scholarly journals Post-vaccination COVID-19: A case-control study and genomic analysis of 119 breakthrough infections in partially vaccinated individuals

2021 ◽  
Author(s):  
Ioannis Baltas ◽  
Florencia A T Boshier ◽  
Charlotte A Williams ◽  
Nadua Bayzid ◽  
Marius Cotic ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Genomic Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Escape Mutation ◽  
Number Needed To Treat ◽  
Sequencing Analysis ◽  
Full Genome Sequencing ◽  
Post Vaccination

Abstract Background Post-vaccination infections challenge the control of the COVID-19 pandemic. Methods We matched 119 cases of post-vaccination SARS-CoV-2 infection with BNT162b2 mRNA, or ChAdOx1 nCOV-19, to 476 unvaccinated patients with COVID-19 (Sept 2020-March 2021), according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single nucleotide polymorphism (SNP) and minority variant allele (MVA) full genome sequencing analysis was performed. Results 116/119 cases developed COVID-19 post first vaccination dose (median 14 days, IQR 9 – 24 days). Overall, 13/119 (10∙9%) cases and 158/476 (33∙2%) controls died (p<0.001), corresponding to 4∙5 number needed to treat (NNT). Multivariably, vaccination was associated with 69∙3% (95%CI 45∙8 – 82∙6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination (RR reduction 65∙1%, 95%CI 27∙2 – 83∙2, NNT 4∙5), and across vaccine subgroups (BNT162b2: RR reduction 66%, 95%CI 34∙9 – 82∙2, NNT 4∙7, ChAdOx1: RR reduction 78∙4%, 95%CI 30∙4 – 93∙3, NNT 4∙1). Hospital admissions (OR 0∙80, 95%CI 0∙51 – 1∙28), and length of stay (-1∙89 days, 95%CI -4∙57 – 0∙78) were lower for cases, while Ct values were higher (30∙8 versus 28∙8, p = 0.053). B.1.1.7 was the predominant lineage in cases (100/108, 92.6%) and controls (341/446, 76.5%). Genomic analysis identified one post-vaccination case harboring the E484K vaccine escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP and MVA analysis were detected.

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9592-9592
Author(s):  
A. H. Kamal ◽  
K. M. Swetz ◽  
H. Liu ◽  
S. R. Ruegg ◽  
E. C. Carey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Median Time ◽  
Mayo Clinic ◽  
Hospital Admissions ◽  
Cox Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Plan ◽  
Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

scholarly journals MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S56-S57
Author(s):  
H. Novak Lauscher ◽  
K. Ho ◽  
J. L. Cordeiro ◽  
A. Bhullar ◽  
R. Abu Laban ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Hospital ◽  
Home Telemonitoring ◽  
Patient Health ◽  
Ed Visits ◽  
Improve Patient

Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

scholarly journals Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

2020 ◽  
Vol 86 (11) ◽  
pp. 1508-1512
Author(s):  
Mariana Kumaira Fonseca ◽  
Eduardo N. Trindade ◽  
Omero P. Costa Filho ◽  
Miguel P. Nácul ◽  
Artur P. Seabra
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Symptom Onset ◽  
Hospital Admissions ◽  
Average Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Time Interval ◽  
Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

scholarly journals Investigation of Surgical Site Infection Outbreak Among Neurosurgical Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s306-s306
Author(s):  
Luísa Ramos ◽  
Jussara Pessoa ◽  
Leonardo Santos ◽  
Carlos Starling ◽  
Braulio Couto
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Infection ◽  
Epidemic Period ◽  
Neurosurgical Patients ◽  
London Protocol

Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.Funding: NoneDisclosures: None

scholarly journals Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

2019 ◽  
Vol 32 (6) ◽  
pp. 453
Author(s):  
João Gonçalves-Pereira ◽  
Filipe Froes ◽  
Fernanda Paula Santos ◽  
Helena Sofia Antão ◽  
João Paulo Guimarães
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Early Discharge ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ambulatory Setting ◽  
Skin Structure ◽  
Clinically Significant ◽  
Prolonged Hospital

Introduction: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections.Material and Methods: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015.Results: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 – 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively.Discussion: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections.Conclusion: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.

scholarly journals Prevalence of Hospital Admissions for Low Back Pain: Protocol for a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Harrison J Lord ◽  
Danielle Coombs ◽  
Christopher Maher ◽  
Gustavo C Machado
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Low Back

Low back pain is the leading cause of years lived with disability in most countries and creates a huge burden for healthcare systems globally. Around the globe, 4.4% of all emergency department attendances are attributed to low back pain, and subsequent admissions to hospital seem to be common. These hospitalisations can result in unnecessary medical care, functional decline and high costs. There are no systematic reviews summarising the global prevalence of hospital admission for low back pain, identifying the sources of admissions or estimating hospital length of stay. This information would be valuable for health and medical researchers, front-line clinicians, and health planners aiming to improve and increase the value of their health services. The objectives of this study are to estimate the prevalence of hospital admission for low back pain from different healthcare facilities across the globe, including the emergency department, as well as investigate hospital length of stay and explore sources of heterogeneity when categorising studies according to low back pain definitions, sources of admission, study period, study setting and country’s region and income level.

Symptom burden and hospital length of stay among patients with curable cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6579-6579
Author(s):  
Sara D'Arpino ◽  
Areej El-Jawahri ◽  
Samantha M.C. Moran ◽  
Connor Johnson ◽  
Daniel Lage ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Psychological Symptoms ◽  
Symptom Burden ◽  
Hospital Length ◽  
Assessment System ◽  
Hospital Length Of Stay ◽  
Cancer Type ◽  
Unplanned Hospital Admissions ◽  
The Relationship

6579 Background: Prolonged hospital admissions are often inconsistent with patients’ preferences and incur significant costs. While patients’ symptoms may result in hospitalizations, the relationship between patients’ symptom burden and their hospital length-of-stay (LOS) has not been fully explored in patients with curable cancers. Methods: We prospectively enrolled patients with curable cancer and unplanned hospital admissions between 8/2015 and 12/2016. Within the first 5 days of admission, we assessed patients’ physical (Edmonton Symptom Assessment System [ESAS]; scored 0-10 with higher scores indicating greater symptom burden) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]; scored categorically and continuous with higher scores indicating greater distress). We created summated ESAS total and physical symptom variables. To assess the relationship between patients’ symptom burden and their hospital LOS, we used separate linear regression models adjusted for age, sex, marital status, education level, time since cancer diagnosis, and cancer type. Results: We enrolled 452 of 497 (91%) approached patients (mean age = 61.9 years; 188 [42%] female). Over half had hematologic cancers (n = 249, 55%). Mean hospital LOS was 8.3 days. Over one-tenth of patients screened positive for PHQ-4 depression (n = 74, 16%) and anxiety (n = 60, 13%) symptoms. Mean ESAS symptom scores were highest for fatigue (6.6), drowsiness (5.4), pain (4.9), and lack of appetite (4.8). In multivariable regression analysis, patients’ physical and psychological symptoms were associated with longer hospital LOS (table). Conclusions: Patients with curable cancer and unplanned hospital admissions experience a substantial symptom burden, which predicts for prolonged hospitalizations. Importantly, patients’ symptoms are modifiable risk factors that, if properly addressed, can improve care delivery and may have the potential to help decrease prolonged hospitalizations. [Table: see text]

scholarly journals Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay

2021 ◽  
Author(s):  
Richard P. Conway ◽  
Declan G. Byrne ◽  
Deirdre M. R. O’Riordan ◽  
Brian D. Kent ◽  
Barry M. J. Kennedy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Number Needed To Treat ◽  
Icu Admission ◽  
Emergency Medical ◽  
Multiple Variable ◽  
Univariate Predictor

Abstract Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. Methods We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. Results There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)—OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor—OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved—OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased. Conclusion A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.

scholarly journals 768. Malaria in a Non-Endemic Setting: A Retrospective Review of Malaria Hospitalisations in Ireland over a Four Year Period

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S428-S429
Author(s):  
David Moynan ◽  
Niamh Reidy ◽  
James O’Connell ◽  
Paul Reidy ◽  
Eoghan de Barra
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Hospital Admissions ◽  
Plasmodium Malariae ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
African Region ◽  
Notification Rate ◽  
High Dependency ◽  
National Quality

Abstract Background With globalisation fuelling the fire for infectious diseases, it’s important for general physicians to be aware of the tropical infections presenting to hospitals. Malaria, with over 400,000 deaths annually worldwide, has an Irish notification rate of 1.2 per 100,000 of the population, the seventh highest incidence rate of imported malaria globally. This analysis aims to examine the demographics and outcomes of Irish patients with malaria over a four year period. Methods A retrospective analysis of all patients with malaria admitted to Irish hospitals between January 1st 2016 and December 31st 2019 was performed. Data was obtained from the National Quality Assurance Improvement System (NQAIS), a national electronic database that collates data from hospital admissions. This was analysed using STATA. Patient demographics, hospital length of stay and documented malaria subspecies are described. Results Between January 1st 2016 and December 31st 2019 there were 289 cases of malaria admitted to Irish hospitals, 13/289 (4.5%) requiring high dependency care. 197/289 (68%) were male. The mean age was 35 years (95% CI 33.3 – 37). 220/289 (76%) of all cases resulted from Plasmodium falciparum infection, 16/289 (5.5%) Plasmodium ovale, 11/289 (3.8%) Plasmodium vivax and 2/289 (0.7%) Plasmodium malariae, while 40/289 (13.8%) were unspecified. The median length of stay was 3 days (IQR 1-4 days) and 72/289 (25%) were admitted under an Infectious Diseases team, although this had no significant impact in length of stay (3.1 days versus 3.4 days, p=0.68). 117/289 (40%) were admitted in the months of August and September. There were no reported deaths. Conclusion This report gives a clinical context to the 2016 – 2019 NQAIS data, particularly with regards to inpatient length of stay, malaria species diagnosed and numbers requiring critical care. The majority of all cases in the four year period were P. falciparum, reflective of the dominant African region of exposure in most cases. Interestingly, 43% of all cases were from hospitals outside of the Dublin City catchment area, reflecting a diversification of travel and population demographics in Ireland. This highlights the importance of malaria awareness in all regions in Ireland, not simply the major urban centres. Disclosures All Authors: No reported disclosures

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