Paediatric outcomes and timing of admission

Studies of adult patients have demonstrated that weekend admissions compared with weekday admissions had a significantly higher hospital mortality rate. We have reviewed the literature to determine if the timing of admission, for example, weekend or weekday, influenced mortality and morbidity in children. Seventeen studies reported the effect of timing of admission on mortality, and only four studies demonstrated an increase in those admitted at the weekend. Meta-analysis of the results of 15 of the studies demonstrated there was no significant weekend effect. There was, however, considerable heterogeneity in the studies. There were two large UK studies: one reported an increased mortality only for planned weekend admissions likely explained by planned admissions for complex conditions and the other showed no significant weekend effect. Two studies, one of which was large (n=2913), reported more surgical complications in infants undergoing weekend oesophageal atresia and trachea-oesophageal repair. Medication errors have also been reported to be more common at weekends. Five studies reported the effect of length of stay, meta-analysis demonstrated a significantly increased length of stay following a weekend admission, the mean difference was approximately 1 day. Those data, however, should be interpreted with the caveat that there was no adjustment in all of the studies for differences in disease severity. We conclude that weekend admission overall does not increase mortality but may be associated with a longer length of stay and, in certain conditions, with greater morbidity.

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Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.353 ◽

2020 ◽

Vol 41 (3) ◽

pp. 342-354 ◽

Cited By ~ 1

Author(s):

Sofia Karagiannidou ◽

Christos Triantafyllou ◽

Theoklis E. Zaoutis ◽

Vassiliki Papaevangelou ◽

Nikolaos Maniadakis ◽

...

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Length Of Stay ◽

Healthcare Cost ◽

Meta Analysis ◽

Random Effect ◽

Bloodstream Infections ◽

Attributable Mortality ◽

Study Selection ◽

Critical Appraisal Skills

AbstractObjective:To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs).Design:A systematic review and meta-analysis.Methods:A systematic search (January 2000–September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case–control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated.Results:In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70–20.11) and the pooled attributable mortality rate was 8% (95% CI, 6–9). A meta-analysis was not conducted for cost due to lack of eligible studies.Conclusions:Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.

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Normalization of mortality rate and life expectancy in schizophrenia: Challenges and options

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1559 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s805-s806

Author(s):

D. Cohen

Keyword(s):

Health Care ◽

Mortality Rate ◽

Life Expectancy ◽

Meta Analysis ◽

The Other ◽

Ultra High Risk ◽

High Risk Populations ◽

Competing Interest ◽

Neuro Imaging

Studies of mortality-rates and life expectancy in schizophrenia have consistently shown that the standardized mortality rate (SMR) are raised compared to the general population. In a meta-analysis (2007) of 38 studies with 22,296 deaths, all cause SMR was 2.98. SMR in a French cohort study (2009) in 3470 patients with schizophrenia, were 3.6 for men and 4.3 for women. A recent epidemiological study (2015) of a US-cohort of 1,138,853 individuals with schizophrenia, 4,807,121 million years of follow-up and 74,003 deaths, all cause SMR was 3.7 for the total population: 3.3 for men and 4.3 for women. Life expectancy, the other side of the coin of increased SMR, in this study was reduced with 28.5 years. Studies in life expectancy, the other side of the coin of increased SMR, show a substantial, if not alarming reduced life expectancy. Israel with 12.5 years and Denmark–15 years for women and 20 years for men – reported the lowest reduction in life expectancy, while Arizona reported the highest reduction of 32 years. Progress in such diverse fields as genetics, neuro-imaging, early diagnosis of (ultra) high-risk populations, CBT and rehabilitation treatment, has not improved schizophrenia SMR or life expectancy. On the contrary, in far a trend is visible, the situation tends to worsen, not to improve. After going through the barriers for optimal somatic care, both patient and health care related, we will discuss options for improvement of the level of somatic health care, at the preventive and therapeutic level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Influence of Egg Characteristics on Survival, Growth and Feeding in Larval Walleye (Stizostedion vitreum)

Canadian Journal of Fisheries and Aquatic Sciences ◽

10.1139/f89-069 ◽

1989 ◽

Vol 46 (3) ◽

pp. 516-521 ◽

Cited By ~ 64

Author(s):

G. E. E. Moodie ◽

N. L. Loadman ◽

M. D. Wiegand ◽

J. A. Mathias

Keyword(s):

Fatty Acids ◽

Mortality Rate ◽

Growth Rates ◽

Egg Size ◽

The Other ◽

Stizostedion Vitreum ◽

Mean Size ◽

Survival And Growth ◽

The Mean ◽

High Level

A subsample of eggs from 109 walleye (Stizostedion vitreum) from Crean Lake, Saskatchewan, was sieved soon after fertilization to yield four groups of eggs ranging in size from 4.86 to 5.62 mm3. Overall egg size tended to correspond to yolk and oil volumes. At hatching, larvae from the eggs with the least yolk and oil were significantly shorter than larvae from all other egg groups. At the end of the experiment, 13 d after hatching, the larvae from the eggs with the most yolk were significantly larger than larvae from the other egg groups. Differences in the mean amount of food ingested by larvae were related to initial egg size. The yolk of the smallest eggs was deficient in the (n-3) series of polyunsaturated fatty acids. Larvae from these small eggs had a high level of major body deformities and a mortality rate which reached 100% by day 10. Small egg size in itself did not appear disadvantageous; larvae from a different stock (Lake of the Prairies, Manitoba) which produced eggs with a mean size less than that of the smallest sieved eggs, had survival and growth rates comparable with those of the larger Crean Lake eggs.

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Determinants of Prolonged Length of Stay among Patients with Road Traffic Injury at the Philippine General Hospital: A Retrospective Cohort Study

Acta Medica Philippina ◽

10.47895/amp.v55i6.3241 ◽

2021 ◽

Vol 55 (6) ◽

Author(s):

Jinky Leilanie Lu ◽

Teodoro J. Herbosa ◽

Sophia Francesca D. Lu

Keyword(s):

Length Of Stay ◽

General Hospital ◽

Road Traffic ◽

Length Of Hospital Stay ◽

First Aid ◽

Road Traffic Injury ◽

The Other ◽

Prolonged Length ◽

Traffic Injury ◽

The Mean

Introduction. Road traffic injuries are among the leading causes of preventable death, claiming around 7000 lives every year. Furthermore, road traffic can injure or disable thousands more every year in the Philippines. Objectives. This study determined the hospital length-of-stay patterns and risk factors for a prolonged length of stay in a tertiary hospital after road traffic injury. Methods. A retrospective cohort study was conducted to determine the determinants of the length of stay in the Philippine General Hospital (PGH) among road traffic injury victims for the year 2016. Length of stay was recorded according to the median. The other variables were cross-tabulated against the length of stay, and each of their crude odds ratios along with corresponding p-values were presented. Continuous variables were analyzed using Wilcoxon Mann-Whitney U-test. The predictor model for the determinants of prolonged length of stay in the hospital was built using forward selection. Likelihood-ratio test was used to compare the model with and without the exposure variable. Results. A total of 427 road traffic injury victims were admitted to the Philippine General Hospital in 2016. The mean age of the patients was 31.55 years (±14.97) with a median age of 29 years. The majority of patients were males (82.4%) and single (60.8%). Most patients were riding a motorcycle during the time of the accident (64.2%) while 20% were pedestrians. The majority of the victims were intoxicated (74.3%) and were not using helmets (57.1%) at the time of the accident. Most of the victims received first aid (69.2%) and the mean time of admission was 3.03 (±13.31) days while the median time to admission was 12 hours. Receiving first aid (p<0.01), availed services (p<0.01), and married civil status (p=0.04) were found to be strongly associated with length of hospital stay. Without controlling for any confounders, pay patients (OR = 3.46, 95% CI: 1.3, -9.87), elective patients (OR = 7.88, 95% CI: 2.64, 31.61), and those in non-trauma wards (OR=2.07, 95% CI: 1.29, 3.36) had higher odds for longer hospitalization stay. On the other hand, those who did not receive first aid (OR = 0.55, CI:0.35, 0.85) had lower odds for prolonged hospitalization. Those who suffered face injury and did not suffer external injuries had a higher mean rank, suggesting a longer length of hospital stay. On the other hand, upon controlling variables found to be associated with previous studies, those with low Glasgow coma scale (GCS) scores were 2.77 times (95% CI: 1.13, 6.91) more likely to stay longer in the hospital. Conclusion. The type of victim, mortality status, age, and sex were found to be important determinants of prolonged hospitalization. To lessen the number of fatalities and road trauma injuries, laws on road safety should be strictly and properly implemented. Shared responsibility of all road users is also important in improving the safe usage of roads.

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Comparison of the effectiveness of captopril and olmesartan in hypertensive patients

10.51271/kmj-0024 ◽

2021 ◽

pp. 97-100

Keyword(s):

Blood Pressure ◽

Emergency Services ◽

Rest Period ◽

Organ Damage ◽

The Other ◽

Pressure Measurements ◽

Hypertensive Patients ◽

Mortality And Morbidity ◽

The Mean ◽

The Difference

Purpose: Hypertensive conditions are situations that require immediate intervention in emergency services. Captopril is one of the most commonly used drugs in patients presenting to emergency departments with high blood pressure. In this study; we aimed to find an answer to the question of whether orally administered olmesartan could be an alternative to captopril in urgent hypertensive situations. Material and Method: In this study, blood pressure measurements were made after a 5-minute rest period in patients who presented to the emergency department of our hospital with the diagnosis of hypertension. Patients with a blood pressure of 180/100 mmHg and above and no signs of end-organ damage were followed up. Forty patients were given sublingual captopril 25 mg, and the other 40 patients were given 40 mg of olmesartan, and they were allowed to swallow the drug with some water. Afterward, the patients were followed for 3 hours (with blood pressure and pulse measurements), and their blood pressure was measured and recorded at five-minute intervals. Results: The mean age of the patients receiving captopril was 60.70±11.43 years, and the mean age of the patients receiving olmesartan was 57.02±13.86 years. Of the patients receiving captopril, 19 (57.5%) were male, 21 (52.5%) were female, 17 (42.5%) of the patients receiving olmesartan were male and 23 (57.5%) were female. In this study, patients treated with captopril and olmesartan were monitored for 3 hours and the differences between them in pulse and blood pressure measurements were evaluated. When the systolic blood pressures were compared, the difference at the tenth minute was significant, but the difference between the other minutes was not significant. Differences in diastolic blood pressure and heart rate were not significant. Conclusion: Oral administration of olmesartan in emergency hypertensive patients may be an alternative to captopril due to its effectiveness in reducing mortality and morbidity.

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The Contingent Negative Variation in Antisocial Behaviour: a Pilot Study of Broadmoor Patients

The British Journal of Psychiatry ◽

10.1192/bjp.132.4.368 ◽

1978 ◽

Vol 132 (4) ◽

pp. 368-377 ◽

Cited By ~ 10

Author(s):

G. W. Fenton ◽

P. B. C. Fenwick ◽

W. Ferguson ◽

C. T. Lam

Keyword(s):

Pilot Study ◽

Length Of Stay ◽

Contingent Negative Variation ◽

Antisocial Behaviour ◽

Response Variability ◽

The Other ◽

Initial Development ◽

The Mean ◽

Mmpi Profile ◽

Age And Sex

Using a classical click/flash paradigm, the CNV was recorded from the following three groups of subjects at Broadmoor Hospital: (1) 14 ‘psychopathic’ patients selected by use of the 4/9 MMPI profile and confirmed by independent clinical diagnosis; (2) 15 ‘non psychopathic’ patients, all psychotic and mainly schizophrenic; (3) 14 healthy staff control subjects. All three groups were matched for age and sex; the two patients groups were also matched for length of stay. Two series of 32 paired stimuli were used, separated by an interval of 30 minutes. The mean CNV voltage was significantly lower in the ‘non-psychopathic’ patients. The amplitude of the ‘psychopath's' CNV response did not differ significantly from that of the staff controls, but the response variability between the first and second series of trials was much greater in the ‘psychopathic’ patients than in the other two subject groups. The ‘psychopathic’ subjects tended to show more rapid initial development of the CNV.

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295 Characteristics of Older Hip Fracture Adults Admitted to a Dublin Hospital

Age and Ageing ◽

10.1093/ageing/afz103.187 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Niamh Maher ◽

Georgina Steen ◽

Nessa Fallon ◽

Claire O Carroll ◽

Máire Rafferty ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Length Of Stay ◽

Hip Fractures ◽

Average Length ◽

Dublin Hospital ◽

Fracture Repair ◽

Mortality And Morbidity ◽

Negative Effect ◽

Bone Protection

Abstract Background Hip fractures are common in older adults and are associated with increased mortality and morbidity resulting in medical and socioeconomic burden for healthcare system and patient alike. Methods A retrospective study was conducted on patients admitted to a Dublin hospital for hip fracture repair between October 2018 and February 2019. Data on sociodemographic characteristics such as; gender; age; pre-admission residence; fracture history; bone protection medication use; pre-fracture mobility; discharge mobility and destination; length of stay and mortality rate was collected. Results 50 patients admitted between 01/10/19 and 31/01/2019. 2:1 female to male. Average age 78 ranging from 48-93. 88% admitted from home. 44% had previous fractures. Vertebral (36%), wrist (23%) and pelvic (23%) most common fractures. 27% of these were on bone protection medication on admission. 41% were taking Calcium and Vit D or Vitamin D only. 70% of participants were independently mobile pre-fracture. 94% required some form of mobility aid on discharge. The average length of stay was 32 days ranging from 2 to 160 days. 38% went home whilst 36% were discharged to rehabilitation. 88% were discharged on bone protection medication - 70% received IV Zoledronic acid as inpatients, 14% commenced Prolia 6 monthly injections and 4% on oral bisphosphonates. Mortality rate was 6% Conclusion Hip fractures have a negative effect on a person’s mobility. Whilst many guidelines for the assessment and treatment of osteoporosis recommend intervention be considered in men and women who have sustained a fragility fracture, it is clear from this study that an osteoporosis care gap exists and further work is required to better identify, assess and treat patients following their first fracture in the hope of reducing further fractures, particularly hip and vertebral fractures.

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Benefits of probiotics in preterm neonates in low-income and medium-income countries: a systematic review of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2017-017638 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017638 ◽

Cited By ~ 31

Author(s):

Girish Deshpande ◽

Gayatri Jape ◽

Shripada Rao ◽

Sanjay Patole

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Low Income ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Preterm Neonates ◽

Controlled Trials ◽

Cochrane Central Register ◽

Mortality And Morbidity ◽

Randomised Controlled

ObjectiveAlthough there is an overall reduction in underfive mortality rate, the progress in reducing neonatal mortality rate has been very slow. Over the last 20 years, preterm births have steadily increased in low-income and medium-income countries (LMICs) particularly in sub-Saharan Africa and South Asia. Preterm birth is associated with increased mortality and morbidity, particularly in LMICs. Based on systematic reviews of randomised controlled trials (RCTs), many neonatal units in high-income countries have adopted probiotics as standard of care for preterm neonates. We aimed to systematically review the safety and efficacy of probiotics in reducing mortality and morbidity in preterm neonates in LMICs.DesignSystematic review and meta-analysis of RCTs.Data sourcesMedline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and E-abstracts from Pediatric Academic Society meetings and other paediatric and neonatal conference proceedings were searched in January 2017.Eligibility criteriaRCTs comparing probiotics versus placebo/no probiotic in preterm neonates (gestation<37 weeks) conducted in LMICs.ResultsTotal 23 (n=4783) RCTs from 4 continents and 10 LMICs were eligible for inclusion in the meta-analysis using fixed effect model. The risk of necrotising enterocolitis (NEC greater than or equal to stage II) (risk ratio (RR) 0.46 (95% CI 0.34 to 0.61), P<0.00001, numbers needed to treat (NNT) 25 (95% CI 20 to 50)), late-onset sepsis (LOS) (RR 0.80 (95% CI 0.71 to 0.91), P=0.0009, NNT 25 (95% CI 17 to 100)) and all-cause mortality (RR 0.73 (95% CI 0.59 to 0.90), P=0.003, NNT 50 (95% CI 25 to 100)) were significantly lower in probiotic supplemented neonates. The results were significant on random effects model analysis and after excluding studies with high risk of bias. No significant adverse effects were reported.ConclusionProbiotics have significant potential to reduce mortality and morbidity (eg, NEC, LOS) in preterm neonates in LMICs.

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Staphylococcus aureus

Microbiology Australia ◽

10.1071/ma08113 ◽

2008 ◽

Vol 29 (3) ◽

pp. 113

Author(s):

Graeme Nimmo ◽

Geoffrey W Coombs

Keyword(s):

Staphylococcus Aureus ◽

Mortality Rate ◽

Lower Respiratory Tract ◽

Meta Analysis ◽

Healthcare Setting ◽

Blood Stream ◽

Soft Tissue Infections ◽

Blood Stream Infections ◽

Invasive Infections ◽

The Mean

Staphylococcus aureus is one of the major bacterial pathogens of man, causing a variety of diseases from mild skin and soft-tissue infections to severe invasive infections with high mortality. In the healthcare setting it is the most frequent cause of surgical site, lower respiratory tract and cardiovascular infections and the second most common cause of blood stream infections and pneumonia. The ability of S. aureus to develop resistance to all classes of antimicrobials, in particular the �-lactams, has become a major global problem. In the pre-antibiotic era, the mortality rate for severe staphylococcal sepsis was as high as 90%. In a recent meta-analysis of nine studies of S. aureus bacteraemia in the antibiotic era, although the mean mortality rate due to methicillin-susceptible S. aureus (MSSA) was 12% (ranging from 0 to 38%), for methicillin-resistant S. aureus (MRSA) the mean was 29% (ranging from 8 to 50%). Whilst estimates vary, the mortality associated with MRSA is on average twice that with MSSA.

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Local or general anesthesia for TAVI surgery? An updated systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.1670 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D R Cheng

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Length Of Stay ◽

Cohort Studies ◽

Meta Analysis ◽

Hospital Length ◽

Cardiovascular Drugs ◽

Hospital Length Of Stay ◽

Procedure Time ◽

Procedural Success

Abstract Background The choice of anesthesia for transcatheter aortic valve implantation (TAVI) is still under controversial. This systematic review and meta-analysis was performed to evaluate the safety of local anesthesia (LA) with or without conscious sedation (CS) and general anesthesia (GA) for the TAVI-procedure. Methods This meta-analysis is registered with PROSPERO (CRD42021221777). We searched OVID, PUBMED, EMBASE, Web of Science databases to collect all the related studies published from January 1, 2002 to December 31, 2020. The primary outcome measures were hospital length of stay, operation time, 30-day mortality, use of cardiovascular drugs, permanent pacemaker (PPM) implantation rate, stroke rate, the incidence of myocardial infarction (MI), incidence of acute kidney injury (AKI), major bleeding (MB) rate, rate of procedural success. Results A total of 33 studies (3 RCT studies, 23 retrospective cohort studies, 4 prospective cohort studies, 3 case-control studies) including 23244 patients were analyzed. There were no significant statistically differences between LA and GA with respect to PPM [OR=0.99, 95% CI (0.88, 1.11), P=0.88], shock [OR=0.91, 95% CI (0.69, 1.21), P=0.52], MI [OR=0.89, 95% CI (0.52, 1.53), P=0.68], AKI [OR=1.26, 95% CI (0.99, 1.62), P=0.06], rate of procedural success [OR=0.66, 95% CI (0.43, 1.03), P=0.06]. However, compared to GA, LA for TAVI was associated with a significantly shorter hospital length of stay [WMD=−2.45, 95% CI (−2.77, −2.13), P<0.ehab724.16701], a reduction in procedure time [WMD=−12.32, 95% CI (−13.78, −10.87), P<0.ehab724.16701], a reduction in using of cardiovascular drugs [OR=0.52, 95% CI (0.35, 0.78), P=0.002] and in MB [OR=0.59, 95% CI (0.46, 0.75), P<0.0001], reduced 30-day mortality rate [OR=1.19, 95% CI (1.00, 1.42), P=0.05]. Conclusion This Systematic review and meta-analysis showed that compared to GA, LA for TAVI can reduce hospital length of stay, procedure time, 30-day mortality rate, use of cardiovascular drugs, and MB rate, but no significant differences in PPM, shock, MI, AKI, and the rate of procedural success. FUNDunding Acknowledgement Type of funding sources: None.

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