scholarly journals Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case–control study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026771 ◽  
Author(s):  
Pei-Ju Liao ◽  
Chien-Tai Mao ◽  
Tun-Liang Chen ◽  
Shin-Tarng Deng ◽  
Kuang-Hung Hsu
Keyword(s):  
Length Of Stay ◽  
Poor Prognosis ◽  
Case Control Study ◽  
Case Control ◽  
Psychoactive Drugs ◽  
Medical Expenses ◽  
Factors Associated ◽  
Older Inpatients ◽  
Nested Case Control ◽  
Control Study

ObjectiveOlder patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients.DesignA nested case–control study.SettingA medical centre located in north Taiwan.Participants539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected.ExposurePolypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses.Primary and secondary outcome measuresADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes.ResultsThe admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively.ConclusionsThe number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care.

scholarly journals Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case–control study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001867
Author(s):  
Hao-Guang Li ◽  
Dan-Min Wang ◽  
Feng-Cai Shen ◽  
Shu-Xin Huang ◽  
Zhi-Duo Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Axial Spondyloarthritis ◽  
Disease Onset ◽  
Case Control ◽  
Buttock Pain ◽  
Juvenile Onset ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectiveTo evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS).MethodsA nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS.ResultsOverall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS.ConclusionPeripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.

scholarly journals Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Akane Takamatsu ◽  
Kenta Yao ◽  
Shutaro Murakami ◽  
Yasuaki Tagashira ◽  
Shinya Hasegawa ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Control Study ◽  
Tertiary Care ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

Abstract Background Postprescription review and feedback (PPRF) is one of the most common strategies in antimicrobial stewardship program (ASP) intervention. However, disagreements between the prescribers and ASP personnel can occur. The aim of the present study was to identify the factors associated with nonadherence to PPRF intervention. Methods The present retrospective nested case-control study was performed at a tertiary care center, which has been conducting a once-weekly PPRF for carbapenems and piperacillin/tazobactam since 2014. Nonadherence to ASP recommendations was defined as the failure of the primary care team to modify or stop antimicrobial therapy 72 hours after the issuance of PPRF recommendations. Factors associated with nonadherence to PPRF intervention were identified using multivariate logistic regression analysis. Results In total, 2466 instances of PPRF in 1714 cases between April 2014 and September 2019 were found. The nonadherence rate was 5.9%, and 44 cases were found in which carbapenems or piperacillin/tazobactam continued to be used against PPRF recommendations. Factors associated with nonadherence to PPRF recommendations were a previous history of hospitalization within 90 days (adjusted odds ratio [aOR], 2.62; 95% confidence interval [CI], 1.18–5.81) and a rapidly fatal McCabe score at the time of PPRF intervention (aOR, 2.87; 95% CI, 1.18–6.98). A review of the narrative comments in the electronic medical records indicated that common reasons for nonadherence were “the patient was sick” (n = 12; 27.3%) and “the antimicrobial seemed to be clinically effective” (n = 9; 20.5%). Conclusions Nonadherence to PPRF recommendations was relatively uncommon at the study institution. However, patients with a severe disease condition frequently continued to receive broad-spectrum antimicrobials against PPRF recommendations. Understanding physicians’ cognitive process in nonadherence to ASP recommendations and ASP interventions targeting medical subspecialties caring for severely ill patients is needed to improve ASP.

scholarly journals Epilepsy and mortality: a retrospective cohort analysis with a nested case–control study identifying causes and risk factors from primary care and linkage-derived data

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052841
Author(s):  
Gabriella Wojewodka ◽  
Martin C Gulliford ◽  
Mark Ashworth ◽  
Mark P Richardson ◽  
Leone Ridsdale
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
General Population ◽  
Cause Of Death ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectivesPeople with epilepsy (PWE) have a higher mortality rate than the general population. Epilepsy-related deaths have increased despite all-cause mortality decreasing in the general population pre-COVID-19. We hypothesised that clinical and lifestyle factors may identify people more at risk.DesignWe used a retrospective cohort study to explore cause of death and a nested case–control study to identify risk factors.SettingWe explored factors associated with mortality using primary care population data from 1 April 2004 to 31 March 2014. Data were obtained from the Clinical Practice Research Datalink which compiles anonymised patient data from primary care in the UK. Cause of death data was supplemented from the Office of National Statistics when available.ParticipantsThe analysis included 70 431 PWE, with 11 241 registered deaths.ResultsThe number of deaths within the database increased by 69% between the first and last year of the study. Epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35. Factors associated with increased risk of death included attendance at emergency departments and/or emergency admissions (OR 3.48, 95% CI 3.19 to 3.80), antiepileptic drug (AED) polytherapy (2 AEDs: OR 1.60, 95% CI 1.51 to 1.71; 3 AEDs: OR 2.06, 95% CI 1.86 to 2.29; 4+AEDs: OR 2.62, 95% CI 2.23 to 3.08), status epilepticus (OR 2.78, 95% CI 1.64 to 4.71), depression (OR 1.67, 95% CI 1.57 to 1.76) and injuries (OR 1.54, 95% CI 1.43 to 1.67). No seizures in the prior year (OR 0.52, 95% CI 0.41 to 0.65).ConclusionOur results add to existing evidence that deaths in epilepsy are increasing. Future studies could focus on identifying PWE at high risk and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority as epilepsy may be a factor in close to half of deaths of PWE under 35 years of age.

scholarly journals Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study

2019 ◽  
Vol 8 (5) ◽  
pp. 300-306 ◽  
Author(s):  
Zhila Najafpour ◽  
Zahra Godarzi ◽  
Mohammad Arab ◽  
Mehdi Yaseri
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Case Control Study ◽  
Case Control ◽  
Patient Falls ◽  
Increased Risk ◽  
Risk Factors For Falls ◽  
Clinical Records ◽  
Nested Case Control ◽  
Control Study

Background: Patient falls are considered a challenge to the patient’s safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group. Methods: A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis. Results: In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI=0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR=6.93; CI=4.22 to 11.38), balance condition (OR= 6.41; CI=4.51 to 9.11), manual transfer aid (OR=8.47; CI=5.65 to 12.69), urinary incontinence (OR= 8.47, CI= 5.65 to 12.69), and cancer (OR=2.86, CI=1.84-4.44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR=0.48; CI= 1.003 to 1.02), poly-pharmacy (OR=1.37, CI=00.85 to 2.2), stroke (OR=0.94, CI= 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio=1.01, CI=0.01 to 0.03) were not significantly associated with falling in hospitals. Conclusion: It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions.

scholarly journals Factors associated with neonatal near-miss in selected hospitals of Gamo and Gofa zones, southern Ethiopia: nested case-control study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abera Mersha ◽  
Agegnehu Bante ◽  
Shitaye Shibiru
Keyword(s):  
Antenatal Care ◽  
Case Control Study ◽  
Case Control ◽  
Near Miss ◽  
Southern Ethiopia ◽  
Factors Affecting ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study ◽  
Neonatal Near Miss

Abstract Background To scale up a comprehensive way of implementation to reduce neonatal mortality evaluation of factors for neonatal near-miss cases is very important. Certain studies were done in assessing near-miss cases, but they failed in identifying the proximate factors affecting profoundly. So, this study is to fill those gaps in the aforementioned studies, in assessing the factors affecting neonatal near-miss cases. Methods A nested case-control study was conducted in selected three Hospitals of Gamo and Gofa Zones, Southern Ethiopia from April 5, 2018, to March 5, 2019. The structured standard tool was used to identify neonatal near-miss cases. Data were entered into Epi data version 3.1 and exported to Stata version 15 for analysis. A conditional logistic regression model was used to identify factors associated with near-miss cases. The goodness of fit was tested by a log-likelihood ratio (LR). In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 121 neonatal near-miss cases, and 363 controls were involved. The identified factors that affect neonatal near-miss were multiparty (AOR = 3.81, 95%CI: 1.72, 8.42), antenatal care follow up (AOR = 0.02, 95%CI: 0.01, 0.05), premature rupture of membrane (AOR = 3.40, 95%CI: 1.53, 7.55), non-vertex presentation (AOR = 2.83, 95%CI: 1.44, 5.58), and cesarean delivery (AOR = 4.89, 95%CI: 2.34, 10.24). Conclusions Those identified factors are better should be intervened. Strengthening antenatal care services by providing appropriate information for the mother and counseling about the consequences of multiparty and providing information on family planning. There is a need to identify, screen and critical follow high-risk mothers and give immediate and appropriate intervention as early as possible.

scholarly journals Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study

2007 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan J Jimenez Rivera ◽  
Jose L Iribarren ◽  
Jose M Raya ◽  
Ibrahim Nassar ◽  
Leonardo Lorente ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Case Control Study ◽  
Case Control ◽  
Excessive Bleeding ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study
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