The prevalence of nasal obstruction as a consideration in the treatment of opioid overdose

2017 ◽  
Vol 13 (2) ◽  
pp. 69 ◽  
Author(s):  
Scott G. Weiner, MD, MPH ◽  
Andrew R. Joyce, PhD ◽  
Heather N. Thomson, MS
Keyword(s):  
Nasal Cavity ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Opioid Overdose ◽  
Intranasal Route ◽  
Deviated Nasal Septum ◽  
International Classification Of Disease ◽  
Nasal Pathology

Objectives: The intranasal route of administration for naloxone delivery is one treatment for opioid overdose, but treatment failures with this modality have been documented. This study determines the incidence of obstructive nasal pathology in patients who experienced serious opioid-induced respiratory depression (OIRD).Design: Retrospective analysis of the IMS LifeLink: Health Plan Claims Database to detect patients with at least one opioid pharmacy claim from 2009 to 2013 and who experienced serious OIRD. Four controls were randomly assigned to each case.Main Outcome Measures: A multivariable analysis determined the adjusted odds ratio of OIRD for patients with obstructive nasal pathology.Results: A total of 7,234 patients experienced a serious OIRD event; 840 (11.6 percent) had obstructive nasal pathology: 20 (2.4 percent) had deviated nasal septum (International Classification of Disease, 9th revision [ICD-9] 470), 246 (29.3 percent) had polyp of the nasal cavity (ICD-9 470.1), 130 (15.5 percent) had hypertrophy of nasal turbinates (ICD-9 478.0), and 659 (78.5 percent) had other disease of the nasal cavity (ICD-9 478.19). The adjusted odds ratio for patients who experienced serious OIRD having concurrent obstructive nasal pathology was 1.28 (95% confidence interval 1.13-1.46).Conclusions: Obstructive nasal pathology is relatively common in patients who experience serious OIRD, and in itself is associated with a higher risk of having OIRD.

scholarly journals Leptomeningeal Collateral Flow Modifies Endovascular Treatment Efficacy on Large-Vessel Occlusion Strokes

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 299-303
Author(s):  
Álvaro García-Tornel ◽  
Ludovico Ciolli ◽  
Marta Rubiera ◽  
Manuel Requena ◽  
Marian Muchada ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
Collateral Flow ◽  
Vessel Occlusion ◽  
Shift Analysis ◽  
Final Degree ◽  
Large Vessel Stroke

Background and Purpose: We aim to evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy on large-vessel stroke. To do that, we used final degree of reperfusion and number of device-passes performed, factors previously associated with better functional outcome, as main outcome measures. Methods: Single-center retrospective study including consecutive stroke patients receiving EVT for anterior circulation large-vessel stroke. CF degree was assessed on CT angiography before EVT using a previously validated 4-grade score. Final degree of reperfusion, using modified Thrombolysis in Cerebral Ischemia (mTICI), and number of device-passes performed were prospectively collected. Multivariable analysis was performed to evaluate the influence of collateral flow degree on final degree of reperfusion and number of device-passes performed. Results: Six hundred twenty-six patients were included in the study; 369 patients (59%) presented good collateral flow on CT angiography. Five hundred twenty-two patients (84%) achieved successful reperfusion (mTICI 2B-3) after EVT, 304 (48%) of them with a final mTICI 2C-3. Median number of device-passes was 2 (interquartile range, 1–3). Good CF was independently associated with better final degree of reperfusion (shift analysis for mTICI0-2A/2B/2C-3%, poor CF 19/38/43 versus good CF 15/32/53, adjusted odds ratio, 1.51 [95% CI, 1.08–2.11]). Poor CF was independently associated with higher number of device-passes performed to achieve successful reperfusion (mTICI2B-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.59, [95% CI, 1.09–2.31]) and complete reperfusion (mTICI2C-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.70 [95% CI, 1.04–2.90]). Conclusions: Patients with good CF treated with EVT experience higher rates of successful reperfusion with lower number of device-passes. CF may facilitate thrombus retrieval and prevent distal embolization of clot fragments, improving device-passes efficacy.

scholarly journals International classification of function, disability and health framework for fall risk stratification in community dwelling older adults

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Majumi M. Noohu ◽  
Aparajit B. Dey ◽  
Shashi Sharma ◽  
Mohammed E. Hussain
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Odds Ratio ◽  
Fall Risk ◽  
Adjusted Odds Ratio ◽  
Community Dwelling ◽  
Disability And Health ◽  
Fall Risk Assessment ◽  
Community Dwelling Older Adults

Falls is an important cause for mortality and morbidity in older adults. The fall risk assessment is an integral component of fall prevention in older adults. The international classification of function, disability and health (ICF) can be an ideal comprehensive model for fall risk assessment. There is lack of information relating ICF and fall risk assessment in community dwelling older adults. In this study we tried to assess the fall risk using different domains of ICF using various clinical tools. A total of 255 subjects were recruited through convenient sampling method from geriatric clinic (OPD) of All India Institute of Medical Sciences, New Delhi. The study was single session cross-section design. The body mass index (BMI), grip strength, depression score (Geriatric depression scale:short form; GDS-S) and co morbidities were used to assess body function and structure domain, timed up and go (TUG), Berg balance scale (BBS) and elderly fall screening test (EFST) scores were used for activity domain, selfreported cause of fall, medications and uses of assistive device for environmental factors. Then the association of body function and structure, activity and environmental factors were determined with falls. There was an association of fall in analysis in subjects with no fall and one or more falls for, BMI, grip strength (kg), GDS-S score, no. of co morbidities, chronic pain, TUG, BBS, TUG (s), BBS, EFST, slip/trip, walking cane, hypoglycemic and antihypertensives medications (unadjusted and adjusted odds ratio).The diabetes, and hyper tension showed association for adjusted odds ratio only. In subjects with one fall and more than one fall, TUG, BBS, EFST, GDS-S score, NSAIDS and antidepressants use showed a significant association with fall (unadjusted and adjusted odds ratio). The ICF may be used in routine for fall risk assessment in community dwelling older adults.

scholarly journals One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Birgitte Thylstrup ◽  
Morten Hesse ◽  
Marian Jørgensen ◽  
Henrik Thiesen
Keyword(s):  
Police Officers ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Prevention Programs ◽  
Opioid Overdose ◽  
Protection Agency ◽  
User Groups ◽  
Low Threshold ◽  
Overdose Deaths

Abstract Background Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program. Methods Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose. Results In all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034). Conclusions Prevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups. Trial registration The Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered

Abstract WMP92: Quality of Care and Outcomes for Acute Ischemic Stroke Patients Admitted During the International Stroke Conference

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Steven R Messe ◽  
Michael T Mullen ◽  
Marguerrite Cox ◽  
Gregg Fonarow ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Stroke Patients ◽  
Time Periods ◽  
Iv Tpa

Introduction: Patients who present to the hospital during off-hours receive sub-optimal care and experience worse outcomes, often attributed to reduced staffing. It is unknown whether stroke patients receive less guideline-adherent care and experience worse outcomes when medical providers attend scientific meetings. The AHA International Stroke Conference (ISC) is the premier US conference for cerebrovascular disease and is well attended by stroke clinicians. Methods: The national Get With The Guidelines - Stroke (GWTG-Stroke) dataset was analyzed from 2009-2015 to identify acute ischemic stroke (AIS) patients admitted during: 1) the week of ISC, and 2) the 2 weeks before and 2 weeks after ISC. We compared adherence to GWTG-Stroke quality measures and outcomes for AIS patients admitted during these two time periods using univariable and multivariable analysis, including both patient and hospital level variables. Results: Overall, 69,738 AIS patients were included, mean age 72, 52% female, and 29% non-white. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non-ISC weeks (1,984 vs 1,997, p= 0.95). Patient and hospital characteristics were also similar between ISC vs. non-ISC time periods. No significant differences were noted in 14 quality of care metrics and 5 clinical outcomes between AIS patients treated during ISC vs. non-ISC weeks (Table). After adjusting for potential confounders, among patients who presented within 2 hours of onset there was no difference in the likelihood of receiving IV tPA within 3 hours (adjusted odds ratio 0.89, 95% confidence interval [CI] 0.77 - 1.03, p=0.13), nor in the likelihood of receiving IV tPA within 60 minutes of arrival (adjusted odds ratio 0.92, 95% CI 0.83 - 1.02, p=0.13). Conclusions: The treatment and outcome of patients who present with AIS to a GWTG-Stroke participating hospital are not degraded during the week of the International Stroke Conference.

scholarly journals Individual Probability of Allogeneic Erythrocyte Transfusion in Elective Spine Surgery

2009 ◽  
Vol 110 (5) ◽  
pp. 1050-1060 ◽  
Author(s):  
Brigitte Lenoir ◽  
Paul Merckx ◽  
Catherine Paugam-Burtz ◽  
Cyril Dauzac ◽  
Marie-Madeleine Agostini ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Odds Ratio ◽  
Goodness Of Fit ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Erythrocyte Transfusion ◽  
Operating Characteristics ◽  
Individual Probability ◽  
Validation Set ◽  
The Individual

Background The aim of this study was to generate a score based on preoperative characteristics and predictive of the individual probability of allogeneic erythrocyte transfusion in patients undergoing elective thoracolumbar spine surgery. Methods Two hundred thirty consecutive patients were retrospectively included over a 15-month period (derivation set). Preoperative independent predictors of erythrocyte transfusion from the day of surgery until postoperative day 5 were determined by multivariable analysis, from which a model of individual probability of transfusion was derived and prospectively validated in 125 additional patients (validation set). Results Four preoperative independent predictors were associated with transfusion: age older than 50 yr (adjusted odds ratio = 4.9 [2-13.5]), preoperative hemoglobin level less than 12 g/dl (adjusted odds ratio = 6.9 [3.1-17.2]), fusion of more than two levels (adjusted odds ratio = 6.7 [3.1-15.2]), and transpedicular osteotomy (adjusted odds ratio = 19.9 [5.6-98.2]). A 0-4 score (0 = no risk, 4 = maximum risk) predictive of allogeneic transfusion was derived by weighting estimate parameters for each variable in a multivariable logistic regression model. Discriminating capacity of the score was 0.86 [0.81-0.92] in the receiver operating characteristics in the derivation sample and 0.83 [0.75-0.91] in the validation sample. The observed transfusion rates in the validation set and the individual probabilities of erythrocyte transfusion from the score were well correlated (y = 0.98x + 0.04; P < 0.0001), and the observed differences were not statistically different (goodness-of-fit chi-square, P = 0.125). The score was also correlated with the number of erythrocyte units transfused (Spearman rho = 0.61; P < 0.0001). Conclusion The Predictive Model of Transfusion in Spine Surgery may be useful in clinical practice to identify patients undergoing spine surgery at risk of massive bleeding and encourage erythrocyte-saving strategies in these patients.

Clinical Outcome of Takotsubo Cardiomyopathy Diagnosed With or Without Coronary Angiography

Angiology ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Naoki Misumida ◽  
Gbolahan O. Ogunbayo ◽  
Sun Moon Kim ◽  
Ahmed Abdel-Latif ◽  
Khaled M. Ziada ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Hospital Mortality ◽  
Takotsubo Cardiomyopathy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Primary Diagnosis ◽  
Coronary Angiogram ◽  
National Inpatient Sample ◽  
Coronary Syndrome

Takotsubo cardiomyopathy (TC) is definitively diagnosed following the exclusion of acute coronary syndrome. We aimed to examine the rate of coronary angiography in patients diagnosed with TC and also the outcome of patients with TC diagnosed with or without coronary angiography. We analyzed the National Inpatient Sample database from 2010 to 2014 and identified patients hospitalized with a primary diagnosis of TC. We compared in-hospital mortality between patients who underwent coronary angiography and those who did not. We also evaluated the association between coronary angiography and in-hospital mortality using a propensity score–adjusted multivariable analysis. Among 22 818 patients diagnosed with TC, 87.4% underwent coronary angiography and 12.6% did not. Patients who did not undergo coronary angiography had a higher in-hospital mortality than those who did (3.0% vs 0.9%; P < .001). Increased mortality in patients who did not undergo coronary angiogram was observed in both male (8.0% vs 2.8%; P = .03) and female patients (2.6% vs 0.7%; P < .001) and in patients 61 to 80 years old and ≥81 years old, but not in patients ≤60 years old. Multivariable analysis demonstrated that the lack of coronary angiography was independently associated with higher in-hospital mortality (adjusted odds ratio: 2.92; 95% confidence interval: 1.52-5.65; P = .001).

Associations Between Patient-Reported Outcome Measures of Asthma Control and Psychosocial Symptoms

2018 ◽  
Vol 58 (3) ◽  
pp. 307-312
Author(s):  
ChangWon C. Lee ◽  
Faye F. Holder-Niles ◽  
Linda Haynes ◽  
Jenny Chan Yuen ◽  
Corinna J. Rea ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Asthma Control ◽  
Outcome Measures ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Primary Care Center ◽  
Patient Reported

There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.

Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 587-597 ◽  
Author(s):  
Pedro GR Teixeira ◽  
Karen Woo ◽  
Adam W Beck ◽  
Salvatore T Scali ◽  
Fred A Weaver ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Subclavian Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Multivariable Analysis ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011–July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82–2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03–5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74–3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

scholarly journals Burnout as a predictor of depression: a cross-sectional study of the sociodemographic and clinical predictors of depression amongst nurses in Cameroon

BMC Nursing ◽  
2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Clarence Mbanga ◽  
Haman Makebe ◽  
Divine Tim ◽  
Steve Fonkou ◽  
Louise Toukam ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
P Value ◽  
Clinical Predictors ◽  
Cross Sectional ◽  
North West ◽  
Oldenburg Burnout Inventory ◽  
English Speaking ◽  
Predictors Of Depression

Abstract Background Depression is a debilitating mental health condition which affects an estimated 350 million people worldwide annually. Nurses are twice as likely to suffer from depression than professionals in other professions. This leads to a considerable loss of efficiency and productivity. We sought to determine the prevalence and predictors of depression among nurses in Cameroon. Methods Cross-sectional analysis carried out over 6 months (January – June 2018) using nurses from public and private healthcare institutions sampled consecutively in the two English-speaking regions (North west and South west regions) of Cameroon. The nurses were handed a structured, printed, self-administered questionnaire to fill and hand in at their earliest convenience. Depression and burnout were assessed using the Patient Health Questionnaire – 9 and the Oldenburg Burnout Inventory respectively. Results A total of 143 nurses were recruited (mean age: 29.75 ± 6.55 years; age range: 20–55 years, 32.87% male). The overall prevalence of depression was 62.24%. Independent predictors of depression after multivariable analysis were: Number of night shifts a week (adjusted odds ratio: 1.58; p value: 0.045, 95% CI; 1.01, 2.48) and Total Oldenburg Burnout Inventory score (adjusted odds ratio: 1.21, p value: 0.001; 95% CI; 1.08, 1.35). Recreational drug use was also found to perfectly predict the outcome – depression. Conclusion Depression is highly prevalent among nurses in the English-speaking regions of Cameroon. Accurate predictors could prove vital for early detection and management of affected individuals. Predictors presented herein require further investigation via multicentric nationwide studies, to obtain more generalizable results.

scholarly journals Preparedness level and associated factors of health professionals regarding COVID-19

2021 ◽  
Vol 9 ◽  
pp. 205031212110011
Author(s):  
Denberu Eshetie Adane ◽  
Basazinew Chekol Demilew ◽  
Netsanet Temesgen Ayenew ◽  
Tadesse Tamrie Negash ◽  
Abebe Tiruneh Boled
Keyword(s):  
Confidence Interval ◽  
Health Professionals ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
P Value ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Logistic Analysis

Objective: To assess the level of preparedness of health professionals working in South Gondar Zone public hospital, Debre Tabor Comprehensive specialized Hospital for coronavirus. Methods: An institutional-based cross-sectional survey was conducted with a self-administered questionnaire from April 20 to May 20. Descriptive statistics, chi-square test, bivariable, and multivariable logistic analysis were done. Bivariable and multivariable regression was held to determine significant predictors for preparedness. For all statistical analyses, a p value ⩽ 0.05 was considered as significant. Results: From a total health professionals, 301 health professionals with a response rate of 86% participated in the study. Among these, 206 were males while 95 participants were females with a mean age of 29.71 ± 5.84 years. To determine the preparedness level, we use the mean preparedness score of the respondents. Around 64.1% of health professionals were well prepared. Among 20 respondents who had a chronic illness, 80% of them think their illness is risky for the pandemic. The majority of the respondents (229/76.1%) responded as they were working without protective equipment. From the multivariable analysis male sex (adjusted odds ratio = 2.07, 95% confidence interval = 1.193–3.590), family living with them (adjusted odds ratio = 4.507, 95% confidence interval = 1.863–10.90), and involvement of other previous outbreak (adjusted odds ratio = 2.245, 95% confidence interval = 1.176–4.286) were the predictors for good preparedness. Conclusion: Most of the health professionals were well prepared. Being male, living within a family, and involvement of other outbreaks leads to good preparation. Governmental bodies and hospital managers have to help health professionals to be prepared enough to combat the pandemic.

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