scholarly journals Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January−December 2016

2022 ◽  
Vol 27 (2) ◽  
Author(s):  
Lena M. Biehl ◽  
Paul G. Higgins ◽  
Jannik Stemler ◽  
Meyke Gilles ◽  
Silke Peter ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Competing Risk ◽  
Contact Precautions ◽  
Vancomycin Resistant Enterococci ◽  
Single Room ◽  
Multicentre Cohort Study ◽  
Vancomycin Resistant ◽  
The Impact ◽  
Multicentre Cohort

Background Evidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited. Aim We assessed the impact of SCP on haVRE and their transmission. Methods We conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis. Results We included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35–2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59–12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46–3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14–2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33–2.34). Conclusions We show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.

An international cohort study investigating the impact of age on clinical outcome in patients with hepatocellular carcinoma treated with sorafenib.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12049-12049
Author(s):  
Rohini Sharma ◽  
Saur Hajiev ◽  
Leila Motedayan Aval ◽  
Dominik Bettinger ◽  
Tadaaki Arizumi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Duration Of Treatment ◽  
Vein Thrombosis ◽  
Multicentre Cohort Study ◽  
Starting Dose ◽  
The Impact ◽  
Multicentre Cohort

12049 Background: There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low dose therapy with the aim to avoid toxicities whilst maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) of patients with HCC, and whether a reduced starting dose of sorafenib impacts on OS or rates of toxicity experienced by the elderly. Methods: In this international, multicentre cohort study, patients with a confirmed diagnosis of advanced-stage HCC receiving sorafenib were recruited from seven specialist centres. Demographic and clinical data including development and grade of sorafenib toxicity and sorafenib starting dose were collected prospectively. Survival time (months) was recorded prospectively. Outcomes for those < or > 75 years were determined Results: A total of 5598 patients were recruited; 792 (14.1%) were over the age of 75. The elderly were more likely to have larger tumours ( > 7cm)(39 vs 33%, p = 0.07) with Child-Pugh A liver function(67 vs 57.7%) and less portal vein thrombosis compared to those < 75years(22.1 vs 29.4)(p < 0.001). They were more likely to be commenced on lower starting dose of sorafenib i.e 400mg/200mg (38.7 vs 37.2%, P < 0.01). In terms of OS, there was no difference in the median OS of those >75 years and patients < 75 (7.3months vs 7.2months; HR 0.98 (95% CI 0.90–1.06), p = 0.63). There was no relationship between starting dose of sorafenib, 800mg vs 400mg/200mg, and OS between those < or > 75years. The elderly experienced a similar incidence of grade 2-4 sorafenib-related toxicity compared to < 75years(74.3 vs 61.7%, p = 0.051)(except for anorexia (14.0 vs 7.2%, p < 0.01) and rash (3.1 vs 6.3%, p < 0.05), irrespective of the dose prescribed. The elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p < 0.01). This did not vary between different starting doses of sorafenib. The mean duration of treatment was similar between those < and > 75 and, again, the starting dose of sorafenib did not affect treatment duration in the elderly. Conclusions: The median OS in the elderly is the same for that of patients under 75 years and is independent of the dose of sorafenib prescribed. Therefore, sorafenib should be offered to elderly patients and they should not be excluded from therapy

scholarly journals Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041726
Author(s):  
Jordi Adamuz ◽  
Maribel González-Samartino ◽  
Emilio Jiménez-Martínez ◽  
Marta Tapia-Pérez ◽  
María-Magdalena López-Jiménez ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
High Tech ◽  
Unfavourable Outcome ◽  
Data Set ◽  
Factors Associated ◽  
Hospitalised Patients ◽  
Multicentre Cohort Study ◽  
The Impact ◽  
Multicentre Cohort

BackgroundEvidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.MethodsA multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.ResultsOut of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01).ConclusionThe systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

An Outbreak of Vancomycin-Resistant Enterococci in a Hematology–Oncology Unit: Control by Patient Cohorting and Terminal Cleaning of the Environment

2002 ◽  
Vol 23 (8) ◽  
pp. 468-470 ◽  
Author(s):  
Mary Lu Sample ◽  
Denise Gravel ◽  
Cathy Oxley ◽  
Baldwin Toye ◽  
Gary Garber ◽  
...  
Keyword(s):  
Infection Control ◽  
Sodium Hypochlorite ◽  
Contact Precautions ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Oncology Unit ◽  
The Impact

AbstractWe describe the impact of enhanced infection control interventions on controlling the spread of vancomycin-resistant enterococci (VRE) in our hematology–oncology unit. Between April and September 1998, 13 patients on this unit were identified as having VRE. In addition to contact precautions, other measures that were needed to control the outbreak included closure of the unit to new admissions, creation of a cohort of VRE-positive patients and staff, and thorough cleaning of patients' rooms with 0.5% sodium hypochlorite.

scholarly journals The impact of psychological factors on recovery from injury: a multicentre cohort study

2016 ◽  
Vol 52 (7) ◽  
pp. 855-866 ◽  
Author(s):  
Blerina Kellezi ◽  
C. Coupland ◽  
R. Morriss ◽  
K. Beckett ◽  
S. Joseph ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psychological Factors ◽  
Multicentre Cohort Study ◽  
The Impact ◽  
Multicentre Cohort

scholarly journals Study for Improving Maternal Pregnancy And Child ouTcomes (IMPACT): a study protocol for a Swedish prospective multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e033851
Author(s):  
Lina Bergman ◽  
Anna Sandström ◽  
Bo Jacobsson ◽  
Stefan Hansson ◽  
Peter Lindgren ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Pregnancy Outcomes ◽  
Child Outcomes ◽  
First Trimester ◽  
Data Encryption ◽  
Blood Samples ◽  
Multicentre Cohort Study ◽  
The Impact ◽  
Multicentre Cohort

IntroductionFirst-trimester pregnancy risk evaluation facilitates individualised antenatal care, as well as application of preventive strategies for pre-eclampsia or birth of a small for gestational age infant. A range of early intervention strategies in pregnancies identified as high risk at the end of the first trimester has been shown to decrease the risk of preterm pre-eclampsia (<37 gestational weeks). The aim of this project is to create the Improving Maternal Pregnancy And Child ouTcomes (IMPACT) database; a nationwide database with individual patient data, including predictors recorded at the end of the first trimester and later pregnancy outcomes, to identify women at high risk of pre-eclampsia. A second aim is to link the IMPACT database to a biobank with first-trimester blood samples.Methods and analysisThis is a Swedish prospective multicentre cohort study. Women are included between the 11th and 14th weeks of pregnancy. At inclusion, pre-identified predictors are retrieved by interviews and medical examinations. Blood samples are collected and stored in a biobank. Additional predictors and pregnancy outcomes are retrieved from the Swedish Pregnancy Register. Inclusion in the study began in November 2018 with a targeted sample size of 45 000 pregnancies by end of 2021. Creation of a new risk prediction model will then be developed, validated and implemented. The database and biobank will enable future research on prediction of various pregnancy-related complications.Ethics and disseminationConfidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (Uppsala 2018-231) and national biobank approval at Uppsala Biobank (18237 2 2018 231). Results from the current as well as future studies using information from the IMPACT database will be published in peer-reviewed journals.Trial registration numberNCT03831490.

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