Impact of vaccination by priority group on UK deaths, hospital admissions and intensive care admissions from COVID‐19

Background: After 5 years since the registration of rifaximin-α as a secondary prophylaxis for overt hepatic encephalopathy (HE) in the Netherlands, we aimed to evaluate the use of hospital resources and safety of rifaximin-α treatment in a real-world setting. Methods: We carried out prospective identification of all patients using rifaximin-α for overt HE. We assessed hospital resource use, bacterial infections, and adverse events during 6-month episodes before and after rifaximin-α initiation. Results: During 26 months we included 127 patients [71.7% male; median age 60.8 years (interquartile range: 56.2–66.1); median model for end-stage liver disease (MELD) score 15.0 (interquartile range: 12.1–20.4); 98% using lactulose treatment]. When comparing the first 6 months after rifaximin-α initiation with the prior 6 months, HE-related hospital admissions decreased (0.86 to 0.41 admissions/patient; p < 0.001), as well as the mean length of stay (8.85 to 3.79 bed days/admission; p < 0.001). No significant differences were found regarding HE-related intensive care unit admissions (0.09 to 0.06 admission/patient; p = 0.253), stay on the intensive care unit (0.43 to 0.57 bed days/admission; p = 0.661), emergency department visits (0.66 to 0.51 visits/patient; p = 0.220), outpatient clinic visits (2.49 to 3.30 bed visits/patient; p = 0.240), or bacterial infections (0.41 to 0.35 infections/patient; p = 0.523). Adverse events were recorded in 2.4% of patients. Conclusions: The addition of rifaximin-α to lactulose treatment was associated with a significant reduction in the number and length of HE-related hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.

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Prototype of a computerized scale for the active search for potential organ donors

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1936.2930 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 1

Author(s):

Érika Fernanda dos Santos Bezerra Ludwig ◽

Marta Cristiane Alves Pereira ◽

Yolanda Dora Évora Martinez ◽

Karina Dal Sasso Mendes ◽

Mariana Angela Rossaneis

Keyword(s):

Intensive Care ◽

Medical Records ◽

Hospital Admissions ◽

Tertiary Hospital ◽

Wilcoxon Test ◽

Organ Donors ◽

Cardiorespiratory Arrest ◽

Active Search ◽

Death Cases ◽

Severity Indexes

ABSTRACT Objective: to develop a prototype of a computerized scale for the active search for potential organ and tissue donors. Method: methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model. Results: 34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes. Conclusion: the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death.

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Validation of automated sepsis surveillance based on the Sepsis-3 clinical criteria against physician record review in a general hospital population: observational study using electronic health records data

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010123 ◽

2020 ◽

Vol 29 (9) ◽

pp. 735-745 ◽

Cited By ~ 4

Author(s):

John Karlsson Valik ◽

Logan Ward ◽

Hideyuki Tanushi ◽

Kajsa Müllersdorf ◽

Anders Ternhag ◽

...

Keyword(s):

Intensive Care ◽

Medical Record ◽

Predictive Value ◽

Hospital Admissions ◽

Medical Record Review ◽

Suspected Infection ◽

Clinical Criteria ◽

Physician Review ◽

Electronic Health ◽

Record Review

BackgroundSurveillance of sepsis incidence is important for directing resources and evaluating quality-of-care interventions. The aim was to develop and validate a fully-automated Sepsis-3 based surveillance system in non-intensive care wards using electronic health record (EHR) data, and demonstrate utility by determining the burden of hospital-onset sepsis and variations between wards.MethodsA rule-based algorithm was developed using EHR data from a cohort of all adult patients admitted at an academic centre between July 2012 and December 2013. Time in intensive care units was censored. To validate algorithm performance, a stratified random sample of 1000 hospital admissions (674 with and 326 without suspected infection) was classified according to the Sepsis-3 clinical criteria (suspected infection defined as having any culture taken and at least two doses of antimicrobials administered, and an increase in Sequential Organ Failure Assessment (SOFA) score by >2 points) and the likelihood of infection by physician medical record review.ResultsIn total 82 653 hospital admissions were included. The Sepsis-3 clinical criteria determined by physician review were met in 343 of 1000 episodes. Among them, 313 (91%) had possible, probable or definite infection. Based on this reference, the algorithm achieved sensitivity 0.887 (95% CI: 0.799 to 0.964), specificity 0.985 (95% CI: 0.978 to 0.991), positive predictive value 0.881 (95% CI: 0.833 to 0.926) and negative predictive value 0.986 (95% CI: 0.973 to 0.996). When applied to the total cohort taking into account the sampling proportions of those with and without suspected infection, the algorithm identified 8599 (10.4%) sepsis episodes. The burden of hospital-onset sepsis (>48 hour after admission) and related in-hospital mortality varied between wards.ConclusionsA fully-automated Sepsis-3 based surveillance algorithm using EHR data performed well compared with physician medical record review in non-intensive care wards, and exposed variations in hospital-onset sepsis incidence between wards.

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Predicting the course of Covid-19 and other epidemic and endemic disease

10.1101/2021.12.26.21268419 ◽

2021 ◽

Author(s):

Ana Cascon ◽

William F Shadwick

Keyword(s):

Intensive Care ◽

Predictive Power ◽

Respiratory Virus ◽

Linear Growth ◽

Hospital Admissions ◽

Reproduction Number ◽

Value Theory ◽

Gompertz Function ◽

Peak Loads ◽

Spanish Flu

The Gompertz Function is an accurate model for epidemics from Cholera in 1853 to Spanish Flu in 1918 and Ebola in 2014. It also describes the acute phase of annual outbreaks of endemic influenza and in all of these instances it has significant predictive power. For Covid-19, we show that the Gompertz Function provides accurate forecasts not just for cases and deaths but, independently, for hospitalisations, intensive care admissions and other medical requirements. In particular Gompertz Function projections of healthcare requirements have been reliable enough to allow planning for: hospital admissions,intensive care admissions,ventilator usage, peak loads and duration. Analysis of data from the Spanish Flu pandemic and the endemic influenza cycle reveals alternating periods of Gompertz Function growth and linear growth in cumulative cases or deaths. Linear growth means the Reproduction Number is equal to 1 which in turn indicates endemicity. The same pattern has been observed with Covid-19. All the initial outbreaks ended in linear growth. Each new outbreak has been preceded by a period of linear growth and has ended with a transition from Gompertz Function growth to linear growth. This suggests that each of these outbreak cycles ended with a transition to endemicity for the current dominant strain and that the normal seasonal respiratory virus periods will continue to see new outbreaks. It remains to be seen if widespread vaccination will disrupt this cyclicality. Because both Gompertz Function Growth and linear growth are accurately predictable, the forecasting problem is reduced to identifying the transition between these modes and to improving the performance in the early Gompertz Function growth phase where its predictive power is lowest. The dynamics of the Gompertz Function are determined by the Gumbel probability distribution. This is an exceptional distribution with respect to the geometry determined by the affine group on the line which is the key to the Gumbel distribution's role as an Extreme Value Theory attractor. We show that this, together with the empirically observed asymmetry in epidemic data, makes the Gompertz Function growth essentially inevitable in epidemic models which agree with observations.

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Title High Flow Nasal cannula oxygen therapy in a general pediatric (non-intensive care) setting

10.21203/rs.2.17416/v1 ◽

2019 ◽

Author(s):

Louise Kooiman ◽

Roelien Reimink ◽

Veerle Langenhorst ◽

Paul Brand ◽

Jolita Bekhof

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Treatment Failure ◽

Hospital Admissions ◽

Work Of Breathing ◽

High Flow ◽

Nasal Cannula ◽

Early Warning Score ◽

High Flow Nasal Cannula ◽

Vital Functions

Abstract Background: High flow nasal cannula therapy (HFNC) is being used increasingly for oxygen delivery in children with impending respiratory failure, however solid evidence of its effectiveness is sparse. Moreover, data on safety regarding its use outside of the Pediatric Intensive Care Unit (PICU), with flowrates exceeding 1 L/kg is lacking. Methods: Retrospective chart review at the pediatric ward of Isala, a general teaching hospital in Zwolle, The Netherlands, 100 km away from the nearest PICU. All children <18 years with impending respiratory failure treated with HFNC between January 2015 and May 2016 were included. A flowrate of 2 L/kg/minute for the first 10 kg was used; with 0.5 L/kg for every kg >10 kg and a maximum of 50 L/min. A pediatric early warning score (PEWS) comprising vital functions and work of breathing (0-28 points) was used to assess severity of respiratory distress. Treatment failure was defined as referral to the PICU. Results: In the 16-month study period HFNC was used during 41 hospital admissions in 39 patients (64.1% male), median age 6.3 months (interquartile range, IQR 3–20.6). Median (IQR) PEWS at the start of HFNC was 8.5 (7–10). Patients were diagnosed with bronchiolitis (70.7%), pneumonia (24.4%) or asthma (4.9%). In 18 cases (43.9%) HFNC failed, with referral to a PICU. No clinical variables (age, comorbidity, PEWS at admission or start of HFNC) nor improvement of the PEWS after 2 hours of HFNC were associated with treatment failure. We found no association between treatment failure and the start of HFNC at an earlier stage or at lower PEWS (odds ratio 1.03; 95% confidence interval 0.82-1.30; p=0.80). There were no safety issues, no cases with air leak or other complications. Conclusions: This small study suggests that HFNC can be safely used and initiated in a general pediatric department. We were unable to find clinical factors that predicted HFNC success. We recommend not to restrict evaluation of the effect of HFNC in studies to short-term (2 hours), but also after longer duration, at least 24 hours.

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Important to Emergency Medicine, Medical Intensive Care and Anesthesiology Trends in Hospital Admissions Due to Poisonings by Antiepileptic, Sedative-Hypnotic and Anti-Parkinsonism Drugs (T42 ICD-10) in the Lower Silesia Region of Poland in the Years 2006-2012

ARC Journal of Anesthesiology ◽

10.20431/2455-9792.0102004 ◽

2016 ◽

Vol 1 (2) ◽

Keyword(s):

Emergency Medicine ◽

Intensive Care ◽

Hospital Admissions ◽

Icd 10 ◽

Medical Intensive Care ◽

Lower Silesia

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Moped Injuries in Children

PEDIATRICS ◽

10.1542/peds.74.5.820 ◽

1984 ◽

Vol 74 (5) ◽

pp. 820-822 ◽

Cited By ~ 1

Author(s):

Judith A. Westman ◽

Grant Morrow

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Admissions ◽

Average Length ◽

Orthopaedic Injuries ◽

Length Of Hospitalization

Moped injuries are an important cause of traffic-related injuries in children. An attempt was made to define the epidemiology as well as the nature and severity of injuries sustained in 88 moped-related accidents. Bicycle injuries among children (579) were used as a control. The patients with moped injuries were younger than expected (mean 12.8 years with a minimum legal driving age of 14 years in the study area). Among 26 hospital admissions due to moped accidents, there were 11 admissions to the intensive care unit, demonstrating the severe nature of the injuries. Fifty percent of the patients had orthopaedic injuries and 46% had neurologic injuries. These injuries resulted in an average length of hospitalization of 8.5 days (intensive care unit admissions lasted an average of 14.6 days). Recommendations are made to aid pediatricians in the counseling of patients and parents.

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Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2017-017661 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017661 ◽

Cited By ~ 16

Author(s):

Hannah E Carter ◽

Sarah Winch ◽

Adrian G Barnett ◽

Malcolm Parker ◽

Cindy Gallois ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Health System ◽

End Of Life ◽

Hospital Admissions ◽

Multicentre Cohort Study ◽

Futile Treatment ◽

Tertiary Hospitals ◽

Bed Days ◽

Multicentre Cohort

ObjectivesTo estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions.DesignRetrospective multicentre cohort study involving a clinical audit of hospital admissions.SettingThree Australian public-sector tertiary hospitals.ParticipantsAdult patients who died while admitted to one of the study hospitals over a 6-month period in 2012.Main outcome measuresIncidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment.ResultsThe incidence rate of futile treatment in end-of-life admissions was 12.1% across the three study hospitals (range 6.0%–19.6%). For admissions involving futile treatment, the mean length of stay following the onset of futile treatment was 15 days, with 5.25 of these days in the intensive care unit. The cost associated with futile bed days was estimated to be $AA12.4 million for the three study hospitals using health system costs, and $A988 000 when using a decision maker’s willingness to pay for bed days. This was extrapolated to an annual national health system cost of $A153.1 million and a decision maker’s willingness to pay of $A12.3 million.ConclusionsThe incidence rate and cost of futile treatment in end-of-life admissions varied between hospitals. The overall impact was substantial in terms of both the bed days and cost incurred. An increased awareness of these economic costs may generate support for interventions designed to reduce futile treatments. We did not include emotional hardship or pain and suffering, which represent additional costs.

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Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

BMJ ◽

10.1136/bmj.m3582 ◽

2020 ◽

pp. m3582 ◽

Cited By ~ 9

Author(s):

Anoop S V Shah ◽

Rachael Wood ◽

Ciara Gribben ◽

David Caldwell ◽

Jennifer Bishop ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

General Population ◽

Hospital Admission ◽

Healthcare Workers ◽

Hospital Admissions ◽

Absolute Risk ◽

Hazard Ratio ◽

Front Door ◽

Household Members

AbstractObjectiveTo assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.DesignNationwide linkage cohort study.SettingScotland, UK, 1 March to 6 June 2020.ParticipantsHealthcare workers aged 18-65 years, their households, and other members of the general population.Main outcome measureAdmission to hospital with covid-19.ResultsThe cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.ConclusionsHealthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

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