Clinical outcomes and the impact of prior oral anticoagulant use in patients with coronavirus disease 2019 admitted to hospitals in the UK — a multicentre observational study

Purpose: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. Design: Observational pre–post study and randomized controlled trial (RCT). Setting: Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. Participants: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. Intervention: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. Measures: (1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. Analysis: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. Results: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. Conclusion: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.

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The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: An observational study based on clinical practice

Arthritis & Rheumatism ◽

10.1002/art.21545 ◽

2005 ◽

Vol 54 (1) ◽

pp. 177-183 ◽

Cited By ~ 116

Author(s):

Gwenda Hughes ◽

Carlos Martinez ◽

Eric Myon ◽

Charles Taïeb ◽

Simon Wessely

Keyword(s):

Primary Care ◽

Health Care ◽

Clinical Practice ◽

Observational Study ◽

Resource Use ◽

Health Care Resource ◽

Primary Care Patients ◽

Health Care Resource Use ◽

The Uk ◽

The Impact

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Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

10.1101/2020.12.21.20248153 ◽

2020 ◽

Author(s):

Emma Vestesson ◽

Carlos Alonso ◽

John Booth ◽

Neil J Sebire ◽

Adam Steventon ◽

...

Keyword(s):

Observational Study ◽

Paediatric Hospital ◽

Children's Hospital ◽

Overnight Stay ◽

Specialist Services ◽

Hospital Bed ◽

Children’S Hospital ◽

Patient Groups ◽

The Uk ◽

The Impact

AbstractObjectiveTo compare hospital activity, patient casemix and medication prescribing and administration before and during the COVID-19 emergency.DesignRetrospective observational studySettingA specialist children’s hospital in the UKPatientsInpatients aged 25 and younger treated at a specialist children’s hospital between 29 April 2019 and 6 September 2020ResultsThere were 21,471 day cases and inpatients treated during the 16 month study period. Day cases (no overnight stay) dropped by around 37% per week. Both admissions and discharges for inpatients (at least one overnight stay) decreased leading to a small reduction in hospital bed days but no reduction in hospital bed nights. The effect on hospital activity on different patient groups varied substantially with some groups such as medical oncology day cases increasing by 13%. As a result, the patient case mix in the hospital was very different during the pandemic. Overall weekly medication administrations decreased for day cases and inpatients, but weekly medication administrations per bed day increased by 10% for day cases and 6% for inpatients.ConclusionsDespite not being badly affected by the disease itself, specialist paediatric hospital services have been greatly affected by the pandemic. The average number of medications per inpatient bed day increased, likely reflecting changes to the patient population, with only those children with severe conditions being treated during the pandemic. These data demonstrate the complex pattern of implications on specialist services and provide evidence for planning the impact of future emergencies and resolution strategies.

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Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

10.21203/rs.3.rs-60119/v1 ◽

2020 ◽

Author(s):

Manish Sinha ◽

Prakash Saha ◽

Melhem Nabil ◽

Nicos Kessaris ◽

Lukla Biasi ◽

...

Keyword(s):

Critical Care ◽

Clinical Outcomes ◽

Vascular Access ◽

Online Survey ◽

High Rate ◽

Minor Bleeding ◽

Complication Rates ◽

Support Team ◽

The Uk ◽

The Impact

Abstract Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey.Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs.Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

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Interartery discordance in fetuses with growth restriction

Prenatal Cardiology ◽

10.1515/pcard-2018-0006 ◽

2018 ◽

Vol 8 (1) ◽

pp. 42-47

Author(s):

A. Dhanya Mackeen ◽

John W. Ross ◽

Alexandria Betz ◽

Wen Feng ◽

Jay J. Bringman ◽

...

Keyword(s):

Observational Study ◽

Clinical Outcomes ◽

Prospective Observational Study ◽

Umbilical Artery ◽

Growth Restriction ◽

Doppler Velocimetry ◽

Umbilical Artery Doppler ◽

The Individual ◽

Umbilical Arteries ◽

The Impact

Abstract OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.

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