Peripherally Inserted Central Catheter (PICC) Insertion Success and Optimal Placement with New Technology: A Pre-Post Cohort Study

2021 ◽  
Vol 26 (1) ◽  
pp. 39-46
Author(s):  
Megan Nicholas ◽  
Emily N. Larsen ◽  
Claire M. Rickard ◽  
Gabor Mihala ◽  
Peter Groom ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Navigation System ◽  
New Technology ◽  
Significant Risk ◽  
Optimal Placement ◽  
Hospital Policy ◽  
Ratio Measurement ◽  
The Impact ◽  
First Time

Highlights Abstract Background: Peripherally inserted central catheters (PICCs) are commonly placed with the assistance of fluoroscopy or medical imaging, ultrasound, electrocardiogram guidance, or all the above. Innovative ultrasound technologies continue to emerge; however, the impact upon clinical outcomes is not well understood. In this study, we aimed to compare outcomes of an existing ultrasound system with SHERLOCK 3CG™ Tip Confirmation (preintervention) to an updated SHERLOCK 3CG Diamond Tip Confirmation system, incorporating catheter-to-vein ratio measurement capabilities and an advanced magnetic-based tip navigation system (postintervention). Methods: In this prospective pre-post cohort study, we recruited adult patients requiring a new PICC. The study was conducted at a quaternary hospital in Queensland, Australia. Data were collected between May 2017 (4 months before equipment introduction) and January 2018 (4 months after equipment introduction), with a 1-month exclusion (education or learning) period in between. Patient, PICC, and device removal details were collected. The primary outcome was first-time insertion success, defined as successful PICC insertion after a single attempt (skin puncture), with the tip confirmed in an optimal location by the navigation system and a subsequent chest x-ray (as per hospital policy). Results: There were 503 participants with patient demographics and PICC characteristics balanced between the preintervention (n = 266) and postintervention (n = 237) groups. First-time insertion success was higher in the preintervention group (203/255, 80%) than the postintervention group (166/226, 73%), but this was not statistically significant (risk ratio = 0.92, 95% confidence interval = 0.83–1.02). Conclusions: There was no change in clinical outcomes with the use of next-generation ultrasound technology. These results justify future large studies and subsequent review into the efficacy of tip-confirmation systems and processes to maintain patient safety.

scholarly journals Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 105
Author(s):  
Jatapat Hemapanpairoa ◽  
Dhitiwat Changpradub ◽  
Sudaluck Thunyaharn ◽  
Wichai Santimaleeworagun
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Significant Risk ◽  
Vancomycin Resistance ◽  
Cox Proportional Hazards Model ◽  
Factors Associated ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

scholarly journals The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study

2021 ◽  
pp. 1753495X2110641
Author(s):  
Diana Oprea ◽  
Nadine Sauvé ◽  
Jean-Charles Pasquier
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Caesarean Delivery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Singleton Pregnancy ◽  
Delivery Outcome ◽  
The Impact

Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.

scholarly journals Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates: a retrospective cohort study from a specialised diabetes centre in Denmark

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019214 ◽  
Author(s):  
Narges Safai ◽  
Bendix Carstensen ◽  
Henrik Vestergaard ◽  
Martin Ridderstråle
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Secondary Outcome ◽  
Treatment Programme ◽  
Cvd Risk ◽  
Treatment Targets ◽  
Risk Engine ◽  
The Impact

ObjectivesTo investigate the impact of a multifactorial treatment programme in a real-life setting on clinical outcomes and estimated cardiovascular disease (CVD) risk.DesignA retrospective observational cohort study, using data from the electronic medical records and national registers.SettingTertiary diabetes centre in Denmark.ParticipantsPatients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016.OutcomesPrimary outcomes were changes in haemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CVD risk. Linear mixed model for repeated measurements were used for continuous variables and logistic regression for dichotomous variables.ResultsThe patients achieved a mean±SD decrease in HbA1c, systolic and diastolic BP and LDL cholesterol of 1.0%±0.04% (10.6±0.4 mmol/mol), 6.3±0.4 mm Hg, 2.7±0.2 mm Hg and 0.32±0.02 mmol/L, respectively (p<0.0001). The proportion of patients who met the treatment goal for HbA1c(<7% (<53 mmol/mol)) increased from 31% to 58% (p<0.0001); for BP (<130/80 mm Hg) from 24% to 34% (p<0.0001), and for LDL cholesterol (<2.5 mmol/L (patients without previous CVD) or <1.8 mmol/L (patients with previous CVD)) from 52% to 65%. Those reaching all three guideline treatment targets increased from 4% to 15% (p<0.0001), and when relaxing the BP target to <140/85 from 8% to 24%. The estimated CVD risk was relatively reduced by 15.2% using the Swedish National Diabetes Register risk engine and 30.9% using the UK Prospective Diabetes Study risk engine.ConclusionsOur data support that short-term multifactorial treatment of patients with glycaemic dysregulation in a specialist outpatient setting is both achievable and effective, and associated with a clinically meaningful improvement in CVD risk.

scholarly journals Renal Function during Hospitalization and Outcome in Chinese Patients with Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Hao-Wei Lee ◽  
Chin-Chou Huang ◽  
Chih-Yu Yang ◽  
Hsin-Bang Leu ◽  
Po-Hsun Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Acute Decompensated Heart Failure ◽  
Significant Risk ◽  
Decompensated Heart Failure ◽  
Chinese Patients ◽  
Cox Regression Analysis ◽  
The Impact

Abstract It is well known that the heart and kidney have a bi-directional correlation, in which organ dysfunction results in maladaptive changes in the other. We aimed to investigate the impact of renal function and its decline during hospitalization on clinical outcomes in patients with acute decompensated heart failure (ADHF). A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF), defined as eGFR decline between admission (eGFRadmission) and pre-discharge (eGFRpredischarge), occurred in 41 patients. Clinical outcomes during the follow-up period were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. During an average follow-up period of 2.6±3.2 years, 66 patients experienced 4P-MACE. Cox regression analysis revealed that impaired eGFRpredischarge, but not eGFRadmission or WRF, was significantly correlated with the development of 4P-MACE (HR, 2.003; 95% CI, 1.072–3.744; P=0.029). In conclusion, impaired renal function before discharge, but not WRF, is a significant risk factor for poor outcomes in patients with ADHF.

scholarly journals The Role of Human Immunodeficiency Virus (HIV) Asymptomatic Status When Starting Antiretroviral Therapy on Adherence and Treatment Outcomes and Implications for Test and Treat: The Swiss HIV Cohort Study

2020 ◽  
Author(s):  
Tracy R Glass ◽  
Huldrych F Günthard ◽  
Alexandra Calmy ◽  
Enos Bernasconi ◽  
Alexandra U Scherrer ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Unprotected Sex ◽  
Test And Treat ◽  
Universal Test And Treat ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background Since the advent of universal test-and-treat , more people living with human immunodeficiency virus (PLHIV) initiating antiretroviral therapy (ART) are asymptomatic with a preserved immune system. We explored the impact of asymptomatic status on adherence and clinical outcomes. Methods PLHIV registered in the Swiss HIV Cohort Study (SHCS) between 2003 and 2018 were included. We defined asymptomatic as Centers for Disease Control and Prevention stage A within 30 days of starting ART, non-adherence as any self-reported missed doses and viral failure as two consecutive viral load&gt;50 copies/mL after &gt;24 weeks on ART. Using logistic regression models, we measured variables associated with asymptomatic status and adherence and Cox proportional hazard models to assess association between symptom status and viral failure. Results Of 7131 PLHIV, 76% started ART when asymptomatic and 1478 (22%) experienced viral failure after a median of 1.9 years (interquartile range, 1.1–4.2). In multivariable models, asymptomatic PLHIV were more likely to be younger, men who have sex with men, better educated, have unprotected sex, have a HIV-positive partner, have a lower viral load, and have started ART more recently. Asymptomatic status was not associated with nonadherence (odds ratio, 1.03 [95% confidence interval {CI}, .93–1.15]). Asymptomatic PLHIV were at a decreased risk of viral failure (adjusted hazard ratio, 0.87 [95% CI, .76–1.00]) and less likely to develop resistance (14% vs 27%, P &lt; .001) than symptomatic PLHIV. Conclusions Despite concerns regarding lack of readiness, our study found no evidence of adherence issues or worse clinical outcomes in asymptomatic PLHIV starting ART.

scholarly journals Effects of an expanded Uber-like transport system on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homa Bay, Kenya

2019 ◽  
Vol 4 (3) ◽  
pp. e001254 ◽  
Author(s):  
Maricianah Atieno Onono ◽  
Samuel Wahome ◽  
Pauline Wekesa ◽  
Catherine Kidiga Adhu ◽  
Lawrence Wandei Waguma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Navigation System ◽  
Prospective Cohort ◽  
Newborn Health ◽  
Standard Of Care ◽  
Text Messages ◽  
Maternal And Newborn Health ◽  
Control Group ◽  
The Impact

IntroductionKenya’s progress towards reducing maternal and neonatal deaths is at present ‘insufficient’. These deaths could be prevented if the three delays, that is, in deciding to seek healthcare (delay 1), in accessing formal healthcare (delay 2) and in receiving quality healthcare (delay 3), are comprehensively addressed. We designed a mobile phone enhanced 24 hours Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages to address these delays. Our main objective was to evaluate the impact of this intervention on women’s adherence to recommended antenatal (ANC) and postnatal care (PNC) regimes and facility birth.MethodsWe conducted a prospective cohort study. Women were eligible to participate in the study if they were 15 years or older and less than 28 weeks gestation. We defined cases as those who received the standard of care plus the intervention and the control group as those who received the standard of care only. For analysis, we used logistic regression analysis and report crude and adjusted OR (aOR) and 95 % CI.ResultsCases (women who received the intervention) had five times higher odds of having four or more ANC visits (aOR=4.7, 95% CI 3.20 to 7.09), three times higher odds of taking between 30 and 60 min to reach a health facility for delivery (aOR=3.14, 95% CI 2.37 to 4.15) and four times higher odds of undergoing at least four PNC visits (aOR=4.10, 95% CI 3.11 to 5.36).ConclusionAn enhanced community-based Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages significantly increased the utilisation of ANC and PNC services as well as shortened the time taken to reach an appropriate facility for delivery compared with standard care.

scholarly journals Monocyte count and the risk for acute exacerbation of fibrosing interstitial lung disease: A retrospective cohort study

2020 ◽  
Vol 17 ◽  
pp. 147997312090984 ◽  
Author(s):  
Kodai Kawamura ◽  
Kazuya Ichikado ◽  
Keisuke Anan ◽  
Yuko Yasuda ◽  
Yuko Sekido ◽  
...  
Keyword(s):  
Cohort Study ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Retrospective Cohort Study ◽  
Scoring System ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Monocyte Count ◽  
Peripheral Monocyte ◽  
The Impact

Recent studies have suggested that an increased peripheral monocyte count predicts a poor outcome in fibrosing interstitial lung disease (ILD). However, the association between an increased monocyte count and acute exacerbations (AEs) of fibrosing ILD remains to be elucidated. Our retrospective cohort study aimed to assess the impact of peripheral monocyte count on AEs of fibrosing ILD. We analyzed the electronic medical records of 122 consecutive patients with fibrosing ILD and no prior history of an AE, who were treated with anti-fibrotic agents from August 2015 to December 2018. We determined their peripheral monocyte counts at anti-fibrotic agent initiation and performed univariate and multivariate Cox regression analyses of time-to-first AE after anti-fibrotic agent initiation to assess the impact of monocyte count on AEs of fibrosing ILD. Twenty-six patients developed an AE during the follow-up period, and there was an increased monocyte count at anti-fibrotic agent initiation in these patients compared to those who did not develop an AE. There was also a significantly shorter time-to-first AE of fibrosing ILD in patients with a higher absolute monocyte count. Subgroup analyses indicated similar results regardless of the idiopathic pulmonary fibrosis diagnoses. This association was independently significant after adjusting for the severity of the fibrosing ILD. Using our results, we developed a simple scoring system consisting of two factors—monocyte count (<>380 µL−1) and ILD-gender, age, physiology score (<>4 points). Our findings suggest that the absolute monocyte count is an independent significant risk factor for AE in patients with fibrosing ILD. Our simple scoring system may be a predictor for AEs of fibrosing ILD, although further studies are needed to verify our findings.

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