scholarly journals Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-control Study in a Czech Tertiary University Hospital

2021 ◽  
Author(s):  
Zuzana Kremenova ◽  
Jan Svancara ◽  
Petra Kralova ◽  
Martin Moravec ◽  
Katerina Hanouskova ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Case Control Study ◽  
Case Control ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Insurance Company ◽  
Retrospective Case ◽  
Control Study

Abstract Background: More than 50% of patients worldwide die in hospitals. It is well known that end-of-life hospital care is costly.Our aims were to test whether the support of the palliative team can reduce end-of-life costs and to study the mechanisms of cost reduction.Methods: This was a one-centre descriptive retrospective case-control study. Big data from registries of routine visits were used for case-control matching. We included the expenses billed to the insurance company and added separately charged drugs and materials. We compared the groups over the duration of the terminal hospitalization, ICU days (ICU=intensive care unit), IV antibiotic use (IV=intravenous), MRI/CT scans (MRI/CR=magnetic resonance imaging/computed tomography), oncologic treatment in the last month of life, and documentation of the dying phase.We searched for all in-hospital cases who died in the university hospital in Prague with the support of the hospital palliative team from January 2019 to April 2020 and matched them with similar controls. The controls were matched according to age, sex, Charlson comorbidity index and diagnosis recorded on the death certificate.Results: We identified 213 dyads. The average daily costs were three times lower in the palliative group (4,392.4 CZK per day=171.3 EUR) than in the non-palliative group (13,992.8 CZK per day=545.8 EUR), and the difference was caused by the shorter time spent in the ICU (16% vs 33% of hospital days). This was probably due to better documentation of the dying phase in the medical records.Conclusions: To date, there are sparse hospital data available on the economic aspects of end-of-life care. We showed that the integration of the palliative care team in the dying phase can be cost saving. The evidence that hospital palliative care can save a substantial amount of money can be used to support the integration of palliative care in hospitals in middle- and low-income countries. A multicentre study with the same design is planned in the future to increase the strength of the results.

scholarly journals Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

2021 ◽  
Vol 10 (6) ◽  
pp. 1153
Author(s):  
Enrique S. Meseguer ◽  
Mikel U. Elizalde ◽  
Alberto M. Borobia ◽  
Elena Ramírez
Keyword(s):  
Valproic Acid ◽  
Liver Injury ◽  
Case Control Study ◽  
Monitoring Program ◽  
Case Control ◽  
University Hospital ◽  
Control Groups ◽  
Retrospective Case ◽  
Drug Induced ◽  
Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring program, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related liver injury but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild liver injury. Mean age for the cases was 45.7 years, 4 (26.7%) were women and 5 (33.34%) were children under 18 years, of them 3 (20%) were fatal. Polytherapy with other antiepileptic drugs (p = 0.047) and alcohol consumption (p < 0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p < 0.001). The cases developed hepatocellular liver injury (p < 0.001), while the mild hepatic damage controls had a higher rate of cholestatic liver injury (p < 0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p = 0.033 and p = 0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

scholarly journals Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

2021 ◽  
Author(s):  
Enrique Seco Meseguer ◽  
Mikel Urroz Elizalde ◽  
Alberto M. Borobia ◽  
Elena Ramírez
Keyword(s):  
Valproic Acid ◽  
Liver Injury ◽  
Case Control Study ◽  
Tertiary Hospital ◽  
Case Control ◽  
University Hospital ◽  
Control Groups ◽  
Retrospective Case ◽  
Drug Induced ◽  
Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring Programme, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related hepatitis but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild hepatitis. Mean age for the cases was 45.7 years, 4(26.7%) were women and 5(33.34%) were children under 18 years, of them 3(20%) were fatal. Polytherapy with other antiepileptic drugs (p=0.047) and alcohol consumption (p&lt;0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p&lt;0.001). The cases developed hepatocellular hepatitis (p&lt;0.001), while the mild hepatitis controls had a higher rate of cholestatic hepatitis (p&lt;0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p= 0.033 and p=0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

scholarly journals Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case–control study in France

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026375 ◽  
Author(s):  
Marie-Pierre Tavolacci ◽  
Quentin Berthon ◽  
Damiano Cerasuolo ◽  
Pierre Dechelotte ◽  
Joel Ladner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Alcohol Dependence ◽  
Binge Drinking ◽  
Case Control Study ◽  
Clinical Investigation ◽  
Case Control ◽  
University Hospital ◽  
Retrospective Case ◽  
Control Study ◽  
Alcohol Dependent

ObjectiveA retrospective case–control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.SettingThe Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.ParticipantsCases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.Results166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.ConclusionsFrequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.Trial registration numberNCT03204214; Results.

Delivery characteristics in pregnancies with stillbirth: a retrospective case-control study from a tertiary teaching hospital

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Pekkola ◽  
Minna Tikkanen ◽  
Mika Gissler ◽  
Mikko Loukovaara ◽  
Jorma Paavonen ◽  
...  
Keyword(s):  
Live Birth ◽  
Gestational Age ◽  
Case Control Study ◽  
Case Control ◽  
University Hospital ◽  
Bleeding Complications ◽  
Maternal Complications ◽  
Retrospective Case ◽  
Tertiary Teaching ◽  
Control Study

Abstract Objectives We compared delivery characteristics and outcome of women with stillbirth to those with live birth. Methods This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003–2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. Results Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37–100.45) and cesarean sections less frequent (9.3 vs 28.7%, p<0.001, aOR 0.21, 95% CI 0.10–0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0–365.0 min] vs. 412.5 min [251.0–574.0 min], p<0.001; second stage 8.0 min [0.0–16.0 min] vs. 15.0 min [4.0–26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51–28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10–20.13). The rates of serious maternal complications were low. Conclusions Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.

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