scholarly journals 56. Could Maturation Effect Contribute to In-hospital Mortality Improvement During COVID-19 Pandemic?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Gina Maki ◽  
Amit T Vahia ◽  
Mayur Ramesh ◽  
Samia Arshad ◽  
Anne Chen ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Disease Process ◽  
Case Fatality ◽  
Care Facility ◽  
Fatality Rate ◽  
Tertiary Care Facility ◽  
Over Time

Abstract Background The surge of COVID-19 cases overwhelms hospital systems necessitating rapid learning of the disease process and management. During the course of a novel pandemic, multiple interventions are rapidly implemented to improve patient outcomes. When evaluating efficacy of individual interventions, one should account for the simultaneous improvements in knowledge and experience of healthcare providers (HCP), known as the maturation effect. We hypothesized that multiple processes rapidly implemented, along with the maturation effect would result in improved survival of COVID-19 patients hospitalized over the course of the pandemic. Methods This retrospective study was done at Henry Ford Hospital (HFH), a 900-bed tertiary care facility in Detroit, Michigan. The first COVID-19 patient was hospitalized on March 10, 2020 followed by a rapid surge of cases. We evaluated the trends of in-hospital case fatality rate of COVID-19 PCR positive patients through April 28, 2020. Time-points of sequential implementation of key measures for the management of COVID-19 patients were recorded. Results A total of 1023 COVID-19 patients were hospitalized during the study period with 165 deaths (16 %). Case fatality rate during week one was 42% and down trended over time (Figure 1). Key measures were sequentially implemented over the course of the study period as shown in Figure 1. These included development and implementation of in-house PCR testing, dedicated infectious diseases COVID-19 rounding teams, treatment guidelines and algorithms, and early steroid use in hypoxic patients. Figure 2 demonstrates that despite the surge of COVID-19 admissions, mortality continued to improve over time. Figure 1. Trend line of all-cause in-house morality over time Figure 2. Mortality by admission date over time Conclusion Maturation effect takes into consideration that regardless of individual interventions, HCP improve their knowledge of the disease process and treatment over time leading to better outcomes. Our study shows the possibility of the maturation effect leading to improved survival in hospitalized COVID-19 patients. The maturation effect should be accounted for when evaluating the effect of specific interventions for COVID-19. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

scholarly journals Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort

2015 ◽  
Vol 144 (1) ◽  
pp. 198-206 ◽  
Author(s):  
R.-F. WANG ◽  
S.-H. SHEN ◽  
A. M.-F. YEN ◽  
T.-L. WANG ◽  
T.-N. JANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Incidence Rate ◽  
Case Fatality Rate ◽  
Tertiary Care ◽  
Case Fatality ◽  
Healthcare Associated Infections ◽  
Fatality Rate ◽  
Infection Site ◽  
Healthcare Associated

SUMMARYInformation is lacking on the integrated evaluation of mortality rates in healthcare-associated infections (HAIs). Our aim was to differentiate the risk factors responsible for the incidence from those for the case-fatality rates in association with HAIs. We therefore examined the time trends of both incidence and case-fatality rates over a 20-year period at a tertiary-care teaching medical centre in Taiwan and the mortality rate was expressed as the product of the incidence rate and the case-fatality rate. During the study period the overall mortality rate fell from 0·46 to 0·32 deaths/1000 patient-days and the incidence rate fell from 3·41 to 2·31/1000 patient-days, but the case-fatality rate increased marginally from 13·5% to 14·0%. The independent risk factors associated with incidence of HAIs were age, gender, infection site, admission type, and department of hospitalization. Significant prognostic factors for HAI case-fatality were age, infection site, intensive care, and clinical department. We conclude that the decreasing trend for the HAI mortality rate was accompanied by a significant decline in the incidence rate and this was offset by a slightly increasing trend in the case-fatality rate. This deconstruction approach could provide further insights into the underlying complex causes of mortality for HAIs.

Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006

2010 ◽  
Vol 12 (2) ◽  
pp. 131-140 ◽  
Author(s):  
Farhad Pirouzmand
Keyword(s):  
Spinal Cord ◽  
Trauma Center ◽  
Case Fatality Rate ◽  
Spinal Cord Injuries ◽  
Head Injuries ◽  
Case Fatality ◽  
Trauma Patients ◽  
Relative Distribution ◽  
Fatality Rate ◽  
Over Time

Object In this study the author documents the epidemiology of spine and spinal cord injuries (SCIs) over 2 decades at the largest Level I adult trauma center in Canada. He describes the current state of spine injuries (SIs), their changing patterns over the years, and the relative distribution of different demographic factors in a defined group of trauma patients. Methods Data on all trauma patients admitted to Sunnybrook Health Sciences Centre between 1986 and 2006 were collected from the Sunnybrook Trauma Registry Database. Aggregate data on SIs and SCIs, including demographic information, etiology, severity of injuries (injury severity score [ISS]), and associated injuries, were recorded. The data were analyzed in a main category of spinal fracture and/or dislocation with or without SI and in two subgroups of patients with SIs, one encompassing all forms of SCIs and the other including only complete SCIs (CSCIs). Collected data were evaluated using univariate techniques to depict the trend of variables over the years. The number of deaths per year and the length of stay (LOS) were used as crude measures of outcome. Several multivariate analysis techniques, including Poisson regression, were used to model the frequency of death and LOS as functions of various trauma variables. Results There were 12,192 trauma patients in the study period with 23.2% having SIs, 5.4% having SCIs, and 3% having CSCIs. The SCIs constituted 23.3% of all SIs. The respective characteristics of the SI, SCI, and CSCI groups were as follows: median age 36, 33, and 30 years; median LOS 18, 27, and 29 days; median ISS 29, 30, and 34; female sex ratio 34, 24, and 23%; and case fatality rate 16.7, 16.6, and 21%. Seventy-nine percent of patients had associated head injuries; conversely, 24% of patients with head injuries had SIs. The mean admission age of patients increased by ~ 10 years over the study period, from the early 30s to the early 40s. The relative incidence of SIs remained stable at ~ 23%, but the incidence of SCIs decreased ~ 40% over time to 4.5%. Motor vehicle accidents remained the principal etiology of trauma, although falling and violence became more frequent contributors of SIs. The average annual ISS remained stable over time, but the LOS was reduced by 50% in both the SI and SCI groups. Age, ISS, and SCIs were associated with a longer LOS. The case fatality rate remained relatively unchanged over time. Poisson analysis suggested that the presence of an SCI does not change the case fatality rate. Conclusions Data in this analysis will provide useful information to guide future studies on changing SI patterns, possible etiologies, and efficient resource allocation for the management of these diseases.

scholarly journals SEIHCRD Model for COVID-19 spread scenarios, disease predictions and estimates the basic reproduction number, case fatality rate, hospital, and ICU beds requirement

2020 ◽  
Author(s):  
Avaneesh Singh ◽  
Manish Kumar Bajpai
Keyword(s):  
Basic Reproduction Number ◽  
Case Fatality Rate ◽  
Reproduction Number ◽  
Case Fatality ◽  
The United States ◽  
Fatality Rate ◽  
Hospital Beds ◽  
The Impact ◽  
Over Time ◽  
The Basic Reproduction Number

We have proposed a new mathematical method, SEIHCRD-Model that is an extension of the SEIR-Model adding hospitalized and critical twocompartments. SEIHCRD model has seven compartments: susceptible (S), exposed (E), infected (I), hospitalized (H), critical (C), recovered (R), and deceased or death (D), collectively termed SEIHCRD. We have studied COVID- 19 cases of six countries, where the impact of this disease in the highest are Brazil, India, Italy, Spain, the United Kingdom, and the United States. SEIHCRD model is estimating COVID-19 spread and forecasting under uncertainties, constrained by various observed data in the present manuscript. We have first collected the data for a specific period, then fit the model for death cases, got the values of some parameters from it, and then estimate the basic reproduction number over time, which is nearly equal to real data, infection rate, and recovery rate of COVID-19. We also compute the case fatality rate over time of COVID-19 most affected countries. SEIHCRD model computes two types of Case fatality rate one is CFR daily and the second one is total CFR. We analyze the spread and endpoint of COVID-19 based on these estimates. SEIHCRD model is time-dependent hence we estimate the date and magnitude of peaks of corresponding to the number of exposed cases, infected cases, hospitalized cases, critical cases, and the number of deceased cases of COVID-19 over time. SEIHCRD model has incorporated the social distancing parameter, different age groups analysis, number of ICU beds, number of hospital beds, and estimation of how much hospital beds and ICU beds are required in near future.

scholarly journals Mortality profile of neonatal deaths and deaths due to neonatal sepsis in a tertiary care center in southern India: a retrospective study

2018 ◽  
Vol 5 (4) ◽  
pp. 1583 ◽  
Author(s):  
N. Muthukumaran
Keyword(s):  
Neonatal Sepsis ◽  
Congenital Malformations ◽  
Case Fatality Rate ◽  
Distress Syndrome ◽  
Tertiary Care ◽  
Case Fatality ◽  
Meconium Aspiration Syndrome ◽  
Coagulase Negative Staphylococcus ◽  
Fatality Rate ◽  
Neonatal Deaths

Background: The Neonatal mortality rate is an important indicator for newborn care and directly reflects prenatal, intranatal, and postnatal care. Objective: Primary objective was to analyse the neonatal mortality profile, incidence of neonatal sepsis among neonatal deaths and the pattern of antimicrobial resistance.Methods: This was a retrospective descriptive study done in a tertiary care regional center. All neonatal deaths from January 2017 to December 2017 were reviewed and primary causes of deaths, incidence of sepsis among neonatal deaths and pattern of antimicrobial resistance were analyzed.Results: Common causes of neonatal deaths were respiratory distress syndrome (27.4%), asphyxia (23.3%), sepsis (20.1%), congenital malformations, extreme preterm, meconium aspiration syndrome. Case fatality rate was high in extreme preterm neonates (96.8%), followed by respiratory distress syndrome (35.9%), asphyxia (33%), meconium aspiration syndrome (29.4%), congenital malformations (28.8%), and sepsis (22.6%). In present study incidence of neonatal sepsis among total neonatal deaths was about 20.1%. Coagulase negative staphylococcus(CONS) (38.6%) and Klebsiella pneumoniae (32.7%) were the predominant organisms isolated. Highest case fatality rate was associated with Pseudomonas sepsis (80%), K. pneumoniae sepsis (64.8%), followed by Escherichia coli sepsis (57%) and non fermenting Gram negative bacilli (55.6%).Conclusions: Sepsis still remains one of the leading cause of death in developing countries. Coagulase negative staphylococcus (CONS) and Klebsiella pneumoniae were the most common organism. 15 % enterococci and 9.7 % of CONS were resistant to vancomycin. 24 % of K. pneumoniae and 16.6% non fermenting Gram negative bacilli were resistant to amikacin. Multidrug resistance is an emerging problem.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Lethality Did not Change Over Time in Two Italian Provinces

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Maria Elena Flacco ◽  
Cecilia Acuti Martellucci ◽  
Francesca Bravi ◽  
Giustino Parruti ◽  
Alfonso Mascitelli ◽  
...  
Keyword(s):  
Cohort Study ◽  
Severe Acute Respiratory Syndrome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Day Case ◽  
Italian Provinces ◽  
Over Time

Abstract This retrospective cohort study included all the subjects diagnosed with severe acute respiratory syndrome coronavirus 2 infection (n = 2493) in 2 Italian provinces. Two hundred fifty-eight persons died, after a median of 14.0 ± 11.0 days. Adjusting for age, gender, and main comorbidities, the ≥28-day case-fatality rate did not decrease from March to April 2020 (adjusted hazard ratio, 0.93; P = .6).

Clinical utility of Ektachem-determined bilirubin fractions for classifying adult inpatients.

1987 ◽  
Vol 33 (9) ◽  
pp. 1662-1664 ◽  
Author(s):  
G A Tetrault ◽  
B A Meiklejohn ◽  
C E Sparks
Keyword(s):  
Liver Disease ◽  
Total Bilirubin ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Disease Process ◽  
Care Facility ◽  
Indirect Bilirubin ◽  
Complex Patient ◽  
Tertiary Care Facility ◽  
Parenchymal Liver

Abstract We determined total bilirubin, "direct" and "indirect" bilirubin fractions, and, in parallel, using Ektachem slides, the total, conjugated, unconjugated, and delta bilirubin contents for specimens from 88 adult inpatients at various times during hospitalization in a tertiary-care facility. We wanted to see if the results correlated with the patients' diagnoses, based on a review of medical records and other laboratory data. The patients (including some with mixed disease types) were assigned to one of three predominant disease-process groups: obstructive liver disease, parenchymal liver disease, or hemolytic disease. Ektachem bilirubin fractions and the comparable total, "direct," and "indirect" bilirubin fractions showed equal sensitivity in screening and monitoring disease in all three groups. Measurements of conjugated bilirubin, unconjugated bilirubin, and their sum were sufficient for evaluating bilirubin abnormalities in this complex patient population. Determining delta bilirubin with the total bilirubin slide was rarely useful clinically. Thus, laboratories using Ektachem instrumentation for bilirubin testing can routinely eliminate the extra costs and occasional problems associated with running both bilirubin slides, reserving delta bilirubin determinations for unusual cases.

scholarly journals Eclampsia-scenario in a hospital- a ten years study

1970 ◽  
Vol 37 (2) ◽  
pp. 66-70 ◽  
Author(s):  
A Pal ◽  
R Bhattacharyya ◽  
S Adhikari ◽  
A Roy ◽  
D Chakrabarty ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Perinatal Mortality ◽  
Magnesium Sulphate ◽  
Rural Areas ◽  
Case Fatality Rate ◽  
Tertiary Care ◽  
Case Fatality ◽  
Fatality Rate ◽  
Cross Sectional

This cross sectional record based institutional study was conducted in the Department of Obstetrics & Gynaecology, Burdwan Medical College, Burdwan over ten years (1999-2008) aiming analysis of eclamptic mothers for evaluation of maternal and perinatal outcome with different anticonvulsant medications. Total 5991 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Subjects with known seizure disorders were excluded from the study. The subjects were managed according to standard regimens (Menon, Ph-sodium, diazepam & magnesium sulphate) and results were documented in standardised format. Case fatality rate, mean induction delivery time & birth-weight, perinatal mortality rates were recorded. Study reveals that the incidence of eclampsia <20 years was 6.97% and majority (5.41%) came from rural areas. Eclampsia was noted primarily in primigravida (7.43%) and unbooked (6.41%) mothers. Ante partum eclampsia predominated (64%) and incidence of caesarean section was 22.25%.The overall case fatality rate was 6.05% and eclampsia contributed 27.85% of all maternal deaths during the last two years of the study period. The overall incidence of low birth weight baby was 26.96% and perinatal mortality was 30.33% (1411/4651).The incidence of perinatal mortality and low birth weight babies are lower in the last 4 years when compared to earlier studies. Proper socio-demographic assessment of pregnancy with eclampsia, planned delivery, shorter induction delivery interval, good control of convulsion by magnesium sulphate, intensive intranatal monitoring causes less maternal and perinatal morbidity and mortality. DOI: http://dx.doi.org/10.3329/bmrcb.v37i2.8437 BMRCB 2011; 37(2): 66-70

scholarly journals Covid-19 pattern in cancer patients-an experience from a tertiary care center of western UP

2021 ◽  
Vol 6 (2) ◽  
pp. 074-081
Author(s):  
Surabhi Gupta ◽  
Tejashwita Singh
Keyword(s):  
Risk Factor ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Case Fatality Rate ◽  
Tertiary Care ◽  
Case Fatality ◽  
Disease Course ◽  
Fatality Rate ◽  
Male Predominance ◽  
Infectivity Rate

Many researches are published and still going on for the effects of comorbidities on coronavirus disease 2019 (COVID-19), but large studies on cancer as a risk factor and severity of covid-19 in cancer patients are still lacking. The aim of this study was to see the prevalence of covid- 19 in cancer patients and to observe the pattern of disease course in cancer patients undergoing active treatment. In this study, 50 patients of covid-19 RTPCR confirmed cancer patients were enrolled who visited the department from 1may to September 2020 and were retrospectively analyzed for their disease course. Infectivity rate of 5% was observed while case fatality rate was 12%. Mean age of presentation was 42.9yr with male predominance. Head and neck carcinoma patients were more prone to covid-19.20% patients were symptomatic, who required admission in covid ward. Infectivity rate as well as case fatality rate was higher in cancer patients, especially those taking active cancer treatment and were having other comorbid conditions also. Cancer treatment makes a risk factor for covid-19 infection. Mortality is more in cases having associated comorbidities. Though more prospective randomized trials are needed for any statistical analysis.

scholarly journals RELATIONSHIP OF MEASLES CASES IN MEASLES VACCINATED CHILDREN DURING OUTBREAK OF MEASLES IN BAHAWALPUR.

2019 ◽  
Vol 26 (07) ◽  
pp. 1125-1130
Author(s):  
Shahzadi Asma Tahseen
Keyword(s):  
Clinical Diagnosis ◽  
Case Fatality Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Fatality Rate ◽  
Medical College ◽  
District Officer ◽  
Relationship Of ◽  
Tertiary Care Hospitals

Objectives: To evaluate the clinical profile and case fatality rate and their comparison in relation with vaccination status in admitted children. Study Design: Case series retrospective study. Setting: Pediatric units of the tertiary care Hospitals (Bahawal Victoria Hospital and the Civil Hospital) affiliated with Quaid-e-Azam medical College Bahawalpur situated in Southern Punjab, Pakistan). Period: 01/01/2013 to 06/9/2013. Methods and Material: A clinical diagnosis of measles (as made by consultants of said Pediatric units) and residing in Bahawalpur district for more than one month of period before admitting in the hospital was included and reviewed. The help of Statistical department of Executive District Officer Health Bahawalpur was taken for missing information as the measles is notifiable disease and all cases were notified to Executive District Officer Health. The children who were nonresident of Bahawalpur District or with incomplete data were excluded. The children were divided into three groups depending on number of measles vaccine doses given. Results: The data of 557 children admitting during the period 01/01/2013 to 06/9/2013 with a clinical diagnosis of measles and resident of Bahawalpur district was included. 52.97% were males. 26.57% were unvaccinated and 73.43% vaccinated (39.14% with one dose and 34.29% with two doses). The mean age ± SD in unvaccinated children was 24.68±27.04, with one dose vaccination 50.94 ±35.58 and with two doses vaccination was 45.05 ±23.67 months. The case fatality rate was 2.87%. The case fatality was significantly higher in males vaccinated with two doses of vaccine as compared to either ones vaccinated with one dose or unvaccinated ones but this difference was not found in females. Conclusion: This study shows that there is urgent need of proper surveillance of measles cases.

Sign in / Sign up

Export Citation Format

Share Document