scholarly journals Understanding Home Hemodialysis Patient Attrition: A Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110221
Author(s):  
Bailey Paterson ◽  
Danielle E. Fox ◽  
Chel Hee Lee ◽  
Victoria Riehl-Tonn ◽  
Elena Qirzaji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Median Time ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Failure Time ◽  
Cumulative Probability ◽  
Home Hemodialysis ◽  
Number Of Patients ◽  
Small Patient Population ◽  
Technique Failure

Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss. Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit. Design: A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020. Setting: Alberta Kidney Care South, AKC-S HHD program. Participants: Patients who started training for HHD in AKC-S. Methods: A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model. Results: A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older ( P < .001) and had 2 or more comorbidities ( P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50]. Limitations: Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit. Conclusions: Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Occupancy Rate ◽  
Number Of Patients ◽  
Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

scholarly journals A Comparison of the Efficacy and Cost of Different Venous Leg Ulcer Dressings: A Retrospective Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Syed M. Asim Hussain
Keyword(s):  
Cohort Study ◽  
Standard Deviation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Healing Rate ◽  
Leg Ulcer ◽  
University Hospital ◽  
Venous Leg Ulcer ◽  
Number Of Patients ◽  
The Difference

Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers.Study Design. Retrospective cohort study.Location. The leg ulcer clinic at the University Hospital of South Manchester.Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings (e.g., NA Ultra) were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost.Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient.Results. Simple nonadherent dressings had a mean healing rate of 0.353 cm2/week (standard deviation ± 0.319) compared with a mean of 0.415 cm2/week (standard deviation ± 0.383) for more expensive dressings. This resulted in a one-tailedpvalue of 0.251 and a two-tailedpvalue of 0.508. Multiple regression analysis gave a significanceFof 0.8134.Conclusion. The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection.

Patient and Physician Predictors of Peritoneal Dialysis Technique Failure: A Population Based, Retrospective Cohort Study

2011 ◽  
Vol 31 (5) ◽  
pp. 565-573 ◽  
Author(s):  
Mala Chidambaram ◽  
Joanne M. Bargman ◽  
Robert R. Quinn ◽  
Peter C. Austin ◽  
Janet E. Hux ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards Model ◽  
First Year ◽  
Patient Death ◽  
Technique Failure ◽  
Late Referral

BackgroundThe use of peritoneal dialysis (PD) has been declining over the past decade in Canada, and high technique failure rates have been implicated. Studies have examined clinical risk factors for PD technique failure, but few studies have addressed sociodemographic factors driving technique failure. There are no studies examining the effect of physician factors on technique failure.MethodsWe conducted a retrospective cohort study using Ontario healthcare databases from 1 April 1995 to 31 March 2005 to examine the effects of patient sociodemographic and physician characteristics on PD technique failure. The primary outcome was time to technique failure. Secondary outcomes included the proportion of patients experiencing technique failure during the first year and the proportion of patients experiencing death during the study period. A competing risks analysis was applied to the Cox proportional hazards model to determine the predictors of technique failure, death, and kidney transplantation.ResultsIn 5162 incident PD patients, the probability of technique success and patient survival at 5 years was 58.2% and 46.9% respectively. Of patients failing PD, 43.5% failed during the first year of treatment. Statistically significant predictors of technique failure included increasing age [hazard ratio (HR) 1.02], diabetes mellitus (HR 1.32), lower neighborhood education level (HR 2.93), and receiving transient (≤ 3 months) hemodialysis before starting PD (HR 1.24). Predictors of patient death included increasing age (HR 1.05), diabetes mellitus (HR 1.44), coronary artery disease (HR 1.26), congestive heart failure (HR 1.58), and late referral to the nephrologist (HR 1.27). Distance from treating dialysis center and residing in a rural area did not impact the risk of technique failure or death. Male physician gender increased the risk of technique failure (HR 1.31). Increased PD patient volume decreased the risk of technique failure (HR 0.98). None of the physician factors were predictors of patient death.ConclusionThese findings support the need for implementing strategies to reduce technique failure, which could include increasing educational resources for patients initiating PD, aggressive risk factor modification in patients with multiple comorbidities, and increasing physician awareness regarding the detrimental outcomes associated with late referral and late PD start.

scholarly journals Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates - a propensity score matched retrospective cohort study of 106 patients

2020 ◽  
Author(s):  
Christian Fang ◽  
Ruiping Liu ◽  
Dennis King Hang Yee ◽  
Jackie Chau ◽  
Tak-Wing Lau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Plate Fixation ◽  
Clinical Results ◽  
Shoulder Range Of Motion ◽  
Locking Compression Plates ◽  
Number Of Patients

Abstract Background: Plate fixation is frequently used to treat displaced midshaft clavicular fractures, however the ideal plate choice remains subject to discussion; reconstruction locking compression plates (RLCPs) are cheaper and can be easily contoured, whereas anatomically pre-contoured locking compression plates (ALCPs) are thought to provide better stability and therefore lower rates of mechanical failure.Objective: To compare the incidence of mechanical failures, functional and radiological outcomes in patients with midshaft clavicular fractures treated with ALCPs versus RLCPs. Methods: A propensity score matched retrospective cohort study was conducted across two trauma centers. 106 consecutively recruited patients with displaced midshaft clavicular fractures, who were treated with plate fixation and had a minimum follow-up of 6 months, were matched on gender, age, fracture grading, energy of injury, and fracture location. The resulting groups included 53 ALCP-treated fractures and 53 matched controls treated with RLCPs. Results: During a mean follow-up of 20.5 months, there were no implant deformities in the ALCP group whereas the RLCP group had 6 patients (11.3%, p=0.012) with implant deformities (5 occurrences of plate bending with fracture union, and 1 plate breakage with nonunion). Despite the higher rate of plate deformities in the RLCP group, there were no statistically significant differences in number of patients recovering full shoulder range of motion (ALCP 90.6%, RLCP 88.7%, p=0.751), incidence of rest pain (ALCP 13.2%, RLCP 9.4%, p=0.542), or implant removals (ALCP 49.1%, RLCP 56.6%, p=0.439). Conclusion: ALCPs may be superior to RLCPs in terms of implant stability but appear to produce similar clinical results.

The Predictive Applicability of Liberal vs Restrictive Intubation Criteria in Adult Patients With Suspected Inhalation Injury—A Retrospective Cohort Study

2020 ◽  
Vol 41 (6) ◽  
pp. 1290-1296
Author(s):  
Minesh Chotalia ◽  
Christine Pirrone ◽  
Thomas Mangham ◽  
Barbara Torlinska ◽  
Randeep Mullhi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Inhalation Injury ◽  
Adult Patients ◽  
Queen Elizabeth Hospital ◽  
Burn Patients ◽  
Prolonged Intubation ◽  
Number Of Patients ◽  
Highly Sensitive

Abstract This study compares the ability of liberal vs restrictive intubation criteria to detect prolonged intubation and inhalation injury in burn patients with suspected inhalation injury. Emerging evidence suggests that using liberal criteria may lead to unnecessary intubation in some patients. A single-center retrospective cohort study was conducted in adult patients with suspected inhalation injury admitted to intensive care at Queen Elizabeth Hospital, Birmingham between April 2016 and July 2019. Liberal intubation criteria, as reflected in local guidelines, were compared to restrictive intubation criteria, as outlined in the American Burn Association guidelines. The number of patients displaying positive characteristics from either guideline was compared to the number of patients who had prolonged intubation (more than 48 hours) and inhalation injury. In detecting a need for prolonged intubation (n = 85), the liberal criteria had greater sensitivity (liberal = 0.98 [0.94–1.00] vs restrictive = 0.84 [0.75–0.93]; P = .013). However, the restrictive criteria had greater specificity (restrictive = 0.96 [0.89–1.00] vs liberal = 0.48 [0.29–0.67]; P &lt; .001). In detecting inhalation injury (n = 72), the restrictive criteria were equally sensitive (restrictive = 0.94 [0.87–1.00] vs liberal = 0.98 [0.84–1.00]; P = .48) and had greater specificity (restrictive = 0.86 [0.72–1.00] vs liberal = 0.04 [0.00–0.13]; P &lt; .001). In patients who met liberal but not restrictive criteria, 65% were extubated within 48 hours and 90% did not have inhalation injury. Liberal intubation criteria were more sensitive at detecting a need for prolonged intubation, while restrictive criteria were more specific. Most patients intubated based on liberal criteria alone were extubated within 48 hours. Restrictive criteria were highly sensitive and specific at detecting inhalation injury.

scholarly journals Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e050131
Author(s):  
Lauren J Scott ◽  
Mairead Murphy ◽  
Sarah Price ◽  
Rhys Lewis ◽  
Rachel Denholm ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Face To Face ◽  
Number Of Patients ◽  
Potential Cancer ◽  
Remote Consultations

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

scholarly journals Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

2021 ◽  
pp. BJGP.2021.0125
Author(s):  
Karoline Freeman ◽  
Ronan Ryan ◽  
Nicholas Parsons ◽  
Sian Taylor-Phillips ◽  
Brian H Willis ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Electronic Patient Records ◽  
Faecal Calprotectin ◽  
Network Database ◽  
Number Of Patients ◽  
The Health Improvement Network

BackgroundFaecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown.AimTo characterise the use of FC testing for IBD in UK general practice.Design and settingA retrospective cohort study of routine electronic patient records from The Health Improvement Network database from UK general practice.MethodThe study included 6 965 853 adult patients (aged ≥18 years), between 2006 and 2016. FC test uptake, the patients tested, and patient management following testing were characterised.ResultsA total of 17 027 patients had 19 840 FC tests recorded. The mean age of tested patients was 44.2 years. The first FC tests were documented in 2009. FC test use was still increasing in 2016. By 2016, 66.8% (n = 493/738) of practices had started FC testing. About one-fifth (20.7%, n = 1253/6051) of tests were carried out in patients aged ≥60 years. Only 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing. Only 3.1% (n = 1720/55 477) of patients with eligible symptoms have received FC testing since the national recommendations were published. There was only a small number of patients with symptoms, FC test, and a IBD diagnosis. In total, 71.3% (n = 1416/1987) of patients with a positive and 47.7% (n = 1337/2805) with a negative FC test were referred or further investigated.ConclusionUptake of FC testing in clinical practice has been slow and inconsistent. The indication of non-compliance with national recommendations may suggest that these recommendations lack applicability to the general practice context.

scholarly journals Retrospective cohort study monitoring PEG-asparaginase activity in acute lymphoblastic leukemia patients with and without premedication

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1007
Author(s):  
Michael Losasso ◽  
Bruce Bostrom ◽  
Yoav Messinger
Keyword(s):  
Cohort Study ◽  
Acute Lymphoblastic Leukemia ◽  
Retrospective Cohort Study ◽  
Neutralizing Antibodies ◽  
Retrospective Cohort ◽  
Lymphoblastic Leukemia ◽  
Allergic Reactions ◽  
Number Of Patients ◽  
Before And After ◽  
Asparaginase Activity

Background: PEG-L-asparaginase (pegaspargase) is a critical component of therapy for children and adults with acute lymphoblastic leukemia (ALL). Allergic reactions, which may occur in up to one third of patients, are the major cause for discontinuation. One study reported lower rates of allergic reactions with premedication. Besides allergy, an unknown number of patients develop silent neutralizing antibodies not associated with allergic reactions. The purpose of this retrospective cohort study was to determine the incidence of silent inactivation of pegasparaginase and compare incidence of allergic reactions with and without premedication. Methods: Using a commercial assay, asparaginase activity was monitored following pegaspargase (2500 units/m2) in newly diagnosed children and young adults with B- and T-cell ALL from February 2013 to May 2017. The incidence of allergic reactions before and after initiation of premedication in May 2015 was compared. Results: One patient out of 59 (1.7%) had silent inactivation after the second dose. No patient had silent inactivation after the first pegaspargase dose and no standard risk B-cell ALL patients, who received only two pegaspargase doses in combination with oral dexamethasone, had silent inactivation. The incidence of grade 3 or 4 allergic reactions was 3.7% per dose with premedication (methylprednisolone, acetaminophen and diphenhydramine) versus 5.2% without.  The incidence per patient with premedication given for most of the doses was 8.3% versus 17% without. These values are not statistically significant. Premedication did not affect pegaspargase activity. Conclusions: Due to the low incidence of silent inactivation with intravenous pegaspargase and the unlikely event patients receiving only two doses of pegasparaginase would receive erwinase for this possible transient silent inactivation, we recommend routine monitoring of pegaspargase activity only in patients scheduled to receive more than two doses.

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