scholarly journals Association Between The Discharge Process And Post-Discharge Events In Patients With Heart Failure

2022 ◽  
Author(s):  
Kyoung Suk Lee ◽  
Hyeongsuk Lee ◽  
Na Eun Min ◽  
Jae-Hyeong Park
Keyword(s):  
Regression Model ◽  
Protective Factor ◽  
Cox Regression ◽  
Emergency Department Visits ◽  
Educational Activity ◽  
Discharge Process ◽  
Family Participation ◽  
Post Discharge ◽  
Modifiable Factors ◽  
Educational Contents

Abstract Background: HF is a burden on healthcare resources due to the high cost of frequent readmissions. Predictive models have been reported for the post-discharge prognosis of HF. However, these models mostly included non-modifiable factors and their predictive accuracy was limited. This implies that potentially modifiable factors are needed, which could be attributed to the discharge process. This study aimed to explore the relationship between the discharge process and post-discharge events in patients with HF.Methods: Medical records were reviewed to identify patients who were admitted for HF exacerbation. Information related to the discharge process included post-discharge clinic appointments, educational contents before discharge, and family participation during patient education. HF-related events were defined as a composite of events, including emergency department visits, readmissions, or death. A multivariable Cox proportional hazards regression model was used to explore the association between the discharge process and HF-related events.Results: Of 201 patients, 41 had at least one HF-related event. Post-discharge clinic appointments were scheduled 8 days after discharge. Patients received their discharge education on average of one topic, and approximately the families of 70% of the patients participated in this educational activity. In the Cox regression model, family participation during education was independently associated with a longer time to HF events (hazard ratio: 2.105). However, and post-discharge follow-up appointments and the number of educational contents received were not associated with the time to HF events. Conclusion: We found that family participation during education is a protective factor for adverse prognosis in patients with HF. Our results highlight the importance of family engagement in HF management.

scholarly journals Prosthetic complications of fixed dental prostheses supported by locking-taper implants: A retrospective study with a mean follow-up of 5 years.

2021 ◽  
Author(s):  
Wen Mo Gao ◽  
Wei Geng ◽  
Chen Chen Luo
Keyword(s):  
Retrospective Study ◽  
Bone Loss ◽  
Regression Model ◽  
Protective Factor ◽  
Cox Regression ◽  
Marginal Bone Loss ◽  
Cox Regression Model ◽  
Prosthetic Complications ◽  
Free Rate

Abstract Background: Restoration with locking-taper implants is a widely used methodology. However, relatively few have examined conical connection systems like locking-taper implant systems. This study provides a retrospective study of locking-taper fixed restorations, mainly focused on prosthetic complications.Methods: All patients who underwent conical connected implants from 2008–2010 were examined. Preparation of the implant sites was performed according to the standard procedures for the Bicon system. The bone healing took over 6 months, and the prosthetic procedure was initiated thereafter. Integrated abutment crowns or gold porcelain crowns were used, and the prosthesis type was a single crown or a fixed dental prosthesis. Once the crown was in place, its occlusion was thoroughly checked and adjusted, and then the crown was glazed or finely polished. The Kaplan-Meier method was used to calculate the cumulative complication-free rates for 5 and 10 years. Additionally, a Cox regression model was used to identify the factors that independently influenced the results. Implant survival and marginal bone loss were also investigated.Results: A total of 392 patients who underwent 541 implants and 434 locking taper implant-based restorations from 2008–2010 were examined. The overall 5-year cumulative complication-free rate was 83.34%. The most common prosthetic complication was veneer chipping, with a frequency of 67.53%. According to the Cox regression model, the complication-free rate of integrated abutment crowns was significantly higher than gold porcelain crowns, molar regions was significantly higher than premolar regions, and females was significantly higher than males. Only three implant failures happened, and a mean marginal bone loss at 1- year, 5-year and 10- year was 0.25mm（95%CI：±0.12）, 0.40mm （95%CI：±0.03）and 0.51mm（95%CI：±0.05）, respectively.Conclusion: Veneer chipping was the most common complication with locking-taper implants supported fixed restorations. According to the result of Cox regression model, gold porcelain crowns are a protective factor relative to integrated abutment crowns, male sex is a protective factor relative to female sex, and premolar prosthetics are a protective factor relative to molar prosthetics. The long-term clinical effect of locking-taper implant is stable, and the implant success rate can meet the clinical needs. The bone tissue level around the implant can maintain long-term stability.

scholarly journals The Relationship Between Patient Satisfaction With Hospitalization and Outcomes Up to 6 Months Post-Discharge in Cardiac Patients

2020 ◽  
Vol 7 (6) ◽  
pp. 1685-1692
Author(s):  
Paige M Anderson ◽  
Rachel Krallman ◽  
Daniel Montgomery ◽  
Eva Kline-Rogers ◽  
Sherry M Bumpus
Keyword(s):  
Patient Satisfaction ◽  
Hospital Staff ◽  
Emergency Department Visits ◽  
Cardiac Patients ◽  
Discharge Process ◽  
Post Discharge ◽  
Discharge Outcomes ◽  
System Improvement ◽  
Care Satisfaction ◽  
The Relationship

Little is known about the relationship between patient satisfaction with inpatient care and post-discharge outcomes. This study examined inpatient hospital satisfaction after a cardiac event and outcomes through 6 months post-discharge. We examined 327 cardiac patients from the Bridging the Discharge Gap Effectively database who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process correlated with fewer readmissions at 90 days post-discharge. Higher patient satisfaction with hospital staff management of personal issues correlated with fewer emergency department visits at 6 months post-discharge. Higher patient satisfaction with overall assessment of care and hospitalization correlated with lower mortality rate at 6 months post-discharge. Being nonwhite correlated with lower nursing care satisfaction. Associations between cardiac patient satisfaction and outcomes exist. In this population, higher patient satisfaction correlated with better outcomes. Patient satisfaction data may be able to inform areas for health system improvement.

scholarly journals Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jaurès Kamgang ◽  
Francklin Tétinou ◽  
Yvan Zolo ◽  
Chee Yang Tan ◽  
Christian Wambo ◽  
...  
Keyword(s):  
Regression Model ◽  
Case Control Study ◽  
Cox Regression ◽  
Case Control ◽  
Abdominal Circumference ◽  
Stroke Recurrence ◽  
Stroke Event ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Control Study

Introduction. Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods. We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors’ institution as of January 15, 2019. Wilcoxon signed-rank and Fisher’s exact tests were used. Also, a Cox regression model was used to identify confounders.Results. We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out of five had diabetes. Most patients presented with their first stroke event, and a quarter had a stroke recurrence. Stroke recurrence was associated with right handedness (OR = 0.23, 95% CI = 0.16–0.33), congestive heart failure (OR = 3.45, 95% CI = 1.16–10.28), gout (OR = 4.34, 95% CI = 1.09–18.09), dysarthria (OR = 4.34, 95% CI = 1.30–14.54), and facial palsy (OR = 3.96, 95% CII = 1.49 – 10.51), as well as modifiable factors such as elevated abdominal circumference (P < 0.01), systolic blood pressure (P < 0.01), blood glucose level (PI <I 0.01), LDL cholesterol (P < 0.01), and triglyceride levels (P < 0.01). The mulitvariable regression model only identified laterality (B = –1.48, P = 0.04) as a statistically significant explanatory varibale for stroke recurrence. Conclusion. We mapped the landscape of recurrent strokes in Cameroon. There is a need to evaluate the causes of suboptimal drug adherence rates and both the role and adherence to nonpharmacologic interventions.

scholarly journals 813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S448-S449
Author(s):  
Jongtak Jung ◽  
Pyoeng Gyun Choe ◽  
Chang Kyung Kang ◽  
Kyung Ho Song ◽  
Wan Beom Park ◽  
...  
Keyword(s):  
Regression Model ◽  
Acinetobacter Baumannii ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Intervention Group ◽  
Feeding Tube ◽  
Control Group ◽  
Cox Regression Model ◽  
Carbapenem Resistant ◽  
Hospital Acquired

Abstract Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p&lt; 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures

scholarly journals Testing the proportional hazards assumption in cox regression and dealing with possible non-proportionality in total joint arthroplasty research: methodological perspectives and review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ilari Kuitunen ◽  
Ville T. Ponkilainen ◽  
Mikko M. Uimonen ◽  
Antti Eskelinen ◽  
Aleksi Reito
Keyword(s):  
Survival Analysis ◽  
Regression Model ◽  
Total Joint Arthroplasty ◽  
Full Text ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Joint Arthroplasty ◽  
Central Research ◽  
Cox Regression Model ◽  
Pubmed Database

Abstract Background Survival analysis and effect of covariates on survival time is a central research interest. Cox proportional hazards regression remains as a gold standard in the survival analysis. The Cox model relies on the assumption of proportional hazards (PH) across different covariates. PH assumptions should be assessed and handled if violated. Our aim was to investigate the reporting of the Cox regression model details and testing of the PH assumption in survival analysis in total joint arthroplasty (TJA) studies. Methods We conducted a review in the PubMed database on 28th August 2019. A total of 1154 studies were identified. The abstracts of these studies were screened for words “cox and “hazard*” and if either was found the abstract was read. The abstract had to fulfill the following criteria to be included in the full-text phase: topic was knee or hip TJA surgery; survival analysis was used, and hazard ratio reported. If all the presented criteria were met, the full-text version of the article was then read. The full-text was included if Cox method was used to analyze TJA survival. After accessing the full-texts 318 articles were included in final analysis. Results The PH assumption was mentioned in 114 of the included studies (36%). KM analysis was used in 281 (88%) studies and the KM curves were presented graphically in 243 of these (87%). In 110 (45%) studies, the KM survival curves crossed in at least one of the presented figures. The most common way to test the PH assumption was to inspect the log-minus-log plots (n = 59). The time-axis division method was the most used corrected model (n = 30) in cox analysis. Of the 318 included studies only 63 (20%) met the following criteria: PH assumption mentioned, PH assumption tested, testing method of the PH assumption named, the result of the testing mentioned, and the Cox regression model corrected, if required. Conclusions Reporting and testing of the PH assumption and dealing with non-proportionality in hip and knee TJA studies was limited. More awareness and education regarding the assumptions behind the used statistical models among researchers, reviewers and editors are needed to improve the quality of TJA research. This could be achieved by better collaboration with methodologists and statisticians and introducing more specific reporting guidelines for TJA studies. Neglecting obvious non-proportionality undermines the overall research efforts since causes of non-proportionality, such as possible underlying pathomechanisms, are not considered and discussed.

scholarly journals Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Wu ◽  
Yu-Chen Wang ◽  
Wen-Jie Luo ◽  
Bo-Dai ◽  
Ding-Wei Ye ◽  
...  
Keyword(s):  
Regression Model ◽  
Competing Risks ◽  
Primary Tumor ◽  
Cox Regression ◽  
Radical Surgery ◽  
Large Population ◽  
Local Therapy ◽  
Primary Site ◽  
Urethral Carcinoma ◽  
The Impact

Abstract Background Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC. Methods A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS). Results The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit. Conclusion Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients.

scholarly journals FRI0181 ORGAN DAMAGE FREE SURVIVAL IN SOUTHERN CHINESE PATIENTS WITH ACTIVE LUPUS NEPHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 674.1-674
Author(s):  
C. C. Mok ◽  
C. S. Sin ◽  
K. C. Hau ◽  
T. H. Kwan
Keyword(s):  
Lupus Nephritis ◽  
Regression Model ◽  
Cox Regression ◽  
Organ Damage ◽  
Renal Survival ◽  
Cox Regression Model ◽  
Free Survival ◽  
Renal Response

Background:The goals of treatment of lupus nephritis (LN) are to induce remission, retard the progression of chronic kidney disease, prevent organ complications and ultimately reduce mortality. Previous cohort studies of LN have mainly focused on the risk of mortality and development of end stage renal failure (ESRF) (renal survival). The cumulative frequency of LN patients who survive without organ damage, which correlates better with the balance between treatment efficacy and toxicity, as well as quality of life, has not been well studied.Objectives:To study the organ damage free survival and its predictive factors in patients with active LN.Methods:Consecutive patients who fulfilled ≥4 ACR/SLICC criteria for SLE and with biopsy proven active LN between 2003 and 2018 were retrospectivey analyzed. Those with organ damage before LN onset were excluded. Data on renal parameters and treatment regimens were collected. Complete renal response (CR) was defined as normalization of serum creatinine (SCr), urine P/Cr (uPCR) <0.5 and inactive urinary sediments. Partial renal response (PR) was defined as ≥50% reduction in uPCR and <25% increase in SCr. Organ damage of SLE was assessed by the ACR/SLICC damage index (SDI). The cumulative risk of having any organ damage or mortality since LN was studied by Kaplan-Meier’s analysis. Factors associated with a poor outcome were studied by a forward stepwise Cox regression model, with entry of covariates with p<0.05 and removal with p>0.10.Results:273 LN patients were identified but 64 were excluded (organ damage before LN onset). 211 LN patients were studied (92% women; age at SLE 30.4±13.5 years; SLE duration at LN 1.9±3.1years). 47 (22%) patients had nephrotic syndrome and 60 (29%) were hypertensive. Histological LN classes was: III/IV±V (75.1%), I/II (7.8%) and pure V (17.1%) (histologic activity and chronicity score 7.0±4.2 and 1.8±1.5, respectively). Induction regimens were: prednisolone (33.1±17.5mg/day) in combination with intravenous cyclophosphamide (CYC) (21.4%; 1.0±0.2g per pulse), oral CYC (8.6%; 96.4±37.8mg/day), azathioprine (AZA) (14.3%; 78.6±25.2mg/day), mycophenolate mofetil (MMF) (22.8%; 1.9±0.43g/day) and tacrolimus (TAC) (17.1%; 4.3±1.1mg/day). After a follow-up of 8.6±5.4 years, 94(45%) patient developed organ damage (SDI≥1) and 21(10%) patients died. The commonest organ damage was renal (36.3%) and musculoskeletal (17.9%), and the causes of death were: infection (38.1%), malignancy (19.0%), cardiovascular events (9.5%) and ESRF complications (9.5%). At last visit, 114 (55%) patients survived without any organ damage. The cumulative organ damage free survival at 5, 10 and 15 years after renal biopsy was 73.5%, 59.6% and 48.3%, respectively. The 5, 10 and 15-year renal survival rate were 95.2%, 92.0% and 84.1% respectively. In a Cox regression model, nephritic relapse (HR 3.72[1.78-7.77]), proteinuric relapse (HR 2.30[1.07-4.95]) and older age (HR 1.89[1.05-3.37]) were associated with either organ damage or mortality, whereas CR (HR 0.25[0.12-0.50]) at month 12 were associated with organ damage free survival. Baseline SCr, uPCR and histological LN classes were not significantly associated with a poor outcome. Among patients with class III/IV LN, the long-term organ damage free survival were not significantly different in users of MMF (reference) from CYC (IV/oral) (HR 1.45[0.76- 2.75]) or TAC (HR 1.03[0.26-1.62]) as induction therapy.Conclusion:Organ damage free survival is achieved in 55% of patients with active LN upon 9 years of follow-up. CYC/MMF/TAC based induction regimens did not differ for the long-term outcome of LN. Targeting complete renal response and preventing renal relapses remain important goals of LN treatment.Acknowledgments:NILDisclosure of Interests:None declared

scholarly journals A cohort study of survival following discharge from hospital in rural Tanzanian children using linked data of admissions with community-based demographic surveillance

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oscar Mukasa ◽  
Honorati Masanja ◽  
Don DeSavigny ◽  
Joanna Schellenberg
Keyword(s):  
Linked Data ◽  
Cox Regression ◽  
District Hospital ◽  
Rural Setting ◽  
Post Discharge ◽  
Community Based ◽  
Related Data ◽  
Clinical Surveillance ◽  
Additional Support ◽  
Discharge From Hospital

Abstract Background To illustrate the public health potential of linking individual bedside data with community-based household data in a poor rural setting, we estimated excess pediatric mortality risk after discharge from St Francis Designated District Hospital in Ifakara, Tanzania. Methods Linked data from demographic and clinical surveillance were used to describe post-discharge mortality and survival probability in children aged < 5 years, by age group and cause of admission. Cox regression models were developed to identify risk factors. Results Between March 2003 and March 2007, demographic surveillance included 28,910 children aged 0 to 5 years and among them 831 (3%) were admitted at least once to the district hospital. From all the children under the demographic surveillance 57,880 person years and 1381 deaths were observed in 24 months of follow up. Survivors of hospital discharge aged 0–5 years were almost two times more likely to die than children of the same age in the community who had not been admitted (RR = 1.9, P < 0.01, 95% CI 1.6, 2.4). Amongst children who had been admitted, mortality rate within a year was highest in infants (93 per 1000 person years) and amongst those admitted due to pneumonia and diarrhoea (97 and 85 per 1000 person years respectively). Those who lived 75 km or further from the district hospital, amongst children who were admitted and survived discharge from hospital, had a three times greater chance of dying within one year compared to those living within 25 km (adjusted HR 3.23, 95% CI 1.54,6.75). The probability of surviving the first 30 days post hospitalization was 94.4% [95% CI 94.4, 94.9], compared to 98.8% [95% CI 97.199.5] in non-hospitalized children of the same age in the commuity. Conclusion This study illustrates the potential of linking health related data from facility and household levels. Our results suggest that families may need additional support post hospitalization.

The effect of censoring on a multivariate cox regression model comparing surgical and medical treatment for aortic disease patients

1998 ◽  
Vol 19 (3) ◽  
pp. S78-S79
Author(s):  
Charles Oprian ◽  
Kwan Hur ◽  
William Henderson ◽  
Bharat Thakkar ◽  
Frederick Masoudi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Regression Model ◽  
Cox Regression ◽  
Aortic Disease ◽  
Cox Regression Model

scholarly journals Cox regression survival analysis with compositional covariates: Application to modelling mortality risk from 24-h physical activity patterns

2019 ◽  
Vol 29 (5) ◽  
pp. 1447-1465 ◽  
Author(s):  
DE McGregor ◽  
J Palarea-Albaladejo ◽  
PM Dall ◽  
K Hron ◽  
SFM Chastin
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Survival Analysis ◽  
Regression Model ◽  
Cox Regression ◽  
Public Health Problem ◽  
Sitting Time ◽  
Cox Regression Model ◽  
Log Ratio ◽  
Activity Behaviour

Survival analysis is commonly conducted in medical and public health research to assess the association of an exposure or intervention with a hard end outcome such as mortality. The Cox (proportional hazards) regression model is probably the most popular statistical tool used in this context. However, when the exposure includes compositional covariables (that is, variables representing a relative makeup such as a nutritional or physical activity behaviour composition), some basic assumptions of the Cox regression model and associated significance tests are violated. Compositional variables involve an intrinsic interplay between one another which precludes results and conclusions based on considering them in isolation as is ordinarily done. In this work, we introduce a formulation of the Cox regression model in terms of log-ratio coordinates which suitably deals with the constraints of compositional covariates, facilitates the use of common statistical inference methods, and allows for scientifically meaningful interpretations. We illustrate its practical application to a public health problem: the estimation of the mortality hazard associated with the composition of daily activity behaviour (physical activity, sitting time and sleep) using data from the U.S. National Health and Nutrition Examination Survey (NHANES).

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