Seasonality of hyponatremia in hospitalized medical patients - data from a nationwide cohort study

2019 ◽  
Author(s):  
Clara O Sailer ◽  
Alexander Kutz ◽  
Fahim Ebrahimi ◽  
Ulrich Wagner ◽  
Philipp Schuetz
Keyword(s):  
Cohort Study ◽  
Medical Patients

Inter-observer reliability of a risk assessment model for venous thromboembolism in acutely-ill medical hospitalized patients: Results from a prospective cohort study

2021 ◽  
pp. 026835552110212
Author(s):  
Cassia RL Ferreira ◽  
Marcos de Bastos ◽  
Mirella L Diniz ◽  
Renan A Mancini ◽  
Yan S Raposo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Risk Classification ◽  
Assessment Model ◽  
Kappa Statistics ◽  
Medical Patients ◽  
Observer Reliability

Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for “immobilization”, to almost perfect (0.98; 95% CI 0.97-0.99) for “thrombophilia”; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

Association between presenting complaints of acutely admitted medical patients and mortality: A cohort study

2018 ◽  
Vol 54 ◽  
pp. e29-e32 ◽  
Author(s):  
Marie Krogh Nielsen ◽  
Daniel Pilsgaard Henriksen ◽  
Karin Brøchner Østergaard ◽  
Jan Dahlin ◽  
Mikkel Brabrand
Keyword(s):  
Cohort Study ◽  
Medical Patients

Associations and predictions of readmission or death in acutely admitted older medical patients using self-reported frailty and functional measures. A Danish cohort study

2018 ◽  
Vol 76 ◽  
pp. 65-72 ◽  
Author(s):  
Jane Andreasen ◽  
Mette Aadahl ◽  
Erik Elgaard Sørensen ◽  
Helle Højmark Eriksen ◽  
Hans Lund ◽  
...  
Keyword(s):  
Cohort Study ◽  
Medical Patients ◽  
Functional Measures ◽  
Danish Cohort

scholarly journals Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026881 ◽  
Author(s):  
Anette Tanderup ◽  
Jesper Ryg ◽  
Jens-Ulrik Rosholm ◽  
Annmarie Touborg Lassen
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Residential Care ◽  
Strong Predictor ◽  
Healthcare Services ◽  
Population Based ◽  
University Hospital ◽  
Secondary Outcome ◽  
Medical Patients

ObjectivesThis study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.DesignPopulation-based prospective cohort study.SettingED of a large university hospital.ParticipantsAll medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).Primary and secondary outcome measuresPatients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.ResultsA total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71–85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.ConclusionPrehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.

scholarly journals A prospective, observational, longitudinal cohort study of sedation practices in SGH intensive care units

2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yi Lin Lee ◽  
Kalyanasundaram Ganesh ◽  
Lian Kah Ti ◽  
Shin Yi Ng
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Early Period ◽  
Patient Comfort ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Medical Patients ◽  
Surgical Intensive Care ◽  
Icu Length Of Stay ◽  
Icu Discharge

Background: Critically ill patients require sedation for patient comfort and ventilator synchrony. Despite the extensive use of sedation, to date there is no consensus on the best sedation practices. We attempt to investigate our local sedation practices. Method: This was a single-centre prospective, observation cohort study in medical and surgical intensive care unit (ICU) patients who were ventilated and sedated for more than 24 hours. Baseline demographics were obtained and patients followed-up for 28 days or to ICU discharge. Details on sedatives, ventilation duration, vasopressors and renal replacement therapy use, hospital/ICU length of stay, mortality, delirium, and sedation depth were collected and analysed. Results: From March to July 2012, 58 patients were recruited with a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20.2 ±8.5. Hospital mortality rates were 32.8%. Patients were followed-up for 387 ICU patient-days. In the early period (first 48 h), the most popular sedative used was propofol (74.1%), followed by morphine (29.3%). In the subsequent period (>48 h), most patients were not sedated (47.6%); morphine became the most popular sedation drug (32.5%) followed by propofol (31%). Ketamine, haloperidol and diazepam were not given. In total, 1994 Richmond Agitation and Sedation Score (RASS) assessments were performed over 387 ICU patient-days; 11.1% of RASS assessments were prescribed a sedation target, and 86% of them met the prescribed targets. Delirium was observed in 22.4% of patients. Compared with medical patients, surgical patients were more likely to be prescribed a sedation target (14.2% vs. 7.4%, p<0.01), require lower doses of sedation, have a RASS score of between −2 to 1 (84.8% vs. 72.3%, p<0.01) and have fewer incidences of delirium (4.1% vs. 12.1%, p=0.01). Conclusion: Propofol and morphine were the most commonly prescribed sedatives. Different sedation practices between units may contribute to a reduction in delirium incidence.

Predictors of thromboprophylaxis in hospitalised medical patients

2015 ◽  
Vol 113 (05) ◽  
pp. 1127-1134 ◽  
Author(s):  
David Spirk ◽  
Mathieu Nendaz ◽  
Drahomir Aujesky ◽  
Daniel Hayoz ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Score ◽  
Low Risk ◽  
Medical Patients ◽  
Clinical Factors ◽  
Thromboembolic Risk ◽  
Factors Associated ◽  
Risk Patients

summaryBoth, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials. gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75–8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69–4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31–4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among highrisk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

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