scholarly journals 973. Inter-facility Patient Sharing and Clostridium difficile Incidence in the Ontario Hospital Network: A 13-Year Longitudinal Cohort Study of 116 Hospitals

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Kevin Brown ◽  
Nick Daneman ◽  
Kevin Schwartz ◽  
Bradley Langford ◽  
Jennie Johnstone ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Discharge Abstract Database ◽  
Patient Transfers ◽  
Retrospective Cohort Analysis ◽  
High Incidence ◽  
Icd 10 ◽  
History Of ◽  
Facility Level ◽  
Acute Care Facilities ◽  
Healthcare Associated

Abstract Background Inter-facility patient movement plays an important role in the dissemination of antimicrobial resistance and C. difficile infection (CDI) throughout healthcare systems. However, the relative performance of different patient sharing metrics for predicting CDI incidence is not known. We compared 3 different measures of inter-facility patient sharing as they relate to CDI incidence in Ontario facilities. Methods A retrospective cohort analysis was used to predict incident CDI (ICD-10 = A04.7 identified from Discharge Abstract Database records) across Ontario hospitals (Nhospitals = 116) between April 1, 2003 to March 31, 2016. Patients with a stay of <3 days and those with a history of CDI in the prior 90 days were excluded from the risk set but not from patient sharing metrics. Poisson regression models with facility-level random effects were used to predict facility CDI incidence (per 1,000 admissions) and measure the percent change in facility-level variance (PCV). The 3 metrics of inter-facility patient sharing included: (1) “importation”—the rate of patients with a discharge from another distinct facility in prior 90 days, (2) “incidence-weighted importation”—equal to importation weighted by the incidence of CDI in the previous facility, and (3) “case importation”—importation of patients with a history of CDI. Results Over the 13-year period, we observed 58,427 cases of healthcare-associated CDI among 12,750,000 admissions. Facility CDI incidence ranged from 2.9 to 19.6 per 1,000 admissions (6.8-fold range). Patient sharing metrics were strongly related to facility CDI incidence (figure). In models adjusting for facility risk factors, all 3 measures still explained an important portion of inter-facility variation in CDI incidence: importation (PCV = 5%, P = 0.01), incidence-weighted importation (PCV = 15%, P < 0.001), and “case importation” (PCV = 48%, P < 0.001). Conclusion We observed a substantial variation in facility CDI incidence that was explained by linkages between acute care facilities, especially linkage to other facilities with a high incidence of CDI. Facility infection prevention staff should consider incorporating the facility CDI incidence into risk stratification assessments of patient transfers. Disclosures All authors: No reported disclosures.

scholarly journals Impact of obesity on male urethral sling outcomes

2020 ◽  
Vol 12 ◽  
pp. 175628722092799
Author(s):  
M. Francesca Monn ◽  
Hannah V. Jarvis ◽  
Thomas A. Gardner ◽  
Matthew J. Mellon
Keyword(s):  
Operative Time ◽  
Cohort Analysis ◽  
Obese Patients ◽  
Retrospective Cohort Analysis ◽  
Surgical Complexity ◽  
History Of ◽  
Sling Placement ◽  
The Impact ◽  
Male Urethral Sling

Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

scholarly journals Repeat Syphilis Is More Likely to Be Asymptomatic in HIV-Infected Individuals: A Retrospective Cohort Analysis With Important Implications for Screening

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Chris Kenyon ◽  
Kara Krista Osbak ◽  
Ludwig Apers
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Care Providers ◽  
Conflicting Evidence ◽  
Retrospective Cohort Analysis ◽  
History Of ◽  
Syphilis Screening ◽  
Multiple Episodes ◽  
Latent Syphilis

Abstract There is conflicting evidence as to whether repeat syphilis is more likely to present asymptomatically than initial syphilis. If it is, then this would motivate more frequent and long-term syphilis screening in persons with a history of multiple episodes of syphilis. We conducted detailed folder reviews of all individuals with 4 or more diagnoses of syphilis between 2000 and 2017 at the Institute of Tropical Medicine, Antwerp, and assessed if there was a difference in the proportion presenting with symptomatic (primary and secondary) vs asymptomatic (latent) syphilis in initial vs repeat syphilis. Forty-five clients with 4 or more episodes of syphilis were included in the study. All were HIV-infected. Repeat episodes of syphilis were less likely to be symptomatic than initial episodes (35/160 [21.9%] vs 28/45 [62.2%]; P < .001). Frequent screening in those with HIV infection may be the only way to diagnose repeat episodes of syphilis. Care providers can use this information to motivate persons with multiple episodes of syphilis to be screened every 3 to 6 months.

scholarly journals 2270. Initial Treatment Selection Among Patients with Recurrent Pseudomonas aeruginosa (PSA) Infections (Infxs): Does Prior PSA Antibiotic Susceptibility Results Effect Subsequent Empiric Treatment Decisions?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S777-S777
Author(s):  
Laura Puzniak ◽  
Vikas Gupta ◽  
Ryan J Dillon ◽  
Kalvin Yu ◽  
John Murray ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Initial Therapy ◽  
Research Database ◽  
Inclusion Criteria ◽  
Becton Dickinson ◽  
Common Culture ◽  
Susceptibility Data ◽  
Retrospective Cohort Analysis ◽  
Number Of Patients ◽  
History Of

Abstract Background Resistance to commonly used anti-pseudomonal β-lactams (AP-BLs) like piperacillin/tazobactam (TZP), meropenem (MER) and cefepime (CEF) among patients (patients) with PSA infx is increasing. To minimize receipt of DAT among patients with PSA infxs, clinicians need to consider the patient’s risk of having a PSA infx that is NS to commonly used AP-BLs. A well-described risk factor for having a NS AP-BL PSA infx is recent history of an NS AP PSA infx. This study evaluates the likelihood that a patient with a PSA infx receives an AP-BL that was found to be NS on a prior PSA culture. Methods This was a multi-center (n = 239), retrospective cohort analysis using the 2018 data from the BD Insights Research Database (Becton, Dickinson and Company). Inclusion criteria: age ≥ 18 years; hospitalized; PSA infx (index PSA infx); occurrence of a PSA infx ≤ 1 year of index PSA infx (post-index PSA infx); and received treatment for the post-index PSA infx for ≥ 24 hours. Frequency of NS to ≥ 1 AP-BL (MER, TZP, or CEF) for the index PSA infxs was calculated. Among patients with an index PSA infx that was NS ≥ 1 AP-BL, the number of patients who received an AP-BL for the post-index PSA infx that was NS on the index PSA infx was determined. Results During study period, 16,062 patients had a PSA infx and 2,386 (14.9%) of patients had a post-index PsA infx. The most common culture sites for the index and post-index PSA infxs were respiratory and urine. The most commonly prescribed AP-BL for the post-index PSA infx were TZP (41.9%), CEF (40.3%), and MER (30.8%). In total, 1,026 (43%) of patients had an index PSA infx that was NS to ≥1 AP-BL. Among the 1,026 patients with an index PSA infx that was NS to ≥1 AP-BL, 902 (88%) patients received an AP-BL as initial therapy for the post-index PSA infx and 558 (62%) patients received an AP-BL that was reported as NS on the index PSA culture. Conclusion The findings highlight the importance of considering prior PSA culture and susceptibility data when selecting initial antibiotic therapy for patients who present with a suspected or documented PSA infx and have a history of a prior PSA infx. Patients with history of a PsA infx that was NS to ≥1 AP-BL may benefit from initial use of novel AP-BL therapies. Disclosures All authors: No reported disclosures.

scholarly journals Impact of adolescent complex regional pain syndrome on the psychopathology of young men ahead of military service: a retrospective cohort analysis of Korean conscription data

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Shin-Heon Lee ◽  
Myeong-Jin Ko ◽  
Taek-Kyun Nam ◽  
Jeong-Taik Kwon ◽  
Yong-Sook Park
Keyword(s):  
Personality Disorder ◽  
Complex Regional Pain Syndrome ◽  
Military Service ◽  
Cohort Analysis ◽  
Pain Syndrome ◽  
Related Data ◽  
Retrospective Cohort Analysis ◽  
Paranoid Personality Disorder ◽  
Pain Duration ◽  
History Of

Abstract Background The relationship between physical and psychopathological features in complex regional pain syndrome (CRPS) has been a subject of constant interest, but no data are available in adolescents. Therefore, we aimed to identify the factors associated with psychopathology in adolescents with CRPS ahead of military service. Methods We retrospectively reviewed all conscription examinees who had completed a Military Personality Inventory (MPI) during a period between February 2013 and December 2016. A total of 63 persons with a history of CRPS (19-years of age for all) were enrolled. Basic demographic and pain-related data were analyzed to examine their association with MPI results. The mean FGR score as well as the 8 subdomain scores were compared between those with pain duration at < 15 months (n = 30) versus ≥15 months (n = 33). Binary MPI results (normal-abnormal) were also compared between the two groups. Results In multivariate analysis, abnormal MPI was associated with pain duration, with an odds ratio (OR) at 1.05 for every 1-month increase (95% confidence interval (CI) 1.02–1.08; P = 0.002). Subjects with pain duration at ≥15 months have lower faking good response score (P < 0.001 vs. those with pain duration at < 15 months), and higher abnormal MPI result rate, faking bad response, inconsistency, anxiety, depression, somatization, paranoid, personality disorder cluster A, and personality disorder cluster B scores (P < 0.05). Pain duration was significantly associated with the MPI variables. Conclusions Pain duration is associated with psychopathology in adolescents with CRPS. Psychopathologic features increased as the disease duration increased. A comprehensive understanding of time-dependent psychopathological factors could support the planning of multimodal approaches for managing adolescent CRPS.

Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis

2020 ◽  
Vol 72 (2) ◽  
Author(s):  
Silvia Alboresi ◽  
Alice Sghedoni ◽  
Giulia Borelli ◽  
Stefania Costi ◽  
Laura Beccani ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Over Time

A new approach to the logic of discovery

2007 ◽  
Vol 50 (1) ◽  
pp. 7-27
Author(s):  
Gerald Massey
Keyword(s):  
Modal Logic ◽  
Scientific Discovery ◽  
Traditional View ◽  
New Approach ◽  
Logic Of Discovery ◽  
Good Fortune ◽  
High Incidence ◽  
History Of ◽  
Deep Sense

Contending that the quest for a logic of scientific discovery was prematurely abandoned, the author lays down eight phenomena that such a logic or theory must explain: the banality of scientific discovery; the trainability of scientists; the high incidence of simultaneous discoveries; the ubiquity of relative novices; the fact of scientific genius; the barrenness of isolated workers; the incommensurability of concepts of successive theories; and the quasi-incorporation of old concepts, objects, and methods in successor theories, The author then presents a new theory or logic of discovery according to which discoveries are the termini of "tweak paths" generated when scientists "tinker" with the laws, concepts, methods, and instruments of a given theory. Tinkering and tweaking are illustrated by examples from many-valued and modal logic and from Darwinian biology. Through the history of planetary discovery, the accidental role played by luck or good fortune in some discoveries is explored, but the author emphasizes that in a deep sense serendipity is an in eliminable feature of all scientific discovery because scientists never know m advance whether their tweaks will lead to dead ends or to positive developments. The author's new theory of scientific discovery is shown to account for all eight explananda, ft also reveals science to be a more egalitarian enterprise than the traditional view of scientific discovery as ultimately inexplicable depicts it.

VP51 Hospitalizations And Costs In Schizophrenia Patients Initiating Long-acting Injectable Antipsychotics

2017 ◽  
Vol 33 (S1) ◽  
pp. 171-171
Author(s):  
Mallik Greene ◽  
Tingjian Yan ◽  
Eunice Chang ◽  
Ann Hartry ◽  
Michael Broder
Keyword(s):  
Index Date ◽  
Reference Group ◽  
Cohort Analysis ◽  
Paliperidone Palmitate ◽  
Linear Regression Models ◽  
Inpatient Hospitalization ◽  
Retrospective Cohort Analysis ◽  
Inpatient Hospitalizations ◽  
Medicaid Population ◽  
Long Acting

INTRODUCTION:Existing evidence on clinical and economic effectiveness of one long-acting injectable antipsychotic (LAI) versus another in successful management of schizophrenia is scarce. The study was conducted to compare all-cause inpatient healthcare utilization and associated costs among Medicaid patients with schizophrenia who initiated LAIs.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database. Schizophrenia patients >18 years with at least one claim for one of the following LAI were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, fluphenazine, haloperidol, paliperidone palmitate, and risperidone. The first day of initiating an LAI was considered the index date. Patients were followed for 1 year from index date. Logistic and general linear regression models were used to estimate risk of inpatient hospitalization and associated costs during follow up.RESULTS:Of the identified Medicaid patients with schizophrenia, 1,672 (36.7 percent) initiated an LAI: 44.0 percent received paliperidone, 26.4 percent haloperidol, 13.8 percent risperidone, 9.2 percent aripiprazole, and 6.6 percent fluphenazine. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.51 (1.05 - 2.16)] and risperidone [OR (95 percent CI): 1.58 (1.07 - 2.33)] cohorts. Fluphenazine and paliperidone palmitate cohorts also had higher risk of having any inpatient hospitalizations compared with aripiprazole, but the differences were not statistically significant (p>.05). Among LAI initiators with any inpatient hospitalizations, the adjusted mean inpatient costs were lowest in the aripiprazole cohort (USD25,616), followed by haloperidol (USD30,811), paliperidone (USD30,833), risperidone (USD31,584), and fluphenazine (USD37,338), although differences were not statistically significant.CONCLUSIONS:Our study findings highlight the value of aripiprazole in reducing inpatient hospitalizations and associated costs among patients with schizophrenia. However, our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.

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