scholarly journals Supine-Related Pseudoanemia in Hospitalized Patients

2021 ◽  
Author(s):  
Arsalan Derakhshan ◽  
Reza Manesh ◽  
Bennett A Peterson ◽  
Bibhu D Mohanty ◽  
Thomas S Kickler ◽  
...  
Keyword(s):  
General Medicine ◽  
Hemoglobin Concentration ◽  
Hospitalized Patients ◽  
Blood Constituents ◽  
Vascular Space ◽  
Supine Posture ◽  
Quasi Experimental ◽  
Hospital Acquired ◽  
Relative Change ◽  
Unnecessary Testing

A patient’s supine posture redistributes plasma into the vascular space, leading to dilution of blood constituents. The extent to which posture may influence identification of hospital-acquired anemia is unknown. Patients in this quasi-experimental study had blood obtained for hemoglobin measurement while recumbent for at least 6 hours, and then again after sitting upright for at least 1 hour. Of the 35 patients who completed the study, 13 were women (37%). Patients had a median increase in hemoglobin of 0.60 g/dL (range, –0.6 to 1.4 g/dL) with sitting, a 5.2% (range, (–4.5% to 15.1%) relative change (P < .001). Ten of 35 patients (29%) exhibited an increase in hemoglobin of 1.0 g/dL or more. Posture influences hemoglobin levels in hospitalized patients on general medicine wards; this knowledge may help curb unnecessary testing to evaluate small changes in hemoglobin concentration.

How fluoroquinolone preauthorization affects third- and fourth-generation cephalosporin use and resistance in a large academic hospital

2021 ◽  
pp. 1-12
Author(s):  
Adeniyi J. Idigo ◽  
Matthew L. Brown ◽  
Howard W. Wiener ◽  
Russell L. Griffin ◽  
Yuanfan Ye ◽  
...  
Keyword(s):  
Regression Models ◽  
Interrupted Time Series ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Academic Hospital ◽  
Gram Negative ◽  
Hospital Acquired Infections ◽  
Quasi Experimental ◽  
Hospital Acquired

Abstract Objective: We observed an overall increase in the use of third- and fourth-generation cephalosporins after fluoroquinolone preauthorization was implemented. We examined the change in specific third- and fourth-generation cephalosporin use, and we sought to determine whether there was a consequent change in non-susceptibility of select Gram-negative bacterial isolates to these antibiotics. Design: Retrospective quasi-experimental study. Setting: Academic hospital. Intervention: Fluoroquinolone preauthorization was implemented in the hospital in October 2005. We used interrupted time series (ITS) Poisson regression models to examine trends in monthly rates of ceftriaxone, ceftazidime, and cefepime use and trends in yearly rates of nonsusceptible isolates (NSIs) of select Gram-negative bacteria before (1998–2004) and after (2006–2016) fluoroquinolone preauthorization was implemented. Results: Rates of use of ceftriaxone and cefepime increased after fluoroquinolone preauthorization was implemented (ceftriaxone RR, 1.002; 95% CI, 1.002–1.003; P < .0001; cefepime RR, 1.003; 95% CI, 1.001–1.004; P = .0006), but ceftazidime use continued to decline (RR, 0.991, 95% CI, 0.990–0.992; P < .0001). Rates of ceftazidime and cefepime NSIs of Pseudomonas aeruginosa (ceftazidime RR, 0.937; 95% CI, 0.910–0.965, P < .0001; cefepime RR, 0.937; 95% CI, 0.912–0.963; P < .0001) declined after fluoroquinolone preauthorization was implemented. Rates of ceftazidime and cefepime NSIs of Enterobacter cloacae (ceftazidime RR, 1.116; 95% CI, 1.078–1.154; P < .0001; cefepime RR, 1.198; 95% CI, 1.112–1.291; P < .0001) and cefepime NSI of Acinetobacter baumannii (RR, 1.169; 95% CI, 1.081–1.263; P < .0001) were increasing before fluoroquinolone preauthorization was implemented but became stable thereafter: E. cloacae (ceftazidime RR, 0.987; 95% CI, 0.948–1.028; P = .531; cefepime RR, 0.990; 95% CI, 0.962–1.018; P = .461) and A. baumannii (cefepime RR, 0.972; 95% CI, 0.939–1.006; P = .100). Conclusions: Fluoroquinolone preauthorization may increase use of unrestricted third- and fourth-generation cephalosporins; however, we did not observe increased antimicrobial resistance to these agents, especially among clinically important Gram-negative bacteria known for hospital-acquired infections.

scholarly journals Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

2019 ◽  
Vol 317 (4) ◽  
pp. G447-G452
Author(s):  
Kavish R. Patidar ◽  
Pranav S. Garimella ◽  
Etienne Macedo ◽  
James E. Slaven ◽  
Marwan S. Ghabril ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Predictive Biomarker ◽  
Hospitalized Patients ◽  
Susceptible Population ◽  
Baseline Creatinine ◽  
Low Levels ◽  
Time Of Admission ◽  
Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

scholarly journals Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital

2010 ◽  
Vol 52 (3) ◽  
pp. 133-137 ◽  
Author(s):  
M. Beatriz Souza Dias ◽  
Juliana Yamashiro ◽  
Vera L. Borrasca ◽  
Valeska A. Stempliuk ◽  
Maria Rita E. Araújo ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Acute Onset ◽  
Hospitalized Patients ◽  
Diagnostic Methods ◽  
Care Hospital ◽  
Toxin A ◽  
Patient Admissions ◽  
Positive Stool ◽  
Hospital Acquired ◽  
Present On Admission

The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.

scholarly journals Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

2018 ◽  
Vol 6 (1) ◽  
pp. e000607 ◽  
Author(s):  
Saumeth Cardona ◽  
Patricia C Gomez ◽  
Priyathama Vellanki ◽  
Isabel Anzola ◽  
Clementina Ramos ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Characteristics ◽  
Glycosylated Hemoglobin ◽  
General Medicine ◽  
Signs And Symptoms ◽  
Male Gender ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Insulin Regimen ◽  
Patients With Diabetes

ImportanceThe frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.ObjectiveWe determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.Research design and methodsProspective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.ResultsAmong 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4–14) vs 7 days (IQR 5–15), p=0.92)) between groups.ConclusionsAsymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.

scholarly journals Study of a multisite prospective adverse event surveillance system

2019 ◽  
Vol 29 (4) ◽  
pp. 277-285 ◽  
Author(s):  
Alan J Forster ◽  
Allen Huang ◽  
Todd C Lee ◽  
Alison Jennings ◽  
Omer Choudhri ◽  
...  
Keyword(s):  
Adverse Event ◽  
Prospective Observational Study ◽  
General Medicine ◽  
Surveillance Period ◽  
Expert Review ◽  
Clinical Procedures ◽  
Hospital Safety ◽  
Surveillance Method ◽  
Hospital Acquired ◽  
Rule Out

BackgroundWe have designed a prospective adverse event (AE) surveillance method. We performed this study to evaluate this method’s performance in several hospitals simultaneously.ObjectivesTo compare AE rates obtained by prospective AE surveillance in different hospitals and to evaluate measurement factors explaining observed variation.MethodsWe conducted a multicentre prospective observational study. Prospective AE surveillance was implemented for 8 weeks on the general medicine wards of five hospitals. To determine if population factors may have influenced results, we performed mixed-effects logistic regression. To determine if surveillance factors may have influenced results, we reassigned observers to different hospitals midway through surveillance period and reallocated a random sample of events to different expert review teams.ResultsDuring 3560 patient days of observation of 1159 patient encounters, we identified 356 AEs (AE risk per encounter=22%). AE risk varied between hospitals ranging from 9.9% of encounters in Hospital D to 35.8% of encounters in Hospital A. AE types and severity were similar between hospitals—the most common types were related to clinical procedures (45%), hospital-acquired infections (21%) and medications (19%). Adjusting for age and comorbid status, we observed an association between hospital and AE risk. We observed variation in observer behaviour and moderate agreement between clinical reviewers, which could have influenced the observed rate difference.ConclusionThis study demonstrated that it is possible to implement prospective surveillance in different settings. Such surveillance appears to be better suited to evaluating hospital safety concerns within rather than between hospitals as we could not definitively rule out whether the observed variation in AE risk was due to population or surveillance factors.

scholarly journals Hospital-Acquired Dysmagnesemia and In-Hospital Mortality

2020 ◽  
Vol 8 (3) ◽  
pp. 37 ◽  
Author(s):  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Api Chewcharat ◽  
Tananchai Petnak ◽  
Michael A. Mao ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Serum Magnesium ◽  
Normal Serum ◽  
Hospitalized Patients ◽  
Normal Range ◽  
Multivariable Logistic Regression ◽  
Hospital Acquired

Background and Objectives: This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. Materials and Methods: We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7–2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. Results: 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; p < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; p < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; p < 0.001) were significantly associated with higher in-hospital mortality. Conclusions: Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality.

Relation between debrisoquine oxidation phenotype and morphological, biological, and pathological variables in a large population

1991 ◽  
Vol 37 (3) ◽  
pp. 327-332 ◽  
Author(s):  
M Vincent-Viry ◽  
J Muller ◽  
B Fournier ◽  
M M Galteau ◽  
G Siest
Keyword(s):  
Large Population ◽  
Hemoglobin Concentration ◽  
Poor Metabolizers ◽  
Mean Corpuscular Hemoglobin ◽  
Extensive Metabolizers ◽  
Mean Cell Volume ◽  
Factors Affecting ◽  
Blood Constituents ◽  
Debrisoquine Oxidation ◽  
Oxidation Phenotype

Abstract Factors affecting biological variations in debrisoquine-oxidation polymorphism were investigated in a population of 3065 unrelated supposedly healthy Caucasian subjects, ages 35 to 50 years. This population, including 1526 men and 1539 women, was used to determine whether the debrisoquine-oxidation phenotype can be related with environmental factors such as alcohol intake, smoking habits or medication; with morphological variables; or with 22 blood constituents and some pathological states. A single dose of 10 mg of debrisoquine sulfate was administered to determine the oxidation phenotype. A metabolic ratio (debrisoquine/4-hydroxydebrisoquine) of 10.0 defined a poor metabolizer [frequency of 8.2% (SD 1.0%)] in this sample. Dose recoveries of debrisoquine excretion (mean and SD) were 8.9% (11.9%) and 45.1% (32.2%) in extensive and poor metabolizers, respectively. The mean (SD) amount of debrisoquine administered that was excreted in urine as 4-hydroxydebrisoquine was 17.4% (17.3%) in extensive metabolizers and 0.5% (0.9%) in poor metabolizers. The main factors differing significantly between poor and extensive metabolizers were mean cell volume, mean corpuscular hemoglobin concentration, albumin, and ponderal index. No other blood constituents (e.g., cholesterol, glucose) differed between poor and extensive metabolizers. The lack of correlation with most of the variables tested is of interest in clinical trials, because our findings indicate that no subgroups will be required, making selection of subjects easier.

Sign in / Sign up

Export Citation Format

Share Document