Abstract P265: Identifying Factors Associated With Early Transfer Death of Stroke Patients Can Improve Transfer Criteria

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Randi R Toumbs ◽  
Thanh Dao ◽  
Liang Zhu ◽  
Sean I Savitz
Keyword(s):  
Hospital Mortality ◽  
High Mortality ◽  
Financial Burden ◽  
Early Death ◽  
University Hospital ◽  
Stroke Patients ◽  
Chi Square ◽  
Exact Test ◽  
Chi Square Test ◽  
Ich Score

Introduction: Mortality is an important performance metric monitored by CMS, US News and World Report, and Vizient UHC. Large academic medical centers have high mortality given higher severity of disease and volume. We analyzed mortality of stroke patients transferred to our university hospital from community EDs. Transferring patients who die within 48 hours raises questions about resources, financial burden, and unrealistic expectations from families. We analyzed our transfer early death (TED) population to improve identification of patients who likely do not benefit from transfer out of a community hospital. Methods: Patients with DRG codes for ischemic and hemorrhagic strokes admitted from July 2018-June 2020 were identified. Transfer patients were isolated and grouped as outside hospital (OSH) or intra-system transfers. Data were analyzed for overall hospital mortality and TED mortalities and characteristics. Demographic and clinic variables were compared between intra-system and outside transfers by chi-square test, Fisher’s exact test, t test or Wilcoxon rank sum test. Results: The total stroke mortality rate was 13% with 276 deaths out of 2,145 patients. There were 171 early deaths out of 276 deaths (62%). There were a total of 923 transfer patients in the 2-year period; 76 were TED (8%) and TED accounted for 27% of all in-hospital mortality at our center. Median age of TED was 67, median NIHSS was 27, 39% were >70, and 80% were ICH with a median ICH score 4. The mean volume of ICH was 68mL (SD=55.2). There were no significant associations between age, sex and ethnicity with TED compared with patients who survived beyond 48 hrs. Among TED, 31 (41%) were from within our health system and 45 (59%) were OHS transfers. There were no significant differences among stroke type, severity (GCS, NIHSS, ICH score, MRS), or demographics between intra-system and OSH transfers. Conclusions: TED patients are more likely to have severe ICH where medical care may be futile. Strategies are needed to work with community hospitals to establish goals of care and implement approaches to provide end-of-life services at these facilities. Identification and implementation of such strategies may also reduce intra-system transfers of patients with high mortality.

scholarly journals Workloads and burnout of nursing workers

2019 ◽  
Vol 72 (6) ◽  
pp. 1435-1441
Author(s):  
Deciane Pintanela de Carvalho ◽  
Laurelize Pereira Rocha ◽  
Eliana Cardia de Pinho ◽  
Jamila Geri Tomaschewski-Barlem ◽  
Edison Luiz Devos Barlem ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Lumbar Pain ◽  
Limb Pain ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Lower Limb Pain ◽  
Chi Square Test

ABSTRACT Objective: to identify workloads in nursing work and its association with nursing worker burnout. Method: a cross-sectional study, including 211 nursing workers from a university hospital, between July and August 2016. For the analysis, the descriptive statistics, Chi-Square Test, Fisher’s Exact Test and Mann Whitney U-Test were used. Results: the most evidenced loads were biological. A significant association was found between workloads and workers’ occupation, as well as a significant association between workloads and worker burnout. Burnout caused upper limb pain, neck and lumbar pain, lower limb pain, muscle spasm, lower limb edema, mental fatigue, headache, nervousness, and forgetfulness. Conclusion: workloads identification is a subsidy for the promotion of interventions that minimize the burnout generated to the health of the nursing worker.

scholarly journals STROKE PATIENTS

2015 ◽  
Vol 22 (07) ◽  
pp. 887-895
Author(s):  
Santosh Kumar ◽  
Muhammad Aslam ◽  
Maria Maria ◽  
Saleem Saleem
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
University Hospital ◽  
P Value ◽  
Stroke Patients ◽  
Chi Square ◽  
Aged Patients ◽  
Chi Square Test ◽  
Bed Sores ◽  
Medical Wards

Stroke is one of the leading factors of morbidity and mortality worldwide. Toreduce the incidences of stroke, it is essential to identify and modify the risk factors for stroke.Risk factors can be modifiable and non modifiable. The aim of study was to ascertain theoutcome of stroke patient admitted in all Medical Wards in Liaquat University Hospital HyderabadObjective: To see the mortality, morbidity, disability and co-infection in stroke patients. StudyDesign: Prospective study. Period: One year. Setting: Medical Wards of Liaquat UniversityHospital Hyderabad / Jamshoro. Material and Methods: 200 Patients were enrolled in ourstudy to see the excepted outcome like mortality, Disability, Bed Sores, UTI & Pneumonia andDehydration in Stroke patients. All the patients were Young Adults, greater than 12 years inage and old aged patients, with Ischemic & Hemorrhagic stroke. On categorical variable suchas sex, mortality, morbidity chi-square test was applied at 95% confidence interval and the P-value ≤0.05 was considered as statically significant while the mean ±SD will be calculated forquantitative variables. Results: Mean age of the patient in our study was 57.03 years with thestandard deviation of ±7.35 years. Gender distribution shows most of the patients in our studywere male, i.e. 75% while, only 25% of the patients were female. Ischemic Stroke was foundin 126(63%) patients while, hemorrhagic stroke was found in 74(37%) patients. Regardingoutcome, mortality was found in 5% patients, disability 2%, UTI 2%, pneumonia 15%, Coinfection4%, Bed Sores 21.5% and dehydration was present in 50.5% patients. Conclusion:The study concludes that maximum patients had Ischemic Stroke. Among these patientsdehydration was the most common entity followed by bed Sores, pneumonia, mortality, Coinfection,disability and UTI.

scholarly journals Exclusive breastfeeding practices reported by mothers and the introduction of additional liquids

2015 ◽  
Vol 23 (2) ◽  
pp. 283-290 ◽  
Author(s):  
Alessandra Marcuz de Souza Campos ◽  
Camila de Oliveira Chaoul ◽  
Elenice Valentim Carmona ◽  
Rosângela Higa ◽  
Ianê Nogueira do Vale
Keyword(s):  
Exclusive Breastfeeding ◽  
Descriptive Analysis ◽  
University Hospital ◽  
Test Results ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Early Introduction ◽  
Beliefs And Values ◽  
Chi Square Test

Aim: To assess the concept of exclusive breastfeeding held by nursing women by comparing the period they consider that they perform it and the infants' age at the introduction of additional liquids. METHOD: Cross-sectional descriptive study conducted with 309 women who delivered babies at a university hospital in the interior of São Paulo, Brazil. The data were subjected to descriptive analysis; the variables of interest were crossed using the non-parametric Kruskal-Wallis test, the chi-square test and Fisher's exact test. RESULTS: Approximately 30% of the women reported having introduced additional liquids before the infants reached aged six months old, while asserting that they were performing exclusive breastfeeding. The following variables were associated with early introduction of liquids: lack of employment (p = 0.0386), younger maternal age (p = 0.0159) and first pregnancy (p = 0.003). CONCLUSION: The concept of exclusive breastfeeding might not be fully clear to women, as they seem to believe that it means not to feed the children other types of milk but that giving other liquids is allowed. These results show that promotion of breastfeeding should take beliefs and values into consideration to achieve effective dialogue and understanding with mothers.

Abstract P68: Disrupted Electrophysiological Sleep in Critically ill Stroke Patients: Does it Matter?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rebecca Dutta ◽  
Leslie Markun ◽  
Ajay Sampat ◽  
Kwan L Ng ◽  
Alan H Yee
Keyword(s):  
Acute Stroke ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sleep Disturbances ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Poor Sleep ◽  
Stroke Patients ◽  
Chi Square ◽  
Chi Square Test ◽  
Ich Score

Mounting evidence suggest that poor sleep quality may impact outcome following stroke. While sleep disturbances are common among critically ill patients, little is known about sleep characteristics in neurocritical stroke patients. We examined sleep characteristics in acute stroke patients admitted to an intensive care unit (ICU) compared to those admitted for non-stroke conditions. Methods: Retrospective analysis of critically ill patients who underwent continuous electroencephalographic (cEEG) monitoring in the ICU from 2018-19. Sleep was scored based on American Academy of Sleep Medicine-defined EEG criteria. EEG and clinical characteristics [NIH Stroke Scale (NIHSS), Hunt and Hess (HH) Grade, and ICH Score] were collected. Primary outcomes were based on modified Rankin Scale (mRS) scores of which 2 or less was considered favorable. Differences were assessed using Chi-Square test. Results: 228 ICU patients underwent cEEG; mean age was 58 years (range 18-91) and 57% were male. 61 (27%) were admitted for acute stroke (16 ischemic, 17 aneurysmal subarachnoid hemorrhage (aSAH), 27 non-traumatic intracerebral hemorrhage (ICH)). The other 167 critically ill patients were admitted for medical, surgical, or non-stroke related neurological conditions. In those with stroke, mean NIHSS scores for ischemia, mean ICH Score for ICH, and mean HH for aSAH were 18.78, 2.12, and 3.36, respectively. Rates of attaining any sleep were similar between stroke (27.9%) and non-stroke patients (26.9%). 29.4% of stroke patients who achieved sleep had good outcomes compared to only 9.1% that did not (χ 2 (1)=2.79, p=0.095). In stroke patients that achieved sleep, 52.9% of patients reached Stage N1, 47.1% Stage N2 and none reached Stages N3 or REM. In the non-stroke cohort, 46.6% who achieved sleep had good outcomes compared to 26.2% who did not (χ 2 (1)=6.34, p=0.012). Of these, 37.8% reached Stage N1 sleep, 60% Stage N2, 2.22% Stage N3, and none reached Stage REM. Discussion: Critically ill stroke and non-stroke patients have disrupted electrophysiological sleep, and none reach REM stage. A trend towards improved outcome in stroke survivors was observed in those who slept. The association between sleep variability, stroke mechanism, and functional outcome needs further exploration.

scholarly journals A clinical study of non-diabetic soft tissue infections: risk factors for mortality and morbidity

2017 ◽  
Vol 5 (1) ◽  
pp. 216
Author(s):  
Anitha Muthusami ◽  
Jawahar Krishnaswamy ◽  
Reshma Sattar
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
High Mortality ◽  
Soft Tissue Infections ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Exact Test ◽  
Chi Square Test ◽  
Beta Coefficient ◽  
Aggressive Debridement

Background: Non-diabetic soft tissue infection is the infection of the soft tissue in a non-diabetic patient. It is rare, but results in high mortality. The aim of the study was to establish a scoring system to predict the outcome of a patient with non-diabetic soft tissue limb infection at the time of admission and to determine the factors which increase the morbidity of a patient with non-diabetic soft tissue limb infection as determined by number of days of hospital stay or limb loss or death of the patient.Methods: Clinical and laboratory details of 200 cases of non-diabetic soft tissue infections of the lower limb were retrospectively analyzed statistically, using pearson's chi square test for comparison of proportions with respect to mortality, fisher's exact test, logistic regression analysis were expressed using beta coefficient values, odds ratios. Statistical analysis was performed using SPSS software version 12.Results: Two hundred patients records were reviewed. 121 patients (60%) were males and 79 (40%) were females. Mean age was 52.5 years ranging from 14 to 91 years. Forty-six patients underwent conservative treatment, 111 patients underwent debridement and 43 patients underwent amputation. Increasing age were the risk factor associated with mortality in non-diabetic soft tissue infections that were statistically significant.Conclusions: Non-diabetic soft tissue infections still lead to high mortality and morbidity despite the use of appropriate conservative treatment, aggressive debridement, resuscitation and amputation. In this series, there is high mortality associated with increasing age.

Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

scholarly journals MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1424
Author(s):  
Esben Nyborg Poulsen ◽  
Anna Olsson ◽  
Stefan Gustavsen ◽  
Annika Reynberg Langkilde ◽  
Annette Bang Oturai ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Brain Mri ◽  
Anatomical Location ◽  
Spinal Cord Lesions ◽  
Chi Square ◽  
Exact Test ◽  
Mcdonald Criteria ◽  
Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

scholarly journals 1591. Antibiotic Utilization Trends in Veterans Affairs (VA) Patients with Carbapenem Resistant Enterobacteriaceae (CRE) Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S792-S792
Author(s):  
Alfredo Traversa ◽  
Linda Poggensee ◽  
Geneva M Wilson ◽  
Katie J Suda ◽  
Charlesnika T Evans ◽  
...  
Keyword(s):  
Treatment Options ◽  
Blood Stream ◽  
Chi Square ◽  
Blood Stream Infections ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
New Antibiotics ◽  
Chi Square Test ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an “urgent threat” to public health. Historically, colistin and tigecycline had been considered the drugs of choice for CRE infections, while other agents such as aminoglycosides and carbapenems had been used as adjunctive therapy. However, the FDA approval of ceftazidime-avibactam in 2015, meropenem-vaborbactam in 2017, and plazomicin in 2018 has expanded treatment options. Our purpose was to assess trends in CRE treatment for “new” antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) as compared with other antibiotics with CRE activity. Methods This was a retrospective cohort study describing treatment of CRE blood stream infections (BSI) across 134 VA facilities from 2012-2018. Patients were censored at their first positive blood culture with CRE. Categorical data was assessed with a Fisher’s exact test or chi-square test. Trends test and logistic regression were used to describe changes in CRE treatment over time. Results 724 patients with positive blood cultures for CRE were identified during the study period. Most patients were male (94%), white (32%) or Hispanic (38%), and the mean age was 71.5+11.9. Of those patients that received antibiotics (N=697), 53.4% carbapenems, 40.3% received aminoglycosides, 39.3% received polymyxins, 32.9% penicillins, 32.6% extended spectrum cephalosporins, 26.1% fluoroquinolones, 11.6% ceftazidime/avibactam, and 0.4% ceftolazone/tazobactam. Over the study period, there was decreased utilization of aminoglycosides (P < 0.0026) and colistin (P< 0.002) and increases in extended spectrum cephalosporins (P < 0.001) and ceftazidime/avibactam (P < 0.001). Conclusion Utilization of “older” agents such as aminoglycosides and polymyxins for the treatment of CRE blood stream infections is decreasing in the VA. Treating CRE with ceftazidime/avibactam, a newly approved antibiotic, and extended spectrum cephalosporins are increasing. Disclosures All Authors: No reported disclosures

scholarly journals Association of cervical carcinogenesis risk with HPV16 E6 and E7 variants in the Taizhou area, China

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mei-Zhen Dai ◽  
Yi Qiu ◽  
Xing-Hong Di ◽  
Wei-Wu Shi ◽  
Hui-Hui Xu
Keyword(s):  
Cervical Cancer ◽  
Cervical Carcinogenesis ◽  
Chi Square ◽  
Major Health Problem ◽  
Hpv16 E6 ◽  
Exact Test ◽  
Chi Square Test ◽  
E6 And E7

Abstract Background Human papillomavirus (HPV) type 16 accounts for a larger share of cervical cancer and has been a major health problem worldwide for decades. The progression of initial infection to cervical cancer has been linked to viral sequence properties; however, the role of HPV16 variants in the risk of cervical carcinogenesis, especially with longitudinal follow-up, is not fully understood in China. Methods We aimed to investigate the genetic variability of HPV16 E6 and E7 oncogenes in isolates from cervical exfoliated cells. Between December 2012 and December 2014, a total of 310 single HPV16-positive samples were selected from women living in the Taizhou area, China. Sequences of all E6 and E7 oncogenes were analysed by PCR-sequencing assay. Detailed sequence comparison, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed with BioEdit Sequence Alignment Editor and MEGA X software. Data for cytology tests and histological diagnoses were obtained from our Taizhou Area Study with longitudinal follow-up for at least 5 years. The relationship between HPV16 variants and cervical carcinogenesis risk was analysed by the chi-square test or Fisher’s exact test. Results In this study, we obtained 64 distinct variation patterns with the accession GenBank numbers MT681266-MT681329. Phylogenetic analysis revealed that 98.3% of HPV16 variants belong to lineage A, in which the A4 (Asian) sublineage was dominant (64.8%), followed by A2 (12.1%), A1 (11.4%), and A3 (10.0%). The A4 (Asian) sublineage had a higher risk of CIN2+ than the A1–3 (European) sublineages (OR = 2.69, 95% CI = 1.04–6.97, P < 0.05). Furthermore, nucleotide variation in HPV16 E6 T178G is associated with the development of cervical cancer. Conclusion These data could provide novel insights into the role of HPV16 variants in cervical carcinogenesis risk in China.

Hardy-Weinberg Testing for Continuous Data

Genetics ◽  
1997 ◽  
Vol 147 (4) ◽  
pp. 1965-1975
Author(s):  
Lauren M McIntyre ◽  
B S Weir
Keyword(s):  
Intraclass Correlation ◽  
Kernel Density ◽  
Variable Number ◽  
Continuous Data ◽  
Test Statistic ◽  
Test Procedures ◽  
Chi Square ◽  
Exact Test ◽  
Chi Square Test ◽  
The Many

Abstract Estimation of allelic and genotypic distributions for continuous data using kernel density estimation is discussed and illustrated for some variable number of tandem repeat data. These kernel density estimates provide a useful representation of data when only some of the many variants at a locus are present in a sample. Two Hardy-Weinberg test procedures are introduced for continuous data: a continuous chi-square test with test statistic TCCS and a test based on Hellinger's distance with test statistic TCCS. Simulations are used to compare the powers of these tests to each other and to the powers of a test of intraclass correlation TIC, as well as to the power of Fisher's exact test TFET applied to discretized data. Results indicate that the power of TCCS is better than that of THD but neither is as powerful as TFET. The intraclass correlation test does not perform as well as the other tests examined in this article.

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