scholarly journals Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors’ changeover

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Balinskaite Violeta ◽  
Bottle Alex ◽  
Aylin Paul
Keyword(s):  
Hospital Mortality ◽  
Estimating Equation ◽  
Equation Model ◽  
Hospital Episode Statistics ◽  
Emergency Admissions ◽  
Medical Graduates ◽  
Equation Analysis ◽  
Significant Change ◽  
The Impact ◽  
Rule Out

Abstract Background To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work. Methods Data on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality. Results There were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme. Conclusion There was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.

scholarly journals Impact of treatment with biologic DMARDs on the risk of sepsis or mortality after serious infection in patients with rheumatoid arthritis

2015 ◽  
Vol 75 (9) ◽  
pp. 1667-1673 ◽  
Author(s):  
A Richter ◽  
J Listing ◽  
M Schneider ◽  
T Klopsch ◽  
A Kapelle ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Renal Disease ◽  
Fatal Outcome ◽  
Estimating Equation ◽  
Equation Model ◽  
Biologic Dmards ◽  
Adjusted Risk ◽  
Serious Infection ◽  
Observational Cohort ◽  
The Impact

ObjectiveThis observational cohort study investigated the impact of biological (b) disease-modifying antirheumatic drugs (DMARDs) on the outcomes of serious infections (SIs) in patients with rheumatoid arthritis.MethodsWe investigated outcomes of SIs observed in 947 patients enrolled in the German biologics register RABBIT(Rheumatoid arthritis: observation of biologic therapy). Outcomes were (1) recovery without complication, (2) sepsis following SI (≤30 days), and (3) death after SI without known sepsis (≤90 days). We applied a multinomial generalised estimating equation model for longitudinal data to evaluate the risks of sepsis and death simultaneously.ResultsSepsis within 30 days after SI was reported in 135 out of 947 patients, 85 of these had a fatal outcome. Fifty-three patients died within 90 days after SI without known sepsis. The adjusted risk of developing sepsis increased with age and was higher in patients with chronic renal disease. Compared with conventional synthetic (cs)DMARDs, the risk was significantly lower when patients were exposed to bDMARDs at the time of SI (OR: 0.56, 95% CI 0.38 to 0.81). Risk factors of fatal SI were higher age, use of glucocorticoids at higher doses and heart failure. Patients treated with bDMARDs and those with better physical function had a significantly lower mortality risk.ConclusionsThese results suggest a beneficial effect of bDMARDs on the risk of sepsis after SI and the risk of a fatal outcome. Successful immunosuppression may prevent an unregulated host response to SI, that is, the escalation to sepsis. Further investigation is needed to validate these results.

scholarly journals Effect of different timescales of drought on water productivity of rain-fed winter wheat in arid and semi-arid regions

2021 ◽  
Author(s):  
Mohammad Mehdi Moghimi ◽  
Ali Shabani ◽  
Abdol Rasoul Zarei
Keyword(s):  
Winter Wheat ◽  
Arid Regions ◽  
Goodness Of Fit ◽  
Water Productivity ◽  
Correlation Coefficients ◽  
Estimating Equation ◽  
Equation Model ◽  
Drought Indices ◽  
The Impact ◽  
Semi Arid

Abstract This research aims at assessing the impact of drought (in the form of original and modified reconnaissance drought indices (ORDI and MRDI)) on water productivity of rainfed winter wheat in some arid and semi-arid regions of Iran. It focuses on different timescales of drought to determine which period of the year had the greatest significant impact. RDI was modified using the Food and Agriculture Organization of the United Nation method (FAO) (MRDI-1), US Bureau of Reclamation (USBR) (MRDI-2), the Simplified version of Soil Conservation Service of the US Department of Agriculture method (USDA-SCS-simplified) (MRDI-3), and the CROPWAT version of USDA-SCS method (USDA-SCS CROPWAT) (MRDI-4). Results showed that in Tabriz and Zanjan stations, 3-month scale of MRDI-2; in Ghazvin, Arak, and Kerman stations, 6-month scale of MRDI-4; in Sanandaj station, 12-month timescale of MRDI-3; and in Shiraz stations, 1-month timescale of MRDI-1 resulted in the highest values of correlation coefficients. According to the goodness-of-fit parameters, in Tabriz and Zanjan stations, MRDI-1; in Ghazvin, Arak and Kerman stations, MRDI-2; in Shiraz station, MRDI-3; and in Sanandaj station, ORDI resulted in the best generalized estimating equation model. These results can be useful to plann for the management of cultivation in impressive timescales.

scholarly journals The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores

2021 ◽  
Vol 13 (5) ◽  
pp. 643-649
Author(s):  
Janae K. Heath ◽  
C. Jessica Dine ◽  
Denise LaMarra ◽  
Serena Cardillo
Keyword(s):  
Internal Medicine ◽  
Communication Skills ◽  
Medical Training ◽  
Secondary Analysis ◽  
Internal Medicine Resident ◽  
Estimating Equation ◽  
Equation Model ◽  
Standardized Patient ◽  
Racial Concordance ◽  
The Impact

ABSTRACT Background Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated. Objective To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1. Methods We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores. Results There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs. Conclusions Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.

scholarly journals Effect of Practicing Health Behaviors on Unmet Needs among Patients with Chronic Diseases: A Longitudinal Study

2021 ◽  
Vol 18 (15) ◽  
pp. 7977
Author(s):  
Bich-Na Jang ◽  
Hwi-Jun Kim ◽  
Bo-Ram Kim ◽  
Seon-Yeong Woo ◽  
Woo-Jin Lee ◽  
...  
Keyword(s):  
Health Behaviors ◽  
Chronic Diseases ◽  
Unmet Needs ◽  
Estimating Equation ◽  
Correlated Data ◽  
Equation Analysis ◽  
Using Data ◽  
High Risk Drinking ◽  
The Impact

With the growing prevalence of chronic diseases, the proportion of unmet needs is increasing. In this study, we investigated the effect of practicing health behaviors on unmet needs among patients with chronic diseases, using data from the Korea Health Panel Survey conducted between 2014–2017. Participants (n = 4069) aged 19 or older, with at least one chronic disease (hypertension, diabetes mellitus, dyslipidemia, or arthrosis) and with existing follow up data were selected. Health behaviors combined three variables: not presently smoking, not belonging to high-risk drinking group, and indulging in moderate- or high-intensity exercise. Those who met all three criteria were classified as the practicing health behaviors group. Generalized Estimating Equation analysis was performed to consider correlated data within a subject. Of the participants, 23.9% practiced health behaviors. Participants who did not practice health behaviors were significantly more likely to have unmet needs compared with those who did (OR: 1.24, 95% CI: 1.10–1.39). Further research would be needed to verify the impact of practicing health behavior on unmet needs.

The Impact of Sociodemographic Factors and Emergency Admissions on the Place of Death of Gynecological Cancer Patients in England: An Analysis of a National Mortality–Hospital Episode Statistics–Linked Data Set

2018 ◽  
Vol 28 (9) ◽  
pp. 1714-1721
Author(s):  
Sonali Kaushik ◽  
Luke Hounsome ◽  
Catherine Blinman ◽  
Robert Gornall ◽  
Julia Verne
Keyword(s):  
Hospital Admissions ◽  
Gynecological Cancer ◽  
Sociodemographic Factors ◽  
Hospital Episode Statistics ◽  
Patient Choice ◽  
Place Of Death ◽  
Data Set ◽  
Emergency Admissions ◽  
Hospital Deaths ◽  
The Impact

ObjectiveThe aim of this study was to develop a predictive model for risk of death in hospital for gynecological cancer patients specifically examining the impact of sociodemographic factors and emergency admissions to inform patient choice in place of death.MethodsThe model was based on data from 71,269 women with gynecological cancer as underlying cause of death in England, January 1, 2000, to July 1, 2012, in a national Hospital Episode Statistics–Office for National Statistics database. Two thousand eight hundred eight deaths were used for validation of the model. Logistic regression identified independent predictors of a hospital death: adjusting for year of death, age group, income deprivation quintile, Strategic Health Authority, gynecological cancer site, and number of elective and emergency hospital admissions and respective total durations of stay.ResultsForty-three percent of deaths from gynecological cancer occurred in hospital. The variables significantly predicting death in hospital were less recent year of death (odds ratio [OR], 0.93; P < 0.001), increasing age (OR, 1.17; P < 0.001), increasing deprivation (OR, 1.06; P < 0. 001), increasing frequency and length of elective and emergency admissions (P < 0.001). The model correctly identified 73% of hospital deaths with a sensitivity of 75% and a specificity of 72%. The areas under the receiver operating curve were 0.78 for the predictive model and 0.71 for the validation data set. Each subsequent emergency admission in the last month of life increased the odds of death in hospital by 2.4 times (OR, 2.38; P < 0.001). Hospital deaths were significantly lower in all other regions compared with London. The model predicted a 16% reduction of deaths in hospital if 50% of emergency hospital admissions in the last month of life could be avoided by better community care.ConclusionsOur findings could enable identification of patients at risk of dying in hospital to ensure greater patient choice for place of death.

scholarly journals Impact of a community respiratory service on emergency hospital admissions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Levin ◽  
D Anderson ◽  
M Milligan ◽  
E Crighton
Keyword(s):  
Hospital Admissions ◽  
Emergency Admission ◽  
Primary Diagnosis ◽  
Relative Reduction ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
North East ◽  
Significant Change ◽  
The Impact

Abstract Background A community respiratory service was implemented in the North West of Glasgow in January 2013, comprising a team of physiotherapists, occupational therapists and support workers, to provide education, self-management advice, and, where appropriate, treatment at home, for COPD patients, to reduce the risk of hospital admission. This study measures the impact of the service on emergency admission to hospital. Methods COPD EAs were defined as emergency admissions to hospital with a primary diagnosis of COPD. Rate of COPD EAs per 1000 population aged 65 years+ in Glasgow City was compared before and after onset of the service, using segmented linear regression with 21-month pre- and 17-month post-intervention periods. COPD EAs for residents of South and North East Glasgow (S+NE) - areas with no such service in place - were used as a comparison group. The model adjusted for the rate of all-cause emergency admissions. Autoregressive terms were included in the model, as well as a fourier term to adjust for seasonality. Models were similarly run for outcome emergency admissions with COPD in any of the other five fields of diagnosis. Results Adjusting for all cause EAs and changes in S+NE, thus factoring out the impact of other initiatives that may have affected emergency admission to hospital, the impact of the service was found to be a level change of -0.33 (-0.51, -0.16) and a trend change of -0.03 (-0.05, -0.02) COPD EAs per 1000 per month. This is equivalent to a predicted reduction due to the service of -0.88 COPD EAs per 1000 popn per month, in March 2015, and a relative reduction of 35.8%. Rate of COPD EAs per month reduced over time after the introduction of the service (from the point of full staffing). Rate of EAs with COPD in a field of diagnosis other than primary saw no significant change in level or trend associated with the service. Conclusions The community respiratory service was associated with a significant reduction in the rate of COPD EAs. Key messages The Community Respiratory service was associated with reductions in emergency hospital admissions with COPD as a primary diagnosis. There was no significant change in emergency admissions with COPD as a secondary diagnosis, suggesting hospital attendance for patients with COPD overall reduced following the intervention.

scholarly journals The Impact of Transitions in Caregiving Status on Depressive Symptoms among Older Family Caregivers: Findings from the Korean Longitudinal Study of Aging

2020 ◽  
Vol 18 (1) ◽  
pp. 42
Author(s):  
Kyungduk Hurh ◽  
Hin Moi Youn ◽  
Yoon Sik Park ◽  
Eun-Cheol Park ◽  
Sung-In Jang
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Longitudinal Study ◽  
Family Caregivers ◽  
Depression Scale ◽  
Estimating Equation ◽  
Epidemiologic Studies ◽  
Equation Model ◽  
Significant Difference ◽  
The Impact

This study identifies the effects of transitions in caregiving status on depressive symptoms among middle-aged or older adults who care for family members with limitations in activities of daily living (ADL). Data were collected from the 2006–2018 Korean Longitudinal Study of Aging. A total of 7817 subjects were included. On the basis of their caregiving status transition, participants were categorized into four groups: started caregiving, continued caregiving, stopped caregiving, and noncaregivers. Depressive symptoms were measured using the 10 item Center for Epidemiologic Studies Depression Scale. Analysis using a generalized estimating equation model and subgroup analyses were conducted. Compared to noncaregivers, women who started caregiving showed more depressive symptoms in the following year (β 0.761, p < 0.0001). Regardless of sex, older adults who continued caregiving had more depressive symptoms than noncaregivers did (β 0.616, p < 0.0277 in men, and β 1.091, p < 0.0001 in women). After relinquishing caregiving responsibilities to other caregivers, participants’ depressive symptoms in the following year showed no statistically significant difference from that of noncaregivers. Thus, starting or continuing caregiving was associated with increased depressive symptoms, and those symptoms could be normalized by stopping caregiving. Intervention strategies to reduce family caregivers’ depressive symptoms are needed.

Impact of Disadvantaged Neighborhoods and Lifestyle Factors on Adult Obesity: Evidence From a 5-Year Cohort Study in Australia

2020 ◽  
Vol 35 (1) ◽  
pp. 28-37
Author(s):  
Syed Afroz Keramat ◽  
Khorshed Alam ◽  
Jeff Gow ◽  
Stuart J. H. Biddle
Keyword(s):  
Longitudinal Research ◽  
Estimating Equation ◽  
Lifestyle Factors ◽  
Equation Model ◽  
Adult Obesity ◽  
Disadvantaged Area ◽  
Disadvantaged Neighborhoods ◽  
Study Results ◽  
Health Decision ◽  
The Impact

Purpose: This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults. Design: Quantitative, longitudinal research design. Setting: Cohort. Sample: Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017. Measures: Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period. Results: Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers. Conclusion: This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.

scholarly journals Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes

2021 ◽  
Vol 19 (1) ◽  
pp. 423
Author(s):  
Stéphane Sanchez ◽  
Jan Chrusciel ◽  
Biné Mariam Ndiongue ◽  
Caroline Blochet ◽  
Jean François Forget ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Intervention Group ◽  
Routine Data ◽  
Estimating Equation ◽  
Equation Model ◽  
Risk Indicators ◽  
Control Group ◽  
Prescription Data ◽  
Target Drug ◽  
The Impact

Aim: The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. Methods: Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. Results: In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. Conclusion: This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.

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