scholarly journals Blood Transfusion Trends in the United States, National Inpatient Sample, 2015-2018

2021 ◽  
Author(s):  
Ruchika Goel ◽  
Xianming Zhu ◽  
Eshan U. Patel ◽  
Elizabeth Patricia Crowe ◽  
Paul M. Ness ◽  
...  
Keyword(s):  
The United States ◽  
Evidence Base ◽  
National Inpatient Sample ◽  
Pediatric Age Group ◽  
Binomial Regression ◽  
Therapeutic Procedures ◽  
Admission Type ◽  
National Trends ◽  
Robust Evidence ◽  
Inpatient Database

Blood transfusions are among the most common therapeutic procedures performed in hospitalized patients. This study evaluates contemporary national trends in RBC, plasma, platelet and cryoprecipitate transfusions. National Inpatient Sample (NIS), the largest all-payer inpatient database representing 94-97% of US population, was evaluated from the 4th quarter of 2015 through 2018. Quarterly trends for the percentage of hospitalizations with a transfusion procedure were separately examined for each blood product using log binomial regression and reported as quarterly percent change (QPC). The percentage of hospitalizations with a RBC transfusion decreased from 4.22% (2015Q4) to 3.79% (2018Q4) (QPC=-0.72[95%CI=-1.26, -0.19]; Ptrend=0.008). While plasma transfusions also decreased QPC=-1.33(95%CI=-2.00, 0.65;Ptrend<0.001), platelet transfusions remained stable QPC=-0.13[95%CI=-0.99,0.73]; Ptrend=0.766). In contrast, hospitalizations with cryoprecipitate utilization significantly increased QPC=2.01(95%CI=0.57,3.44; Ptrend=0.006). Significant quarterly reductions in RBC transfusions were also seen among many -but not all- strata of sex, race/ethnicity, patient risk-severity, and admission type (elective versus non-elective). Despite significant declines in RBC transfusions among older adults, there were no significant changes among pediatric age-group (<18-years) and those 18-49 years. The decline in RBC and plasma transfusions suggests steady incorporation of robust evidence base showing safety of restrictive transfusions. Increased cryoprecipitate use may be reflective of wider adoption of hypofibrinogenemia management and hemostasis testing for coagulopathic patients.

scholarly journals Establishing Credibility for Medical Marijuana: The Proposed Prometheus Dispensary Registry for Botanical Cannabis

2019 ◽  
Vol 10 (1) ◽  
pp. 2
Author(s):  
Paul Langley
Keyword(s):  
Randomized Clinical Trials ◽  
Medical Marijuana ◽  
Good Clinical Practice ◽  
The United States ◽  
Evidence Base ◽  
Severe Nausea ◽  
Dosing Regimens ◽  
Medical Marijuana Dispensaries ◽  
Delivery Options ◽  
Robust Evidence

A previous commentary in INNOVATIONS in Pharmacy argued that, given the lack of evidence for outcomes in medical marijuana, outside of a handful of randomized clinical trials and even fewer observational studies, good clinical practice points to the need for monitoring patients who received cannabis through certified medical marijuana dispensaries. The commentary noted the lack of standards for monitoring cannabis patients and the lack of feedback from the dispensary to providers. Botanical cannabis administration was occurring in, effectively, an evidence vacuum. More to the point, dispensary owners and investors seem uninterested in establishing a robust evidence base for cannabis outcomes.  Given the range of conditions and symptoms presented by patients, to include the prevalence of multiple symptoms together with the range of potential cannabis formulations, dosing regimens and delivery options, a failure to monitor patients over the course of their exposure to cannabis in not acceptable. The purpose of this commentary is to report on a proposed on-line registry structure proposed by Prometheus Research for medical marijuana dispensaries in the US. The registry tracks and reports on patients over the course of treatment with botanical cannabis with the focus on severe or chronic non-cancer pain, severe nausea, persistent muscle spasms and seizures, together with prevalent comorbidities – fatigue, anxiety, depression and sleep. This is the first time a registry has been developed for dispensaries in the United States as a model for a robust evidence base to support botanical cannabis as a therapy option.   Article Type: Commentary

National Trends in Surgical Resection of Vestibular Schwannomas

2020 ◽  
Vol 163 (6) ◽  
pp. 1244-1249
Author(s):  
Yin Ren ◽  
Rosh K. V. Sethi ◽  
Konstantina M. Stankovic
Keyword(s):  
Surgical Resection ◽  
The United States ◽  
Population Based ◽  
Hospital Charges ◽  
Future Research ◽  
Seer Database ◽  
Surgical Volume ◽  
National Inpatient Sample ◽  
Discharge Patterns ◽  
National Trends

Objective To characterize the national trend for surgical resection of vestibular schwannoma (VS) and to assess changes in demographics, length of stay (LOS), discharge patterns, and hospital charges. Study Design Population-based inpatient registry analysis. Setting National Inpatient Sample and SEER database (Surveillance, Epidemiology, and End Results). Patients and Methods Retrospective review of the US National Inpatient Sample and the SEER database from 2001 to 2014 of all patients who underwent resection of VS. Results A total of 24,380 VS resections were performed. While the annual incidence of VS remained stable at 1.38 per 100,000, surgical volume declined by 36.1%, from 2807 in 2001 to 1795 in 2014 ( R2 = 0.58). Total hospital charges more than doubled, from $52,475 in 2001 to $115,164 in 2014 ($4478 per year, R2 = 0.96). While most procedures were performed at large-sized hospitals, this decreased from 89% in 2002 to 75.8% in 2014. Average LOS remained stable at 5.2 days during the study period. The number of discharges to a nursing facility increased from 113 (5.5%) in 2002 to 245 (13.6%) in 2014 ( P = .0002). Conclusion VS resection has evolved in the United States. While the incidence remained stable, surgical volume decreased by 36%, and hospital charges more than doubled. More cases are being performed at smaller hospitals. Although LOS did not vary significantly, there is an increase in nonroutine discharges. These data may guide future research in resource utilization in neurotology.

A Subtle but Intractable Problem? Public Attitudes to Sectarianism in 2014

2015 ◽  
Vol 24 (3) ◽  
pp. 266-287 ◽  
Author(s):  
Rachel Ormston ◽  
John Curtice ◽  
Stephen Hinchliffe ◽  
Anna Marcinkiewicz
Keyword(s):  
Public Opinion ◽  
Public Attitudes ◽  
Evidence Base ◽  
Social Attitudes ◽  
The Public ◽  
Public Beliefs ◽  
Intractable Problem ◽  
Robust Evidence

Discussion of sectarianism often focuses on evidence purporting to show discriminatory behaviour directed at Catholics or Protestants in Scotland. But attitudes also matter – in sustaining (or preventing) such discriminatory behaviours, and in understanding the nature of the ‘problem of sectarianism’ from the perspective of the Scottish public. This paper uses data from the Scottish Social Attitudes survey 2014. The survey fills a gap in the evidence base by providing robust evidence on what the public actually thinks about sectarianism in modern Scotland. It assesses public beliefs about the extent and nature of sectarianism and its perceived causes. Tensions in public opinion and differences in the attitudes of different sections of Scottish society are explored.

scholarly journals Su1597 – Increasing Inpatient Burden of Constipation and Its Relation to Opioid Use: National Trends in the United States

2019 ◽  
Vol 156 (6) ◽  
pp. S-577
Author(s):  
Eula P. Tetangco ◽  
Supannee Rassameehiran ◽  
George Tan ◽  
Humberto Sifuentes
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use ◽  
National Trends

Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

2021 ◽  
pp. 019459982098070
Author(s):  
Habib Khoury ◽  
Shaghauyegh S. Azar ◽  
Hannah Boutros ◽  
Nina L. Shapiro
Keyword(s):  
Health Care ◽  
Financial Burden ◽  
Preoperative Assessment ◽  
Health Care Expenditures ◽  
The United States ◽  
Postoperative Hemorrhage ◽  
International Classification Of Disease ◽  
Neurologic Disorders ◽  
Common Causes ◽  
National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

scholarly journals Caring for Older Patients With Cancer: Estimates of the Prevalence, Burden, and Unmet Needs of Caregivers in the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 690-690
Author(s):  
Erin Kent
Keyword(s):  
Family Caregivers ◽  
Older Patients ◽  
Unmet Needs ◽  
The United States ◽  
Population Based ◽  
Data Sources ◽  
Behavioral Risk ◽  
Ripple Effect ◽  
The Us ◽  
National Trends

Abstract In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey (HINTS, 2017-2019), the Behavioral Risk Factors Surveillance System (BRFSS, 2015-2019), and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers.

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