Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data

Background There was a national roll out of "COVID Virtual Wards" (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge and avoid readmissions, reducing pressure on beds. This study is an evaluation of the impact of the CVW services on hospital activity. Methods Using retrospective patient-level hospital admissions data, we built multivariate models to analyse the relationship between the implementation of CVW services and hospital activity outcomes: length of COVID-19 related stays and subsequent COVID-19 readmissions within 28 days. We used data from more than 98% of recorded COVID-19 hospital stays in England, where the patient was discharged alive between mid-August 2020 and late February 2021. Findings We found a longer length of stay for COVID-19 patients discharged from hospitals where a CVW was available, when compared to patients discharged from hospitals where there was no CVW (adjusted IRR 1.05, 95% CI 1.01 to 1.09). We found no evidence of a relationship between the availability of CVW and subsequent rates of readmission for COVID-19 (adjusted OR 0.95, 95% CI 0.89 to 1.02). Interpretation We found no evidence of early discharges or reduced readmissions associated with the roll out of COVID Virtual Wards across England. Our analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled) may have meant that true impacts, especially at a local level, were not ultimately discernible. Funding This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme and NHSEI.

Effect of oseltamivir phosphate versus placebo on platelet recovery and plasma leakage in adults with dengue and thrombocytopenia; a phase 2, multicenter, double-blind, randomized trial

Background Thrombocytopenia, bleeding and plasma leakage are major complications of dengue. Activation of endogenous sialidases with desialylation of platelets and endothelial cells may underlie these complications. We aimed to assess the effects of the neuraminidase inhibitor oseltamivir on platelet recovery and plasma leakage in dengue. Methods We performed a phase 2, double-blind, multicenter, randomized trial in adult dengue patients with thrombocytopenia (<70,000/μl) and a duration of illness ≤ 6 days. Oseltamivir phosphate 75mg BID or placebo were given for a maximum of five days. Primary outcomes were the time to platelet recovery (≥ 100,000/μl) or discharge from hospital and the course of measures of plasma leakage. Results A total of 70 patients were enrolled; the primary outcome could be assessed in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n = 9) were similar in the oseltamivir and placebo group (3.0 days [95% confidence interval, 2.7 to 3.3] vs. 2.9 days [2.5 to 3.3], P = 0.055). The kinetics of platelet count and parameters of plasma leakage (gall bladder thickness, hematocrit, plasma albumin, syndecan-1) were also similar between the groups. Discussion In this trial, adjunctive therapy with oseltamivir phosphate had no effect on platelet recovery or plasma leakage parameters. Trial registration ISRCTN35227717.

A multi-professional approach for transition of care at discharge in hyperglycemic inpatients with covid-19: a single center study

Background: The discharge from hospital of insulin-treated hyperglycemic patients is always challenging. This is even more so in patients requiring glucocorticoid treatment, such as those with COVID-19. Patients and method: A retrospective monocentric study of 23 inpatients with newly diagnosed or already known diabetes mellitus (DM) who were naïve to insulin treatment, , and who were hospitalized with COVID-19 in non-critical settings and then discharged. Patients were followed-up for one month after discharge for the management of insulin treatment by a multi-professional team through phone consultations. Results: Insulin prescriptions at discharge were 24.6 ± 14 U/day injected in 2 ± 1.5 daily shots. A mean of three phone consultations were required. One month later, the mean insulin reduction was 1.5 ± 1.3 shots and 6 ± 5 U/day. All patients reached their glycemic target without hypoglycemic events, drop-outs, or readmissions. Conclusion: This study demonstrates the feasibility, efficacy, and safety of a multi-professional approach through telemedicine for managing DM patients after discharge during COVID-19.

Current Trends in Nosocomial Associated UTI (NAUTI) in Urology Ward

Background: Nosocomial associated urinary tract infections are common, which not only causes morbidity and mortality but also increases cost of health related expenditure in urology patients. Such infections are more difficult to treat because of presence of risk factors e.g. stone, reduced kidney functions. Limited studies are available which focus on type of organisms involved in NAUTI and their presentation in urology departments. Objective: To determine the proportion of microorganisms involved in Nosocomial associated urinary tract infections (NAUTI) and their presentations in urology ward. Methods: This cross-sectional study was conducted in Dubai Hospital in Dubai UAE, from 2017-2018. All patients, who were admitted in urology department with negative urine cultures, were included in study. Urine cultures were sent at time of discharge and a week after discharge from hospital. Patients were followed up in outdoor at first and second week. Results: Total 475 patients were included in this study in given time period. 315(66.31%) patients were male and 160(33.68%) patients were female. On their first follow up after a week, Urine cultures, which were sent at discharge time reveals,73(15.36%) patient’s urine cultures were positive, out of them 21(28.76%) were Mixed Bacterial Growth (MBG). E.coli was most common organism 20(27.39%) in which 11(15.06%) were ESBL positive, klebsiela 9(12.32%) in which 4(5.47%) were ESBL positive. Other organisms include Psuedomonas 4(5.47%), candida 16(21.91%) and enterococcus 3(4.11%). Frequency of candida was second highest, probably because of use of antibiotics during admission. Conclusion: Prevalence of NAUTI in urology is 19.79% (94/475 patients). Enterobacterale species were main responsible organisms for NAUTI in Urology ward. E.coli was most common organism isolated and klebsiela was second most common. Key words: Nosocomial UTI, ESBL UTI, Urology ward

SATISFACTION OF SUSPECTED COVID-19 PATIENTS REGARDING MEAL SERVICES AT A TERTIARY CARE HOSPITAL OF NORTH INDIA

Introduction: Meal services plays a significant role in speedy recovery and increases patient satisfaction. Objective: Present study was done to assess the satisfaction of suspected COVID-19 patients regarding meal services at a tertiary care hospital of north India. Methodology: This cross-sectional study in retrospective design was done to understand the factors affecting the satisfaction of suspected COVID-19 patients with respect to meal services. The data was collected for patients admitted from January 2020-June 2020 with the help of a questionnaire with graded responses i.e Yes, No or Maybe/Not applicable, gathered from participants after discharge from hospital through ‘google forms’. Results: Out of 160 participants, 159 filled up the questionnaire through ‘google form’. Majority of the participants were <30 Years old 46.5%, had university or higher education 52.8%. The study showed 96.9% patients were satisfied and 3.1% were not satisfied with the quality of the meal services provided during the hospital stay. There was no significant association observed between taste of meals and consumption of whole meal with the quality of the meal served (p = 0.875, p = 0.855 respectively). Although significant association was observed between temperature of meal, time of meal distribution, quantity of water bottles provided, and quality of meal served (p = 0.000, p = <0.001, p = 0.000). Conclusion: Present study connotes that such types of assessments can help identify the gaps which can be worked on for achieving maximal satisfaction of patients with respect to quality of meal services in the hospital. Key words: COVID-19 patients; Meal services; Patient Satisfaction; Tertiary care hospital

Fusion of Imaging and Non-Imaging Data for Disease Trajectory Prediction for COVID-19 Patients

ABSTRCATPurposeThis study investigates whether graph-based fusion of imaging data with non-imaging EHR data can improve the prediction of disease trajectory for COVID-19 patients, beyond the prediction performance of only imaging or non-imaging EHR data.Materials and MethodsWe present a novel graph-based framework for fine-grained clinical outcome prediction (discharge, ICU admission, or death) that fuses imaging and non-imaging information using a similarity-based graph structure. Node features are represented by image embedding and edges are encoded with clinical or demographic similarity.ResultsOur experiments on data collected from Emory Healthcare network indicate that our fusion modeling scheme performs consistently better than predictive models using only imaging or non-imaging features, with f1-scores of 0.73, 0.77, and 0.66 for discharge from hospital, mortality, and ICU admission, respectively. External validation was performed on data collected from Mayo Clinic. Our scheme highlights known biases in the model prediction such as bias against patients with alcohol abuse history and bias based on insurance status.ConclusionThe study signifies the importance of fusion of multiple data modalities for accurate prediction of clinical trajectory. Proposed graph structure can model relationships between patients based on non-imaging EHR data and graph convolutional networks can fuse this relationship information with imaging data to effectively predict future disease trajectory more effectively than models employing only imaging or non-imaging data. Forecasting clinical events can enable intelligent resource allocation in hospitals. Our graph-based fusion modeling frameworks can be easily extended to other prediction tasks to efficiently combine imaging data with non-imaging clinical data.

Changes in care in the fourth trimester in Ireland: 2010–2020

Background There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital.