scholarly journals Hospital complications among older adults: Better processes could reduce the risk of delirium

2021 ◽  
pp. 095148482110287
Author(s):  
Valdery Moura Junior ◽  
M Brandon Westover ◽  
Feng Li ◽  
Eyal Kimchi ◽  
Maura Kennedy ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Natural Experiment ◽  
Hospital Admissions ◽  
Proportional Hazard ◽  
Proportional Hazard Models ◽  
Delayed Initiation ◽  
Delirium Prevention ◽  
Prevention Protocol ◽  
Social Demographic ◽  
Neurologic Event

Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37–1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.

scholarly journals LAMB1 Is Related to the T Stage and Indicates Poor Prognosis in Gastric Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382110049
Author(s):  
Tao Ran ◽  
ZhiJi Chen ◽  
LiWen Zhao ◽  
Wei Ran ◽  
JinYu Fan ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Poor Prognosis ◽  
Hazard Models ◽  
Proportional Hazard ◽  
Kegg Analysis ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Gastric Cancer Patients

Background and Objective: Gastric cancer (GC) is a common tumor malignancy with high incidence and poor prognosis. Laminin is an indispensable component of basement membrane and extracellular matrix, which is responsible for bridging the internal and external environment of cells and transmitting signals. This study mainly explored the association of the LAMB1 expression with clinicopathological characteristics and prognosis in gastric cancer. Methods: The expression data and clinical information of gastric cancer patients were downloaded from The Cancer Genome Atlas (TCGA) and Asian Cancer Research Group (ACRG). And we analyzed the relationship between LAMB1 expression and clinical characteristics through R. CIBERSORTx was used to calculate the absolute score of immune cells in gastric tumor tissues. Then COX proportional hazard models and Kaplan-Meier curves were performed to evaluate the role of LAMB1 and its influence on prognosis in gastric cancer patients. Finally, GO and KEGG analysis were applied for LAMB1-related genes in gastric cancer, and PPI network was constructed in Cytoscape software. Results: In the TCGA cohort, patients with gastric cancer frequently generated LAMB1 gene copy number variation, but had little effect on mRNA expression. Both in the TCGA and ACRG cohorts, the mRNA expression of LAMB1 in gastric cancer tissues was higher than it in normal tissues. All patients were divided into high expression group and low expression group according to the median expression level of LAMB1. The elevated expression group obviously had more advanced cases and higher infiltration levels of M2 macrophages. COX proportional hazard models and Kaplan-Meier curves revealed that patients with enhanced expression of LAMB1 have a worse prognosis. GO/KEGG analysis showed that LAMB1-related genes were enriched in PI3K-Akt signaling pathway, focal adhesion, ECM-receptor interaction, etc. Conclusions: The high expression of LAMB1 in gastric cancer is related to the poor prognosis of patients, and it may be related to microenvironmental changes in tumors.

scholarly journals Hospital admissions in children who had pelvicalyceal diltation detected on ultrasound scan during pregnancy: an e-cohort study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Melissa Wright ◽  
Shantini Paranjothy ◽  
David Fone ◽  
Sinead Brophy ◽  
Joanne Demmler
Keyword(s):  
Hospital Admissions ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Ultrasound Scan ◽  
Second Trimester ◽  
Proportional Hazard Model ◽  
Activity Data ◽  
Cox Proportional Hazard ◽  
Uncertain Significance ◽  
The Impact

ABSTRACTObjectiveTo explore whether children with pelvicalyceal dilatation (PCD, a marker detected during the 18-20 week gestation ultrasound scan in which there is enlargement of tubes that collect urine in the kidney) have more hospital admissions for kidney problems in childhood compared to children without the marker. Approach We were funded by NISCHR to study outcomes associated with markers of uncertain significance at the second trimester anomaly scan (Welsh Study of Mothers and Babies). Data collected in the WSMB was uploaded to the Secure Anonymised Information Linkage (SAIL) databank and record linked to hospital activity data. Patterns of hospital admissions for renal causes were described and compared between those with no markers and those with PCD. Children were followed up from birth until 31st December 2014 or until the age of 5. A Cox Proportional Hazard Model was used to investigate the impact of PCD on time to first presentation. Results (Preliminary)Of the WSMB cohort, 20,834 children were eligible for inclusion in analyses. Those with PCD had 6.29 times the hazard of a renal admission compared to those without the marker (95% CI: 3.69 to 10.72). Children with PCD were more likely to have multiple renal admissions to hospital - median (interquartile range) number of renal admissions, 2.5 (1 to 5) compared to 1 (1 , 1) in children without markers. ConclusionPreliminary analysis suggests there is increased childhood renal morbidity associated with the presence of a PCD marker detected on the 18-20 week gestation ultrasound scan. These findings will inform the discussions clinicians have with parents when discussing the implications of this marker for the health of the chid.

scholarly journals Prognostic implications of depression and inflammation in patients with metastatic lung cancer

2020 ◽  
Author(s):  
Daniel C McFarland ◽  
Rebecca M. Saracino ◽  
Andrew H. Miller ◽  
William Breitbart ◽  
Barry Rosenfeld ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hazard Ratio ◽  
Proportional Hazard ◽  
Metastatic Lung Cancer ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Metastatic Lung ◽  
Cox Proportional Hazard Models ◽  
Prognostic Implications

Background: Lung cancer-related inflammation is associated with depression. Both elevated inflammation and depression are associated with worse survival. However, outcomes of patients with concomitant depression and elevated inflammation are not known. Materials & methods: Patients with metastatic lung cancer (n = 123) were evaluated for depression and inflammation. Kaplan–Meier plots and Cox proportional hazard models provided survival estimations. Results: Estimated survival was 515 days for the cohort and 323 days for patients with depression (hazard ratio: 1.12; 95% CI: 1.05–1.179), 356 days for patients with elevated inflammation (hazard ratio: 2.85, 95% CI: 1.856–4.388), and 307 days with both (χ2 = 12.546; p < 0.001]). Conclusion: Depression and inflammation are independently associated with inferior survival. Survival worsened by inflammation is mediated by depression-a treatable risk factor.

scholarly journals Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study

BMJ ◽  
2021 ◽  
pp. n1943 ◽  
Author(s):  
Hannah Chung ◽  
Siyi He ◽  
Sharifa Nasreen ◽  
Maria E Sundaram ◽  
Sarah A Buchan ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Clinical Characteristics ◽  
Hospital Admissions ◽  
Vaccine Effectiveness ◽  
Community Dwelling ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Design Study ◽  
Symptomatic Infection ◽  
Polymerase Chain

AbstractObjectiveTo estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death).DesignTest negative design study.SettingOntario, Canada between 14 December 2020 and 19 April 2021.Participants324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2.InterventionsBNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine.Main outcome measuresLaboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes.ResultsOf 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation.ConclusionsTwo doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.

Social, demographic and clinical characteristics of female patients with schizophrenia and HIV

2021 ◽  
Vol 121 (1) ◽  
pp. 31
Author(s):  
L.A. Burygina ◽  
V.A. Orlov ◽  
A.V. Zhilenkova ◽  
D.E. Makaryan ◽  
A.N. Khannanova ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Female Patients ◽  
Social Demographic

scholarly journals Revolutions and the Military: Endgame Coups, Instability, and Prospects for Democracy

2019 ◽  
Vol 47 (1) ◽  
pp. 148-176 ◽  
Author(s):  
Kevin Koehler ◽  
Holger Albrecht
Keyword(s):  
Distinct Type ◽  
Proportional Hazard ◽  
Data Set ◽  
Systematic Analysis ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Original Medium ◽  
Cox Proportional Hazard Models ◽  
The Military ◽  
Nondemocratic Regimes

This article presents a systematic analysis of military coups following popular mass uprisings in nondemocratic regimes, conceptualized as endgame coups. Drawing on our original, medium- n data set of revolutionary situations, we find that such endgame coups form a distinct type of military intervention in politics. Compared to regular coups, episodes of popular mass contestation prompt conservative interventions in politics of the military’s leadership aimed at preserving the regime’s authoritarian infrastructure. A systematic test of factors characterizing postcoup political trajectories is based on Cox proportional hazard models and provides empirical evidence in contrast to the widely held notion of “democratic coups.” Our findings reveal that endgame coups are conservative rollback coups, executed by military leaderships, that result in continued political instability and illiberal politics.

scholarly journals Low rather than high mean corpuscular volume is associated with mortality in Japanese patients under hemodialysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hirokazu Honda ◽  
Miho Kimachi ◽  
Noriaki Kurita ◽  
Nobuhiko Joki ◽  
Masaomi Nangaku
Keyword(s):  
Mean Corpuscular Volume ◽  
Japanese Patients ◽  
Cubic Spline ◽  
Hazard Models ◽  
Proportional Hazard ◽  
Corpuscular Volume ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Models

Abstract Recent studies have reported that high mean corpuscular volume (MCV) might be associated with mortality in patients with advanced chronic kidney disease (CKD). However, the question of whether a high MCV confers a risk for mortality in Japanese patients remains unclear. We conducted a longitudinal analysis of a cohort of 8571 patients using data derived from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phases 1 to 5. Associations of all-cause mortality, vascular events, and hospitalization due to infection with baseline MCV were examined via Cox proportional hazard models. Non-linear relationships between MCV and these outcomes were examined using restricted cubic spline analyses. Associations between time-varying MCV and these outcomes were also examined as sensitivity analyses. Cox proportional hazard models showed a significant association of low MCV (< 90 fL), but not for high MCV (102 < fL), with a higher incidence of all-cause mortality and hospitalization due to infection compared with 94 ≤ MCV < 98 fL (reference). Cubic spline analysis indicated a graphically U-shaped association between baseline MCV and all-cause mortality (p for non-linearity p < 0.001). In conclusion, a low rather than high MCV might be associated with increased risk for all-cause mortality and hospitalization due to infection among Japanese patients on hemodialysis.

scholarly journals Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathleen Morrisroe ◽  
Wendy Stevens ◽  
Joanne Sahhar ◽  
Gene-Siew Ngian ◽  
Nava Ferdowsi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systemic Sclerosis ◽  
Ambulatory Care ◽  
Clinical Characteristics ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Healthcare Resource Utilization ◽  
Digital Ulcers ◽  
Diffuse Disease

Abstract Background To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. Methods Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1–5 DUs, moderate 6–10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008–2015. Healthcare cost determinants were estimated using logistic regression. Results Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 ± 13.9 vs 48.8 ± 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs. Conclusion DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost.

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