Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Introduction Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery. Methods and analysis In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors. Results We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02–0.99). Discussion Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient.

A Meta-Analysis on the Effectiveness of Video Laryngoscopy versus Laryngoscopy for Emergency Orotracheal Intubation

Background. Video laryngoscopy has been associated with some orotracheal intubations and enhances the glottic view at time of laryngoscopy and the success rate of the intubation in patients from the emergency department and the intensive care unit. In usual cases, direct laryngoscopy is performed among the patients from the emergency department or the intensive care unit. In this systematic review and meta-analysis, we draw the comparison between the video laryngoscopy and direct laryngoscopy for the emergency orotracheal intubation. Objective. The objective of the study was to identify the clinical efficacy of video laryngoscopy versus laryngoscopy for emergency orotracheal intubation. Materials and Methods. MEDLINE, CENTRAL, EMBASE, and Web of Science databases were analyzed from 2003 to 2020. Keywords used for searching the studies were “laryngoscopy,” “video laryngoscopy,” “direct laryngoscopy,” “emergency department,” “intensive care unit,” “orotracheal,” “video laryngoscope,” “glidescope,” “airway scope,” “airway,” “Macintosh laryngoscopy,” “airway management,” “tracheal intubation,” “orotracheal intubation,” and “intubation.” Results. The first-pass intubation success rates in the intensive care unit were low in video laryngoscopy with 95% CI 1.21 (1.13–1.30) and heterogeneity I2 = 78% favoring direct laryngoscopy nonsignificantly with low heterogeneity. Odds ratio for airway trauma or dental damage was 0.67, 95% CI (0.18–2.54), reported higher in video laryngoscopy. Complications with oesophageal laryngoscopy were higher in video laryngoscopy with risk ratio 0.16, 95% CI (0.09–0.29), odds ratio 0.88, 95% CI (0.65–1.18) for sever hypoxemia, risk ratio 1.53, 95% CI (1.02–2.28) for cardiovascular collapse, risk ratio with 95% CI 1.11 (0.59–2.07) for aspiration complications, and odds ratio 1.32, 95% CI (0.95, 1.85) for Inexperienced medical staff handling laryngoscopy. Conclusion. No significant efficiency was noticed in using video laryngoscopy when compared with direct laryngoscopy with the available data. The data reported in studies are not enough for efficient clinical analysis of the benefits of using video laryngoscopy over direct laryngoscopy. Thus, information such as length of stay, mortality, sever complications, and length of hospital stay must be reported.

Evaluation of Effects of Credit-Risk on Return on Assets of Commercial Banks in Nepal

Introduction: The major cause of bank distress in Nepal is associated with poor credit management which results to decline in credit standing of the banks. The study adopts judgmental sampling techniques. Objective: To analyze and evaluate the impact of credit-risk ratio on return on assets of commercial banks in Nepal. Research design: Descriptive and exploratory research designs were used. Methods and materials: Review of various articles and collection of secondary data through the websites of Nepal Rastra Bank. Results and conclusion: It is found that there is inverse relationship between credit risk ratio and return on assets ratio. The findings provide sufficient evidence that credit risk management indicators impact significantly on commercial bank performance in Nepal. Article type: Research Paper

Effectiveness of casirivimab and imdevimab, and sotrovimab during Delta variant surge: a prospective cohort study and comparative effectiveness randomized trial

IMPORTANCE The effectiveness of monoclonal antibodies (mAbs), casirivimab and imdevimab, and sotrovimab, for patients with mild to moderate Covid-19 from the Delta variant is unknown. OBJECTIVE To evaluate the effectiveness of mAbs for the Delta variant compared to no treatment, and the comparative effectiveness between mAbs. DESIGN, SETTING, AND PARTICIPANTS Two parallel studies among patients who met Emergency Use Authorization criteria for mAbs from July 14, 2021 to September 29, 2021: i.) prospective observational cohort study comparing mAb treatment to no mAb treatment and, ii.) Bayesian adaptive randomized trial comparing the effectiveness of casirivimab-imdevimab versus sotrovimab. In the observational study, we compared eligible patients who received mAb at an outpatient infusion center at UPMC, to nontreated patients with a positive SARS-CoV-2 test. In the comparative effectiveness trial, we randomly allocated casirivimab-imdevimab or sotrovimab to patients presenting to infusion centers and emergency departments, per system therapeutic interchange policy. EXPOSURE Intravenous mAb per their EUA criteria. MAIN OUTCOMES AND MEASURES For the observational study, risk ratio estimates for hospitalization or death by 28 days were compared between mAb treatment to no mAb treatment using propensity matched models. For the comparative effectiveness trial, the primary outcome was hospital-free days (days alive and free of hospital) within 28 days, where patients who died were assigned -1 day) in a Bayesian cumulative logistic model, adjusted for treatment location, age, sex, and time. Inferiority was defined as a 99% posterior probability of an odds ratio <1. Equivalence was defined as a 95% posterior probability that the odds ratio is within a given bound. RESULTS Among 3,558 patients receiving mAb, the mean age was 54 (SD 18 years), 1,511 (43%) were treated in an infusion center, and 450 (13%) were hospitalized or died by day 28. In propensity matched models, mAb treatment was associated with reduced risk of hospitalization or death compared to no treatment (risk ratio (RR)=0.40, 95% CI: 0.28-0.57). Both casirivimab and imdevimab (RR=0.31, 95% CI: 0.20-0.50), and sotrovimab (RR=0.60, 95% CI: 0.37-1.00) reduced hospitalization or death compared to no mAb treatment. Among patients allocated randomly to casirivimab and imdevimab (n=2,454) or sotrovimab (n=1,104), the median hospital-free days were 28 (IQR 28-28) for both groups, 28-day mortality was 0.5% (n=12) and 0.6% (n=7), and hospitalization by day 28 was 12% (n=291) and 12% (n=140), respectively. Compared to casirivimab and imdevimab, the median adjusted odds ratio for hospital-free days was 0.88 (95% credible interval, 0.70-1.11) for sotrovimab. This odds ratio yielded 86% probability of inferiority of sotrovimab versus casirivimab and imdevimab, and 79% probability of equivalence. CONCLUSIONS AND RELEVANCE In non-hospitalized patients with mild to moderate Covid-19 due to the Delta variant, casirivimab and imdevimab and sotrovimab were both associated with a reduced risk of hospitalization or death. The comparative effectiveness of mAbs appeared similar, though prespecified criteria for statistical inferiority or equivalence were not met. TRIAL REGISTRATION ClinicalTrials.gov: NCT04790786

Inhaled antiseptics and inhaled antiviral non-prescription drugs in the prevention of ARVI, in particular COVID-19: an epidemiological study

BACKGROUND. The article presents the results of a continuous, cross-sectional, non-interventional, multicenter retrospective epidemiological study, which included cases of 3443 participants. Questionnaires and rapid test for antibodies to SARS-CoV-2 were used to collect data. OBJECTIVE. To determine the relationship between the systematic use of additional drugs for the prevention of COVID-19, including inhaled antiseptics and inhaled antiviral drugs, separately and in combination with other drugs, and the risk of developing of coronavirus disease (COVID-19). RESULTS AND DISCUSSION. 396 participants (11.8 %) took inhaled antiseptics in any period since March 2020, and 410 participants (12.2 %) took inhaled antivirals. A statistically significant protective relationship between episode of COVID-19 when taking inhaled antiseptics and inhaled antiviral drugs (risk ratio 0.901; 95 % confidence interval 0.856-0.948) was determined. CONCLUSIONS. The use of inhaled antiseptics and inhaled antiviral drugs as additional methods of prevention of COVID-19 has shown a statistically significant effect not only on reducing the risk of COVID-19, but different combinations of inhaled antiseptics or inhaled antiviral drugs with other drug groups as additional methods of preventing COVID-19 had a statistically significant protective relationship with the episode of the disease, with the severity of COVID-19 and with the need for hospitalization.

Prevalence of blindness and distance vision impairment in the Gambia across three decades of eye health programming

Background/aimsThe 1986 Gambia National Eye Health Survey provided baseline data for a National Eye Health Programme. A second survey in 1996 evaluated changes in population eye health a decade later. We completed a third survey in 2019, to determine the current state of population eye health, considering service developments and demographic change.MethodsWe estimated prevalence and causes of vision impairment (VI) in a nationally representative population-based sample of adults 35 years and older. We used multistage cluster random sampling to sample 10 800 adults 35 and above in 360 clusters of 30. We measured monocular distance visual acuity (uncorrected and with available correction) using Peek Acuity. Participants with either eye uncorrected or presenting (with available correction) acuity <6/12 were retested with pinhole and refraction, and dilated exams were completed on all eyes by ophthalmologists using a direct ophthalmoscope, slit lamp and 90 D lens.ResultsWe examined 9188 participants (response rate 83%). The 2013 census age–sex adjusted prevalence of blindness (presenting acuity<3/60 in better seeing eye) was 1.2% (95% CI 0.9 to 1.4) and of moderate or severe VI (MSVI,<6/18 to ≥3/60) was 8.9% (95% CI 9.1 to 9.7). Prevalence of all distance VI (<6/12) was 13.4% (12.4–14.4). Compared with 1996, the relative risk of blindness decreased (risk ratio 0.7, 95% CI 0.5 to 1.0) and MSVI increased (risk ratio 1.5, 95% CI 1.2 to 0.17).ConclusionSignificant progress has been made to reduce blindness and increase access to eye health across the Gambia, with further work is needed to decrease the risk of MSVI.

Cardiovascular safety of celecoxib in rheumatoid arthritis and osteoarthritis patients: A systematic review and meta-analysis

Objective To assess the cardiovascular safety of celecoxib compared to non-selective non-steroid anti-inflammatory drugs or placebo. Methods We included randomized controlled trials of oral celecoxib compared with a non-selective NSAID or placebo in rheumatoid arthritis and osteoarthritis patients. We conducted searches in EMBASE, Cochrane CENTRAL, MEDLINE, China National Knowledge Infrastructure, VIP, Wanfang, and Chinese Biomedical Literature Database. Study selection and data extraction were done by two authors independently. The risk of bias was assessed using Cochrane’s risk-of-bias Tool for Randomized Trials. The effect size was presented as a risk ratio with their 95% confidence interval. Results Until July 22nd, 2021, our search identified 6279 records from which, after exclusions, 21 trials were included in the meta-analysis. The overall pooled risk ratio for Antiplatelet Trialists Collaboration cardiovascular events for celecoxib compared with any non-selective non-steroid anti-inflammatory drugs was 0.89 (95% confidence interval: 0.80–1.00). The pooled risk ratio for all-cause mortality for celecoxib compared with non-selective non-steroid anti-inflammatory drugs was 0.81 (95% confidence interval: 0.66–0.98). The cardiovascular mortality rate of celecoxib was lower than non-selective non-steroid anti-inflammatory drugs (risk ratio: 0.75, 95% confidence interval: 0.57–0.99). There was no significant difference between celecoxib and non-selective non-steroid anti-inflammatory drugs or placebo in the risk of other cardiovascular events. Conclusion Celecoxib is relatively safe in rheumatoid arthritis and osteoarthritis patients, independent of dose or duration. But it remains uncertain whether this would remain the same in patients treated with aspirin and patients with established cardiovascular diseases.

Cochlear Implantation and Risk of Falls in Older Adults

Objective To examine whether cochlear implantation (CI) increases the risk of clinically significant falls in older adults. Study Design Retrospective analysis of deidentified administrative claims from a US commercial insurance database. Setting Nationwide deidentified private insurance claims database (Clinformatics Data Mart; Optum). Methods Patients undergoing CI were identified through Current Procedural Terminology codes. Number of days with falls resulting in health care expenditure were counted 1 year pre- and post-CI. Generalized estimating equation Poisson regression was used to determine medical and sociodemographic predictors for fall days, including age, sex, race, and income, with pre- vs post-CI status. Results Between 2003 and 2019, 3773 patients aged >50 years underwent CI. An overall 139 (3.68%) patients recorded at least 1 fall diagnosis a year pre-CI, and 142 (3.76%) recorded at least 1 fall diagnosis post-CI. The average number of days with fall diagnoses per patient with a recorded fall was 3.12 pre-CI and 2.04 post-CI. In bivariate analysis, age ( P < .0001) and Charlson Comorbidity Index ( P < .0001) were predictive of falls, but sex ( P < .10), race ( P < .72), and income ( P < .51) were not. Poisson regression demonstrated a statistically significant association between Charlson Comorbidity Index and days with fall diagnoses (risk ratio, 1.39 [95% CI, 1.30-1.49]; P < .0001]). No statistically significant difference in falls was seen pre- vs post-CI (risk ratio, 0.67 [95% CI, 0.34-1.33]; P < .25]). Age also was not predictive of falls in multivariate analysis. Conclusions CI does not appear to increase the risk of falls in older adults. Patient comorbidities correlate most strongly with fall risk and should be considered in patient selection for CI.

Effectiveness of COVID-19 vaccines against delta variant (B.1.617.2): A meta-analysis

ObjectivesThe highly transmissible COVID-19 delta variant (DV) has contributed to the surge in cases and has now been exacerbated the worldwide public health crisis. Several COVID-19 vaccines play a significant role in a high degree of protection against DV. The primary purpose of this meta-analysis is to estimate the pooled effectiveness of the COVID-19 vaccines against DV in terms of risk ratio (RR) among fully vaccinated, compared to unvaccinated populations.MethodsWe carried out a systematic review with meta-analysis of original studies focused on COVID-19 vaccines effectiveness of COVID-19 vaccines against B.1.617.2 clinical perspective among fully COVID-19 vaccinated populations, compared to placebo (unvaccinated populations), published before September 30, 2021. Eleven studies containing data of 17.2 million participants were identified and included in our study. Pooled estimates of COVID-19 vaccines effectiveness (i.e., risk ratio, RR) against delta variant with 95% confidence intervals were assessed using random-effect models. Publication bias was assessed using Egger's regression test and funnel plot to investigate potential sources of heterogeneity and identify any differences in study design.ResultsA total population of 17.2 million (17,200,341 peoples) were screened for the COVID-19 vaccines' effectiveness against delta variant. We found 61.13% of study population were fully vaccinated with 2-dose of COVID-19 vaccines. Weighted pooled incidence of COVID-19 infection was more than double (20.07%) among unvaccinated populations, compared to the fully vaccinated population (8.16%). Overall, the effectiveness of COVID-19 vaccine against DV was 85% (RR = 0.15, 95% CI: 0.07-0.31). The effectiveness of COVID-19 vaccines varied slidably by study designs, 87% (RR = 0.13, 95% CI: 0.06-0.30) and 84% (RR = 0.16, 95% CI:0.02, 1.64) for cohort and case-control studies, respectively. ConclusionEffectiveness COVID-19 vaccines were noted to offer higher protection against delta variant among populations who received two vaccine doses compared with unvaccinated populations. This finding would help efforts to maximise vaccine coverage (i.e., at least 60 to 70% of the population) with two doses among vulnerable populations to have herd immunity to breat the chain of transmission and gain greater overall population protection more rapidly.

Initial assessment of the COVID-19 vaccination’s impact on case numbers, hospitalisations and deaths in people aged 80 years and older, 15 EU/EEA countries, December 2020 to May 2021

Prioritisation of elderly people in COVID-19 vaccination campaigns aimed at reducing severe outcomes in this group. Using EU/EEA surveillance and vaccination uptake, we estimated the risk ratio of case, hospitalisation and death notifications in people 80 years and older compared with 25–59-year-olds. Highest impact was observed for full vaccination uptake 80% or higher with reductions in notification rates of cases up to 65% (IRR: 0.35; 95% CI: 0.13–0.99), hospitalisations up to 78% (IRR: 0.22; 95% CI: 0.13–0.37) and deaths up to 84% (IRR: 0.16; 95% CI: 0.13–0.20).