scholarly journals Clinical management of hospitalized COVID-19 patients in the United States

2021 ◽  
Author(s):  
Essy Mozaffari ◽  
Aastha Chandak ◽  
Zhiji Zhang ◽  
Shuting Liang ◽  
Julie Gayle ◽  
...  
Keyword(s):  
Clinical Management ◽  
Invasive Mechanical Ventilation ◽  
Corticosteroid Treatment ◽  
The United States ◽  
Supplemental Oxygen ◽  
Low Flow ◽  
Healthcare Database ◽  
High Flow Oxygen ◽  
Evidence Based Treatments ◽  
Over Time

Abstract Objective The objective of this study was to characterize hospitalized COVID-19 patients and describe their real-world treatment patterns and outcomes over time. Methods Adult patients hospitalized 5/1/2020–12/31/2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), ICU utilization and mortality were examined. Results The study included 295 657 patients (847 hospitals), with median age(IQR) of 66(54-77) years. Majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, while 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within two days of hospitalization in December vs May (RDV: 87% vs 40%; corticosteroids: 93% vs 62%; convalescent plasma: 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% (May) vs. 83.1% (December)). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/ECMO (IMV/ECMO):53.7%, high-flow oxygen/non-invasive ventilation (HFO/NIV):32.2%, LFO:11.7%, NSOc:7.3%). ICU use decreased, while mortality decreased for NSOc and LFO. Conclusions Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, while improvement in outcomes occurred over this time-period.

scholarly journals Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort

2021 ◽  
Author(s):  
Essy Mozaffari ◽  
Aastha Chandak ◽  
Zhiji Zhang ◽  
Shuting Liang ◽  
Mark Thrun ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Statistical Significance ◽  
Invasive Mechanical Ventilation ◽  
Supplemental Oxygen ◽  
Cox Proportional Hazards ◽  
Low Flow ◽  
Healthcare Database ◽  
Cox Proportional Hazards Models ◽  
High Flow Oxygen ◽  
Oxygenation Level

Abstract Background Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited. Methods We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO. Results 28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14- and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI]: 0.76[0.70−0.83]) and 28-days (0.89[0.82−0.96]). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO:0.69[0.57−0.83], LFO:0.68[0.80−0.77], IMV/ECMO:0.70[0.58−0.84]) and 28-days (NSO:0.80[0.68−0.94], LFO:0.77[0.68−0.86], IMV/ECMO:0.81[0.69−0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81[0.70−0.93]) but no statistical significance at 28-days. Conclusions RDV initiated upon hospital admission was associated with improved survival among COVID-19 patients. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.

scholarly journals Clinical and Pregnancy Outcomes of COVID-19 Among Hospitalized Pregnant Women in the United States

2021 ◽  
Author(s):  
Christina M Ackerman ◽  
Jennifer L Nguyen ◽  
Swapna Ambati ◽  
Maya Reimbaeva ◽  
Birol Emir ◽  
...  
Keyword(s):  
United States ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Negative Impact ◽  
Invasive Mechanical Ventilation ◽  
Age Groups ◽  
The United States ◽  
Supplemental Oxygen ◽  
Healthcare Database ◽  
The Impact

Abstract Background Pregnant women with coronavirus disease 19 (COVID-19) may be at greater risk of poor maternal and pregnancy outcomes. This retrospective analysis reports clinical and pregnancy outcomes among hospitalized pregnant women with COVID-19 in the United States. Methods The Premier Healthcare Database – Special Release was used to examine the impact of COVID-19 among pregnant women aged 15–44 years who were hospitalized and who delivered compared with pregnant women without COVID-19. Outcomes evaluated were COVID-19 clinical progression, including the use of supplemental oxygen therapy, intensive care unit admission, critical illness, receipt of invasive mechanical ventilation/extracorporeal membrane oxygenation, and maternal death, and pregnancy outcomes, including preterm delivery and stillbirth. Results Overall, 473,902 hospitalized pregnant women were included, of whom 8584 (1.8%) had a COVID-19 diagnosis (mean [SD] age 28.4 [6.1] years; 40% Hispanic). The risk of poor clinical and pregnancy outcomes was greater among pregnant women with COVID-19 compared with pregnant women without a COVID-19 diagnosis in 2020; the risk of poor clinical and pregnancy outcomes increased with increasing age. Hispanic and Black non-Hispanic women were consistently observed to have the highest relative risk of experiencing poor clinical or pregnancy outcomes across all age groups. Conclusions Overall, COVID-19 had a significant negative impact on maternal health and pregnancy outcomes. These data help inform clinical practice and counselling to pregnant women regarding the risks of COVID-19. Clinical studies evaluating the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in pregnant women are urgently needed.

scholarly journals Anti-COVID property of subcutaneous ivermectin in synergy with zinc among midlife moderately symptomatic patients: a structured summary of a study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shoaib Ashraf ◽  
Sohaib Ashraf ◽  
Iqra Farooq ◽  
Sidra Ashraf ◽  
Moneeb Ashraf ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Study Protocol ◽  
Primary Care Physicians ◽  
Invasive Mechanical Ventilation ◽  
Supplemental Oxygen ◽  
Study Objective ◽  
Link Type ◽  
High Flow Oxygen ◽  
Full Protocol

Abstract Objectives The study objective is to quantify the effectiveness of ivermectin (subcutaneous/oral IVM) in the presence or absence of zinc (Zn) for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients with moderate severity. Trial design This quadruple-blinded, placebo-controlled randomized clinical trial will be a multiarmed multi-centered study with superiority framework. Participants Quinquagenarian and sexagenarian patients with moderate COVID-19 symptoms and positive severe respiratory syndrome coronavirus -2 (SARS-CoV-2) PCR will be included. Participants with co-morbidities and pregnant women will be excluded. Patient recruitment will be done in Shaikh Zayed Medical Complex, Doctors Lounge and Ali Clinic in Lahore (Pakistan). Intervention and comparator The registered patients will be allocated in 6 groups (30 participants each). Patients will be taking subcutaneous IVM at 200 μg/kg/48 h (Arm A) or subcutaneous IVM at 200 μg/kg/48 h and oral Zn 20mg/8 h (Arm B) or oral IVM at 0.2 mg/kg/day (Arm C) or oral IVM at 0.2 mg/kg/day and oral Zn 20mg/8 h (Arm D) or alone oral Zn 20mg/8 h (Arm E) or placebo alone (Arm X). Patients in all arms will receive standard care and respective placebo (empty capsule 8 hourly and/or subcutaneous normal saline 2ml/48 h). Main outcomes Primary endpoints will be duration of symptomatic phase and SARS-CoV-2 clearance along with high resolution CT (HRCT) chest score and clinical grade scale (CGS) on day 6. 30-day mortality will be documented as a secondary endpoint. SARS-CoV-2 clearance will be calculated by second PCR on day 7. HRCT chest score will be measured by the percentage and lung lobes involvement on day 6 with a maximum score of 25. CGS will be recorded on a seven-point scale; grade 1 (not hospitalized, no evidence of infection and resumption of normal activities), grade 2 (not hospitalized, but unable to resume normal activities), grade 3 (hospitalized, not requiring supplemental oxygen), grade 4 (hospitalized, requiring supplemental oxygen), grade 5 (hospitalized, requiring nasal high-flow oxygen therapy and/or noninvasive mechanical ventilation), grade 6 (hospitalized, requiring ECMO and/or invasive mechanical ventilation) and grade 7 (death). Randomisation A simple lottery method will be used to randomly allocate scrutinized patients in 1:1:1:1:1:1 ratio in 6 groups. Blinding (masking) Patients, primary care physicians, outcome assessors and the data collection team will be blinded. Numbers to be randomised (sample size) 180 participants will be randomized into six arms with five investigational and one placebo group. Trial Status Institutional Review Board Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan has approved the protocol (version 2.3) with ID SZMC/IRB/Internal0056/2020. The trial was approved on July 14, 2020, and enrolment started on July 30, 2020. The estimated completion date is October 30, 2021. Trial registration Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04472585 dated July 16, 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

scholarly journals Comparison of confirmed and probable COVID-19 patients in the intensive care unit during the normalization period

2021 ◽  
Author(s):  
Fatma İrem Yeşiler ◽  
Mesher Çapras ◽  
Emre Kandemir ◽  
Helin Şahintürk ◽  
Ender Gedik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii ◽  
Low Flow ◽  
Apache Ii Score ◽  
Common Symptom ◽  
Hemoglobin C ◽  
High Flow Oxygen ◽  
The Mean

The decrease in social distance together with the normalization period as of June 1, 2020 in our country caused an increase in the number of COVID 19 patients. Our aim was to compare the demographic features, clinical courses and outcomes of confirmed and probable coronavirus disease 2019 (COVID-19) patients admitted to our intensive care unit (ICU) during the normalization period. Critically ill 128 COVID-19 patients between June 1 - December 2, 2020 were analyzed retrospectively. The mean age was 69.7±15.5y (61.7% male). Sixty-one patients (47.7%) were confirmed. Dyspnea (75.0%) was the most common symptom and hypertension (71.1%) was the most common comorbidity. The mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score; Glasgow Coma Score (GCS); Sequential Organ Failure Assessment (SOFA) scores on ICU admission were 17.4 ± 8.2, 12.3 ± 3.9 and 5.9 ± 3.4, respectively. 101 patients (78.1%) received low flow oxygen, 48 had high flow oxygen therapy (37.5%) and 59 (46.1%) had invasive mechanical ventilation. 53 patients (41.4%) had vasopressor therapy and 30 (23.4%) patients had renal replacement therapy (RRT) due to acute kidney injury (AKI). Confirmed patients were more tachypneic (p=0.005) and more hypoxemic than probable patients (p<0.001). Acute respiratory distress syndrome (ARDS) and AKI were more common in confirmed patients than probable (both p<0.001). Confirmed patients had higher values of hemoglobin, C- reactive protein, fibrinogen, D-dimer than probables (respectively, p=0.028, 0.006, 0.000, 0.019). The overall mortality was higher in confirmed patients (p=0.209, 52.6% vs 47.4%). Complications are more common among confirmed COVID-19 patients admitted to ICU. The mortality rate of confirmed COVID-19 patients admitted to the ICU was found to be higher than probable patients. Mortality of confirmed cases were higher than prediction of APACHE-II scoring system.

scholarly journals Comparison of baseline characteristics, treatment and clinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia

2021 ◽  
Vol 23 (3) ◽  
pp. 308-319
Author(s):  
Aidan JC Burrell ◽  
◽  
Ary Serpa Neto ◽  
Tessa Broadley ◽  
Tony Trapani ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Non Invasive ◽  
Icu Length Of Stay ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Evidence Based Treatments ◽  
Baseline Characteristics ◽  
New Evidence ◽  
Second Wave ◽  
Over Time

OBJECTIVE: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. DESIGN, SETTING AND PARTICIPANTS: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. RESULTS: A total of 461 patients were recruited in 53 ICUs across Australia; a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years; P = 0.001) and less commonly male (68.9% v 60.0%; P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14; P = 0.998). High flow oxygen use (75.2% v 43.4%; P < 0.001) and non-invasive ventilation (16.5% v 7.1%; P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%; P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days; P = 0.003). In-hospital mortality was similar (12.2% v 14.6%; P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43; 95% CI, 1.13–1.79; P = 0.002). CONCLUSION: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity.

scholarly journals Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 472
Author(s):  
Elena Fernández Fernández ◽  
Mary Joyce ◽  
Andrew O’Sullivan ◽  
Ronan MacLoughlin
Keyword(s):  
Cystic Fibrosis ◽  
Bacterial Infections ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Hospital Setting ◽  
Clinical Intervention ◽  
Supplemental Oxygen ◽  
Low Flow ◽  
Size Analysis ◽  
Aerosol Therapy

Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF). CF patients inhale antibiotics regularly as treatment against persistent bacterial infections. The goal of this study was to investigate the effect of clinical intervention on aerosol therapy during the escalation of care using a bench model of adult CF. Droplet size analysis of selected antibiotics was completed in tandem with the delivered aerosol dose (% of total dose) assessments in simulations of various interventions providing oxygen supplementation or ventilatory support. Results highlight the variability of aerosolised dose delivery. In the homecare setting, the vibrating mesh nebuliser (VMN) delivered significantly more than the jet nebuliser (JN) (16.15 ± 0.86% versus 6.51 ± 2.15%). In the hospital setting, using VMN only, significant variability was seen across clinical interventions. In the emergency department, VMN plus mouthpiece (no supplemental oxygen) was seen to deliver (29.02 ± 1.41%) versus low flow nasal therapy (10 L per minute (LPM) oxygen) (1.81 ± 0.47%) and high flow nasal therapy (50 LPM oxygen) (3.36 ± 0.34%). In the ward/intensive care unit, non-invasive ventilation recorded 19.02 ± 0.28%, versus 22.64 ± 1.88% of the dose delivered during invasive mechanical ventilation. These results will have application in the design of intervention-appropriate aerosol therapy strategies and will be of use to researchers developing new therapeutics for application in cystic fibrosis and beyond.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

An Analysis of Fraudulent Qui Tam Actions Over Time in the United States

2007 ◽  
Author(s):  
Karen A. Fitzner ◽  
Charlie Bennett ◽  
June McKoy ◽  
Cara Tigue
Keyword(s):  
United States ◽  
The United States ◽  
Over Time

Forecasting Interconnections in International Housing Markets: Evidence from the Dynamic Model Averaging Approach

2020 ◽  
Vol 42 (1) ◽  
pp. 37-103
Author(s):  
Hardik A. Marfatia
Keyword(s):  
Dynamic Model ◽  
Model Averaging ◽  
Housing Markets ◽  
The United States ◽  
Forecasting Model ◽  
Change Over Time ◽  
The United Kingdom ◽  
Novel Approach ◽  
Dynamic Model Averaging ◽  
Over Time

In this paper, I undertake a novel approach to uncover the forecasting interconnections in the international housing markets. Using a dynamic model averaging framework that allows both the coefficients and the entire forecasting model to dynamically change over time, I uncover the intertwined forecasting relationships in 23 leading international housing markets. The evidence suggests significant forecasting interconnections in these markets. However, no country holds a constant forecasting advantage, including the United States and the United Kingdom, although the U.S. housing market's predictive power has increased over time. Evidence also suggests that allowing the forecasting model to change is more important than allowing the coefficients to change over time.

The New Economic Populism and the Future of Inequality in the United States

2017 ◽  
Author(s):  
William W. Franko ◽  
Christopher Witko
Keyword(s):  
United States ◽  
Federal Government ◽  
Labor Unions ◽  
Republican Party ◽  
The United States ◽  
The Public ◽  
Empirical Results ◽  
Income Disparities ◽  
The Face ◽  
Over Time

The authors conclude the book by recapping their arguments and empirical results, and discussing the possibilities for the “new economic populism” to promote egalitarian economic outcomes in the face of continuing gridlock and the dominance of Washington, DC’s policymaking institutions by business and the wealthy, and a conservative Republican Party. Many states are actually addressing inequality now, and these policies are working. Admittedly, many states also continue to embrace the policies that have contributed to growing inequality, such as tax cuts for the wealthy or attempting to weaken labor unions. But as the public grows more concerned about inequality, the authors argue, policies that help to address these income disparities will become more popular, and policies that exacerbate inequality will become less so. Over time, if history is a guide, more egalitarian policies will spread across the states, and ultimately to the federal government.

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