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Sample records for 30-day in-hospital mortality

  1. Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

    PubMed Central

    Rosenthal, G. E.; Baker, D. W.; Norris, D. G.; Way, L. E.; Harper, D. L.; Snow, R. J.

    2000-01-01

    OBJECTIVE: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN: A retrospective cohort study was conducted. DATA COLLECTION: Demographic and clinical data were collected from patients' medical records and were used to develop multivariable models that estimated the risk of in-hospital and 30-day (post-admission) mortality. Standardized mortality ratios (SMRs) for in-hospital and 30-day mortality were determined by dividing observed death rates by predicted death rates. PRINCIPAL FINDINGS: In-hospital SMRs ranged from 0.54 to 1.42, and six hospitals were classified as statistical outliers (p <.05); 30-day SMRs ranged from 0.63 to 1.73, and seven hospitals were outliers. Although the correlation between in-hospital SMRs and 30-day SMRs was substantial (R = 0.78, p < .001), outlier status changed for seven of the 30 hospitals. Nonetheless, changes in outlier status reflected relatively small differences between in-hospital and 30-day SMRs. Rates of discharge to nursing homes or other inpatient facilities varied from 5.4 percent to 34.2 percent across hospitals. However, relationships between discharge rates to such facilities and in-hospital SMRs (R = 0.08; p = .65) and early post-discharge mortality rates (R = 0.23; p = .21) were not significant. CONCLUSIONS: SMRs based on in-hospital and 30-day mortality were relatively similar, although classification of hospitals as statistical outliers often differed. However, there was no evidence that in-hospital SMRs were biased by differences in post-discharge mortality or discharge practices. PMID:10737447

  2. Vitamin D Status Predicts 30 Day Mortality in Hospitalised Cats

    PubMed Central

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F.; Lalor, Stephanie M.; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X.; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J.

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  3. New consensus definition for acute kidney injury accurately predicts 30-day mortality in cirrhosis with infection

    PubMed Central

    Wong, Florence; O’Leary, Jacqueline G; Reddy, K Rajender; Patton, Heather; Kamath, Patrick S; Fallon, Michael B; Garcia-Tsao, Guadalupe; Subramanian, Ram M.; Malik, Raza; Maliakkal, Benedict; Thacker, Leroy R; Bajaj, Jasmohan S

    2015-01-01

    Background & Aims A consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined as an increase in serum creatinine by >50% from the stable baseline value in <6 months or by ≥0.3mg/dL in <48 hrs. We prospectively evaluated the ability of these criteria to predict mortality within 30 days among hospitalized patients with cirrhosis and infection. Methods 337 patients with cirrhosis admitted with or developed an infection in hospital (56% men; 56±10 y old; model for end-stage liver disease score, 20±8) were followed. We compared data on 30-day mortality, hospital length-of-stay, and organ failure between patients with and without AKI. Results 166 (49%) developed AKI during hospitalization, based on the consensus criteria. Patients who developed AKI had higher admission Child-Pugh (11.0±2.1 vs 9.6±2.1; P<.0001), and MELD scores (23±8 vs17±7; P<.0001), and lower mean arterial pressure (81±16mmHg vs 85±15mmHg; P<.01) than those who did not. Also higher amongst patients with AKI were mortality in ≤30 days (34% vs 7%), intensive care unit transfer (46% vs 20%), ventilation requirement (27% vs 6%), and shock (31% vs 8%); AKI patients also had longer hospital stays (17.8±19.8 days vs 13.3±31.8 days) (all P<.001). 56% of AKI episodes were transient, 28% persistent, and 16% resulted in dialysis. Mortality was 80% among those without renal recovery, higher compared to partial (40%) or complete recovery (15%), or AKI-free patients (7%; P<.0001). Conclusions 30-day mortality is 10-fold higher among infected hospitalized cirrhotic patients with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure. PMID:23999172

  4. Integrated systems of stroke care and reduction in 30-day mortality

    PubMed Central

    Ganesh, Aravind; Lindsay, Patrice; Fang, Jiming; Kapral, Moira K.; Côté, Robert; Joiner, Ian; Hakim, Antoine M.

    2016-01-01

    Objective: To evaluate the association between the presence of integrated systems of stroke care and stroke case-fatality across Canada. Methods: We used the Canadian Institute of Health Information's Discharge Abstract Database to retrospectively identify a cohort of stroke/TIA patients admitted to all acute care hospitals, excluding the province of Quebec, in 11 fiscal years from 2003/2004 to 2013/2014. We used a modified Poisson regression model to compute the adjusted incidence rate ratio (aIRR) of 30-day in-hospital mortality across time for provinces with stroke systems compared to those without, controlling for age, sex, stroke type, comorbidities, and discharge year. We conducted surveys of stroke care resources in Canadian hospitals in 2009 and 2013, and compared resources in provinces with integrated systems to those without. Results: A total of 319,972 patients were hospitalized for stroke/TIA. The crude 30-day mortality rate decreased from 15.8% in 2003/2004 to 12.7% in 2012/2013 in provinces with stroke systems, while remaining 14.5% in provinces without such systems. Starting with the fiscal year 2009/2010, there was a clear reduction in relative mortality in provinces with stroke systems vs those without, sustained at aIRR of 0.85 (95% confidence interval 0.79–0.92) in the 2011/2012, 2012/2013, and 2013/2014 fiscal years. The surveys indicated that facilities in provinces with such systems were more likely to care for patients on a stroke unit, and have timely access to a stroke prevention clinic and telestroke services. Conclusion: In this retrospective study, the implementation of integrated systems of stroke care was associated with a population-wide reduction in mortality after stroke. PMID:26850979

  5. Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

    PubMed Central

    Safatli, Diaa A.; Günther, Albrecht; Schlattmann, Peter; Schwarz, Falko; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background: Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts. Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. Results: From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661–0.796, P < 0.001), bleeding volume (OR = 1.012 per ml, 95% CI = 1.007 – 1.017, P < 0.001), and infratentorial hematoma location (OR = 5.381, 95% CI = 2.166-13.356, P = 0.009) were significant predictors for the 30-day mortality. After receiver operating characteristics analysis, we defined a “high-risk group” for an unfavorable short-term outcome with GCS <11 and ICH volume >32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001). Conclusions: GCS score on admission together with the baseline volume and localization of the hemorrhage are strong

  6. Measuring hospital mortality rates: are 30-day data enough? Ischemic Heart Disease Patient Outcomes Research Team.

    PubMed Central

    Garnick, D W; DeLong, E R; Luft, H S

    1995-01-01

    OBJECTIVE. We compare 30-day and 180-day postadmission hospital mortality rates for all Medicare patients and those in three categories of cardiac care: coronary artery bypass graft surgery, acute myocardial infarction, and congestive heart failure. DATA SOURCES/COLLECTION. Health Care Financing Administration (HCFA) hospital mortality data for FY 1989. STUDY DESIGN. Using hospital level public use files of actual and predicted mortality at 30 and 180 days, we constructed residual mortality measures for each hospital. We ranked hospitals and used receiver operating characteristic (ROC) curves to compare 0-30, 31-180, and 0-180-day postadmission mortality. PRINCIPAL FINDINGS. For the admissions we studied, we found a broad range of hospital performance when we ranked hospitals using the 30-day data; some hospitals had much lower than predicted 30-day mortality rates, while others had much higher than predicted mortality rates. Data from the time period 31-180 days postadmission yield results that corroborate the 0-30 day postadmission data. Moreover, we found evidence that hospital performance on one condition is related to performance on the other conditions, but that the correlation is much weaker in the 31-180-day interval than in the 0-30-day period. Using ROC curves, we found that the 30-day data discriminated the top and bottom fifths of the 180-day data extremely well, especially for AMI outcomes. CONCLUSIONS. Using data on cumulative hospital mortality from 180 days postadmission does not yield a different perspective from using data from 30 days postadmission for the conditions we studied. PMID:7860319

  7. Hyperkalemia is Associated with Increased 30-Day Mortality in Hip Fracture Patients.

    PubMed

    Norring-Agerskov, Debbie; Madsen, Christian Medom; Abrahamsen, Bo; Riis, Troels; Pedersen, Ole B; Jørgensen, Niklas Rye; Bathum, Lise; Lauritzen, Jes Bruun; Jørgensen, Henrik L

    2017-02-17

    Abnormal plasma concentrations of potassium in the form of hyper- and hypokalemia are frequent among hospitalized patients and have been linked to poor outcomes. In this study, we examined the prevalence of hypo- and hyperkalemia in patients admitted with a fractured hip as well as the association with 30-day mortality in these patients. A total of 7293 hip fracture patients (aged 60 years or above) with admission plasma potassium measurements were included. Data on comorbidity, medication, and death was retrieved from national registries. The association between plasma potassium and mortality was examined using Cox proportional hazards models adjusted for age, sex, and comorbidities. The prevalence of hypo- and hyperkalemia on admission was 19.8% and 6.6%, respectively. The 30-day mortality rates were increased for patients with hyperkalemia (21.0%, p < 0.0001) compared to normokalemic patients (9.5%), whereas hypokalemia was not significantly associated with mortality. After adjustment for age, sex, and individual comorbidities, hyperkalemia was still associated with increased risk of death 30 days after admission (HR = 1.93 [1.55-2.40], p < 0.0001). After the same adjustments, hypokalemia remained non-associated with increased risk of 30-day mortality (HR = 1.06 [0.87-1.29], p = 0.6). Hyperkalemia, but not hypokalemia, at admission is associated with increased 30-day mortality after a hip fracture.

  8. Hypotension During Hospitalization for Acute Heart Failure Is Independently Associated With 30-Day Mortality: Findings from ASCEND-HF

    PubMed Central

    Patel, Priyesh A.; Heizer, Gretchen; O’Connor, Christopher M.; Schulte, Phillip J.; Dickstein, Kenneth; Ezekowitz, Justin A.; Armstrong, Paul W.; Hasselblad, Vic; Mills, Roger M.; McMurray, John J.; Starling, Randall C.; Wilson Tang, W. H.; Califf, Robert M.; Hernandez, Adrian F.

    2015-01-01

    Background Outcomes associated with episodes of hypotension while hospitalized are not well understood. Methods and Results Using data from ASCEND-HF, we assessed factors associated with inhospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between inhospital hypotension and renal function at hospital discharge. Overall, 1555/7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.76–2.23; p<0.001), chronic metolazone therapy (OR 1.74, 95% CI 1.17–2.60; p<0.001), and baseline orthopnea (OR 1.31, 95% CI 1.13–1.52; p=0.001) or S3 gallop (OR 1.21, 95% CI 1.06–1.40; p=0.006). In-hospital hypotension was associated with increased hazards of 30-day mortality (hazard ratio [HR] 2.03, 95% CI 1.57–2.61; p<0.001), 30-day heart failure (HF) hospitalization or mortality (HR 1.58, 95% CI 1.34–1.86; p<0.001), and 30-day all-cause hospitalization or mortality (HR 1.40, 95% CI 1.22–1.61; p<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction p=0.874 for death, p=0.908 for death/HF hospitalization, p=0.238 death/all-cause hospitalization). Conclusions Hypotension while hospitalized for acute decompensated HF is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT

  9. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism

    PubMed Central

    Ghiasi, Farzin; Ahmadpoor, Amin; Amra, Babak

    2015-01-01

    Background: Pulmonary embolism (PE) is the most life-threatening form of venous thrombosis which causes the majority of mortalities in this category. Obstructive sleep apnea (OSA) has been indicated as one of the risk factors for thromboembolism because of hemostatic alterations. The present study was designed to seek for the relationship between OSA and 30-day mortality of patients with PE. Materials and Methods: This prospective cohort study was conducted among 137 consecutive patients referred to hospital with symptoms of PE and preliminary stable hemodynamic. Confirmation of PE was made by multislice computed tomography pulmonary angiography and in the case of contraindication; V/Q lung scan and Doppler sonography were done. A STOP-Bang Questionnaire was used to determine patients with high- and low-risk of OSA. Patients were followed up for 1-month, and their survivals were recorded. Results: This study showed that there was no relationship between OSA and 30-day mortality (P = 0.389). Chronic kidney disease (P = 0.004), hypertension (P = 0.003), main thrombus (P = 0.004), and segmental thrombus (P = 0.022) were associated with 30-day mortality. In the logistic regression analysis, history of chronic kidney disease was diagnosed as a risk factor for 30-day mortality among the PE patients (P = 0.029, odds ratio = 4.93). Conclusion: Results of this study showed 30-day mortality was not affected by OSA directly. In fact, it was affected by complications of OSA such as hypertension and thrombus. Also, positive history of chronic kidney disease increased the risk of 30-day mortality. PMID:26622255

  10. Analysis of weekend effect on 30-day mortality among patients with acute myocardial infarction

    PubMed Central

    Noad, Rebecca; Stevenson, Michael; Herity, Niall A

    2017-01-01

    Objectives Several publications have demonstrated increased 30-day mortality in patients admitted on Saturdays or Sundays compared with weekdays. We sought to determine whether this was true for two different cohorts of patients admitted with acute myocardial infarction (MI). Methods and results Thirty-day mortality data were obtained for 3757 patients who had been admitted to the Belfast Health and Social Care Trust with acute MI between 2009 and 2015. They were subdivided into those presenting with ST elevation MI (n=2240) and non-ST elevation MI (n= 1517). We observed no excess 30-day mortality in those admitted over weekends. Conclusion Excess mortality in patients admitted at weekends is not a universal finding. This may mean that that there are patient subgroups with proportionately greater weekend hazard and points to the need for more detailed understanding of the weekend effect.

  11. A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery

    PubMed Central

    Hossain, Fahad Siddique; Aqil, Adeel; Akinbamijo, Babawande; Mushtaq, Vhaid; Kapoor, Harish

    2017-01-01

    Background A fracture neck of femur is the leading cause of injury-related mortality in the elderly population. The 30-day mortality figure is a well utilised marker of clinical outcome following a fracture neck of femur. Current studies fail to analyse all patient demographic, biochemical and comorbid parameters associated with increased 30-day mortality. We aimed to assess medical risk factors for mortality, which are easily identifiable on admission for patients presenting with a fractured neck of femur. Methods A retrospective review of a prospectively populated database was undertaken to identify all consecutive patients with a fracture neck of femur between October 2008 and March 2011. All factors related to the patient, injury and surgery were identified. The primary outcome of interest was 30-day mortality. Univariate and subsequent multivariate analyses using a backward stepwise likelihood ratio Cox regression model were performed in order to establish all parameters that significantly increased the risk of death. Results A total of 1,356 patients were included in the study. The 30-day mortality was 8.7%. The most common causes of death included pneumonia, sepsis and acute myocardial infarction. Multiple regression analysis revealed male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than 10 g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score and liver disease to be significant predictors of mortality. Conclusions This study has elucidated risk factors for mortality using clinical and biochemical information which are easily gathered at the point of hospitalization. These results allow for identification of vulnerable patients who may benefit from a prioritisation of resources. PMID:28261422

  12. Surgeon volume and 30 day mortality for brain tumours in England

    PubMed Central

    Williams, Matt; Treasure, Peter; Greenberg, David; Brodbelt, Andrew; Collins, Peter

    2016-01-01

    Background: There is evidence that surgeons who perform more operations have better outcomes. However, in patients with brain tumours, all of the evidence comes from the USA. Methods: We examined all English patients with an intracranial neoplasm who had an intracranial resection in 2008–2010. We included surgeons who performed at least six operations over 3 years, and at least one operation in the first and last 6 months of the period. Results: The analysis data set comprised 9194 operations, 163 consultant neurosurgeons and 30 centres. Individual surgeon volumes varied widely (7–272; median=46). 72% of operations were on the brain, and 30 day mortality was 3%. A doubling of surgeon load was associated with a 20% relative reduction in mortality. Thirty day mortality varied between centres (0·95–8·62%) but was not related to centre workload. Conclusions: Individual surgeon volumes correlated with patient 30 day mortality. Centres and surgeons in England are busier than surgeons and centres in the USA. There is no relationship between centre volume and 30 day mortality in England. Services in the UK appear to be adequately arranged at a centre level, but would benefit from further surgeon sub-specialisation. PMID:27764843

  13. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke

    PubMed Central

    Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M.; Ko, Sang-Bae; Yoon, Byung-Woo

    2017-01-01

    Background Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. Aim In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46–3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00–1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10–8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. Conclusions D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer. PMID:28282388

  14. Preadmission use of SSRIs alone or in combination with NSAIDs and 30-day mortality after peptic ulcer bleeding.

    PubMed

    Gasse, Christiane; Christensen, Steffen; Riis, Anders; Mortensen, Preben B; Adamsen, Sven; Thomsen, Reimar W

    2009-01-01

    OBJECTIVE. Use of selective serotonin reuptake inhibitors (SSRIs) increases the risk of upper gastrointestinal bleeding and this risk is amplified by concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to examine the impact of SSRI use alone or in combination with NSAIDs on 30-day mortality after peptic ulcer bleeding (PUB). MATERIAL AND METHODS. A population-based cohort study of patients with a first hospitalization with PUB in three Danish counties was carried out between 1991 and 2005 using medical databases. We calculated 30-day mortality rate ratios (MRRs) associated with the use of SSRIs, alone or in combination with NSAIDs, adjusted for important covariates. RESULTS. Of 7415 patients admitted with PUB, 5.9% used SSRIs only, and 3.8% used SSRIs in combination with NSAIDs, with a 30-day mortality of 11.8% and 11.3%, respectively. Compared with patients who used neither SSRIs nor NSAIDs, the adjusted 30-day MRR was 1.02 (95% CI: 0.76-1.36) for current users of SSRIs and 0.89 (0.62-1.28) for the combined use of SSRIs with NSAIDs. There was a 2.11-fold (95% CI 1.35-3.30) increased risk of death associated with SSRI use starting within 60 days of admission; for those younger than 80 years, the adjusted MRR was 1.54 (0.72-3.29), and 2.57 (1.47-4.49) for those older than 80 years. CONCLUSIONS. Use of SSRIs, alone or in combination with NSAIDs, was not associated with increased 30-day mortality following PUB. However, increased mortality was found in patients who started SSRI therapy, particularly among those older than 80 years. We can only speculate on whether this finding is due to pharmacological action or confounding factors.

  15. Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplasty

    PubMed Central

    2013-01-01

    Introduction Serious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis (RA). Whether RA affects the risk for these complications after total joint arthroplasty (TJA) is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis (OA) patients undergoing hip or knee TJA. Methods Analyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors. Results The 34,524 patients (839 RA, 33,685 OA) underwent knee (65.9%) or hip TJA. Patients were 95.7% men with a mean (SD) age of 64.4 (10.7) years and had 3,764 deaths over a mean follow-up of 3.7 (2.3) years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room (odds ratio (OR), 1.45 (95% CI, 1.08 to 1.94), but had similar rates of 30-day postoperative infection, OR 1.02 (0.72 to 1.47), cardiovascular events, OR 0.69 (0.37 to 1.28), and mortality, OR 0.94 (0.38 to 2.33). RA was associated with a significantly higher long-term mortality; hazard ratio (HR), 1.22 (1.00 to 1.49). Conclusion In this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality. PMID:24252350

  16. Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons.

    PubMed

    Torner, Núria; Izquierdo, Conchita; Soldevila, Núria; Toledo, Diana; Chamorro, Judith; Espejo, Elena; Fernández-Sierra, Amelia; Domínguez, Angela

    2017-02-01

    Community-acquired pneumonia (CAP) refers to pneumonia unrelated to hospitals or extended-care facilities. The aim of this study was to determine factors associated with 30-day mortality in patients with CAP aged ≥ 65 y admitted to 20 hospitals in 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Logistic regression was used to identify factors associated with 30-day mortality. The adjusted model included variables selected by backward elimination with a cut off of < 0.02. A total of 1928 CAP cases were recorded; 60.7% were male, 46.67% were aged 75-84 years, and 30-day mortality was 7.6% (n = 146). Pneumococcal vaccination had a significant protective effect (OR 0.68, 95% CI, 0.48-0.96; p = 0.03) and influenza vaccination in any 3 preceding seasons slight protective effect against CAP (OR 0.72, 95% CI, 0.51-1.02;p = 0.06). Factors significantly associated with 30-day mortality were having a degree of dependence (aOR 3.67, 95% CI, 2.34-5.75; p < 0,001); age ≥ 85 y (OR 3.01, 95% CI, 1.71-5.30; p < 0.001), liver impairment (aOR 2.41, 95% CI, 1.10-5.31; p = 0.03); solid organ neoplasm (aOR 2.24, 95% CI, 1.46-3.45; p < 0.001), impaired cognitive function (aOR 1.93, 95% CI, 1.22-3.05; p = 0.005), and ICU admittance (aOR2.56, 95% CI, 1.27-5.16; p = 0.009); length of stay (aOR 1.56, 95% CI, 1.02 - 2.40; p = 0.04) and cardio-respiratory resuscitation (aOR 7.75, 95% CI, 1.20 - 49.98; p = 0.03). No association was observed for other comorbidities such as chronic pulmonary obstructive disease (COPD) or heart conditions in the adjusted model. Offering both pneumococcal and influenza vaccination to the elderly may improve 30-day mortality in patients with CAP.

  17. 30-Day Mortality and Late Survival with Reinterventions and Readmissions after Open and Endovascular Aortic Aneurysm Repair in Medicare Beneficiaries

    PubMed Central

    Giles, Kristina A; Landon, Bruce E; Cotterill, Philip; O'Malley, A. James; Pomposelli, Frank B; Schermerhorn, Marc L

    2010-01-01

    Objectives Late survival is similar after EVAR and open AAA repair despite a perioperative benefit with EVAR. AAA-related reinterventions are more common after EVAR while laparotomy related reinterventions are more common after open repair. The impact of reinterventions on survival, however, is unknown. We therefore evaluate the rate of reinterventions and readmission after initial AAA repair along with 30-day mortality and the effect upon long term survival. Methods We identified AAA and laparotomy-related reinterventions for propensity score matched cohorts of Medicare beneficiaries (n=45,652) undergoing EVAR and open repair from 2001-2004. Follow-up was up to 6 years. Hospitalizations for ruptured AAA without repair and for bowel obstruction or ventral hernia without abdominal surgery were also recorded. Event rates were calculated per year and are also presented through 6 years of follow-up as events per 100 person years. Thirty day mortality was calculated for each reintervention or readmission. Results Through 6 years, overall reinterventions or readmissions were similar between repair methods but slightly more common after EVAR (7.6 vs. 7.0 per 100 person years, RR 1.1, P < .001). Overall 30 day mortality with any reintervention or readmission was 9.1%. EVAR patients had more ruptures (0.50 vs. 0.09, RR 5.7, P < .001) with a mortality of 28%, but these were uncommon. EVAR patients also had more AAA-related reinterventions through 6 years (3.7 vs. 0.9, RR 4.0, P < .001) (mortality 5.6%), the majority of which were minor endovascular reinterventions (2.4 vs. 0.2, RR 11.4, P < .001) with a 30 day mortality of 3.0%. However, minor open (0.8 vs. 0.5, RR 1.4, P < .001) (mortality 6.9%) and major reinterventions (0.4 vs. 0.2, RR 2.4, P < .001) (mortality 12.1%) were also more common after EVAR than open repair. Conversely, EVAR patients had fewer laparotomy related reinterventions than open patients (1.4 vs. 3.0, RR 0.5, P < .001) (mortality 8.1%) and readmissions

  18. Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

    PubMed Central

    Guerrero, Mónica; Crisafulli, Ernesto; Liapikou, Adamantia; Huerta, Arturo; Gabarrús, Albert; Chetta, Alfredo; Soler, Nestor; Torres, Antoni

    2016-01-01

    Background and Objective Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients. Methods The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years. Results Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5). Conclusion In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death. PMID:26943928

  19. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales

    PubMed Central

    McAllister, Katherine S.L.; Ludman, Peter F.; Hulme, William; de Belder, Mark A.; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A.; Sperrin, Matthew; Buchan, Iain E.

    2016-01-01

    Background The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. Methods and results The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. Conclusion We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. PMID:26942330

  20. Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

    PubMed Central

    Melvan, John N; Sancheti, Manu S; Gillespie, Theresa; Nickleach, Dana C; Liu, Yuan; Higgins, Kristin; Ramalingam, Suresh; Lipscomb, Joseph; Fernandez, Felix G

    2015-01-01

    Background Clinical variables associated with 30-day mortality after lung cancer surgery are well known. However, the effects of non-clinical factors, including insurance coverage, household income, education, type of treatment center, and area of residence, on short term survival are less appreciated. We studied the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify disparities in 30-day mortality after lung cancer resection based on these non-clinical factors. Study Design We performed a retrospective cohort analysis of patients undergoing lung cancer resection from 2003-2011, using the NCDB. Data were analyzed using a multivariable logistic regression model to identify risk factors for 30-day mortality. Results 215,645 patients underwent lung cancer resection during our study period. We found that clinical variables such as age, gender, comorbidity, cancer stage, preoperative radiation, extent of resection, positive surgical margins, and tumor size were associated with 30-day mortality after resection. Non-clinical factors including living in lower income neighborhoods with a lesser proportion of high school graduates, and receiving cancer care at a non-academic medical center were also independently associated with increased 30-day postoperative mortality. Conclusions This study represents the largest analysis of 30-day mortality for lung cancer resection to date from a generalizable national cohort. Our results demonstrate that, in addition to known clinical risk factors, several non-clinical factors are associated with increased 30-day mortality after lung cancer resection. These disparities require further investigation to improve lung cancer patient outcomes. PMID:26206651

  1. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease: An Observational Study of a Historical Cohort.

    PubMed

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann; Petersen, Michael Mørk

    2016-04-01

    Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group. We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton. We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR). All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80-10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16-19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality.

  2. Radiologic Findings and Patient Factors Associated with 30-Day Mortality after Surgical Evacuation of Subdural Hematoma in Patients Less Than 65 Years Old

    PubMed Central

    Han, Myung-Hoon; Ryu, Je Il; Kim, Choong Hyun; Kim, Jae Min; Cheong, Jin Hwan; Yi, Hyeong-Joong

    2017-01-01

    Objective The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. Methods From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan–Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. Results We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52–0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27–4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20–4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27–3.58; p=0.005) were positively associated with 30-day mortality. Conclusion We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses. PMID:28264246

  3. Predictors of 30-Day Mortality and 90-Day Functional Recovery after Primary Intracerebral Hemorrhage : Hospital Based Multivariate Analysis in 585 Patients

    PubMed Central

    2009-01-01

    Objective The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. Methods Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. Results Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. Conclusion The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decision-making, when advising patients or family members about the prognosis of PICH and when planning intervention trials. PMID:19609417

  4. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  5. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

    PubMed Central

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

  6. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    PubMed Central

    Gebauer, Katrin; Diller, Gerhard-Paul; Kaleschke, Gerrit; Kerckhoff, Gregor; Malyar, Nasser; Meyborg, Matthias; Reinecke, Holger; Baumgartner, Helmut

    2012-01-01

    Background. Transcatheter aortic valve implantation (TAVI) is widely used in high risk patients (pts) with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%). AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%). Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P = 0.09). Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P < 0.0001) and long-term mortality (43% versus 18%, P < 0.0001) were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P = 0.03). Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P = 0.32) and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential. PMID:23365748

  7. Worse Prognosis in Heart Failure Patients with 30-Day Readmission

    PubMed Central

    Tung, Ying-Chang; Chou, Shing-Hsien; Liu, Kuan-Liang; Hsieh, I-Chang; Wu, Lung-Sheng; Lin, Chia-Pin; Wen, Ming-Shien; Chu, Pao-Hsien

    2016-01-01

    Background Heart failure (HF) readmission results in substantial expenditure on HF management. This study aimed to evaluate the readmission rate, outcome, and predictors of HF readmission. Methods Patients with reduced left ventricular ejection fraction (LVEF < 40%) who were admitted for acute decompensation of de novo HF were enrolled to analyze readmission rate, mortality and predictors of readmission. Results A total of 433 de novo HF patients with LVEF < 40% were enrolled during the period August 2013 to December 2014. The in-hospital and 6-month mortality rates were 3.9% and 15.2%, respectively. In those patients surviving the index HF hospitalization, the 30-day and 6-month readmission rates were 10.9% and 27%, respectively. At the end of the 6-month follow-up, the readmission group had higher mortality than the non-readmission group (27.66% vs. 10.36%; p = 0.001). The survivors of the 30-day readmission had similar mortality rates at 6 months, regardless of the cause of readmission (cardiovascular vs. non-cardiovascular: 25% vs. 30.43%, p = 0.677). Among all the parameters, prescription of beta blockers independently reduced the risk of 30-day readmission (odds ratio 0.15; 95% confidence interval 0.02-0.99; p = 0.049). Conclusions Those HF patients who suffered from 30-day readmission had worse prognosis at the 6-month follow-up. Regardless of the readmission causes, the patients surviving the 30-day readmission had similar mortality rates at 6-month follow-up. These results underscored the importance of reducing readmission as a means to improve HF outcome. PMID:27899857

  8. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  9. Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia

    PubMed Central

    Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin

    2012-01-01

    Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality. PMID:22677348

  10. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology.

    PubMed

    Pohlenz, P; Klatt, J; Schmelzle, R; Li, L

    2013-09-01

    Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.

  11. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores

    PubMed Central

    Schellings, Dirk AAM; Adiyaman, Ahmet; Dambrink, Jan-Henk E; Gosselink, AT Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; van’t Hof, Arnoud WJ

    2016-01-01

    Background The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable. Purpose To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS. Methods Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement. Results A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p=0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p<0.001). Adjustment of the GRACE risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 (p=0.57), integrated discrimination improvement 0.04 (p=0.003), net reclassification improvement 0.12 (p=0.21). Conclusion In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated. PMID:27920547

  12. Risk factors for in-hospital mortality in patients starting hemodialysis

    PubMed Central

    Bae, Eun Hui; Kim, Ha Yeon; Kang, Yong Un; Kim, Chang Seong; Ma, Seong Kwon; Kim, Soo Wan

    2015-01-01

    Background Incident hemodialysis patients have the highest mortality in the first several months after starting dialysis. This study evaluated the in-hospital mortality rate after hemodialysis initiation, as well as related risk factors. Methods We examined in-hospital mortality and related factors in 2,692 patients starting incident hemodialysis. The study population included patients with acute kidney injury, acute exacerbation of chronic kidney disease, and chronic kidney disease. To determine the parameters associated with in-hospital mortality, patients who died in hospital (nonsurvivors) were compared with those who survived (survivors). Risk factors for in-hospital mortality were determined using logistic regression analysis. Results Among all patients, 451 (16.8%) died during hospitalization. The highest risk factor for in-hospital mortality was cardiopulmonary resuscitation, followed by pneumonia, arrhythmia, hematologic malignancy, and acute kidney injury after bleeding. Albumin was not a risk factor for in-hospital mortality, whereas C-reactive protein was a risk factor. The use of vancomycin, inotropes, and a ventilator was associated with mortality, whereas elective hemodialysis with chronic kidney disease and statin use were associated with survival. The use of continuous renal replacement therapy was not associated with in-hospital mortality. Conclusion Incident hemodialysis patients had high in-hospital mortality. Cardiopulmonary resuscitation, infections such as pneumonia, and the use of inotropes and a ventilator was strong risk factors for in-hospital mortality. However, elective hemodialysis for chronic kidney disease was associated with survival. PMID:26484040

  13. Serum C-reactive protein predicts early mortality in hospitalized patients with HBV-related decompensated cirrhosis

    PubMed Central

    Zhu, ShaoMing; Waili, Yulituzi; Qi, XiaoTing; Chen, YueMei; Lou, YuFeng; Chen, Bo

    2017-01-01

    Abstract The serum C-reactive protein (CRP) is an inflammatory marker. The aim of the present study was to elucidate whether CRP could serve as a potential surrogate marker for 30-day mortality in hospitalized patients with HBV-related decompensated cirrhosis (HBV-DeCi). This was a retrospective cohort study that included 140 patients with HBV-DeCi. All patients were followed up for 1-month. A panel of clinical and biochemical variables were analyzed for potential associations with outcomes using multiple regression models. The serum CRP was significantly higher in nonsurviving patients than in surviving patients. Multivariate analysis demonstrated that CRP levels (odds ratio: 1.047, P = 0.002) and the model for end-stage liver disease score (odds ratio: 1.370, P = 0.001) were independent predictors for mortality. Serum CRP is a simple marker that may serve as an additional predictor of 1-month mortality in hospitalized patients with HBV-DeCi. PMID:28121954

  14. Serum C-reactive protein predicts early mortality in hospitalized patients with HBV-related decompensated cirrhosis.

    PubMed

    Zhu, ShaoMing; Waili, Yulituzi; Qi, XiaoTing; Chen, YueMei; Lou, YuFeng; Chen, Bo

    2017-01-01

    The serum C-reactive protein (CRP) is an inflammatory marker. The aim of the present study was to elucidate whether CRP could serve as a potential surrogate marker for 30-day mortality in hospitalized patients with HBV-related decompensated cirrhosis (HBV-DeCi).This was a retrospective cohort study that included 140 patients with HBV-DeCi. All patients were followed up for 1-month. A panel of clinical and biochemical variables were analyzed for potential associations with outcomes using multiple regression models.The serum CRP was significantly higher in nonsurviving patients than in surviving patients. Multivariate analysis demonstrated that CRP levels (odds ratio: 1.047, P = 0.002) and the model for end-stage liver disease score (odds ratio: 1.370, P = 0.001) were independent predictors for mortality.Serum CRP is a simple marker that may serve as an additional predictor of 1-month mortality in hospitalized patients with HBV-DeCi.

  15. Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

    PubMed Central

    Ong, Cheung-Ter; Wong, Yi-Sin; Wu, Chi-Shun; Su, Yu-Hsiang

    2016-01-01

    Background/purpose In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients. Materials and methods Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed. Results Of the 2,556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of the 2,556 patients (3.1%) died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9%) died during hospitalization. History of atrial fibrillation (AF, P<0.01) and stroke severity (P<0.01) were independent risk factors of in-hospital mortality. AF, stroke severity, cardioembolism stroke, and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complications of stroke that were attributed to in-hospital mortality. Approximately 70% of in-hospital mortality was related to stroke severity (total middle cerebral artery occlusion with herniation, basilar artery occlusion, and hemorrhagic transformation). The other 30% of in-hospital mortality was related to sepsis, heart disease, and other complications. Conclusion AF is associated with higher in-hospital mortality rate than in patients without AF. For improving outcome of stroke patients, we also need to focus to reduce serious neurological or medical complications. PMID:27418830

  16. Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008

    PubMed Central

    2013-01-01

    Background Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap. Methods Swiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed. Results Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend < 0.001). Percutaneous revascularizations increased from 6.0% to 39.9% (p for trend < 0.001). Bare stents rose from 1.3% to 16.6% (p for trend < 0.001). Drug eluting stents appeared in 2004 and increased to 23.5% in 2008 (p for trend < 0.001). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend < 0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend < 0.001). Among patients managed in a single hospital (not transferred), seven-day and total in-hospital mortality decreased from 8.0% to 7.0% (p for trend < 0.01) and from 11.2% to 10.1%, respectively. These changes were no longer significant after multivariate adjustment for age, gender, region, revascularization procedures and transfer type. After multivariate adjustment, differing trends in revascularization procedures and in in-hospital mortality were found according to the geographical region considered. Conclusion In Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates. PMID:23530470

  17. A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke

    PubMed Central

    Wood, Adrian D; Gollop, Nicholas D; Bettencourt-Silva, Joao H; Clark, Allan B; Metcalf, Anthony K; Bowles, Kristian M; Flather, Marcus D; Potter, John F

    2016-01-01

    Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients. PMID:27819414

  18. Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality

    PubMed Central

    Ueda, Sho; Yamaoka, Masatoshi; Sekiya, Yoshiaki; Yamada, Hitoshi; Kawakami, Naoki; Araki, Yuichi; Wakai, Yoko; Saito, Kazuhito; Inagaki, Masaharu; Matsumiya, Naoki

    2017-01-01

    Background. Optimal treatment practices and factors associated with in-hospital mortality in spontaneous pneumothorax (SP) are not fully understood. We evaluated prevalence, clinical characteristics, and in-hospital mortality among Japanese patients with primary or secondary SP (PSP/SSP). Methods. We retrospectively reviewed and stratified 938 instances of pneumothorax in 751 consecutive patients diagnosed with SP into the PSP and SSP groups. Factors associated with in-hospital mortality in SSP were identified by multiple logistic regression analysis. Results. In the SSP group (n = 327; 34.9%), patient age, requirement for emergency transport, and length of stay were greater (all, p < 0.001), while the prevalence of smoking (p = 0.023) and number of surgical interventions (p < 0.001) were lower compared to those in the PSP group (n = 611; 65.1%). Among the 16 in-hospital deceased patients, 12 (75.0%) received emergency transportation and 10 (62.5%) exhibited performance status (PS) of 3-4. In the SSP group, emergency transportation was an independent factor for in-hospital mortality (odds ratio 16.37; 95% confidence interval, 4.85–55.20; p < 0.001). Conclusions. The prevalence and clinical characteristics of PSP and SSP differ considerably. Patients with SSP receiving emergency transportation should receive careful attention. PMID:28386166

  19. Cerebral infarction in diabetes: Clinical pattern, stroke subtypes, and predictors of in-hospital mortality

    PubMed Central

    Arboix, Adrià; Rivas, Antoni; García-Eroles, Luis; de Marcos, Lourdes; Massons, Joan; Oliveres, Montserrat

    2005-01-01

    Background To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke. Methods Diabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis. Results People with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillation Conclusion Ischemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately. PMID:15833108

  20. Predictors of in-hospital mortality following redo cardiac surgery: Single center experience

    PubMed Central

    Coskun, Isa; Cayli, Murat; Gulcan, Oner

    2015-01-01

    Purpose Redo cardiac operations represent one of the main challenges in heart surgery. The purpose of the study was to analyze the predictors of in-hospital mortality in patients undergoing reoperative cardiac surgery by a single surgical team. Methods A total of 1367 patients underwent cardiac surgical procedures and prospectively entered into a computerized database. Patients were divided into 2 groups based on the reoperative cardiac surgery (n = 109) and control group (n = 1258). Uni- and multivariate logistic regression analysis were performed to evaluate the possible predictors of hospital mortality. Results Mean age was 56 ± 13, and 46% were female in redo group. In-hospital mortality was 4.6 vs. 2.2%, p = 0.11. EuroSCORE (6 vs. 3; p < 0.01), cardiopulmonary bypass time (90 vs. 71 min; p < 0.01), postoperative bleeding (450 vs. 350 ml; p < 0.01), postoperative atrial fibrillation (AF) (29 vs. 16%; p < 0.01), and inotropic support (58 vs. 31%; p = 0.001) were significantly different. These variables were entered into uni- and multivariate regression analysis. Postoperative AF (OR1.76, p = 0.007) and EuroSCORE (OR 1.42, p < 0.01) were significant risk factors predicting hospital mortality. Conclusions Reoperative cardiac surgery can be performed under similar risks as primary operations. Postoperative AF and EuroSCORE are predictors of in-hospital mortality for redo cases. PMID:26527452

  1. Association of In-Hospital Mortality and Dysglycemia in Septic Patients

    PubMed Central

    Lin, Shen-Che; Chen, Chun-Kuei; Chen, Jih-Chang; Chan, Yi-Lin; Wu, Chin-Chieh; Blaney, Gerald N.; Liu, Zhen-Ying; Wu, Cho-Ju

    2017-01-01

    Background The associations between dysglycemia and mortality in septic patients with and without diabetes are yet to be confirmed. Our aim was to analyze the association of diabetes and sepsis mortality, and to examine how dysglycemia (hyperglycemia, hypoglycemia and glucose variability) affects in-hospital mortality of patients with suspected sepsis in emergency department (ED) and intensive care units. Methods Clinically suspected septic patients admitted to ED were included, and stratified into subgroups according to in-hospital mortality and the presence of diabetes. We analyzed patients’ demographics, comorbidities, clinical and laboratory parameters, admission glucose levels and severity of sepsis. Odds ratio of mortality was assessed after adjusting for possible confounders. The correlations of admission glucose and CoV (blood glucose coefficients of variation) and mortality in diabetes and non-diabetes were also tested. Results Diabetes was present in 58.3% of the patients. Diabetic patients were older, more likely to have end-stage renal disease and undergoing hemodialysis, but had fewer malignancies, less sepsis severity (lower Mortality in Emergency Department Sepsis Score), less steroid usage in emergency department, and lower in-hospital mortality rate (aOR:0.83, 95% CI 0.65–0.99, p = 0.044). Hyperglycemia at admission (glucose≥200 mg/dL) was associated with higher risks of in-hospital mortality among the non-diabetes patients (OR:1.83 vs. diabetes, 95% CI 1.20–2.80, p = 0.005) with the same elevated glucose levels at admission. In addition, CoV>30% resulted in higher risk of death as well (aOR:1.88 vs. CoV between 10 and 30, 95%CI 1.24–2.86 p = 0.003). Conclusions This study indicates that while diabetes mellitus seems to be a protective factor in sepsis patients, hyper- or hypoglycemia status on admission, and increased blood glucose variation during hospital stays, were independently associated with increased odds ratio of mortality. PMID

  2. Comparing three clinical prediction rules for primarily predicting the 30-day mortality of patients with pulmonary embolism: The “Simplified Revised Geneva Score,” the “Original PESI,” and the “Simplified PESI”

    PubMed Central

    Tamizifar, Babak; Fereyduni, Farid; Esfahani, Morteza Abdar; Kheyri, Saeed

    2016-01-01

    Background: Patients with suspected pulmonary embolism (PE) should be evaluated for the clinical probability of PE using an applicable risk score. The Geneva prognostic score, the PE Severity Index (PESI), and its simplified version (sPESI) are well-known clinical prognostic scores for PE. The purpose of this study was to analyze these clinical scores as prognostic tools. Materials and Methods: A historical cohort study was conducted on patients with acute PE in Al-Zahra Teaching Hospital, Isfahan, Iran, from June 2013 to August 2014. To compare survival in the 1-month follow-up and factor-analyze mortality from the survival graph, Kaplan–Meier, and log-rank logistic regression were applied. Results: Two hundred and twenty four patients were assigned to two “low risk” and “high risk” groups using the three versions of “Simplified PESI, Original PESI, and Simplified Geneva.” They were followed for a period of 1 month after admission. The overall mortality rate within 1 month from diagnosis was about 24% (95% confidence interval, 21.4–27.2). The mortality rate of low risk PE patients was about 4% in the PESI, 17% in the Geneva, and <1% in the simplified PESI scales (P < 0.005). The mortality rate among high risk patients was 33%, 33.5%, and 27.5%, respectively. Conclusions: Among patients with acute PE, the simplified PESI model was able to accurately predict mortality rate for low risk patients. Among high risk patients, however, the difference between the three models in predicting prognosis was not significant. PMID:27656606

  3. Coronary artery surgery in women compared with men: analysis of coronary risk factors and in-hospital mortality in a single centre.

    PubMed Central

    Barbir, M.; Lazem, F.; Ilsley, C.; Mitchell, A.; Khaghani, A.; Yacoub, M.

    1994-01-01

    OBJECTIVE--To determine differences in coronary risk factors between women and men and their relation to in-hospital mortality associated with coronary artery bypass grafting. DESIGN--Prospective observational study. SETTING--A regional cardiothoracic centre. PATIENTS--482 (362 (75%) men and 120 (25%) women) consecutive patients who had primary isolated coronary artery bypass grafting. RESULTS--The women were on average three years older than the men (63 v 60 years, P < 0.001). Women more frequently had hypertension (47% v 33%, P < 0.01), diabetes mellitus (21% v 10%, P < 0.005), hypothyroidism (9% v 2%, P < 0.003), and a family history of premature coronary heart disease (49% v 31%, P < 0.0006). More of the men were cigarette smokers (67% v 45%, P > 0.00001). Many of the women and men had dyslipidaemia. Postmenopausal women had a higher concentration of serum total cholesterol than men of a comparable age, (7.3 mmol/l v 6.5 mmol/l, P = 0.0002). Although arterial grafts were often used in both sexes, they were more often used in men than in women (91% v 78% respectively, P = 0.0003). In-hospital mortality was 2.1% (1.4% in men and 4.2% in women, P = 0.14). The estimated one year probability of survival in men who had survived 30 days was 0.99 with 95% confidence interval 0.98 to approximately 1 while that for women was 0.97 with 95% confidence interval 0.91 to approximately 1. Univariate analysis showed that preoperative history of diabetes mellitus was a predictor of mortality (P = 0.03). CONCLUSION--There were differences in the incidence and type of risk factors in men and women who had coronary artery bypass grafting. Preoperative diabetes mellitus was a predictor of in-hospital mortality. PMID:8011402

  4. 30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis

    PubMed Central

    Hassani, Sahar; Lindman, Anja Schou; Kristoffersen, Doris Tove; Tomic, Oliver; Helgeland, Jon

    2015-01-01

    Background The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator. Methods and Findings Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated

  5. Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

    PubMed Central

    Gwon, Jun Gyo; Cho, Yong-Pil; Han, Young Jin; Noh, Min Su

    2016-01-01

    Purpose The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. Methods A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. Results Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival. Conclusion Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients. PMID:27904852

  6. Ares I-X 30 Day Report

    NASA Technical Reports Server (NTRS)

    Ess, Bob; Smith, Marshall

    2009-01-01

    This slide presentation represents the 30 day report on the Ares I-X test flight. Included in the review is information on the following areas: (1) Ground Systems, (2) Guidance, Navigation and Control, (3) Roll Response, (4) Vehicle Response, (5) Control System Performance, (6) Structural Damping, (7) Thrust Oscillation, (8) Stage Separation, (9) Connector Assessment, (10) USS Splashdown, (11) Data Recorder and (12) FS Hardware Assessment.

  7. Patient characteristics associated with in-hospital mortality in children following tracheotomy

    PubMed Central

    Berry, Jay G; Graham, Robert J; Roberson, David W; Rhein, Lawrence; Graham, Dionne A; Zhou, Jing; O’Brien, Jane; Putney, Heather; Goldmann, Donald A

    2011-01-01

    Objectives To identify children at risk for in-hospital mortality following tracheotomy. Design Retrospective cohort study. Setting 25 746 876 US hospitalisations for children within the Kids’ Inpatient Database 1997, 2000, 2003 and 2006. Participants 18 806 hospitalisations of children ages 0–18 years undergoing tracheotomy, identified from ICD-9-CM tracheotomy procedure codes. Main outcome measure Mortality during the initial hospitalisation when tracheotomy was performed in relation to patient demographic and clinical characteristics (neuromuscular impairment (NI), chronic lung disease, upper airway anomaly, prematurity, congenital heart disease, upper airway infection and trauma) identified with ICD-9-CM codes. Results Between 1997 and 2006, mortality following tracheotomy ranged from 7.7% to 8.5%. In each year, higher mortality was observed in children undergoing tracheotomy who were aged <1 year compared with children aged 1–4 years (mortality range: 10.2–13.1% vs 1.1–4.2%); in children with congenital heart disease, compared with children without congenital heart disease (13.1–18.7% vs 6.2–7.1%) and in children with prematurity, compared with children who were not premature (13.0–19.4% vs 6.8–7.3%). Lower mortality was observed in children with an upper airway anomaly compared with children without an upper airway anomaly (1.5–5.1% vs 9.1–10.3%). In 2006, the highest mortality (40.0%) was observed in premature children with NI and congenital heart disease, who did not have an upper airway anomaly. Conclusions Congenital heart disease, prematurity, the absence of an upper airway anomaly and age <1 year were characteristics associated with higher mortality in children following tracheotomy. These findings may assist provider communication with children and families regarding early prognosis following tracheotomy. PMID:20522454

  8. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study

    PubMed Central

    Curiati, Jose A. E.; Jacob-Filho, Wilson

    2017-01-01

    Background Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD) on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults. Methods and findings This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating) and delirium (Confusion Assessment Method). Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample). Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD). The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates). Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001). DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios

  9. Effect of β-adrenergic antagonists on in-hospital mortality after ischemic stroke

    PubMed Central

    Phelan, Christopher; Alaigh, Vivek; Fortunato, Gil; Staff, Ilene; Sansing, Lauren

    2015-01-01

    Background Ischemic stroke accounts for 85–90% of all strokes and currently has very limited therapeutic options. Recent studies of β-adrenergic antagonists suggest they may have neuroprotective effects that lead to improved functional outcomes in rodent models of ischemic stroke, however there is limited data in patients. We aimed to determine whether there was an improvement in mortality rates among patients who were taking β-blockers during the acute phase of their ischemic stroke. Methods A retrospective analysis of a prospectively collected database of ischemic stroke patients was performed. Patients who were on β-adrenergic antagonists both at home and during the first three days of hospitalization were compared to patients who were not on β-adrenergic antagonists to determine the association with patient mortality rates. Results The study included a patient population of 2804 patients. In univariate analysis, use of β-adrenergic antagonists was associated with older age, atrial fibrillation, hypertension and more severe initial stroke presentation. Despite this, multivariable analysis revealed a reduction in in-hospital mortality among patients who were treated with β-adrenergic antagonists (odds ratio 0.657; 95% confidence interval 0.655–0.658). Conclusions The continuation of home β-adrenergic antagonist medication during the first three days of hospitalization after an ischemic stroke is associated with a decrease in patient mortality. This supports the work done in rodent models suggesting neuroprotective effects of β-blockers after ischemic stroke. PMID:26163891

  10. The clinical impacts of apparent embolic event and the predictors of in-hospital mortality in patients with infective endocarditis.

    PubMed

    Lee, Su Jin; Jeon, Doosoo; Cho, Woo Hyun; Kim, Yun Seong

    2014-12-01

    Embolic event is a common and important complication of infective endocarditis (IE). The objective of this study was to investigate the clinical impacts of embolic event in patients with IE and the predictors of in-hospital mortality. Data was collected in Pusan National University Hospital and Pusan National University Yangsan Hospital between January 2009 and December 2010. One hundred ten patients were included. Embolic events occur in 39 of 110 patients (35.5%). Brain (n = 18, 38.5%) was the main site of embolic infarction. Patients with embolism showed higher in-hospital mortality (46.2% vs. 8.5%, respectively, P = 0.03), more frequent ICU admission (53.8% vs. 35.2%, respectively, P = 0.045) and more accompanying other cardiac complication (43.6% vs. 21.1%, respectively, P = 0.017). The in-hospital mortality rate was 18.2%. On the logistic regression analysis of the predictors for in-hospital mortality, age (RR, 1.079; 95% CI, 1.036-1.123, P = 0.001), embolic event (RR, 3.510; 95% CI, 1.271-9.69, P = 0.015) and staphylococcal infection (RR, 5.098; 95% CI, 1.308-18.508, P = 0.023) were independently associated with in-hospital mortality. Embolic events in IE are associated with poor in-hospital outcome; and these data about embolic events and the predictors of in-hospital mortality may improve the management of this disease in hospitals.

  11. Respiratory Syncytial Virus–Associated Mortality in Hospitalized Infants and Young Children

    PubMed Central

    Wilkes, Jacob; Korgenski, Kent; Sheng, Xiaoming

    2015-01-01

    BACKGROUND AND OBJECTIVE: Respiratory syncytial virus (RSV) is a common cause of pediatric hospitalization, but the mortality rate and estimated annual deaths are based on decades-old data. Our objective was to describe contemporary RSV-associated mortality in hospitalized infants and children aged <2 years. METHODS: We queried the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) for 2000, 2003, 2006, and 2009 and the Pediatric Health Information System (PHIS) administrative data from 2000 to 2011 for hospitalizations with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for RSV infection and mortality. RESULTS: The KID data sets identified 607 937 RSV-associated admissions and 550 deaths (9.0 deaths/10 000 admissions). The PHIS data set identified 264 721 RSV-associated admissions and 671 deaths (25.4 deaths/10 000 admissions) (P < .001 compared with the KID data set). The 2009 KID data set estimated 42.0 annual deaths (3.0 deaths/10 000 admissions) for those with a primary diagnosis of RSV. The PHIS data set identified 259 deaths with a primary diagnosis of RSV, with mortality rates peaking at 14.0/10 000 admissions in 2002 and 2003 and decreasing to 4.0/10 000 patients by 2011 (odds ratio: 0.27 [95% confidence interval: 0.14–0.52]). The majority of deaths in both the KID and PHIS data sets occurred in infants with complex chronic conditions and in those with other acute conditions such as sepsis that could have contributed to their deaths. CONCLUSIONS: Deaths associated with RSV are uncommon in the 21st century. Children with complex chronic conditions account for the majority of deaths, and the relative contribution of RSV infection to their deaths is unclear. PMID:25489019

  12. In-hospital and long-term mortality in Takotsubo cardiomyopathy: a community hospital experience

    PubMed Central

    Vriz, Olga; Brosolo, Gabriele; Martina, Stefano; Pertoldi, Franco; Citro, Rodolfo; Mos, Lucio; Ferrara, Francesco; Bossone, Eduardo

    2016-01-01

    Background Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event. Despite the favorable course and good long-term prognosis, a variety of complications may occur in the acute phase of the disease. The aim of this study was to evaluate the in-hospital and long-term outcomes of a cohort of TTC patients. Methods Fifty-five patients (mean age 68.1±12 years) were prospectively followed for a mean of 69.6±32.2 months (64,635 days). In-hospital (death, heart failure, arrhythmias) and long-term events (death and recurrences) were recorded. Results Patients were predominantly women (87.3%) who experienced a recent stressful event (emotional or physical) and were admitted to hospital for chest pain. Eleven patients (20%) had a diagnosis of depressive disorder, and arterial hypertension was the most frequent cardiovascular risk factor. The ECG revealed ST-segment elevation in 43.6% of patients. At angiography, seven cases (12.7%) had at least one significant (≥50%) coronary artery stenosis and four patients (7.3%) had myocardial bridging of the left anterior descending artery. During hospitalization, three patients died (one from cardiac causes) and cardiovascular complications occurred in 12 patients. During follow-up, five patients died (none from cardiac causes), six patients had recurrences within the first year. Two patients had two recurrences: one after 114 days, triggered by an asthma attack as the first event, and the other after 1,850 days. Conclusions In TTC patients, in-hospital and long-term mortality is primarily due to non-cardiovascular causes. Recurrences are not infrequent and coronary artery disease is not an uncommon finding. PMID:27406446

  13. The effect of methodology in determining disparities in in-hospital mortality of trauma patients based on payer source.

    PubMed

    Berg, Gina M; Lee, Felecia A; Hervey, Ashley M; Hines, Robert B; Basham-Saif, Angela; Harrison, Paul B

    2015-01-01

    A retrospective registry review of adult patients admitted to a Level I trauma center sought to determine whether results regarding in-hospital mortality associated with payer source vary on the basis of methodology. Patients were categorized into 4 literature-derived definitions (Definition 1: insured and uninsured; Definition 2: commercially insured, publicly insured, and uninsured; Definition 3: commercially insured, Medicaid, Medicare, and uninsured; and Definition 4: commercially insured, Medicaid, and uninsured). In-hospital mortality differences were found in Definitions 2 and 3, and when reclassifying dual-eligible Medicare/Medicaid into socioeconomic and age indicators. Variations in methodology culminated in results that could be interpreted with differing conclusions.

  14. Pre-Stage Acute Kidney Injury Can Predict Mortality and Medical Costs in Hospitalized Patients

    PubMed Central

    Ahn, Shin Young; Chin, Ho Jun; Na, Ki Young; Chae, Dong-Wan; Kim, Sejoong

    2016-01-01

    The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25–50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention

  15. Prognostic factors of in-hospital mortality in all comers with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

    PubMed Central

    Kiatchoosakun, Songsak; Wongwipaporn, Chaiyasith; Pussadhamma, Burabha

    2016-01-01

    Background The prognostic factors of in-hospital mortality in all comers and unselected patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have not been well established. Objective To identify the predictive factors of in-hospital mortality in patients with STEMI undergoing primary PCI in a tertiary heart centre. Methods Between January 2008 and December 2011, all patients with STEMI undergoing primary PCI were retrospectively included in this study. Baseline characteristics and angiographic data were reviewed and recorded. The study endpoint was all-cause in-hospital mortality. Results Of the 541 patients included in the study, 63 (11.6%) died during hospitalisation. Cardiogenic shock at admission was recorded in 301 patients (55.6%) and 424 patients (78%) had multivessel disease. Median door-to-device time was 65 min. After adjustment for baseline variables, the factors associated with in-hospital mortality included age >60 years (OR 2.98, 95% CI 1.17 to 7.05; p=0.01), left ventricular ejection fraction <40% (OR 2.53, 95% CI 1.20 to 5.36; p=0.02), and final TIMI flow grade 0/1 (OR 20.55, 95% CI 3.49 to 120.94; p=0.001). Conclusions Age, left ventricular function and final TIMI flow are significant predictors of adverse outcomes in unselected patients with STEMI undergoing primary PCI. PMID:27347008

  16. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    ERIC Educational Resources Information Center

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  17. Upper gastrointestinal haemorrhage: predictive factors of in-hospital mortality in patients treated in the medical intensive care unit.

    PubMed

    Skok, P; Sinkovič, A

    2011-01-01

    This prospective, cohort study assessed the independent predictors of in-hospital mortality in patients with acute upper gastrointestinal haemorrhage admitted to the medical intensive care unit (MICU) at the University Clinical Centre Maribor, Slovenia. Using univariate, multivariate and logistic regression methods the predictors of mortality in 54 upper gastrointestinal haemorrhage patients (47 men, mean ± SD age 61.6 ± 14.2 years) were investigated. The mean ± SD duration of treatment in the MICU was 2.8 ± 2.9 days and the mortality rate was 31.5%. Significant differences between nonsurvivors and survivors were observed in haemorrhagic shock, heart failure, infection, diastolic blood pressure at admission, haemoglobin and red blood cell count at admission, and lowest haemoglobin and red blood cell count during treatment. Heart failure (odds ratio 59.13) was the most significant independent predictor of in-hospital mortality. Haemorrhagic shock and the lowest red blood cell count during treatment were also important independent predictive factors of in-hospital mortality.

  18. In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

    PubMed

    Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard

    2016-04-01

    Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with P<0.1 were included in a binary logistic regression model. The binary logistic regression model was adjusted for age, initial Glasgow Coma Score (GCS), the presence of intraventricular hemorrhage (IVH), and pre-ICH disability prior to ictus. In 8,421 patients with spontaneous ICH, pre-treatment with oral anticoagulants or antiplatelet agents was documented in 16.3% and 25.1%, respectively. Overall in-hospital mortality was 23.2%. In-hospital mortality was decreased in operatively treated patients compared to conservatively treated patients (11.6% versus 24.0%; P<0.001). Patients with antiplatelet pre-treatment had a significantly higher risk of death during the hospital stay after hematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort.

  19. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes

    PubMed Central

    Benamer, Sufyan; Eljazwi, Imhemed; Mohamed, Rima; Masoud, Heba; Tuwati, Mussa; Elbarsha, Abdulwahab M.

    2015-01-01

    Objective Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). Methods In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. Results During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). Conclusion In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with

  20. Who Dies after ICU Discharge? Retrospective Analysis of Prognostic Factors for In-Hospital Mortality of ICU Survivors

    PubMed Central

    2017-01-01

    We investigated the causes of inpatient death after intensive care unit (ICU) discharge and determined predictors of in-hospital mortality in Korea. Using medical ICU registry data of Seoul National University Hospital, we performed a retrospective cohort study involving patients who were discharged alive from their first ICU admission with at least 24 hours of ICU length of stay (LOS). From January 2011 to August 2013, 723 patients were admitted to ICU and 383 patients were included. The estimated in-hospital mortality rate was 11.7% (45/383). The most common cause of death was respiratory failure (n = 25, 56%) followed by sepsis and cancer progression; the causes of hospital death and ICU admission were the same in 64% of all deaths; sudden unexpected deaths comprised about one-fifth of all deaths. In order to predict in-hospital mortality among ICU survivors, multivariate analysis identified presence of solid tumor (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.01–8.2; P < 0.001), hematologic disease (OR, 4.75; 95% CI, 1.51–14.96; P = 0.013), Sequential Organ Failure Assessment (SOFA) score upon ICU admission (OR, 1.08; 95% CI, 0.99–1.17; P = 0.075), and hemoglobin (Hb) level (OR, 0.67; 95% CI, 0.52–0.86; P = 0.001) and platelet count (Plt) (OR, 0.99; 95% CI, 0.99–1.00; P = 0.033) upon ICU discharge as significant factors. In conclusion, a significant proportion of in-hospital mortality is predictable and those who die in hospital after ICU discharge tend to be severely-ill, with comorbidities of hematologic disease and solid tumor, and anemic and thrombocytopenic upon ICU discharge. PMID:28145659

  1. Effect of outpatient therapy with inhaled corticosteroids on decreasing in-hospital mortality from pneumonia in patients with COPD

    PubMed Central

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Hasegawa, Wakae; Sakamoto, Yukiyo; Takeshima, Hideyuki; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    Background and objectives Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are beneficial for the management of COPD. Although ICS has been reported to increase the risk of pneumonia in patients with COPD, it remains controversial whether it influences mortality. Using a Japanese national database, we examined the association between preadmission ICS therapy and in-hospital mortality from pneumonia in patients with COPD. Methods We retrospectively collected data from 1,165 hospitals in Japan on patients with COPD who received outpatient inhalation therapy and were admitted with pneumonia. Patients were categorized into those who received ICS with IBD and those who received IBD alone. We performed multivariate logistic regression analysis to examine the association between outpatient ICS therapy and in-hospital mortality, adjusting for the patients’ backgrounds. Results Of the 7,033 eligible patients, the IBD alone group (n=3,331) was more likely to be older, have lower body mass index, poorer general conditions, and more severe pneumonia than the ICS with IBD group (n=3,702). In-hospital mortality was 13.2% and 8.1% in the IBD alone and the ICS with IBD groups, respectively. After adjustment for patients’ backgrounds, the ICS with IBD group had significantly lower mortality than the IBD alone group (adjusted odds ratio, 0.80; 95% confidence interval, 0.68–0.94). Higher mortality was associated with older age, being male, lower body mass index, poorer general status, and more severe pneumonia. Conclusion Outpatient inhaled ICS and IBD therapy was significantly associated with lower mortality from pneumonia in patients with COPD than treatment with IBD alone. PMID:27382276

  2. Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta-Analysis.

    PubMed

    Sjögren, Petteri; Wårdh, Inger; Zimmerman, Mikael; Almståhl, Annica; Wikström, Maude

    2016-10-01

    The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare-associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta-analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25-0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97-1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

  3. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk.

    PubMed

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-12-23

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56-3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15-41) versus 23 days (IQR 14-36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.

  4. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk

    PubMed Central

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-01-01

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15–41) versus 23 days (IQR 14–36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation. PMID:28025528

  5. Comorbid disease and the effect of race and ethnicity on in-hospital mortality from aspiration pneumonia.

    PubMed Central

    Oliver, M. Norman; Stukenborg, George J.; Wagner, Douglas P.; Harrell, Frank E.; Kilbridge, Kerry L.; Lyman, Jason A.; Einbinder, Jonathan; Connors, Alfred F.

    2004-01-01

    BACKGROUND: Racial and ethnic disparities in mortality have been demonstrated in several diseases. African Americans are hospitalized at a significantly higher rate than whites for aspiration pneumonia; however, no studies have investigated racial and ethnic disparities in mortality in this population. OBJECTIVE: To assess the independent effect of race and ethnicity on in-hospital mortality among aspiration pneumonia discharges while comprehensively controlling for comorbid diseases, and to assess whether the prevalence and effects of comorbid illness differed across racial and ethnic categories. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 41,581 patients admitted to California hospitals for aspiration pneumonia from 1996 through 1998, using principal and secondary diagnoses present on admission. MEASUREMENT: The primary outcome measure was in-hospital mortality. RESULTS: The adjusted odds of in-hospital death for African-American compared with white discharges [odds ratio (OR)=1.01; 95% confidence interval (CI), 0.91-1.11] was not significantly different. The odds of death for Asian compared with white discharges was significantly lower (OR=0.83; 95% CI, 0.75-0.91). Hispanics had a significantly lower odds of death (OR=0.90; 95% CI, 0.82-0.988) compared to non-Hispanics. Comorbid diseases were more prevalent among African Americans and Asians than whites, and among Hispanics compared to non-Hispanics. Differences in effects of comorbid disease on mortality risk by race and ethnicity were not statistically significant. CONCLUSION: Asians have a lower risk of death, and the risk of death for African Americans is not significantly different from whites in this analysis of aspiration pneumonia discharges. Hispanics have a lower risk of death than non-Hispanics. While there are differences in prevalence of comorbid disease by racial and ethnic category, the effects of comorbid disease on mortality risk do not differ meaningfully by race or

  6. In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team

    PubMed Central

    Rostagno, Carlo; Buzzi, Roberto; Campanacci, Domenico; Boccacini, Alberto; Cartei, Alessandro; Virgili, Gianni; Belardinelli, Andrea; Matarrese, Daniela; Ungar, Andrea; Rafanelli, Martina; Gusinu, Roberto; Marchionni, Niccolò

    2016-01-01

    Objectives Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. Methods In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. Results In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Conclusions Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution. PMID:27389193

  7. Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

    PubMed Central

    2011-01-01

    Background Infectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward. Methods Overall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality. Results Of these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality. Conclusion Bacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal

  8. Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment

    PubMed Central

    de Andrade Falcão, Felipe José; Alves, Cláudia Maria Rodrigues; Barbosa, Adriano Henrique Pereira; Caixeta, Adriano; Sousa, José Marconi Almeida; Souza, José Augusto Marcondes; Amaral, Amaury; Wilke, Luiz Carlos; Perez, Fátima Cristina A.; Gonçalves, Iran; Stefanini, Edson; Carvalho, Antônio Carlos

    2013-01-01

    OBJECTIVES: To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment. METHODS: This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764 RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p<0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality. CONCLUSIONS: In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients. PMID:24473509

  9. Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients.

    PubMed

    Chin, Bum Sik; Kim, Myung Soo; Han, Sang Hoon; Shin, So Youn; Choi, Hee Kyung; Chae, Yun Tae; Jin, Sung Joon; Baek, Ji-Hyeon; Choi, Jun Yong; Song, Young Goo; Kim, Chang Oh; Kim, June Myung

    2011-01-01

    Urinary tract infection (UTI) is the most frequent cause of bacteremia/sepsis in elderly people and increasing antimicrobial resistance in uropathogens has been observed. To describe the characteristics of bacteremic UTI in elderly patients and to identify the independent risk factors of all-cause in-hospital mortality, a retrospective cohort study of bacteremic UTI patients of age over 65 was performed at a single 2000-bed tertiary hospital. Bacteremic UTI was defined as the isolation of the same organism from both urine and blood within 48 h. Eighty-six elderly bacteremic UTI patients were enrolled. Community-acquired infection was the case for most patients (79.1%), and Escherichia coli accounted for 88.6% (70/79) among Gram-negative organisms. Non-E. coli Gram-negative organisms were more frequent in hospital-acquired cases and male patients while chronic urinary catheter insertion was related with Gram-positive urosepsis. The antibiotic susceptibility among Gram-negative organisms was not different depending on the source of bacteremic UTI, while non-E. coli Gram-negative organisms were less frequently susceptible for cefotaxime, cefoperazone/sulbactam, and aztreonam. All-cause in-hospital mortality was 11.6%, and functional dependency (adjusted hazard ratio=HR=10.9, 95% confidence interval=95%CI=2.2-54.6) and low serum albumin (adjusted HR=27.0, 95%CI=2.0-361.2) were independently related with increased all-cause in-hospital mortality.

  10. Temporal Trends of In-Hospital Mortality in Patients Treated with Intra-Aortic Balloon Pumping: A Nationwide Population Study in Taiwan, 1998-2008.

    PubMed

    Ho, Chung-Han; Chen, Zhih-Cherng; Chu, Chin-Chen; Wang, Jhi-Joung; Chiang, Chun-Yen

    2015-01-01

    Intra-aortic balloon pumping (IABP) is widely used for hemodynamic support in critical patients with cardiogenic shock (CS). We examined whether the in-hospital mortality of patients in Taiwan treated with IABP has recently declined. We used Taiwan's National Health Insurance Research Database to retrospectively review the in-hospital all-cause mortality of 9952 (7146 men [71.8%]) 18-year-old and older patients treated with IABP between 1998 and 2008. The mortality rate was 13.84% (n = 1377). The urbanization levels of the hospitals, and the number of days in the intensive care unit, of hospitalization, and of IABP treatment, and prior percutaneous coronary intervention (PCI) were associated with mortality. Seven thousand six hundred thirty-five patients (76.72%) underwent coronary artery bypass grafting (CABG) surgery, and 576 (5.79%) underwent high-risk PCI with IABP treatment. The number of patients treated with IABP significantly increased during this decade (ptrend < 0.0001), the in-hospital all-cause mortality for patients treated with IABP significantly decreased (ptrend = 0.0243), but the in-hospital all-cause mortality of patients who underwent CABG and PCI plus IABP did not decrease. In conclusion, the in-hospital mortality rate of IABP treatment decreased annually in Taiwan during the study period. However, high-risk patients who underwent coronary revascularization with IABP had a higher and unstable in-hospital mortality rate.

  11. Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia

    PubMed Central

    Beatty, Jessica A.; Majumdar, Sumit R.; Tyrrell, Gregory J.; Marrie, Thomas J.; Eurich, Dean T.

    2016-01-01

    Abstract Bacteremic pneumococcal pneumonia (BPP) causes considerable mortality and morbidity. We aimed to identify prognostic factors associated with mortality and major in-hospital complications in BPP. A prospective, population-based clinical registry of 1636 hospitalized adult patients (≥18 years) with BPP was established between 2000 and 2010 in Northern Alberta, Canada. Prognostic factors for mortality and major in-hospital complications (e.g., cardiac events, mechanical ventilation, aspiration) were evaluated using multivariable logistic regression. Average age was 54 (standard deviation 18) years, 57% males, and 59% had high case-fatality rate (CFR) serotypes. Overall, 14% (226/1636) of patients died and 22% (315/1410) of survivors developed at least 1 complication. Independent prognostic factors for mortality were age (adjusted odds ratio [aOR], 1.5 per decade; 95% confidence interval [CI], 1.3–1.7), nursing home residence (aOR, 3.7; 95% CI 1.8–7.4), community-dwelling dementia (aOR 3.7; 95% CI, 1.6–8.6), alcohol abuse (aOR, 2.2; 95% CI, 1.4–3.4), acid-suppressing drugs (aOR, 1.5; 95% CI, 1.0–2.3), guideline-discordant antibiotics (aOR, 3.4; 95% CI, 2.4–4.8), multilobe pneumonia (aOR, 2.6; 95% CI, 1.8–3.6), and high CFR serotypes (aOR, 1.8; 95% CI, 1.2–2.8). Similar prognostic factors were observed for major in-hospital complications. Pneumococcal vaccination was associated with reduced in-hospital mortality (aOR, 0.2; 95% CI, 0.05–0.9) but not major complications (P = 0.2). Older and frailer patients, and those who abuse alcohol or take acid-suppressing drugs, are at increased risk of BPP-related mortality and complications, as are those with high CFR serotypes. Beyond identifying those at highest risk, our findings demonstrate the importance of guideline-concordant antibiotics and pneumococcal vaccination in those with BPP. PMID:27861340

  12. The clinical outcomes and predictive factors for in-hospital mortality in non-neutropenic patients with candidemia

    PubMed Central

    Wang, Tsai-Yu; Hung, Chia-Yen; Shie, Shian-Sen; Chou, Pai-Chien; Kuo, Chih-Hsi; Chung, Fu-Tsai; Lo, Yu-Lun; Lin, Shu-Min

    2016-01-01

    Abstract Recent epidemiologic studies have showed that candidemia is an important nosocomial infection in hospitalized patients. The majority of candidemia patients were non-neutropenic rather than neutropenic status. The aim of this study was to determine the clinical outcome of non-neutropenic patients with candidemia and to measure the contributing factors for mortality. A total of 163 non-neutropenic patients with candidemia during January 2010 to December 2013 were retrospectively enrolled. The patients’ risk factors for mortality, clinical outcomes, treatment regimens, and Candida species were analyzed. The overall mortality was 54.6%. Candida albicans was the most frequent Candida species (n = 83; 50.9% of patients). Under multivariate analyses, hemodialysis (OR, 4.554; 95% CI, 1.464–14.164) and the use of amphotericin B deoxycholate (OR, 8.709; 95% CI, 1.587–47.805) were independent factors associated with mortality. In contrast, abdominal surgery (OR, 0.360; 95% CI, 0.158–0.816) was associated with a better outcome. The overall mortality is still high in non-neutropenic patients with candidemia. Hemodialysis and use of amphotericin B deoxycholate were independent factors associated with mortality, whereas prior abdominal surgery was associated with a better outcome. PMID:27281087

  13. In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

    PubMed Central

    Chao, Chia-Ter; Lin, Yu-Feng; Tsai, Hung-Bin; Hsu, Nin-Chieh; Tseng, Chia-Lin; Ko, Wen-Je

    2013-01-01

    Background/Aims The elderly constitute an increasing proportion of admitted patients worldwide. We investigate the determinants of hospital length of stay and outcomes in patients aged 90 years and older. Methods We retrospectively analyzed all admitted patients aged >90 years from the general medical wards in a tertiary referral medical center between August 31, 2009 and August 31, 2012. Patients’ clinical characteristics, admission diagnosis, concomitant illnesses at admission, and discharge diagnosis were collected. Each patient was followed until discharge or death. Multivariate logistic regression analysis was utilized to study factors associated with longer hospital length of stay (>7 days) and in-hospital mortality. Results A total of 283 nonagenarian in-patients were recruited, with 118 (41.7%) hospitalized longer than one week. Nonagenarians admitted with pneumonia (p = 0.04) and those with lower Barthel Index (p = 0.012) were more likely to be hospitalized longer than one week. Multivariate logistic regression analysis revealed that patients with lower Barthel Index (odds ratio [OR] 0.98; p = 0.021) and those with heart failure (OR 3.05; p = 0.046) had hospital stays >7 days, while patients with lower Barthel Index (OR 0.93; p = 0.005), main admission nephrologic diagnosis (OR 4.83; p = 0.016) or acute kidney injury (OR 30.7; p = 0.007) had higher in-hospital mortality. Conclusion In nonagenarians, presence of heart failure at admission was associated with longer hospital length of stay, while acute kidney injury at admission predicted higher hospitalization mortality. Poorer functional status was associated with both prolonged admission and higher in-hospital mortality. PMID:24223127

  14. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia.

    PubMed

    Pieralli, Filippo; Vannucchi, Vieri; Mancini, Antonio; Grazzini, Maddalena; Paolacci, Giulia; Morettini, Alessandro; Nozzoli, Carlo

    2014-03-01

    Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p < 0.0001), and CURB-65 score (OR 3.98, p < 0.0001). Several predictors of in-hospital death (COPD, male gender, CURB-65) in patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.

  15. Prognostic role of D-dimer for in-hospital and 1-year mortality in exacerbations of COPD

    PubMed Central

    Hu, Guoping; Wu, Yankui; Zhou, Yumin; Wu, Zelong; Wei, Liping; Li, Yuqun; Peng, GongYong; Liang, Weiqiang; Ran, Pixin

    2016-01-01

    Background and objective Serum D-dimer is elevated in respiratory disease. The objective of our study was to investigate the effect of D-dimer on in-hospital and 1-year mortality after acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods Upon admission, we measured 343 AECOPD patients’ serum D-dimer levels and arterial blood gas analysis, and recorded their clinical characteristics. The level of D-dimer that discriminated survivors and non-survivors was determined using a receiver operator curve (ROC). The risk factors for in-hospital mortality were identified through univariate analysis and multiple logistic regression analyses. To evaluate the predictive role of D-dimer for 1-year mortality, univariate and multivariate Cox regression analyses were performed. Results In all, 28 patients died, and 315 patients survived in the in-hospital period. The group of dead patients had lower pH levels (7.35±0.11 vs 7.39±0.05, P<0.0001), higher D-dimer, arterial carbon dioxide tension (PaCO2), C-reactive protein (CRP), and blood urea nitrogen (BUN) levels (D-dimer 2,244.9±2,310.7 vs 768.2±1,078.4 µg/L, P<0.0001; PaCO2: 58.8±29.7 vs 46.1±27.0 mmHg, P=0.018; CRP: 81.5±66, P=0.001; BUN: 10.20±6.87 vs 6.15±3.15 mmol/L, P<0.0001), and lower hemoglobin levels (118.6±29.4 vs 128.3±18.2 g/L, P=0.001). The areas under the ROC curves of D-dimer for in-hospital death were 0.748 (95% confidence interval (CI): 0.641–0.854). D-dimer ≥985 ng/L was a risk factor for in-hospital mortality (relative risk =6.51; 95% CI 3.06–13.83). Multivariate logistic regression analysis also showed that D-dimer ≥985 ng/L and heart failure were independent risk factors for in-hospital mortality. Both univariate and multivariate Cox regression analyses showed that D-dimer ≥985 ng/L was an independent risk factor for 1-year death (hazard ratio (HR) 3.48, 95% CI 2.07–5.85 for the univariate analysis; and HR 1.96, 95% CI 1.05–3.65 for the multivariate analysis

  16. Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism

    PubMed Central

    Guo, Lu; Chughtai, Aamer Rasheed; Jiang, Hongli; Gao, Lingyun; Yang, Yan; Yang, Yang; Liu, Yuejian

    2016-01-01

    Backgrounds Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. Methods We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III–V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. Results We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04–1.66). Conclusions Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. PMID:28066591

  17. Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality

    PubMed Central

    Arboix, Adrià; Rodríguez-Aguilar, Raquel; Oliveres, Montserrat; Comes, Emili; García-Eroles, Luis; Massons, Joan

    2007-01-01

    Background There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a) to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal capsule-basal ganglia haemorrhage, and b) to identify predictors of in-hospital mortality in patients with thalamic haemorrhage. Methods Forty-seven patients with thalamic haemorrhage were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 17 years. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The region of the intracranial haemorrhage was identified on computerized tomographic (CT) scans and/or magnetic resonance imaging (MRI) of the brain. Results Thalamic haemorrhage accounted for 1.4% of all cases of stroke (n = 3420) and 13% of intracerebral haemorrhage (n = 364). Hypertension (53.2%), vascular malformations (6.4%), haematological conditions (4.3%) and anticoagulation (2.1%) were the main causes of thalamic haemorrhage. In-hospital mortality was 19% (n = 9). Sensory deficit, speech disturbances and lacunar syndrome were significantly associated with thalamic haemorrhage, whereas altered consciousness (odds ratio [OR] = 39.56), intraventricular involvement (OR = 24.74) and age (OR = 1.23), were independent predictors of in-hospital mortality. Conclusion One in 8 patients with acute intracerebral haemorrhage had a thalamic hematoma. Altered consciousness, intraventricular extension of the hematoma and advanced age were determinants of a poor early outcome. PMID:17919332

  18. Population attributable risks of patient, child and organizational risk factors for perinatal mortality in hospital births.

    PubMed

    Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Bonsel, Gouke J

    2015-04-01

    The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.

  19. Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest

    PubMed Central

    2011-01-01

    Introduction Hyperoxia has recently been reported as an independent risk factor for mortality in patients resuscitated from cardiac arrest. We examined the independent relationship between hyperoxia and outcomes in such patients. Methods We divided patients resuscitated from nontraumatic cardiac arrest from 125 intensive care units (ICUs) into three groups according to worst PaO2 level or alveolar-arterial O2 gradient in the first 24 hours after admission. We defined 'hyperoxia' as PaO2 of 300 mmHg or greater, 'hypoxia/poor O2 transfer' as either PaO2 < 60 mmHg or ratio of PaO2 to fraction of inspired oxygen (FiO2 ) < 300, 'normoxia' as any value between hypoxia and hyperoxia and 'isolated hypoxemia' as PaO2 < 60 mmHg regardless of FiO2. Mortality at hospital discharge was the main outcome measure. Results Of 12,108 total patients, 1,285 (10.6%) had hyperoxia, 8,904 (73.5%) had hypoxia/poor O2 transfer, 1,919 (15.9%) had normoxia and 1,168 (9.7%) had isolated hypoxemia (PaO2 < 60 mmHg). The hyperoxia group had higher mortality (754 (59%) of 1,285 patients; 95% confidence interval (95% CI), 56% to 61%) than the normoxia group (911 (47%) of 1,919 patients; 95% CI, 45% to 50%) with a proportional difference of 11% (95% CI, 8% to 15%), but not higher than the hypoxia group (5,303 (60%) of 8,904 patients; 95% CI, 59% to 61%). In a multivariable model controlling for some potential confounders, including illness severity, hyperoxia had an odds ratio for hospital death of 1.2 (95% CI, 1.1 to 1.6). However, once we applied Cox proportional hazards modelling of survival, sensitivity analyses using deciles of hypoxemia, time period matching and hyperoxia defined as PaO2 > 400 mmHg, hyperoxia had no independent association with mortality. Importantly, after adjustment for FiO2 and the relevant covariates, PaO2 was no longer predictive of hospital mortality (P = 0.21). Conclusions Among patients admitted to the ICU after cardiac arrest, hyperoxia did not have a robust or

  20. 77 FR 62518 - Submission for OMB Review; Comment Request (30-Day FRN); Prostate, Lung, Colorectal and Ovarian...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-15

    ... their full effect if received within 30 days of the date of this publication. Proposed Collection... ovarian cancer can reduce mortality from these cancers which currently cause an estimated 255,700 deaths... term effects of the screening on cancer incidence and mortality for the four targeted cancers....

  1. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

    PubMed Central

    Ahmed, Vazeer; Palmer, Christopher R; Bennett, Tom J H; Robinson, Susan M

    2012-01-01

    Objectives Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals. Design Quasi-experimental before and after study using routinely collected data. Setting and participants 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009. Outcome measures Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs). Results The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively. Conclusion Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital. PMID:22858459

  2. 78 FR 29147 - 30-Day Notice and Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-17

    ... SECURITY United States Secret Service 30-Day Notice and Request for Comments SUMMARY: The Department of... United States Secret Service, Department of Homeland Security, and sent via electronic mail to oira... additional information or copies of the form(s) and instructions should be directed to: United States...

  3. 78 FR 18373 - Paperwork Reduction Act; 30-Day Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... CONTROL POLICY Paperwork Reduction Act; 30-Day Notice AGENCY: Office of National Drug Control Policy. ] The Office of National Drug Control Policy (ONDCP) proposes the collection of information concerning... of the President, Office of National Drug Control Policy, Research & Data Analysis, Washington,...

  4. 75 FR 160 - Paperwork Reduction Act; 30-Day Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-04

    ... [Federal Register Volume 75, Number 1 (Monday, January 4, 2010)] [Notices] [Page 160] [FR Doc No: E9-31132] OFFICE OF NATIONAL DRUG CONTROL POLICY Paperwork Reduction Act; 30-Day Notice AGENCY: Office of National Drug Control Policy. The Office of National Drug Control Policy (ONDCP) proposes...

  5. In-Hospital Morbidity and Mortality Following Total Joint Arthroplasty in Patients with Hemoglobinopathies.

    PubMed

    Enayatollahi, Mohammad Ali; Novack, Thomas A; Maltenfort, Mitchell G; Tabatabaee, Reza Mostafavi; Chen, Antonia F; Parvizi, Javad

    2015-08-01

    Given the growing patient population with hemoglobinopathies needing total joint arthroplasty (TJA) and paucity of literature addressing this cohort, we examined the in-hospital complications in patients with hemoglobinopathies undergoing TJA. International Classification of Diseases, Ninth Revision codes were used to search the Nationwide Inpatient Sample database for hemoglobinopathy patients undergoing primary or revision TJA. Hemoglobinopathy patients had a significant increase in cardiac, respiratory, and wound complications; blood product transfusion; pulmonary embolism; surgical site infection; and systemic infection events, while there was no significant effect on deaths, deep vein thrombosis, and renal complications. It may be prudent to implement blood conservation strategies as well as diligent postoperative protocols to minimize the need for transfusion and related complications in this patient population.

  6. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality.

    PubMed

    Lalezarzadeh, Fariborz; Wisniewski, Paul; Huynh, Katie; Loza, Maria; Gnanadev, Dev

    2009-10-01

    Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

  7. Advancing Age and 30-Day Adverse Outcomes Following Non-Emergent General Surgical Operations

    PubMed Central

    Gajdos, Csaba; Kile, Deidre; Hawn, Mary T.; Finlayson, Emily; Henderson, William G.; Robinson, Thomas N.

    2014-01-01

    Background While some single center studies have demonstrated that major surgical operations are safe to perform in older adults, most multicenter database studies find advancing age to independently predict adverse postoperative outcomes. We hypothesized that thirty-day postoperative mortality, complications, failure to rescue rates and postoperative length of stay will increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participants Patients undergoing non-emergent major general surgical operations between 2005 and 2008 were studied. Measures Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to OR within 30 days, failure to rescue after a postoperative complication, post-surgical length of stay and 30 day mortality. Results A total of 165,600 patients were studied. The rates of postoperative mortality, overall morbidity, and each type of postoperative complication increased as age increased. The rates of failure to rescue after each type of postoperative complication also increased with age. Mortality rates in patients ≥80 following renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age following surgical site infection, UTI, pneumonia, return to OR, and overall morbidity, but not after venous thromboembolism, stroke, myocardial infarction, renal insufficiency, failure to wean from the ventilator or reintubations. Conclusion Thirty-day mortality, complications and failure to rescue rates increase with advancing age following non-emergent general surgical operations. Patients over 80 years of age have especially high mortality following renal, cardiovascular, and pulmonary complications. As patient age advances, surgeons need to be

  8. [Predictors of in-hospital mortality in adult postcardiotomy cardiacgenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation].

    PubMed

    Xie, H X; Yang, F; Jiang, C J; Wang, J H; Hou, D B; Wang, J G; Wang, H; Hou, X T

    2017-03-28

    Objective: To assess the factors associated with outcome of patients undergoing extracorporeal membrane oxygenation (ECMO) in a large ECMO center. Methods: Patients aged >18 years who received ECMO support for postcardiotomy cardiogenic shock were identified between January 2011 and December 2015. One hundred and seventy-seven patients (64.8%) successfully weaned from ECMO. These patients were divided into two groups depending on whether they could survive to hospital discharge: the survival group (group S, n=119) and death group (group D, n=58). Multivariate logistic regression was performed to identify risk factors independently associated with in-hospital mortality. Results: Compared to those from group D, patients in group S exhibited a younger age[(53.4±11.7) vs (58.9±11.5) years], a lower inotrope score at the beginning of ECMO [25(15, 60) vs 35.0(23, 60)], a lower average platelets transfusion [4.0(2.0, 5.2) vs 5.0(3.0, 7.2)U] (all P<0.05). There were shorter duration of ECMO support [95.0(73.0, 131.0) vs 120.0(95.8, 160.2) h], shorter ventilation time [137.0(70.0, 236.8) vs 215.0(164.0, 305.0) h], shorter stay in ICU [182.0(140.0, 236.0) vs 259.0(207.0, 382.0) h] and longer hospital stay after weaned from ECMO [14(11, 24) vs 8(4, 16) d] in group S patients compared to those in group D (all P<0.05). Age>65 years (P=0.046), neurologic complications (P<0.001) and lower extremity ischemia (P<0.001) during ECMO support, left ventricular ejection fraction<35% (P=0.011) and central venous pressure (CVP)>12 cmH(2)O(P=0.018) when weaned from ECMO, and the multi-organ function failure (P<0.001) after weaned from ECMO were independently associated with in-hospital mortality. Conclusions: Neurologic complications and lower extremity ischemia that occurred during ECMO, multi-organ function failure after weaned from ECMO had a significant impact on in-hospital mortality. Further studies are needed to prevent neurologic complications and lower extremity ischemia in

  9. Comparison of 60-day mortality in hospitalized heart failure patients with versus without hypothermia.

    PubMed

    Payvar, Saeed; Orlandi, Cesare; Stough, Wendy Gattis; Elkayam, Uri; Ouyang, John; Casscells, S Ward; Gheorghiade, Mihai

    2006-12-01

    The use of aggressive treatments and the modification of current treatment in patients with heart failure (HF) relies heavily on the assessment of disease severity using prognostic markers. However, many such markers are unavailable in routine clinical practice, and others have little prognostic value. This study tested the hypothesis that low body temperature could predict short-term survival after discharge in patients hospitalized for HF. Data from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Congestive Heart Failure (ACTIV in CHF) trial, which randomized 319 patients hospitalized for HF to receive placebo or tolvaptan, were retrospectively analyzed. Hypothermia was defined a priori as an oral body temperature <35.8 degrees C at randomization. Cox regression was used to analyze survival within a 60-day follow-up period. Hypothermia was observed in 32 patients (10%). Mortality rates at 60 days after discharge were 6.3% (20 of 319) overall, 9.4% (3 of 32) in hypothermic patients, and 5.9% (17 of 287) in nonhypothermic patients. Hypothermia was a strong multivariate predictor of mortality; hypothermic patients were 3.9 times more likely to die within 60 days than nonhypothermic patients (95% confidence interval 1.002 to 15.16, p = 0.0497) after adjustment for treatment group, age, and other confounders. Hypothermia was associated with such indicators of low cardiac output as an elevated blood urea nitrogen/creatinine ratio, narrow pulse pressure, and a reduced ejection fraction. In conclusion, hypothermia appears to be a strong predictor of mortality in patients with HF.

  10. Roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients

    PubMed Central

    Nogueira, Glaucia R.; Azevedo, Paula S.; Polegato, Bertha F.; Zornoff, Leonardo A.M.; Paiva, Sergio A.R.; Nogueira, Celia R.; Araujo, Natalia C.; Carmona, Bruno H.M.; Conde, Sandro J.; Minicucci, Marcos F.

    2016-01-01

    OBJECTIVE: The aim of this study was to evaluate the roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients. METHODS: In total, 105 consecutive burn injury patients over 18 years in age who were admitted to the Burn Unit of Bauru State Hospital from January to December 2013 were prospectively evaluated. Upon admission, patient demographic information was recorded and a blood sample was taken for biochemical analysis to identify the presence of the Taql(rs731236) and Bsml(rs1544410) polymorphisms. All of the patients were followed over their hospital stay and mortality was recorded. RESULTS: Eighteen of the patients did not sign the informed consent form, and there were technical problems with genotype analysis for 7 of the patients. Thus, 80 patients (mean age, 42.5±16.1 years) were included in the final analysis. In total, 60% of the patients were male, and 16.3% died during the hospital stay. The genotype frequencies for the Taql polymorphism were 51.25% TT, 41.25% TC and 7.50% CC; for the Bsml polymorphism, they were 51.25% GG, 42.50% GA and 6.25% AA. In logistic regression analysis, after adjustments for age, gender and total body surface burn area, there were no associations between the Taql (OR: 1.575; CI95%: 0.148-16.745; p=0.706) or Bsml (OR: 1.309; CI95%: 0.128-13.430; p=0.821) polymorphisms and mortality for the burn patients. CONCLUSIONS: Our results suggest that the Taql and Bsml vitamin D receptor gene polymorphisms are not associated with hospital mortality of burn patients. PMID:27626478

  11. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

    PubMed Central

    Sobolev, Boris G; Fradet, Guy; Hayden, Robert; Kuramoto, Lisa; Levy, Adrian R; FitzGerald, Mark J

    2008-01-01

    Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11). Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis. PMID:18803823

  12. Weight-for-age standard score - distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery

    PubMed Central

    George, Antony; Jagannath, Pushpa; Joshi, Shreedhar S.; Jagadeesh, A. M.

    2015-01-01

    Objective: To study the distribution of weight for age standard score (Z score) in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score) to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical unit at our institute were enrolled. Z score for weight for age was calculated. Patients were classified according to Z score and mortality across the classes was compared. Discrimination and calibration of the for Z score model was assessed. Improvement in predictability of mortality after addition of Z score to Aristotle Comprehensive Complexity (ACC) score was analyzed. Results: The median Z score was -3.2 (Interquartile range -4.24 to -1.91] with weight (mean±SD) of 8.4 ± 3.38 kg. Overall mortality was 11.5%. 71% and 52.59% of patients had Z score < -2 and < -3 respectively. Lower Z score classes were associated with progressively increasing mortality. Z score as continuous variable was associated with O.R. of 0.622 (95% CI- 0.527 to 0.733, P < 0.0001) for in-hospital mortality and remained significant predictor even after adjusting for age, gender, bypass duration and ACC score. Addition of Z score to ACC score improved its predictability for in-hosptial mortality (δC - 0.0661 [95% CI - 0.017 to 0.0595, P = 0.0169], IDI- 3.83% [95% CI - 0.017 to 0.0595, P = 0.00042]). Conclusion: Z scores were lower in our cohort and were associated with in-hospital mortality. Addition of Z score to ACC score significantly improves predictive ability for in-hospital mortality. PMID:26139742

  13. Hospitalization rates, length of stay and in-hospital mortality in a cohort of HIV infected patients from Rio de Janeiro, Brazil.

    PubMed

    Coelho, Lara E; Ribeiro, Sayonara R; Veloso, Valdilea G; Grinsztejn, Beatriz; Luz, Paula M

    2016-12-03

    In this study, we evaluated trends in hospitalization rates, length of stay and in-hospital mortality in a cohort of HIV-infected patients in Rio de Janeiro, Brazil, from 2007 through 2013. Among the 3991 included patients, 1861 hospitalizations occurred (hospitalization rate of 10.44/100 person-years, 95% confidence interval 9.98-10.93/100 person-years). Hospitalization rates decreased annually (per year incidence rate ratio 0.92, 95% confidence interval 0.89-0.95) as well as length of stay (median of 15 days in 2007 vs. 11 days in 2013, p-value for trend<0.001), and in-hospital mortality (13.4% in 2007 to 8.1% in 2013, p-value for trend=0.053). Our results show that, in a middle-income setting, hospitalization rates are decreasing over time and non-AIDS hospitalizations are currently more frequent than those related to AIDS. Notwithstanding, compared with high-income settings, our patients had longer length of stay and higher in-hospital mortality. Further studies addressing these outcomes are needed to provide information that may guide protocols and interventions to further reduce health-care costs and in-hospital mortality.

  14. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery.

    PubMed

    Sherrod, Brandon A; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients

  15. Hospital Based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-Hospital Mortality

    PubMed Central

    Allareddy, Veerajalandhar; Asad, Rahimullah; Lee, Min Kyeong; Nalliah, Romesh P.; Rampa, Sankeerth; Speicher, David G.; Rotta, Alexandre T.; Allareddy, Veerasathpurush

    2014-01-01

    Objectives To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. Materials and Methods We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the years 2008–2010. All ED visits and subsequent hospitalizations with a diagnosis of “Child physical abuse” (Battered baby or child syndrome) due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors. Results Of the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years). Male or female partner of the child’s parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%), intracranial injuries (32.3%) and crushing/internal injuries (9.1%). Death occurred in 246 patients (13 in ED and 233 following hospitalization). Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81–0.96, p<0.0001). Females (OR = 2.39, 1.07–5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57–154.41, p<0.0001), or crushing/internal injury (OR = 4.98, 2.24–11.07, p<0

  16. Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

    PubMed Central

    Lima, Julie C.; Intrator, Orna; Karuza, Jurgis; Wetle, Terrie; Mor, Vincent; Katz, Paul

    2013-01-01

    Objectives To examine the relationship between features of nursing home (NH) medical staff organization and residents’ 30-day rehospitalizations. Design Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database. Setting A total of 202 freestanding US nursing homes. Participants Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home. Measurements Medical staff organization dimensions derived from the survey, NH residents’ characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org. Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized. Results Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = −0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08). Conclusion This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care. PMID:22682694

  17. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

    PubMed Central

    2012-01-01

    Background While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair. Methods A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors. Results Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis. Conclusions Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not. PMID:22257790

  18. Diagnosis, Clinical Presentation, and In-Hospital Mortality of Severe Malaria in HIV-Coinfected Children and Adults in Mozambique

    PubMed Central

    Hendriksen, Ilse C. E.; Ferro, Josefo; Montoya, Pablo; Chhaganlal, Kajal D.; Seni, Amir; Gomes, Ermelinda; Silamut, Kamolrat; Lee, Sue J.; Lucas, Marcelino; Chotivanich, Kesinee; Fanello, Caterina I.; Day, Nicholas P. J.; White, Nicholas J.; von Seidlein, Lorenz; Dondorp, Arjen M.

    2012-01-01

    Background. Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria. Methods. HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status. Results. HIV-1 seroprevalence was 11% (74/655) in children under 15 years and 72% (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26% (19/74) versus 9% (53/581) in uninfected children (P < .001). In an age- and antimalarial treatment–adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. Conclusions. Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. PMID:22752514

  19. Effectiveness of Hospital Functions for Acute Ischemic Stroke Treatment on In-Hospital Mortality: Results From a Nationwide Survey in Japan

    PubMed Central

    Iwamoto, Tetsuya; Hashimoto, Hideki; Horiguchi, Hiromasa; Yasunaga, Hideo

    2015-01-01

    Background Though evidence is limited in Japan, clinical controlled studies overseas have revealed that specialized care units are associated with better outcomes for acute stoke patients. This study aimed to examine the effectiveness of hospital functions for acute care of ischemic stroke on in-hospital mortality, with statistical accounting for referral bias. Methods We derived data from a large Japanese claim-based inpatient database linked to the Survey of Medical Care Institutions and Hospital Report data. We compared the mortality of acute ischemic stroke patients (n = 41 476) in hospitals certified for acute stroke treatment with that in non-certified institutions. To adjust for potential referral bias, we used differential distance to hospitals from the patient’s residence as an instrumental variable and constructed bivariate probit models. Results With the ordinary probit regression model, in-hospital mortality in certified hospitals was not significantly different from that in non-certified institutions. Conversely, the model with the instrumental variable method showed that admission to certified hospitals reduced in-hospital mortality by 30.7% (P < 0.001). This difference remained after adjusting for hospital size, volume, staffing, and intravenous use of tissue plasminogen activator. Conclusions Comparison accounting for referral selection found that certified hospital function for acute ischemic stroke care was associated with significantly lower in-hospital mortality. Our results indicate that organized stroke care—with certified subspecialty physicians and around-the-clock availability of personnel, imaging equipment, and emergency neurosurgical procedures in an intensive stroke care unit—is effective in improving outcomes in acute ischemic stroke care. PMID:26165489

  20. Predictors of in-hospital mortality among patients with pulmonary tuberculosis: a protocol of systematic review and meta-analysis of observational studies

    PubMed Central

    de Almeida, Carlos Podalirio Borges; Couban, Rachel; Kallyth, Sun Makosso; Cabral, Vagner Kunz; Craigie, Samantha; Busse, Jason Walter; Silva, Denise Rossato

    2016-01-01

    Introduction Tuberculosis (TB) continues to be a major public health issue worldwide, with 1.4 million deaths occurring annually. There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB. This knowledge gap complicates efforts to identify and improve the management of those individuals with TB at greatest risk of death. The aim of this systematic review and meta-analysis is to establish predictors of in-hospital mortality among patients with pulmonary TB to enhance the evidence base for public policy. Methods and analysis Studies will be identified by a MEDLINE, EMBASE and Global Health search. Eligible studies will be cohort and case–control studies that report predictors or risk factors for in-hospital mortality among patients with pulmonary TB and an adjusted analysis to explore factors associated with in-hospital mortality. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to summarise the findings of some reported predictors. Teams of 2 reviewers will screen the titles and abstracts of all citations identified in our search, independently and in duplicate, extract data, and assess scientific quality using standardised forms quality assessment and tools tailored. We will pool all factors that were assessed for an association with mortality that were reported by >1 study, and presented the OR and the associated 95% CI. When studies provided the measure of association as a relative risk (RR), we will convert the RR to OR using the formula provided by Wang. For binary data, we will calculate a pooled OR, with an associated 95% CI. Ethics and dissemination This study is based on published data, and therefore ethical approval is not a requirement. Findings will be disseminated through publication in peer-reviewed journals and conference presentations at relevant conferences. Trial registration number CRD42015025755. PMID:27884842

  1. Differences between determinants of in-hospital mortality and hospitalisation costs for patients with acute heart failure: a nationwide observational study from Japan

    PubMed Central

    Sasaki, Noriko; Kunisawa, Susumu; Ikai, Hiroshi; Imanaka, Yuichi

    2017-01-01

    Objectives Although current case-mix classifications in prospective payment systems were developed to estimate patient resource usage, whether these classifications reflect clinical outcomes remains unknown. The efficient management of acute heart failure (AHF) with high mortality is becoming more important in many countries as its prevalence and associated costs are rapidly increasing. Here, we investigate the determinants of in-hospital mortality and hospitalisation costs to clarify the impact of severity factors on these outcomes in patients with AHF, and examine the level of agreement between the predicted values of mortality and costs. Design Cross-sectional observational study. Setting and participants A total of 19 926 patients with AHF from 261 acute care hospitals in Japan were analysed using administrative claims data. Main outcome measures Multivariable logistic regression analysis and linear regression analysis were performed to examine the determinants of in-hospital mortality and hospitalisation costs, respectively. The independent variables were grouped into patient condition on admission, postadmission procedures indicating disease severity (eg, intra-aortic balloon pumping) and other high-cost procedures (eg, single-photon emission CT). These groups of independent variables were cumulatively added to the models, and their effects on the models' abilities to predict the respective outcomes were examined. The level of agreement between the quartiles of predicted mortality and predicted costs was analysed using Cohen's κ coefficient. Results In-hospital mortality was associated with patient's condition on admission and severity-indicating procedures (C-statistics 0.870), whereas hospitalisation costs were associated with severity-indicating procedures and high-cost procedures (R2 0.32). There were substantial differences in determinants between the outcomes. In addition, there was no consistent relationship observed (κ=0.016, p<0.0001) between the

  2. N-terminal pro b-type natriuretic peptide (NT-pro-BNP) –based score can predict in-hospital mortality in patients with heart failure

    PubMed Central

    Huang, Ya-Ting; Tseng, Yuan-Teng; Chu, Tung-Wei; Chen, John; Lai, Min-Yu; Tang, Woung-Ru; Shiao, Chih-Chung

    2016-01-01

    Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as “serum NT-pro-BNP level above 8100 mg/dl,” “age above 79 years,” “without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker,” “without taking beta-blocker,” “without taking loop diuretics,” “with mechanical ventilator support,” “with non-invasive ventilator support,” “with vasopressors use,” and “experience of cardio-pulmonary resuscitation” were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients. PMID:27411951

  3. Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection

    PubMed Central

    Zhou, Qin; Chai, Xiang-Ping; Fang, Zhen-Fei; Hu, Xin-Qun; Tang, Liang

    2016-01-01

    Background: Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD). Methods: A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis. Results: During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality. Conclusion: High PTX3 levels on admission are independently

  4. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization

    PubMed Central

    KELLES, Silvana Márcia Bruschi; MACHADO, Carla Jorge; BARRETO, Sandhi Maria

    2014-01-01

    Background Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. Aim To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. Methods Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. Results Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. Conclusion Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients. PMID:25626935

  5. Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013.

    PubMed

    Shalaka, N S; Garred, N A; Zeglam, H T; Awasi, S A; Abukathir, L A; Altagdi, M E; Rayes, A A

    2015-10-02

    In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older (40.0 versus 36.5 years), reported injection drug use (58.3% versus 0%) and were hepatitis C virus co-infected (65.8% versus 0%) compared with females. Severe immunosuppression was prevalent (median CD4 count = 42 cell/μL). Candidiasis was the most common diagnosis (26.0%); Pneumocystis pneumonia was the most common respiratory disease (8.8%), while cerebral toxoplasmosis was diagnosed in 8.4% of patients. Current HAART use was independently associated with low risk of in-hospital mortality (OR 0.33), while central nervous system symptoms (OR 4.12), sepsis (OR 6.98) and low total lymphocyte counts (OR 3.60) were associated with increased risk. In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality.

  6. Canada acute coronary syndrome score was a stronger baseline predictor than age ≥75 years of in-hospital mortality in acute coronary syndrome patients in western Romania

    PubMed Central

    Pogorevici, Antoanela; Citu, Ioana Mihaela; Bordejevic, Diana Aurora; Caruntu, Florina; Tomescu, Mirela Cleopatra

    2016-01-01

    Background Several risk scores were developed for acute coronary syndrome (ACS) patients, but their use is limited by their complexity. Purpose The purpose of this study was to identify predictors at admission for in-hospital mortality in ACS patients in western Romania, using a simple risk-assessment tool – the new Canada acute coronary syndrome (C-ACS) risk score. Patients and methods The baseline risk of patients admitted with ACS was retrospectively assessed using the C-ACS risk score. The score ranged from 0 to 4; 1 point was assigned for the presence of each of the following parameters: age ≥75 years, Killip class >1, systolic blood pressure <100 mmHg, and heart rate >100 bpm. Results A total of 960 patients with ACS were included, 409 (43%) with ST-segment elevation myocardial infarction (STEMI) and 551 (57%) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The C-ACS score predicted in-hospital mortality in all ACS patients with a C-statistic of 0.95 (95% CI: 0.93–0.96), in STEMI patients with a C-statistic of 0.92 (95% confidence interval [CI]: 0.89–0.94), and in NSTE-ACS patients with a C-statistic of 0.97 (95% CI: 0.95–0.98). Of the 960 patients, 218 (22.7%) were aged ≥75 years. The proportion of patients aged ≥75 years was 21.7% in the STEMI subgroup and 23.4% in the NSTE-ACS subgroup (P>0.05). Age ≥75 years was significantly associated with in-hospital mortality in ACS patients (odds ratio [OR]: 3.25, 95% CI: 1.24–8.25) and in the STEMI subgroup (OR >3.99, 95% CI: 1.28–12.44). Female sex was strongly associated with mortality in the NSTE-ACS subgroup (OR: 27.72, 95% CI: 1.83–39.99). Conclusion We conclude that C-ACS score was the strongest predictor of in-hospital mortality in all ACS patients while age ≥75 years predicted the mortality well in the STEMI subgroup. PMID:27217732

  7. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  8. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale for... U.S.C. 1a(25)) for the first 30 days of trading, if: (1) Such index would not have been a...

  9. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  10. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... narrow-based security index under section 1a(35) of the Act (7 U.S.C. 1a(35)) for the first 30 days...

  11. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  12. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 2 2011-01-01 2011-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  13. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  14. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Special 30-day rules for certain reportable... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... certification of notified payee underreporting) within 30 days after the establishment or acquisition...

  15. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  16. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  17. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  18. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  19. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  20. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 2 2013-01-01 2013-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  1. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  2. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale for... U.S.C. 1a(25)) for the first 30 days of trading, if: (1) Such index would not have been a...

  3. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 2 2012-01-01 2012-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  4. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Special 30-day rules for certain reportable... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... certification of notified payee underreporting) within 30 days after the establishment or acquisition...

  5. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  6. Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

    PubMed Central

    Olveira, Gabriel; Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D.; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, Maria del Carmen; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P.; Cabrerizo, Lucio; Matia, Pilar; Chicharro, Luisa; Burgos, Rosa; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Prieto, Javier; Diéguez, Marta; Carrera, María José; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Rovira, Adela; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; del Olmo, Dolores; Pereira, José Luis; Tous, María C.

    2013-01-01

    OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels <140 mg/dL (95% CI 1.47–21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels. CONCLUSIONS Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality. PMID:23223407

  7. A Model to Predict Duration of Ventilation and 30-Day Mortality in Patients with Traumatic Injuries

    DTIC Science & Technology

    2014-12-02

    Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...2 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98...383 PATTERN OF HOSPITAL ADMISSIONS AND OUTCOME OF ACUTE ALUMINIUM PHOSPHIDE POISONING IN AN INDIAN ICU RANVIR SINGH1, diptimala agrawal2, vivek

  8. Modeling of in hospital mortality determinants in myocardial infarction patients, with and without stroke: A national study in Iran

    PubMed Central

    Ahmadi, Ali; Khaledifar, Arsalan; Etemad, Koorosh

    2016-01-01

    Background: The data and determinants of mortality due to stroke in myocardial infarction (MI) patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. Materials and Methods: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization's definition. The data were analyzed by logistic regression in STATA software. Results: Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13–21.24). Of the patients, 2537 (59.1%) had ST-elevation MI (STEMI). Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42–9) for chest pain resistant to treatment, 2.39 (95% CI: 1.97–2.9) for STEMI, 3.02 (95% CI: 2.5–3.64) for lack of thrombolytic therapy, 2.2 (95% CI: 1.66–2.91) for heart failure, and 2.17 (95% CI: 1.6–2.9) for ventricular tachycardia. Conclusion: With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities. PMID:27904619

  9. Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study

    PubMed Central

    Konstanty-Kalandyk, Janusz; Kiełbasa, Grzegorz; Olszewska, Marta; Song, Bryan HyoChan; Wierzbicki, Karol; Milaniak, Irena; Darocha, Tomasz; Sobczyk, Dorota; Kapelak, Bogusław

    2016-01-01

    Background Age remains a significant and unmodifiable risk factor for cardiovascular diseases, and an increasing number of patients older than 80 years of age undergo Coronary Artery Bypass Grafting (CABG). Old age is also an independent risk factor for postoperative complications. The aim of this study is to describe the population of patients 80 years of age or older who underwent CABG procedure and to assess the mortality rate and risk factors for in-hospital mortality. Methods A retrospective case-series study analyzing 388 consecutive patients aged 80 years of age or older who underwent isolated CABG procedure between 2010 and 2014 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Results In-hospital mortality stood at 7%, compared to 3.4% for all isolated CABG procedures at our Institution. In an univariate logistic regression analysis, risk factors for in-hospital mortality were as follows: NYHA class (p = 0.005, OR 1.95, 95% CI [1.23–3.1]), prolonged mechanical ventilation (p < 0.001, OR 7.08, 95% CI [2.47–20.3]), rethoracotomy (p = 0.04, OR 3.31, 95% CI [1.04–10.6]), duration of the procedure and ECC (for every 10 min p = 0.01, OR 1.01, 95% CI [1.0–1.01]; p = 0.03, OR 1.01, 95% CI [1.0–1.02], respectively), PRBC, FFP, and PLT transfusion (for every unit transfused p = 0.004, OR 1.42, 95% CI [1.12–1.8]; p = 0.002, OR 1.55, 95% CI [1.18–2.04]; p = 0.009, OR 1.93, 95% CI [1.18–3.14], respectively). Higher LVEF (p = 0.02, OR 0.97, 95% CI [0.94–0.99]) and LIMA graft implantation (p = 0.04, OR 0.36, 95% CI [0.13–0.98) decreased the in-hospital mortality. Death before discharge was more often observed in patients with multiple risk factors for cardiovascular diseases (0–2 –5.7%; 3–7.4%, 4–26.6%; p = 0.03). Conclusions Older age is associated with higher in-hospital mortality after isolated CABG at our Institution. Risk stratification scores and individualized risk

  10. Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Pooled analysis of four ISAR trials.

    PubMed

    Iijima, Raisuke; Ndrepepa, Gjin; Mehilli, Julinda; Bruskina, Olga; Schulz, Stefanie; Schömig, Albert; Kastrati, Adnan

    2007-10-01

    Platelets play an important role in the development of major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI). The impact of platelet count on the outcome of patients undergoing PCI after pre-treatment with clopidogrel is unknown. The study included 5,256 patients enrolled in four randomized trials - ISAR-REACT, ISAR-SMART2, ISAR-SWEET, and ISAR-REACT2 - which assessed the value of abciximab in patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. Platelet count was measured at baseline before PCI. Primary endpoint was the 30-day incidence of MACE, secondary endpoint was mortality. The tertiles of platelet counts were: lower tertile (<198 x 10(9)/L; n = 1,726), middle tertile (198-244 x 10(9)/L; n = 1,750) and upper tertile (>244 x 10(9)/L; n = 1,780). The 30-day incidence of MACE was 6.7% (n = 116) among patients of the lower tertile, 6.3% (n = 111) among patients of the middle tertile, and 7.0% (n = 124) among patients of the upper tertile (P = 0.76). The 30-day mortality was 1.2% (n = 22) among patients of the upper tertile, 0.5% (n = 9) among patients of middle tertile and 0.6% (n = 11) among patients of the lower tertile (P = 0.04). Q-wave myocardial infarction occurred in 1.3% of patients (n = 23) in the upper tertile, 0.7% of patients (n = 13) in the middle tertile and 0.5% of patients (n = 8) in the lower tertile (P = 0.02). Platelet count was an independent correlate of 30-day mortality (hazard ratio 2.69, 95% confidence interval 1.08-6.67; P = 0.033 for the third vs. the first tertile). In conclusion, in patients with CAD undergoing PCI after pre-treatment with 600 mg clopidogrel, baseline platelet count predicts 30-day mortality.

  11. Sex Differences in the Rate, Timing and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction

    PubMed Central

    Dreyer, Rachel P.; Ranasinghe, Isuru; Wang, Yongfei; Dharmarajan, Kumar; Murugiah, Karthik; Nuti, Sudhakar V.; Hsieh, Angela F.; Spertus, John A.; Krumholz, Harlan M.

    2016-01-01

    Background Young women (<65 years) experience a 2–3-fold greater mortality risk than younger men after acute myocardial infarction (AMI). However, it is unknown whether they are at higher risk for 30-day readmission, and if this association varies by age. We examined sex differences in the rate, timing and principal diagnoses of 30-day readmissions, including the independent effect of sex following adjustment for confounders. Methods and Results We included patients aged 18–64 years with a principal diagnosis of AMI. Data was utilized from the Healthcare Cost and Utilization Project-State Inpatient Database for California (07–09). Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services’ Condition Categories, and readmission timing was determined from the day after discharge. Of 42,518 younger patients with AMI (26.4% female), 4,775 (11.2%) had at least one readmission. The 30-day all-cause readmission rate was higher for women (15.5% vs. 9.7%, P<0.0001). For both sexes, readmission risk was highest on days 2–4 after discharge and declined thereafter, and women were more likely to present with non-cardiac diagnoses (44.4% vs. 40.6%, P=0.01). Female sex was associated with a higher rate of 30-day readmission, which persisted after adjustment (HR=1.22, 95% CI 1.15, 1.30). There was no significant interaction between age and sex on readmission. Conclusions Compared with men, younger women have a higher risk for readmission, even after adjustment for confounders. The timing of 30-day readmission was similar in women and men, and both sexes were susceptible to a wide range of causes for readmission. PMID:26085455

  12. Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

    PubMed Central

    Li, Jian-ping; Momin, Mohetaboer; Huo, Yong; Wang, Chun-yan; Zhang, Yan; Gong, Yan-jun; Liu, Zhao-ping; Wang, Xin-gang; Zheng, Bo

    2012-01-01

    Objective: To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI), who were treated with emergency percutaneous coronary intervention (PCI). Methods: 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate (eGFR) was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results: There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01). CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032, odds ratio (OR) 4.159, 95% confidence interval (CI) 1.127–15.346). Conclusions: Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI. PMID:22843184

  13. Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

    PubMed Central

    Zhou, Can; Zhang, Li; Wang, Hua; Ma, Xiaoxia; Shi, Bohui; Chen, Wuke; He, Jianjun; Wang, Ke; Liu, Peijun; Ren, Yu

    2015-01-01

    Background Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM). Objective The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM). Data Sources Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched. Study Selection Data of randomized and non-randomized clinical trials related to MIO versus OE were included. Interventions Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE. Study Appraisal and Synthesis Methods Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran’s Q and I2 statistics. Results A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49). Limitation Most of the included studies were non-randomized case-control studies, with a diversity of study

  14. In-Hospital Mortality and Post-Transplant Complications in Elderly Multiple Myeloma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation: a Population-Based Study.

    PubMed

    Sanchez, Larysa; Sylvester, Michael; Parrondo, Ricardo; Mariotti, Veronica; Eloy, Jean Anderson; Chang, Victor T

    2017-03-09

    Autologous hematopoietic stem cell transplantation (auto-HSCT) has improved survival in patients with multiple myeloma (MM) and is increasingly used in elderly patients. The aim of this study was to characterize and compare in-hospital complications and mortality after auto-HSCT in younger (< age 65) vs. elderly (≥ age 65) MM patients utilizing the Nationwide Inpatient Sample (NIS). Over a three-year period (2008-2010), 2209 patients with MM were admitted to U.S. Hospitals for auto-HSCT. The median age was 59 years, with 1650 patients (74.7%) younger than age 65 and 559 patients (25.3%) age 65 or older. Overall, in-hospital mortality in MM patients following auto-HSCT was rare (1.5%) and there was no significant difference in mortality between elderly and younger patients. Elderly patients did have a significantly increased mean length of stay (18.6 days + 10.8 days (standard deviation) vs. 16.8 days + 7.2 days, p<0.001) and mean total hospital charges ($161,117 + $105,008 vs. $151,192 + $78,342, p=0.018) compared to younger pts. Elderly patients were significantly more likely than younger patients to develop major in-hospital post-transplant complications such as severe sepsis (OR 2.70, 95% CI: 1.40-5.21, p=0.003), septic shock, (OR 3.10, 95% CI: 1.43-6.71, p=0.004), pneumonia (OR 1.62, 95% CI: 1.06-2.46, p=0.024), acute respiratory failure (OR 3.44, 95% CI: 1.70-6.96, p=0.001), endotracheal intubation requiring prolonged mechanical ventilation (OR 2.19, 95% CI: 1.06-4.55, p=0.035), acute renal failure (OR 2.14, 95% CI: 1.38-3.33, p=0.001), and cardiac arrhythmias (OR 2.06, 95% CI: 1.52-2.79, <0.001). This data may help guide informed consent discussions and provide a focus for future studies to reduce treatment-related morbidity in elderly MM patients undergoing auto-HSCT.

  15. 78 FR 52005 - 30-Day Notice of Proposed Information Collection: Multifamily Project Construction Contract...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... August 21, 2013 Part IV Department of Housing and Urban Development 30-Day Notice of Proposed Information...; ] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily... Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at...

  16. 77 FR 48160 - Division of Cardiovascular Devices 30-Day Notices and Annual Reports; Public Workshop; Request...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-13

    ... following public workshop entitled ``Division of Cardiovascular Devices 30-Day Notices and Annual Reports... requirements applicable to premarket approval applications (PMAs), 30-day notices and annual reports... periodic (annual) report. This workshop is intended to focus on manufacturing method and procedure...

  17. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Procedure if 30-day decision requirement is...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  18. 78 FR 64141 - 30-Day Notice of Proposed Information Collection: Certificate of Housing Counseling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... October 25, 2013 Part III Department of Housing and Urban Development 30-Day Notice of Proposed... / Notices#0;#0; ] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Certificate of Housing Counseling: Homeownership and Certificate of Housing Counseling:...

  19. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Procedure if 30-day decision requirement...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  20. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  1. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Procedure if 30-day decision requirement...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  2. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  3. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  4. Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency?

    PubMed

    Uscinska, Ewa; Sobkowicz, Bozena; Sawicki, Robert; Kiluk, Izabela; Baranicz, Malgorzata; Stepek, Tomasz; Dabrowska, Milena; Szmitkowski, Maciej; Musial, Wlodzimierz J; Tycinska, Agnieszka M

    2015-04-01

    We investigated the incidence and prognostic value of anemia as well as of the iron status in non-selected patients admitted to an intensive cardiac care unit (ICCU). 392 patients (mean age 70 ± 13.8 years, 43% women), 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure, and 102 with other acute cardiac disorders were consecutively, prospectively assessed. The biomarkers of iron status-serum iron concentration (SIC), total iron binding capacity (TIBC), and transferrin saturation (TSAT) together with standard clinical, biochemical and echocardiographic variables-were analyzed. In-hospital mortality was 3.8% (15 patients). The prevalences of anemia (according to WHO criteria), and iron deficiency (ID) were 64 and 63%, respectively. The level of biomarkers of iron status, but not anemia, was lower in patients who died (p < 0.05). Anemia was less frequent in patients with ACS as compared to the remaining ICCU population (p = 0.019). The analysis by logistic regression indicated the highest risk of death for age [odds ratio (OD) 1.38, 95% CI 1.27-1.55], SIC (OR 0.85, 95% CI 0.78-0.94), TIBC (OR 0.95, 95% CI 0.91-0.98), left ventricle ejection fraction (OR 0.85, 95% CI 0.77-0.93), as well as hospitalization for non-ACS (OR 0.25, 95% CI 0.14-0.46), (p < 0.05). The risk of death during hospitalization tended to increase with decreasing levels of TIBC (p = 0.49), as well as with the absence of ACS (p = 0.54). The incidence of anemia and ID in heterogeneous ICCU patients is high. Parameters of the iron status, but not anemia per se, independently influence in-hospital mortality. The prevalence of anemia is higher in non-ACS patients, and tends to worsen the prognosis.

  5. Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012]).

    PubMed

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Schreiber, Theodore; Patel, Nileshkumar J; Pandya, Bhavi; Gupta, Vishal; Grines, Cindy L; Deshmukh, Abhishek; Badheka, Apurva O

    2016-10-01

    The primary objective of our study was to evaluate the in-hospital outcomes in terms of mortality, procedural complications, hospitalization costs, and length of stay (LOS) after multivessel percutaneous coronary intervention (MVPCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, years 2006 to 2012. Percutaneous coronary interventions (PCI) performed during STEMI were identified using appropriate International Classification of Diseases, Ninth Revision, diagnostic and procedural codes. Patients in cardiogenic shock were excluded. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables such as in-hospital mortality and composite of in-hospital mortality and complications, and hierarchical mixed-effects linear regression models were used for continuous dependent variables such as cost of hospitalization and LOS. We identified 106,317 (weighted n = 525,161) single-vessel PCI and 15,282 (weighted n = 74,543) MVPCIs. MVPCI (odds ratio, 95% confidence interval [CI], p value) was not associated with significant increase in in-hospital mortality (0.99, 0.85 to 1.15, 0.863) but predicted a higher composite end point of in-hospital mortality and postprocedural complications (1.09, 1.02 to 1.17, 0.013) compared to single-vessel PCI. MVPCI was also predictive of longer LOS (LOS +0.19 days, 95% CI +0.14 to +0.23 days, p <0.001) and higher hospitalization costs (cost +$4,445, 95% CI +$4,128 to +$4,762, p <0.001). MVPCI performed during STEMI in hemodynamically stable patients is associated with no increase in in-hospital mortality but a higher rate of postprocedural complications and longer LOS and greater hospitalization costs compared to single-vessel PCI.

  6. Development and validation of a risk-prediction nomogram for in-hospital mortality in adults poisoned with drugs and nonpharmaceutical agents

    PubMed Central

    Lionte, Catalina; Sorodoc, Victorita; Jaba, Elisabeta; Botezat, Alina

    2017-01-01

    Abstract Acute poisoning with drugs and nonpharmaceutical agents represents an important challenge in the emergency department (ED). The objective is to create and validate a risk-prediction nomogram for use in the ED to predict the risk of in-hospital mortality in adults from acute poisoning with drugs and nonpharmaceutical agents. This was a prospective cohort study involving adults with acute poisoning from drugs and nonpharmaceutical agents admitted to a tertiary referral center for toxicology between January and December 2015 (derivation cohort) and between January and June 2016 (validation cohort). We used a program to generate nomograms based on binary logistic regression predictive models. We included variables that had significant associations with death. Using regression coefficients, we calculated scores for each variable, and estimated the event probability. Model validation was performed using bootstrap to quantify our modeling strategy and using receiver operator characteristic (ROC) analysis. The nomogram was tested on a separate validation cohort using ROC analysis and goodness-of-fit tests. Data from 315 patients aged 18 to 91 years were analyzed (n = 180 in the derivation cohort; n = 135 in the validation cohort). In the final model, the following variables were significantly associated with mortality: age, laboratory test results (lactate, potassium, MB isoenzyme of creatine kinase), electrocardiogram parameters (QTc interval), and echocardiography findings (E wave velocity deceleration time). Sex was also included to use the same model for men and women. The resulting nomogram showed excellent survival/mortality discrimination (area under the curve [AUC] 0.976, 95% confidence interval [CI] 0.954–0.998, P < 0.0001 for the derivation cohort; AUC 0.957, 95% CI 0.892–1, P < 0.0001 for the validation cohort). This nomogram provides more precise, rapid, and simple risk-analysis information for individual patients acutely exposed to

  7. Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

    PubMed

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.

  8. 78 FR 64143 - 30-Day Notice of Proposed Information Collection: Contractor's Requisition-Project Mortgages

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Contractor's Requisition--Project..., 2013. A. Overview of Information Collection Title of Information Collection: Contractor's...

  9. 78 FR 44579 - 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program Evaluation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program.... A. Overview of Information Collection Title of Information Collection: Fellowship Placement Pilot.... Description of the need for the information and proposed use: The Fellowship Placement Program places...

  10. 78 FR 64234 - 30-Day Notice of Proposed Information Collection: Environmental Review Procedures for Entities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... (NEPA), the regulations of the Council on Environmental Quality, related federal environmental laws... compliance with all applicable environmental laws and authorities. HUD (or the State for certain State... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Environmental Review Procedures...

  11. 78 FR 59046 - 30-Day Notice of Proposed Information Collection: Federal Labor Standards Questionnaire(s...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Federal Labor Standards..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  12. 78 FR 69103 - 30-Day Notice of Proposed Information Collection: Quality Control for Rental Assistance Subsidy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Quality Control for Rental... Information Collection: Quality Control for Rental Assistance Subsidy Determinations. OMB Approval Number... Quality Control process involves selecting a nationally representative sample of assisted households...

  13. 78 FR 36561 - 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal Advisory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal... Information Collection: The Housing Counseling Federal Advisory Committee Membership Application. OMB Approval... for the information and proposed use: The Housing Counseling Federal Advisory Committee (HCFAC)...

  14. Effect of feeding in 30-day bioaccumulation assays using Hyalella azteca in fluoranthene-dosed sediment

    SciTech Connect

    Harkey, G.A.; Landrum, P.F.

    1995-12-31

    Current protocols for conducting freshwater sediment bioaccumulation tests require that food be added to exposures. To determine effects of adding food, 30-day bioaccumulation assays were conducted with H. azteca exposed to sediment dosed with four concentrations (0.05 to 1,267 nmol/g dry weight) of fluoranthene. Accumulation was significantly greater in fed versus non-fed animals at all dose levels after 96 and 240 hours of exposure and continued to be greater after 30 days in the low dose levels. At sediment concentrations above 634 nmol/g dw, survival of unfed animals dropped to 34% after 30 days, However, after 30 days, reproduction was observed in fed animals exposed to sediment concentrations > 16 times the expected LC50 calculated for fluoranthene in sediment. These data raise questions concerning the interpretation of standard toxicity and bioaccumulation tests when food is routinely added.

  15. Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease

    PubMed Central

    Nahab, Fadi; Takesaka, Jennifer; Mailyan, Eugene; Judd, Lilith; Culler, Steven; Webb, Adam; Frankel, Michael; Choi, Dennis; Helmers, Sandra

    2012-01-01

    Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease. PMID:23983857

  16. Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

    PubMed Central

    Mentz, Robert J.; Hernandez, Adrian F.; Stebbins, Amanda; Ezekowitz, Justin A.; Felker, G. Michael; Heizer, Gretchen M.; Atar, Dan; Teerlink, John R.; Califf, Robert M.; Massie, Barry M.; Hasselblad, Vic; Starling, Randall C.; O'Connor, Christopher M.; Ponikowski, Piotr

    2013-01-01

    Aims To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes. Methods and results ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68–0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74–0.99), but similar mortality. Conclusion Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes. PMID:23159547

  17. Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006–2012

    PubMed Central

    An, Ruopeng; Wang, Peizhong Peter

    2017-01-01

    Purpose In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). Methods We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. Results In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831–308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%. The average length of stay for an ITP-related hospitalization was found to be 6.02 days (95% CI: 5.93–6.10), which is 28% higher than that of the overall US discharge population (4.70 days, 95% CI: 4.66–4.74). The average cost of ITP-related hospitalizations was found to be US$16,594 (95% CI: US$16,257–US$16,931), which is 48% higher than that of the overall US discharge population (US$11,200; 95% CI: US$11,033–US$11,368). Gender- and age-adjusted mortality risk in inpatients with ITP was 22% (95% CI: 19%–24%) higher than that of the overall US discharge population. Across diagnosis related groups, length of stay for ITP-related hospitalizations was longest for septicemia (7.97 days, 95% CI: 7.55–8.39) and splenectomy (7.40 days, 95% CI: 6.94–7.86). Splenectomy (US$25,262; 95% CI: US$24,044–US$26,481) and septicemia (US$18,430; 95% CI: US$17,353–US$19,507) were associated with the highest cost of hospitalization. The prevalence of mortality in ITP-related hospitalizations was highest for septicemia (11.11%, 95% CI: 9.60%–12.63%) and intracranial hemorrhage (9.71%, 95% CI: 7.65%–11.77%). Conclusion Inpatients with ITP had longer hospital stay, bore higher costs, and faced greater risk of mortality than the overall US discharge population. PMID:28176930

  18. Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD

    PubMed Central

    Bishwakarma, Raju; Zhang, Wei; Kuo, Yong-Fang; Sharma, Gulshan

    2017-01-01

    Background The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitalization. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, P-value 0.11; 18.0% vs 17.8%, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3% vs 3.4%, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11–1.93) and readmission (7.8% vs 5.0%, P-value <0.0001 and aOR 1.48 [95% CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07–1.96) and that of readmission was 1.34 (95% CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospitalized for COPD. PMID:28203071

  19. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

    PubMed Central

    Kitchell, Ellen; Etherton, Sarah Shelby; Duarte, Piper; Halm, Ethan A.; Jain, Mamta K.

    2015-01-01

    Abstract Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4–14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population. PMID:26154066

  20. Characteristics of older adults rehospitalized within 7 and 30 days of discharge: implications for nursing practice.

    PubMed

    Hain, Debra J; Tappen, Ruth; Diaz, Sanya; Ouslander, Joseph G

    2012-08-01

    Rehospitalization within 30 days consumes a significant portion of health care costs; therefore, interventions aimed at reducing the risk of rehospitalization are needed. A retrospective study was conducted examining rehospitalization rates and diagnoses according to discharge location and comparing characteristics of older adults within 7 and 30 days of discharge from a community hospital. Data on rehospitalization for Medicare fee-for-service patients (75 and older) over a 12-month period were obtained from the information technology department of a not-for-profit community hospital. A total of 6,809 patients were discharged, with 12% rehospitalized within 30 days. Skilled nursing facilities had the highest rehospitalization rates (15%), followed by home with home health care (13%) and then home with self-care (8%). The highest rehospitalization rates were in areas where nursing has a strong presence, suggesting that nurses can play an important role in the development of interventions aimed at reducing rehospitalizations.

  1. Myelinated fibers of the mouse spinal cord after a 30-day space flight.

    PubMed

    Povysheva, T V; Rezvyakov, P N; Shaimardanova, G F; Nikolskii, E E; Islamov, R R; Chelyshev, Yu A; Grygoryev, A I

    2016-07-01

    Myelinated fibers and myelin-forming cells in the spinal cord at the L3-L5 level were studied in C57BL/6N mice that had spent 30 days in space. Signs of destruction of myelin in different areas of white matter, reduction of the thickness of myelin sheath and axon diameter, decreased number of myelin-forming cells were detected in "flight" mice. The stay of mice in space during 30 days had a negative impact on the structure of myelinated fibers and caused reduced expression of the markers myelin-forming cells. These findings can complement the pathogenetic picture of the development of hypogravity motor syndrome.

  2. 77 FR 67657 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... health care and preventive health services. To support the IHS mission and to provide the product/service... HUMAN SERVICES Indian Health Service Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS) Sharing What Works--Best Practice, Promising Practice, and Local...

  3. 77 FR 13128 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-05

    ...'' campaign is a national Public Service Announcement (PSA) campaign that aims to educate, engage and empower... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  4. 78 FR 49280 - 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile Transmittal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  5. 78 FR 52008 - 30-Day Notice of Proposed Information Collection: Multifamily Housing Service Coordinator Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily Housing Service..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  6. 78 FR 39002 - 30-Day Notice of Proposed Information Collection: Request for Withdrawals From Replacements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Request for Withdrawals From..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  7. 78 FR 52009 - 30-Day Notice of Proposed Information Collection: Utility Allowance Adjustments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Utility Allowance Adjustments AGENCY... Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at...

  8. 78 FR 39001 - 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and Physical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  9. 78 FR 52007 - 30-Day Notice of Proposed Information Collection: Management Certification and Management Entity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Management Certification and... Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW., Washington,...

  10. 78 FR 52007 - 30-Day Notice of Proposed Information Collection: Financial Statement of Corporate Applicant for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Financial Statement of Corporate..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street,...

  11. 78 FR 52006 - 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit Instrument

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit..., Department of Housing and Urban Development, 451 7th Street, SW., Washington, DC 20410; email Colette...

  12. 77 FR 39318 - 30-Day Notice of Proposed Information Collection: DS-5513, Supplemental Questionnaire To...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-02

    ..., Office of Project Management and Operational Support, Program Coordination (CA/PPT/PMO/PC) Form Number... information collection request to the Office of Management and Budget (OMB) for approval in accordance with... to the Office of Management and Budget (OMB) for up to 30 days from July 2, 2012. ADDRESSES:...

  13. 78 FR 36565 - 30-Day Notice of Proposed Information Collection: Standardized Form for Collecting Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Standardized Form for Collecting... Information Collection: Standardized Form for Collecting Information Regarding Race and Ethnic Data. OMB... quality, utility, and clarity of the information to be collected; and (4) Ways to minimize the burden...

  14. 77 FR 37407 - Agency Information Collection Request-30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-21

    ... HUMAN SERVICES Agency Information Collection Request--30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is.... Proposed Project: New Comprehensive Communication Campaign on Right To Non-Discrimination in Certain...

  15. Enhanced recovery of Phytophthora ramorum from soil following 30 days storage at 4C

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chlamydospores of Phytophthora ramorum produced by mixing 20 percent V8 juice broth cultures with sand and incubating over a 30 day period were used to infest field soil at densities ranging from 0.2 to 42 chlamydospores per cubic centimeter of soil. Chlamydospore recovery was determined by baiting...

  16. 77 FR 18820 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  17. 78 FR 38070 - 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing... Marketing (AFHM) Plan. OMB Approval Number: 2529-0013. Type of Request: Extension of a currently approved collection. Form Number: HUD-935.2A Affirmative Fair Housing Marketing (AFHM) Plan (Multifamily),...

  18. 78 FR 1916 - 30-Day Notice of Proposed Information Collection: Smart Traveler Enrollment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-09

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Smart Traveler Enrollment Program ACTION: Notice of request... Information Collection: Smart Traveler Enrollment Program (STEP). OMB Control Number: 1405-0152. Type...

  19. 78 FR 64142 - 30-Day Notice of Proposed Information Collection: Condominium Project Approval Document Collection

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    2013-10-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Condominium Project Approval... submitted the proposed information collection requirement described below to the Office of Management and... Management and Budget, New Executive Office Building, Washington, DC 20503; fax: 202-395-5806. Email:...

  20. 78 FR 36560 - 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal, Periodic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th... Title of Information Collection: FHA Lender Approval, Annual Renewal, Periodic Updates and...

  1. 78 FR 40309 - 30-Day Notice of Proposed Information Collection: Application for Multifamily Project Mortgage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public comment. DATES... sent to: HUD Desk Officer, Office of Management and Budget, New Executive Office Building,...

  2. 77 FR 59354 - Removal of 30-Day Residency Requirement for Per Diem Payments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-27

    ... reasons other than hospital care, such as when a veteran travels to visit family members. This proposed... payments, stating: ``We believe that 30 days is a minimal amount of time for demonstrating that a veteran... State home within a specific period of time, or communicates that he or she will not be returning....

  3. 77 FR 59318 - Removal of 30-Day Residency Requirement for Per Diem Payments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-27

    ... reasons other than hospital care, such as when a veteran travels to visit family members. This rule also... 30 days is a minimal amount of time for demonstrating that a veteran intends to be a resident at the... State home within a specific period of time, or communicates that he or she will not be returning....

  4. 78 FR 75366 - 30-Day Notice of Proposed Information Collection: Public Housing Energy Audits and Utility...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Public Housing Energy Audits and... Audits and Utility Allowances. OMB Approval Number: 2577-062. Type of Request: Reinstatement, with change... information and proposed use: 24 CFR 965.301, Subpart C, Energy Audit and Energy Conservation...

  5. 76 FR 59129 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-23

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... to send comments regarding this burden estimate or any other aspect of this collection of...

  6. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Special 30-day rules for certain reportable payments. 31.3406(d)-3 Section 31.3406(d)-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... account. (b) Sale of an instrument for a customer by electronic transmission or by mail. The special...

  7. 78 FR 39305 - 30-Day Notice of Proposed Information Collection: OSHC Progress Report Template

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ... Doc No: 2013-15689] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5683-N-54] 30-Day... Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at Colette.Pollard@hud.gov or... proposed use: The Appropriations Act, provided a total of $100,000,000 to HUD for a Sustainable...

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  9. 78 FR 52964 - 30-Day Notice of Proposed Information Collection: Section 8 Management Assessment Program (SEMAP...

    Federal Register 2010, 2011, 2012, 2013, 2014

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  10. 78 FR 65695 - 30-Day Notice of Proposed Information Collection: Technical Processing Requirements for...

    Federal Register 2010, 2011, 2012, 2013, 2014

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    Federal Register 2010, 2011, 2012, 2013, 2014

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    Federal Register 2010, 2011, 2012, 2013, 2014

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    ... HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... new AIDS cases. As one strategy to address this disparity, the U.S. Department of Health and...

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    Federal Register 2010, 2011, 2012, 2013, 2014

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    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

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    Federal Register 2010, 2011, 2012, 2013, 2014

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    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

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    Federal Register 2010, 2011, 2012, 2013, 2014

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    Federal Register 2010, 2011, 2012, 2013, 2014

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  19. Predictors of Early Post-discharge Mortality in Critically Ill Patients: A Retrospective Cohort Study from the California Intensive Care Outcomes Project

    PubMed Central

    Vasilevskis, Eduard E.; Kuzniewicz, Michael W.; Cason, Brian A.; Lane, Rondall K.; Dean, Mitzi L.; Clay, Ted; Rennie, Deborah J.; Dudley, R. Adams

    2013-01-01

    Purpose Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early post-discharge mortality contributes significantly to overall 30-day mortality. Factors associated with early post-discharge mortality are unknown. Methods We performed a retrospective study of 8,484 ICU patients. Our primary outcome was early post-discharge mortality: death after hospital discharge and ≤ 30 days from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome. Results In multivariate analyses, the hazard for early post-discharge mortality increased with rising severity of illness and decreased with full code status (HR = 0.33, 95% CI 0.21 to 0.49). Compared to discharges home, early post-discharge mortality was highest for acute care transfers (HR 3.18, 95% CI 2.45 to 4.12). Finally, patients with very short ICU length of stay (< 1 day) had greater early post-discharge mortality (HR 1.86, 95% CI 1.32 to 2.61) than those with longest stays (≥ 7 days). Conclusions Early post-discharge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely upon in-hospital mortality measures to do so. PMID:20716477

  20. Work capacity during 30 days of bed rest with isotonic and isokinetic exercise training

    NASA Technical Reports Server (NTRS)

    Greenleaf, J. E.; Bernauer, E. M.; Ertl, A. C.; Trowbridge, T. S.; Wade, C. E.

    1989-01-01

    Results are presented from a study to determine whether or not short-term variable intensity isotonic and intermittent high-intensity isokinetic short-duration leg exercise is effective for the maintenance of peak O2 (VO2) uptake and muscular strength and endurance, respectively, during 30 days of -6 deg head-down bed rest deconditioning. The results show no significant changes in leg peak torque, leg mean total work, arm total peak torque, or arm mean total work for members of the isotonic, isokinetic, and controls groups. Changes are observed, however, in peak VO2 levels. The results suggest that near-peak variabile intensity, isotonic leg excercise maintains peak VO2 during 30 days of bed rest, while peak intermittent, isokinetic leg excercise protocol does not.

  1. Incidence, Causes and Predictors of 30-Day Readmission After Shoulder Arthroplasty

    PubMed Central

    Westermann, Robert W; Anthony, Chris A.; Duchman, Kyle R.; Pugely, Andrew J.; Gao, Yubo; Hettrich, Carolyn M.

    2016-01-01

    Background The Center for Medicare and Medicaid Service has identified several quality metrics, including unplanned readmission within 30 days of surgery, to assess and compare surgeons and hospitals. The purpose of this study was to identify the incidence, causes and risk factors for unplanned 30-day readmission after total shoulder arthroplasty. Methods We identified patients undergoing primary elective shoulder arthroplasty performed at American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participating hospitals in 2013. Cases were stratified by readmission status. Univariate and multivariate analyses were employed to assess patient demographics, comorbidities and operative variables predicting unplanned readmission. Results 2779 patients undergoing shoulder arthroplasty were identified, with 74 (2.66%) requiring unplanned readmissions within 30 days of surgery. The most common surgical causes for unplanned readmission were surgical site infections (18.6%), dislocations (16.3%) and venous thromboembolism (14.0%). Medical causes for readmission were responsible for 51% of unplanned readmissions. Multivariate analysis identified patient age >75 (OR 2.62, 95% CI: 1.27 - 5.41), and ASA class of 3 (OR 1.79, 95% CI: 1.01 - 3.18) or 4 (OR 3.63, 95% CI: 1.31 - 10.08) as independent risk factors for unplanned readmission. Predictive modeling estimated that patients with ASA class of 4 and age >75 are 17.4 times more likely (95% CI 1.77-171.09) to be readmitted within 30 days of shoulder arthroplasty. Conclusion Unplanned readmission after shoulder arthroplasty is infrequent and medical complications account for more than 50% of occurrences. The risk of readmission exponentially increases when age and preoperative comorbidity burden are increased. PMID:27528839

  2. Skeletal muscle adaptations following blood flow-restricted training during 30 days of muscular unloading.

    PubMed

    Cook, Summer B; Brown, Kimberly A; Deruisseau, Keith; Kanaley, Jill A; Ploutz-Snyder, Lori L

    2010-08-01

    This study evaluated the effectiveness of low-load resistance training with a blood flow restriction (LL(BFR)) to attenuate muscle loss and weakness after 30 days of unilateral lower limb suspension (ULLS). Sixteen subjects (ages 18-50 yr) underwent 30 days of ULLS. Measurements of muscle strength, cross-sectional area, and endurance on the knee extensors and plantar flexors were collected before and after ULLS. Plasma concentrations of IGF-1 and IGFBP-3 were also assessed. During ULLS, eight subjects (5 males, 3 females) participated in LL(BFR) three times per week (ULLS + Exercise) while eight subjects (4 males, 4 females) did not exercise (ULLS). The blood flow-restricted exercise consisted of dynamic knee extension at 20% of the subject's isometric maximum voluntary contraction coupled with a suprasystolic blood flow restriction. After 30 days of limb suspension, the ULLS + Exercise group experienced minimal and insignificant losses in knee extensor cross-sectional area and strength (1.2% and 2.0%, respectively; P 0.05). Muscular endurance in the knee extensors improved 31% in the ULLS + Exercise group, while it decreased 24% in the ULLS group (P = 0.01). No changes were seen in hormone concentrations throughout the study. In conclusion, LL(BFR) of the knee extensors is effective in maintaining muscle strength and size during 30 days of ULLS and results in improved knee extensor muscular endurance.

  3. The 10-30-day intraseasonal variation of the East Asian winter monsoon: The temperature mode

    NASA Astrophysics Data System (ADS)

    Yao, Suxiang; Sun, Qingfei; Huang, Qian; Chu, Peng

    2016-09-01

    East Asia is known for its monsoon characteristics, but little research has been performed on the intraseasonal time scale of the East Asian winter monsoon (EAWM). In this paper, the extended reanalysis (ERA)-Interim sub-daily data are used to study the surface air temperature intraseasonal oscillation (ISO) of the EAWM. The results show that the air temperature (2-m level) of the EAWM has a dominant period of 10-30 days. Lake Baikal and south China are the centers of the air temperature ISO. An anomalous low frequency (10-30-day filtered) anticyclone corresponds to the intraseasonal cold air. The 10-30-day filtered cold air spreads from Novaya Zemlya to Lake Baikal and even to South China. The ISO of the Arctic Oscillation (AO) index influences the temperature of the EAWM by stimulating Rossby waves in middle latitude, causing meridional circulation, and eventually leads to the temperature ISO of the EAWM. RegCM4 has good performance for the simulation of the air temperature ISO. The simulated results indicate that the plateau is responsible for the southward propagation of the intraseasonal anticyclone. The anticyclone could not reach South China when there was no plateau in western China and its upper reaches.

  4. Discharge to a rehabilitation facility is associated with decreased 30-day readmission in elective spinal surgery.

    PubMed

    Abt, Nicholas B; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Murphy, Meghan; Rinaldo, Lorenzo; Fogelson, Jeremy; Nassr, Ahmad; Currier, Bradford L; Bydon, Mohamad

    2017-02-01

    The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.

  5. The 30-day prognosis of chronic-disease patients after contact with the out-of-hours service in primary healthcare

    PubMed Central

    Carlsen, Anders Helles; Moth, Grete; Christensen, Morten Bondo; Vestergaard, Mogens; Olesen, Frede; Vedsted, Peter

    2014-01-01

    Abstract Objective. Little is known about the prognosis of patients with chronic disease who contact the out-of-hours (OOH) service in primary care. The characteristics of contacts with the Danish out-of-hours service and daytime general practice, hospitalization, and death were studied during a 30-day follow-up period in patients with chronic heart diseases. Design. Cohort study. Setting and subjects. The study was based on data from 11 897 adults aged 18 + years from a Danish survey of OOH contacts, including information on consultation type. Reason for encounter (RFE) was categorized by OOH GPs at triage as either “exacerbation” or “new health problem”. Registry data were used to identify eligible patients, and the cohort was followed for 30 days after OOH contact through nationwide registries on healthcare use and mortality. Main outcome measures. The 30-day prognosis of chronic-disease patients after OOH contact. Results. Included patients with chronic disease had a higher risk of new OOH contact, daytime GP contact, and hospitalization than other patients during the 30-day follow-up period. OOH use was particularly high among patients with severe mental illness. A strong association was seen between chronic disease and risk of dying during follow-up. Conclusion. Patients with chronic disease used both daytime general practice and the out-of-hours service more often than others during the 30-day follow-up period; they were more often hospitalized and had higher risk of dying. The findings call for a proactive approach to future preventive day care and closer follow-up of this group, especially patients with psychiatric disease. PMID:25471829

  6. Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

    PubMed Central

    AlHilli, Mariam; Langstraat, Carrie; Tran, Christine; Martin, Janice; Weaver, Amy; McGree, Michaela; Mariani, Andrea; Cliby, William; Bakkum-Gamez, Jamie

    2015-01-01

    Background To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Methods Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. Results In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89; P = 0.007), ascites [1.76 (1.11–2.81); P = 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33; P = 0.04). Conclusions Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce

  7. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  8. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  9. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  10. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  11. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  12. Rat brain pro-oxidant effects of peripherally administered 5 nm ceria 30 days after exposure.

    PubMed

    Hardas, Sarita S; Sultana, Rukhsana; Warrier, Govind; Dan, Mo; Florence, Rebecca L; Wu, Peng; Grulke, Eric A; Tseng, Michael T; Unrine, Jason M; Graham, Uschi M; Yokel, Robert A; Butterfield, D Allan

    2012-10-01

    The objective of this study was to determine the residual pro-or anti-oxidant effects in rat brain 30 days after systemic administration of a 5 nm citrate-stabilized ceria dispersion. A ∼4% aqueous ceria dispersion was iv-infused (0 or 85 mg/kg) into rats which were terminated 30 days later. Ceria concentration, localization, and chemical speciation in the brain was assessed by inductively coupled plasma mass spectrometry (ICP-MS), light and electron microscopy (EM), and electron energy loss spectroscopy (EELS), respectively. Pro- or anti-oxidant effects were evaluated by measuring levels of protein carbonyls (PC), 3-nitrotyrosine (3NT), and protein-bound-4-hydroxy-2-trans-nonenal (HNE) in the hippocampus, cortex, and cerebellum. Glutathione reductase (GR), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase levels and activity were measured in addition to levels of inducible nitric oxide (iNOS), and heat shock protein-70 (Hsp70). The blood brain barrier (BBB) was visibly intact and no ceria was seen in the brain cells. Ceria elevated PC and Hsp70 levels in hippocampus and cerebellum, while 3NT and iNOS levels were elevated in the cortex. Whereas glutathione peroxidase and catalase activity were decreased in the hippocampus, GR levels were decreased in the cortex, and GPx and catalase levels were decreased in the cerebellum. The GSH:GSSG ratio, an index of cellular redox status, was decreased in the hippocampus and cerebellum. The results are in accordance with the observation that this nanoscale material remains in this mammal model up to 30 days after its administration and the hypothesis that it exerts pro-oxidant effects on the brain without crossing the BBB. These results have important implications on the potential use of ceria ENM as therapeutic agents.

  13. Derivation and validation of a 30-day heart failure readmission model.

    PubMed

    Fleming, Lisa M; Gavin, Michael; Piatkowski, Gail; Chang, James D; Mukamal, Kenneth J

    2014-11-01

    In 2006, there were >1 million hospital admissions for heart failure (HF), and the estimated cost to the United States in 2009 was >$37.2 billion. Better models to target aggressive therapy to patients at the highest risk for readmission are clearly needed. We studied 3,413 consecutive admissions for HF based on discharge diagnosis codes from October 2007 to August 2011 from a single academic center. We randomly generated derivation and validation sets in a 3:1 ratio. We used generalized estimating equations to develop our models, accounting for repeated hospitalizations and the Hosmer-Lemeshow test to examine model calibration. The 30-day readmission rate was 24.2% in the derivation set. Of 25 candidate variables, the best fitting model included creatinine, troponin, hematocrit, and hyponatremia at discharge; race; zip code of residence; discharge hour; and number of hospitalizations in the previous year. Insignificant variables included intravenous diuretic use on day of discharge, discharge service, diabetes, atrial fibrillation, age, and gender. The risk of 30-day readmission increased with increasing decile of predicted risk in both the validation and derivation cohorts. The area under the receiver operating characteristic curve for the model was 0.69 in the derivation set and 0.66 in the validation set. In conclusion, we derived and validated a simple model relating discharge-specific characteristics at risk of 30-day readmission. Application of this approach may facilitate targeted intervention to reduce the burden of rehospitalization in patients with HF, but our results suggest that the best readmission models may require incorporation of both clinical and local system factors for optimal prediction.

  14. Changes in size and compliance of the calf after 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Convertino, Victor A.; Doerr, Donald F.; Stein, Stewart L.

    1989-01-01

    The hypothesis that reducing muscle compartment by a long-term exposure to microgravity would cause increased leg venous compliance was tested in eight men who were assessed for vascular compliance and for serial circumferences of the calf before and after 30 days of continuous 6-deg head-down bed rest. It was found that head-down bed rest caused decreases in the calculated calf volume and the calf-muscle compartment, as well as increases in calf compliance. The percent increases in calf compliance correlated significantly with decreases in calf muscle compartment.

  15. Race, Rehabilitation, and 30-Day Readmission After Elective Total Knee Arthroplasty

    PubMed Central

    Jorgenson, Erik S.; Richardson, Diane M.; Thomasson, Arwin M.; Nelson, Charles L.

    2015-01-01

    Introduction: To examine racial variations in access to postacute care (PAC) and rehabilitation (Rehab) services following elective total knee arthroplasty and whether where patients go after surgery for PAC/Rehab is associated with 30-day readmission to acute care facility. Materials and Methods: Sample consisted of 129 522 patients discharged from 169 hospitals in the State of Pennsylvania between fiscal years 2008 and 2012. We used multinomial regression models to assess the relationship between patient race and discharge destination after surgery, for patients aged 18 to 64 years and for those aged 65 and older. We used multivariable (MV) regression and propensity score (PS) approaches to examine the relationship between patient discharge destination after surgery for PAC/Rehab and 30-day readmission, controlling for key individual- and facility-level factors. Results: Lower proportions of younger patients compared to those older than 65 were discharged to inpatient rehabilitation facilities (IRFs; 5.8% vs 12.6%, respectively) and skilled nursing facilities (SNFs; 15.2% vs 32.7%, respectively) compared to home-based Rehab (self-care; 23.3% vs 14.2%, respectively). Compared to whites, African American patients had significantly higher odds of discharge to IRF (age < 65, odds ratio = 2.04; age ≥ 65, odds ratio = 1.64) and to SNF (age < 65, odds ratio = 2.86; age ≥ 65, odds ratio = 2.19) and discharge to home care in patients younger than 65 years (odds ratio = 1.31). The odds of 30-day readmission among patients discharged to an IRF (MV odds ratio = 7.76; PS odds ratio = 8.34) and SNF (MV odds ratio = 2.01; PS odds ratio = 1.83) were significantly higher in comparison to patients discharged home with self-care. Conclusion: African American patients with knee replacement are more likely to be discharged to inpatient Rehab settings following surgery. Inpatient Rehab is significantly associated with 30-day readmission to acute care facility. PMID:26623166

  16. Development and implementation of a real-time 30-day readmission predictive model.

    PubMed

    Cronin, Patrick R; Greenwald, Jeffrey L; Crevensten, Gwen C; Chueh, Henry C; Zai, Adrian H

    2014-01-01

    Hospitals are under great pressure to reduce readmissions of patients. Being able to reliably predict patients at increased risk for rehospitalization would allow for tailored interventions to be offered to them. This requires the creation of a functional predictive model specifically designed to support real-time clinical operations. A predictive model for readmissions within 30 days of discharge was developed using retrospective data from 45,924 MGH admissions between 2/1/2012 and 1/31/2013 only including factors that would be available by the day after admission. It was then validated prospectively in a real-time implementation for 3,074 MGH admissions between 10/1/2013 and 10/31/2013. The model developed retrospectively had an AUC of 0.705 with good calibration. The real-time implementation had an AUC of 0.671 although the model was overestimating readmission risk. A moderately discriminative real-time 30-day readmission predictive model can be developed and implemented in a large academic hospital.

  17. The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure

    PubMed Central

    Giuliano, Karen K.; Danesh, Valerie; Funk, Marjorie

    2016-01-01

    OBJECTIVE The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. BACKGROUND Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. METHODS A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report “Best Hospitals” survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. RESULTS A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. CONCLUSION These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes. PMID:26579974

  18. 78 FR 58318 - Submission for OMB Review; 30-day Comment Request: The Framingham Heart Study (FHS)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ... studying the determinants of cardiovascular disease. Morbidity and mortality follow-up will continue to... data collection plans and instruments, contact Dr. Gina Wei, Division of Cardiovascular Sciences,...

  19. 78 FR 70958 - 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: HUD has... allow for an additional 30 days of public comment. DATES: Comments Due Date: December 27,...

  20. Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization.

    PubMed

    Horne, Benjamin D; Budge, Deborah; Masica, Andrew L; Savitz, Lucy A; Benuzillo, José; Cantu, Gabriela; Bradshaw, Alejandra; McCubrey, Raymond O; Bair, Tami L; Roberts, Colleen A; Rasmusson, Kismet D; Alharethi, Rami; Kfoury, Abdallah G; James, Brent C; Lappé, Donald L

    2017-03-01

    Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk.

  1. Correspondence between hair cortisol concentrations and 30-day integrated daily salivary and weekly urinary cortisol measures.

    PubMed

    Short, Sarah J; Stalder, Tobias; Marceau, Kristine; Entringer, Sonja; Moog, Nora K; Shirtcliff, Elizabeth A; Wadhwa, Pathik D; Buss, Claudia

    2016-09-01

    Characterization of cortisol production, regulation and function is of considerable interest and relevance given its ubiquitous role in virtually all aspects of physiology, health and disease risk. The quantification of cortisol concentration in hair has been proposed as a promising approach for the retrospective assessment of integrated, long-term cortisol production. However, human research is still needed to directly test and validate current assumptions about which aspects of cortisol production and regulation are reflected in hair cortisol concentrations (HCC). Here, we report findings from a validation study in a sample of 17 healthy adults (mean±SD age: 34±8.6 yrs). To determine the extent to which HCC captures cumulative cortisol production, we examined the correspondence of HCC, obtained from the first 1cm scalp-near hair segment, assumed to retrospectively reflect 1-month integrated cortisol secretion, with 30-day average salivary cortisol area-under-the curve (AUC) based on 3 samples collected per day (on awakening, +30min, at bedtime) and the average of 4 weekly 24-h urinary free cortisol (UFC) assessments. To further address which aspects of cortisol production and regulation are best reflected in the HCC measure, we also examined components of the salivary measures that represent: (1) production in response to the challenge of awakening (using the cortisol awakening response [CAR]), and (2) chronobiological regulation of cortisol production (using diurnal slope). Finally, we evaluated the test-retest stability of each cortisol measure. Results indicate that HCC was most strongly associated with the prior 30-day integrated cortisol production measure (average salivary cortisol AUC) (r=0.61, p=0.01). There were no significant associations between HCC and the 30-day summary measures using CAR or diurnal slope. The relationship between 1-month integrated 24-h UFC and HCC did not reach statistical significance (r=0.30, p=0.28). Lastly, of all cortisol

  2. Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure.

    PubMed

    Arora, Shilpkumar; Patel, Prashant; Lahewala, Sopan; Patel, Nilay; Patel, Nileshkumar J; Thakore, Kosha; Amin, Aditi; Tripathi, Byomesh; Kumar, Varun; Shah, Harshil; Shah, Mahek; Panaich, Sidakpal; Deshmukh, Abhishek; Badheka, Apurva; Gidwani, Umesh; Gopalan, Radha

    2017-03-01

    Heart failure (HF) is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data 2013, sponsored by the Agency for Healthcare Research and Quality. HF was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. From a total 301,892 principal admissions (73.4% age ≥65 years and 50.6% men), 55,857 (18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by coronary artery disease and arrhythmias), whereas pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (odds ratio, 95% confidence interval, p value: 1.06, 1.03 to 1.08, p <0.001), chronic lung disease (1.13, 1.11 to 1.16, p <0.001), renal failure/electrolyte imbalance (1.12, 1.10 to 1.15, p <0.001), discharge to facilities (1.07, 1.04 to 1.09, p <0.001), lengthier hospital stay, and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to

  3. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  4. Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?

    PubMed

    Dunbar-Yaffe, Richard; Stitt, Audra; Lee, Joseph J; Mohamed, Shanas; Lee, Douglas S

    2015-10-01

    Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.

  5. The Gravity of LBNP Exercise: Lessons Learned from Identical Twins in Bed for 30 Days

    NASA Technical Reports Server (NTRS)

    Hargens, Alan R.; Groppo, Eli R.; Lee, Stuart M. C.; Watenpaugh, Donald; Schneider, Suzanne; O'Leary, Deborah; Smith, Scott M.; Steinbach, Gregory C.; Tanaka, Kunihiko; Kimura, Shinji; Meyer, R. Scott

    2002-01-01

    Microgravity leads to cardiovascular deconditioning in humans, which is manifested by post-flight reduction of orthostatic tolerance and upright exercise capacity. During upright posture on Earth, blood pressures are greater in the feet than at heart or head levels due to gravity's effects on columns of blood in the body. During exposure to Microgravity, all gravitational blood pressures disappear. Presently, there is no exercise hardware available for space flight to provide gravitational blood pressures to tissues of the lower body. We hypothesized that 40 minutes of supine treadmill running per day in a LBNP chamber at 1.0 to 1.2 body weight (approximately 50 - 60 mm Hg LBNP) with a 5 min resting, nonexercise LBNP exposure at 50 mm Hg after the exercise session will maintain aerobic fitness orthostatic tolerance, and selected parameters of musculoskeletal function during 30 days of bed rest (simulated microgravity). This paper is an interim report of some of our findings on 16 subjects.

  6. Development of Lightweight Material Composites to Insulate Cryogenic Tanks for 30-Day Storage in Outer Space

    NASA Technical Reports Server (NTRS)

    Krause, D. R.

    1972-01-01

    A conceptual design was developed for an MLI system which will meet the design constraints of an ILRV used for 7- to 30-day missions. The ten tasks are briefly described: (1) material survey and procurement, material property tests, and selection of composites to be considered; (2) definition of environmental parameters and tooling requirements, and thermal and structural design verification test definition; (3) definition of tanks and associated hardware to be used, and definition of MLI concepts to be considered; (4) thermal analyses, including purge, evacuation, and reentry repressurization analyses; (5) structural analyses (6) thermal degradation tests of composite and structural tests of fastener; (7) selection of MLI materials and system; (8) definition of a conceptual MLI system design; (9) evaluation of nondestructive inspection techniques and definition of procedures for repair of damaged areas; and (10) preparation of preliminary specifications.

  7. Structural and metabolic characteristics of human skeletal muscle following 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Hikida, Robert S.; Gollnick, Philip D.; Dudley, Gary A.; Convertino, Victor A.; Buchanan, Paul

    1989-01-01

    The effects of simulated microgravity (30 days of continuous 6-deg headdown bedrest, BR) on the structural and metabolic characteristics of human skeletal muscle were determined. Percutaneous needle biopsy samples obtained from the vastus lateralis and soleus muscles before and after the headdown BR were analyzed for histochemical, biochemical and ultrastructual changes. It was found that headdown BR led to decreases in both fast-twitch and slow-twitch fiber areas in both muscles, and there was evidence of remodeling of the ultrastructure in both muscles. The activities of beta-hydroxyacyl-CoA dehydrogenase and citrate synthase were reduced during BR, but phosphofructokinase and lactate dehydrogenase activities did not change. The results indicate that 30-d exposure to simulated microgravity decreased the capacity for aerobic energy supply of human skeletal muscle and led to a disorganization of the contractile machinery.

  8. Continuous 30-day measurements utilizing the monkey metabolism pod. [study of weightlessness effects

    NASA Technical Reports Server (NTRS)

    Pace, N.; Kodama, A. M.; Mains, R. C.; Rahlmann, D. F.; Grunbaum, B. W.

    1977-01-01

    A fiberglass system was previously described, using which quantitative physiological measurements could be made to study the effects of weightlessness on 10 to 14 kg adult monkeys maintained in comfortable restraint under space flight conditions. Recent improvements in the system have made it possible to obtain continuous measurements of respiratory gas exchange, cardiovascular function, and mineral balance for periods of up to 30 days on pig-tailed monkeys. It has also been possible to operate two pods which share one set of instrumentation, thereby permitting simultaneous measurements to be made on two animals by commutating signal outputs from the pods. In principle, more than two pods could be operated in this fashion. The system is compatible with Spacelab design. Representative physiological data from ground tests of the system are presented.

  9. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest.

    PubMed

    Morgan, Jennifer L L; Zwart, Sara R; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen; Smith, Scott M

    2012-11-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25-49 yr) who participated in a 30-day -6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ~20% (P < 0.001), and serum parathyroid hormone decreased ~25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ~20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = -0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration.

  10. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest

    PubMed Central

    Morgan, Jennifer L. L.; Zwart, Sara R.; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen

    2012-01-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25–49 yr) who participated in a 30-day −6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ∼20% (P < 0.001), and serum parathyroid hormone decreased ∼25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ∼20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = −0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration. PMID:22995395

  11. Analysis of 30-Day Postdischarge Morbidity and Readmission after Radical Gastrectomy for Gastric Carcinoma: A Single-Center Study of 2107 Patients With Prospective Data

    PubMed Central

    Jeong, Oh; Kyu Park, Young; Ran Jung, Mi; Yeop Ryu, Seong

    2015-01-01

    Abstract PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system. Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care. No previous studies have extensively investigated PD complications after gastric cancer surgery. We investigated the incidence, types, treatment, and risk factors of 30-day postdischarge (PD) complications after gastric cancer surgery. Between 2010 and 2013, data concerning complications and readmission within 30 days of hospital discharge were prospectively collected in 2107 patients undergoing gastric cancer surgery. In total, 1642 patients (77.9%) underwent distal gastrectomy, 418 (19.8%) total gastrectomy, and 47 (2.3%) other procedures. Postoperative morbidity and mortality were 17.4% and 0.6%, respectively, with a mean 8.8-day hospital stay. Sixty-one patients (2.9%) developed 30-day PD morbidity (58 local and 3 systemic complications), accounting for 16.6% of overall morbidity; 47 (2.2%) were readmitted; and 7 (0.3%) underwent a reoperation. The mean time to PD complications was 9.5 days after index hospital discharge. The most common complication was intra-abdominal abscess (n = 14), followed by wound, ascites, and anastomosis leakage. No mortality occurred resulting from PD complications. In the univariate and multivariate analyses, underlying comorbidity (hypertension and liver cirrhosis) and obesity were independent risk factors for developing PD complications. The early PD period is a vulnerable time for surgical patients with substantial risk of complication and readmission. Tailored discharge plans along with appropriate PD patient support are essential for improving the quality of patient care. PMID:25789945

  12. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

    PubMed Central

    Báez-Saldaña, Renata; Villafuerte-García, Adriana; Cruz-Hervert, Pablo; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Melchor-Romero, Ada; García-García, Lourdes

    2015-01-01

    Background Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. Objective To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. Material and Methods We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. Results We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. Conclusions HAART for 180 days or more was associated

  13. Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

    PubMed Central

    Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

    2013-01-01

    Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

  14. 78 FR 65697 - 30-Day Notice of Proposed Information Collection: Public Housing, Contracting With Resident-Owned...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Public Housing, Contracting With...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451...

  15. 77 FR 73731 - 30-Day Notice of Proposed Information Collection: Application Under the Hague Convention on the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-11

    ... Notice is to allow 30 days for public comment. DATES: Submit comments directly to the Office of Management and Budget (OMB) up to January 10, 2013. ADDRESSES: Direct comments to the Department of...

  16. Analysis of rat testicular proteome following 30-day exposure to 900 MHz electromagnetic field radiation.

    PubMed

    Sepehrimanesh, Masood; Kazemipour, Nasrin; Saeb, Mehdi; Nazifi, Saeed

    2014-12-01

    The use of electromagnetic field (EMF) generating apparatuses such as cell phones is increasing, and has caused an interest in the investigations of its effects on human health. We analyzed proteome in preparations from the whole testis in adult male Sprague-Dawley rats that were exposed to 900 MHz EMF radiation for 1, 2, or 4 h/day for 30 consecutive days, simulating a range of possible human cell phone use. Subjects were sacrificed immediately after the end of the experiment and testes fractions were solubilized and separated via high-resolution 2D electrophoresis, and gel patterns were scanned, digitized, and processed. Thirteen proteins, which were found only in sham or in exposure groups, were identified by MALDI-TOF/TOF-MS. Among them, heat shock proteins, superoxide dismutase, peroxiredoxin-1, and other proteins related to misfolding of proteins and/or stress were identified. These results demonstrate significant effects of radio frequency modulated EMFs exposure on proteome, particularly in protein species in the rodent testis, and suggest that a 30-day exposure to EMF radiation induces nonthermal stress in testicular tissue. The functional implication of the identified proteins was discussed.

  17. Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

    PubMed Central

    Baker, Dustin; Sherrod, Brandon; McGwin, Gerald; Ponce, Brent; Gilbert, Shawn

    2016-01-01

    Introduction The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures. Methods The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated. Results Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P = <0.001), pneumonia (P = <0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P = <0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died. Conclusion In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population. PMID:26855119

  18. [Activity of various oxidases and transaminases in the rat liver in the readaptation period after hypokinesia up to 30 days].

    PubMed

    Potapov, P P

    1990-01-01

    The activity of alpha-ketoglutarate dehydrogenase and succinic dehydrogenase in readaptation after 15-day hypokinesia was within normal limits, whereas following 30-day hypokinesia it was enhanced on days 11-15. Pyruvate dehydrogenase exhibited hyperactivity in the end of readaptation week 2 both in 15- and 30-day hypokinesia which resulted in rat liver hyperactivity of glutamate dehydrogenase and transaminases. Normal levels of the latter were recorded on readaptation day 12-19.

  19. Relationship Between Severity Classification of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Clinical Outcomes in Hospitalized Patients

    PubMed Central

    Sanjuán, Pilar; Huerta, Arturo; Nieto-Codesido, Irene; Ferreira-Gonzalez, Lucía; Sibila, Oriol; Restrepo, Marcos I

    2017-01-01

    Background Limited data are available regarding the impact of the potential validation of the Canadian Thoracic Society (CTS) guidelines recommendations in classifying patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in simple and complex. The aim of the present study was to assess the CTS recommendations regarding risk stratification on clinical outcomes among patients hospitalized with an AECOPD. Methods We developed a retrospective cohort study of patients admitted to one tertiary hospital with a diagnosis of AECOPD. The main clinical outcome was the percentage of treatment failure. Secondary outcomes were 30-day, 90-day, and 1-year readmission and mortality rate, length of stay in hospital, intensive care unit (ICU) admission rate, time to readmission, and time to death. Multivariate analyses were performed using 1-year mortality rate as the dependent measures. Results One hundred forty-three patients composed the final study population, most of them (106 [74.1%)] classified as complex acute exacerbation (C-AE) of COPD. C-AE patients had similar rate of treatment failure compared with simple acute exacerbation (S-AE) of COPD (31.1% vs. 27%; p = 0.63). There were no differences regarding the length of stay in hospital, ICU admission rate, and 30-day, 90-day, and 1-year readmission rate. C-AE patients had faster declined measures on time to death (691.6 ± 430 days vs. 998.1 ± 355 days; p = 0.02). In the multivariate analysis, after adjusting for comorbidity, lung function and previous treatment, C-AE patients had a significant higher mortality at one year (Odds Ratio [OR] = 4.9 (Confidence Interval [CI] 95%: 1.16-21); p = 0.031). Conclusions In hospitalized patients with an AECOPD, CTS classification, according to the presence of risk factors, was not associated with worse short-term clinical outcomes although it is related with long-term mortality.  PMID:28265524

  20. Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center

    PubMed Central

    Manzano, Joanna-Grace M.; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

    2015-01-01

    Purpose: Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. Methods: We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. Results: We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01). Conclusion: We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals. PMID:26152375

  1. Hospital Blood Transfusion Patterns During Major Noncardiac Surgery and Surgical Mortality.

    PubMed

    Chen, Alicia; Trivedi, Amal N; Jiang, Lan; Vezeridis, Michael; Henderson, William G; Wu, Wen-Chih

    2015-08-01

    We retrospectively examined intraoperative blood transfusion patterns at US veteran's hospitals through description of national patterns of intraoperative blood transfusion by indication for transfusion in the elderly; assessment of temporal trends in the use of intraoperative blood transfusion; and relationship of institutional use of intraoperative blood transfusion to hospital 30-day risk-adjusted postoperative mortality rates.Limited data exist on the pattern of intraoperative blood transfusion by indication for transfusion at the hospital level, and the relationship between intraoperative transfusion rates and institutional surgical outcomes.Using the Department of Veterans Affairs Surgical Quality Improvement Program database, we assigned 424,015 major noncardiac operations among elderly patients (≥65 years) in 117 veteran's hospitals, from 1997 to 2009, into groups based on indication for intraoperative blood transfusion according to literature and clinical guidelines. We then examined institutional variations and temporal trends in surgical blood use based on these indications, and the relationship between these institutional patterns of transfusion and 30-day postoperative mortality.Intraoperative transfusion occurred in 38,056/424,015 operations (9.0%). Among the 64,390 operations with an indication for transfusion, there was wide variation (median: 49.9%, range: 8.7%-76.2%) in hospital transfusion rates, a yearly decline in transfusion rates (average 1.0%/y), and an inverse relationship between hospital intraoperative transfusion rates and hospital 30-day risk-adjusted mortality (adjusted mortality of 9.8 ± 2.8% vs 8.3 ± 2.1% for lowest and highest tertiles of hospital transfusion rates, respectively, P = 0.02). In contrast, for the 225,782 operations with no indication for transfusion, there was little variation in hospital transfusion rates (median 0.7%, range: 0%-3.4%), no meaningful temporal change in transfusion (average 0.0%/y), and

  2. Retraction: 'rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis' by Ming-Yi Lv, Shu-Ling Deng and Xiao-Feng Long.

    PubMed

    2016-05-01

    The above article, published online on 28(th) November 2015 in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.1111/bcp.12788/full), and in volume 81, pp. 174-185, has been retracted by agreement between the authors, the journal Editor in Chief, Professor A Cohen, and John Wiley & Sons Limited. The retraction has been agreed owing to evidence indicating that the peer review of this paper was compromised. The authors were unaware of the actions of the third party responsible for compromising the peer review. Reference Lv M-Y, Deng S-L, Long X-F. rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis. Br J Clin Pharmacol 2016; 81: 174-85. doi:10.1111/bcp.12788.

  3. Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

    PubMed Central

    2017-01-01

    The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23–27] vs. 26 [23–27] weeks; P = 0.012) and lighter (655 [500–930] vs. 880 [370–1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ≤ 2 postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent. PMID:27914140

  4. Monitoring and Modeling the Fluctuations in Apparent Groundwater Age During a 30-Day Pumping Test.

    NASA Astrophysics Data System (ADS)

    Perle, M. E.; Zhang, Y.; Fogg, G. E.

    2004-12-01

    Recent research shows that dispersion due to geologic heterogeneity can cause large (10's to 100's of yrs) variations in actual groundwater age within individual samples drawn from a well, even if well bore mixing is not significant. We hypothesize that the presence of such large ranges in groundwater age may cause the mean apparent age as estimated from environmental tracers such as CFC's, SF&_{6}, and ^{3}H-^{3}He to drift measurably during long-term, continuous pumping. This hypothesis was confirmed by 3-D numerical experiments wherein variation in groundwater ages under high-rate (\\sim0.06 m^{3}/s; 1,000 gpm) long-term pumping was modeled using backward-time random walk particle tracking techniques combined with geostatistical simulations of hydrofacies heterogeneity. Results indicate that the age distribution within a water sample and the mean apparent age implied by environmental tracers is strongly influenced by historical atmospheric concentrations of environmental tracers and subsurface heterogeneity. As a partial implementation of this same experiment in the field, an abandoned well was pumped at a low rate (\\sim0.005 m^{3}/s; 75 gpm) during 53 days. Water samples were collected from the top and bottom of a 25 foot well screen at 12 hour intervals for the first 30 days and were analyzed for CFC's, SF&6, and 3H-3He. The measured tracer ages indicate that 1) CFC-11 apparent ages increased with time within the first five days of pumping and then remained constant for the remainder of the pump test; 2) trends in CFC-12, CFC-113 and SF&_{6}$ indicate a discrepancy in apparent ages with CFC-11, 3) water reaching the top interval is younger than water reaching the bottom interval. Gas samples were collected from the unsaturated zone to investigate possible CFC contamination and tracer concentration spatial variations in the pumping well recharge zone. Potential effects of heterogeneity and local CFC contamination on the monitoring results will be discussed.

  5. Bion M1. Peculiarities of life activities of microbes in 30-day spaceflight

    NASA Astrophysics Data System (ADS)

    Viacheslav, Ilyin; Korshunov, Denis; Morozova, Julia; Voeikova, Tatiana; Tyaglov, Boris; Novikova, Liudmila; Krestyanova, Irina; Emelyanova, Lydia

    The aim of this work was to analyze the influence of space flight factors ( SFF) to microorganism strains , exposed inside unmanned spacecraft Bion M-1 during the 30- day space flight. Objectives of the work - the study of the influence of the SFF exchange chromosomal DNA in crosses microorganisms of the genus Streptomyces; the level of spontaneous phage induction of lysogenic strains fS31 from Streptomyces lividans 66 and Streptomyces coelicolor A3 ( 2 ) on the biosynthesis of the antibiotic tylosin strain of Streptomyces fradiae; survival electrogenic bacteria Shewanella oneidensis MR- 1 is used in the microbial fuel cell As a result of this work it was found that the SFF affect the exchange of chromosomal DNA by crossing strains of Streptomyces. Was detected polarity crossing , expressed in an advantageous contribution chromosome fragment of one of the parent strains in recombinant offspring. This fact may indicate a more prolonged exposure of cells in microgravity and , as a consequence, the transfer of longer fragments of chromosomal DNA This feature is the transfer of genetic material in microgravity could lead to wider dissemination and horizontal transfer of chromosomal and plasmid DNA of symbiotic microflora astronauts and other strains present in the spacecraft. It was shown no effect on the frequency of recombination PCF and the level of mutation model reversion of auxotrophic markers to prototrophy It was demonstrated that PCF increase the level of induction of cell actinophage fS31 lysogenic strain of S. lividans 66, but did not affect the level of induction of this phage cells S. coelicolor A3 ( 2). It is shown that the lower the level of synthesis PCF antibiotic aktinorodina (actinorhodin) in lysogenic strain S. coelicolor A3 ( 2). 66 Strains of S. lividans and S. coelicolor A3 ( 2 ) can be used as a biosensor for studying the effect on microorganisms PCF It is shown that the effect of the PCF reduces synthesis of tylosin and desmicosyn S. fradiae at

  6. Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept.

    PubMed

    Ickenstein, G W; Riecker, A; Höhlig, C; Müller, R; Becker, U; Reichmann, H; Prosiegel, M

    2010-09-01

    The aim of our work was to develop a step-wise concept for investigating neurogenic oropharyngeal dysphagia (NOD) that could be used by both trained nursing staff as well as swallowing therapists and physicians to identify patients with NOD at an early stage and so enable an appropriate therapy to be started. To achieve this objective, we assessed uniform terminology and standard operating procedures (SOP) in a new NOD step-wise concept. In-house stroke mortality rates and rates of pneumonia were measured over time (2003-2009) in order to show improvements in quality of care. In addition, outcome measures in a stroke-unit monitoring system were studied after neurorehabilitation (day 90) assessing quality of life (QL) and patient feedback. An investigation that was carried out in the context of internal and external quality assurance stroke projects revealed a significant correlation between the NOD step-wise concept and low rates of pneumonia and in-house mortality. The quality of life measures show a delta value that can contribute to "post-stroke" depression. The NOD step-wise concept (NSC) should, on the one hand, be capable of being routinely used in clinical care and, on the other, being able to fulfil the requirements of being scientifically based for investigating different stages of swallowing disorders. The value of our NSC relates to the effective management of clinical resources and the provision of adequate diagnostic and therapeutic options for different grades of dysphagia. We anticipate that our concept will provide substantial support to physicians, as well as swallowing therapists, in clinical settings and rehabilitation facilities, thereby promoting better guidance and understanding of neurogenic dysphagia as a concept in acute and rehabilitation care, especially stroke-unit settings.

  7. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    PubMed

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  8. Effects of nurse staffing, work environments, and education on patient mortality: An observational study

    PubMed Central

    Cho, Eunhee; Sloane, Douglas M.; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H.

    2014-01-01

    Background While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. Objective To examine the effects of nurse staffing, work environment, and education on patient mortality. Methods This study linked hospital facility data with staff nurse survey data (N=1,024) and surgical patient discharge data (N = 76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Results Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00–1.10; OR 0.52, 95% CI 0.31–0.88; and OR 0.91, CI 0.83–0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in BSN nurse is associated with a 9% decrease in patient deaths. Conclusions Nurse staffing, nurse work environments, and percentages of BSN nurses in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of BSN nurses would help reduce the number of preventable in-hospital deaths. PMID:25213091

  9. Superfund reform: US Environmental Protection Agency`s 30-day study and its implication for the US Department of Energy

    SciTech Connect

    Siegel, M.R.; Friedman, J.R.; Neff, R.W.

    1993-03-01

    As part of an ongoing effort to reform and restructure the US Environmental Protection Agency`s (EPAS) Superfund program, the EPA Administrator on October 21, 1991, announced several key programmatic reforms. These reforms are a result of the Superfund 30-Day Task Force Report (30-Day Study, EPA 1991a), an effort carried out by EPAs office of Solid Waste and Emergency Response (OSWER). The EPA OSWER oversees environmental cleanup activities under a number of statutory authorities, including the Comprehensive Environmental response, Compensation, and Liability Act (CERCLA, also known as Superfund). CERCLA and its implementing regulation, the National Contingency Plan (NCP), establish a regulatory framework to govern the cleanup of existing, and often abandoned, hazardous waste sites. The purposes of this report are to (1) review the background and recommendations of EPNs 30-Day Study, (2) identify and discuss the initiatives from the 30-Day Study that may impact DOE`s environmental restoration mission, (3) report on EPAs progress in implementing the selected priority initiatives, and (4) describe potentially related DOE activities.

  10. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  11. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  12. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  13. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  14. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  15. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  16. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  17. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  18. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore

    PubMed Central

    Low, Lian Leng; Lee, Kheng Hock; Hock Ong, Marcus Eng; Wang, Sijia; Tan, Shu Yun; Thumboo, Julian; Liu, Nan

    2015-01-01

    The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. PMID:26682212

  19. 76 FR 17734 - 30-Day Notice of Proposed Information Collection: Form DS-1998E, Foreign Service Officer Test...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    .... Originating Office: Human Resources, HR/REE/BEX. Form Number: DS-1998E. Respondents: Registrants for the... information collection request to the Office of Management and Budget (OMB) for ] approval in accordance with... Office of Management and Budget (OMB) for up to 30 days from March 30, 2011. ADDRESSES: Direct...

  20. 78 FR 31999 - 30-Day Notice of Proposed Information Collection: Young Turkey/Young America Evaluation (YTYA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Young Turkey/ Young America Evaluation (YTYA) Survey ACTION... Collection: Young Turkey/Young America Evaluation (YTYA) Survey. OMB Control Number: None. Type of...

  1. 78 FR 36562 - 30-Day Notice of Proposed Information Collection: Application and Re-certification Packages for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  2. 78 FR 66040 - 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate-Sales Contract and Addendums

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate--Sales... collection entitled HUD-Owned Real Estate-Sales Contract and Addendums (2502-0306). HUD will republish...

  3. 78 FR 59047 - 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... Title of Information Collection: Semi-annual Labor Standards Enforcement Report--Local Contracting... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report--Local Contracting Agencies (HUD Programs) AGENCY: Office of the Chief Information...

  4. 76 FR 58074 - 30-Day Notice of Proposed Information Collection: DS-7001 and DS-7005, DOS-Sponsored Academic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-19

    ... information collection request to the Office of Management and Budget (OMB) for approval in accordance with... Collection. Originating Office: Bureau of Educational and Cultural Affairs, ECA/A/E/EUR. Form Number: DS-7001... to the Office of Management and Budget (OMB) for up to 30 days from September 19, 2011....

  5. 77 FR 47690 - 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing Electronic Form... Database In-Processing Electronic Form. OMB Control Number: 1405-0168. Type of Request: Extension of...

  6. 75 FR 32961 - 30-Day Federal Register Notice of Intention To Request Clearance of Collection of Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-10

    ... collection Office of Management and Budget (OMB) Control 1024-0231. The OMB has up to 60 days to approve or... consideration, OMB should receive public comments within 30 days of the date on which this notice is published... were received on this notice. DATES: Public comments on the proposed Information Collection...

  7. 78 FR 15799 - 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S. Passport Book and/or... INFORMATION: Title of Information Collection: Statement Regarding a Lost or Stolen U.S. Passport Book...

  8. 78 FR 64145 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing..., 2013. A. Overview of Information Collection Title of Information Collection: Housing Finance Agency... Secretary to implement risk sharing with State and local housing finance agencies (HFAs). Under this...

  9. 78 FR 65696 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing... Collection Title of Information Collection: Housing Finance Agency Risk- Sharing Program. OMB Approval Number... with State and local housing finance agencies (HFAs). Under this program, HUD provides full...

  10. 78 FR 35040 - Submission for OMB Review; 30-day Comment Request; Web-Based Media Literacy Parent Training for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request; Web-Based Media Literacy Parent Training for Substance Use Prevention in Rural Locations SUMMARY: Under the... Branch, Division of Epidemiology, Services, and Prevention Research, NIDA, NIH, 6001 Executive...

  11. Relationship between Early Physician Follow-Up and 30-Day Readmission after Acute Myocardial Infarction and Heart Failure

    PubMed Central

    Tung, Yu-Chi; Chang, Guann-Ming; Chang, Hsien-Yen

    2017-01-01

    Background Thirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and heart failure are inconclusive. We used nationwide population-based data to examine associations between 7-day physician follow-up and 30-day readmission, and further associations of 7-day same physician (during the index hospitalization and at follow-up) and cardiologist follow-up with 30-day readmission for non-ST-segment-elevation myocardial infarction (NSTEMI) or heart failure. Methods We analyzed all patients 18 years or older with NSTEMI and heart failure and discharged from hospitals in 2010 in Taiwan through Taiwan’s National Health Insurance Research Database. Cox proportional hazard models with robust sandwich variance estimates and propensity score weighting were performed after adjustment for patient and hospital characteristics to test associations between 7-day physician follow-up and 30-day readmission. Results The study population for NSTEMI and heart failure included 5,008 and 13,577 patients, respectively. Early physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with NSTEMI (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.39–0.57), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60). Same physician follow-up was associated with a reduced hazard ratio of readmission compared with different physician follow-up for patients with NSTEMI (HR, 0.56; 95% CI, 0.48–0.65), and for patients with heart failure (HR, 0.69; 95% CI, 0.62–0.76). Conclusions For each condition, patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission. Moreover

  12. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

    PubMed Central

    Souza, André Luiz Silveira; Salgado, Constantino González; Mourilhe-Rocha, Ricardo; Mesquita, Evandro Tinoco; Lima, Luciana Cristina Lima Correia; de Mattos, Nelson Durval Ferreira Gomes; Rabischoffsky, Arnaldo; Fagundes, Francisco Eduardo Sampaio; Colafranceschi, Alexandre Siciliano; Carvalho, Luiz Antonio Ferreira

    2016-01-01

    Background Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality. PMID:27192383

  13. Impact of Peri-Operative Acute Kidney Injury as a Severity Index for 30-day Readmission After Cardiac Surgery

    PubMed Central

    Brown, Jeremiah R.; Parikh, Chirag R.; Ross, Cathy S.; Kramer, Robert S.; Magnus, Patrick C.; Chaisson, Kristine; Boss, Richard A.; Helm, Robert E.; Horton, Susan R.; Hofmaster, Patricia; Desaulniers, Helen; Blajda, Pamela; Westbrook, Benjamin M.; Duquette, Dennis; LeBlond, Kelly; Quinn, Reed D.; Jones, Cheryl; DiScipio, Anthony W.; Malenka, David J.

    2014-01-01

    Background Of patients undergoing cardiac surgery in the United States, 15–20% are re-hospitalized within 30-days. Current models to predict readmission have not evaluated the association between severity of post-operative acute kidney injury (AKI) and 30-day readmissions. Methods We collected data from 2,209 consecutive patients who underwent either coronary artery bypass (CABG) or valve surgery at seven member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry (NNE) between July 2008 and December 2010. Administrative data at each hospital was searched to identify all patients readmitted to the index hospital within 30 days of discharge. We defined AKI Stages by the AKI Network definition of 0.3 or 50% increase (Stage 1), 2-fold increase (stage 2) and a 3-fold or 0.5 increase if the baseline serum creatinine was at least 4.0 (mg/dL) or new dialysis (stage 3). We evaluate the association between stages of AKI and 30-day readmission using multivariate logistic regression. Results There were 260 patients readmitted within 30-days (12.1%). The median time to readmission was 9 (IQR 4–16) days. Patients not developing AKI following cardiac surgery had a 30-day readmission rate of 9.3% compared to patients developing AKI stage 1 (16.1%), AKI stage 2 (21.8%) and AKI stage 3 (28.6%, p <0.001). Adjusted odds ratios for AKI stage 1 (1.81; 1.35, 2.44), stage 2 (2.39; 1.38, 4.14) and stage 3 (3.47; 1.85–6.50). Models to predict readmission were significantly improved with the addition of AKI stage (c-statistic 0.65, p = 0.001) and net reclassification rate of 14.6% (95%CI: 5.05% to 24.14%, p = .003). Conclusions In addition to more traditional patient characteristics, the severity of post-operative AKI should be used when assessing a patient’s risk for readmission. PMID:24119985

  14. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants

    PubMed Central

    Ericson, Jessica E.; Popoola, Victor O.; Smith, P. Brian; Benjamin, Daniel K.; Fowler, Vance G.; Benjamin, Daniel K.; Clark, Reese H.; Milstone, Aaron M.

    2015-01-01

    Importance Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity, and longer hospital stays, but data on the burden of S. aureus disease in hospitalized infants are limited. Objective To compare demographics and mortality of infants with invasive methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA), determine the annual proportion of S. aureus infections that were MRSA, and compare the risk of death following an invasive MRSA infection to the risk following an invasive MSSA infection. Design Multicenter retrospective study of a large, nationally representative cohort. Setting 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants 3888 infants with an invasive S. aureus infection who were discharged between 1997 and 2012. Exposure Invasive S. aureus infection. Main Outcomes and Measures Incidence of invasive S. aureus infections. Infant characteristics and mortality following MRSA or MSSA infection. Results The 3888 infants had 3978 invasive S. aureus infections (2868 MSSA, 1110 MRSA). The incidence of invasive S. aureus infection was 44.8 infections/10,000 infants. The yearly proportion of invasive infections caused by MRSA increased from 1997 to 2006 and has remained relatively stable since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections died at hospital discharge (N=237) than those with invasive MRSA infections (N=110). The proportion of infants who died following invasive MSSA or MRSA infection were similar: 237/2474 (9.6%) and 110/926 (11.9%), P=.05, respectively. Adjusted risk of death at hospital discharge was similar after invasive MSSA and MRSA infections overall (risk ratio, 1.19; 95% CI, 0

  15. 30 Days Wild: Development and Evaluation of a Large-Scale Nature Engagement Campaign to Improve Well-Being.

    PubMed

    Richardson, Miles; Cormack, Adam; McRobert, Lucy; Underhill, Ralph

    2016-01-01

    There is a need to increase people's engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature.

  16. African Easterly Waves in 30-day High-Resolution Global Simulations: A Case Study During the 2006 NAMMA Period

    NASA Technical Reports Server (NTRS)

    Shen, Bo-Wen; Tao, Wei-Kuo; Wu, Man-Li C.

    2010-01-01

    In this study, extended -range (30 -day) high-resolution simulations with the NASA global mesoscale model are conducted to simulate the initiation and propagation of six consecutive African easterly waves (AEWs) from late August to September 2006 and their association with hurricane formation. It is shown that the statistical characteristics of individual AEWs are realistically simulated with larger errors in the 5th and 6th AEWs. Remarkable simulations of a mean African easterly jet (AEJ) are also obtained. Nine additional 30 -day experiments suggest that although land surface processes might contribute to the predictability of the AEJ and AEWs, the initiation and detailed evolution of AEWs still depend on the accurate representation of dynamic and land surface initial conditions and their time -varying nonlinear interactions. Of interest is the potential to extend the lead time for predicting hurricane formation (e.g., a lead time of up to 22 days) as the 4th AEW is realistically simulated.

  17. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery.

    PubMed

    Hunter, Tracey; Yoon, Richard S; Hutzler, Lorraine; Band, Philip; Liublinksa, Victoria; Slover, James; Bosco, Joseph A

    2015-01-01

    The Centers for Medicare & Medicaid Services considers readmissions within 30 days of discharge to be a quality indicator. Hospitals' and eventually physicians' readmission rates will be used to determine payment for services. It is imperative that health care providers understand which patients are at risk for readmission so that they can apply the appropriate preventive interventions. The research team analyzed all orthopedic admissions and readmissions at their institution from September 2008 to April 2011 in this study. Preparing for the next stage in health care reform, identifying any preoperative factors that may place certain patients into a "high-risk" category for readmission following an orthopedic procedure is of paramount importance. This data analysis of more than 13 000 patients noted that race-based and income-based risk factors did not translate into significant risk factors or predictors of 30-day readmission following orthopedic admission.

  18. 30 Days Wild: Development and Evaluation of a Large-Scale Nature Engagement Campaign to Improve Well-Being

    PubMed Central

    Richardson, Miles; Cormack, Adam; McRobert, Lucy; Underhill, Ralph

    2016-01-01

    There is a need to increase people’s engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature. PMID:26890891

  19. Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity

    PubMed Central

    Low, Lian Leng; Liu, Nan; Wang, Sijia; Thumboo, Julian; Ong, Marcus Eng Hock; Lee, Kheng Hock

    2016-01-01

    Background To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months), an established risk stratification tool. Method This was a retrospective cohort study of all patients ≥ 21 years of age, who were admitted to a tertiary hospital in Singapore from January 1, 2013 through May 31, 2015. Data were extracted from the hospital’s electronic health records. The outcome was defined as unplanned readmissions within 30 days of discharge from the index hospitalization. Candidate predictive variables were broadly grouped into five categories: Patient demographics, social determinants of health, past healthcare utilization, medical comorbidities, and markers of hospitalization severity. Multivariable logistic regression was used to predict the outcome, and receiver operating characteristic analysis was performed to compare our model with the LACE index. Results 74,102 cases were enrolled for analysis. Of these, 11,492 patient cases (15.5%) were readmitted within 30 days of discharge. A total of fifteen predictive variables were strongly associated with the risk of 30-day readmissions, including number of emergency department visits in the past 6 months, Charlson Comorbidity Index, markers of hospitalization severity such as ‘requiring inpatient dialysis during index admission, and ‘treatment with intravenous furosemide 40 milligrams or more’ during index admission. Our predictive model outperformed the LACE index by achieving larger area under the curve values: 0.78 (95% confidence interval [CI]: 0.77–0.79) versus 0.70 (95% CI: 0.69–0.71). Conclusion Several factors are important for

  20. International Validity of the “HOSPITAL” Score to Predict 30-day Potentially Avoidable Readmissions in Medical Patients

    PubMed Central

    Donzé, Jacques D.; Williams, Mark V.; Robinson, Edmondo J.; Zimlichman, Eyal; Aujesky, Drahomir; Vasilevskis, Eduard E.; Kripalani, Sunil; Metlay, Joshua P.; Wallington, Tamara; Fletcher, Grant S.; Auerbach, Andrew D.; Schnipper, Jeffrey L.

    2016-01-01

    IMPORTANCE Identification of patients at high risk of potentially avoidable readmission allows hospitals to efficiently direct additional care transitions services to the patients most likely to benefit. OBJECTIVE To externally validate the “HOSPITAL” score in an international multicenter study to assess its generalizability. DESIGN International multicenter retrospective cohort study. SETTING 9 large hospitals across 4 different countries. PARTICIPANTS All adult patients consecutively discharged alive from a medical department between January and December, 2011 (117,065 participants). Patients transferred to another acute care facility were excluded. EXPOSURES The “HOSPITAL” score includes the following predictors at discharge: Hemoglobin, discharge from an Oncology service, Sodium level, Procedure during the index admission, Index Type of admission (urgent), number of Admissions during the last 12 months, and Length of stay. MAIN OUTCOMES AND MEASURES 30-day potentially avoidable readmission to the index hospital using the SQLape algorithm. RESULTS Of all medical discharges, 14.5% (n=16,992) were followed by a 30-day readmission, and 9.7% (n=11,307) were followed by a 30-day potentially avoidable readmission. The discriminatory power of the “HOSPITAL” score to predict potentially avoidable readmission was good with a C-statistic of 0.72 (95% CI 0.72-0.72). As in the derivation study, patients were classified into 3 risk categories: low (62%), intermediate (24%), and high risk (14%). The estimated proportions of potentially avoidable readmission for each risk category matched the observed proportion, resulting in an excellent calibration (Pearson goodness of fit test P=0.89). CONCLUSIONS AND RELEVANCE The “HOSPITAL” score identified patients at high risk of 30-day potentially avoidable readmission with moderately high discrimination and excellent calibration when applied to a large international multicenter cohort of medical patients. This score

  1. Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

    PubMed Central

    Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

    2014-01-01

    Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

  2. Emergency department evaluation and 30-day readmission after craniotomy for primary brain tumor resection in New York State.

    PubMed

    Missios, Symeon; Bekelis, Kimon

    2017-01-06

    OBJECTIVE Fragmentation of care has been recognized as a major contributor to 30-day readmissions after surgical procedures. The authors investigated the association of evaluation in the hospital where the original procedure was performed with the rate of 30-day readmissions for patients presenting to the emergency department (ED) after craniotomy for primary brain tumor resection. METHODS A cohort study was conducted, involving patients who were evaluated in the ED within 30 days after discharge following a craniotomy for primary brain tumor resection between 2009 and 2013, and who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. A propensity score-adjusted model was used to control for confounding, whereas a mixed-effects model accounted for clustering at the hospital level. RESULTS Of the 610 patients presenting to the ED, 422 (69.2%) were evaluated in a hospital different from the one where the original procedure was performed (28.9% were readmitted), and 188 (30.8%) were evaluated at the original hospital (20.3% were readmitted). In a multivariable analysis, the authors demonstrated that being evaluated in the ED of the original hospital was associated with a decreased rate of 30-day readmission (OR 0.64, 95% CI 0.41-0.98). Similar associations were found in a mixed-effects logistic regression model (OR 0.63, 95% CI 0.40-0.96) and a propensity score-adjusted model (OR 0.64, 95% CI 0.41-0.98). This corresponds to one less readmission per 12 patients evaluated in the hospital where the original procedure was performed. CONCLUSIONS Using a comprehensive all-payer cohort of patients in New York State who were evaluated in the ED after craniotomy for primary brain tumor resection, the authors identified an association of assessment in the hospital where the original procedure was performed with a lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in

  3. Pulmonary Support On Day 30 As A Predictor Of Morbidity And Mortality In Congenital Diaphragmatic Hernia

    PubMed Central

    Cauley, Ryan P.; Stoffan, Alexander; Potanos, Kristina; Fullington, Nora; Graham, Dionne A.; Finkelstein, Jonathan A.; Kim, Heung Bae; Wilson, Jay M.

    2016-01-01

    Purpose Congenital diaphragmatic hernia (CDH) is associated with significant in-hospital mortality, morbidity and length-of-stay (LOS). We hypothesized that the degree of pulmonary support on hospital day-30 may predict in-hospital mortality, LOS, and discharge oxygen needs and could be useful for risk prediction and counseling. Methods 862 patients in the CDH Study Group registry with a LOS≥30 days were analyzed (2007–2010). Pulmonary support was defined as (1) room-air (n=320) (2) noninvasive supplementation (n=244) (3) mechanical ventilation (n=279) and (4) extracorporeal membrane oxygenation (ECMO, n=19). Cox Proportional hazards and logistic regression models were used to determine the case-mix adjusted association of oxygen requirements on day-30 with mortality and oxygen requirements at discharge. Results On multivariate analysis, use of ventilator (HR 5.1, p=.003) or ECMO (HR 19.6, p<.001) were significant predictors of in-patient mortality. Need for non-invasive supplementation or ventilator on day-30 was associated with a respective 22-fold (p<.001) and 43-fold (p<.001) increased odds of oxygen use at discharge compared to those on room-air. Conclusions Pulmonary support on Day-30 is a strong predictor of length of stay, oxygen requirements at discharge and in-patient mortality and may be used as a simple prognostic indicator for family counseling, discharge planning, and identification of high-risk infants. PMID:23845605

  4. Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

    PubMed Central

    Snider, Julia Thornton; Linthicum, Mark T.; Hegazi, Refaat A.; Partridge, Jamie S.; LaVallee, Chris; Lakdawalla, Darius N.; Wischmeyer, Paul E.

    2015-01-01

    BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS: Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. PMID:25357165

  5. Effects of leg strength and bicycle ergometry exercise on cardiovascular deconditioning after 30-day head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wu, Bin; Liu, Yusheng; Sun, Hongyi; Zhao, Dongming; Wang, Yue; Wu, Ping; Ni, Chengzhi

    2010-10-01

    The purpose of this study is to determine if the intermittent leg muscular strength exercise and bicycle ergometry exercise could attenuate cardiovascular deconditioning induced by prolonged -6° head-down bed rest (HDBR). Fifteen male subjects were randomly allocated into group A ( n=5, 30 days HDBR without exercise), group B ( n=5, 30 days HDBR with leg muscular strength exercise) and group C ( n=5, 30 days HDBR with bicycle ergometry exercise). The orthostatic tolerance (OT) was determined by +75°/20 min head-up tilt (HUT) test and the submaximal exercise capacity was determined by bicycle ergometry before and after HDBR. The results were as follows: (1) Compared with that before HDBR, OT time decreased dramatically by 57.6% ( p<0.001) after HDBR in group A, while it decreased by 36.4% ( p=0.084) in group B and by 34.7% ( p=0.062) in group C. (2) Compared with that before HDBR, the submaximal exercise time decreased significantly by 17.7% ( p<0.05) and 21.1% ( p<0.05) in groups A and B, respectively, after HDBR. However, it had no change (+1.3%, p>0.77) in group C. (3) compared with that before HDBR, the changes of heart rate (HR) and blood pressure were slightly improved in group B and C, while deteriorated in group A during orthostatic test and exercise test after HDBR. The results indicate that leg muscular strength exercise and bicycle ergometry exercise could partially attenuate the cardiovascular deconditioning induced by 30 d HDBR, and the latter exercise training could fully provide the protection for the loss of exercise capacity.

  6. Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

    PubMed Central

    McHugh, Matthew D.; Ma, Chenjuan

    2013-01-01

    Background Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions. PMID:23151591

  7. Effects of Cardiopulmonary Support With a Novel Pediatric Pump-Lung in a 30-Day Ovine Animal Model.

    PubMed

    Liu, Yang; Sanchez, Pablo G; Wei, Xufeng; Watkins, Amelia C; Niu, Shuqiong; Wu, Zhongjun J; Griffith, Bartley P

    2015-12-01

    The scarcity of donor organs has led to the development of devices that provide optimal long-term respiratory or cardiopulmonary support to bridge recipients as they wait for lung and/or heart transplantation. This study was designed to evaluate the 30-day in vivo performance of the newly developed pediatric pump-lung (PediPL) for cardiopulmonary support using a juvenile sheep model. The PediPL device was placed surgically between the right atrium and descending aorta in eight sheep (25.4-31.2 kg) and evaluated for 30 days. Anticoagulation was maintained with continuous heparin infusion (activated clotting time 150-200 s). The flow rate was measured continually, and gas transfer was measured daily. Plasma free hemoglobin, platelet activation, hematologic data, and blood biochemistry were assessed twice a week. Sheep were euthanized after 30 days. The explanted devices were examined for gross thrombosis. Six sheep survived for 30-32 days. During the study, the oxygen transfer rate of the devices was 54.9 ± 13.2 mL/min at a mean flow rate of 1.14 ± 0.46 L/min with blood oxygen saturation of 95.4% ± 1.7%. Plasma free hemoglobin was 8.2 ± 3.7 mg/dL. Platelet activation was 5.35 ± 2.65%. The animals had normal organ chemistries except for surgery-related transient alterations in kidney and liver function. Although we found some scattered thrombi on the membrane surfaces of some explanted devices during the necropsy, the device function and performance did not degrade. The PediPL device was capable of providing cardiopulmonary support with long-term reliability and good biocompatibility over the 30-day duration and offers the potential option for bridging pediatric patients with end-stage heart or lung disease to heart and/or lung transplantation.

  8. A space maintainability experiment aboard the Ben Franklin submersible during the 30-day Gulf Stream drift mission.

    NASA Technical Reports Server (NTRS)

    Kappler, J. R.; May, C. B.

    1972-01-01

    In the summer of 1969, a deep submersible drifted for 30 days below the surface of the Gulf Stream, while operated by a six man crew. The main purpose of the mission was oceanographic research. The crew's activities and completely self-contained environment resembled those of a space station such as Skylab. Because of these similarities aspects of onboard vehicle maintenance during the actual conduct of a scientific mission were investigated. The maintainability study was accomplished in six distinct phases. Two useful plots of manpower distribution were developed. A maintenance action summary is presented in a table.

  9. Pharmacokinetic and Genomic Effects of Arsenite in Drinking Water on Mouse Lung in a 30-Day Exposure.

    PubMed

    Chilakapati, Jaya; Wallace, Kathleen; Hernandez-Zavala, Araceli; Moore, Tanya; Ren, Hongzu; Kitchin, Kirk T

    2015-01-01

    The 2 objectives of this subchronic study were to determine the arsenite drinking water exposure dependent increases in female C3H mouse liver and lung tissue arsenicals and to characterize the dose response (to 0, 0.05, 0.25, 1, 10, and 85 ppm arsenite in drinking water for 30 days and a purified AIN-93M diet) for genomic mouse lung expression patterns. Mouse lungs were analyzed for inorganic arsenic, monomethylated, and dimethylated arsenicals by hydride generation atomic absorption spectroscopy. The total lung mean arsenical levels were 1.4, 22.5, 30.1, 50.9, 105.3, and 316.4 ng/g lung tissue after 0, 0.05, 0.25, 1, 10, and 85 ppm, respectively. At 85 ppm, the total mean lung arsenical levels increased 14-fold and 131-fold when compared to either the lowest noncontrol dose (0.05 ppm) or the control dose, respectively. We found that arsenic exposure elicited minimal numbers of differentially expressed genes (DEGs; 77, 38, 90, 87, and 87 DEGs) after 0.05, 0.25, 1, 10, and 85 ppm, respectively, which were associated with cardiovascular disease, development, differentiation, apoptosis, proliferation, and stress response. After 30 days of arsenite exposure, this study showed monotonic increases in mouse lung arsenical (total arsenic and dimethylarsinic acid) concentrations but no clear dose-related increases in DEG numbers.

  10. Kansas City Cardiomyopathy Questionnaire Utility in Prediction of 30-Day Readmission Rate in Patients with Chronic Heart Failure

    PubMed Central

    Gui, Junhong; Zhu, Xiang; Malhotra, Divyanshu; Li, Shenjing; Virkram, Fnu; Chada, Aditya; Jiang, Haibing

    2016-01-01

    Background. Heart failure (HF) is one of the most common diagnoses associated with hospital readmission. We designed this prospective study to evaluate whether Kansas City Cardiomyopathy Questionnaire (KCCQ) score is associated with 30-day readmission in patients hospitalized with decompensated HF. Methods and Results. We enrolled 240 patients who met the study criteria. Forty-eight (20%) patients were readmitted for decompensated HF within thirty days of hospital discharge, and 192 (80%) patients were not readmitted. Compared to readmitted patients, nonreadmitted patients had a higher average KCCQ score (40.8 versus 32.6, P = 0.019) before discharge. Multivariate analyses showed that a high KCCQ score was associated with low HF readmission rate (adjusted OR = 0.566, P = 0.022). The c-statistic for the base model (age + gender) was 0.617. The combination of home medication and lab tests on the base model resulted in an integrated discrimination improvement (IDI) increase of 3.9%. On that basis, the KCQQ further increased IDI of 2.7%. Conclusions. The KCCQ score determined before hospital discharge was significantly associated with 30-day readmission rate in patients with HF, which may provide a clinically useful measure and could significantly improve readmission prediction reliability when combined with other clinical components. PMID:27872790

  11. Psychometric Properties of 7- and 30-Day Versions of the PROMIS Emotional Distress Item Banks in an Australian Adult Sample.

    PubMed

    Batterham, Philip J; Sunderland, Matthew; Carragher, Natacha; Calear, Alison L

    2017-01-01

    This study aimed to examine the psychometric properties of the PROMIS depression, anxiety, and anger item banks in a large Australian population-based sample. The study tested for unidimensionality; evaluated invariance across age, gender, and education; assessed local independence; and tested item bank scores as an indicator for clinical criteria. In addition, equivalence of the 7-day time frame against an alternative 30-day time frame was assessed. A sample of 3,175 Australian adults were recruited into the study through online advertising. All three item banks showed strong evidence of unidimensionality and parsimony, with no items showing local dependence. All items were invariant across age, gender, and education. The item banks were accurate in detecting clinical criteria for major depressive disorder, generalized anxiety disorder, and panic disorder, although legacy measures designed for this purpose sometimes performed marginally better. Responses to the 30-day time frame were highly consistent with the original 7-day time frame. The study provided support for the validity of the PROMIS emotional distress item banks as measures of depression, anxiety, and anger in the Australian population, supporting the generalizability of the measures. The time frame chosen for assessing mental health outcomes using these item banks should be based on pragmatic considerations.

  12. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.

    PubMed

    de Kraker, Marlieke E A; Wolkewitz, Martin; Davey, Peter G; Koller, Walter; Berger, Jutta; Nagler, Jan; Icket, Claudine; Kalenic, Smilja; Horvatic, Jasminka; Seifert, Harald; Kaasch, Achim J; Paniara, Olga; Argyropoulou, Athina; Bompola, Maria; Smyth, Edmond; Skally, Mairead; Raglio, Annibale; Dumpis, Uga; Kelmere, Agita Melbarde; Borg, Michael; Xuereb, Deborah; Ghita, Mihaela C; Noble, Michelle; Kolman, Jana; Grabljevec, Stanko; Turner, David; Lansbury, Louise; Grundmann, Hajo

    2011-04-01

    Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.

  13. Mortality, Length of Stay, and Inpatient Charges for Heart Failure Patients at Public versus Private Hospitals in South Korea

    PubMed Central

    Kim, Sun Jung; Park, Eun-Cheol; Kim, Tae Hyun; Yoo, Ji Won

    2015-01-01

    Purpose This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. Materials and Methods We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. Results The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. Conclusion We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending. PMID:25837196

  14. Central Venous Pressure After Coronary Artery Bypass Surgery: Does it Predict Postoperative Mortality or Renal Failure?

    PubMed Central

    Williams, Judson B.; Peterson, Eric D.; Wojdyla, Daniel; Ferguson, T. Bruce; Smith, Peter K.; Milano, Carmelo A.; Lopes, Renato D.

    2015-01-01

    Background While hemodynamic monitoring is often performed following coronary artery bypass grafting (CABG), the relationship between postoperative central venous pressure (CVP) measurement and clinical outcomes is unknown. Methods Detailed clinical data were analyzed from 2,390 randomly selected patients undergoing high risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database from 2004 to 2005. Eligible patients underwent elective/urgent isolated CABG with an ejection fraction < 40%, or elective/urgent CABG at age ≥65 years with diabetes or a glomerular filtration rate 60 mL/min per 1.73 m2. Correlation between post-operative CVP and in-hospital / 30-day mortality and renal failure was assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling. Results Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients’ CVP 6 hours post-operation was strongly associated with in-hospital and 30 day mortality: odds ratio (OR) 1.5 (95% confidence interval [CI] 1.23, 1.87) for every 5 mmHg increase in CVP, p<0.0001. This association remained significant after risk-adjustment for cardiac index: adjusted OR 1.44 (95% CI 1.10, 1.89), p<0.01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR 1.5 (95% CI 1.28, 1.86) for every 5 mmHg increase in CVP, p<0.0001. Conclusion Patients’ central venous pressure at 6 hours following CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether post-operative CVP can be used to guide intervention and improve outcomes. PMID:25035048

  15. [Effect of 30-day space flight and subsequent readaptation on the signaling processes in m. longissimus dorsi of mice].

    PubMed

    Mirzoev, T M; Vil'chinskaia, N A; Lomonosova, Iu N; Nemirovskaia, T L; Shenkman, B S

    2014-01-01

    Some steps of anabolic and catabolic signaling pathways were investigated in postural/tonic m. longissimus dorsi of mice following the 30-day orbital flight of biosatellite "Bion-M1" and 8-day recovery. Western blotting was used for determining insulin receptor substrate 1 (IRS-1) and AMR-activated protein kinase (AMPK) involved in reciprocal regulation of anabolic and catabolic pathways, as well as E3-ligase MURF-1, and elongation factor eEF2. Functioning of the IGF-1-dependent IRS-1 signaling pathway was activated in the recovery period only. Though the content of ubiquitinligase MURF-1 showed an increase after flight, on completion of the recovery period it did not exceed the pre-flight level unambiguously.

  16. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    PubMed

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families.

  17. Effect of a 30-day isolation stress on calcium, phosphorus and other excretory products in an unrestrained chimpanzee.

    NASA Technical Reports Server (NTRS)

    Sabbot, I. M.; Mcnew, J. J.; Hoshizaki, T.; Sedgwick, C. J.; Adey, W. R.

    1972-01-01

    An unrestrained chimpanzee was studied in an isolation chamber and in his home cage environment. The study consisted of 49 urine collection days (14 days pre-, 5 days post- and 30 days of isolation), and then of 10 days in the home cage. Dietary intake, urine and fecal data were obtained. The effect of isolation on various excretory parameters was studied. Urine samples were analyzed for volume, osmolarity, creatinine, creatine, urea-N, 17-hydroxy corticosteroids, VMA, calcium and inorganic phosphorus. One way analyses of variance performed on the urinary excretion parameters showed all except creatinine excretion to vary significantly during periods of the study. The changes observed in calcium and phosphorus were highly significant. The data suggests that the calcium to phosphorus excretion ratio might serve as a physiological stress indicator of Selye's adaptation syndrome (period of resistance).

  18. Community Level Association between Home Health and Nursing Home Performance on Quality and Hospital 30-day Readmissions for Medicare Patients.

    PubMed

    Wang, Yun; Pandolfi, Michelle M; Fine, Jonathan; Metersky, Mark L; Wang, Changqin; Ho, Shih-Yieh; Galusha, Deron; Nuti, Sudhakar V; Murugiah, Karthik; Spenard, Ann; Elwell, Timothy; Krumholz, Harlan M

    2016-11-01

    We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients used data from the Centers for Medicare & Medicaid Service from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zipcodes. Based on a mixed effect model, we found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases of 0.25% (95% CI 0.17-0.34) and 0.60% (95% CI 0.33-0.83), respectively, in community-level risk-standardized readmission rates.

  19. Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

    PubMed Central

    Blunt, Ian; Bardsley, Martin; Grove, Amy; Clarke, Aileen

    2015-01-01

    Background Many health systems across the globe have introduced arrangements to deny payment for patients readmitted to hospital as an emergency. The purpose of this study was to develop an exploratory categorisation based on likely causes of readmission, and then to assess the prevalence of these different types. Methods Retrospective analysis of 82 million routinely collected National Health Service hospital records in England (2004–2010) was undertaken using anonymised linkage of records at person-level. Numbers of 30-day readmissions were calculated. Exploratory categorisation of readmissions was applied using simple rules relating to International Classification of Diseases (ICD) diagnostic codes for both admission and readmission. Results There were 5 804 472 emergency 30-day readmissions over a 6-year period, equivalent to 7.0% of hospital discharges. Readmissions were grouped into hierarchically exclusive categories: potentially preventable readmission (1 739 519 (30.0% of readmissions)); anticipated but unpredictable readmission (patients with chronic disease or likely to need long-term care; 1 141 987 (19.7%)); preference-related readmission (53 718 (0.9%)); artefact of data collection (16 062 (0.3%)); readmission as a result of accident, coincidence or related to a different body system (1 101 818 (19.0%)); broadly related readmission (readmission related to the same body system (1 751 368 (30.2%)). Conclusions In this exploratory categorisation, a large minority of emergency readmissions (eg, those that are potentially preventable or due to data artefacts) fell into groups potentially amenable to immediate reduction. For other categories, a hospital's ability to reduce emergency readmission is less clear. Reduction strategies and payment incentives must be carefully tailored to achieve stated aims. PMID:24668396

  20. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    NASA Astrophysics Data System (ADS)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  1. Effect of 30-day orbital flight BION M1 on excretion of expired endogenous CO in mice

    NASA Astrophysics Data System (ADS)

    Shulagin, Yury; Tatarkin, Sergey; Dyachenko, Alexander

    It is known that increased destruction of hem structures is accompanied by increase of the endogenous carbon monoxide excretion rate with respiration (VCO). Changes VCO preceded the observed changes in the blood composition [D’yachenko A. et al., 2010]. Changes in blood composition, i.e. rise of red blood cells content and reduction of reticulocytes content was detected after a 12-day orbital flight (OF) in mice C57BL/6 [Gridley D.et al., 2003]. The purpose of this study was to investigate the effect of 30-day OF on excretion of endogenous CO. The method and apparatus for simultaneous measurement of VCO, and O2 and CO2 exchange were developed. The research consisted of three parts: 1). Measurement of VCO in five C57BL/6 mice after 30-day OF on the Russian satellite BION M1. 2). Measurement of VCO in six C57BL/6 mice after 30-day ground-based experiment (GBE) with simulated flight telemetry environment of BION M1. 3). Measurement of VCO in seven C57BL/6 mice in vivarium The results: Mice weight after OF was 24.3+-3.3 (mean +-SD) with minimal weight 18.1 g, and maximal weight 29.9 g. Vivarium mice weight was 27.0+-1.8 g. KGE mice weight was 25.0+-1.3 g. Mice age in all three groups was the same. We measured and estimated VCO and total CO excretion (MCO) for two gas mixtures ventilated mouse camera: atmospheric CO-contained air and then CO-free air(30 min). The results showed that the average MCO allocated GBE and vivarium mice did not significantly differ. Average MCO in mice after OF was significantly higher then in vivarium group (T=-2,74; p=0.02). MCO after GBE was between the vivarium and OF groups. MCO in OF and KGE groups did not differ ( T=-1,93; p=0,085). Blood tests in mice after OF was not carried out, because the recovery after the OF was studied in this group. The largest excretion of CO was observed in a mouse N39 after the OF. The weight of this mouse was only 18.1 g, i.e. much less than mean weight. Increase of VCO in food-restricted animal is known

  2. Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review

    PubMed Central

    Zhou, Huaqiong; Della, Phillip R; Roberts, Pamela; Goh, Louise; Dhaliwal, Satvinder S

    2016-01-01

    Objective To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design Systematic review. Setting/data source CINAHL, Embase, MEDLINE from 2011 to 2015. Participants All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions. Conclusions The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative

  3. Immunohistochemical study of motoneurons in lumbar spinal cord of c57black/6 mice after 30-days space flight

    NASA Astrophysics Data System (ADS)

    Tyapkina, Oksana; Islamov, Rustem; Nurullin, Leniz; Petrov, Konstantin.; Rezvyakov, Pavel; Nikolsky, Evgeny

    To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported

  4. Effects of 30 day simulated microgravity and recovery on fluid homeostasis and renal function in the rat

    NASA Technical Reports Server (NTRS)

    Tucker, Bryan J.; Mendonca, Margarida M.

    1995-01-01

    Transition from a normal gravitational environment to that of microgravity eventually results in decreased plasma and blood volumes, increasing with duration of exposure to microgravity. This loss of vascular fluid is presumably due to negative fluid and electrolyte balance and most likely contributes to the orthostatic intolerance associated with the return to gravity. The decrease in plasma volume is presumed to be a reflection of a concurrent decrease in extracellular fluid volume with maintenance of normal plasma-interstitial fluid balance. In addition, the specific alterations in renal function contributing to these changes in fluid and electrolyte homeostasis are potentially responding to neuro-humoral signals that are not consistent with systemic fluid volume status. We have previously demonstrated an early increase in both glomerular filtration rate and extracellular fluid volume and that this decreases towards control values by 7 days of simulated microgravity. However, longer duration studies relating these changes to plasma volume alterations and the response to return to orthostasis have not been fully addressed. Male Wistar rats were chronically cannulated, submitted to 30 days heat-down tilt (HDT) and followed for 7 days after return to orthostasis from HDT. Measurements of renal function and extracellular and blood volumes were performed in the awake rat.

  5. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect

    PubMed Central

    Kozak, Marcelo Felipe; Kozak, Ana Carolina Leiroz Ferreira Botelho Maisano; Marchi, Carlos Henrique De; Hassem Sobrinho Junior, Sirio; Croti, Ulisses Alexandre; Moscardini, Airton Camacho

    2015-01-01

    Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of surgical repair of complete atrioventricular septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger presenting with complete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down syndrome. At the time of preoperative evaluation, there were 26 cases with moderate or severe left atrioventricular valve regurgitation (49.1%). Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or severe left atrioventricular valve regurgitation (39.6%). After performing a multivariate analysis, the only significant factor associated with moderate or severe left atrioventricular valve regurgitation was the absence of Down syndrome (P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect at our practice. PMID:26313720

  6. Increased in vivo glucose utilization in 30-day-old obese Zucker rat: Role of white adipose tissue

    SciTech Connect

    Krief, S.; Bazin, R.; Dupuy, F.; Lavau, M. )

    1988-03-01

    In vivo whole-body glucose utilization and uptake in multiple individual tissues were investigated in conscious 30-day-old Zucker rats, which when obese are hyperphagic, hyperinsulinemic, and normoglycemic. Whole-body glucose metabolism (assessed by (3-{sup 3}H)glucose) was 40% higher in obese (fa/fa) than in lean (Fa/fa) rats, suggesting that obese rats were quite responsive to their hyperinsulinemia. In obese compared with lean rats, tissue glucose uptake was increased by 15, 12, and 6 times in dorsal, inguinal, perigonadal white depots, respectively; multiplied by 2.5 in brown adipose tissue; increased by 50% in skin from inguinal region but not in that from cranial, thoracic, or dorsal area; and increased twofold in diaphragm but similar in heart in proximal intestine, and in total muscular mass of limbs. The data establish that in young obese rats the hypertrophied white adipose tissue was a major glucose-utilizing tissue whose capacity for glucose disposal compared with that of half the muscular mass. Adipose tissue could therefore play an important role in the homeostasis of glucose in obese rats in the face of their increased carbohydrate intake.

  7. Human performance profiles for planetary analog extra-vehicular activities: 120 day and 30 day analog missions

    NASA Astrophysics Data System (ADS)

    Swarmer, Tiffany M.

    Understanding performance factors for future planetary missions is critical for ensuring safe and successful planetary extra-vehicular activities (EVAs). The goal of this study was to gain operational knowledge of analog EVAs and develop biometric profiles for specific EVA types. Data was collected for a 120 and 30 day analog planetary exploration simulation focusing on EVA type, pre and post EVA conditions, and performance ratings. From this five main types of EVAs were performed: maintenance, science, survey/exploratory, public relations, and emergency. Each EVA type has unique characteristics and performance ratings showing specific factors in chronological components, environmental conditions, and EVA systems that have an impact on performance. Pre and post biometrics were collected to heart rate, blood pressure, and SpO2. Additional data about issues and specific EVA difficulties provide some EVA trends illustrating how tasks and suit comfort can negatively affect performance ratings. Performance decreases were noted for 1st quarter and 3rd quarter EVAs, survey/exploratory type EVAs, and EVAs requiring increased fine and gross motor function. Stress during the simulation is typically higher before the EVA and decreases once the crew has returned to the habitat. Stress also decreases as the simulation nears the end with the 3rd and 4th quarters showing a decrease in stress levels. Operational components and studies have numerous variable and components that effect overall performance, by increasing the knowledge available we may be able to better prepare future crews for the extreme environments and exploration of another planet.

  8. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks.

    PubMed

    Schulte, Laura H; May, Arne

    2016-07-01

    Functional imaging using positron emission tomography and later functional magnetic resonance imaging revealed a particular brainstem area that is believed to be specifically activated in migraine during, but not outside of the attack, and consequently has been coined the 'migraine generator'. However, the pathophysiological concept behind this term is not undisputed and typical migraine premonitory symptoms such as fatigue and yawning, but also a typical association of attacks to circadian and menstrual cycles, all make the hypothalamus a possible regulating region of migraine attacks. Neuroimaging studies investigating native human migraine attacks however are scarce and for methodological but also clinical reasons there are currently no studies investigating the last 24 h before headache onset. Here we report a migraine patient who had magnetic resonance imaging every day for 30 days, always in the morning, to cover, using functional imaging, a whole month and three complete, untreated migraine attacks. We found that hypothalamic activity as a response to trigeminal nociceptive stimulation is altered during the 24 h prior to pain onset, i.e. increases towards the next migraine attack. More importantly, the hypothalamus shows altered functional coupling with the spinal trigeminal nuclei and the region of the migraine generator, i.e. the dorsal rostral pons during the preictal day and the pain phase of native human migraine attacks. These data suggest that although the brainstem is highly linked to the migraine biology, the real driver of attacks might be the functional changes in hypothalamo-brainstem connectivity.

  9. Gene Expression Profiling in Slow-Type Calf Soleus Muscle of 30 Days Space-Flown Mice.

    PubMed

    Gambara, Guido; Salanova, Michele; Ciciliot, Stefano; Furlan, Sandra; Gutsmann, Martina; Schiffl, Gudrun; Ungethuem, Ute; Volpe, Pompeo; Gunga, Hanns-Christian; Blottner, Dieter

    2017-01-01

    Microgravity exposure as well as chronic disuse are two main causes of skeletal muscle atrophy in animals and humans. The antigravity calf soleus is a reference postural muscle to investigate the mechanism of disuse-induced maladaptation and plasticity of human and rodent (rats or mice) skeletal musculature. Here, we report microgravity-induced global gene expression changes in space-flown mouse skeletal muscle and the identification of yet unknown disuse susceptible transcripts found in soleus (a mainly slow phenotype) but not in extensor digitorum longus (a mainly fast phenotype dorsiflexor as functional counterpart to soleus). Adult C57Bl/N6 male mice (n = 5) flew aboard a biosatellite for 30 days on orbit (BION-M1 mission, 2013), a sex and age-matched cohort were housed in standard vivarium cages (n = 5), or in a replicate flight habitat as ground control (n = 5). Next to disuse atrophy signs (reduced size and myofiber phenotype I to II type shift) as much as 680 differentially expressed genes were found in the space-flown soleus, and only 72 in extensor digitorum longus (only 24 genes in common) compared to ground controls. Altered expression of gene transcripts matched key biological processes (contractile machinery, calcium homeostasis, muscle development, cell metabolism, inflammatory and oxidative stress response). Some transcripts (Fzd9, Casq2, Kcnma1, Ppara, Myf6) were further validated by quantitative real-time PCR (qRT-PCR). Besides previous reports on other leg muscle types we put forth for the first time a complete set of microgravity susceptible gene transcripts in soleus of mice as promising new biomarkers or targets for optimization of physical countermeasures and rehabilitation protocols to overcome disuse atrophy conditions in different clinical settings, rehabilitation and spaceflight.

  10. Gene Expression Profiling in Slow-Type Calf Soleus Muscle of 30 Days Space-Flown Mice

    PubMed Central

    Gambara, Guido; Salanova, Michele; Ciciliot, Stefano; Furlan, Sandra; Gutsmann, Martina; Schiffl, Gudrun; Ungethuem, Ute; Volpe, Pompeo; Gunga, Hanns-Christian; Blottner, Dieter

    2017-01-01

    Microgravity exposure as well as chronic disuse are two main causes of skeletal muscle atrophy in animals and humans. The antigravity calf soleus is a reference postural muscle to investigate the mechanism of disuse-induced maladaptation and plasticity of human and rodent (rats or mice) skeletal musculature. Here, we report microgravity-induced global gene expression changes in space-flown mouse skeletal muscle and the identification of yet unknown disuse susceptible transcripts found in soleus (a mainly slow phenotype) but not in extensor digitorum longus (a mainly fast phenotype dorsiflexor as functional counterpart to soleus). Adult C57Bl/N6 male mice (n = 5) flew aboard a biosatellite for 30 days on orbit (BION-M1 mission, 2013), a sex and age-matched cohort were housed in standard vivarium cages (n = 5), or in a replicate flight habitat as ground control (n = 5). Next to disuse atrophy signs (reduced size and myofiber phenotype I to II type shift) as much as 680 differentially expressed genes were found in the space-flown soleus, and only 72 in extensor digitorum longus (only 24 genes in common) compared to ground controls. Altered expression of gene transcripts matched key biological processes (contractile machinery, calcium homeostasis, muscle development, cell metabolism, inflammatory and oxidative stress response). Some transcripts (Fzd9, Casq2, Kcnma1, Ppara, Myf6) were further validated by quantitative real-time PCR (qRT-PCR). Besides previous reports on other leg muscle types we put forth for the first time a complete set of microgravity susceptible gene transcripts in soleus of mice as promising new biomarkers or targets for optimization of physical countermeasures and rehabilitation protocols to overcome disuse atrophy conditions in different clinical settings, rehabilitation and spaceflight. PMID:28076365

  11. The statistical extended-range (10-30-day) forecast of summer rainfall anomalies over the entire China

    NASA Astrophysics Data System (ADS)

    Zhu, Zhiwei; Li, Tim

    2017-01-01

    The extended-range (10-30-day) rainfall forecast over the entire China was carried out using spatial-temporal projection models (STPMs). Using a rotated empirical orthogonal function analysis of intraseasonal (10-80-day) rainfall anomalies, China is divided into ten sub-regions. Different predictability sources were selected for each of the ten regions. The forecast skills are ranked for each region. Based on temporal correlation coefficient (TCC) and Gerrity skill score, useful skills are found for most parts of China at a 20-25-day lead. The southern China and the mid-lower reaches of Yangtze River Valley show the highest predictive skills, whereas southwestern China and Huang-Huai region have the lowest predictive skills. By combining forecast results from ten regional STPMs, the TCC distribution of 8-year (2003-2010) independent forecast for the entire China is investigated. The combined forecast results from ten STPMs show significantly higher skills than the forecast with just one single STPM for the entire China. Independent forecast examples of summer rainfall anomalies around the period of Beijing Olympic Games in 2008 and Shanghai World Expo in 2010 are presented. The result shows that the current model is able to reproduce the gross pattern of the summer intraseasonal rainfall over China at a 20-day lead. The present study provides, for the first time, a guide on the statistical extended-range forecast of summer rainfall anomalies for the entire China. It is anticipated that the ideas and methods proposed here will facilitate the extended-range forecast in China.

  12. Clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease.

    PubMed

    Park, Jin Kyoung; Lee, Chang Hun; Kim, In Hee; Kim, Seon Min; Jang, Ji Won; Kim, Seong Hun; Kim, Sang Wook; Lee, Seung Ok; Lee, Soo Teik; Kim, Dae-Ghon

    2015-05-01

    Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na <135 mM/L, albumin <2.5 g/dL, C-reactive protein ≥20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P < 0.001) higher than those without infection (22.3% vs. 5.1% and 32.3% vs. 8.2%, respectively). Furthermore, bacterial infection (HR, 2.2; 95% CI, 1.049-4.579, P = 0.037), SIRS positivity (HR, 2.5; 95% CI, 1.240-4.861, P = 0.010), Maddrey's discriminant function score ≥32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.

  13. Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange

    PubMed Central

    Hao, Shiying; Wang, Yue; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Zheng, Le; Luo, Jin; Hu, Zhongkai; Fu, Changlin; Dai, Dorothy; Wang, Yicheng; Culver, Devore S.; Alfreds, Shaun T.; Rogow, Todd; Stearns, Frank; Sylvester, Karl G.; Widen, Eric; Ling, Xuefeng B.

    2015-01-01

    Objectives Identifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups. Methods Our objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients. Results A risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0–30), intermediate (score of 30–70) and high (score of 70–100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates. Conclusions The risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient’s risk of readmission score may be useful to providers

  14. 75 FR 77901 - 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-14

    ... National Park Service 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List and Potential Additions to the U.S. World Heritage Tentative List AGENCY: National Park... to comment on the next potential U.S. nominations from the U.S. World Heritage Tentative List to...

  15. The association of culling and death rate within 30 days after calving with productivity or reproductive performance in dairy herds in Fukuoka, Southern Japan

    PubMed Central

    GOTO, Akira; NAKADA, Ken; KATAMOTO, Hiromu

    2015-01-01

    The incidence of peripartum disorders in dairy herds negatively influences productivity and reproductive performance. Concrete data from local areas are helpful for explaining the importance of peripartum management to dairy farmers. This study was conducted to clarify the association of culling and death rate within 30 days after calving with productivity or reproductive performance in 179 dairy herds in Fukuoka, Southern Japan. A database was compiled from the records of the Livestock Improvement Association of Japan, the Dairy Cooperative Association and the Federation of Agricultural Mutual Relief Association. In this study, we created a comprehensive database of dairy farm production data for epidemiological analysis and used a general linear mixed model to analyze the association of culling and death rate within 30 days after calving with milk production or reproductive performance. The database can be used to describe, analyze and predict the risk of production. A cross-sectional analysis with contrasts was applied to investigate the association of cows served by AI/all cows, pregnant cows/cows served by AI, days open, milk yield and somatic cell counts with culling and death rate within 30 days after calving. The days open value significantly increased with increasing rate of culling and death within 30 days after calving (P for trend <0.001). No significant differences were found for the other comparisons. Our data suggest that proper feeding and management in the dry period may lead to improved postpartum reproductive performance in this dairy cow cohort. PMID:26666177

  16. 75 FR 55625 - 30-Day Notice of Proposed Information Collection: Form DS-1622, DS-1843, DS-1622P, and DS-1843P...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-13

    .... SUMMARY: The Department of State is seeking Office of Management and Budget (OMB) approval for the... Management and Budget (OMB) for up to 30 days from August 30, 2010. ADDRESSES: You may submit comments by any... maintain the health and fitness of the individual and family members within the Department of State...

  17. The AFFORD Clinical Decision Aid To Identify Emergency Department Patients With Atrial Fibrillation At Low Risk For 30-Day Adverse Events

    PubMed Central

    Barrett, Tyler W.; Storrow, Alan B.; Jenkins, Cathy A.; Abraham, Robert L.; Liu, Dandan; Miller, Karen F.; Moser, Kelly M.; Russ, Stephan; Roden, Dan M.; Harrell, Frank E.; Darbar, Dawood

    2015-01-01

    There is wide variation in the management of emergency department (ED) patients with atrial fibrillation (AF). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated, tertiary-care, ED. Patients were enrolled from June 9, 2010 to February 28, 2013 and followed for 30 days. We enrolled a convenience sample of ED patients presenting with symptomatic AF. Candidate predictors were based on ED data available in the first two hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We utilized an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients, respectively. The decision aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement); medical history (heart failure, home sotalol use, prior percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms); ED data (2 hour heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid’s c-statistic in predicting any 30-day adverse event was 0.7 (95% CI, 0.65, 0.76). In conclusion, among ED patients with AF, AFFORD provides the first evidence based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. PMID:25633190

  18. Tropical 40-50- and 25-30-day oscillations appearing in realistic and idealized GFDL climate models and the ECMWF dataset

    SciTech Connect

    Hayashi, Y.; Golder, D.G. )

    1993-02-01

    To clarify differences between the tropical 40-50- and 25-30-day oscillations and to evaluate simulations and various theories, space-time spectrum and filter analyses were performed on a nine-year dataset taken from the nine-level R30 spectral general circulation model and the nine-year (1979-1987) ECMWF four-dimensional analysis dataset. The 40-level SKYHI model was analyzed to examine the effect of increased vertical resolution, while an ocean-surface perpetual January R30 model was analyzed to examine the effects of the absence of geographical and seasonal variations. The R30 model results indicate that the relative amplitude of the wavenumber-one component of the 40-50- and 25-30-day oscillations varies greatly from year to year. The SKYHI model indicates that 25-30-day oscillations still appear too strong, although this model reveals a longer vertical wavelength, a higher penetration of the 25-30-day amplitude above the level of convective heating, and a slightly greater height of the convective-heating amplitude, which cannot be detected in the R30 model. The ocean-surface perpetual January R30 model indicates that not only the 25-30-day mode but also the 40-50-day mode can be simulated in the absence of geographical and seasonal modulations, while the wave-CISK and evaporation-wind feedback theories cannot explain the 40-50-day mode. Both R30 models indicate that daily precipitation is usuallys associated with upward motion. A comparison between the two R30 models suggests that the sea surface temperature geographically modules the intrinsically eastward-moving wavenumber-one precipitation oscillations, resulting in their major Pacific and minor Atlantic local amplitudes. This causes planetary-scale eastward-moving zonal-velocity oscillations and standing geopotential oscillations. 121 refs., 26 figs.

  19. Temporal Changes in Survival after Cardiac Surgery Are Associated with the Thirty-Day Mortality Benchmark

    PubMed Central

    Maxwell, Bryan G; Wong, Jim K; Miller, D Craig; Lobato, Robert L

    2014-01-01

    Objective To assess the hypothesis that postoperative survival exhibits heterogeneity associated with the timing of quality metrics. Data Sources Retrospective observational study using the Nationwide Inpatient Sample from 2005 through 2009. Study Design Survival analysis was performed on all admission records with a procedure code for major cardiac surgery (n = 595,089). The day-by-day hazard function for all-cause in-hospital mortality at 1-day intervals was analyzed using joinpoint regression (a data-driven method of testing for changes in hazard). Data Extraction Methods A comprehensive analysis of a publicly available national administrative database was performed. Principal Findings Statistically significant shifts in the pattern of postoperative mortality occurred at day 6 (95 percent CI = day 5–8) and day 30 (95 percent CI = day 20–35). Conclusions While the shift at day 6 plausibly can be attributed to the separation between routine recovery and a complicated postoperative course, the abrupt increase in mortality at day 30 has no clear organic etiology. This analysis raises the possibility that this observed shift may be related to clinician behavior because of the use of 30-day mortality as a quality metric, but further studies will be required to establish causality. PMID:24713085

  20. Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study

    PubMed Central

    Figueroa, Jose F; Tsugawa, Yusuke; Zheng, Jie; Orav, E John

    2016-01-01

    Objective To determine the impact of the Hospital Value-Based Purchasing (HVBP) program—the US pay for performance program introduced by Medicare to incentivize higher quality care—on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia. Design Observational study. Setting 4267 acute care hospitals in the United States: 2919 participated in the HVBP program and 1348 were ineligible and used as controls (44 in general hospitals in Maryland and 1304 critical access hospitals across the United States). Participants 2 430 618 patients admitted to US hospitals from 2008 through 2013. Main outcome measures 30 day risk adjusted mortality for acute myocardial infarction, heart failure, and pneumonia using a patient level linear spline analysis to examine the association between the introduction of the HVBP program and 30 day mortality. Non-incentivized, medical conditions were the comparators. A secondary outcome measure was to determine whether the introduction of the HVBP program was particularly beneficial for a subgroup of hospital—poor performers at baseline—that may benefit the most. Results Mortality rates of incentivized conditions in hospitals participating in the HVBP program declined at −0.13% for each quarter during the preintervention period and −0.03% point difference for each quarter during the post-intervention period. For non-HVBP hospitals, mortality rates declined at −0.14% point difference for each quarter during the preintervention period and −0.01% point difference for each quarter during the post-intervention period. The difference in the mortality trends between the two groups was small and non-significant (difference in difference in trends −0.03% point difference for each quarter, 95% confidence interval −0.08% to 0.13% point difference, P=0.35). In no subgroups of hospitals was HVBP associated with better outcomes, including poor performers at baseline

  1. Modeling of in hospital mortality determinants in myocardial infarction patients, with and without type 2 diabetes, undergoing pharmaco-invasive strategy: the first national report using two approaches in Iran.

    PubMed

    Ahmadi, Ali; Soori, Hamid; Sajjadi, Homeira

    2015-05-01

    This study was conducted to compare the characteristics of patients, with and without diabetes mellitus, presenting with myocardial infarction (MI) and treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or thrombolytic therapy. Factors related to mortality due to MI in Iran were also determined. This study was a prospective analysis. To analyze the data, Stata software (chi square, t test, Cox and logistic regression) was used. Participants were patients hospitalized for MI for the first time in 540 hospitals from April, 2012 to March, 2013. Out of 20,750 patients with MI, 461 2 (22.3%) had type 2 diabetes. MI case fatality rate was 13.22% (95%CI: 12.24-14.19) and 11.78% (95%CI: 11.28-12.27) in patients with and without diabetes, respectively. The rates of CABG, PCI, and thrombolytic therapy use were 4.2%, 8%, and 58% in patients with diabetes, and 2.1%, 6.5%, and 55% in patients without diabetes. The odds ratio of mortality for ST segment elevation myocardial infarction (STEMI) and chest pain resistant to treatment was, respectively, 6.3 and 2.8 in those with diabetes, and 3.9 and 3.7 in patients without diabetes. The hazard ratio of mortality for gender, education, smoking, left bundle branch block, PCI, and type of MI was different between the two groups (P<0.05). Characteristics of patients dying post MI were different in those with or without diabetes mellitus. Although use of CABG, PCI, and thrombolytic therapy was more frequent in patients with diabetes than without, mortality was higher in diabetes patients.

  2. Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older.

    PubMed

    Robinson, Robert

    2015-01-01

    Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan-Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30-4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03-1.38]) to be significant independent

  3. Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older

    PubMed Central

    2015-01-01

    Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan–Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30–4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03–1.38]) to be significant independent

  4. The impact of documentation of severe acute kidney injury on mortality

    PubMed Central

    Wilson, Francis Perry; Bansal, Amar D.; Jasti, Sravan K.; Lin, Jennie J.; Shashaty, Michael G.S.; Berns, Jeffrey S.; Feldman, Harold I; Fuchs, Barry D.

    2013-01-01

    Aims: Modification of the mortality risk associated with acute kidney injury (AKI) necessitates recognition of AKI when it occurs. We sought to determine whether formal documentation of AKI in the medical record, assessed by billing codes for AKI, would be associated with improved clinical outcomes. Methods: Retrospective cohort study conducted at three hospitals within a single university health system. Adults without severe underlying kidney disease who suffered in-hospital AKI as defined by a doubling of baseline creatinine (n = 5,438) were included. Those whose AKI was formally documented according to discharge billing codes were compared to those without such documentation in terms of 30-day mortality. Results: Formal documentation of AKI occurred in 2,325 patients (43%). Higher baseline creatinine, higher peak creatinine, medical admission status, and higher Sequential Organ Failure Assessment (SOFA) score were strongly associated with documentation of AKI. After adjustment for severity of disease, formal AKI documentation was associated with reduced 30-day mortality – OR 0.81 (0.68 – 0.96, p = 0.02). Patients with formal documentation were more likely to receive a nephrology consultation (31% vs. 6%, p < 0.001) and fluid boluses (64% vs. 45%, p < 0.001), and had a more rapid discontinuation of angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker medications (HR 2.04, CI 1.69 – 2.46, p < 0.001). Conclusions: Formal documentation of AKI is associated with improved survival after adjustment for illness severity among patients with creatinine-defined AKI. PMID:24075024

  5. Decompressive craniectomy for malignant middle cerebral artery infarction: Impact on mortality and functional outcome

    PubMed Central

    Raffiq, Mohammad Azman Mohammed; Haspani, Mohammed Saffari Mohammad; Kandasamy, Regunath; Abdullah, Jafri Malin

    2014-01-01

    Background: Malignant middle cerebral artery (MCA) infarction is a devastating clinical entity affecting about 10% of stroke patients. Decompressive craniectomy has been found to reduce mortality rates and improve outcome in patients. Methods: A retrospective case review study was conducted to compare patients treated with medical therapy and decompressive surgery for malignant MCA infarction in Hospital Kuala Lumpur over a period of 5 years (from January 2007 to December 2012). A total of 125 patients were included in this study; 90 (72%) patients were treated with surgery, while 35 (28%) patients were treated with medical therapy. Outcome was assessed in terms of mortality rate at 30 days, Glasgow Outcome Score (GOS) on discharge, and modified Rankin scale (mRS) at 3 and 6 months. Results: Decompressive craniectomy resulted in a significant reduction in mortality rate at 30 days (P < 0.05) and favorable GOS outcome at discharge (P < 0.05). Good functional outcome based on mRS was seen in 48.9% of patients at 3 months and in 64.4% of patients at 6 months (P < 0.05). Factors associated with good outcome include infarct volume of less than 250 ml, midline shift of less than 10 mm, absence of additional vascular territory involvement, good preoperative Glasgow Coma Scale (GCS) score, and early surgical intervention (within 24 h) (P < 0.05). Age and dominant hemisphere infarction had no significant association with functional outcome. Conclusion: Decompressive craniectomy achieves good functional outcome in, young patients with good preoperative GCS score and favorable radiological findings treated with surgery within 24 h of ictus. PMID:25101197

  6. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

    PubMed Central

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna

    2017-01-01

    Objectives The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. PMID:28182162

  7. Influence of second- and third-degree heart block on 30-day outcome following acute myocardial infarction in the drug-eluting stent era.

    PubMed

    Kim, Hack-Lyoung; Kim, Sang-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Zo, Joo-Hee; Kim, Myung-A; Park, Kyung-Woo; Koo, Bon-Kwon; Kim, Hyo-Soo; Chae, In-Ho; Choi, Dong-Ju; Cho, Myeong-Chan; Kim, Young-Jo; Kim, Ju Han; Ahn, Youngkeun; Jeong, Myung Ho

    2014-12-01

    This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block.

  8. In vitro study of 24-hour and 30-day shear bond strengths of three resin-glass ionomer cements used to bond orthodontic brackets.

    PubMed

    Lippitz, S J; Staley, R N; Jakobsen, J R

    1998-06-01

    Interest in using composite resin-glass ionomer hybrid cements as orthodontic bracket adhesives has grown because of their potential for fluoride release. The purpose of this pilot study was to compare shear bond strengths of three resin-glass ionomer cements (Advance, Fuji Duet, Fuji Ortho LC) used as bracket adhesives with a composite resin 24 hours and 30 days after bonding. The amount of adhesive remaining on the debonded enamel surface was scored for each adhesive. Mesh-backed stainless-steel brackets were bonded to 100 extracted human premolars, which were stored in artificial saliva at 37 degrees C until being tested to failure in a testing machine. The hybrid cements, with one exception, had bond strengths similar to those of the composite resin at 24 hours and 30 days. Fuji Ortho LC had significantly lower bond strengths (ANOVA p < or = 0.05) than the other adhesives at 24 hours and 30 days when it was bonded to unetched, water-moistened enamel. Adhesive-remnant scores were similar for all cements, except for cement Fuji Ortho LC when it was bonded to unetched enamel. The resin-glass ionomer cements we tested appear to have bond strengths suitable for routine use as orthodontic bracket-bonding adhesives.

  9. The age estimation of blood stains up to 30 days old using visible wavelength hyperspectral image analysis and linear discriminant analysis.

    PubMed

    Li, Bo; Beveridge, Peter; O'Hare, William T; Islam, Meez

    2013-09-01

    A novel application of visible wavelength hyperspectral image analysis has been applied to determine the age of blood stains up to 30 days old. Reflectance spectra from selected locations within the hyperspectral image, obtained from a portable instrument, were subjected to spectral pre-processing. This was followed by the application of a linear discriminant classification model, making estimations possible with an average error of ±0.27days for the first 7 days and an overall average error of ±1.17days up to 30 days. This is also the first reported study of the determination of the age of fresh blood stains (less than one day old) with an error of ±0.09h. The studies have been made under controlled conditions and represent, at this stage, proof of concept results but also are the most accurate age estimation results for measurements between 0 and 30 days reported to date. The results are consistent with well-established kinetic processes suggesting that the pre-processing stages described are revealing spectroscopic changes which are reliably following the time dependent oxidation of HbO2. The potential for parameterisation of environmental factors to make the method generally applicable at crime scenes is discussed, along with the developments required to further improve classification and to make the instrument genuinely portable.

  10. The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

    PubMed Central

    Hudali, Tamer

    2017-01-01

    Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Validated risk assessment tools such as the HOSPITAL score and LACE index have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. This study aims to evaluate the utility of HOSPITAL score and LACE index for predicting hospital readmission within 30 days in a moderate-sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients who underwent one or more ICD-10 defined procedures discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC) from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score and LACE index were a significant predictors of hospital readmission within 30 days. Results During the study period, 463 discharges were recorded for the hospitalist service. The analysis includes data for the 432 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 35 (8%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.75 (95% CI [0.67–0.83]), indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.069, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 3.71 with a p value of 0.59. A receiver operating characteristic evaluation of the LACE index for this patient population shows a C statistic of 0.58 (95% CI [0.48–0.68]), indicating poor discrimination for hospital readmission. The Brier score for the LACE index in this setting was 0.082, indicating good overall performance

  11. [Causal analysis and management strategies of 30-day unplanned revision surgery following single-stage posterior vertebral column resection for severe spinal deformity].

    PubMed

    Tao, Y P; Wu, J G; Ma, H S; Shao, S L; Zhang, L L; Gao, B; Li, H X

    2017-03-01

    Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306(th) Hospital of People's Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients' neurological status improved from Frankel D to Frankel E, one patient's neurological status improved from Frankel C to Frankel E. Conclusions: One

  12. Clinical Profiles Related to Timing of Death, Including In-Hospital Deaths Before Admission, in Patients With ST-Elevation Myocardial Infarction.

    PubMed

    Bogaty, Peter; L'Allier, Philippe L; Segal, Eli; Rinfret, Stéphane; Racine, Normand; Harvey, Richard; Ross, Dave; Maire, Sébastien; Kouz, Simon; Carroll, Céline; Boothroyd, Lucy J; Kezouh, Abbas; Azzi, Leila; Brown, Kevin A; Nasmith, James; Lambert, Laurie J

    2016-02-01

    Patients with ST-elevation myocardial infarction (STEMI) who die in hospital before inpatient admission are generally not included in clinical studies and registries, and the clinical profiles of patients who die earlier versus later are not well defined. We aimed to characterize all patients with STEMI who arrived at emergency departments in the province of Quebec (Canada) based on inpatient admission status and when they died. All patients who presented with symptoms and core laboratory-confirmed STEMI or left bundle branch block during 6 months in 82 hospitals in Quebec were included. Death certificates were used to identify nonadmitted deaths. Of the 2017 patients with STEMI, 340 (16.9%) died within 1 year. Of the latter, 63 (18.5%) were nonadmitted deaths (group A), 179 (52.6%) were deaths after admission but within 30 days (group B), and 98 (28.8%) were deaths after 30 days to 1 year (group C). Group A was younger and most often hemodynamically unstable, followed for both features by B then C. Earliest presentation from symptom onset and most frequent ambulance use were found in group A, followed by B, then C. Presenting electrocardiogram (ECG) features were most severe in A, then B, then C (more arrhythmias, more anterior STEMI, more leads with ST elevation, and higher ST elevation). Patients who died earliest had the least frequency of previous myocardial infarction, coronary revascularization, vascular disease, and heart failure, and the least noncardiac co-morbidity. In conclusion, patients with STEMI dying in hospital before inpatient admission contributed substantially to overall STEMI mortality. Although dying patients who presented earlier had severer presenting clinical profiles, they were paradoxically younger and had less co-morbidity. Previous co-morbidities may favor adaptive protective mechanisms on initial presentation with STEMI.

  13. An invasive strategy is associated with decreased mortality in patients with unstable angina and non-ST-elevation myocardial infarction: GUSTO IIb trial.

    PubMed

    Cho, Leslie; Bhatt, Deepak L; Marso, Steve P; Brennan, Danielle; Holmes, David R; Califf, Robert M; Topol, Eric J

    2003-02-01

    There has been much debate concerning an invasive versus a conservative strategy for patients with acute coronary syndromes. The purpose of this study was to determine whether early in-hospital catheterization reduced mortality in patients with unstable angina and non-ST-elevation myocardial infarction. We performed a retrospective analysis of data collected in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial, which compared hirudin and heparin in patients with acute coronary syndromes. We identified 8011 patients with non-ST-segment elevation myocardial infarction and unstable angina who were enrolled in the trial. The primary endpoints were all-cause mortality at 30 days and 1 year. Data were analyzed with multivariate hazards models and propensity scores.After accounting for inception time bias, there were 7897 patients identified, of whom 4536 patients (57%) underwent invasive therapy and 3361 (43%) underwent conservative therapy. Adjusting for propensity scores, the adjusted 30-day mortality for the invasive group was 2.5% compared with 2.7% in the conservative group (P = 0.92); at 1 year, the invasive group had a 6.2% mortality, versus 8.6% in the conservative group (P = 0.005). In a multivariate analysis that adjusted for other clinical factors, an invasive strategy was associated with lower 1-year mortality (hazard ratio = 0.46; 95% confidence interval: 0.10 to 0.84). In patients presenting with acute coronary syndromes, an invasive strategy is associated with improved survival at 1 year even after adjusting for baseline differences.

  14. Effectiveness of using thyrocalcitonin for the prevention of a calcium metabolic disorder in the mineralized tissues of rabbits with 30 days hypokinesia

    NASA Technical Reports Server (NTRS)

    Volozhin, A. I.; Shashkov, V. S.; Dmitriyev, B. S.; Yegorov, B. B.; Lobachik, V. I.; Brishin, A. I.

    1980-01-01

    A 30 day hypokinesia in rabbits led to a considerable lag in weight gain for the skeletal bones, reduction in Ca45 uptake, and an increase in isotope resorption rate in the rapidly metabolized fraction of extremity bones. On the other hand, Ca45 content in the teeth and maxillae increased, which may be explained by redistribution of isotope among the various mineralized tissues. Injection of thyrocalcitonin (50 IU/day) produced a distinct normalizing effect on Ca45 uptake and resorption in the mineralized tissues of rabbits kept hypokinetic.

  15. Life sciences payload definition and integration study. Volume 4: Appendix, costs, and data management requirements of the dedicated 30-day laboratory. [carry-on laboratory for Spacelab

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The results of the updated 30-day life sciences dedicated laboratory scheduling and costing activities are documented, and the 'low cost' methodology used to establish individual equipment item costs is explained in terms of its allowances for equipment that is commerical off-the-shelf, modified commercial, and laboratory prototype; a method which significantly lowers program costs. The costs generated include estimates for non-recurring development, recurring production, and recurring operations costs. A cost for a biomedical emphasis laboratory and a Delta cost to provide a bioscience and technology laboratory were also generated. All cost reported are commensurate with the design and schedule definitions available.

  16. [Infections in hospitalized patients with cirrhosis].

    PubMed

    Mathurin, Sebastián; Chapelet, Adrián; Spanevello, Valeria; Sayago, Gabriel; Balparda, Cecilia; Virga, Eliana; Beraudo, Nora; Bartolomeo, Mirta

    2009-01-01

    We evaluated the prevalence and the clinical relevance of bacterial and nonbacterial infections in predominantly alcoholic cirrhotic patients, admitted to an intermediate complexity hospital, and we also compared the clinical characteristics, laboratory and evolution of these patients with and without bacterial infection in a prospective study of cohort. A total of 211 consecutive admissions in 132 cirrhotic patients, between April 2004 and July 2007, were included. The mean age was 51.8 (+/-8) years, being 84.8% male. The alcoholic etiology of cirrhosis was present in 95.4%. One hundred and twenty nine episodes of bacterial infections were diagnosed in 99/211 (46.9%) admissions, community-acquired in 79 (61.2%) and hospital-acquired in 50 (38.8%): spontaneous bacterial peritonitis (23.3%); urinary tract infection (21.7%); pneumonia (17.8%); infection of the skin and soft parts (17.1%), sepsis by spontaneous bacteremia (7.7%); other bacterial infections (12.4%). Gram-positive organisms were responsible for 52.2% of total bacterial infections documented cases. There were eight serious cases of tuberculosis, fungal and parasitic infections; the prevalence of tuberculosis was 6% with an annual mortality of 62.5%; 28.1% (9/32) of the coproparasitological examination had Strongyloides stercolaris. The in-hospital mortality was significantly higher in patients with bacterial infection than in non-infected patients (32.4% vs. 13.2%; p=0.02). The independent factors associated with mortality were bacterial infections, the score of Child-Pügh and creatininemia > 1.5 mg/dl. By the multivariate analysis, leukocytosis and hepatic encephalopathy degree III/IV were independent factors associated to bacterial infection. This study confirms that bacterial and nonbacterial infections are a frequent and severe complication in hospitalized cirrhotic patients, with an increase of in-hospital mortality.

  17. [Homicide crimes in hospitals].

    PubMed

    Dürwald, W

    1993-02-01

    Report of some cases of willful homicide in hospitals of the former GDR. In no case the patient has wished his death. Besides compassion the cause of the homicide was a large carefully expense and in two cases the attempt to prove the incapability of the competent doctor. The patients were only means to an end. All the cases are discovered by the great number of obscure death.

  18. [The participation of opioids in the antinociceptive effect induced by the stimulation of hypothalamic "pleasure zones" in 20- to 30-day-old rabbits].

    PubMed

    Butkevich, I P; Kassil', V G

    1995-01-01

    The involvement of opioid peptides in the mediation of inhibitory influences of the positive reinforcement system ("reward areas") on the evoked potential (EPs) recorded in the thalamic parafascicular complex (CM-Pf) in response to the nociceptive electrodermal stimulation of the hind paw in 20-30 day rabbits has been studied. Electrical stimulation of "reward areas" identified in the preliminary behavioural experiments inhibited the EPs. The systemic injection of naloxone potentiated the antinociceptive effect of "reward areas" stimulation in 75% of cases under the incomplete inhibition of EPs (the decrease of EPs amplitude) but decreased its inhibitory effect in 87% of cases under the complete inhibition of EPs. Naloxone did not change the inhibitory effect of "reward areas" stimulation suggesting to the relationship of analgesic "reward areas" function with nonopioid mechanisms too. On the basis of the comparison of the present data and the ones obtained before it can be inferred that opioid mechanism in realization of antinociceptive influence of "reward areas" stimulation on EPs in CM-Pf is more important for 20-30 day rabbits compared with 41-60 day ones. The correlation of the phenomenon under investigation with the formation of neurotransmitter systems has been discussed.

  19. Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes

    PubMed Central

    Cooper, Zara; Scott, John W.; Rosenthal, Ronnie A.; Mitchell, Susan L.

    2016-01-01

    OBJECTIVES To systematically review the current literature on mortality and functional outcomes after emergency major abdominal surgery in older adults. DESIGN Systematic literature search and standardized data collection of primary research publications from January 1994 through December 2013 on mortality or functional outcome in adults aged 65 and older after emergency major abdominal surgery using PubMed, EMBASE, Web of Science, Cochrane, and CINAHL. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies. SETTING Systematic review of retrospective and cohort studies using Preferred Reporting Items for Systematic reviews and Meta-Analyses, Meta-analysis Of Observational Studies in Epidemiology, Strengthening the Reporting of Observational Studies in Epidemiology, and A Measurement Tool to Assess Systematic Reviews guidelines. PARTICIPANTS Older adults. MEASUREMENTS Articles were assessed using a standardized quality scoring system based on study design, measurement of exposures, measurement of outcomes, and control for confounding. RESULTS Of 1,459 articles screened, 93 underwent full-text review, and 20 were systematically reviewed. In-hospital and 30-day mortality of all older adults exceeded 15% in 14 of 16 studies, where reported. Older adults undergoing emergency major abdominal surgery consistently had higher mortality across study settings and procedure types than younger individuals undergoing emergency procedures and older adults undergoing elective procedures. In studies that stratified older adults, odds of death increased with age. None of these studies examined postoperative functional status, which precluded including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using metaanalysis. CONCLUSION Age independently predicts mortality after emergency major abdominal surgery. Data on changes in

  20. Characteristics and preliminary observations of the influence of electromyostimulation on the size and function of human skeletal muscle during 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A.; Buchanan, Paul; Gollnick, Philip A.; Dudley, Gary A.

    1989-01-01

    The effect of transcutaneous electromyostimulation (EMS) on the development of atrophy and the loss of strength in lower limb musculature in humans exposed to microgravity was determined in three subjects who received EMS twice daily in a 3-d on/1-d off cycle on their dominant leg during 30 days of bedrest. The output waveform from the stimulator was sequenced to the knee extensors, knee flexors, ankle extensors, and ankle flexors, and caused three isometric contractions of each muscle group per minute. It was found that, in the dominant leg, EMS acted to attenuate the changes caused by bedrest, such as reductions in the leg volume, muscle compartment size, cross-sectional area of slow- and fast-twitch fibers, strength, and aerobic enzyme activities, and an increase in leg compliance.

  1. Results of 30-day petroleum Co-Fire test at the Houston Lighting & Power W.A. Parish Station. Final report

    SciTech Connect

    Jones, A.F.; Booth, R.C.; Machtemes, A.P.

    1995-10-01

    As more heavy crude oil is refined, petroleum coke may become cheaper and more available. A 30-day test co-firing of petroleum coke with Western coal was performed on Unit 8 of Houston Lighting & Power`s W.A. Parish Station to address several concerns about the effects of co-firing coke. The test program studied fuel handling and consistency issues, coal mill performance, furnace operation, emissions, baghouse operation, and flue gas desulfurization (FGD) system performance. Results indicated that petroleum coke can be co-fired with Western coal without any significant problems. The limiting factor on how much coke can be in the bend is the ability of the FGD system to meet emission limits for SO{sub 2}.

  2. Myeloid Precursors in the Bone Marrow of Mice after a 30-Day Space Mission on a Bion-M1 Biosatellite.

    PubMed

    Sotnezova, E V; Markina, E A; Andreeva, E R; Buravkova, L B

    2017-02-01

    The content of myeloid stem CFU in bone marrow karyocytes from the tibial bone of C57Bl/6 mice was evaluated after a 30-day Bion-M1 pace flight/ground control experiment and subsequent 7-day recovery period. After the space flight, we observed a significant decrease in the number of erythroid progenitors in the bone marrow, including common myeloid precursor - granulocyte, erythrocyte, monocyte/macrophage, megakaryocyte CFU. After 7-day readaptation, CFU level in flight animals did not recover completely. In the ground control, the count of erythroid burst-forming units was higher than in vivarium animals. Comparison of the changes observed in fight and ground experiments demonstrated effects associated space flight factors and manifesting in suppression of the bone marrow erythropoiesis.

  3. Immunotoxicological Evaluation of Corn Genetically Modified with Bacillus thuringiensis Cry1Ah Gene by a 30-Day Feeding Study in BALB/c Mice

    PubMed Central

    Song, Yan; Liang, Chunlai; Wang, Wei; Fang, Jin; Sun, Nana; Jia, Xudong; Li, Ning

    2014-01-01

    This study was to investigate the immunotoxicological potential of corn genetically modified (GM) with Bacillus thuringiensis (Bt) Cry1Ah gene in BALB/c mice. Female BALB/c mice were randomly assigned to one of the four groups: the negative control group, the parental corn group, the GM corn group and the positive control group with 10 mice per group. Mice in the GM corn group and the parental corn group were fed with diets containing 70% corresponding corn for 30 days. Mice in the negative control group and the positive control group were fed with AIN93G diet, administered with saline or 200 mg/kg of cyclophosphamide (CY) via intraperitoneal injection 24 h before the termination of the study, respectively. At the end of the study, the immunotoxicological effects of the GM corn were evaluated through immunopathology parameters including body and organ weights, hematology and clinical chemistry parameters, histological examination, peripheral blood lymphocytes phenotype; humoral immunity including antibody plaque-forming cell, serum immunoglobulin, cytokine and half hemolysis value; cellular immunity such as mitogen-induced splenocyte proliferation, cytotoxic T-lymphocyte reaction, delayed-type hypersensitivity reaction; non-specific immunity including phagocytic activities of phagocytes, natural killer cell activity. A single dose of cyclophosphamide (200 mg/kg bw) was found to have significant adverse effects on immunopathology, cellular immunity, and humoral immunity in mice. The corn genetically modified with Bt Cry1Ah gene is considered consistent with the parental corn in terms of immunopathology, humoral immunity, cellular immunity and non-specific immunity. No adverse immunotoxicological effects of GM corn with Bt Cry1Ah gene were found when feeding mice for 30 days. PMID:24520311

  4. Immunotoxicological evaluation of corn genetically modified with Bacillus thuringiensis Cry1Ah gene by a 30-day feeding study in BALB/c mice.

    PubMed

    Song, Yan; Liang, Chunlai; Wang, Wei; Fang, Jin; Sun, Nana; Jia, Xudong; Li, Ning

    2014-01-01

    This study was to investigate the immunotoxicological potential of corn genetically modified (GM) with Bacillus thuringiensis (Bt) Cry1Ah gene in BALB/c mice. Female BALB/c mice were randomly assigned to one of the four groups: the negative control group, the parental corn group, the GM corn group and the positive control group with 10 mice per group. Mice in the GM corn group and the parental corn group were fed with diets containing 70% corresponding corn for 30 days. Mice in the negative control group and the positive control group were fed with AIN93G diet, administered with saline or 200 mg/kg of cyclophosphamide (CY) via intraperitoneal injection 24 h before the termination of the study, respectively. At the end of the study, the immunotoxicological effects of the GM corn were evaluated through immunopathology parameters including body and organ weights, hematology and clinical chemistry parameters, histological examination, peripheral blood lymphocytes phenotype; humoral immunity including antibody plaque-forming cell, serum immunoglobulin, cytokine and half hemolysis value; cellular immunity such as mitogen-induced splenocyte proliferation, cytotoxic T-lymphocyte reaction, delayed-type hypersensitivity reaction; non-specific immunity including phagocytic activities of phagocytes, natural killer cell activity. A single dose of cyclophosphamide (200 mg/kg bw) was found to have significant adverse effects on immunopathology, cellular immunity, and humoral immunity in mice. The corn genetically modified with Bt Cry1Ah gene is considered consistent with the parental corn in terms of immunopathology, humoral immunity, cellular immunity and non-specific immunity. No adverse immunotoxicological effects of GM corn with Bt Cry1Ah gene were found when feeding mice for 30 days.

  5. Exposure to microgravity for 30 days onboard Bion M1 caused muscle atrophy and decreased regeneration in the mouse femoral Quadriceps

    NASA Astrophysics Data System (ADS)

    Grigoryan, Eleonora; Radugina, Elena A.; Almeida, Eduardo; Blaber, Elizabeth; Poplinskaya, Valentina; Markitantova, Yulia

    Mechanical unloading of muscle during spaceflight in microgravity is known to cause muscular atrophy, changes in muscle fiber type composition, gene expression, and reductions in regenerative muscle growth. Although limited data exists for long-term effects of microgravity in human muscle, these processes have mostly been studied in rodents for short periods of time, up to two weeks of spaceflight. Here we report on how 30-day, long-term, mechanical unloading in microgravity affects mouse muscle of the femoral Quadriceps group. To conduct these studies we used muscle tissue from 6 mice from the NASA Biospecimen Sharing Program conducted in collaboration with the Institute for Biomedical Problems of the Russian Academy of Sciences, during the Russian Bion M1 biosatellite mission in 2013. Muscle morphology observed in histological sections shows signs of extensive atrophy and regenerative hypoplasia. Specifically, we observed a two-fold decrease in the number of myonuclei and low density of myofibrils, their separation and fragmentation. Despite obvious atrophy, muscle regeneration nevertheless appears to have continued after 30 days in microgravity as evidenced by thin and short newly formed muscle fibers. Many of them however showed evidence of apoptosis and degradation of synthesized fibrils, suggesting long-term unloading in microgravity affects late stages of myofiber differentiation. Ground asynchronous and vivarium control animals showed normal, well-developed tissue structure with sufficient blood and nerve supply and evidence of regenerative formation of new muscle fibers free of apoptotic nuclei. Myofiber nuclei stress responses in spaceflight animals was detected by positive nuclear immunolocalization of c-jun and c-myc proteins. Regenerative activity of satellite cells in muscle was localized with pax-7, MyoD and MCad immunostaining, and did not appear altered in microgravity. In summary, long-term spaceflight in microgravity causes significant atrophy

  6. Speech intelligibility in hospitals.

    PubMed

    Ryherd, Erica E; Moeller, Michael; Hsu, Timothy

    2013-07-01

    Effective communication between staff members is key to patient safety in hospitals. A variety of patient care activities including admittance, evaluation, and treatment rely on oral communication. Surprisingly, published information on speech intelligibility in hospitals is extremely limited. In this study, speech intelligibility measurements and occupant evaluations were conducted in 20 units of five different U.S. hospitals. A variety of unit types and locations were studied. Results show that overall, no unit had "good" intelligibility based on the speech intelligibility index (SII > 0.75) and several locations found to have "poor" intelligibility (SII < 0.45). Further, occupied spaces were found to have 10%-15% lower SII than unoccupied spaces on average. Additionally, staff perception of communication problems at nurse stations was significantly correlated with SII ratings. In a targeted second phase, a unit treated with sound absorption had higher SII ratings for a larger percentage of time as compared to an identical untreated unit. Taken as a whole, the study provides an extensive baseline evaluation of speech intelligibility across a variety of hospitals and unit types, offers some evidence of the positive impact of absorption on intelligibility, and identifies areas for future research.

  7. Infant Mortality

    MedlinePlus

    ... Control and Prevention. (2013). CDC health disparities and inequalities report—United States, 2013. Morbidity and Mortality Weekly ... M. (2008). The fall and rise of U.S. inequalities in premature mortality: 1960–2002. PLOS Medicine, 5 ( ...

  8. [Pulmonary Embolism in Portugal: Epidemiology and In-Hospital Mortality].

    PubMed

    Gouveia, Miguel; Pinheiro, Luís; Costa, João; Borges, Margarida

    2016-08-01

    Introdução: Em Portugal, a epidemiologia da embolia pulmonar aguda é mal conhecida. Neste estudo, pretendeu-se caracterizar a embolia pulmonar a partir dos dados do internamento hospitalar, assim como avaliar a sua mortalidade intra-hospitalar (definida como mortalidade do internamento hospitalar) e respetivos fatores de prognóstico.Material e Métodos: Microdados dos Grupos de Diagnóstico Homogéneo dos hospitais do Sistema Nacional de Saúde (2003 a 2013) e dados sobre população do Instituto Nacional de Estatística para estabelecer a evolução dos internamentos, da mortalidade intrahospitalar e das taxas de incidência na população. Os microdados foram estudados numa regressão logit modelizando a mortalidade intra-hospitalar como função de características individuais e de variáveis de contexto.Resultados: Entre 2003 e 2013 ocorreram 35 200 episódios de internamento (doentes ≥ 18 anos) em que pelo menos um dos diagnósticos foi embolia pulmonar (diagnóstico principal em 67% dos casos). A taxa de incidência estimada em 2013 foi 35/100 000 habitantes (≥ 18 anos). Entre 2003 e 2013, o número anual de episódios foi aumentando, mas a taxa de mortalidade intra-hospitalar foi diminuindo (de 31,8% para 17% em todos os episódios e de 25% para 11,2% nos episódio com embolia pulmonar como diagnóstico principal). Entre 2010 e 2013 a probabilidade de morte reduziu-se com a existência de registo de tomografia computorizada, em doentes do género feminino e aumentou com a idade e a presença de comorbilidades.Discussão: Na última década ocorreu um aumento da incidência de embolia pulmonar provavelmente relacionado com um maior número de pessoas dependentes e acamadas. No entanto, verificou-se uma redução da mortalidade intra-hospitalar de tal dimensão que a própria taxa de mortalidade na população em geral se reduziu. Uma explicação possível é que tenha ocorrido um aumento dos episódios de embolia pulmonar com níveis de gravidade incrementalmente menores, pela maior capacidade de diagnóstico de casos menos graves. Outra explicação possível é uma maior efetividade dos cuidados de saúde hospitalares. De acordo com a análise deregressão logística, as melhorias na efetividade dos cuidados hospitalares nos últimos anos são o principal responsável pela redução da mortalidade.Conclusão: Cerca de 79% da redução da mortalidade intra-hospitalar da embolia pulmonar entre 2003 e 2013 pode-se atribuir à maior efetividade dos cuidados de saúde hospitalares e o restante à alteração favorável nas características dos doentes associadas ao risco de morte.

  9. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

    Objective To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. Design Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. Main measurements Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. Results Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ≥65; meeting ≥2 deterioration criteria; an index of frailty with ≥2 criteria; early warning score >4; presence of ≥1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. Conclusions An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL. PMID:25613983

  10. [Desmin content and transversal stiffness of the left ventricle mouse cardiomyocytes and skeletal muscle fibers after a 30-day space flight on board "BION-M1" biosatellite].

    PubMed

    Ogneva, I V; Maximova, M V; Larina, I M

    2014-01-01

    The aim of this study was to determine the transversal stiffness of the cortical cytoskeleton and the cytoskeletal protein desmin content in the left ventricle cardiomyocytes, fibers of the mouse soleus and tibialis anterior muscle after a 30-day space flight on board the "BION-M1" biosatellite (Russia, 2013). The dissection was made after 13-16.5 h after landing. The transversal stiffness was measured in relaxed and calcium activated state by, atomic force microscopy. The desmin content was estimated by western blotting, and the expression level of desmin-coding gene was detected using real-time PCR. The results indicate that, the transversal stiffness of the left ventricle cardiomyocytes and fibers of the soleus muscle in relaxed and activated states did not differ from the control. The transversal stiffness of the tibialis muscle fibers in relaxed and activated state was increased in the mice group after space flight. At the same time, in all types of studied tissues the desmin content and the expression level of desmin-coding gene did not differ from the control level.

  11. Isoform composition and gene expression of thick and thin filament proteins in striated muscles of mice after 30-day space flight.

    PubMed

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft "BION-M" number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from "Flight" group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the "Flight" group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from "Flight" and "Control" groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness.

  12. The 2013 German-Russian BION-M1 Joint Flight Project: Skeletal Muscle and Neuromuscular Changes in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Blottner, Dieter; Shenkman, Boris; Salanova, Michele

    Exposure to microgravity results in various structural, biochemical and molecular changes of the skeletal neuromuscular system. The BION Joint Flight Proposal between the Charité Berlin Center of Space Medicine (www.zwmb.de) in Berlin, and the Institute of Biomedical Problem (IMBP) in Moscow, provided an exciting opportunity for a more detailed analysis of neuromuscular changes in mice (C57/bl6) exposed to real microgravity housed for 30 days in a BION M1 biosatellite on orbit. The mice from the BION flight group (n=5) were compared to three different on-ground control groups (Flight control, BION-ground and Vivarium, each n=5 mice). We started to analyse various skeletal muscles from the hind limbs or trunk. Apart from routine structural and biochemical analysis (fiber size and type distribution, slow/fastMyHC) we test the hypothesis for the presence of a microgravity-induced sarcolemma-cytosolic protein shift of nitric oxide synthase (NOS) and partial loss in neuromuscular synapse scaffold protein (Homer) immunoexpression known to be prone to disuse in mice or humans (hind limb unloading, bed rest) as previously shown (Sandonà D et al., PLoS One, 2012, Salanova M et al., FASEB J, 2011). National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121); Contract RAS-IMBP/Charité Berlin # Bion-M1/2013

  13. Isoform Composition and Gene Expression of Thick and Thin Filament Proteins in Striated Muscles of Mice after 30-Day Space Flight

    PubMed Central

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft “BION-M” number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from “Flight” group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the “Flight” group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from “Flight” and “Control” groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness. PMID:25664316

  14. Nutritional Status and Physical and Mental Performance of Special Operations Soldiers Consuming the Ration, Lightweight, or the Meal, Ready-to-Eat Military Field Ration during a 30-Day Field Training Exercise

    DTIC Science & Technology

    1987-03-23

    reverse if necessary and identify by block number) A 2000 kcal lightweight ration (RLW-30) was tested as the sole source of food for 30 continuous days...after the 30-day FTX. Food and water intakes were recorded daily and nutritional and hydration status were evaluated. Medical examinations were...sole source of food for 30 days, can be expected to cause some uncomfortable physical symptoms and a small to moderate decrement in physical

  15. Improved Survival of Patients with ST-Segment Elevation Myocardial Infarction 3–6 Hours After Symptom Onset Is Associated with Inter-Hospital Transfer for Primary Percutaneous Coronary Intervention (PCI) at a Large Regional ST-Segment Elevation Myocardial Infarction (STEMI) Program vs. In-Hospital Thrombolysis in a Community Hospital

    PubMed Central

    Zhao, Xiangmei; Yang, Xianzhi; Gao, Chuanyu; Chu, Yingjie; Yang, Lei; Tian, Lixiao; Li, Lin

    2017-01-01

    Background This study sought to compare the 30-day and 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction (STEMI), whose symptom onset to in-hospital first medical contact (IHFMC) was 3–6 h, who received either in-hospital thrombolysis (IHT) in the nearest county hospital or direct transfer to a larger hospital in Henan province, China for primary percutaneous coronary intervention (PPCI). Material/Methods Patients were allocated into 2 groups: one group received IHT in the local county hospital, whereas the other group were transferred to the PCI centers to receive PPCI. Patient demographic data, baseline characteristics, and time between different stages of patient contact to the initiation of treatment for IHT or PPCI were recorded for analysis. Results No significant difference was identified between the 2 groups with the baseline characteristics and demographic data. The all-cause mortality was not significantly different between the IHT and PPCI group at 30 days (13.0% vs. 9.9%, p=0.386). However, a significant difference in mortality between the IHT and PPCI group was observed at 1 year (23.4% vs. 14.1%, p=0.035). Inter-hospital transfer time for PPCI tended to be the independent predictor for survival (OR: 4.4 CI 95%: 1.9–14.5, p 0.001). Overall, the patients undergoing PPCI in inter-hospital transfer had a higher survival rates for 1 year compared with patients receiving IHT. Conclusions Despite the delay associated with inter-hospital transfer for PPCI, patients with STEMI 3–6 h after symptom onset have improved survival with PPCI over patients treated locally with IHT. PMID:28240997

  16. Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study

    PubMed Central

    Morita, Plinio P; Picton, Peter; Seto, Emily; Zbib, Ahmad; Cafazzo, Joseph A

    2016-01-01

    Background Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F 8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0

  17. Early processing variations in selective attention to the color and direction of moving stimuli during 30 days head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wang, Lin-Jie; He, Si-Yang; Niu, Dong-Bin; Guo, Jian-Ping; Xu, Yun-Long; Wang, De-Sheng; Cao, Yi; Zhao, Qi; Tan, Cheng; Li, Zhi-Li; Tang, Guo-Hua; Li, Yin-Hui; Bai, Yan-Qiang

    2013-11-01

    Dynamic variations in early selective attention to the color and direction of moving stimuli were explored during a 30 days period of head-down bed rest. Event-related potentials (ERPs) were recorded at F5, F6, P5, P6 scalp locations in seven male subjects who attended to pairs of bicolored light emitting diodes that flashed sequentially to produce a perception of movement. Subjects were required to attend selectively to a critical feature of the moving target, e.g., color or direction. The tasks included: a no response task, a color selective response task, a moving direction selective response task, and a combined color-direction selective response task. Subjects were asked to perform these four tasks on: the 3rd day before bed rest; the 3rd, 15th and 30th day during the bed rest; and the 5th day after bed rest. Subjects responded quickly to the color than moving direction and combined color-direction response. And they had a longer reaction time during bed rest on the 15th and 30th day during bed rest after a relatively quicker response on the 3rd day. Using brain event-related potentials technique, we found that in the color selective response task, the mean amplitudes of P1 and N1 for target ERPs decreased in the 3rd day during bed rest and 5th day after bed rest in comparison with pre-bed rest, 15th day and 30th day during bed rest. In the combined color-direction selective response task, the P1 latencies for target ERPs on the 3rd and 30th day during bed rest were longer than on the 15th day during bed rest. As 3rd day during bed rest was in the acute adaptation period and 30th day during bed rest was in the relatively adaptation stage of head-down bed rest, the results help to clarify the effects of bed rest on different task loads and patterns of attention. It was suggested that subjects expended more time to give correct decision in the head-down tilt bed rest state. A difficulty in the recruitment of brain resources was found in feature selection task

  18. Structure of cortical cytoskeleton in fibers of mouse muscle cells after being exposed to a 30-day space flight on board the BION-M1 biosatellite.

    PubMed

    Ogneva, I V; Maximova, M V; Larina, I M

    2014-05-15

    The aim of the work was to analyze changes in the organization of the cortical cytoskeleton in fibers of the mouse soleus muscle, tibialis anterior muscle and left ventricular cardiomyocytes after completion of a 30-day space flight on board the BION-M1 biosatellite (Russia, 2013). The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles did not differ significantly within the study groups compared with the vivarium control group. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes did not differ significantly within all study groups and correlated with the transversal stiffness. A similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues compared with the control levels in the postflight group, with lowered beta-actin gene expression rates in the postflight group. After completion of the space flight, the content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins from the mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this protein were decreased at the time of dissection (it was started after 13 h after landing). At the same time, the content of alpha-actinin-1 decreased in the membranous fraction and increased in the cytoplasmic fraction of proteins from the soleus muscle fibers.

  19. Coat and claws as new matrices for noninvasive long-term cortisol assessment in dogs from birth up to 30 days of age.

    PubMed

    Veronesi, M C; Comin, A; Meloni, T; Faustini, M; Rota, A; Prandi, A

    2015-09-15

    The last stage of fetal development and the neonatal period represent the most critical phases for the mammals' offspring. In the dog, the knowledge about the final intrauterine fetal development and biology, as well as about the neonatal physiology, remains scarce. Hormonal changes occurring in the last intrauterine fetal phase and during the early neonatal age are still not completely clear, probably because of the invasiveness related to the collection of the more common biological matrix, represented by circulating blood. Toward term of pregnancy, during parturition, and after birth, the hypothalamic-pituitary-adrenal axis is a key system regulating several physiological processes, and its activity was previously investigated by blood analysis, considered an invasive procedure providing a single-point measurement. In respect to animal welfare, and for a more correct long-term retrospective investigation, noninvasive hormonal studies were performed firstly on the hair of humans and coat of animals and, more recently, in the nails of human beings. This study was aimed to assess cortisol (COR) in coat and claws of newborn puppies and to evaluate the possible influence of the newborn gender, breed body size, and age on coat and claws COR concentrations. The results obtained from 165 newborn puppies evidenced that coat and claws COR levels were highly correlated each other (P < 0.0001), although the COR accumulation in the two matrices was different in relation to the class of age. Moreover, the puppies age influenced both coat and claws COR concentrations (P < 0.05), with premature puppies showing higher values when compared to term born-dead puppies or puppies dead between 1 and 30 days of age. The present study reported that COR is quantifiable in coat and claws of newborn dogs. Moreover, both matrices appear as useful tools for new, noninvasive, long-term perinatal and neonatal researches also in canine species.

  20. Copeptin Predicts Mortality in Critically Ill Patients

    PubMed Central

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.

    2017-01-01

    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU. PMID:28118414

  1. Characteristics and Preliminary Observations of the Influence of Electromyostimulation on the Size and Function of Human Skeletal Muscle During 30 Days of Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A; Buchanan, Paul; Gollinick, Philip D.; Dudley, Gary A.

    1989-01-01

    During 30 days (d) of bedrest, the practicality of using Elec- troMyoStimulation (EMS) as a deterrent to atrophy and strength loss of lower limb musculature was examined. An EMS system was developed that provided variable but quantifiable levels of EMS, and measured torque. The dominant log of three male subjects was stimulated twice daily in a 3-d on/1-d off cycle during bedrest. The non-dominant leg of each subject acted as a control. A stimulator, using a 0.3 ms monophasic 60 Hz pulse waveform, activated muscle tissue for 4 s. The output waveform from the stimulator was sequenced to the Knee Extensors (KE), Knee Flex- ors (KF), Ankle Extensors (AE), and Ankle Flexors (AF), and caused three isometric contractions of each muscle group per minute. Subject tolerance determined EMS Intensity. Each muscle group received four 5-min bouts of EMS each session with a 10 -min rest between bouts. EMS and torque levels for each muscle action were recorded directly an a computer. Overall average EMS Intensity was 197, 197, 195, and 188 mA for the KE, KF, AF, and AE, respectively. Overall average torque development for these muscle groups was 70, 16, 12, and 27 Nm, respectively. EMS intensity doubled during the study, and average torque increased 2.5 times. Average maximum torque throughout a session reached 54% of maximal voluntary for the KE and 29% for the KF. Reductions in leg volume, muscle compartment size, cross-sectional area of slow and fast-twitch fibers, strength, and aerobic enzyme activities, and increased log compliance were attenuated in the legs which received EMS during bedrest. These results indicate that similar EMS levels induce different torques among different muscle groups and that repeated exposure to EMS increases tolerance and torque development. Longer orien- tation periods, therefore, may enhance its effectiveness. Our preliminary data suggest that the efficacy of EMS as an effective countermeasure for muscle atrophy and strength loss during long

  2. Mechanical properties of non-sarcomeric cytoskeleton of mice cardiomyocytes and skeletal muscle fibers after 30-day spaceflight biosatellite BION-M1

    NASA Astrophysics Data System (ADS)

    Ogneva, Irina; Maximova, Maria; Larina, Irina

    The aim of this study was to determine transversal stiffness of the cortical cytoskeleton and cytoskeletal protein desmin content of the left ventricle cardiomyocytes, soleus and tibialis anterior muscle fibers of the mice after 30-days space flight biosatellite «BION-M1» (Russia, 2013). The dissection was made after 13-16.5 hours after landing. Transversal stiffness was measured in relaxed and calcium activated state by atomic force microscope. Desmin content was estimated by using western-blot, expression level of the gene, coding desmin, - by real time PCR. The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles (as measured using the atomic force microscopy) did not differ significantly within the study groups in comparison to the vivarium control group, except for its slight increase in tibialis anterior fibers muscle in the post-flight group of animals. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes (as detected using the western blot technique) did not differ significantly within all study groups and correlated with the transversal stiffness. Similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle, as well as correlation with the transversal stiffness of their cortical cytoskeleton was noted. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues in comparison to the control levels in the post-flight group, as well as lowered beta-actin gene expression rates in the post-flight group of animals (as detected using the RT-PCR technique). After completion of the space flight, content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins of mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this

  3. Body Temperature at the Emergency Department as a Predictor of Mortality in Patients With Bacterial Infection.

    PubMed

    Yamamoto, Shungo; Yamazaki, Shin; Shimizu, Tsunehiro; Takeshima, Taro; Fukuma, Shingo; Yamamoto, Yosuke; Tochitani, Kentaro; Tsuchido, Yasuhiro; Shinohara, Koh; Fukuhara, Shunichi

    2016-05-01

    Hypothermia is a risk factor for death in intensive care unit (ICU) patients with severe sepsis and septic shock. In the present study, we investigated the association between body temperature (BT) on arrival at the emergency department (ED) and mortality in patients with bacterial infection.We conducted a retrospective cohort study in consecutive ED patients over 15 years of age with bacterial infection who were admitted to an urban teaching hospital in Japan between 2010 and 2012. The main outcome measure was 30-day in-hospital mortality. Each patient was assigned to 1 of 6 categories based on BT at ED admission. We conducted multivariable logistic regression analysis to adjust for predictors of death.A total of 913 patients were enrolled in the study. The BT categories were <36, 36 to 36.9, 37 to 37.9, 38 to 38.9, 39 to 39.9, and ≥40 °C, with respective mortalities of 32.5%, 14.1%, 8.7%, 8.2%, 5.7%, and 5.3%. Multivariable analysis showed that the risk of death was significantly low in patients with BT 37 to 37.9 °C (adjusted odds ratio [AOR]: 0.2; 95% confidence interval [CI] 0.1-0.6, P = 0.003), 38-38.9 °C (AOR: 0.2; 95% CI 0.1-0.6, P = 0.002), 39-39.9 °C (AOR: 0.2; 95% CI 0.1-0.5, P = 0.001), and ≥40 °C (AOR: 0.1; 95% CI 0.02-0.4, P = 0.001), compared with hypothermic patients (BT <36 °C).The higher BT on arrival at ED, the better the outcomes observed in patients with bacterial infection were.

  4. Airborne transmission of disease in hospitals

    PubMed Central

    Eames, I.; Tang, J. W.; Li, Y.; Wilson, P.

    2009-01-01

    Hospital-acquired infection (HAI) is an important public health issue with unacceptable levels of morbidity and mortality, over the last 5 years. Disease can be transmitted by air (over large distances), by direct/indirect contact or a combination of both routes. While contact transmission of disease forms the majority of HAI cases, transmission through the air is harder to control, but one where the engineering sciences can play an important role in limiting the spread. This forms the focus of this themed volume. In this paper, we describe the current hospital environment and review the contributions from microbiologists, mechanical and civil engineers, and mathematicians to this themed volume on the airborne transmission of infection in hospitals. The review also points out some of the outstanding scientific questions and possible approaches to mitigating transmission. PMID:19828499

  5. Vitamin D Status and Long-Term Mortality in Community-Acquired Pneumonia: Secondary Data Analysis from a Prospective Cohort

    PubMed Central

    Holter, Jan C.; Ueland, Thor; Norseth, Jon; Brunborg, Cathrine; Frøland, Stig S.; Husebye, Einar; Aukrust, Pål; Heggelund, Lars

    2016-01-01

    Background Low vitamin D status has been associated with short-term (30-day) mortality in hospitalized adults with community-acquired pneumonia (CAP). Data on its prevalence in these patients are scarce, and impact on long-term prognosis is unknown. We examined the prevalence of vitamin D deficiency and inadequacy and their effect on long-term mortality in hospitalized adults with CAP. Methods Secondary follow-up analysis of data from a prospectively recruited (January 2008–January 2011) well-defined cohort of 241 hospital survivors of CAP (Norway, latitude 60°N). Serum 25-hydroxyvitamin D levels, demographic, clinical, and laboratory data were measured within 48 hours of admission. The etiology of CAP was established in 63% of patients through extensive microbiological investigations. Mortality data were obtained from the national Cause of Death Registry. Explanatory strategy and Cox regression models were used to explore the association between vitamin D status and all-cause mortality. Results Median age was 66 years. Eighty-seven (36%) patients were vitamin D deficient (<30 nmol/L), 81 (34%) were inadequate (30–49 nmol/L), and 73 (30%) were sufficient (≥50 nmol/L). Seventy-two patients died over a median of 1839 days (range 1–2520 days), corresponding to cumulative 5-year survival rates of 66.2% (95% CI 56.2–76.2%), 77.0% (67.6–86.4%), and 77.8% (67.8–87.8%) for vitamin D deficient, inadequate, and sufficient patients, respectively. After adjusting for confounders (age, chronic obstructive pulmonary disease, immunocompromization and season), vitamin D deficiency, but not inadequacy, was significantly associated with higher mortality compared to patients with sufficiency (HR 1.91, 95% CI 1.06–3.45; P = .031). Conclusions There is a high prevalence of vitamin D deficiency and inadequacy among hospitalized adults with CAP. The results of this study also suggest that vitamin D deficiency is associated with an increased risk of mortality way beyond

  6. Impact of early in-hospital medication review by clinical pharmacists on health services utilization

    PubMed Central

    Partovi, Nilu; Ghement, Isabella; Wickham, Maeve E.; McGrail, Kimberlyn; Reddekopp, Lisa N.; Sobolev, Boris

    2017-01-01

    Background Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients. Methods We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient’s medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use. Results Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058) in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03), representing 11% reduction in the median

  7. Chronic conditions and risk of in-hospital death.

    PubMed Central

    Iezzoni, L I; Heeren, T; Foley, S M; Daley, J; Hughes, J; Coffman, G A

    1994-01-01

    OBJECTIVE. This study examined the relationship of in-hospital death and 13 conditions likely to have been present prior to the patient's admission to the hospital, defined using secondary discharge diagnosis codes. DATA SOURCES AND STUDY SETTING. 1988 California computerized hospital discharge abstract data, including 24 secondary diagnosis coding slots, from all general, acute care hospitals. STUDY DESIGN. The odds ratio for in-hospital death associated with each of 13 chronic conditions was computed from a multivariable logistic regression using patient age and all chronic conditions to predict in-hospital death. DATA EXTRACTION. All 1,949,276 general medical and surgical admissions of persons over 17 years of age were included. Patients were assigned to four groups according to the mortality rate of their reason for admission; some analyses separated medical and surgical hospitalizations. PRINCIPAL FINDINGS. Overall mortality was 4.4 percent. For all cases, mortality varied by chronic condition, ranging from 5.3 percent for coronary artery disease to 18.6 percent for nutritional deficiencies. The odds ratios associated with the presence of a chronic condition were generally highest for patients in the rare mortality group. Although chronic conditions were more commonly listed for medical patients, the associated odds ratios were generally higher for surgical patients, particularly in lower mortality groups. CONCLUSIONS. Studies examining death rates need to consider the influence of chronic conditions. Chronic conditions had a particularly significant association with the likelihood of death for admission types generally associated with low mortality rates and for surgical hospitalizations. The accuracy and completeness of discharge diagnoses require further study, especially relating to chronic illnesses. PMID:7928371

  8. Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain

    PubMed Central

    Marino, Rossella; Magrini, Laura; Orsini, Francesca; Russo, Veronica; Cardelli, Patrizia; Salerno, Gerardo; Hur, Mina

    2017-01-01

    Background High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. Methods Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. Results The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33-163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. Conclusions sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality. PMID:28029000

  9. 14-Year Survey in a Swedish County Reveals a Pronounced Increase in Bloodstream Infections (BSI). Comorbidity - An Independent Risk Factor for Both BSI and Mortality

    PubMed Central

    Giske, Christian G.; Fredrikson, Mats; Östholm Balkhed, Åse; Claesson, Carina; Nilsson, Lennart E.; Hoffmann, Mikael; Hanberger, Håkan

    2016-01-01

    Objectives we assessed the incidence, risk factors and outcome of BSI over a 14-year period (2000–2013) in a Swedish county. Methods retrospective cohort study on culture confirmed BSI among patients in the county of Östergötland, Sweden, with approximately 440,000 inhabitants. A BSI was defined as either community-onset BSI (CO-BSI) or hospital-acquired BSI (HA-BSI). Results of a total of 11,480 BSIs, 67% were CO-BSI and 33% HA-BSI. The incidence of BSI increased by 64% from 945 to 1,546 per 100,000 hospital admissions per year during the study period. The most prominent increase, 83% was observed within the CO-BSI cohort whilst HA-BSI increased by 32%. Prescriptions of antibiotics in outpatient care decreased with 24% from 422 to 322 prescriptions dispensed/1,000 inhabitants/year, whereas antibiotics prescribed in hospital increased by 67% (from 424 to 709 DDD per 1,000 days of care). The overall 30-day mortality for HA-BSIs was 17.2%, compared to 10.6% for CO-BSIs, with an average yearly increase per 100,000 hospital admissions of 2 and 5% respectively. The proportion of patients with one or more comorbidities, increased from 20.8 to 55.3%. In multivariate analyses, risk factors for mortality within 30 days were: HA-BSI (2.22); two or more comorbidities (1.89); single comorbidity (1.56); CO-BSI (1.21); male (1.05); and high age (1.04). Conclusion this survey revealed an alarming increase in the incidence of BSI over the 14-year study period. Interventions to decrease BSI in general should be considered together with robust antibiotic stewardship programmes to avoid both over- and underuse of antibiotics. PMID:27835663

  10. Comorbidity, age and mortality among adults treated intensively for acute myeloid leukemia (AML)

    PubMed Central

    Tawfik, Bernard; Pardee, Timothy; Isom, Scott; Sliesoraitis, Sarunas; Winter, Allison; Lawrence, Julia; Powell, Bayard L.; Klepin, Heidi D.

    2015-01-01

    Introduction Our goal was to characterize comorbidities among adults receiving intensive therapy for AML, and investigate their association with outcomes. Methods We retrospectively analyzed 277 consecutive patients with newly diagnosed AML treated intensively at the Comprehensive Cancer Center of Wake Forest University from 2002–2009. Pretreatment comorbidities were identified by ICD-9 codes and chart review. Comorbidity burden (modified Charlson Comorbidity Index [CCI]) and specific conditions were analyzed individually. Outcomes were overall survival (OS), remission, and 30-day mortality. Covariates included age, gender, cytogenetic characteristics, hemoglobin, white cell count, lactate dehydrogenase, body mass index, and insurance type. Cox proportional hazards models were used to evaluate OS; logistic regression was used for remission and 30-day mortality. Results In this series, 144 patients were ≥60 years old (median age 70 years, median survival 8.7 months) and 133 were <60 years (median age 47 years, median survival 23.1 months). Older patients had a higher comorbidity burden (CCI≥1 58% versus 26%, p<0.001). Prevalent comorbid conditions differed by age (diabetes 19.2% versus 7.5%; cardiovascular disease 12.5% versus 4.5%, for older versus younger patients, respectively). The CCI was not independently associated with OS or 30-day mortality in either age group. Among older patients, diabetes was associated with higher 30-day mortality (33.3% vs. 12.0% in diabetic vs. non diabetic patients, p =0.006). Controlling for age, cytogenetic characteristics and other comorbidities, the presence of diabetes increased the odds of 30-day mortality by 4.9 (CI 1.6–15.2) times. Discussion Diabetes is adversely associated with 30-day survival in older AML patients receiving intensive therapy. PMID:26527394

  11. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    PubMed

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-03-02

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates.

  12. Low blood lymphocyte count at 30 days post transplant predicts worse acute GVHD and survival but not relapse in a large retrospective cohort.

    PubMed

    Gul, Z; Van Meter, E; Abidi, M; Ditah, I; Abdul-Hussein, M; Deol, A; Ayash, L; Lum, L G; Waller, E K; Ratanatharathorn, V; Uberti, J; Al-Kadhimi, Z

    2015-03-01

    Multiple reports have shown that low absolute lymphocyte count at day 30 (ALC30) after allogeneic hematopoietic SCT (AHSCT) is associated with higher risk of disease relapse and worse OS. However, these reports included heterogeneous populations with different grafts and GVHD prophylaxis. Therefore, we retrospectively evaluated the association of ALC30 with transplant outcomes in a cohort of 381 consecutive patients who underwent AHSCT between 2005 and 2010 and received T-replete PBSC grafts and Tacrolimus/Mycophenolate combination as GVHD prophylaxis. Median follow-up was 57 months. Lower ALC30 (⩽400 × 10(6)/L) was associated with lower OS and increased nonrelapse mortality (NRM) for the whole cohort as well as for recipients of SD and UD grafts separately. Lower ALC30 was associated with more severe acute GVHD (aGVHD; III-IV) for the entire cohort as well as for the SD and UD groups. No association was found between lower ALC30 and relapse. Pretransplant factors associated with lower ALC30 were: unrelated donors; HLA mismatch; older donors; lower recipient age; and lower CD34+ cell dose. In this large retrospective study, ALC30⩽400 × 10(6)/L was associated with worse OS, increased NRM and severe aGVHD.

  13. Initial antifungal strategy does not correlate with mortality in patients with candidemia.

    PubMed

    Murri, R; Scoppettuolo, G; Ventura, G; Fabbiani, M; Giovannenze, F; Taccari, F; Milozzi, E; Posteraro, B; Sanguinetti, M; Cauda, R; Fantoni, M

    2016-02-01

    The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.

  14. Complications Associated with Mortality after Head and Neck Surgery.

    PubMed

    Mulvey, Carolyn L; Brant, Jason A; Bur, Andrés M; Chen, Jinbo; Fischer, John P; Cannady, Steven B; Newman, Jason G

    2017-03-01

    Objective To determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. Study Design Retrospective review of prospectively collected national database. Setting NSQIP. Subjects and Methods NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality. Results In total, 15,410 cases met criteria with 3499 complications in 2235 cases. After controlling for patient and surgical variables, postoperative pneumonia ( P = .02; odds ratio [OR], 2.39; 95% confidence interval [CI], 1.15-4.72), progressive renal insufficiency ( P < .001; OR, 21.28; 95% CI, 4.22-87.94), bleeding requiring transfusion ( P = .02; OR, 2.10; 95% CI, 1.12-3.84), sepsis ( P = .02; OR, 2.86; 95% CI, 1.15-6.46), septic shock ( P = .045; OR, 2.87; 95% CI, 0.98-7.81), stroke ( P < .001; OR, 19.81; 95% CI, 6.23-56.03), and cardiac arrest ( P < .001; OR, 135.59; 95% CI, 65.00-286.48) were independently associated with increased odds of 30-day mortality. Conclusion The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.

  15. Mortality, morbidity, and disease severity of patients with aspiration pneumonia

    PubMed Central

    Lanspa, Michael J.; Jones, Barbara E.; Brown, Samuel M.; Dean, Nathan C.

    2013-01-01

    Background Aspiration pneumonia is a common syndrome, although less well characterized than other pneumonia syndromes. We describe a large population of patients with aspiration pneumonia. Methods In this retrospective population study, we queried the electronic medical record at a tertiary-care, university-affiliated hospital from 1996–2006. Patients were initially identified by ICD-9 code 507.x; subsequent physician chart review excluded patients with aspiration pneumonitis and those without a confirmatory radiograph. Patients with community-acquired aspiration pneumonia were compared to a contemporaneous population of community-acquired pneumonia (CAP) patients. We compared CURB-65 predicted mortality with actual 30-day mortality. Results We identified 628 patients with aspiration pneumonia, of which 510 were community-acquired. Median age was 77, with 30-day mortality of 21%. Compared to CAP patients, patients with community-acquired aspiration pneumonia had more frequent inpatient admission (99% vs. 58%) and ICU admission (38% vs. 14%), higher Charlson comorbidity index (3 vs. 1), and higher prevalence of “do not resuscitate/intubate” orders (24% vs. 11%). CURB-65 predicted mortality poorly in aspiration pneumonia patients (AUC 0.66). Conclusions Patients with community-acquired aspiration pneumonia are older, have more comorbidities, and demonstrate higher mortality than CAP patients, even after adjustment for age and comorbidities. CURB-65 poorly predicts mortality in this population. PMID:23184866

  16. Interpretable Topic Features for Post-ICU Mortality Prediction

    PubMed Central

    Luo, Yen-Fu; Rumshisky, Anna

    2016-01-01

    Electronic health records provide valuable resources for understanding the correlation between various diseases and mortality. The analysis of post-discharge mortality is critical for healthcare professionals to follow up potential causes of death after a patient is discharged from the hospital and give prompt treatment. Moreover, it may reduce the cost derived from readmissions and improve the quality of healthcare. Our work focused on post-discharge ICU mortality prediction. In addition to features derived from physiological measurements, we incorporated ICD-9-CM hierarchy into Bayesian topic model learning and extracted topic features from medical notes. We achieved highest AUCs of 0.835 and 0.829 for 30-day and 6-month post-discharge mortality prediction using baseline and topic proportions derived from Labeled-LDA. Moreover, our work emphasized the interpretability of topic features derived from topic model which may facilitates the understanding and investigation of the complexity between mortality and diseases. PMID:28269879

  17. Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia.

    PubMed

    Thønnings, S; Knudsen, J D; Schønheyder, H C; Søgaard, M; Arpi, M; Gradel, K O; Østergaard, C

    2016-08-01

    Invasive Listeria monocytogenes infections carry a high mortality despite antibiotic treatment. The rareness of the infection makes it difficult to improve antibiotic treatment through randomized clinical trials. This observational study investigated clinical features and outcome of invasive L. monocytogenes infections including the efficacy of empiric and definitive antibiotic therapies. Demographic, clinical and biochemical findings, antibiotic treatment and 30-day mortality for all episodes of L. monocytogenes bacteraemia and/or meningitis were collected by retrospective medical record review in the North Denmark Region and the Capital Region of Denmark (17 hospitals) from 1997 to 2012. Risk factors for 30-day all-cause mortality were assessed by logistic regression. The study comprised 229 patients (median age: 71 years), 172 patients had bacteraemia, 24 patients had meningitis and 33 patients had both. Significant risk factors for 30-day mortality were septic shock (OR 3.0, 95% CI 1.4-6.4), altered mental state (OR 3.6, 95% CI 1.7-7.6) and inadequate empiric antibiotic therapy (OR 3.8, 95% CI 1.8-8.1). Cephalosporins accounted for 90% of inadequately treated cases. Adequate definitive antibiotic treatment was administered to 195 patients who survived the early period (benzylpenicillin 72, aminopenicillin 84, meropenem 28, sulfamethoxazole/trimethoprim 6, and piperacillin/tazobactam 5). Definitive antibiotic treatment with benzylpenicillin or aminopenicillin resulted in a lower 30-day mortality in an adjusted analysis compared with meropenem (OR 0.3; 95% CI 0.1-0.8). In conclusion, inadequate empiric antibiotic therapy and definitive therapy with meropenem were both associated with significantly higher 30-day mortality.

  18. TRICARE: changes included in the National Defense Authorization Act for Fiscal Year 2010; enhancement of transitional dental care for members of the Reserve Component on active duty for more than 30 days in support of a contingency operation. Final rule.

    PubMed

    2011-12-28

    The Department is publishing this final rule to implement section 703 of the National Defense Authorization Act for Fiscal Year 2010 (NDAA for FY10). Specifically, that legislation amends the transitional health care dental benefits for Reserve Component members on active duty for more than 30 days in support of a contingency operation. The legislation entitles these Reserve Component members to dental care in the same manner as a member of the uniformed services on active duty for more than 30 days, thus providing care to the Reserve member in both military dental treatment facilities and authorized private sector dental care. This final rule does not eliminate any medical or dental care that is currently covered as transitional health care for the member.

  19. Business Intelligence in Hospital Management.

    PubMed

    Escher, Achim; Hainc, Nicolin; Boll, Daniel

    2016-01-01

    Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

  20. Distribution and biomarkers of Carbon-14 labeled fullerene C60 ([14C(U)]C60) in female rats and mice for up to 30 days after intravenous exposure

    PubMed Central

    Sumner, Susan C. J.; Snyder, Rodney W.; Wingard, Christopher; Mortensen, Ninell P.; Holland, Nathan A.; Shannahan, Jonathan H.; Dhungana, Suraj; Pathmasiri, Wimal; Han, Li; Lewin, Anita H.; Fennell, Timothy R.

    2016-01-01

    A comprehensive distribution study was conducted in female rats and mice exposed to a suspension of uniformly carbon-14 labeled C60 ([14C(U)]C60). Rodents were administered [14C(U)]C60 (~0.9 mg /kg body weight) or 5% PVP-saline vehicle alone via a single tail vein injection. Tissues were collected at 1 hour, 1, 7, 14 and 30 days after administration. A separate group of rodents received 5 daily injections of suspensions of either [14C(U)]C60 or vehicle with tissue collection 14 days post exposure. Radioactivity was detected in over 20 tissues at all time period. The highest concentration of radioactivity in rodents at each time point was in liver, lungs and spleen. Elimination of [14C(U)]C60 was <2% in urine and feces at any 24 hour time points. [14C(U)]C60 and [14C(U)]C60-retinol were detected in liver of rats and together accounted for ~99% and ~56% of the total recovered at 1 and 30 days post exposure, respectively. The blood radioactivity at 1 hour after [14C(U)]C60 exposure was four-fold higher in rats than in mice; blood radioactivity was still in circulation at 30 days post [14C(U)]C60 exposure in both species (<1%). Levels of oxidative stress markers increased by 5 days after exposure and remained elevated, while levels of inflammation markers initially increased and then returned to control values. The level of cardiovascular marker vWF, increased in rats, but remained at control levels in mice. This study demonstrates that [14C(U)]C60 is retained in female rodents with little elimination by 30 days after i.v. exposure, and leads to systemic oxidative stress. PMID:25727383

  1. Distribution and biomarkers of carbon-14-labeled fullerene C60 ([(14) C(U)]C60 ) in female rats and mice for up to 30 days after intravenous exposure.

    PubMed

    Sumner, Susan C J; Snyder, Rodney W; Wingard, Christopher; Mortensen, Ninell P; Holland, Nathan A; Shannahan, Jonathan H; Dhungana, Suraj; Pathmasiri, Wimal; Han, Li; Lewin, Anita H; Fennell, Timothy R

    2015-12-01

    A comprehensive distribution study was conducted in female rats and mice exposed to a suspension of uniformly carbon-14-labeled C60 ([(14) C(U)]C60 ). Rodents were administered [(14) C(U)]C60 (~0.9 mg kg(-1) body weight) or 5% polyvinylpyrrolidone-saline vehicle alone via a single tail vein injection. Tissues were collected at 1 h and 1, 7, 14 and 30 days after administration. A separate group of rodents received five daily injections of suspensions of either [(14) C(U)]C60 or vehicle with tissue collection 14 days post exposure. Radioactivity was detected in over 20 tissues at all time points. The highest concentration of radioactivity in rodents at each time point was in liver, lungs and spleen. Elimination of [(14) C(U)]C60 was < 2% in urine and feces at any 24 h time points. [(14) C(U)]C60 and [(14) C(U)]C60 -retinol were detected in liver of rats and together accounted for ~99% and ~56% of the total recovered at 1 and 30 days postexposure, respectively. The blood radioactivity at 1 h after [(14) C(U)]C60 exposure was fourfold higher in rats than in mice; blood radioactivity was still in circulation at 30 days post [(14) C(U)]C60 exposure in both species (<1%). Levels of oxidative stress markers increased by 5 days after exposure and remained elevated, while levels of inflammation markers initially increased and then returned to control values. The level of cardiovascular marker von Willebrand factor, increased in rats, but remained at control levels in mice. This study demonstrates that [(14) C(U)]C60 is retained in female rodents with little elimination by 30 days after i.v. exposure, and leads to systemic oxidative stress.

  2. Mortality Risk Assessment of Total Knee Arthroplasty and Related Surgery After Percutaneous Coronary Intervention

    PubMed Central

    Von Keudell, Arvind G.; Thornhill, Thomas S.; Katz, Jeffrey N.; Losina, Elena

    2016-01-01

    Background: The optimal antiplatelet therapy (APT) treatment strategy after Coronary Artery Stenting (CAS) in non-cardiac surgery, such as total knee arthroplasty (TKA) or urgent TKA-related surgery remains unknown. Methods: We built a decision tree model to examine the mortality outcomes of two alternative strategies for APT after CAS use in the perioperative period namely, continuous use and discontinuation. Results: If surgery was performed in the first month after CAS placement, discontinuing APT led to an estimated 30-day post TKA mortality of 10.5%, compared to 1.0% in a strategy with continuous APT use. Mortality with both strategies decreased with longer intervals. Conclusion: Our model demonstrated that APT discontinuation in patients undergoing TKA or urgent TKA related surgery after CAS placement might lead to greater 30-day mortality up to one year. PMID:28144380

  3. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

    PubMed Central

    Lim, Joo Hyun; Choi, Seung Ho; Seo, Ji Yeon; Kang, Hae Yeon; Yang, Jong In; Chung, Su Jin; Kim, Joo Sung

    2016-01-01

    Background/Aims A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. Methods Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. Results Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. Conclusions The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy. PMID:27799884

  4. Mortal assets

    SciTech Connect

    Howe, Geoffrey R.; Zablotska, Lydia B.; Fix, John J.; Egel, John N.; Buchanan, Jeffrey A.

    2005-11-01

    Workers employed in 15 utilities that generate nuclear power in the United States have been followed for up to 18 years between 1979 and 1997. Their cumulative dose from whole-body ionizing radiation has been determined from the dose records maintained by the facilities themselves and the REIRS and REMS systems maintained by the Nuclear Regulatory Commission and the Department of Energy, respectively. Mortality in the cohort from a number of causes has been analyzed with respect to individual radiation doses. The cohort displays a very substantial healthy worker effect, i.e. considerably lower cancer and noncancer mortality than the general population. Based on 26 and 368 deaths, respectively, positive though statistically nonsignificant associations were seen for mortality from leukemia (excluding chronic lymphocytic leukemia) and all solid cancers combined, with excess relative risks per sievert of 5.67 (95% confidence interval (CI) -2.56, 30.4) and 0.596 (95% CI -2.01, 4.64), respectively. These estimates are very similar to those from the atomic bomb survivors study, though the wide confidence intervals are also consistent with lower or higher risk estimates. A strong positive and statistically significant association between radiation dose and deaths from arteriosclerotic heart disease including coronary heart disease was also observed in the cohort, with an ERR of 8.78 (95% CI 2.10, 20.0). Whle associations with heart disease have been reported in some other occupational studies, the magnitude of the present association is not consistent with them and therefore needs cautious interpretation and merits further attention. At present, the relatively small number of deaths and the young age of the cohort (mean age at end of follow-up is 45 years) limit the power of the study, but further follow-up is 45 years) limit the power of the study, but further follow-up and the inclusion of the present data in an ongoing IARC combined analysis of nuclear workers from 15

  5. Association between anesthesiologist experience and mortality after orthotopic liver transplantation.

    PubMed

    Hofer, Ira; Spivack, John; Yaport, Miguel; Zerillo, Jeron; Reich, David L; Wax, David; DeMaria, Samuel

    2015-01-01

    The anesthesiologist has been recognized as an integral member of the liver transplant team, and previous studies have demonstrated that inter-anesthesiologist variability can be a driver of outcomes for high-risk patients. We hypothesized that anesthesiologist experience, defined as the number of previous liver transplants performed at our institution, the Icahn School of Medicine at Mount Sinai, would be independently associated with outcomes for liver transplant patients. Eight hundred forty-nine liver transplants performed between January 2003 and January 2013 with a total of 22 anesthesiologists were analyzed. Each transplant was assigned an incremental case number that corresponded to the number of transplants that the attending anesthesiologist had already performed at our institution. Several perioperative covariates were controlled for in the context of a generalized linear mixed effects model to detail the influence of threshold levels of the incremental case number on the primary outcome, 30-day mortality, and a secondary outcome, 30-day graft failure. Sensitivity analyses were conducted to confirm the robustness of these findings. An incremental case number ≤ 5 was associated with a significantly greater risk of 30-day mortality (odds ratio = 2.24, 95% confidence interval = 1.11-4.54, P = 0.025), and there was evidence suggestive of a greater risk of 30-day graft failure (odds ratio = 1.93, 95% confidence interval = 0.95-3.93, P = 0.071). Sensitivity analyses ruled out threats to the validity of these findings, including dropout effects and time trends in the overall performance of the transplantation unit. In conclusion, this study shows that an anesthesiologist's level of experience has a significant effect on outcomes for liver transplant recipients, with increased mortality and possibly graft failure during a provider's first 5 cases. These findings may indicate the need for increased training and supervision for

  6. Mortality associated with bone fractures in COPD patients

    PubMed Central

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Sakamoto, Yukiyo; Hasegawa, Wakae; Takeshima, Hideyuki; Urushiyama, Hirokazu; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    Background and objective COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan. Methods Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures. Results Among 5,975 eligible patients, those with hip fractures (n=4,059) were older, had lower body mass index (BMI), and had poorer general condition than those with vertebral (n=1,477), shoulder (n=281), or forearm (n=158) fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32–0.56) after adjustment for patient backgrounds. Higher in-hospital mortality was associated with male sex, lower BMI, lower level of consciousness, and having several comorbidities, including pneumonia, lung cancer, congestive heart failure, chronic liver disease, and chronic renal failure. Conclusion COPD patients with hip fractures had higher mortality than COPD patients with other types of fracture. Surgery for hip fracture was associated with lower mortality than conservative treatment. PMID:27703343

  7. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  8. Long-term mortality of hospitalized pneumonia in the EPIC-Norfolk cohort.

    PubMed

    Myint, P K; Hawkins, K R; Clark, A B; Luben, R N; Wareham, N J; Khaw, K-T; Wilson, A M

    2016-03-01

    Little is known about cause-specific long-term mortality beyond 30 days in pneumonia. We aimed to compare the mortality of patients with hospitalized pneumonia compared to age- and sex-matched controls beyond 30 days. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study. Hospitalized pneumonia cases were identified from record linkage (ICD-10: J12-J18). For this study we excluded people with hospitalized pneumonia who died within 30 days. Each case identified was matched to four controls and followed up until the end June 2012 (total 15 074 person-years, mean 6·1 years, range 0·08-15·2 years). Cox regression models were constructed to examine the all-cause, respiratory and cardiovascular mortality using date of pneumonia onset as baseline with binary pneumonia status as exposure. A total of 2465 men and women (503 cases, 1962 controls) [mean age (s.d.) 64·5 (8·3) years] were included in the study. Between a 30-day to 1-year period, hazard ratios (HRs) of all-cause and cardiovascular mortality were 7·3 [95% confidence interval (CI) 5·4-9·9] and 5·9 (95% CI 3·5-9·7), respectively (with very few respiratory deaths within the same period) in cases compared to controls after adjusting for age, sex, asthma, smoking status, pack years, systolic and diastolic blood pressure, diabetes, physical activity, waist-to-hip ratio, prevalent cardiovascular and respiratory diseases. All outcomes assessed also showed increased risk of death in cases compared to controls after 1 year; respiratory cause of death being the most significant during that period (HR 16·4, 95% CI 8·9-30·1). Hospitalized pneumonia was associated with increased all-cause and specific-cause mortality beyond 30 days.

  9. [Dialogical leadership in hospitals institutions].

    PubMed

    Amestoy, Simone Coelho; Trindade, Letícia de Lima; Waterkemper, Roberta; Heidman, Ivonete Teresinha Schülter; Boehs, Astrid Egged; Backes, Vânia Marli Schubert

    2010-01-01

    The aim of this study is make a theorical-reflection about the importance of using dialogical leadership in hospital institutions through Freirean referencial. The dialogical leadership pattern differs from the coercive and autocratic methods, for being reasoned on the establishment of an efficient communicational process, able to stimulate autonomy, co-responsibility and appreciation of each member from nurse team. The dialogical leadership, unlike the directive one, is a management instrument, that pursuits to minimize the conflicts and stimulate the formation of healthy interpersonal relationships, which can contribute to the improvement of organizational atmosphere and quality care provided to health services users.

  10. Measuring nutritional risk in hospitals

    PubMed Central

    Rasmussen, Henrik H; Holst, Mette; Kondrup, Jens

    2010-01-01

    About 20%–50% of patients in hospitals are undernourished. The number varies depending on the screening tool amended and clinical setting. A large number of these patients are undernourished when admitted to the hospital, and in most of these patients, undernutrition develops further during hospital stay. The nutrition course of the patient starts by nutritional screening and is linked to the prescription of a nutrition plan and monitoring. The purpose of nutritional screening is to predict the probability of a better or worse outcome due to nutritional factors and whether nutritional treatment is likely to influence this. Most screening tools address four basic questions: recent weight loss, recent food intake, current body mass index, and disease severity. Some screening tools, moreover, include other measurements for predicting the risk of malnutrition. The usefulness of screening methods recommended is based on the aspects of predictive validity, content validity, reliability, and practicability. Various tools are recommended depending on the setting, ie, in the community, in the hospital, and among elderly in institutions. The Nutrition Risk Screening (NRS) 2002 seems to be the best validated screening tool, in terms of predictive validity ie, the clinical outcome improves when patients identified to be at risk are treated. For adult patients in hospital, thus, the NRS 2002 is recommended. PMID:21042553

  11. Past and Present ARDS Mortality Rates: A Systematic Review.

    PubMed

    Máca, Jan; Jor, Ondřej; Holub, Michal; Sklienka, Peter; Burša, Filip; Burda, Michal; Janout, Vladimír; Ševčík, Pavel

    2017-01-01

    ARDS is severe form of respiratory failure with significant impact on the morbidity and mortality of critical care patients. Epidemiological data are crucial for evaluating the efficacy of therapeutic interventions, designing studies, and optimizing resource distribution. The goal of this review is to present general aspects of mortality data published over the past decades. A systematic search of the MEDLINE/PubMed was performed. The articles were divided according to their methodology, type of reported mortality, and time. The main outcome was mortality. Extracted data included study duration, number of patients, and number of centers. The mortality trends and current mortality were calculated for subgroups consisting of in-hospital, ICU, 28/30-d, and 60-d mortality over 3 time periods (A, before 1995; B, 1995-2000; C, after 2000). The retrospectivity and prospectivity were also taken into account. Moreover, we present the most recent mortality rates since 2010. One hundred seventy-seven articles were included in the final analysis. General mortality rates ranged from 11 to 87% in studies including subjects with ARDS of all etiologies (mixed group). Linear regression revealed that the study design (28/30-d or 60-d) significantly influenced the mortality rate. Reported mortality rates were higher in prospective studies, such as randomized controlled trials and prospective observational studies compared with retrospective observational studies. Mortality rates exhibited a linear decrease in relation to time period (P < .001). The number of centers showed a significant negative correlation with mortality rates. The prospective observational studies did not have consistently higher mortality rates compared with randomized controlled trials. The mortality trends over 3 time periods (before 1995, 1995-2000, and after 2000) yielded variable results in general ARDS populations. However, a mortality decrease was present mostly in prospective studies. Since 2010, the

  12. Chloride alterations in hospitalized patients: Prevalence and outcome significance

    PubMed Central

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Cheng, Zhen

    2017-01-01

    Serum Cl (sCl) alterations in hospitalized patients have not been comprehensively studied in recent years. The aim of this study is to investigate the prevalence and outcome significance of (1) sCl alterations on hospital admission, and (2) sCl evolution within the first 48 hr of hospital admission. We conducted a retrospective study of all hospital admissions in the years 2011–2013 at Mayo Clinic Rochester, a 2000-bed tertiary medical center. Outcome measures included hospital mortality, length of hospital stay and discharge disposition. 76,719 unique admissions (≥18 years old) were studied. Based on hospital mortality, sCl in the range of 105–108 mmol/L was found to be optimal. sCl <100 (n = 13,611) and >108 (n = 11,395) mmol/L independently predicted a higher risk of hospital mortality, longer hospital stay and being discharged to a care facility. 13,089 patients (17.1%) had serum anion gap >12 mmol/L; their hospital mortality, when compared to 63,630 patients (82.9%) with anion gap ≤12 mmol/L, was worse. Notably, patients with elevated anion gap displayed a progressively worsening mortality with rising sCl. sCl elevation within 48 hr of admission was associated with a higher proportion of 0.9% saline administration and was an independent predictor for hospital mortality. Moreover, the magnitude of sCl rise was inversely correlated to the days of patient survival. In conclusion, serum Cl alterations on admission predict poor clinical outcomes. Post-admission sCl increase, due to Cl-rich fluid infusion, independently predicts hospital mortality. These results raise a critical question of whether iatrogenic cause of hyperchloremia should be avoided, a question to be addressed by future prospective studies. PMID:28328963

  13. Shuttle flight experiment 30-day summary report

    NASA Technical Reports Server (NTRS)

    1985-01-01

    A total of 12 AFT training sessions were administered to SL 3 Payload Specialists over a 7 month period. Nine of these sessions were 2 hours in duration and three were 3 hours in duration. A total of three rotating chair tests were conducted in this time frame with four subjects. The performance of these crewmen across tests is shown. Test 1, a baseline motion sickness test, was conducted approximately 10 months prior to the mission, before any AFT was administered. Test 2 was administered after 2 hours of AFT, test 3 after 4 hours and test 4 after 6 hours (total) of training in symptom control. Improvement in performance is reflected by a subject's ability to tolerate a greater number of rotations across tests. Additional training for crewman was not possible within the constraints of the mission. Results of the mission indicate that, as predicted preflight, subject #32 was relatively symptom free inflight while subject #33 was not. Other preflight and postflight tests and analyses are reported.

  14. Knowledge of healthcare professionals about medication errors in hospitals

    PubMed Central

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Statistical Analysis Used: Data were analyzed with Statistical Package for the Social Sciences software Version 17. Results: A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. Conclusions: This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals. PMID:27330261

  15. 90-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality

    PubMed Central

    Mise, Yoshihiro; Vauthey, Jean-Nicolas; Zimmitti, Giuseppe; Parker, Nathan H.; Conrad, Claudius; Aloia, Thomas A.; Lee, Jeffery E.; Fleming, Jason B.; Katz, Matthew H. G.

    2015-01-01

    Objective To investigate the legitimacy of 90-day mortality as a measure of hepatopancreatobiliary quality. Summary Background Data The 90-day mortality rate has been increasingly but not universally reported after hepatopancreatobiliary surgery. The legitimacy of this definition as a measure of surgical quality has not been evaluated. Methods We retrospectively reviewed the causes of all deaths that occurred within 365 postoperative days in patients undergoing hepatectomy (n = 2811) and/or pancreatectomy (n = 1092) from January 1997 through December 2012. The rates of surgery-related, disease-related, and overall mortality within 30 days, within 30 days or during the index hospitalization, within 90 days, and within 180 days following surgery were calculated. Results Seventy-nine (3%) surgery-related deaths and 92 (3%) disease-related deaths occurred within 365 days after hepatectomy. Twenty (2%) surgery-related deaths and 112 (10%) disease-related deaths occurred within 365 days after pancreatectomy. The overall mortality rates at 99 day and 118 days optimally reflected surgery-related mortality following hepatobiliary and pancreatic operations, respectively. The 90-day overall mortality rate was a less sensitive but equivalently specific measure of surgery-related death. Conclusions and Relevance The 99-day and 118-day definitions of postoperative mortality optimally reflected surgery-related mortality following hepatobiliary and pancreatic operations, respectively. However, among commonly reported metrics, the 90-day overall mortality rate represents a legitimate measure of surgical quality. PMID:25590497

  16. Understanding Information about Mortality among People with Intellectual and Developmental Disabilities in Canada

    ERIC Educational Resources Information Center

    Ouellette-Kuntz, Hélène; Shooshtari, Shahin; Balogh, Robert; Martens, Patricia

    2015-01-01

    Background: This paper reviews what is currently known about mortality among Canadians with intellectual and developmental disabilities and describes opportunities for ongoing monitoring. Methods: In-hospital mortality among adults with intellectual and developmental disabilities in Ontario was examined using hospital data. Mortality was compared…

  17. Strategies and performance in hospitals.

    PubMed

    Madorrán García, Cristina; de Val Pardo, Isabel

    2004-01-01

    Today, more than ever in the past, the variables within the health care environment (demand, costs, system deregulation) are undergoing such rapid change that hospital administrators are finding it necessary to develop and implement competitive strategies in order to survive in the increasingly competitive hospital environment. The primary aim of this paper is to answer the following question: Is it possible to transfer strategic management research from other sectors into the hospital industry? The first objective was to identify strategies in hospital management. A questionnaire was designed and sent to hospital CEOs and the data extracted were used to construct the variables needed to identify strategies and perform the subsequent analyses. The second aim was to try to identify groups of organizations using similar strategies and, finally, analyse the impact of these on hospital performance.

  18. Vancomycin minimum inhibitory concentration, host comorbidities and mortality in Staphylococcus aureus bacteraemia.

    PubMed

    Holmes, N E; Turnidge, J D; Munckhof, W J; Robinson, J O; Korman, T M; O'Sullivan, M V N; Anderson, T L; Roberts, S A; Warren, S J C; Gao, W; Johnson, P D R; Howden, B P

    2013-12-01

    We reported an association between elevated vancomycin MIC and 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB), including patients with methicillin-susceptible S. aureus (MSSA) treated with flucloxacillin. A detailed analysis of comorbidities and disease severity scores in the same cohort of patients was performed to ascertain if unknown clinical parameters may have influenced these results. The association between elevated vancomycin MIC and 30-day mortality in SAB remained significant (p 0.001) on multivariable logistic regression analysis even when accounting for clinical factors. In addition, the association persisted when restricting analysis to patients with MSSA bacteraemia treated with flucloxacillin. This suggests that elevated vancomycin MIC is associated with but not causally linked to an organism factor that is responsible for increased mortality.

  19. The Effect of Cuts in Medicare Reimbursement on Hospital Mortality

    PubMed Central

    Seshamani, Meena; Schwartz, J Sanford; Volpp, Kevin G

    2006-01-01

    Objective To determine if patients treated at hospitals under different levels of financial strain from the Balanced Budget Act (BBA) of 1997 had differential changes in 30-day mortality, and whether vulnerable patient populations such as the uninsured were disproportionately affected. Data Source Hospital discharge data from all general acute care hospitals in Pennsylvania from 1997 to 2001. Study Design A multivariate regression analysis was performed retrospectively on 30-day mortality rates, using hospital discharge data, hospital financial data, and death certificate information from Pennsylvania. Data Collection We used 370,017 hospital episodes with one of four conditions identified by the Agency for Healthcare Research and Quality as inpatient quality indicators were extracted. Principal Findings The average magnitude of Medicare payment reduction on overall net revenues was estimated at 1.8 percent for hospitals with low BBA impact and 3.6 percent for hospitals with a high impact in 1998, worsening to 2 and 4.8 percent, respectively, by 2001. Operating margins decreased significantly over the time period for all hospitals (p<.05). While unadjusted mortality rates demonstrated a disproportionate rise in mortality for patients from high impact hospitals from 1997 to 2000, adjusted analyses show no consistent, significant difference in the rate of change in mortality between high-impact and low-impact hospitals (p = .04–.94). Similarly, uninsured patients did not experience greater increases in mortality in high-impact hospitals relative to low-impact hospitals. Conclusions An analysis of hospitalizations in the Commonwealth of Pennsylvania did not find an adverse impact of increased financial strain from the BBA on patient mortality either among all patients or among the uninsured. PMID:16704507

  20. In-hospital versus post discharge adverse events following carotid endarterectomy

    PubMed Central

    Fokkema, M; Bensley, RP; Lo, RC; Hamdan, AD; Wyers, MC; Moll, FL; de Borst, GJ; Schermerhorn, ML

    2013-01-01

    Introduction and objectives Most studies based on state and nation-wide registries evaluating perioperative outcome after carotid endarterectomy (CEA) rely on hospital discharge data only. Therefore, the true 30-day complication risk after carotid revascularization may be underestimated. Methods We used the National Surgical Quality Improvement Program (NSQIP) database 2005–2010 to assess the in-hospital and post discharge rate of any stroke, death, cardiac event (new Q-wave MI or cardiac arrest), combined stroke/death and combined adverse outcome (S/D/CE) at 30 days following CEA. Multivariable analyses were used to identify predictors for in-hospital and post discharge events separately, and in particular, those that predict post discharge events distinctly. Results A total of 35,916 patients who underwent CEA during 2005–2010 were identified in the NSQIP database. 59% were male (median age 72 years) and 44% had a previous neurologic event. Thirty-day stroke rate was 1.6% (n=591), death rate was 0.8% (n=272), cardiac event rate was 1.0% (n=350), stroke or death rate was 2.2% (n=794) and combined S/D/CE rate was 2.9% (n=1043). 33% of strokes, 53% of deaths, 32% of cardiac events, 40% of combined stroke/death and 38% of combined S/D/CE took place after hospital discharge. Patients with a prior stroke or TIA had similar proportions of post discharge events as compared to patients without prior symptoms. Independent predictors for post discharge events, but not for in-hospital events were female gender (stroke [OR 1.6, 95% CI 1.2–2.1] and stroke/death [OR 1.4, 95% CI 1.1–1.7]), renal failure (stroke [OR 3.0, 95% CI 1.4–6.2]) and COPD (stroke/death [OR 1.8, 95% CI 1.4–2.4] and S/D/CE [OR 1.8, 95% CI 1.4–2.3]). Conclusions With 38% of perioperative adverse events after CEA happening post hospitalization, regardless of symptoms status, we need to be alert to the ongoing risks after discharge particularly in women, patients with renal failure, or a history

  1. Association between Interleukin-6 Promoter Polymorphism (-174 G/C), Serum Interleukin-6 Levels and Mortality in Severe Septic Patients

    PubMed Central

    Lorente, Leonardo; Martín, María M.; Pérez-Cejas, Antonia; Barrios, Ysamar; Solé-Violán, Jordi; Ferreres, José; Labarta, Lorenzo; Díaz, César; Jiménez, Alejandro

    2016-01-01

    The association between interleukin (IL)-6 promoter polymorphism (-174 G/C), circulating IL-6 levels and mortality in septic patients has scarcely been addressed, and then only in studies of small sample size, and a direct association among them has not been previously reported. Therefore, the purpose of our study was to determine whether this association exists. An observational, prospective and multicenter study including severe septic patients was undertaken and serum IL-6 levels at severe sepsis diagnosis and IL-6 promoter polymorphism (-174 G/C) were determined. The end-point of the study was 30-day mortality. The study included 263 patients with the following genotypes of IL-6 promoter polymorphism (-174 G/C): 123 (46.8%) GG, 110 (41.8%) GC and 30 (11.4%) CC. CC homozygous patients showed lower sepsis-related organ failure assessment (SOFA) score, serum IL-6 levels and mortality at 30 days compared to those with other genotypes (GC or GG). On regression analysis, CC homozygous patients showed lower 30-day mortality than those with genotype GG (odds ratio = 0.21; 95% CI = 0.053−0.838; p = 0.03) or GC (hazard ratio = 0.28; 95% CI = 0.074−1.037; p = 0.06). The most important results of our study were that CC might be a favorable genotype in septic patients showing lower serum IL-6 levels and lower risk of death within 30 days. PMID:27834822

  2. Association between body mass index and in-hospital outcomes

    PubMed Central

    Akinyemiju, Tomi; Meng, Qingrui; Vin-Raviv, Neomi

    2016-01-01

    Abstract Importance: Over one-third of American adults (36%) are obese and more than two-thirds (69%) are overweight. The impact of obesity on hospitalization outcomes is not well understood. Objective: To examine the association between body mass index (BMI) and overall, cancer, chronic obstructive pulmonary disease (COPD), asthma, and cardiovascular disease (CVD)-specific in-hospital mortality; postsurgical complications; and hospital length of stay (LOS). Design: Cross-sectional study. Setting: Representative sample of US hospitals included in the Health Cost and Utilization Project Nationwide Inpatient Sample database. Participants: We obtained data for patients admitted with a primary diagnosis of cancer, COPD, asthma, and CVD. Main Outcome: In-hospital mortality, postsurgical complications, and hospital LOS. Results: A total of 800,417 patients were included in this analysis. A higher proportion of Blacks (26.8%; 12.5%) and Whites (23.3%; 8.7%) had BMI of 40 to 49.9 and ≥50, respectively, compared with Hispanics (20.4%; 7.3%). Compared with normal BMI patients, the odds of in-hospital mortality increased 3.6-fold (odds ratio [OR] 3.62, 95% confidence interval [CI]: 3.37–3.89) for preobese patients, 6.5-fold (OR: 6.52, 95% CI: 5.79–7.34) for patients with BMI: 30 to 31.9, 7.5-fold (OR: 7.57, 95% CI: 6.67–8.59) for patients with BMI: 34 to 35.9, and 1.6- fold (OR: 1.77, 95% CI: 1.56–1.79) for patients with BMI ≥ 50. Compared with normal BMI patients, preobese and overweight patients had shorter hospital stays (β preobese: −1.58, 95% CI: −1.63, −1.52); however, no clear trends were observed for postsurgical complications. Conclusions: The majority of hospitalized patients in this analysis had a BMI > 30, and higher BMI was associated with increased risk of mortality and longer hospital stay. PMID:27428218

  3. Air Pollution and Deaths among Elderly Residents of São Paulo, Brazil: An Analysis of Mortality Displacement

    PubMed Central

    Costa, Amine Farias; Hoek, Gerard; Brunekreef, Bert; Ponce de Leon, Antônio C.M.

    2016-01-01

    Background: Evaluation of short-term mortality displacement is essential to accurately estimate the impact of short-term air pollution exposure on public health. Objectives: We quantified mortality displacement by estimating single-day lag effects and cumulative effects of air pollutants on mortality using distributed lag models. Methods: We performed a daily time series of nonaccidental and cause-specific mortality among elderly residents of São Paulo, Brazil, between 2000 and 2011. Effects of particulate matter smaller than 10 μm (PM10), nitrogen dioxide (NO2) and carbon monoxide (CO) were estimated in Poisson generalized additive models. Single-day lag effects of air pollutant exposure were estimated for 0-, 1- and 2-day lags. Distributed lag models with lags of 0–10, 0–20 and 0–30 days were used to assess mortality displacement and potential cumulative exposure effects. Results: PM10, NO2 and CO were significantly associated with nonaccidental and cause-specific deaths in both single-day lag and cumulative lag models. Cumulative effect estimates for 0–10 days were larger than estimates for single-day lags. Cumulative effect estimates for 0–30 days were essentially zero for nonaccidental and circulatory deaths but remained elevated for respiratory and cancer deaths. Conclusions: We found evidence of mortality displacement within 30 days for nonaccidental and circulatory deaths in elderly residents of São Paulo. We did not find evidence of mortality displacement within 30 days for respiratory or cancer deaths. Citation: Costa AF, Hoek G, Brunekreef B, Ponce de Leon AC. 2017. Air pollution and deaths among elderly residents of São Paulo, Brazil: an analysis of mortality displacement. Environ Health Perspect 125:349–354; http://dx.doi.org/10.1289/EHP98 PMID:27713111

  4. Beyond volume: hospital-based healthcare technology as a predictor of mortality for cardiovascular patients in Korea.

    PubMed

    Kim, Jae-Hyun; Lee, Yunhwan; Park, Eun-Cheol

    2016-06-01

    To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.This study used the National Health Insurance Service-Cohort Sample Database from 2002 to 2013, which was released by the Korean National Health Insurance Service. A total of 11,109 cardiovascular surgical procedure patients were analyzed. The primary analysis was based on logistic regression models to examine our hypothesis.After adjusting for hospital volume of cardiovascular surgical procedures as well as for all other confounders, the odds ratio (OR) of 30-day mortality in low healthcare technology hospitals was 1.567-times higher (95% confidence interval [CI] = 1.069-2.297) than in those with high healthcare technology. We also found that, overall, cardiovascular surgical patients treated in low healthcare technology hospitals, regardless of the extent of cardiovascular surgical procedures, had the highest 30-day mortality rate.Although the results of our study provide scientific evidence for a hospital volume-mortality relationship in cardiovascular surgical patients, the independent effect of hospital-based healthcare technology is strong, resulting in a lower mortality rate. As hospital characteristics such as clinical pathways and protocols are likely to also play an important role in mortality, further research is required to explore their respective contributions.

  5. Physician Alerts to Prevent Symptomatic Venous Thromboembolism in Hospitalized Patients

    PubMed Central

    Piazza, Gregory; Rosenbaum, Erin J.; Pendergast, William; Jacobson, Joseph O.; Pendleton, Robert C.; McLaren, Gordon D.; Elliott, C. Gregory; Stevens, Scott M.; Patton, William F.; Dabbagh, Ousama; Paterno, Marilyn D.; Catapane, Elaine; Li, Zhongzhen; Goldhaber, Samuel Z.

    2010-01-01

    Background Venous thromboembolism (VTE) prophylaxis remains underutilized among hospitalized patients. We designed and carried out a large multicenter randomized controlled trial to test the hypothesis that an alert from a hospital staff member to the Attending Physician will reduce the rate of symptomatic VTE among high-risk patients not receiving prophylaxis. Methods and Results We enrolled patients using a validated point score system to detect hospitalized patients at high risk for symptomatic VTE who were not receiving prophylaxis. 2,493 patients (82% on Medical Services) from 25 study sites were randomized to the intervention group (n=1,238), in which the responsible physician was alerted by another hospital staff member, versus the control group (n=1,255), in which no alert was issued. The primary end point was symptomatic, objectively confirmed VTE within 90 days. Patients whose physicians were alerted were more than twice as likely to receive VTE prophylaxis as controls (46.0% versus 20.6%, p<0.0001). The symptomatic VTE rate was lower in the intervention group (2.7% versus 3.4%; hazard ratio, 0.79; 95% confidence interval, 0.50 to 1.25), but the difference did not achieve statistical significance. The rate of major bleeding at 30 days in the alert group was similar to the control group (2.1% versus 2.3%, p=0.68). Conclusions A strategy of direct staff member to physician notification increases prophylaxis utilization and leads toward reducing the rate of symptomatic VTE in hospitalized patients. However, VTE prophylaxis continues to be underutilized even after physician notification, especially among Medical Service patients. PMID:19364975

  6. Sex differences in hospital readmission among colorectal cancer patients

    PubMed Central

    Gonzalez, J. R.; Fernandez, E.; Moreno, V.; Ribes, J.; Peris, M.; Navarro, M.; Cambray, M.; Borras, J. M.

    2005-01-01

    Background: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. Objective: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. Design: Prospective cohort study. Setting: Hospital Universitary in L'Hospitalet (Barcelona, Spain). Participants: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and methods: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. Results: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes's stage, mortality, and Charlson's index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). Conclusions: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients. PMID:15911648

  7. Mortality table construction

    NASA Astrophysics Data System (ADS)

    Sutawanir

    2015-12-01

    Mortality tables play important role in actuarial studies such as life annuities, premium determination, premium reserve, valuation pension plan, pension funding. Some known mortality tables are CSO mortality table, Indonesian Mortality Table, Bowers mortality table, Japan Mortality table. For actuary applications some tables are constructed with different environment such as single decrement, double decrement, and multiple decrement. There exist two approaches in mortality table construction : mathematics approach and statistical approach. Distribution model and estimation theory are the statistical concepts that are used in mortality table construction. This article aims to discuss the statistical approach in mortality table construction. The distributional assumptions are uniform death distribution (UDD) and constant force (exponential). Moment estimation and maximum likelihood are used to estimate the mortality parameter. Moment estimation methods are easier to manipulate compared to maximum likelihood estimation (mle). However, the complete mortality data are not used in moment estimation method. Maximum likelihood exploited all available information in mortality estimation. Some mle equations are complicated and solved using numerical methods. The article focus on single decrement estimation using moment and maximum likelihood estimation. Some extension to double decrement will introduced. Simple dataset will be used to illustrated the mortality estimation, and mortality table.

  8. Comparative evaluation of honey, chlorhexidine gluconate (0.2%) and combination of xylitol and chlorhexidine mouthwash (0.2%) on the clinical level of dental plaque: A 30 days randomized control trial

    PubMed Central

    Jain, Ankita; Bhaskar, Dara John; Gupta, Devanand; Agali, Chandan; Gupta, Vipul; Gupta, Rajendra Kumar; Yadav, Priyanka; Lavate, Akash B.; Chaturvedi, Mudita

    2015-01-01

    Aim: To compare the effect of honey, chlorhexidine mouthwash and combination of xylitol chewing gum and chlorhexidine mouthwash on the dental plaque level. Materials and Methods: Ninety healthy dental students, both male and female, aged between 21 to 25 years participated in the study. The subjects were randomly divided into three groups, i.e. the honey group, the chlorhexidine gluconate mouthwash group and the combination of xylitol chewing gum and chlorhexidine (CHX) mouthwash group. The data was collected at the baseline, 15th day and 30th day; the plaque was disclosed using disclosing solution and their scores were recorded at six sites per tooth using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Statistical analysis was carried out later to compare the effect of all the three groups. P ≤ 0.05 was considered as statistically significant. Results: Our result showed that all the three groups were effective in reducing the plaque but post-hoc LSD (Least Significant Difference) showed that honey group and chlorhexidine + xylitol group were more effective than chlorhexidine group alone. The results demonstrated a significant reduction of plaque indices in honey group and chlorhexidine + xylitol group over a period of 15 and 30 days as compared to chlorhexidine. PMID:25657903

  9. Therapy of acute hypertension in hospitalized children and adolescents.

    PubMed

    Webb, Tennille N; Shatat, Ibrahim F; Miyashita, Yosuke

    2014-04-01

    Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.

  10. Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

    PubMed

    Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

    2015-01-01

    Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

  11. Metabonomics Analysis of Plasma Reveals the Lactate to Cholesterol Ratio as an Independent Prognostic Factor of Short-Term Mortality in Acute Heart Failure

    PubMed Central

    Desmoulin, Franck; Galinier, Michel; Trouillet, Charlotte; Berry, Matthieu; Delmas, Clément; Turkieh, Annie; Massabuau, Pierre; Taegtmeyer, Heinrich; Smih, Fatima; Rouet, Philippe

    2013-01-01

    Objective Mortality in heart failure (AHF) remains high, especially during the first days of hospitalization. New prognostic biomarkers may help to optimize treatment. The aim of the study was to determine metabolites that have a high prognostic value. Methods We conducted a prospective study on a training cohort of AHF patients (n = 126) admitted in the cardiac intensive care unit and assessed survival at 30 days. Venous plasmas collected at admission were used for 1H NMR–based metabonomics analysis. Differences between plasma metabolite profiles allow determination of discriminating metabolites. A cohort of AHF patients was subsequently constituted (n = 74) to validate the findings. Results Lactate and cholesterol were the major discriminating metabolites predicting 30-day mortality. Mortality was increased in patients with high lactate and low total cholesterol concentrations at admission. Accuracies of lactate, cholesterol concentration and lactate to cholesterol (Lact/Chol) ratio to predict 30-day mortality were evaluated using ROC analysis. The Lact/Chol ratio provided the best accuracy with an AUC of 0.82 (P < 0.0001). The acute physiology and chronic health evaluation (APACHE) II scoring system provided an AUC of 0.76 for predicting 30-day mortality. APACHE II score, Cardiogenic shock (CS) state and Lact/Chol ratio ≥ 0.4 (cutoff value with 82% sensitivity and 64% specificity) were significant independent predictors of 30-day mortality with hazard ratios (HR) of 1.11, 4.77 and 3.59, respectively. In CS patients, the HR of 30-day mortality risk for plasma Lact/Chol ratio ≥ 0.4 was 3.26 compared to a Lact/Chol ratio of < 0.4 (P  =  0.018). The predictive power of the Lact/Chol ratio for 30-day mortality outcome was confirmed with the independent validation cohort. Conclusion This study identifies the plasma Lact/Chol ratio as a useful objective and simple parameter to evaluate short term prognostic and could be integrated into quantitative

  12. Challenge of Fetal Mortality

    MedlinePlus

    ... Mortality Series 21. Data on Natality, Marriage, and Divorce Series 22. Data from the National Natality and ... Compilations of Data on Natality, Mortality, Marriage, and Divorce Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard ...

  13. A propensity score analysis shows that empirical treatment with linezolid does not increase the thirty-day mortality rate in patients with Gram-negative bacteremia.

    PubMed

    Ternavasio-de la Vega, Hugo-Guillermo; Mateos-Díaz, Ana-María; Martinez, Jose-Antonio; Almela, Manel; Cobos-Trigueros, Nazaret; Morata, Laura; De-la-Calle, Cristina; Sala, Marta; Mensa, Josep; Marcos, Miguel; Soriano, Alex

    2014-12-01

    The role of linezolid in empirical therapy of suspected bacteremia remains unclear. The aim of this study was to evaluate the influence of empirical use of linezolid or glycopeptides in addition to other antibiotics on the 30-day mortality rates in patients with Gram-negative bacteremia. For this purpose, 1,126 patients with Gram-negative bacteremia in the Hospital Clinic of Barcelona from 2000 to 2012 were included in this study. In order to compare the mortality rates between patients who received linezolid or glycopeptides, the propensity scores on baseline variables were used to balance the treatment groups, and both propensity score matching and propensity-adjusted logistic regression were used to compare the 30-day mortality rates between the groups. The overall 30-day mortality rate was 16.0% during the study period. Sixty-eight patients received empirical treatment with linezolid, and 1,058 received glycopeptides. The propensity score matching included 64 patients in each treatment group. After matching, the mortality rates were 14.1% (9/64) in patients who received glycopeptides and 21.9% (14/64) in those who received linezolid, and a nonsignificant association between empirical linezolid treatment and mortality rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.69 to 3.82; P = 0.275, McNemar's test) was found. This association remained nonsignificant when variables that remained unbalanced after matching were included in a conditional logistic regression model. Further, the stratified propensity score analysis did not show any significant relationship between empirical linezolid treatment and the mortality rate after adjustment by propensity score quintiles or other variables potentially associated with mortality. In conclusion, the propensity score analysis showed that empirical treatment with linezolid compared with that with glycopeptides was not associated with 30-day mortality rates in patients with Gram-negative bacteremia.

  14. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    PubMed Central

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-01-01

    Background and purpose Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25–0.91) and by 46% (HR =0.54, 95% CI: 0.35–0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise. PMID:27088484

  15. Race and Mortality.

    ERIC Educational Resources Information Center

    Scanlan, James P.

    2000-01-01

    Discusses increasing racial and socioeconomic disparities in mortality despite general declines in mortality, examining disparities in infant mortality and explaining that whenever two groups differ in their susceptibility to some condition, the less prevalent the condition, the greater will be the disparity in rates of experiencing the condition.…

  16. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    PubMed Central

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  17. Association between Serum Malondialdehyde Levels and Mortality in Patients with Severe Brain Trauma Injury

    PubMed Central

    Martín, María M.; Abreu-González, Pedro; Ramos, Luis; Argueso, Mónica; Cáceres, Juan J.; Solé-Violán, Jordi; Lorenzo, José M.; Molina, Ismael; Jiménez, Alejandro

    2015-01-01

    Abstract There is a hyperoxidative state in patients with trauma brain injury (TBI). Malondialdehyde (MDA) is an end-product formed during oxidative stress, concretely lipid peroxidation. In small studies (highest sample size 50 patients), higher levels of MDA have been found in nonsurviving than surviving patients with TBI. An association between serum MDA levels and mortality in patients with TBI, however, has not been reported. Thus, the objective of this prospective, observational, multicenter study, performed in six Spanish intensive care units, was to determine whether MDA serum levels are associated with early mortality in a large series of patients with severe TBI. Serum MDA levels were measured in 100 patients with severe TBI on day 1 and in 75 healthy controls. The end-point of the study was 30-day mortality. We found higher serum MDA levels in patients with severe TBI than in healthy controls (p<0.001). Nonsurviving patients with TBI (n=27) showed higher serum MDA levels (p<0.001) than survivors (n=73). Logistic regression analysis showed that serum MDA levels were associated with 30-day mortality (odds ratio [OR]=4.662; 95% confidence interval [CI]=1.466–14.824; p=0.01), controlling for Glasgow Coma Score, age, and computed tomography findings. Survival analysis showed that patients with serum MDA levels higher than 1.96 nmol/mL presented increased 30-day mortality than patients with lower levels (hazard ratio=3.5; 95% CI=1.43–8.47; p<0.001). Thus, the most relevant new finding of our study, the largest to date on serum MDA levels in patients with severe TBI, was an association between serum MDA levels and early mortality. PMID:25054973

  18. Cumulative lactate and hospital mortality in ICU patients

    PubMed Central

    2013-01-01

    Background Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. Methods Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied. Results A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0–1881] min·mmol/L) and time-to-first normalization (44.0 [0–427] min) were higher than in hospital survivors (n = 1846; 0 [0–134] min·mmol/L and 0 [0–75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36). Conclusions Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold. PMID:23446002

  19. The association of subclinical hypocalcemia, negative energy balance and disease with bodyweight change during the first 30 days post-partum in dairy cows milked with automatic milking systems.

    PubMed

    Caixeta, L S; Ospina, P A; Capel, M B; Nydam, D V

    2015-05-01

    In a prospective cohort study, the daily bodyweight (BW) and milk production of 92 cows were recorded using automatic milking systems. The objectives were to characterize calcium serum concentration variability on days 1-3 post-partum and to evaluate the association between subclinical hypocalcemia (SHPC) and change in BW over the first 30 days in milk (DIM) in Holstein dairy cows, while controlling for concurrent disease and negative energy balance (NEB). SHPC was defined as total serum calcium concentration between 6 and 8 mg/dL, NEB was defined as non-esterified fatty acids (NEFA) > 0.7 mEq/L or β-hydroxybutyrate (BHB) ≥ 1.2 mmol/L. The peak incidence of SHPC was at 1 DIM for all groups (11%, 42% and 60% for parities 1, 2, and ≥3, respectively). All parity groups lost weight (21, 33, and 34 kg) during the first 30 DIM. Parity 1 animals with disease compared with those without disease lost the most weight (2.6 kg/day BW loss vs. <1.9 kg/day, respectively). Normocalcemic parity 2 animals with either NEB or disease lost the most weight (>5 kg/day) compared with those in the SHPC group (≤4.5 kg/day). In parity ≥ 3 animals, SHPC was an important factor for BW loss; SHPC animals lost the most weight (>3.7 kg/day) vs. normocalcemic cows (≤3.3 kg/day) regardless of NEB or disease status. Even though all animals lost weight during early lactation the effect of disease, NEB, and SHPC on BW loss was different in each parity group.

  20. The 2013 German-Russian Bion-M1 Joint Flight Project: Altered cAMP/PKA Signaling Pathway in Skeletal Muscle during Exposure to Real Microgravity in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Salanova, Michele; Blottner, Dieter; Shenkman, Boris S.; Lomonosova, Yulia

    Exposure to real microgravity (muG) results in an impaired skeletal muscle structure and function. We here hypothesized that the cAMP/PKA cell signaling pathway, which triggers a multitude of intracellular effects in response to a variety of extracellular stimuli and which further promote muscle growth, play an important role during Spaceflight- induced disuse atrophy. Particularly, we hypothesized that different effectors of the cAMP-PKA signaling machinery, which are highly compartmentalized into subcellular functional microdomains in order to guarantee signal specificity, are altered after long term exposure to real µG. Taking advantage of the Bion-M1 Spaceflight program which provided us an excellent opportunity to explore mice skeletal muscle exposed for 30 days to real µG, by investigating at the cAMP-dependent protein kinase A (PKA) subcellular localization we compared muscle soleus (SOL) and extensor digitorum longus (EDL) of C57/black mice of a Bion-flight (n=5) group with a Bion-ground control (n=5) group and a ground control (n=5) group which was housed in a standard cage considered as vivarium control. Preliminary results of our experiments showed that different cAMP-PKA micro pools were normally detectable using high-resolution images of immunofluorescence experiments in different subcellular compartments of both SOL and EDL of Bion-ground and ground control groups which were not any longer detectable in Bion-flight group. In summary, our data indicate that an efficient organization in microdomains of the cAMP/PKA pathway may exist in skeletal muscle on ground and that such compartmentalization may be altered in response to prolonged exposure to real muG. National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121 to DB); Contract RAS-IMPB/Charité Berlin # Bion-M1/2013

  1. Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

    PubMed Central

    Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

    2017-01-01

    Introduction Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe. PMID:28344618

  2. Intracerebral hemorrhage mortality is not changing despite declining incidence

    PubMed Central

    Lisabeth, Lynda D.; Sánchez, Brisa N.; Smith, Melinda A.; Brown, Devin L.; Garcia, Nelda M.; Skolarus, Lesli E.; Meurer, William J.; Burke, James F.; Adelman, Eric E.; Morgenstern, Lewis B.

    2014-01-01

    Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. Methods: We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease. Results: A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was −31% (95% CI −47%, −11%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time. Conclusions: ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death. PMID:24838789

  3. Disbalance between mortality and non-fatal vascular events in the CHAMPION-PHOENIX trial: the cangrelor efficacy challenge.

    PubMed

    Serebruany, Victor L; Pokov, Alex N; Fortmann, Seth D; DiNicolantonio, James J

    2014-01-01

    The recently published, largest trial with cangrelor, the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION)-PHOENIX, suggested that the experimental agent significantly reduced the rate of stent thrombosis (ST) and myocardial infarction (MI) during PCI at 48 hours (h) and 30 days. However, the declared impressive cangrelor vascular non-fatal benefit was contradicted by identical deaths at 48 h, and a trend toward excess mortality at 30 days. We analysed the mismatch between outcomes in the CHAMPION-PHOENIX trial. The trial reported identical mortality (18 death in each arm; odds ratio [OR] 1.00 (0.52-1.92); p>0.999) at 48 h, but more deaths, 60 vs 55, after cangrelor at 30 days. There was a significant reduction of ST from 0.8% (n=46) of the patients in the cangrelor group versus 1.4% (n=74) in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; p= 0.01) at 48 h, and a persistent but less impressive ST prevention benefit OR of 0.68 (0.50=0.92, p = 0.01) at 30 days. There were also 48 less MI's following cangrelor usage enforced by a significant difference (odds ratio 0.80 (0.67-0.97) p = 0.02), which was also less prevalent at 30 days (OR 0.82 (0.68-0.98), p = 0.03). The reported ST/MI advantage should result in at least a trend towards numerically less deaths after cangrelor at 30 days follow-up, which was opposite of the results reported in CHAMPION-PHOENIX trial. Efficacy of cangrelor is challenged by the disproportional "reduction" of ST and MI conflicting with identical mortality at 48 h and worsened at day 30 fatalities. The dissociation between vascular mortality and non-fatal vascular ischaemic occlusions, unless compensated by some other unreported cause(s) of death, should be explored and explained. Unadjudicated 30-day outcomes, and all ST types should be fully disclosed. The ongoing FDA cangrelor review should focus on appropriate event count and/or possible mismatch between site-reported and

  4. Nighttime Intensivist Staffing and Mortality among Critically Ill Patients

    PubMed Central

    Wallace, David J.; Angus, Derek C.; Barnato, Amber E.; Kramer, Andrew A.; Kahn, Jeremy M.

    2014-01-01

    BACKGROUND Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown. METHODS We conducted a retrospective cohort study involving ICUs that participated in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010, linking a survey of ICU staffing practices with patient-level outcomes data from adult ICU admissions. Multivariate models were used to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix. We conducted a confirmatory analysis in a second, population-based cohort of hospitals in Pennsylvania from which less detailed data were available. RESULTS The analysis with the use of the APACHE database included 65,752 patients admitted to 49 ICUs in 25 hospitals. In ICUs with low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for death, 0.62; P = 0.04). Among ICUs with high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect to risk-adjusted in-hospital mortality (odds ratio, 1.08; P = 0.78). In the verification cohort, there was a similar relationship among daytime staffing, nighttime staffing, and in-hospital mortality. The interaction between nighttime staffing and daytime staffing was not significant (P = 0.18), yet the direction of the findings were similar to those in the APACHE cohort. CONCLUSIONS The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing. (Funded by the

  5. [Training concepts for in-hospital emergencies].

    PubMed

    Fritzsche, Katrin; Jantzen, Tanja; Rüsseler, Miriam; Müller, Michael P

    2013-06-01

    In this manuscript training concepts, which help us to manage in-hospital emergency situations adequately, are described. International courses such as the Basic Life Support Course and the Advanced Life Support Course of the ERC are introduced. Recently the European Trauma Course has been established; technical and non-technical skills, which are necessary to treat traumatised patients, are taught in this course. The quality of the medical emergency team in the hospital should be monitored to find deficits and to improve teaching. The use of the new in-hospital emergency chart and participation in the new emergency register of the DGAI may be helpful.

  6. An inquiry - aesthetics of art in hospitals.

    PubMed

    Gates, Jillian

    2008-09-01

    Historically, art has served a significant purpose within hospital waiting rooms. However, in recent times we have experienced cuts in funding and less interest in improving the aesthetic of art displayed in Australian hospitals. This article briefly discusses the history of art in hospitals and explores a methodology for researching the preference of Australian patients today. Potentially, Australians waiting in hospitals and medical clinics could benefit from art works that reflect their preferences; this may help to ease the pain, anxiety, and boredom of waiting.

  7. Cancer mortality in Brazil

    PubMed Central

    Barbosa, Isabelle R.; de Souza, Dyego L.B.; Bernal, María M.; Costa, Íris do C.C.

    2015-01-01

    Abstract Cancer is currently in the spotlight due to their heavy responsibility as main cause of death in both developed and developing countries. Analysis of the epidemiological situation is required as a support tool for the planning of public health measures for the most vulnerable groups. We analyzed cancer mortality trends in Brazil and geographic regions in the period 1996 to 2010 and calculate mortality predictions for the period 2011 to 2030. This is an epidemiological, demographic-based study that utilized information from the Mortality Information System on all deaths due to cancer in Brazil. Mortality trends were analyzed by the Joinpoint regression, and Nordpred was utilized for the calculation of predictions. Stability was verified for the female (annual percentage change [APC] = 0.4%) and male (APC = 0.5%) sexes. The North and Northeast regions present significant increasing trends for mortality in both sexes. Until 2030, female mortality trends will not present considerable variations, but there will be a decrease in mortality trends for the male sex. There will be increases in mortality rates until 2030 for the North and Northeast regions, whereas reductions will be verified for the remaining geographic regions. This variation will be explained by the demographic structure of regions until 2030. There are pronounced regional and sex differences in cancer mortality in Brazil, and these discrepancies will continue to increase until the year 2030, when the Northeast region will present the highest cancer mortality rates in Brazil. PMID:25906105

  8. Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure.

    PubMed

    Carazo, Matthew; Sadarangani, Tina; Natarajan, Sundar; Katz, Stuart D; Blaum, Caroline; Dickson, Victoria Vaughan

    2016-08-15

    Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

  9. Epidemiology of Acute Pancreatitis in Hospitalized Children in the United States from 2000–2009

    PubMed Central

    Pant, Chaitanya; Deshpande, Abhishek; Olyaee, Mojtaba; Anderson, Michael P.; Bitar, Anas; Steele, Marilyn I.; Bass, Pat F.; Sferra, Thomas J.

    2014-01-01

    Background Single-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States. Methods We used the Healthcare Cost and Utilization Project Kids’ Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions. Results We identified 55,012 cases of AP in hospitalized children (1–20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78–0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40–2.46), and higher charges (aOR 1.62, 95% CI, 1.59–1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP. Conclusions These results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity. PMID

  10. Forecasting Flooding in the Brahmaputra and Ganges Delta of Bangladesh on Short (1-10 days), Medium (20-30 days) and Seasonal Time Scales (1-6 months)

    NASA Astrophysics Data System (ADS)

    Webster, P. J.; Hoyos, C. D.; Hopson, T. M.; Chang, H.; Jian, J.

    2007-12-01

    Following the devastating flood years of 1998 during which 60% of Bangladesh was under water for a period of 3 months, the Climate Forecast Applications in Bangladesh (CFAB) project was formed with funding by USAID and NSF which eventually resulted in a joint project with the European Centre for Medium Range Weather Forecasting (ECMWF), the Asian Disaster Preparedness Centre (ADPC) and the Bangladesh Flood Forecasting and Warning Centre. The project was organized and developed through the Georgia Institute of Technology. The aim of CFAB was to develop innovative methods of extending the warning of flooding in Bangladesh noting that there was a unique problem: India provided no upstream discharge data to Bangladesh so that before CFAB the maximum lead time of a forecast was that given by measuring river discharge at the India-Bangladesh border: no lead-time at the border and 2 days in the southern parts of the country. Given that the Brahmaputra and Ganges catchment areas had to be regarded as essentially unguaged, it was clear that innovative techniques had to be developed. On of the basic criterion was that the system should provide probabilistic forecasts in order for the Bangladeshis to assess risk. A three-tier system was developed to allow strategic and tactical decisions to be made for agricultural purposes and disaster mitigation: seasonal (1-6 months: strategic), medium range (20-30 days: strategic/tactical) and short range (1-10 days: tactical). The system that has been developed brings together for the first time operational meteorological forecasts (ensemble forecasts from ECMWF), with satellite and discharge data and a suite of hydrological models. In addition, with ADPC and FFWC we have developed an in-country forecast dispersion system that allows a rapid dissemination. The system has proven to be rather successful, especially in the short range. The flooding events of 2004 were forecast with all forecasting tiers at the respective lead time. In

  11. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study

    PubMed Central

    Walsh, Michael; Devereaux, P J; MacNeil, S Danielle; Lam, Ngan N; Hildebrand, Ainslie M; Acedillo, Rey R; Mrkobrada, Marko; Chow, Clara K; Lee, Vincent W; Thabane, Lehana; Garg, Amit X

    2017-01-01

    Introduction The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. Methods and analysis The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. Ethics and dissemination The research ethics board at each site approved the VISION protocol prior to recruitment. We will

  12. Association between day of the week of elective surgery and postoperative mortality

    PubMed Central

    Dubois, Luc; Vogt, Kelly; Vinden, Chris; Winick-Ng, Jennifer; McClure, J. Andrew; Roshanov, Pavel S.; Bell, Chaim M.; Garg, Amit X.

    2017-01-01

    BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5–8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97–1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place. PMID:27754897

  13. Serum Malondialdehyde Levels in Patients with Malignant Middle Cerebral Artery Infarction Are Associated with Mortality

    PubMed Central

    Lorente, Leonardo; Martín, María M.; Abreu-González, Pedro; Ramos, Luis; Argueso, Mónica; Solé-Violán, Jordi; Riaño-Ruiz, Marta; Jiménez, Alejandro

    2015-01-01

    Objective Malondialdehyde (MDA) is an end-product formed during lipid peroxidation, due to degradation of cellular membrane phospholipids. MDA is released into extracellular space and finally into the blood; it has been used as an effective biomarker of lipid oxidation. High circulating levels of MDA have been previously described in patients with ischemic stoke than in controls, and an association between circulating MDA levels and neurological functional outcome in patients with ischemic stoke. However, an association between serum MDA levels and mortality in patients with ischemic stroke has not been previously reported, and that was the objective of this study. Methods Observational, prospective and multicenter study performed in six Intensive Care Units. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as Glasgow Coma Scale (GCS) lower than 9. We measured serum MDA levels in 50 patients with severe MMCAI at the time of diagnosis and in 100 healthy subjects. Mortality at 30 days was the end point of the study. Results We found that patients with severe MMCAI showed higher serum MDA levels than healthy subjects (p<0.001). We found higher serum MDA levels (p<0.001) in non-surviving MMCAI patients (n=26) than in survivors (n=24). The area under the curve for prediction of 30-day mortality for serum MDA levels was 0.77 (95% CI = 0.63-0.88; p<0.001). Serum MDA levels >2.27 nmol/mL were associated with 30-day mortality (OR=7.23; 95% CI=1.84-28.73; p=0.005) controlling for GCS and age on multiple binomial logistic regression analysis. Conclusions To our knowledge, this is the first study showing that serum malondialdehyde levels in patients with MMCAI are associated with early mortality. PMID:25933254

  14. On forecasting mortality.

    PubMed

    Olshansky, S J

    1988-01-01

    Official forecasts of mortality made by the U.S. Office of the Actuary throughout this century have consistently underestimated observed mortality declines. This is due, in part, to their reliance on the static extrapolation of past trends, an atheoretical statistical method that pays scant attention to the behavioral, medical, and social factors contributing to mortality change. A "multiple cause-delay model" more realistically portrays the effects on mortality of the presence of more favorable risk factors at the population level. Such revised assumptions produce large increases in forecasts of the size of the elderly population, and have a dramatic impact on related estimates of population morbidity, disability, and health care costs.

  15. Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome.

    PubMed

    Lown, Mark T; Munyombwe, Theresa; Harrison, Wendy; West, Robert M; Hall, Christiana A; Morrell, Christine; Jackson, Beryl M; Sapsford, Robert J; Kilcullen, Niamh; Pepper, Christopher B; Batin, Phil D; Hall, Alistair S; Gale, Chris P

    2012-02-01

    Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.

  16. Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

    PubMed Central

    Kim, Elizabeth W.; Teague-Ross, Terri J.; Greenfield, William W.; Williams, D. Keith; Kuo, Dennis; Hall, Richard W.

    2014-01-01

    OBJECTIVES We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth-weight (VLBW, <1500 grams) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality. STUDY DESIGN This prospective study used obstetrical and neonatal interventions through TM consults, education, and census rounds with 9 hospitals from July 1, 2009 – March 31, 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality, and morbidity before and after TM use. Arkansas Health Department data and chi square analysis were used to compare infant mortality. RESULTS Deliveries of VLBW neonates in targeted hospitals decreased from 13.1% to 7.0% (p=0.0099); deliveries of VLBW neonates in remaining hospitals was unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (p=0.043). CONCLUSIONS TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.. PMID:23579490

  17. Valve surgery in octogenarians: In-hospital and long-term outcomes

    PubMed Central

    Bossone, Eduardo; Di Benedetto, Giuseppe; Frigiola, Alessandro; Carbone, Giannignazio Luigi; Panza, Antonello; Cirri, Silvia; Ballotta, Andrea; Messina, Stefano; Rega, Saverio; Citro, Rodolfo; Trimarchi, Santi; Fang, Jianming; Righini, Paolo; Distante, Alessandro; Eagle, Kim A; Mehta, Rajendra H

    2007-01-01

    BACKGROUND: Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. METHODS: Three hundred seven consecutive patients 80 years and older (60% female; mean age 83±2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). RESULTS: The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0±0.7 to 1.7±0.6; P<0.0001). CONCLUSIONS: Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients’ preoperative clinical status and increased comorbidity than the type of surgery per se. PMID:17347695

  18. Association of Physician Certification in Interventional Cardiology with In-Hospital Outcomes of Percutaneous Coronary Intervention

    PubMed Central

    Fiorilli, Paul N.; Minges, Karl E.; Herrin, Jeph; Messenger, John C.; Ting, Henry H.; Nallamothu, Brahmajee K.; Lipner, Rebecca S.; Hess, Brian J.; Holmboe, Eric S.; Brennan, Joseph J.; Curtis, Jeptha P.

    2015-01-01

    Background The value of American Board of Internal Medicine (ABIM) certification has been questioned. We evaluated the association of interventional cardiology (ICARD) certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. Methods and Results We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined ICARD status using ABIM data. We compared in-hospital outcomes of patients treated by certified and non-certified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary endpoints were all-cause in-hospital mortality and bleeding complications. Secondary endpoints included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5,175 physicians, case mix and unadjusted outcomes were similar among certified and non-certified physicians. The adjusted risks of in-hospital mortality (OR 1.10, 95% CI 1.02-1.19) and emergency CABG (OR 1.32, 95% CI 1.12-1.56) were higher in the non-ICARD certified group, but the risks of bleeding, vascular complications, and the composite endpoint were not statistically significantly different between groups. Conclusions We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency CABG in patients treated by non-ICARD certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes, and indicate a need to enhance the value of subspecialty certification. PMID:26384518

  19. Usefulness of combined white blood cell count and plasma glucose for predicting in-hospital outcomes after acute myocardial infarction.

    PubMed

    Ishihara, Masaharu; Kojima, Sunao; Sakamoto, Tomohiro; Asada, Yujiro; Kimura, Kazuo; Miyazaki, Shunichi; Yamagishi, Masakazu; Tei, Chuwa; Hiraoka, Hisatoyo; Sonoda, Masahiro; Tsuchihashi, Kazufumi; Shinoyama, Nobuo; Honda, Takashi; Ogata, Yasuhiro; Ogawa, Hisao

    2006-06-01

    Admission white blood cell (WBC) count and plasma glucose (PG) have been associated with adverse outcomes after acute myocardial infarction (AMI). This study investigated the joint effect of WBC count and PG on predicting in-hospital outcomes in patients with AMI. WBC count and PG were measured at the time of hospital admission in 3,665 patients with AMI. Patients were stratified into tertiles (low, medium, and high) based on WBC count and PG. Patients with a high WBC count had a 2.0-fold increase in in-hospital mortality compared with those with a low WBC count. Patients with a high PG level had a 2.7-fold increase in mortality compared with those with a low PG level. When a combination of different strata for each variable was analyzed, a stepwise increase in mortality was seen. There was a considerable number of patients with a high WBC count and low PG level or with a low WBC count and high PG level. These patients had an intermediate risk, whereas those with a high WBC count and high PG level had the highest risk, i.e., 4.8-fold increase in mortality, compared with those with a low WBC count and low PG level. Multivariate analysis was performed to assess the predictor for in-hospital mortality using WBC count and PG level as continuous variables and showed that WBC count and PG level were independently associated with in-hospital mortality. These findings suggested that a simple combination of WBC count and PG level might provide further information for predicting outcomes in patients with AMI.

  20. Is Left Atrial Size a Predictor of Mortality after Coronary Artery Bypass Surgery? A Single Center Study

    PubMed Central

    Ibrahim, Khalid S.; Mayyas, Fadia A.; Kheirallah, Khalid; AlWaqfi, Nizar R.; Van Wagoner, David R.

    2017-01-01

    Background To investigate the left atrial (LA) size as an independent predictor of mortality following coronary artery bypass surgery (CABG). Methods This single center study evaluated determinants of mortality in 1070 patients who underwent isolated CABG from 2005-2014. Clinical, laboratory and demographic data were obtained from medical records. Collinearity between enlarged LA size (diameter ≥ 4 cm) and covariates was identified. The adjusted effects of enlarged LA size on 30-day mortality post CABG were tested using multiple logistic regression models. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported. Results The mean age was 59 ± 9.8 years, and 238 patients were female. Two multivariate logistic regression models were evaluated. In Model A, mitral regurgitation (MR), ejection fraction, intensive care unit length-of-stay and variables found to be collinear with LA size as predictors of mortality were excluded. In model B, the collinear variables were included. By multivariate analysis (Model A), the statistically significant independent predictors of 30-day mortality after CABG were: enlarged LA size (OR 4.82, 95% CI 2.16-10.79), emergency CABG (OR 3.54, 95% CI 1.75-7.18), prolonged inotropic support (OR 2.79, 95% CI 1.38-5.6), diuretic use ≥ 1 month (OR 1.29, 95% CI 1.3-8.42), and use of clopidogrel within a week before surgery (OR 3.27, 95% CI 1.28-8.36. In Model B, enlarged LA and moderate MR were identified as independent predictors of 30-day mortality. Conclusions Increased LA size is a strong independent predictor of mortality after isolated CABG. PMID:28344424

  1. Recognition of dementia in hospitalized older adults.

    PubMed

    Maslow, Katie; Mezey, Mathy

    2008-01-01

    Many hospital patients with dementia have no documented dementia diagnosis. In some cases, this is because they have never been diagnosed. Recognition of Dementia in Hospitalized Older Adults proposes several approaches that hospital nurses can use to increase recognition of dementia. This article describes the Try This approaches, how to implement them, and how to incorporate them into a hospital's current admission procedures. For a free online video demonstrating the use of these approaches, go to http://links.lww.com/A216.

  2. Market orientation and organizational culture in hospitals.

    PubMed

    Proenca, E J

    1996-01-01

    Hospitals have been advised to respond to environmental pressures by changing from a product to a market orientation. Such changes are difficult to accomplish because of the entrenched behaviors and attitudes of hospitals employees. This article proposes organizational cultures as the avenue to a market orientation. It describes the role of hospital culture as an antecedent to market orientation. It also suggests ways to develop and maintain a market-oriented culture in hospitals.

  3. Association between hypoalbuminemia and mortality among subjects treated with ertapenem versus other carbapenems: prospective cohort study.

    PubMed

    Zusman, O; Farbman, L; Tredler, Z; Daitch, V; Lador, A; Leibovici, L; Paul, M

    2015-01-01

    The aim of this study was to determine whether ertapenem, being highly protein bound, is less effective than other carbapenems in the presence of hypoalbuminemia. In a prospective cohort study, we included adults with clinically and microbiologically documented infections caused by carbapenem-susceptible Enterobacteriaceae who were hospitalized in a tertiary medical center from March 2010 to September 2012. We tested whether hypoalbuminemia (serum albumin <2.5 g/dL) had a larger effect on 30-day mortality in subjects treated with ertapenem compared to those treated with meropenem or imipenem (I/M). Logistic regression analysis was used to identify independent risk factors for death including the carbapenem drug and the interaction between albumin and the carbapenem. Of 279 individual subjects included, 173 were treated with ertapenem and 106 with I/M. The odds ratio (OR) for 30-day mortality with hypoalbuminemia was 4.6 (95% confidence interval (CI) 2.1-10.1) among subjects with ertapenem versus 1.2 (95% CI 0.5-2.70) with I/M (p = 0.02 for difference between groups). In the regression model, the interaction between carbapenem type and albumin levels was significant (p = 0.03); for ertapenem lower albumin levels were associated with increased 30-day mortality (OR 2.45, 95% CI 1.19-5.05), while for I/M the change was not significant (OR 0.67, 95% CI 0.31-1.41). The model suggests that the risk of death for ertapenem-treated subjects quintupled when albumin was 2 g/dL compared to 4 g/dL. Hypoalbuminemia was associated with mortality significantly more among subjects treated with ertapenem compared to subjects treated with I/M. The effectiveness of current dosing schemes of ertapenem in subjects with significant hypoalbuminemia should be revisited.

  4. Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews

    PubMed Central

    Zegers, Marieke; Hesselink, Gijs; Geense, Wytske; Vincent, Charles; Wollersheim, Hub

    2016-01-01

    Objective To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. Design Systematic review of systematic reviews. Data sources PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. Study selection English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. Results Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. Conclusions The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians. PMID:27687901

  5. The relationship between hospital market competition, evidence-based performance measures, and mortality for chronic heart failure.

    PubMed

    Maeda, Jared Lane K; Lo Sasso, Anthony T

    2012-01-01

    Using data from the Joint Commission's ORYX initiative and the Medicare Provider Analysis and Review file from 2003 to 2006, this study employed a fixed-effects approach to examine the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at seven days, 30 days, 90 days, and one year for patients with chronic heart failure. We found that, on average, higher adherence with most of the Joint Commission's heart failure performance measures was not associated with lower mortality; the level of market competition also was not associated with any differences in mortality. However, higher adherence with the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentiles of the mortality distribution was associated with incrementally lower mortality rates. These findings suggest that targeting evidence-based processes of care might have a stronger impact in improving patient outcomes.

  6. Mortality in HIV-Infected Alcohol and Drug Users in St. Petersburg, Russia

    PubMed Central

    Fairbairn, Nadia S.; Walley, Alexander Y.; Cheng, Debbie M.; Quinn, Emily; Bridden, Carly; Chaisson, Christine; Blokhina, Elena; Lioznov, Dmitry; Krupitsky, Evgeny; Raj, Anita; Samet, Jeffrey H.

    2016-01-01

    In Russia, up to half of premature deaths are attributed to hazardous drinking. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described. Criminalization and stigmatization of substance use in Russia may also contribute to mortality. We explored whether alcohol, drug use and risk environment factors are associated with short-term mortality in HIV-infected Russians who use substances. Secondary analyses were conducted using prospective data collected at baseline, 6 and 12-months from HIV-infected people who use substances recruited between 2007–2010 from addiction and HIV care settings in a single urban setting of St. Petersburg, Russia. We used Cox proportional hazards models to explore associations between 30-day alcohol hazardous drinking, injection drug use, polysubstance use and environmental risk exposures (i.e. past incarceration, police involvement, selling sex, and HIV stigma) with mortality. Among 700 participants, 59% were male and the mean age was 30 years. There were 40 deaths after a median follow-up of 12 months (crude mortality rate 5.9 per 100 person-years). In adjusted analyses, 30-day NIAAA hazardous drinking was significantly associated with mortality compared to no drinking [adjusted Hazard Ratio (aHR) 2.60, 95% Confidence Interval (CI): 1.24–5.44] but moderate drinking was not (aHR 0.95, 95% CI: 0.35–2.59). No other factors were significantly associated with mortality. The high rates of short-term mortality and the strong association with hazardous drinking suggest a need to integrate evidence-based alcohol interventions into treatment strategies for HIV-infected Russians. PMID:27898683

  7. Mortality among professional drivers.

    PubMed

    Rafnsson, V; Gunnarsdóttir, H

    1991-10-01

    The mortality of truck drivers and taxi drivers was studied in Reykjavík. The national mortality rate was used for comparison, and the follow-up lasted until 1 December 1988. The 868 truck drivers (28,788.0 person-years) had an excess of lung cancer deaths [24 observed, 11.2 expected, standardized mortality ratio (SMR) 2.14], but fewer deaths than expected from respiratory diseases (15 observed versus 30.1 expected). The SMR from lung cancer did not steadily increase as the duration of employment increased, nor did it change with the length of follow-up. The SMR values did not deviate substantially from unity for the taxi drivers. Since the high mortality from lung cancer among the truck drivers did not seem to be due to their smoking habits, it might have been caused by one or more occupational factors, especially in light of this group's exposure to engine exhaust gases.

  8. Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

    PubMed Central

    Alleman, Brandon W.; Li, Lei; Dagle, John M.; Smith, P. Brian; Ambalavanan, Namasivayam; Laughon, Matthew M.; Stoll, Barbara J.; Goldberg, Ronald N.; Carlo, Waldemar A.; Murray, Jeffrey C.; Cotten, C. Michael; Shankaran, Seetha; Walsh, Michele C.; Laptook, Abbot R.; Ellsbury, Dan L.; Hale, Ellen C.; Newman, Nancy S.; Wallace, Dennis D.; Das, Abhik; Higgins, Rosemary D.

    2013-01-01

    OBJECTIVE: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006–2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs <25 weeks and ≥25 weeks. RESULTS: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs <25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants <25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at <25 weeks’ GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality. PMID:23753096

  9. Characteristics, in-hospital and long-term clinical outcomes of nonagenarian compared with octogenarian acute myocardial infarction patients.

    PubMed

    Lee, Ki Hong; Ahn, Youngkeun; Kim, Sung Soo; Rhew, Si Hyun; Jeong, Young Wook; Jang, Soo Young; Cho, Jae Yeong; Jeong, Hae Chang; Park, Keun-Ho; Yoon, Nam Sik; Sim, Doo Sun; Yoon, Hyun Joo; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Cho, Jeong Gwan; Park, Jong Chun; Jeong, Myung Ho; Cho, Myeong-Chan; Kim, Chong Jin; Kim, Young Jo

    2014-04-01

    We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.

  10. Weather-Related Mortality

    PubMed Central

    Anderson, Brooke G.; Bell, Michelle L.

    2012-01-01

    Background Many studies have linked weather to mortality; however, role of such critical factors as regional variation, susceptible populations, and acclimatization remain unresolved. Methods We applied time-series models to 107 US communities allowing a nonlinear relationship between temperature and mortality by using a 14-year dataset. Second-stage analysis was used to relate cold, heat, and heat wave effect estimates to community-specific variables. We considered exposure timeframe, susceptibility, age, cause of death, and confounding from pollutants. Heat waves were modeled with varying intensity and duration. Results Heat-related mortality was most associated with a shorter lag (average of same day and previous day), with an overall increase of 3.0% (95% posterior interval: 2.4%–3.6%) in mortality risk comparing the 99th and 90th percentile temperatures for the community. Cold-related mortality was most associated with a longer lag (average of current day up to 25 days previous), with a 4.2% (3.2%–5.3%) increase in risk comparing the first and 10th percentile temperatures for the community. Mortality risk increased with the intensity or duration of heat waves. Spatial heterogeneity in effects indicates that weather–mortality relationships from 1 community may not be applicable in another. Larger spatial heterogeneity for absolute temperature estimates (comparing risk at specific temperatures) than for relative temperature estimates (comparing risk at community-specific temperature percentiles) provides evidence for acclimatization. We identified susceptibility based on age, socioeconomic conditions, urbanicity, and central air conditioning. Conclusions Acclimatization, individual susceptibility, and community characteristics all affect heat-related effects on mortality. PMID:19194300

  11. Quality gaps identified through mortality review

    PubMed Central

    Kobewka, Daniel M; van Walraven, Carl; Turnbull, Jeffrey; Worthington, James; Calder, Lisa; Forster, Alan

    2017-01-01

    Background Hospital mortality rate is a common measure of healthcare quality. Morbidity and mortality meetings are common but there are few reports of hospital-wide mortality-review processes to provide understanding of quality-of-care problems associated with patient deaths. Objective To describe the implementation and results from an institution-wide mortality-review process. Design A nurse and a physician independently reviewed every death that occurred at our multisite teaching institution over a 3-month period. Deaths judged by either reviewer to be unanticipated or to have any opportunity for improvement were reviewed by a multidisciplinary committee. We report characteristics of patients with unanticipated death or opportunity for improved care and summarise the opportunities for improved care. Results Over a 3-month period, we reviewed all 427 deaths in our hospital in detail; 33 deaths (7.7%) were deemed unanticipated and 100 (23.4%) were deemed to be associated with an opportunity for improvement. We identified 97 opportunities to improve care. The most common gap in care was: ‘goals of care not discussed or the discussion was inadequate’ (n=25 (25.8%)) and ‘delay or failure to achieve a timely diagnosis’ (n=8 (8.3%)). Patients who had opportunities for improvement had longer length of stay and a lower baseline predicted risk of death in hospital. Nurse and physician reviewers spent approximately 142 h reviewing cases outside of committee meetings. Conclusions Our institution-wide mortality review found many quality gaps among decedents, in particular inadequate discussion of goals of care. PMID:26856617

  12. Genetic characterization of norovirus strains in hospitalized children from Pakistan.

    PubMed

    Alam, Amna; Qureshi, Sohail A; Vinjé, Jan; Zaidi, Anita

    2016-02-01

    Norovirus is one of the most common causes of acute gastroenteritis among children in developing countries. No data on the prevalence and genetic variability of norovirus are available for Pakistan, where early childhood mortality due to acute gastroenteritis is common. We tested 255 fecal specimens from children under 5 years of age hospitalized between April 2006 and March 2008 with severe acute gastroenteritis in five hospitals in the four largest cities in Pakistan for norovirus by real-time RT-PCR. Positive samples were further genotyped by conventional RT-PCR targeting the 5'-end of the capsid gene followed by sequencing of the positive PCR products. Overall, 41 (16.1%) samples tested positive for norovirus with an equal frequency in rotavirus-positive and rotavirus-negative samples. Nine (22%) samples were genogroup (G)I positive, 30 (73%) GII positive and two (5%) samples contained a mixture of GI and GII viruses. Sequence analyses demonstrated co-circulation of 14 norovirus genotypes including four GI genotypes (GI.3, GI.5, GI.7, GI.8) and 10 GII genotypes (GII.2, GII.3, GII.4, GII.5, GII.6, GII.7, GII.9, GII.13, GII.16, and GII.21). The most prevalent genotypes were GI.7 and GII.4 both causing 12.2% of the infections. This report confirms the presence of multiple norovirus genotypes in hospitalized children with acute gastroenteritis in Pakistan and a lack of clear predominance of GII.4 viruses.

  13. Association between Serum Tissue Inhibitor of Matrix Metalloproteinase-1 Levels and Mortality in Patients with Severe Brain Trauma Injury

    PubMed Central

    Lorente, Leonardo; Martín, María M.; López, Patricia; Ramos, Luis; Blanquer, José; Cáceres, Juan J.; Solé-Violán, Jordi; Solera, Jorge; Cabrera, Judith; Argueso, Mónica; Ortiz, Raquel; Mora, María L.; Lubillo, Santiago; Jiménez, Alejandro; Borreguero-León, Juan M.; González, Agustín; Orbe, Josune; Rodríguez, José A.; Páramo, José A.

    2014-01-01

    Objective Matrix metalloproteinases (M