scholarly journals Clinical Characteristics and Outcomes of Non-ICU Hospitalization for COVID-19 in a Nonepicenter, Centrally Monitored Healthcare System

2020 ◽  
Vol 16 (1) ◽  
pp. 7-14 ◽  
Author(s):  
David M Nemer ◽  
Bryan R Wilner ◽  
Alicia Burkle ◽  
Jose Aguilera ◽  
Joseph Adewumi ◽  
...  
Keyword(s):  
Health Care ◽  
Lactate Dehydrogenase ◽  
Health Care System ◽  
Clinical Characteristics ◽  
Multivariable Analysis ◽  
Severe Illness ◽  
C Reactive Protein ◽  
Oxygen Requirement ◽  
Reactive Protein ◽  
Care System

BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non-ICU) hospitalizations for coronavirus disease 2019 (COVID-19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non-ICU patient hospitalizations for COVID-19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off-site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high-flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C-reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01-1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001-1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C-reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory-related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high-risk patients.

scholarly journals Clinical characteristics of antimitochondrial antibody-positive patients at a safety net health care system in Arizona

2017 ◽  
Vol 4 (1) ◽  
pp. e000158 ◽  
Author(s):  
Susanna Tan ◽  
Napatkamon Ayutyanont ◽  
Bikash Bhattarai ◽  
Zohreh Movahedi ◽  
Lakshmi Jayaram ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Clinical Characteristics ◽  
Safety Net ◽  
Antimitochondrial Antibody ◽  
Care System

scholarly journals Comparison of the Clinical Characteristics of Hospital-Acquired and Non-Hospital-Acquired Acinetobacter calcoaceticus-baumannii Complex in a Large Midwest US Health Care System

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Juan J Calix ◽  
Jason P Burnham ◽  
Mario F Feldman
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Clinical Characteristics ◽  
Carbapenem Resistance ◽  
Acinetobacter Calcoaceticus ◽  
Resistance Rates ◽  
Hospital Acquired ◽  
Large Health Care System ◽  
Care System

Abstract We retrospectively compared the clinical characteristics of hospital-acquired (HA) vs non-hospital-acquired (nHA) Acinetobacter calcoaceticus-baumannii complex isolates in a large health care system in St. Louis, Missouri, from 2007 to 2017. More than 60% of the total isolates were nHA; they were predominantly from nonrespiratory sources and exhibited ~40% carbapenem resistance rates and stably persisted, though HA occurrence waned.

scholarly journals Role of Nasopharyngeal lactate dehydrogenase as a possible economical mass screening test for the detection and segregation of SARS-CoV-2 (COVID-19) cases in India

2020 ◽  
Vol 72 ◽  
pp. 21-24 ◽  
Author(s):  
Mukul Arvind Gharote
Keyword(s):  
Health Care ◽  
Lactate Dehydrogenase ◽  
Health Care System ◽  
Mass Screening ◽  
Screening Test ◽  
Clinical Presentation ◽  
Respiratory Infections ◽  
Upper Respiratory ◽  
Care System

COVID-19 pandemic is affecting almost every country in the world. Every country must test all the individuals with suspected clinical presentation of COVID-19. Unfortunately, the symptoms are mild and often the incubation period is 5–7 days. Hence, the detection of COVID-19 takes time and is costly even, many resource-constrained nations are not testing their citizens due to cost incurred. That is why we need an economical mass screening test to detect and help the health-care system to segregate cases needing their attention. Nasopharyngeal lactate dehydrogenase (LDH) is raised in viral upper respiratory infections, it can be easily tested and raised serum LDH in addition to nasopharyngeal LDH can predict stormy outcome of disease. Such prediction will help health-care system for effective resource allocation.

Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System

2021 ◽  
Vol 41 (2) ◽  
pp. 120-132
Author(s):  
Kevin D. Li ◽  
Christopher S. Saigal ◽  
Megha D. Tandel ◽  
Lorna Kwan ◽  
Moira Inkelas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Decision Making ◽  
Health Care System ◽  
Clinical Characteristics ◽  
Implementation Strategies ◽  
Shared Decision ◽  
Implementation Outcomes ◽  
Academic Center ◽  
Care System

Background Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. Methods We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. Results Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients’ records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. Conclusions Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.

scholarly journals Anaemia is Associated with Severe Illness in COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Zheying Tao ◽  
Mingyu Liu ◽  
Jingyi Wu ◽  
Jing Xu ◽  
Wei Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Virus Disease ◽  
Severe Illness ◽  
C Reactive Protein ◽  
Severe Condition ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Reactive Protein ◽  
The Impact ◽  
The Relationship

Abstract Background and objective:Anaemia commonly aggravates the severity of respiratory diseases, whereas thus far, no study has elucidated the impact of anaemiaonCorona Virus Disease 2019(COVID-19). The aim of this study was to evaluate the clinical characteristics of patients with anaemia, and to further explore the relationship between anaemiaand the severity of COVID-19.METHODS:In this single-center, retrospective, observational study, a total of 222 patients were recruited, including 79 patients with anaemia and 143 patients without anaemia. Clinical characteristics, laboratory findings, disease progression and prognosis were collected and analyzed. Risk factors associated with the severe illness in COVID-19were established by univariable and multivariable logistic regression models.Result：In our cohort, compared to patients without anaemia, patients with anaemia were more likely to experience one or more comorbidities and severe COVID-19 illness, as well as higher mortality. More patients demonstrated elevated levels of C-reactive protein (CRP), procalcitonin(PCT) and creatinine in anaemia group. Levels of erythrocyte sedimentation rate(ESR), D-dimer, myoglobin, T-pro brain natriuretic peptide(T-pro-BNP) and urea nitrogen(BUN)in patients with anaemia were significantly higher than those without. In addition,the proportion of patients with dyspnoea，elevated CRP and PCT was positively associated with the severity of anaemia. The Odd Ratio (OR) of anaemia related to the severe condition of COVID-19 was 5.07 (95% CI:1.82-14.18, P=0.002) and 3.47 (95% CI:1.02-11.75, P=0.046) after adjustment for baseline date and laboratory indices, respectively.Conclusion:Anaemia is an independent risk factor associated with the severe illness of COVID-19, and healthcare professionals should be more sensitive to the haemoglobin levels of COVID-19 patients on admission. To avoid rapid deterioration, more intensive care should be given to patients with anaemia.Trial registration: Ethics committee of Wuhan University People's Hospital (wdry2020-k064)

Association of Respiratory Picornaviruses With High Acuity and Severe Illness in a Pediatric Health Care System

2015 ◽  
Vol 5 (8) ◽  
pp. 432-438
Author(s):  
K. E. Fleming-Dutra ◽  
H. K. Simon ◽  
J. D. Fortenberry ◽  
R. Jerris ◽  
J. Radecke ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Severe Illness ◽  
Pediatric Health ◽  
Pediatric Health Care ◽  
High Acuity ◽  
Care System

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

What is the best way to reform the U.S. health care system?

2007 ◽  
Vol 38 (1) ◽  
pp. 18
Author(s):  
KEVIN GRUMBACH ◽  
ROBERT MOFFIT
Keyword(s):  
Health Care ◽  
Health Care System ◽  
The U.S ◽  
Care System
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