scholarly journals Excess Deaths and Hospital Admissions for COVID-19 Due to a Late Implementation of the Lockdown in Italy

2020 ◽  
Vol 17 (16) ◽  
pp. 5644 ◽  
Author(s):  
Raffaele Palladino ◽  
Jordy Bollon ◽  
Luca Ragazzoni ◽  
Francesco Barone-Adesi
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
National Data ◽  
Epidemic Curve ◽  
Early Implementation ◽  
Excess Deaths

In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic.

scholarly journals Hospitalization for ischemic stroke was affected more in independent cases than in dependent cases during the COVID-19 pandemic: An interrupted time series analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261587
Author(s):  
Hiroyuki Nagano ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Daisuke Takada ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Time Series ◽  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
State Of Emergency ◽  
Its Analysis ◽  
Care Systems ◽  
The Impact

Background The pandemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study is to assess the impact of the COVID-19 pandemic on the number of hospital admissions for ischemic stroke by severity in Japan. Methods We analysed administrative (Diagnosis Procedure Combination—DPC) data for cases of inpatients aged 18 years and older who were diagnosed with ischemic stroke and admitted during the period April 1 2018 to June 27 2020. Levels of change of the weekly number of inpatient cases with ischemic stroke diagnosis after the declaration of state of emergency were assessed using interrupted time-series (ITS) analysis. The numbers of patients with various characteristics and treatment approaches were compared. We also performed an ITS analysis for each group (“independent” or “dependent”) divided based on components of activities of daily living (ADL) and level of consciousness at hospital admission. Results A total of 170,294 cases in 567 hospitals were included. The ITS analysis showed a significant decrease in the weekly number of ischemic stroke cases hospitalized (estimated decrease: −156 cases; 95% confidence interval (CI): −209 to −104), which corresponds to −10.4% (95% CI: −13.6 to −7.1). The proportion of decline in the independent group (−21.3%; 95% CI: −26.0 to −16.2) was larger than that in the dependent group (−8.6%; 95% CI: −11.7 to −5.4). Conclusions Our results show a marked reduction in hospital admissions due to ischemic stroke after the declaration of the state of emergency for the COVID-19 pandemic. The independent cases were affected more in proportion than dependent cases.

Decreased Resistance of Pseudomonas aeruginosa with Restriction of Ciprofloxacin in a Large Teaching Hospital's Intensive Care and Intermediate Care Units

2012 ◽  
Vol 33 (4) ◽  
pp. 368-373 ◽  
Author(s):  
G. Jonathan Lewis ◽  
Xiangming Fang ◽  
Michael Gooch ◽  
Paul P. Cook
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Gram Negative

Objective.To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.Design.Interrupted time-series analysis.Setting.Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.Patients.All nosocomial isolates of P. aeruginosa.Intervention.Restriction of ciprofloxacin.Results.There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004 ) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.Conclusion.Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (10) ◽  
pp. 1137-1143 ◽  
Author(s):  
Nneka I. Nzegwu ◽  
Michelle R. Rychalsky ◽  
Loren A. Nallu ◽  
Xuemei Song ◽  
Yanhong Deng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Interrupted Time Series ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Late Onset Sepsis

OBJECTIVETo evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP).DESIGNQuasi-experimental, interrupted time-series study.SETTINGA 54-bed, level IV NICU in a regional academic and tertiary referral center.PATIENTS AND PARTICIPANTSAll neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion.INTERVENTIONImplementation of a NICU-specific ASP beginning July 2012.METHODSWe convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance.RESULTSAntibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time.CONCLUSIONSImplementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices.Infect Control Hosp Epidemiol 2017;38:1137–1143

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