scholarly journals Pre-Hospital Management of Critically Ill Patients with SARS-CoV-2 Infection: A Retrospective Multicenter Study

2020 ◽  
Vol 9 (11) ◽  
pp. 3744
Author(s):  
Pierrick Le Borgne ◽  
Mathieu Oberlin ◽  
Adrien Bassand ◽  
Laure Abensur Vuillaume ◽  
Yannick Gottwalles ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Phenotype ◽  
Care Pathway ◽  
Hospital Management ◽  
Mobile Service ◽  
Multicentric Study ◽  
East Region ◽  
Initial Stage ◽  
Lesion Extension ◽  
Retrospective Multicenter Study

Introduction: The COVID-19 outbreak had a major impact on healthcare systems worldwide. Our study aims to describe the characteristics and therapeutic emergency mobile service (EMS) management of patients with vital distress due to COVID-19, their in-hospital care pathway and their in-hospital outcome. Methods: This retrospective and multicentric study was conducted in the six main centers of the French Greater East region, an area heavily impacted by the pandemic. All patients requiring EMS dispatch and who were admitted straight to the intensive care unit (ICU) were included. Clinical data from their pre-hospital and hospital management were retrieved. Results: We included a total of 103 patients (78.6% male, median age 68). In the initial stage, patients were in a critical condition (median oxygen saturation was 72% (60–80%)). In the field, 77.7% (CI 95%: 71.8–88.3%) were intubated. Almost half of our population (45.6%, CI 95%: 37.1–56.9%) had clinical Phenotype 1 (silent hypoxemia), while the remaining half presented Phenotype 2 (acute respiratory failure). In the ICU, a great number had ARDS (77.7%, CI 95% 71.8–88.3% with a PaO2/FiO2 < 200). In-hospital mortality was 33% (CI 95%: 24.6–43.3%). The two phenotypes showed clinical and radiological differences (respiratory rate, OR = 0.98, p = 0.02; CT scan lesion extension >50%, OR = 0.76, p < 0.03). However, no difference was found in terms of overall in-hospital mortality (OR = 1.07, p = 0.74). Conclusion: The clinical phenotypes appear to be very distinguishable in the pre-hospital field, yet no difference was found in terms of mortality. This leads us to recommend an identical management in the initial phase, despite the two distinct presentations.

scholarly journals Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version

10.2196/17485 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e17485
Author(s):  
Elise Verot ◽  
Wafa Bouleftour ◽  
Corinne Macron ◽  
Romain Rivoirard ◽  
Franck Chauvin
Keyword(s):  
Nursing Care ◽  
Cancer Care ◽  
Care Pathway ◽  
Patient Activation ◽  
Oncology Nurses ◽  
Multicentric Study ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers ◽  
Semistructured Interviews ◽  
Patient Activation Measure

Background The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient’s needs, with nursing care adapting accordingly. Objective The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods This study will follow the “Reach, Effectiveness, Adoption, Implementation, and Maintenance” framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the “Capability, Opportunity, Motivation, and Behavior” model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient’s anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient’s enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID) DERR1-10.2196/17485

scholarly journals Body Mass Index and In-Hospital Management and Outcomes of Acute Myocardial Infarction

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 926
Author(s):  
Sri Harsha Patlolla ◽  
Gayathri Gurumurthy ◽  
Pranathi R. Sundaragiri ◽  
Wisit Cheungpasitporn ◽  
Saraschandra Vallabhajosyula
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Hospital Management ◽  
Obesity Paradox ◽  
Nursing Facilities ◽  
Cardiac Procedures ◽  
Hospitalization Costs

Background and Objectives: Contemporary data on the prevalence, management and outcomes of acute myocardial infarction (AMI) in relation to body mass index (BMI) are limited. Materials and Methods: Using the National Inpatient Sample from 2008 through 2017, we identified adult AMI hospitalizations and categorized them into underweight (BMI < 19.9 kg/m2), normal BMI and overweight/obese (BMI > 24.9 kg/m2) groups. We evaluated in-hospital mortality, utilization of cardiac procedures and resource utilization among these groups. Results: Among 6,089,979 admissions for AMI, 38,070 (0.6%) were underweight, 5,094,721 (83.7%) had normal BMI, and 957,188 (15.7%) were overweight or obese. Over the study period, an increase in the prevalence of AMI was observed in underweight and overweight/obese admissions. Underweight AMI admissions were, on average, older, with higher comorbidity, whereas overweight/obese admissions were younger and had lower comorbidity. In comparison to the normal BMI and overweight/obese categories, significantly lower use of coronary angiography (62.3% vs. 74.6% vs. 37.9%) and PCI (40.8% vs. 47.7% vs. 19.6%) was observed in underweight admissions (all p < 0.001). The underweight category was associated with significantly higher in-hospital mortality (10.0% vs. 5.5%; OR 1.23 (95% CI 1.18–1.27), p < 0.001), whereas being overweight/obese was associated with significantly lower in-hospital mortality compared to normal BMI admissions (3.1% vs. 5.5%; OR 0.73 (95% CI 0.72–0.74), p < 0.001). Underweight AMI admissions had longer lengths of in-hospital stay with frequent discharges to skilled nursing facilities, while overweight/obese admissions had higher hospitalization costs. Conclusions: In-hospital management and outcomes of AMI vary by BMI. Underweight status was associated with worse outcomes, whereas the obesity paradox was apparent, with better outcomes for overweight/obese admissions.

Abstract 13490: Patterns of In-Hospital Management and Disposition of Patients Over 90 Years of Age Admitted with an Acute Coronary Syndrome at a Tertiary Medical Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nicolas W Shammas ◽  
Gail A Shammas ◽  
Carolyn Shanks ◽  
Amanda Dvorak ◽  
Patricia Serrano ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Nursing Home ◽  
Hospital Mortality ◽  
Conservative Management ◽  
Medical Center ◽  
Beta Blockers ◽  
Hospital Management ◽  
Smoking History ◽  
Clinical Variables ◽  
Coronary Syndrome

Introduction: It is estimated that by 2020 there will be 2.6 million nonagenarians and 135,000 centenarians in the United States. The in-hospital management and disposition of these patients remain poorly defined. Hypothesis: We describe in-hospital management and disposition of patients over the age of 90 years presenting with an acute coronary syndrome (ACS) at a tertiary medical center. Methods: All patients admitted between January 1, 2008 to December 31, 2012 with the diagnosis of an ACS and are over the age of 90 were included in this study. Demographic, clinical variables, in-hospital treatment, and post-hospital disposition were reviewed from medical records. The use of aspirin (ASA), beta-blockers, statins, ACEI/ARB, clopidogrel and aggressive versus conservative management were recorded. Results: 109 patients (13.9% males) were included. Demographics and clinical variables were as follows: Prior CAD 63.3%, prior MI 25.7%, renal insufficiency 33%, HT 80.7%, hyperlipidemia 45%, DM 23.9%, heart failure 30.3%, dementia 15.6%, smoking history 21.1%, and atrial fibrillation 22%. Patients were admitted from home 50.9%, nursing home/assisted living 35.2%, transfer from a local cath lab 12% and from primary care physician’s office 1.2%. ACS symptoms consisted of UA 23.9%, NSTEMI 65.4%, STEMI 11%. Coronary intervention was performed in 43.5%. Conservative management was driven by: dementia 4.6%, patient or family wishes 34.2%, physician 13%, non-treatable disease 4.6%. Pharmacologic management on discharge included ASA 82.1%, beta blockers 72%, statins 41.1%, ACEI 31.5%, ARB 8.3%, clopidogrel 52.4%. In-hospital mortality was 8.4% (cardiac related 7.5%) and length of hospital stay was 4.8 ± 4 days. Patients were discharged to home with visiting nurse (VN) support 30.1%, without VN 7.8%, to a family member’s home 4.9%, nursing home 29.1%, skilled nursing/rehabilitation 15.5%, and hospice 5.8%. Conclusions: In-hospital mortality rates of patients over the age of 90 is acceptable. Frequently these patients are treated with PCI. Conservative management is mostly guided by the patient and family wishes. Unfortunately, these patients remain markedly undertreated with standard post MI or UA drugs. Less than half of these patients returned home.

scholarly journals Type A aortic aneurysm dissection: causes of development, diagnostic methods and treatment results

2019 ◽  
pp. 43-47
Author(s):  
I. M. Kravchenko ◽  
V. I. Kravchenko ◽  
I. I. Zhekov ◽  
I. A. Osadovska ◽  
I.I. Zinovchyk ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Type A ◽  
Diagnostic Methods ◽  
Moderate Hypothermia ◽  
Type I ◽  
Treatment Results ◽  
Initial Stage ◽  
Aneurysm Dissection

Surgical treatment of Type A aortic aneurysm dissection remains one of the most complicated problems in car-diac surgery. The whole surgical treatment experience of such aneurysms by one team is presented in the article. Factors that could have caused the aortic aneurysm (dissection) development are provided. It is shown that experience accumulation, methods improvement of surgical treatment, brain, heart and internal organs protection have allowed to reach the hospital mortality rate of 4.5% over the last 5 years. Data on severe baseline of the operated patients are presented in the paper. It is represented that in the Institute’s experience type A aneurysm dissection accounts for 28.9% of all aneurysms. The vast majority (79.6%) of patients were operated on for acute or subacute type A dissection; 69.2% of patients had type I dissec-tion. All operations were performed under conditions of bypass, moderate hypothermia (30–32 °C) and during the aortic arch replacement (42.4%) – under conditions of deep hypothermia (13–20 °C) and retrograde cerebral perfusion. Surgical correction methods are presented with valve-saving surgeries performed in 63.7% of patients. The surgical treatment results have been shown to be highly dependent on the time of the surgery. Thus, at the initial stage of surgical experience, hospital mortality was 24.1% with a decrease to 16.1% and with a decrease to 4.6% over the last 8 years.

scholarly journals Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 880-880
Author(s):  
Chelsea Liu ◽  
Hong-Qiu Gu ◽  
Xin Yang ◽  
Chun-Juan Wang ◽  
Kai-Xuan Yang ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Care Pathway ◽  
Lipid Lowering ◽  
Smoking History ◽  
Thrombosis Prophylaxis ◽  
Stroke Severity ◽  
Care Needs ◽  
Hospital Outcomes ◽  
History Of ◽  
Stroke Center

Abstract Little is known about the prevalence of pre-stroke dementia in China and whether this group is at higher risk of adverse in-hospital outcomes. We aimed to understand this association using data from the Chinese Stroke Center Alliance. Multivariable logistic regressions were conducted to assess the association between pre-stroke dementia status and ambulation at day 2, in-hospital mortality, and in-hospital complications. Covariates included age, sex, medical history, history of smoking, history of alcohol use, medication history (antiplatelet drugs, lipid-lowering drugs), stroke severity (measured by the National Institute of Health Stroke Scale), whether IV tPA was administered within 4.5 hours, and whether the patient received deep vein thrombosis prophylaxis as needed. Odds ratios and 95% confidence intervals were presented for the adjusted models. In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1476 hospitals, 1511 (0.3%) had pre-stroke dementia, and they were older and more likely to be female. Patients with pre-stroke dementia had lower odds of ambulating at day 2, higher odds of having any complications and higher odds of in-hospital mortality compared to those without pre-stroke dementia, despite little difference in treatment received. Our findings may be explained by communication barriers experienced by patients with pre-stroke dementia that limited their ability to advocate for their own care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.

scholarly journals Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jason Talevski ◽  
Viviana Guerrero-Cedeño ◽  
Oddom Demontiero ◽  
Pushpa Suriyaarachchi ◽  
Derek Boersma ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Outcome Measures ◽  
Care Pathway ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Care Pathways ◽  
Discharge Location

Abstract Background Care pathways are generally paper-based and can cause communication failures between multidisciplinary teams, potentially compromising the safety of the patient. Computerized care pathways may facilitate better communication between clinical teams. This study aimed to investigate whether an electronic care pathway (e-pathway) reduces delays in surgery and hospital length of stay compared to a traditional paper-based care pathway (control) in hip fracture patients. Methods A single-centre evaluation with a retrospective control group was conducted in the Orthogeriatric Ward, Nepean Hospital, New South Wales, Australia. We enrolled patients aged > 65 years that were hospitalized for a hip fracture in 2008 (control group) and 2012 (e-pathway group). The e-pathway provided the essential steps in the care of patients with hip fracture, including examinations and treatment to be carried out. Main outcome measures were delay in surgery and hospital length of stay; secondary outcomes were in-hospital mortality and discharge location. Results A total of 181 patients were enrolled in the study (129 control; 54 e-pathway group). There was a significant reduction in delay to surgery in the e-pathway group compared to control group in unadjusted (OR = 0.19; CI 0.09–0.39; p < 0.001) and adjusted (OR = 0.22; CI 0.10–0.49; p < 0.001) models. There were no significant differences between groups for length of stay (median 11 vs 12 days; p = 0.567), in-hospital mortality (1 vs 7 participants; p = 0.206) or discharge location (p = 0.206). Conclusions This pilot study suggests that, compared to a paper-based care pathway, implementation of an e-pathway for hip fracture patients results in a reduction in total number of delays to surgery, but not hospital length of stay. Further evaluation is warranted using a larger cohort investigating both clinical and patient-reported outcome measures.

scholarly journals Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jean-Rémi Lavillegrand ◽  
Emmanuelle Mercier-Des-Rochettes ◽  
Elodie Baron ◽  
Frédéric Pène ◽  
Damien Contou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Multicenter Study ◽  
Sofa Score ◽  
Acute Cholangitis ◽  
Biliary Decompression ◽  
Retrospective Multicenter Study

Abstract Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n  = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

scholarly journals Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

2019 ◽  
Vol 10 ◽  
Author(s):  
Fernando Zanela Areas ◽  
Marcelo Liborio Schwarzbold ◽  
Alexandre Paim Diaz ◽  
Igor Kunze Rodrigues ◽  
Daniel Santos Sousa ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Severe Traumatic Brain Injury ◽  
Burden Of Disease ◽  
Multicentric Study

scholarly journals Deradicalization of Islamism: Case of Yemen

2021 ◽  
Vol 16 (4) ◽  
pp. 131-142
Author(s):  
T. R. Khayrullin
Keyword(s):  
Armed Conflict ◽  
Arab Spring ◽  
Armed Conflicts ◽  
East Region ◽  
Initial Stage ◽  
Financial Investments ◽  
Before And After ◽  
The Arab Spring ◽  
Work Done ◽  
Middle East Region

The ongoing armed conflict in Yemen between the forces of ousted President M. Hadi, supported by the coalition units of the Gulf monarchies led by Saudi Arabia and the Houthi group Ansar Allah, has a destabilizing effect on the entire Arabian Peninsula as a whole. In this regard, the creation of a deradicalization program and its implementation will help to solve several main tasks. First, to change the worldview of members of Islamist groups and movements from radical to moderate. Secondly, it will significantly reduce the level of instability in the Middle East region, where the majority of armed conflicts is conducted under religious slogans. The main focus of this study is on measures to counter radical Islamism, which were taken by the Yemeni authorities before and after the events of the Arab Spring. At the initial stage, the Yemeni administration’s use of the de-radicalization program showed impressive results. However, the ongoing fighting, as well as the reluctance of the Yemeni elite to Fund the deradicalization programme, led to its closure. The subsequent events of the Arab Spring brought additional instability to the domestic political situation in Yemen. Attempts to revive the program of deradicalization by the new Yemeni administration have failed. In general, the work done by the Yemeni authorities to deradicalize Islamism has demonstrated the ability to use non-violent methods of struggle, but their use is associated with serious financial investments, which the Yemeni state is not yet able to make due to the difficult financial situation caused by the prolonged armed conflict.

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