scholarly journals Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
◽  
Matthew D Hall ◽  
Joaquín Baruch ◽  
Gail Carson ◽  
Barbara Wanjiru Citarella ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Rapid Decline ◽  
Design Data ◽  
Hospitalised Patients ◽  
Gates Foundation ◽  
The Uk

Background: There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics.Methods: We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay.Results: Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors.Conclusions: Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation.Funding: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill and Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

scholarly journals Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort

2021 ◽  
Author(s):  
Matthew Hall ◽  
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Symptom Onset ◽  
Time Trends ◽  
Time Course ◽  
Case Fatality ◽  
Treatment Modalities ◽  
Rapid Decline ◽  
Hospitalised Patients

There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an ongoing infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU), while novel treatment modalities may reduce the time course of illness. On the other hand, limited resources at times of high demand may lead to rationing of resources, with less beneficial consequences. Despite little evidence on how the values of such variables change over the course of a crisis (such as the current COVID-19 pandemic), they may nevertheless be used as proxies for disease severity, outcome measures for clinical trials, and to inform planning and logistics. In this study, we investigate such time trends in an extremely large international cohort of 142,540 patients with symptom onset of, or hospital admission for, COVID-19 during 2020. The variables investigated are time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, case fatality ratio (CFR) and total length of hospital stay. Time from hospital symptom onset to hospital admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December. ICU/HDU admission was more frequent from June to August, while there were only modest time trends in time from hospital admission to ICU/HDU. The CFR was lowest from June to August, a trend mostly driven by patients with no ICU/HDU admission. Raw numbers for overall hospital stay showed little overall variation over the time period, but further examination reveals a clear decline in time to discharge for ICU/HDU survivors. Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

scholarly journals Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

2020 ◽  
Vol 148 ◽  
Author(s):  
T. Kimura ◽  
S. Stanhope ◽  
T. Sugitani
Keyword(s):  
Hospital Stay ◽  
Excess Mortality ◽  
Length Of Hospital Stay ◽  
Administrative Database ◽  
Matched Cohort ◽  
Limited Evidence ◽  
Immortal Time Bias ◽  
Hospitalised Patients ◽  
Substantial Economic Burden ◽  
Support Decision Making

Abstract Clostridioides (Clostridium) difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients, representing a substantial economic burden driven mainly by increased length of hospital stay (LoS). Currently in Japan, limited evidence on CDI-associated excess LoS is available. We conducted a retrospective, matched-cohort study using a large, Japanese, hospital-based administrative database. CDI was defined as CDI treatment plus either CDI diagnosis or positive enzyme immunoassay result. Propensity score matching at the time of CDI or recurrent CDI (rCDI) onset was applied to adjust baseline confounding and immortal time bias. The analysis included 5 994 054 hospitalisation records during 2008–2017, of which 11 823 were identified as CDI and 1359 as rCDI. The median excess LoS attributable to CDI and rCDI was 3 days and 6.5 days, respectively. The excess mortality attributable to CDI was 6.9%; there was no excess mortality attributable to rCDI (−1.9%). The median difference in costs attributable to CDI and rCDI during the residual stay was JPY 130 296 (USD 1185) and JPY 81 054 (USD 737) per hospitalisation, respectively. By adjusting the biases, the burden of CDI in Japan was evaluated. The findings could support decision making and resource allocation for CDI management in Japanese hospitals.

scholarly journals Epidemiological Trend of Sepsis in Patients with Hospital Admissions Related to Hepatitis C in Spain (2000–2015): A Nationwide Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1607
Author(s):  
Alejandro Alvaro-Meca ◽  
Irene Maté-Cano ◽  
Pablo Ryan ◽  
Verónica Briz ◽  
Salvador Resino
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Hospital Admission ◽  
Chronic Hepatitis C ◽  
Hospital Admissions ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Data Set ◽  
Epidemiological Trend ◽  
Epidemiological Trends

Background: Hepatitis C virus (HCV) infection predisposes patients to other infectious diseases, such as sepsis. We aimed to analyze epidemiological trends of sepsis-related admissions, deaths, and costs in hospital admissions with chronic hepatitis C who had a hospital admission in Spain. Methods: We performed a retrospective study of all hospitalizations involving chronic hepatitis C in the Spanish Minimum Basic Data Set (MBDS) between 2000 and 2015. This period was divided into four calendar periods (2000–2004, 2005–2007, 2008–2011, and 2012–2015). Results: We selected 868,523 hospital admissions of patients with chronic hepatitis C over 16 years in the Spanish MBDS. Among them, we found 70,976 (8.17%) hospital admissions of patients who developed sepsis, of which 13,915 (19.61%) died during admission. We found an upward trend, from 2000–2003 to 2012–2015, in the rate of sepsis-related admission (from 6.18% to 10.64%; p < 0.001), the risk of sepsis-related admission (from 1.31 to 1.55; p < 0.001), and the sepsis-related cost per hospital admission (from 7198€ to above 9497€; p < 0.001). However, we found a downward trend during the same study period in the sepsis case-fatality rate (from 21.99% to 18.16%; p < 0.001), the risk of sepsis-related death (from 0.81 to 0.56; p < 0.001), and the length of hospital stay (LOHS) (from 16.9 to 13.9; p < 0.001). Moreover, the rate of bacterial Gram-positive and candidiasis infections decreased, while Gram-negative microorganisms increased from 2000–2003 to 2012–2015. Conclusions: Sepsis, in chronic hepatitis C patients admitted to the hospital, has increased the period 2000–2015 and has been an increasing burden for the Spanish public health system. However, there has also been a significant reduction in lethality and LOHS during the study period. In addition, the most prevalent specific microorganisms have also changed in this period.

Analysis of Hospital Admissions for Psychiatric Care in Portugal: Results from the SMAILE Study

2017 ◽  
Vol 41 (S1) ◽  
pp. S250-S250
Author(s):  
M. Silva ◽  
A. Antunes ◽  
A. Loureiro ◽  
P. Santana ◽  
J. Caldas-de-Almeida ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Psychiatric Care ◽  
Hospital Admissions ◽  
Common Mental Disorders ◽  
Length Of Hospital Stay ◽  
Compulsory Admission ◽  
Clinical Factors ◽  
Psychiatric Admissions

IntroductionEvidence shows that the prevalence and severity of mental disorders and the need for psychiatric admission is influenced by socio-demographic and contextual factors.ObjectivesTo characterize the severity of hospital admissions for psychiatric care due to common mental disorders and psychosis in Portugal.AimsThis retrospective study analyses all acute psychiatric admissions for common mental disorders and psychosis in four Portuguese departments of psychiatry in the metropolitan areas of Lisbon and Porto, and investigates the association of their severity with socio-demographic and clinical factors.MethodsSocio-demographic and clinical variables were obtained from the clinical charts of psychiatric admissions in 2002, 2007 and 2012 (n = 2621). The number of hospital admissions per year (>1) and the length of hospital stay (31 days) were defined as measures of hospital admission severity. Logistic regression analysis was used to assess which socio-demographic and clinical factors were associated with both hospital admission severity outcomes.ResultsResults showed different predictors for each outcome. Being widowed, low level of education, being retired, having psychiatric co-morbidity, and a compulsory admission were statistically associated (P < 0.05) with a higher number of hospital admissions. Being single or widowed, being retired, a diagnosis of psychosis, and a compulsory admission were associated with higher length of hospital stay, while having suicidal ideation was associated with a lower length of hospital stay.ConclusionsSocio-demographic and clinical characteristics of the patients are determinants of hospital admissions for psychiatric care and of their severity.Funding Fundação para a Ciência e Tecnologia (FCT), Portugal.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Staged Bilateral Hip or Knee Arthroplasties

2007 ◽  
Vol 15 (2) ◽  
pp. 159-162 ◽  
Author(s):  
FR Hashmi ◽  
K Barlas ◽  
CF Mann ◽  
FR Howell
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Early Complication ◽  
Early Complications ◽  
Hospital Stays ◽  
The Mean

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.

scholarly journals Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Helena Enocsson ◽  
Cornelia Idoff ◽  
Annette Gustafsson ◽  
Melissa Govender ◽  
Francis Hopkins ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Plasminogen Activator ◽  
Disease Severity ◽  
Length Of Hospital Stay ◽  
Urokinase Plasminogen Activator ◽  
Enzyme Linked Immunosorbent Assay ◽  
Urokinase Plasminogen Activator Receptor ◽  
Cell Counts ◽  
Hospitalised Patients ◽  
Plasminogen Activator Receptor

Background: Efficient healthcare based on prognostic variables in hospitalised patients with COVID-19 could reduce the risk of complications and death. Recently, soluble urokinase Plasminogen Activator Receptor (suPAR) was shown to predict respiratory failure, kidney injury, and clinical outcome in patients with SARS-CoV-2 infection. The aim of this study was to investigate the value of suPAR as a prognostic tool, in comparison with other variables, regarding disease severity and length of hospital stay in patients with COVID-19.Patients and Methods: Individuals hospitalised with COVID-19 (40 males, 20 females; median age 57.5 years) with a median symptom duration of 10 days and matched, healthy controls (n = 30) were included. Admission levels of suPAR were measured in serum by enzyme-linked immunosorbent assay. Blood cell counts, C-reactive protein (CRP) levels, lactate dehydrogenase (LDH), plasma creatinine and estimated glomerular filtration rates were analysed and oxygen demand, level of care and length of hospitalisation recorded.Results: Patients had significantly higher suPAR levels compared to controls (P &lt; 0.001). Levels were higher in severely/critically (median 6.6 ng/mL) compared with moderately ill patients (median 5.0 ng/mL; P = 0.002). In addition, suPAR levels correlated with length of hospitalisation (rho = 0.35; P = 0.006). Besides suPAR, LDH, CRP, neutrophil count, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratio, body mass index and chronic renal failure were discriminators of COVID-19 severity and/or predictors of length of hospitalisation.Conclusion: Admission levels of suPAR were higher in patients who developed severe/critical COVID-19 and associated with length of hospital stay. In addition, we showed that suPAR functioned as an independent predictor of COVID-19 disease severity.

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