Abstract P75: Association Between Caregiving, 30-Day Outcomes, and Baseline Risk Status Among Hospitalized Cardiac Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Lori Mosca ◽  
Brooke Aggarwal ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Niurka Suero-Tejeda ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Participation Rate ◽  
Cardiac Patients ◽  
University Hospital ◽  
Baseline Risk ◽  
Risk Status ◽  
Available N ◽  
Comorbidity Score ◽  
History Of ◽  
Comorbidity Index

BACKGROUND: Caregivers might represent a unique opportunity to improve clinical outcomes among cardiovascular disease (CVD) patients, however prospective data are limited. PURPOSE: To determine if having a caregiver is associated with 30-day clinical outcomes and baseline risk status among hospitalized CVD patients. METHODS: We prospectively studied 4500 consecutive patients admitted to the CVD service line at a university hospital as part of the NHLBI-sponsored F amily Cardiac Caregiver I nvestigation T o Evaluate O utcomes ( FIT-O ) Study. Clinical outcomes included rehospitalization or death within 30-days. Patients [N=4500, 59% white, 62% male, 93% participation rate] completed a standardized interviewer assisted questionnaire in English/Spanish about caregiving (paid or non-paid). In a subsample of patients with baseline data available (n=1324), comorbidities, labs, and medications were analyzed by caregiver status. Comorbidity score was calculated using the Ghali Comorbidity Index (range 0-11). The association between caregiving and clinical outcomes was evaluated by logistic regression adjusted for confounders. RESULTS: At 30-days, 11% (475/4500) of patients had been rehospitalized or had died. Cardiac patients who had a caregiver vs. those who did not were significantly more likely to have been rehospitalized or to have died within 30-days (OR=1.4, 95%CI=1.2-1.7). This association was similar when analyzed by paid (OR=1.7, 95%CI=1.2-2.3) or non-paid (OR=1.2, 95%CI=1.0-1.6) caregiver status, and was not materially altered when adjusted for demographic confounders. In a subsample (n=1324), cardiac patients who had caregivers vs. those who did not were significantly (p<.05) more likely to have a history of diabetes, renal failure, CVD, COPD, creatinine >2.5 mg/dL, HbA1C ≥7%, comorbidity score >1, and take ≥11 medications. The association between caregiving and 30-day outcomes was not significant after adjustment for demographics, baseline risk factors, and comorbidities (OR=1.2, 95%CI=0.4-3.3). CONCLUSION: Cardiac patients who had a caregiver vs. those who did not had significantly higher rehospitalization and mortality rates at 30-days; this association is largely explained by their higher baseline risk status.

scholarly journals Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital

2020 ◽  
Author(s):  
Olivier Paccoud ◽  
Florence Tubach ◽  
Amandine Baptiste ◽  
Alexandre Bleibtreu ◽  
David Hajage ◽  
...  
Keyword(s):  
Propensity Score ◽  
Charlson Comorbidity Index ◽  
Standard Of Care ◽  
Unfavorable Outcome ◽  
University Hospital ◽  
Primary Analysis ◽  
Weighted Analysis ◽  
Hospital Patients ◽  
History Of ◽  
Comorbidity Index

Abstract Background Data from non-randomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against Covid-19. Methods We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe Covid-19 in a French university hospital. Patients who received hydroxychloroquine (200mg tid dosage for 10 days) on a compassionate basis in addition to SOCwere compared to patients without contraindications to hydroxychloroquine who received SOCalone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, and obesity, NEWS2 score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first. Results Data from 89 patients with laboratory-confirmed Covid-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOCalone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxycholoroquine was not associated with a significantly reduced risk of unfavorable outcome (HR 0.90 [0.38; 2.1], p = 0.81). Overall survival was not significantly different between the two groups (HR 0.89 [0.23; 3.47], p = 1) Conclusion In hospitalized adults with Covid-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to standard of care. Unmeasured confounders may however have persisted despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of Covid-19.

Abstract P336: Are Post-Operative Length-of-Stay and Rehospitalization Linked to Caregiving among Cardiac Surgery Patients?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Heidi Mochari-Greenberger ◽  
Matthew Mosca ◽  
Brooke Aggarwal ◽  
Tianna M Umann ◽  
Lori Mosca
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Clinical Information System ◽  
Univariate Analysis ◽  
Participation Rate ◽  
University Hospital ◽  
Comorbid Conditions ◽  
Simple Method ◽  
Multivariable Adjustment

Background: Cardiac surgery patients are frequently cared for by family members or paid aides, potentially impacting clinical outcomes, yet data are sparse. The purpose of this study was to evaluate the association between access to paid or informal (unpaid) caregiving among cardiac surgery patients and post-operative length-of-stay, and death or rehospitalization at 1 year. Methods: We prospectively studied 665 consecutive patients admitted for cardiac surgery at a university hospital as part of a NHLBI-sponsored clinical outcomes study (93% participation rate). Participants (mean age 65 years; 35% female; 21% minority) completed an interviewer-assisted questionnaire at baseline to determine if they had a caregiver and the extent of care received. A hospital-based clinical information system was used to document post-operative length-of-stay and death or rehospitalization at 1 year (supplemented by standardized questionnaire). Demographics and comorbid conditions were documented by electronic chart assessment; comorbidity score was calculated using the Ghali comorbidity index. Associations between caregiving and clinical outcomes were evaluated by multiple logistic regression, adjusted for demographics (age, race, sex, marital status, health insurance) and comorbid conditions. Results: At baseline, 28% (183/665) of cardiac surgery patients reported having a caregiver (8% paid; 20% informal only). Having a caregiver was significantly associated with longer (>7 days) post-operative length-of-stay (OR=1.86; 95%CI=1.30−2.65). This association varied by whether patients had a paid (OR=3.00; 95%CI=1.57−5.74) or informal caregiver (OR=1.55; 95%CI=1.04−2.31) versus none and was attenuated after multivariable adjustment ( paid caregiver OR=2.15; 95%CI=1.02−4.52, informal caregiver OR=1.23;95%CI=0.78−1.95). Having a paid caregiver was significantly associated with death or rehospitalization at 1 year in univariate analysis (OR=2.09; 95%CI=1.18−3.69) and was significantly attenuated after multivariable adjustment (OR=1.40; 95%CI=0.74−2.62). There was a non-significant univariate association between having an informal caregiver and death or rehospitalization at 1 year (OR=1.39; 95%CI=0.94−2.06). Conclusions: Cardiac surgery patients who identified having a caregiver had longer post-operative stays and a higher rate of death or rehospitalization at 1 year compared to those without a caregiver, not fully explained by comorbidities/confounders. These data suggest that assessment of caregiver status may be a powerful predictor and a simple method to identify cardiac surgery patients at risk for adverse clinical outcomes.

scholarly journals Gas-filled urachal abscess with a pinging sound in a heifer calf

2019 ◽  
Vol 64 (No. 8) ◽  
pp. 362-366 ◽  
Author(s):  
R Sato ◽  
K Yamada ◽  
Y Shinozuka ◽  
H Ochiai ◽  
K Onda
Keyword(s):  
Fistulous Tract ◽  
Failure To Thrive ◽  
Abdominal Distension ◽  
Intravenous Urography ◽  
University Hospital ◽  
Growth Depression ◽  
Poor Growth ◽  
History Of ◽  
Heifer Calf ◽  
Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

Malaria among migrants in a university hospital in Colombia during 2018: A case series

2020 ◽  
pp. 004947552098130
Author(s):  
Fabián R Carreño-Almánzar ◽  
Adán Coronado-Galán ◽  
Sonia A Cala-Gómez ◽  
Agustín Vega-Vera
Keyword(s):  
Latin American ◽  
Previous History ◽  
Case Series ◽  
Cross Sectional Study ◽  
Imported Malaria ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of ◽  
Clinical Profiles

Imported malaria has increased in Colombia since 2015 and has been attributed to migrants coming from Venezuela. We present a series of malaria cases, nested in a retrospective cross-sectional study between 2017 and 2018, aimed at calculating the prevalence of medical diseases among immigrants in a University Hospital in Colombia. Among 154 immigrants admitted for medical causes between 2017 and 2018, 8 were diagnosed with malaria, all due to Plasmodium vivax. Of these, seven had uncomplicated malaria, five had a previous history of malaria, one was critically ill, but none died. We highlight that, similar to other case series of imported malaria, Latin American migrants were young, with similar clinical profiles, having a low proportion of severe cases, and P. vivax was the most frequent cause.

Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention

2020 ◽  
Author(s):  
Raquel Aitken Soares Mueller ◽  
Ana Cristina Cisne Frota ◽  
Daniela Durão Menna Barreto ◽  
Daniela Pires Ferreira Vivacqua ◽  
Gabriela Bueno Loria ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Congenital Toxoplasmosis ◽  
First Trimester ◽  
University Hospital ◽  
Serological Testing ◽  
Missed Opportunities ◽  
Clinic Appointment ◽  
History Of ◽  
Acute Toxoplasmosis ◽  
Made In

Abstract Objectives Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016. Methods Descriptive study including infants with CT, diagnosis established based on Brazil’s Ministry of Health’s criteria. All data regarding the infants and their mother’s prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)—a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded. Results The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth. Conclusion Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

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