scholarly journals Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology

2021 ◽  
pp. 1-7
Author(s):  
Hendrik Borgmann ◽  
Julian P. Struck ◽  
Angelika Mattigk ◽  
Mike Wenzel ◽  
Adrian Pilatz ◽  
...  
Keyword(s):  
Emergency Room ◽  
Reduction Rate ◽  
Time Frame ◽  
Stone Disease ◽  
Adverse Outcomes ◽  
Intensive Care Treatment ◽  
Collateral Damage ◽  
Emergency Room Visits ◽  
Disease Outcomes ◽  
Set Up

<b><i>Purpose:</i></b> The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. <b><i>Methods:</i></b> We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. <b><i>Results:</i></b> The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (<i>p</i> = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, <i>p</i> = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). <b><i>Conclusion:</i></b> This report of collateral damage during CO­VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic.

scholarly journals Differences in Healthcare Use Between Patients With Persistent and Paroxysmal Atrial Fibrillation Undergoing Catheter‐Based Atrial Fibrillation Ablation: A Population‐Based Cohort Study From Ontario, Canada

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrew C. T. Ha ◽  
Harindra C. Wijeysundera ◽  
Feng Qiu ◽  
Kayley Henning ◽  
Kamran Ahmad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Room ◽  
Persistent Atrial Fibrillation ◽  
Population Based ◽  
Adverse Outcomes ◽  
Administrative Databases ◽  
Emergency Room Visits ◽  
Success Rates ◽  
Healthcare Use ◽  
Af Ablation

Background Patients with persistent atrial fibrillation (AF) undergoing catheter‐based AF ablation have lower success rates than those with paroxysmal AF. We compared healthcare use and clinical outcomes between patients according to their AF subtypes. Methods and Results Consecutive patients undergoing AF ablation were prospectively identified from a population‐based registry in Ontario, Canada. Via linkage with administrative databases, we performed a retrospective analysis comparing the following outcomes between patients with persistent and paroxysmal AF: healthcare use (defined as AF‐related hospitalizations/emergency room visits), periprocedural complications, and mortality. Multivariable Poisson modeling was performed to compare the rates of AF‐related and all‐cause hospitalizations/emergency room visits in the year before versus after ablation. Between April 2012 and March 2016, there were 3768 consecutive patients who underwent first‐time AF ablation, of whom 1040 (27.6%) had persistent AF. The mean follow‐up was 1329 days. Patients with persistent AF had higher risk of AF‐related hospitalization/emergency room visits (hazard ratio [HR], 1.21; 95% CI, 1.09–1.34), mortality (HR, 1.74; 95% CI, 1.15–2.63), and periprocedural complications (odds ratio, 1.36; 95% CI, 1.02–1.75) than those with paroxysmal AF. In the overall cohort, there was a 48% reduction in the rate of AF‐related hospitalization/emergency room visits in the year after versus before ablation (rate ratio [RR], 0.52; 95% CI, 0.48–0.56). This reduction was observed for patients with paroxysmal (RR, 0.45; 95% CI, 0.41–0.50) and persistent (RR, 0.74; 95% CI, 0.63–0.87) AF. Conclusions Although patients with persistent AF had higher risk of adverse outcomes than those with paroxysmal AF, ablation was associated with a favorable reduction in downstream AF‐related healthcare use, irrespective of AF type.

scholarly journals Association Between Glucagon-Like Peptide 1 Receptor Agonist and Sodium–Glucose Cotransporter 2 Inhibitor Use and COVID-19 Outcomes

2021 ◽  
Author(s):  
Anna R. Kahkoska ◽  
Trine Julie Abrahamsen ◽  
G. Caleb Alexander ◽  
Tellen D. Bennett ◽  
Christopher G. Chute ◽  
...  
Keyword(s):  
Emergency Room ◽  
Total Mortality ◽  
Likelihood Estimation ◽  
Adverse Outcomes ◽  
Emergency Room Visits ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Design And Methods

<b>Objective: </b>To determine the respective associations of premorbid glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose-linked cotransporter 2 inhibitors (SGLT2i) use, compared to premorbid dipeptidyl peptidase-4 inhibitor (DPP4i) use, with severity of outcomes in the setting of COVID-19 infection. <p><b>Research Design and Methods: </b>We analyzed observational data from SARS-CoV-2-positive adults in the National COVID Cohort Collaborative, a multicenter, longitudinal U.S. cohort (January 2018–February 2021) with a prescription for GLP1-RA, SGLT2i, or DPP4i within 24 months of positive SARS-CoV-2 PCR test<b>. </b>The primary outcome was 60-day mortality, measured from positive SARS-CoV-2 test date. Secondary outcomes were total mortality during the observation period, and emergency room visits, hospitalization, and mechanical ventilation within 14 days. <b> </b>Associations were quantified with odds ratios (OR) estimated with targeted maximum likelihood estimation using a super learner approach, accounting for baseline characteristics. </p> <p><b>Results</b>: The study included 12,446 individuals (53.4% female, 62.5% White, mean±SD age 58.6±13.1 years). The 60-day mortality was 3.11% (387/12,446), with 2.06% (138/6,692) for GLP1-RA use, 2.32% (85/3,665) for SGLT2i use, and 5.67% (199/3,511) for DPP4i use. Both GLP1-RA and SGLT2i use was associated with lower 60-day mortality compared to DPP4i use (OR (95% confidence intervals (95%CI)): 0.54 (0.37–0.80) and 0.66 (0.50–0.86), respectively). Use of both medications was also associated with decreased total mortality, emergency room visits, and hospitalizations. </p> <b>Conclusions: </b>Among SARS-CoV-2-positive adults, premorbid GLP1-RA and SGLT2i use, compared to DPP4i use, was associated with lower odds of mortality and other adverse outcomes, although DPP4i users were older and generally sicker.

scholarly journals Association Between Glucagon-Like Peptide 1 Receptor Agonist and Sodium–Glucose Cotransporter 2 Inhibitor Use and COVID-19 Outcomes

2021 ◽  
Author(s):  
Anna R. Kahkoska ◽  
Trine Julie Abrahamsen ◽  
G. Caleb Alexander ◽  
Tellen D. Bennett ◽  
Christopher G. Chute ◽  
...  
Keyword(s):  
Emergency Room ◽  
Total Mortality ◽  
Likelihood Estimation ◽  
Adverse Outcomes ◽  
Emergency Room Visits ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Design And Methods

<b>Objective: </b>To determine the respective associations of premorbid glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose-linked cotransporter 2 inhibitors (SGLT2i) use, compared to premorbid dipeptidyl peptidase-4 inhibitor (DPP4i) use, with severity of outcomes in the setting of COVID-19 infection. <p><b>Research Design and Methods: </b>We analyzed observational data from SARS-CoV-2-positive adults in the National COVID Cohort Collaborative, a multicenter, longitudinal U.S. cohort (January 2018–February 2021) with a prescription for GLP1-RA, SGLT2i, or DPP4i within 24 months of positive SARS-CoV-2 PCR test<b>. </b>The primary outcome was 60-day mortality, measured from positive SARS-CoV-2 test date. Secondary outcomes were total mortality during the observation period, and emergency room visits, hospitalization, and mechanical ventilation within 14 days. <b> </b>Associations were quantified with odds ratios (OR) estimated with targeted maximum likelihood estimation using a super learner approach, accounting for baseline characteristics. </p> <p><b>Results</b>: The study included 12,446 individuals (53.4% female, 62.5% White, mean±SD age 58.6±13.1 years). The 60-day mortality was 3.11% (387/12,446), with 2.06% (138/6,692) for GLP1-RA use, 2.32% (85/3,665) for SGLT2i use, and 5.67% (199/3,511) for DPP4i use. Both GLP1-RA and SGLT2i use was associated with lower 60-day mortality compared to DPP4i use (OR (95% confidence intervals (95%CI)): 0.54 (0.37–0.80) and 0.66 (0.50–0.86), respectively). Use of both medications was also associated with decreased total mortality, emergency room visits, and hospitalizations. </p> <b>Conclusions: </b>Among SARS-CoV-2-positive adults, premorbid GLP1-RA and SGLT2i use, compared to DPP4i use, was associated with lower odds of mortality and other adverse outcomes, although DPP4i users were older and generally sicker.

scholarly journals Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Guerrero Fernández de Alba ◽  
A Gimeno-Miguel ◽  
B Poblador Plou ◽  
K Bliek Bueno ◽  
J Carmona Pirez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Substance Abuse ◽  
Early Detection ◽  
Health Outcomes ◽  
Emergency Room ◽  
Mental Disease ◽  
Emergency Room Visits ◽  
Mental Diseases ◽  
The Impact

Abstract Background Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes. Methods Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities. Results Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23). Conclusions The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes. Key messages Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

scholarly journals The Challenging but Imperative Path to Monoclonal Antibody Use Against COVID-19 for a Small Overseas Military Hospital

2021 ◽  
Author(s):  
Spencer Shirk ◽  
Danielle Kerr ◽  
Crystal Saraceni ◽  
Garret Hand ◽  
Michael Terrenzi ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Lessons Learned ◽  
Military Hospital ◽  
Clinical Criteria ◽  
Fda Approval ◽  
Life Saving ◽  
Set Up ◽  
Naval Hospital

ABSTRACT Upon the U.S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U.S. Naval Hospital Rota, Spain (USNH Rota) requested and received a limited number of doses. Concurrently, our host nation, which previously had reported the highest number of daily deaths from COVID-19, was deep within a second wave of infections, increasing hospital admissions, near intensive care unit capacity, and deaths. As USNH Rota was not normally equipped for the complex infusion center required to effectively deliver the monoclonal antibody, we coordinated a multi-directorate and multidisciplinary effort in order to set up an infusion room that could be dedicated to help with our fight against COVID. Identifying a physician team lead, with subject matter experts from nursing, pharmacy, facilities, and enlisted corpsmen, our team carefully ensured that all requisite steps were set up in advance in order to be able to identify the appropriate patients proactively and treat them safely with the infusion that has been clinically proven to decrease hospital admissions and mortality. Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.

scholarly journals Beneficial Effects of Remote Medical Care for Patients with Hereditary Hemorrhagic Telangiectasia during the COVID-19 Pandemic

2021 ◽  
Vol 10 (11) ◽  
pp. 2311
Author(s):  
Eleonora Gaetani ◽  
Fabiana Agostini ◽  
Luigi Di Martino ◽  
Denis Occhipinti ◽  
Giulio Cesare Passali ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Room ◽  
Medical Care ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Iron Supplementation ◽  
Quality Care ◽  
Psychological Status ◽  
Blood Transfusions ◽  
Emergency Room Visits

Background: Hereditary hemorrhagic telangiectasia (HHT) needs high-quality care and multidisciplinary management. During the COVID-19 pandemic, most non-urgent clinical activities for HHT outpatients were suspended. We conducted an analytical observational cohort study to evaluate whether medical and psychological support, provided through remote consultation during the COVID-19 pandemic, could reduce the complications of HHT. Methods: A structured regimen of remote consultations, conducted by either video-calls, telephone calls, or e-mails, was provided by a multidisciplinary group of physicians to a set of patients of our HHT center. The outcomes considered were: number of emergency room visits/hospitalizations, need of blood transfusions, need of iron supplementation, worsening of epistaxis, and psychological status. Results: The study included 45 patients who received remote assistance for a total of eight months. During this period, 9 patients required emergency room visits, 6 needed blood transfusions, and 24 needed iron supplementation. This was not different from what was registered among the same 45 patients in the same period of the previous year. Remote care also resulted in better management of epistaxis and improved quality of life, with the mean epistaxis severity score and the Euro-Quality of Life-Visual Analogue Scale that were significantly better at the end than at the beginning of the study. Discussion: Remote medical care might be a valid support for HHT subjects during periods of suspended outpatient surveillance, like the COVID-19 pandemic.

scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

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