500 30-DAY SURVIVAL AND RECOVERY AFTER HIP FRACTURE BY MOBILISATION TIMING AND DEMENTIA: A UK DATABASE STUDY

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii5-ii7
Author(s):  
K J Sheehan ◽  
A Goubar ◽  
F C Martin ◽  
C Potter ◽  
G D Jones ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Quality Improvement ◽  
Hip Fracture ◽  
Propensity Score ◽  
Odds Ratio ◽  
Secondary Analysis ◽  
Early Mobilisation ◽  
Probability Of Survival ◽  
The Uk ◽  
Weighted Probability

Abstract Introduction To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery. Methods Secondary analysis of the UK National Hip Fracture Database linked to hospitalisation records for 126,897 patients 60 years or older who underwent surgery for nonpathological first hip fracture in England or Wales between 2014 and 2016. We used logistic regression to regress survival and ambulation recovery at 30-days with respect to mobilisation timing, overall and by dementia, with adjustment for confounding using a propensity score for mobilisation treatment with respect to confounders. Results Overall, 99,667 (79%) patients mobilised early. Among those who mobilised early compared to those who mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.80–2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03–1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32–1.78) by 30 days. Early compared with late mobilisation led to a 3.8% increase in the weighted probability of survival, 22.8% increase in weighted probability of recovering outdoor ambulation and 10.0% increase in the weighted probability of recovering indoor ambulation, by 30-days. Patients with dementia were less likely to mobilise early but increases in survival and ambulation recovery were observed both for those with and without dementia. Conclusion Early mobilisation led to increase probability of survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality internationally. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives.

scholarly journals The 30-day survival and recovery after hip fracture by timing of mobilization and dementia

2021 ◽  
Vol 103-B (7) ◽  
pp. 1317-1324
Author(s):  
Aicha Goubar ◽  
Finbarr C. Martin ◽  
Chris Potter ◽  
Gareth D. Jones ◽  
Catherine Sackley ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Quality Improvement ◽  
Hip Fracture ◽  
Propensity Score ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Early Mobilization ◽  
Walking Ability ◽  
Hospital Records ◽  
England And Wales

Aims The aim of this study to compare 30-day survival and recovery of mobility between patients mobilized early (on the day of, or day after surgery for a hip fracture) and patients mobilized late (two days or more after surgery), and to determine whether the presence of dementia influences the association between the timing of mobilization, 30-day survival, and recovery. Methods Analysis of the National Hip Fracture Database and hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for a hip fracture in England and Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between the timing of mobilization, survival, and recovery of walking ability. Results A total of 99,667 patients (79%) mobilized early. Among those mobilized early compared to those mobilized late, the weighted odds ratio of survival was 1.92 (95% confidence interval (CI) 1.80 to 2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03 to 1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32 to 1.78) by 30 days. The weighted probabilities of survival at 30 days post-admission were 95.9% (95% CI 95.7% to 96.0%) for those who mobilized early and 92.4% (95% CI 92.0% to 92.8%) for those who mobilized late. The weighted probabilities of regaining the ability to walk outdoors were 9.7% (95% CI 9.2% to 10.2%) and indoors 81.2% (95% CI 80.0% to 82.4%), for those who mobilized early, and 7.9% (95% CI 6.6% to 9.2%) and 73.8% (95% CI 71.3% to 76.2%), respectively, for those who mobilized late. Patients with dementia were less likely to mobilize early despite observed associations with survival and ambulation recovery for those with and without dementia. Conclusion Early mobilization is associated with survival and recovery for patients (with and without dementia) after hip fracture. Early mobilization should be incorporated as a measured indicator of quality. Reasons for failure to mobilize early should also be recorded to inform quality improvement initiatives. Cite this article: Bone Joint J 2021;103-B(7):1317–1324.

scholarly journals Discharge after hip fracture surgery in relation to mobilisation timing by patient characteristics: linked secondary analysis of the UK National Hip Fracture Database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katie J. Sheehan ◽  
Aicha Goubar ◽  
Finbarr C. Martin ◽  
Chris Potter ◽  
Gareth D. Jones ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Residential Care ◽  
Secondary Analysis ◽  
Fold Increase ◽  
Patient Characteristics ◽  
Competing Risk ◽  
Early Mobilisation ◽  
Hip Fracture Surgery ◽  
Risk Of Death ◽  
The Uk

Abstract Background Early mobilisation leads to a two-fold increase in the adjusted odds of discharge by 30-days compared to late mobilisation. Whether this association varies by patient characteristics identified as reasons for delayed mobilisation is unknown. Methods Audit data was linked to hospitalisation records for 133,319 patients 60 years or older surgically treated for hip fracture in England or Wales between 2014 and 2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed between those mobilised early and those mobilised late for subgroups defined by dementia, delirium, hypotension, prefracture ambulation, and prefracture residence, accounting for the competing risk of death. Results Overall, 34,253 patients presented with dementia, 9818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 1502 had incomplete data for ambulation and 2587 for prefracture residence. 10, 8, 8, 12, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or admitted from residential care mobilised early when compared to those who presented without dementia, delirium, hypotension, with outdoor ambulation prefracture, or admitted from home. The adjusted odds ratios of discharge by 30-days postoperatively among those who mobilised early compared with those who mobilised late were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) admitted from home, and 1.64 (95% CI 1.51–1.77) admitted from residential care, accounting for the competing risk of death. Conclusion Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of hospital discharge by 30-days postoperatively. However, fewer patients with dementia, delirium, or hypotension, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.

scholarly journals Safety netting in routine primary care consultations: an observational study using video-recorded UK consultations

2019 ◽  
Vol 69 (689) ◽  
pp. e878-e886 ◽  
Author(s):  
Peter J Edwards ◽  
Matthew J Ridd ◽  
Emily Sanderson ◽  
Rebecca K Barnes
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Observational Study ◽  
Confidence Interval ◽  
Treatment Planning ◽  
Odds Ratio ◽  
Adult Patients ◽  
Specific Advice ◽  
The Uk ◽  
Safety Netting

BackgroundSafety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.AimTo assess when and how safety-netting advice is delivered in routine GP consultations.Design and settingThis was an observational study using 318 recorded GP consultations with adult patients in the UK.MethodA safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.ResultsA total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.ConclusionGPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient’s part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.

scholarly journals Suicide and attempted suicide among people of Caribbean origin with psychosis living in the UK

2003 ◽  
Vol 183 (1) ◽  
pp. 40-44 ◽  
Author(s):  
K. McKenzie ◽  
J. Van Os ◽  
C. Samele ◽  
E. Van Horn ◽  
T. Tattan ◽  
...  
Keyword(s):  
Suicidal Behaviour ◽  
Odds Ratio ◽  
Lower Risk ◽  
Attempted Suicide ◽  
Secondary Analysis ◽  
Negative Interaction ◽  
Age And Gender ◽  
Significant Difference ◽  
And Gender ◽  
The Uk

BackgroundA report from a 1980s cohort claimed that suicidal behaviour was four times less common in UK-resident people of Caribbean origin with psychosis than in British Whites. Since then, evidence has accumulated that the rate of suicide and suicidal ideation has been increasing.AimsTo compare rates of suicidal behaviour in people of Caribbean and British White origin in a large multi-centre sample of patients with psychosis.MethodA secondary analysis of 708 patients with psychosis followed up for 2 years. Outcome measures of reported suicide and attempted suicide were adjusted for socio-economic and clinical differences between groups at baseline.ResultsPeople of Caribbean origin had a lower risk of suicidal behaviour than British Whites (odds ratio adjusted for age and gender 0.49, 95% C1 0.26–0.92). There was a strong negative interaction between ethnic group and age: suicidal acts were four times less likely in people of Caribbean origin aged over 35 years compared with British Whites, but there was no large or significant difference in those under 35.ConclusionsThe previously reported lower relative risk of suicidal behaviour in people of Caribbean origin with psychosis is restricted to those over 35 years, suggesting that the protective effect of Caribbean origin is disappearing in younger generations.

Traditional Chinese Medicine Decoctions Significantly Reduce the Mortality in Severe and Critically Ill Patients with COVID-19: A Retrospective Cohort Study

2021 ◽  
pp. 1-30
Author(s):  
Qin-Guo Sun ◽  
Xue-Dong An ◽  
Ping Xie ◽  
Bo Jiang ◽  
Jia-Xing Tian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Hospital Death ◽  
The Impact

Coronavirus disease (COVID-19) is a new infectious disease associated with high mortality, and traditional Chinese medicine decoctions (TCMDs) have been widely used for the treatment of patients with COVID-19 in China; however, the impact of these decoctions on severe and critical COVID-19-related mortality has not been evaluated. Therefore, we aimed to address this gap. In this retrospective cohort study, we included inpatients diagnosed with severe/critical COVID-19 at the Tongren Hospital of Wuhan University and grouped them depending on the recipience of TCMDs (TCMD and non-TCMD groups). We conducted a propensity score-matched analysis to adjust the imbalanced variables and treatments and used logistic regression methods to explore the risk factors associated with in-hospital death. Among 282 patients with COVID-19 who were discharged or died, 186 patients (66.0%) received TCMD treatment (TCMD cohort) and 96 (34.0%) did not (non-TCMD cohort). After propensity score matching at a 1:1 ratio, 94 TCMD users were matched to 94 non-users, and there were no significant differences in baseline clinical variables between the two groups of patients. The all-cause mortality was significantly lower in the TCMD group than in the non-TCMD group, and this trend remained valid even after matching (21.3% [20/94] vs. 39.4% [37/94]). Multivariable logistic regression model showed that disease severity (odds ratio: 0.010; 95% CI: 0.003, 0.037; [Formula: see text] < 0.001) was associated with increased odds of death and that TCMD treatment significantly decreased the odds of in-hospital death (odds ratio: 0.115; 95% CI: 0.035, 0.383; [Formula: see text] < 0.001), which was related to the duration of TCMD treatment. Our findings show that TCMD treatment may reduce the mortality in patients with severe/critical COVID-19.

scholarly journals Signalment risk factors for cutaneous and renal glomerular vasculopathy (Alabama rot) in dogs in the UK

2018 ◽  
Vol 183 (14) ◽  
pp. 448-448 ◽  
Author(s):  
Kim B Stevens ◽  
Dan O’Neill ◽  
Rosanne Jepson ◽  
Laura Phillipa Holm ◽  
David John Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Odds Ratio ◽  
Causal Models ◽  
Kennel Club ◽  
Multivariable Logistic Regression ◽  
The Uk ◽  
Age And Sex

Seasonal outbreaks of cutaneous and renal glomerular vasculopathy (CRGV) have been reported annually in UK dogs since 2012, yet the aetiology of the disease remains unknown. The objectives of this study were to explore whether any breeds had an increased or decreased risk of being diagnosed with CRGV, and to report on age and sex distributions of CRGV cases occurring in the UK. Multivariable logistic regression was used to compare 101 dogs diagnosed with CRGV between November 2012 and May 2017 with a denominator population of 446,453 dogs from the VetCompass database. Two Kennel Club breed groups—hounds (odds ratio (OR) 10.68) and gun dogs (OR 9.69)—had the highest risk of being diagnosed with CRGV compared with terriers, while toy dogs were absent from among CRGV cases. Females were more likely to be diagnosed with CRGV (OR 1.51) as were neutered dogs (OR 3.36). As well as helping veterinarians develop an index of suspicion for the disease, better understanding of the signalment risk factors may assist in the development of causal models for CRGV and help identify the aetiology of the disease.

client satisfaction with abortion care in three russian cities

2005 ◽  
Vol 37 (5) ◽  
pp. 585-601 ◽  
Author(s):  
elizabeth oliveras ◽  
ulla larsen ◽  
patricia h. david
Keyword(s):  
Logistic Regression ◽  
Quality Improvement ◽  
Client Satisfaction ◽  
Secondary Analysis ◽  
Self Care ◽  
Married Women ◽  
Important Predictor ◽  
Client Characteristics ◽  
Abortion Care

this paper explores client satisfaction with abortion care, looking at overall satisfaction and satisfaction with hygiene, comfort and courtesy. the analysis aimed to determine whether client satisfaction was related to the characteristics of the client, in order to guide quality improvement efforts. the analysis is a secondary analysis of data collected in a survey of 489 abortion clients who attended a limited number of hospitals in three cities in russia. the data were analysed using logistic regression. client characteristics, in general, did not affect overall satisfaction though there were significant differences in overall satisfaction for unmarried versus married women (or=0·29, ci=0·13, 0·63). similarly, most characteristics of the abortion visit were not related to client satisfaction, although women who were awake for the procedure were less likely to be satisfied (or=0·37, ci=0·16, 0·89). information provided to abortion clients about self-care was the most important predictor of overall satisfaction for abortion clients (or=3·55, ci=1·64, 7·69). this suggests that improving the information provided to clients, through training providers and other staff, is important in these settings.

scholarly journals COVID-19 In-Hospital Mortality in People with Diabetes Is Driven by Comorbidities and Age—Propensity Score-Matched Analysis of Austrian National Public Health Institute Data

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2401
Author(s):  
Faisal Aziz ◽  
Felix Aberer ◽  
Alexander Bräuer ◽  
Christian Ciardi ◽  
Martin Clodi ◽  
...  
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
National Public Health Institute ◽  
Data Platform ◽  
National Public Health ◽  
The Impact ◽  
Public Health Institute

Background: It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) admission and in-hospital mortality in hospitalized COVID-19 patients. Methods: A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression. Results: 12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.15–1.34, p < 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97–1.19, p = 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25–1.47, p < 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04–1.28, p = 0.009). Conclusions: People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document