Care ◽  
Physician Workforce ◽  
Data Set ◽  
Minimum Data ◽  
State Medical Boards ◽  
The Impact ◽  
Current Practices

ABSTRACT Recent media coverage has focused on the supply of physicians in the United States, especially with the impact of a growing physician shortage and the Affordable Care Act. State medical boards and other entities maintain data on physician licensure and discipline, as well as some biographical data describing their physician populations. However, there are gaps of workforce information in these sources. The Federation of State Medical Boards' (FSMB) Census of Licensed Physicians and the AMA Masterfile, for example, offer valuable information, but they provide a limited picture of the physician workforce. Furthermore, they are unable to shed light on some of the nuances in physician availability, such as how much time physicians spend providing direct patient care. In response to these gaps, policymakers and regulators have in recent years discussed the creation of a physician minimum data set (MDS), which would be gathered periodically and would provide key physician workforce information. While proponents of an MDS believe it would provide benefits to a variety of stakeholders, an effort has not been attempted to determine whether state medical boards think it is important to collect physician workforce data and if they currently collect workforce information from licensed physicians. To learn more, the FSMB sent surveys to the executive directors at state medical boards to determine their perceptions of collecting workforce data and current practices regarding their collection of such data. The purpose of this article is to convey results from this effort. Survey findings indicate that the vast majority of boards view physician workforce information as valuable in the determination of health care needs within their state, and that various boards are already collecting some data elements. Analysis of the data confirms the potential benefits of a physician minimum data set (MDS) and why state medical boards are in a unique position to collect MDS information from physicians.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals Survival in elderly glioblastoma patients treated with bevacizumab-based regimens in the United States

2018 ◽  
Vol 5 (4) ◽  
pp. 251-261 ◽  
Author(s):  
Jessica Davies ◽  
Irmarie Reyes-Rivera ◽  
Thirupathi Pattipaka ◽  
Stephen Skirboll ◽  
Beatrice Ugiliweneza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Lower Risk ◽  
Karnofsky Performance Status ◽  
The United States ◽  
Cox Proportional Hazards Model ◽  
Sensitivity Analyses ◽  
Primary Analysis ◽  
Risk Of Death ◽  
Initial Surgery ◽  
The Impact

AbstractBackgroundThe efficacy of bevacizumab (BEV) in elderly patients with glioblastoma remains unclear. We evaluated the effect of BEV on survival in this patient population using the Survival, Epidemiology, and End Results (SEER)-Medicare database.MethodsThis retrospective, cohort study analyzed SEER-Medicare data for patients (aged ≥66 years) diagnosed with glioblastoma from 2006 to 2011. Two cohorts were constructed: one comprised patients who had received BEV (BEV cohort); the other comprised patients who had received any anticancer treatment other than BEV (NBEV cohort). The primary analysis used a multivariate Cox proportional hazards model to compare overall survival in the BEV and NBEV cohorts with initiation of BEV as a time-dependent variable, adjusting for potential confounders (age, gender, Charlson comorbidity index, region, race, radiotherapy after initial surgery, and diagnosis of coronary artery disease). Sensitivity analyses were conducted using landmark survival, propensity score modeling, and the impact of poor Karnofsky Performance Status.ResultsWe identified 2603 patients (BEV, n = 597; NBEV, n = 2006). In the BEV cohort, most patients were Caucasian males and were younger with fewer comorbidities and more initial resections. In the primary analysis, the BEV cohort showed a lower risk of death compared with the NBEV cohort (hazard ratio, 0.80; 95% confidence interval, 0.72–0.89; P < .01). The survival benefit of BEV appeared independent of the number of temozolomide cycles or frontline treatment with radiotherapy and temozolomide.ConclusionBEV exposure was associated with a lower risk of death, providing evidence that there might be a potential benefit of BEV in elderly patients with glioblastoma.

Abstract MP35: The American Heart Association’s Life’s Simple 7 and Mortality by Race and Sex in the U.S.: the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Mary Cushman ◽  
Suzanne E Judd ◽  
Virginia J Howard ◽  
Neil A Zakai ◽  
Brett Kissela ◽  
...  
Keyword(s):  
Racial Differences ◽  
Mortality Risk ◽  
Lower Risk ◽  
Population Sample ◽  
White Men ◽  
The United States ◽  
Risk Of Death ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
The Impact

Background: The Life’s Simple 7 (LSS) metric is being used by AHA to track the cardiovascular health of the United States population and move toward a 2020 impact goal for improvement. Levels of LSS are associated with mortality risk but there are limited data on whether this association differs by race or sex. Hypothesis: There will be sex and race differences in the association of LSS with mortality in the REGARDS cohort study. Methods: We studied 29,692 REGARDS participants; a population sample of black and white men and women aged 45-98 from across the US, enrolled in 2003-7. Extensive baseline risk factor data were measured in participants’ homes. The 7 LSS components (blood pressure, cholesterol, glucose, body-mass index, smoking, physical activity, diet) were each scored in AHA-defined categories of poor (0 points), intermediate (1 point) and ideal (2 points), and were summed to yield scores ranging from poor for all (0) to ideal for all (14). With 6.4 years follow up there were 3709 deaths. Results: The LSS score was normally distributed with mean (SD) of 7.9 (2.0) in whites and 6.9 (2.0) in blacks. The age, region, income and education adjusted hazard ratio (HR) of death for a 1-unit worse LSS score, stratified by race and sex, are shown in the table. Race and sex interactions were tested individually in separate models. While better scores for LSS were strongly associated with lower mortality, associations differed by race and sex, being weaker in blacks than whites and in men than women. Conclusion: There were large associations of LSS with mortality risk in the REGARDS national sample; 1 point difference in score, corresponding to movement from poor to intermediate or intermediate to ideal for 1 of the 7 factors, was associated with a 16% lower risk of death in white women, 14% lower risk in white men or black women, but only an 11% lower risk in black men. Observed differences in the association of LSS with mortality by race and sex should be considered in efforts to gauge the impact of LSS interventions on health disparities.

Eviction and Voter Turnout: The Political Consequences of Housing Instability

2021 ◽  
pp. 003232922110507
Author(s):  
Gillian Slee ◽  
Matthew Desmond
Keyword(s):  
Voter Turnout ◽  
Causal Effect ◽  
Additive Model ◽  
The United States ◽  
Data Set ◽  
Endogeneity Bias ◽  
Political Consequences ◽  
Housing Costs ◽  
Election Results ◽  
The Impact

In recent years, housing costs have outpaced incomes in the United States, resulting in millions of eviction filings each year. Yet no study has examined the link between eviction and voting. Drawing on a novel data set that combines tens of millions of eviction and voting records, this article finds that residential eviction rates negatively impacted voter turnout during the 2016 presidential election. Results from a generalized additive model show eviction’s effect on voter turnout to be strongest in neighborhoods with relatively low rates of displacement. To address endogeneity bias and estimate the causal effect of eviction on voting, the analysis treats commercial evictions as an instrument for residential evictions, finding that increases in neighborhood eviction rates led to substantial declines in voter turnout. This study demonstrates that the impact of eviction reverberates far beyond housing loss, affecting democratic participation.

scholarly journals Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States

2020 ◽  
Author(s):  
Niayesh Afshordi ◽  
Benjamin Holder ◽  
Mohammad Bahrami ◽  
Daniel Lichtblau
Keyword(s):  
United States ◽  
Population Density ◽  
The United States ◽  
Effective Response ◽  
Susceptible Population ◽  
Local Climate ◽  
Climate Conditions ◽  
Mortality And Morbidity ◽  
Social Distancing ◽  
The Impact

The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e., “herd immunity”), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.

scholarly journals The Impact of Antihypertensive Drugs on the Number and Risk of Death, Stroke and Myocardial Infarction in the United States

2006 ◽  
Author(s):  
Genia Long ◽  
David Cutler ◽  
Ernst Berndt ◽  
Jimmy Royer ◽  
Andrée-Anne Fournier ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Antihypertensive Drugs ◽  
The United States ◽  
Risk Of Death ◽  
The Impact

Cardiac Disease in Pregnancy

2018 ◽  
Vol 29 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Stephanie Martin ◽  
Julie Arafeh
Keyword(s):  
Cardiac Disease ◽  
Management Strategy ◽  
Pregnant Patient ◽  
The United States ◽  
Patient Treatment ◽  
Physiological Changes ◽  
Mortality And Morbidity ◽  
Disease Management Strategy ◽  
Maternal Mortality And Morbidity ◽  
The Impact

In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.

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