Changing Epidemiology ofClostridium difficile-Associated Disease in Children

2007 ◽  
Vol 28 (11) ◽  
pp. 1233-1235 ◽  
Author(s):  
Lacey Benson ◽  
Xiaoyan Song ◽  
Joseph Campos ◽  
Nalini Singh
Keyword(s):  
Emergency Department ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Temporal Trends ◽  
Outpatient Setting ◽  
Incidence Rates ◽  
Steady Increase ◽  
Ofclostridium Difficile ◽  
Number Of Patients ◽  
Stool Specimens

Objective.To determine temporal trends in the incidence rate forClostridium difficile-associated disease (CDAD) in a pediatric patient population.Methods.We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.Results.A total of 513 patients whose stool specimens tested positive forC. difficiletoxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006;P= .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006;P= .004). In the neonatal intensive care unit,C. difficile toxinwas detected in stool specimens collected from 22 patients aged from 15 days to 6 months.Conclusion.This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

scholarly journals Colorectal Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Regional and Western Countries

2021 ◽  
Vol 28 ◽  
pp. 107327482199686
Author(s):  
Najla A. Lakkis ◽  
Ola El-Kibbi ◽  
Mona H. Osman
Keyword(s):  
Colorectal Cancer ◽  
Cancer Incidence ◽  
Temporal Trends ◽  
Incidence Rates ◽  
Steady Increase ◽  
P Value ◽  
Western Countries ◽  
Incidence And Mortality ◽  
Colorectal Cancer Incidence ◽  
Males And Females

Global trends in the incidence and mortality rates of colorectal cancer show a steady increase with significant predilection to western developed countries, possibly linking it to westernized lifestyles among other risk factors. This study aims to investigate the incidence and trends of colorectal cancer in Lebanon, a country in the Middle East and North Africa region, and to compare these rates to those in regional and western countries. Colorectal cancer incidence data were extracted from the Lebanese National Cancer Registry for the currently available years 2005 to 2016. The calculated age-standardized incidence rates and age-specific rates were expressed as per 100,000 population. The age-standardized incidence rates of colorectal cancer in Lebanon increased from 16.3 and 13.0 per 100,000 in 2005 to 23.2 and 20.2 per 100,000 in 2016, among males and females, respectively. The incidences were higher for males, and they increased with age. The annual percent change was +4.36% and +4.45%, in males and females respectively (p-value < 0.05). There was a non-statistically significant trend of decrease in recent years (since 2012 in males and since 2011 in females). The age-standardized incidence rates in Lebanon were higher than those in the majority of the regional countries, but lower than the rates in developed western countries. There were high age-specific incidence rates at age groups 40-44 and 45-49 years in Lebanon in both males and females (with significant rising temporal trend) compared to other countries, including the ones reported to have the highest colorectal cancer age-standardized incidence rate worldwide. Therefore, the burden of colorectal cancer is significant in Lebanon. This raises the necessity to develop national strategies tailored to reduce colorectal cancer incidence through promoting healthy lifestyles, raising awareness, and early detection as of 40 years of age.

scholarly journals Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Occupancy Rate ◽  
Number Of Patients ◽  
Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

scholarly journals 845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S513-S513
Author(s):  
Elizabeth A Aguilera ◽  
Gilhen Rodriguez ◽  
Gabriela P Del Bianco ◽  
Gloria Heresi ◽  
James Murphy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Program ◽  
Medical Center ◽  
Hiv Infections ◽  
Hiv Screening ◽  
Opt Out ◽  
Number Of Patients ◽  
Confirmatory Tests ◽  
Routine Hiv Screening ◽  
The Impact

Abstract Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score &gt; 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

scholarly journals Trends in Incidence of Norovirus-associated Acute Gastroenteritis in 4 Veterans Affairs Medical Center Populations in the United States, 2011–2015

2019 ◽  
Vol 70 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Scott Grytdal ◽  
Hannah Browne ◽  
Nikail Collins ◽  
Blanca Vargas ◽  
Maria C Rodriguez-Barradas ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Gastroenteritis ◽  
Medical Center ◽  
Seasonal Pattern ◽  
Adult Population ◽  
Diagnostic Testing ◽  
The United States ◽  
Incidence Rates ◽  
Veterans Affairs ◽  
Stool Specimens

Abstract Background Norovirus is an important cause of epidemic acute gastroenteritis (AGE), yet the burden of endemic disease in adults has not been well documented. We estimated the prevalence and incidence of outpatient and community-acquired inpatient norovirus AGE at 4 Veterans Affairs Medical Centers (VAMC) (Atlanta, Georgia; Bronx, New York; Houston, Texas; and Los Angeles, California) and examined trends over 4 surveillance years. Methods From November 2011 to September 2015, stool specimens collected within 7 days of AGE symptom onset for clinician-requested diagnostic testing were tested for norovirus, and positive samples were genotyped. Incidence was calculated by multiplying norovirus prevalence among tested specimens by AGE-coded outpatient encounters and inpatient discharges, and dividing by the number of unique patients served. Results Of 1603 stool specimens, 6% tested were positive for norovirus; GII.4 viruses (GII.4 New Orleans [17%] and GII.4 Sydney [47%]) were the most common genotypes. Overall prevalence and outpatient and inpatient community-acquired incidence followed a seasonal pattern, with higher median rates during November–April (9.2%, 376/100 000, and 45/100 000, respectively) compared to May–October (3.0%, 131/100 000, and 13/100 000, respectively). An alternate-year pattern was also detected, with highest peak prevalence and outpatient and inpatient community-acquired norovirus incidence rates in the first and third years of surveillance (14%–25%, 349–613/100 000, and 43–46/100 000, respectively). Conclusions This multiyear analysis of laboratory-confirmed AGE surveillance from 4 VAMCs demonstrates dynamic intra- and interannual variability in prevalence and incidence of outpatient and inpatient community-acquired norovirus in US Veterans, highlighting the burden of norovirus disease in this adult population.

scholarly journals Incidence and prevalence of psoriatic arthritis in Denmark: a nationwide register linkage study

2017 ◽  
Vol 76 (9) ◽  
pp. 1591-1597 ◽  
Author(s):  
Alexander Egeberg ◽  
Lars Erik Kristensen ◽  
Jacob P Thyssen ◽  
Gunnar Hilmar Gislason ◽  
Alice B Gottlieb ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Certolizumab Pegol ◽  
National Level ◽  
Temporal Trends ◽  
Linkage Study ◽  
Incidence Rates ◽  
Biologic Agents ◽  
Clear Trend ◽  
Number Of Patients ◽  
Gender And Age

ObjectivesTo examine the incidence and temporal trends of psoriatic arthritis (PsA) in the general population in Denmark.MethodsUsing nationwide registry data, we estimated the number of patients with incident PsA within each 1-year period between 1997 and 2011 and calculated the rate of PsA cases within gender and age subgroups. Incidence rates were presented per 100 000 person-years.ResultsThere was a female predominance ranging from 50.3% (1998) to 59.2% (2010), and the mean age at time of diagnosis was 47–50 years. We identified a total of 12 719 patients with PsA (prevalence=0.22%), including 9034 patients where the PsA diagnosis was made by a rheumatologist (prevalence=0.16%). Incidence rates of PsA (per 100 000 person-years) increased from 7.3 in 1997 to a peak incidence of 27.3 in 2010. Incidence rates were highest for women and patients aged 50–59 years, respectively. The use of systemic non-biologic agents, that is, methotrexate, leflunomide, ciclosporin or sulfasalazine increased over the 15-year study course and were used in 66.3% of all patients. Biologic agents (etanercept, infliximab, adalimumab, certolizumab pegol, golimumab or ustekinumab) were used in 17.7% of patients with PsA.ConclusionsWe found a clear trend of rising PsA incidence on a national level. While the cause remains unclear, our findings might be explained by increased attention by patients and physicians.

scholarly journals Changes in Emergency Department Volumes at the Largest U.S. Military Hospital During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Adrianna Long ◽  
Meghan Fillinger ◽  
Michael D April ◽  
Ian L Hudson ◽  
Wesley Trueblood ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Control Period ◽  
Temporal Trends ◽  
Healthcare Delivery ◽  
Severity Index ◽  
Median Number ◽  
Military Hospital ◽  
Record System ◽  
Number Of Visits

ABSTRACT Introduction The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD’s largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic. Materials and Methods We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020). Results Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P &lt; .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P &lt; .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P &lt; .001 for all). Conclusions The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.

scholarly journals Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 986
Author(s):  
Byeong-Keon Moon ◽  
Ryeok Ahn ◽  
Deulle Min ◽  
JaeLan Shim
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Medical Center ◽  
Financial Burden ◽  
Foreign Worker ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Discharge Against Medical Advice

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

scholarly journals Prevalence, Incidence, Diagnostic Delay, and Mortality in Turner Syndrome

2006 ◽  
Vol 91 (10) ◽  
pp. 3897-3902 ◽  
Author(s):  
Kirstine Stochholm ◽  
Svend Juul ◽  
Knud Juel ◽  
Rune Weis Naeraa ◽  
Claus Højbjerg Gravholt
Keyword(s):  
Turner Syndrome ◽  
Causes Of Death ◽  
Diagnostic Delay ◽  
Incidence Rates ◽  
Age At Diagnosis ◽  
Steady Increase ◽  
Background Population ◽  
Coronary Diseases ◽  
Number Of Patients ◽  
Standardized Mortality Ratios

Abstract Aim: Our aim was to study prevalence, incidence, age at diagnosis, and mortality in Turner syndrome (TS) in Denmark. Methods: Using the Danish Cytogenetic Register, we identified all cases (n = 781) of TS alive in Denmark during 1970–2001. Sixty-nine deceased women with TS were identified in the Causes of Death Register. We divided the cohort into women having the karyotype 45,X, karyotypes including an isochromosome Xq, and all other karyotypes associated with TS. We describe the number of patients diagnosed in Denmark yearly, incidence rates, and the age at diagnosis. Standardized mortality ratios (SMR) were calculated. Results: A total of 349 women had a 45,X karyotype, 86 had a karyotype including an isochromosome Xq (isoXq), and 346 had another TS karyotype. Mortality was increased in TS with an SMR of 2.86 (95% confidence interval, 2.18–3.55). SMR was increased for coronary diseases, congenital malformations, endocrine diseases, and other causes. The mortality was increased for all types of karyotypes in comparison with the general population but was highest among females with 45,X and isoXq. There was a steady increase in prevalence, but incidence was unchanged. Age at diagnosis was mainly distributed in three periods: less than 1 yr of age (14.9%), during adolescence (10–17 yr) (33.2%), and during adulthood (38.5%), with a median age at diagnosis of 15.1 yr, decreasing during the study period (P &lt; 0.01). Conclusions: Patients with TS and especially the karyotypes 45,X and isoXq have a higher mortality compared with the background population. TS was diagnosed with a considerable diagnostic delay. Prevalence is increasing, but incidence of TS was stable.

scholarly journals The effect of the Covid-19 pandemic on patient visits to the emergency department and hospitalizations in medical wards in an Israeli medical center

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Yael Frenkel Nir ◽  
Yuval Levy ◽  
Amit Gutkind ◽  
Ehud Grossman
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Data ◽  
Complex Patients ◽  
Israeli Population ◽  
Number Of Patients ◽  
Tertiary Center ◽  
Medical Wards

Abstract Background The Covid-19 pandemic began in Israel on February 2020. Between February and October 2020, 2 periods of lockdown were imposed on Israeli population. Objective To assess the effect of the Covid-19 pandemic on visits to the emergency department (ED) and on hospitalizations in medical wards in Israel’s Chaim Sheba Medical Center, and to compare the effect during the first and second lockdowns. Methods Data regarding the number of visits of non-Covid-19 patients to the ED and the number of admissions to the medical wards, were extracted from the computerized system of the hospital. Data were analyzed for patients' characteristics, length of stay in the medical wards, in hospital mortality and the rate of 7 and 30 days re-hospitalization, and compared to the same period during 2019. Results Total visits to the Sheba ED during March-October decreased by 18.5%. The most dramatic decrease occurred during the first lockdown. The number of patients admitted to the Sheba medical wards decreased by 28% (P < 0.05). The length of stay decreased from 3.69 days during 2019 to 3.42 days during 2020 (P < 0.01). The most pronounced decrease in the length of stay was observed during the second month of the first lockdown. During the pandemic, hospitalized patients at Sheba were older and were less likely to be males. The in-hospital absolute non-COVID mortality decreased from 913 to 858 respectively. Conclusions The Covid-19 crisis emphasizes the role of medical wards in the care of complex patients. Medical wards in Israel were at the frontline of Israel's battle against this pandemic, while continuing to treat very complex non-Covid patients. To avoid burnout of the medical staff who treat very intensively complex patients, we believe these wards should be strengthen with specialists having expertise in treating these patients. Due to our insights, the Sheba medical Center is now redesigning the concept of how intensive care beds should be managed in a big tertiary center.

scholarly journals Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

2020 ◽  
Vol 49 (6) ◽  
pp. 1034-1041 ◽  
Author(s):  
Laura C Blomaard ◽  
Simon P Mooijaart ◽  
Shanti Bolt ◽  
Jacinta A Lucke ◽  
Jelle de Gelder ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Medical Center ◽  
Routine Care ◽  
Adverse Outcomes ◽  
Lower Probability ◽  
Older Patient ◽  
Emergency Department Care ◽  
Number Of Patients ◽  
High Urgency

Abstract Background risk stratification tools for older patients in the emergency department (ED) have rarely been implemented successfully in routine care. Objective to evaluate the feasibility and acceptability of the ‘Acutely Presenting Older Patient’ (APOP) screener, which identifies older ED patients at the highest risk of adverse outcomes within 2 minutes at presentation. Design and setting 2-month prospective cohort study, after the implementation of the APOP screener in ED routine care in the Leiden University Medical Center. Subjects all consecutive ED patients aged ≥70 years. Methods feasibility of screening was assessed by measuring the screening rate and by identifying patient- and organisation-related determinants of screening completion. Acceptability was assessed by collecting experienced barriers of screening completion from triage-nurses. Results we included 953 patients with a median age of 77 (IQR 72–82) years, of which 560 (59%) patients were screened. Patients had a higher probability of being screened when they had a higher age (OR 1.03 (95%CI 1.01–1.06), P = 0.017). Patients had a lower probability of being screened when they were triaged very urgent (OR 0.55 (0.39–0.78), P = 0.001) or when the number of patients upon arrival was high (OR 0.63 (0.47–0.86), P = 0.003). Experienced barriers of screening completion were patient-related (‘patient was too sick’), organisation-related (‘ED was too busy’) and personnel-related (‘forgot to complete screening’). Conclusion with more than half of all older patients screened, feasibility and acceptability of screening in routine ED care is very promising. To further improve screening completion, solutions are needed for patients who present with high urgency and during ED rush hours.

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