scholarly journals July Effect on Mortality and Complications in Patients With ARDS in US Teaching Hospitals

2021 ◽  
Vol 30 (4) ◽  
pp. e64-e70
Author(s):  
Titilope Olanipekun ◽  
Abimbola Chris-Olaiya ◽  
Shawn Esperti ◽  
Vinod Nambudiri ◽  
Richard Duff ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Bloodstream Infection ◽  
The United States ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Ventilator Associated Pneumonia ◽  
Central Catheter ◽  
Difference In Differences ◽  
July Effect ◽  
States Experience

Background Each July, teaching hospitals in the United States experience an influx of new resident and fellow physicians. It has been theorized that this occurrence may be associated with increased patient mortality, complication rates, and health care resource use, a phenomenon known as the “July effect.” Objective To assess the existence of a July effect in clinical outcomes of patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation in the intensive care unit in US teaching hospitals. Methods The National Inpatient Sample database was queried for all adult patients with ARDS who received mechanical ventilation from 2012 to 2014. Using a multivariate difference-in-differences (DID) model, differences in mortality, ventilator-associated pneumonia, iatrogenic pneumothorax, central catheter–associated bloodstream infection, and Clostridium difficile infection were compared between teaching and nonteaching hospitals during April-May and July-August. Results There were 70 535 and 43 175 hospitalizations meeting study criteria in teaching and nonteaching hospitals, respectively. Multivariate analyses revealed no differential effect on the rates of all-cause inpatient mortality (DID, 0.66; 95% CI, −0.42 to 1.75), C difficile infection (DID, 0.29; 95% CI, −0.19 to 0.78), central catheter–associated bloodstream infection (DID, 0.14; 95% CI, −0.04 to 0.33), iatrogenic pneumothorax (DID, 0.00; 95% CI, −0.25 to 0.24), ventilator-associated pneumonia (DID, 0.22; 95% CI, −0.05 to 0.49), and any complication (DID, 0.60; 95% CI, −0.01 to 1.20) for July-August versus April-May in teaching hospitals compared with nonteaching hospitals. Conclusion This study did not show a differential July effect on mortality outcomes and complication rates in ARDS patients receiving mechanical ventilation in teaching hospitals compared with nonteaching hospitals.

scholarly journals Economic Impact of Ventilator-Associated Pneumonia in a Large Matched Cohort

2012 ◽  
Vol 33 (3) ◽  
pp. 250-256 ◽  
Author(s):  
Marin H. Kollef ◽  
Cindy W. Hamilton ◽  
Frank R. Ernst
Keyword(s):  
Mechanical Ventilation ◽  
Economic Impact ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Cost Effective ◽  
The United States ◽  
Absolute Difference ◽  
Ventilator Associated Pneumonia ◽  
Matched Cohort ◽  
Hospitalization Costs

Objective.To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs.Design.Retrospective matched cohort study.Setting.Premier database of hospitals in the United States.Patients.Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009.Methods.VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods.Results.Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP (n = 2,144) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all P< .0001) than patients without VAP (n = 2,144). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP (P< .0001), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; P<.0001).Conclusions.Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.Infect Control Hosp Epidemiol 2012;33(3):250-256

Assessment of the July Effect on Bronchoscopies in Teaching Hospitals Across the United States

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jay Pescatore ◽  
Iriagbonse Asemota ◽  
William Davis ◽  
Viviana R. Pinzon ◽  
Parnia Khamooshi ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Teaching Hospitals ◽  
July Effect

scholarly journals Hospitalizations for Respiratory Syncytial Virus Among Adults in the United States, 1997–2012

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Susan T. Pastula ◽  
Judith Hackett ◽  
Jenna Coalson ◽  
Xiaohui Jiang ◽  
Tonya Villafana ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Syncytial Virus ◽  
The United States ◽  
Teaching Hospitals ◽  
Inpatient Mortality ◽  
Admission Rates ◽  
Hospitalization Rates ◽  
Syncytial Virus ◽  
Lower Respiratory Disease ◽  
Mean Cost

Abstract Background Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied. Methods We conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997–2012 National Inpatient Sample. Trends in RSV admissions were described relative to unspecified viral pneumonia admissions. Hospitalization severity indicators were compared among immunocompromised RSV, non-immunocompromised RSV, and influenza admissions. Results An estimated 28237 adult RSV hospitalizations occurred, compared with 652818 influenza hospitalizations; 34% were immunocompromised individuals. Respiratory syncytial virus and influenza patients had similar age, gender, and race distributions, but RSV was more often diagnosed in urban teaching hospitals (73.0% for RSV vs 34.6% for influenza) and large hospitals (71.9% vs 56.4%). Respiratory syncytial virus hospitalization rates increased from 1997 to 2012, particularly for those ≥60, increasing from 0.5 to 4.6 per 100000, whereas unspecified pneumonia admission rates decreased significantly (P &lt; .001). Immunocompromised patients with RSV hospitalization had significantly higher inpatient mortality (P = .013), use of mechanical ventilation (P = .016), mean length of stay (LOS) (P &lt; .001), and mean cost (P &lt; .001) than non-immunocompromised RSV hospitalizations. Overall, RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean LOS of 6.0 vs 3.6 days, and mean cost of $38828 vs $14519). Conclusions Respiratory syncytial virus hospitalizations in adults are increasing, likely due to increasing recognition and diagnosis. The burden of RSV in adults deserves attention. Although there are fewer hospitalizations than influenza, those that are diagnosed are on average more severe.

A Ventilator-associated Pneumonia Prediction Model in Patients With Acute Respiratory Distress Syndrome

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S400-S408
Author(s):  
Zongsheng Wu ◽  
Yao Liu ◽  
Jingyuan Xu ◽  
Jianfeng Xie ◽  
Shi Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neuromuscular Blocking ◽  
Calibration Plot ◽  
Binary Logistic Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Mechanical Ventilation Duration

Abstract Background Mechanical ventilation is crucial for acute respiratory distress syndrome (ARDS) patients and diagnosis of ventilator-associated pneumonia (VAP) in ARDS patients is challenging. Hence, an effective model to predict VAP in ARDS is urgently needed. Methods We performed a secondary analysis of patient-level data from the Early versus Delayed Enteral Nutrition (EDEN) of ARDSNet randomized controlled trials. Multivariate binary logistic regression analysis established a predictive model, incorporating characteristics selected by systematic review and univariate analyses. The model’s discrimination, calibration, and clinical usefulness were assessed using the C-index, calibration plot, and decision curve analysis (DCA). Results Of the 1000 unique patients enrolled in the EDEN trials, 70 (7%) had ARDS complicated with VAP. Mechanical ventilation duration and intensive care unit (ICU) stay were significantly longer in the VAP group than non-VAP group (P &lt; .001 for both) but the 60-day mortality was comparable. Use of neuromuscular blocking agents, severe ARDS, admission for unscheduled surgery, and trauma as primary ARDS causes were independent risk factors for VAP. The area under the curve of the model was .744, and model fit was acceptable (Hosmer-Lemeshow P = .185). The calibration curve indicated that the model had proper discrimination and good calibration. DCA showed that the VAP prediction nomogram was clinically useful when an intervention was decided at a VAP probability threshold between 1% and 61%. Conclusions The prediction nomogram for VAP development in ARDS patients can be applied after ICU admission, using available variables. Potential clinical benefits of using this model deserve further assessment.

scholarly journals Save a Life: Implementation and Evaluation of a Community-Focused CPR Education Program in Houston, Texas

2021 ◽  
Vol 12 ◽  
pp. 215013272199824
Author(s):  
Ebun O. Ebunlomo ◽  
Laura Gerik ◽  
Rene Ramon
Keyword(s):  
Health Education ◽  
Education Program ◽  
Heart Association ◽  
The United States ◽  
Outcome Evaluation ◽  
Collaborative Education ◽  
Kirkpatrick Model ◽  
Bystander Cpr ◽  
States Experience ◽  
Cpr Training

Over 350 000 people in the United States experience out-of-hospital cardiac arrest (OHCA) annually—and almost 90% die as a result. However, survival varies widely between counties, ranging from 3.4% to 22.0%—a disparity that the American Heart Association (AHA) largely attributes to variation in rates of bystander CPR. Studies show that regions with low rates of bystander CPR have low rates of CPR training, making CPR training initiatives a high-priority intervention to reduce OHCA mortality. In Houston, Texas, researchers have identified census tracts with higher OCHA incidence and lower rates of bystander CPR. We developed a free, annual Hands-Only CPR bilingual health education program central to these high-risk neighborhoods. In 5 years, this collaborative effort trained over 2700 individuals. In 2016, 2017, and 2018, we conducted a process evaluation to assess fidelity, dose delivered, and dose received. We also conducted an outcome evaluation using the Kirkpatrick Model for Training Evaluation to assess participants’ reactions and learning. Overall, the program yielded positive outcomes. Of the 261 respondents (from 314 attendees), 63% were first-time learners. The majority (87%) were satisfied with the event and 85% felt that information was presented clearly and concisely. Pre- and post-knowledge assessments showed a 51% increase in the proportion of respondents who could correctly identify the steps for Hands-Only CPR. This program exemplifies how collaborative education can impact a community’s health status. Leveraging each partner’s resources and linkages with the community can enhance the reach and sustainability of health education initiatives.

“I Knew It Was Gonna Be Hard, but I Always Knew I Had Support From My Parents”: The Role of Family on Undocumented Students’ College Aspirations and Persistence

2021 ◽  
pp. 152102512110188
Author(s):  
Cinthya Salazar
Keyword(s):  
Higher Education ◽  
Undocumented Students ◽  
The United States ◽  
Public University ◽  
College Aspirations ◽  
Higher Education Research ◽  
Research And Practice ◽  
Postsecondary Success ◽  
States Experience

Literature shows that undocumented students in the United States experience significant challenges to and through higher education. Only a few studies have uncovered the mechanisms that undocumented students use to persist in college; in particular, the role that family plays on their postsecondary success is understudied. In this qualitative study, I examine the role that family plays on undocumented students’ college aspirations and persistence. Findings from a sample of 16 undocumented students attending a four-year public university show that their families are the stimulus motivating them to pursue higher education, as well as the support system they can rely on to manage college barriers. However, the data also revealed that for a few participants, their families are a source of stress, resulting in additional challenges they must manage as they navigate higher education. I present these findings using participants’ vignettes and conclude with implications for higher education research and practice.

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