scholarly journals Clinical characteristics with inflammation profiling of Long-COVID and association with one-year recovery following hospitalisation in the UK: a prospective observational study

2021 ◽  
Author(s):  
Rachael Andrea Evans ◽  
Olivia C Leavy ◽  
Matthew Richardson ◽  
Omer Elneima ◽  
Hamish J C McAuley ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Protein Profiling ◽  
Full Recovery ◽  
Patient Reported ◽  
One Year ◽  
The Uk ◽  
Prospective Longitudinal

Background There are currently no effective pharmacological or non-pharmacological interventions for Long-COVID. To identify potential therapeutic targets, we focussed on previously described four recovery clusters five months after hospital discharge, their underlying inflammatory profiles and relationship with clinical outcomes at one year. Methods PHOSP-COVID is a prospective longitudinal cohort study, recruiting adults hospitalised with COVID-19 across the UK. Recovery was assessed using patient reported outcomes measures (PROMs), physical performance, and organ function at five-months and one-year after hospital discharge. Hierarchical logistic regression modelling was performed for patient-perceived recovery at one-year. Cluster analysis was performed using clustering large applications (CLARA) k-medoids approach using clinical outcomes at five-months. Inflammatory protein profiling from plasma at the five-month visit was performed. Findings 2320 participants have been assessed at five months after discharge and 807 participants have completed both five-month and one-year visits. Of these, 35.6% were female, mean age 58.7 (SD 12.5) years, and 27.8% received invasive mechanical ventilation (IMV). The proportion of patients reporting full recovery was unchanged between five months 501/165 (25.6%) and one year 232/804 (28.9%). Factors associated with being less likely to report full recovery at one year were: female sex OR 0.68 (95% CI 0.46-0.99), obesity OR 0.50 (95%CI 0.34-0.74) and IMV OR 0.42 (95%CI 0.23-0.76). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate/cognitive, mild relating to the severity of physical, mental health and cognitive impairments at five months in a larger sample. There was elevation of inflammatory mediators of tissue damage and repair in both the very severe and the moderate/cognitive clusters compared to the mild cluster including interleukin-6 which was elevated in both comparisons. Overall, there was a substantial deficit in median (IQR) EQ5D-5L utility index from pre-COVID (retrospective assessment) 0.88 (0.74-1.00), five months 0.74 (0.60-0.88) to one year: 0.74 (0.59-0.88), with minimal improvements across all outcome measures at one-year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 remain substantial one year after discharge across a range of health domains with the minority in our cohort feeling fully recovered. Patient perceived health-related quality of life remains reduced at one year compared to pre-hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

Clinical Characteristics and Adverse Clinical Outcomes of Invasive Haemophilus influenzae Serotype a Cases—United States, 2011–2015

2020 ◽  
Author(s):  
Catherine H Bozio ◽  
Amy Blain ◽  
Karen Edge ◽  
Monica M Farley ◽  
Lee H Harrison ◽  
...  
Keyword(s):  
United States ◽  
Haemophilus Influenzae ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Clinical Characteristics ◽  
Disease Onset ◽  
The United States ◽  
Serotype A ◽  
Bacteremic Pneumonia ◽  
One Year

Abstract Background Incidence of invasive disease due to Haemophilus influenzae serotype a (Hia) increased an average of 13% annually from 2002 through 2015. We describe clinical characteristics and adverse clinical outcomes of US invasive Hia cases detected through multistate surveillance during 2011–2015. Methods Medical record data were abstracted for cases reported in 8 jurisdictions conducting active population- and laboratory-based surveillance for invasive Hia disease across the United States. Isolates from sterile sites were serotyped using real-time polymerase chain reaction. Adverse clinical outcomes were defined as any possible complication of meningitis, bacteremic pneumonia, or bacteremia (including hearing loss and developmental delay, but excluding death) and were assessed at hospital discharge and one-year post-disease onset. Results During 2011–2015, 190 Hia cases were reported to the 8 participating sites; 169 (88.9%) had data abstracted. Many patients were aged <5 years (42.6%). Meningitis was the most common clinical presentation among those aged <1 year (71.4%); bacteremic pneumonia was the most common presentation among persons aged ≥50 years (78.7%). Overall, 95.9% of patients were hospitalized. Among those hospitalized, 47.5% were admitted to an intensive care unit and 6.2% died during hospitalization. At hospital discharge and one-year post-disease onset, adverse outcomes were identified in 17.7% and 17.8% of patients overall and in 43.9% and 48.5% of patients with meningitis (primarily children). Conclusions Hia infection can cause severe disease that requires hospitalization and may also cause short- and long-term adverse clinical outcomes, especially among children. Novel vaccines could prevent morbidity and mortality.

scholarly journals Two Year Clinical Outcomes of the Subchondroplasty® Procedure for Treatment of Symptomatic Bone Marrow Lesions of the Knee

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Christopher Hajnik ◽  
Sam Akhavan ◽  
Douglas J. Wyland ◽  
Steven B. Cohen ◽  
Laith M. Jazrawi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Conversion Rate ◽  
Bone Substitute ◽  
Patient Reported Outcomes ◽  
Bone Substitute Material ◽  
Bone Marrow Lesions ◽  
Patient Reported ◽  
Substitute Material ◽  
One Year

Objectives: Bone Marrow Lesions (BML) are a common finding on knee MRI. In the knee, BML have a strong correlation to patient-reported pain, function, joint deterioration and rapid progression to TKR. Histologic analyses of BML have demonstrated findings consistent with fracture and bony remodeling of the trabeculae. The Subchondroplasty (SCP®) Procedure aims to treat the bone defects present in the BML by percutaneously filling them with a bone substitute material, designed to flow through intact bone, harden at body temperature and then heal through natural bone turnover. Previous retrospective, single-center case series have demonstrated improvements in patient-reported outcomes. The purpose of this prospective, multi-center study is to evaluate the 2-year clinical and radiographic outcomes of patients with BML of the knee treated with the Subchondroplasty Procedure. Methods: Seventy patients were treated between 2012 and 2017 for BML of the tibial plateau and/or femoral condyle. Self-drilling cannulas were inserted into the BML using arthroscopic and fluoroscopic guidance, then injected with AccuFill® Bone Substitute Material. All patients also underwent arthroscopy to aid in targeting the underlying bony lesion and address intra-articular pathology. MRIs and radiographs were obtained pre-operatively, at 6, 12 and 24 months, with additional radiographs collected at 6 weeks and 3 months. Patient-reported outcomes, including VAS pain, IKDC and KOOS were collected pre-operatively, 2 and 6 weeks, and 3, 6, 12 and 24 months post-operatively. Results: Seventy patients (36 males and 34 females), average age 57 were consented and enrolled in the study. Preoperative K-L grade included 1.4% Grade 0, 2.9% Grade 1, 27.1% Grade 2, 55.7% Grade 3 and 7.1% Grade 4. Fifty eight tibial plateaus and 41 femoral condyles were treated (29 bipolar lesions treated). VAS Pain scores improved from a mean of 6.2/10 pre-op to 2.9/10 at 1 year. IKDC scores improved from mean 33.9 pre-op to 61.3 at 1 year. KOOS scores improved from baseline to 1 year (Fig. 1) with mean KOOS Pain from 45.8 to 73.9, ADL 52.9 to 79.2, Symptoms 49.7 to 71.9, Sports 21.2 to 49.9 and Quality of Life 18.1 to 52.3. All patient-reported outcomes showed statistically significant improvement at one year. Two year outcomes collected to date appear to follow the same trend. The last study subject is due to return in January 2019 at which point the final 2 year analysis will be completed. Six patients (8.6%) converted to arthroplasty (1 UKA and 5 TKA) at one year. To date, the 24 month conversion rate is 16.1% out of 62 subjects. The final conversion rate for 24 months will be calculated after the final subject returns. Radiographs and MRIs demonstrated good incorporation of the AccuFill material through 12 months with evidence of early remodeling and a lack of OA progression in the majority of subjects. Twenty-four month MRIs demonstrate continued remodeling of the AccuFill material. Conclusion: This study presents statistically and clinically-meaningful evidence of improvements in clinical outcomes following Subchondroplasty procedure for BML of the knee. The low conversion rate suggests this less-invasive procedure may delay the need for knee arthroplasty. MR imaging demonstrates good incorporation of the BSM and evidence of remodeling and reduction in material volume over time. [Figure: see text][Table: see text]

scholarly journals Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Ryan Bradley ◽  
Karen J Sherman ◽  
Sheryl Catz ◽  
Carlo Calabrese ◽  
Erica B Oberg ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Outcomes ◽  
Diabetes Patient ◽  
Patient Reported ◽  
One Year

Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey

2018 ◽  
Vol 26 (6) ◽  
pp. 624-637 ◽  
Author(s):  
Selina K Berg ◽  
Charlotte B Thorup ◽  
Britt Borregaard ◽  
Anne V Christensen ◽  
Lars Thrysoee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hospital Discharge ◽  
Patient Reported Outcomes ◽  
Severe Symptom ◽  
Poor Quality ◽  
Anxiety And Depression ◽  
Cardiac Events ◽  
Patient Reported ◽  
One Year

Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.

Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia

2015 ◽  
Vol 30 (5) ◽  
pp. 452-456 ◽  
Author(s):  
Eric Cortez ◽  
Ashish R. Panchal ◽  
James Davis ◽  
Paul Zeeb ◽  
David P. Keseg
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Retrospective Chart Review ◽  
Publication Type ◽  
Treatment Benefit ◽  
Prehospital Treatment ◽  
Chain Of Survival

AbstractIntroductionRecent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important.Hypothesis/ProblemThis study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized.MethodsThis evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger.ResultsFifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge.ConclusionRecent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.CortezE, PanchalAR, DavisJ, ZeebP, KesegDP. Clinical outcomes in cardiac arrest patients following prehospital treatment with therapeutic hypothermia. Prehosp Disaster Med2015; 30(5):452–456.

scholarly journals Discharge Communication and Patient Involvement are Associated with Unplanned Hospital Readmissions: Results from a Validated Hospital Experience Survey

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Kyle Kemp ◽  
Maria Santana ◽  
Rachel Jolley ◽  
Danielle Southern ◽  
Hude Quan
Keyword(s):  
Hospital Discharge ◽  
Patient Involvement ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Individual Level ◽  
Written Information ◽  
Hospital Experience ◽  
Patient Reported ◽  
Returning Home ◽  
One Year

ABSTRACTObjectivesUnplanned hospital readmissions are an indicator of quality of care, and are associated with significant costs to healthcare systems. Previous research has shown that poor communication and discharge experiences are associated with higher readmission rates. This, however, has only been examined in the short-term, and in many instances, at the hospital-level. The purpose of the study was to examine the relationship between aspects of inpatient communication and discharge instructions and unplanned readmissions at the individual-level up to one-year post-discharge. ApproachThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey was completed by patients within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records using personal health number, discharge date, and facility codes. Unplanned readmissions (yes vs. no; all causes) from 43 to 365 days post-hospital discharge comprised the outcome variable. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in their care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. Multivariate logistic regression was used to examine each question in the presence of the other predictors. Odds ratios and 95% confidence intervals were calculated. ResultsFrom April 2011 to March 2014, 24,868 patients completed a survey which was successfully linked to the corresponding inpatient record. The cohort had a mean age of 52.8±19.8 years of age (range=18-100), and was predominantly female (65.4%). 18.6% of patients (n=4,620) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. Patients who felt that they were not involved in their care decisions were more likely to be readmitted (OR=1.79; 95%CI: 1.59-2.01), as were patients who did not receive written information at discharge (OR=1.96; 95%CI: 1.83-2.11). Odds of unplanned readmissions did not differ according to understanding of medications (OR=1.08; 95%CI: 0.90-1.30), understanding responsibility for one’s health (OR=1.02; 95%CI: 0.86-1.20), or discussion of help needed when returning home (OR=1.03; 95%CI: 0.93-1.14). ConclusionOur results demonstrate that a lack of patient involvement in their care and not receiving written information at discharge is associated with increased unplanned readmission rate up to one-year post-discharge. This present study provides an example of how patient-reported measures may be linked to individual-level administrative data to drive healthcare improvements. Future research examining patient-reported hospital experience and other health system measures is warranted.

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