Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool

2017 ◽  
Vol 16 (2) ◽  
pp. 60-64
Author(s):  
Daniel Wilding ◽  
◽  
Kate Evans ◽  
Keyword(s):  
Length Of Stay ◽  
Retrospective Review ◽  
Early Identification ◽  
Decision Aid ◽  
Significant Positive Correlation ◽  
Limited Resources ◽  
Positive Correlation ◽  
Acute Hospitals ◽  
Clinical Records ◽  
Simple Bedside

Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability. Method: Retrospective review of 250 consecutive admissions at five acute hospitals. Clinical records were reviewed for a total of 1003 patients. ALICE score was calculated for each patient and compared to LoS data. Results: There was a statistically significant positive correlation between rising ALICE scores and increasing length of stay irrespective of final diagnoses. Conclusion: The ALICE score provides a simple bedside tool to predict length of stay.

Prevalence of opioid dependence in spine surgery patients and correlation with length of stay

2007 ◽  
Vol 3 (3) ◽  
pp. 127 ◽  
Author(s):  
Mohammad Sami Walid, MD, PhD ◽  
Leon Hyer, PhD ◽  
Mohammed Ajjan, MD ◽  
Aaron C. M. Barth ◽  
Joe Sam Robinson, Jr, MD
Keyword(s):  
Regression Analysis ◽  
Length Of Stay ◽  
Pain Intensity ◽  
Spine Surgery ◽  
Opioid Dependence ◽  
Significant Positive Correlation ◽  
Pearson Correlation ◽  
World Health ◽  
Convenience Sample ◽  
Positive Correlation

Objective: We addressed the prevalence of opioid dependence (OD) in spine surgery patients and its correlation with length of stay (LOS) as the most important determinant of hospital cost.Methods: The study took place at Georgia Neurosurgical Institute and the Medical Center of Central Georgia between March 2006 and January 2007. A prospective convenience sample of 150 spine surgery patients (48 lumbar diskectomy, 60 cervical decompression and fusion, and 42 lumbar decompression and fusion [LDF]) was assembled. Patients were interviewed before surgery using a questionnaire designed in accordance with the World Health Organization and DSM-IV-TR criteria for the diagnosis of OD. The prevalence of OD was calculated based on questionnaire results. Pain intensity was quantified during admission using a 0-to-10 pain scale. We used pain intensity multiplied by duration of pain in months (WR index) as a new parameter. Lengths of stay were collected following patients’ discharge from hospital. Pearson correlation and regression analysis were performed using SPSS software.Results: Thirty (20.00 percent) patients were opioid dependent. The prevalence was highest among LDF patients (23.81 percent), females (22.78 percent), and, to a lesser degree, Caucasians (20.87percent). There was no correlation between OD and age (r = 0.08, p > 0.1) or between OD and LOS (r = 0.09, p > 0.1). This study proved a very significant positive correlation between OD and pain intensity (r = 0.24, p < 0.01) and between OD and the WR index (r = 0.30, p < 01). On the other hand, there was a significant positive correlation between LOS and age(r= 0.42, p < 0.01), between LOS and the number of previous spine surgeries (r = 0.28, p < 01), and between LOS and duration of pain (r = 0.18, p < 0.05). Regression analysis showed that age, ethnicity, and type of surgery were the main determinants of LOS.Conclusions: Chronic pain and prolonged use of opioids raise the prevalence of OD in spine surgery patients to 20 percent. The lack of effect of OD on LOS after surgical intervention means that efforts to decrease LOS by trying to satisfy patients’ craving for opioids will not be fruitful. Older, African-American LDF patients with a lengthy history of pain and multiple spine surgeries in the past are the most likely to stay longer in hospital.

scholarly journals Correlates of SARS-CoV-2 Variants on Deaths, Case Incidence and Case Fatality Ratio among the Continents for the Period of 1 December 2020 to 15 March 2021

Genes ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 1061
Author(s):  
Wajdy J. Al-Awaida ◽  
Baker Jawabrah Al Hourani ◽  
Samer Swedan ◽  
Refat Nimer ◽  
Foad Alzoughool ◽  
...  
Keyword(s):  
Negative Correlation ◽  
Significant Positive Correlation ◽  
Vaccine Development ◽  
Case Fatality ◽  
Significant Negative Correlation ◽  
Reference Sequence ◽  
Genome Sequences ◽  
Positive Correlation ◽  
Case Fatality Ratio ◽  
Epidemiological Surveys

The outbreak of coronavirus disease 2019 (COVID-19), by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly developed into a worldwide pandemic. Mutations in the SARS-CoV-2 genome may affect various aspects of the disease including fatality ratio. In this study, 553,518 SARS-CoV-2 genome sequences isolated from patients from continents for the period 1 December 2020 to 15 March 2021 were comprehensively analyzed and a total of 82 mutations were identified concerning the reference sequence. In addition, associations between the mutations and the case fatality ratio (CFR), cases per million and deaths per million, were examined. The mutations having the highest frequencies among different continents were Spike_D614G and NSP12_P323L. Among the identified mutations, NSP2_T153M, NSP14_I42V and Spike_L18F mutations showed a positive correlation to CFR. While the NSP13_Y541C, NSP3_T73I and NSP3_Q180H mutations demonstrated a negative correlation to CFR. The Spike_D614G and NSP12_P323L mutations showed a positive correlation to deaths per million. The NSP3_T1198K, NS8_L84S and NSP12_A97V mutations showed a significant negative correlation to deaths per million. The NSP12_P323L and Spike_D614G mutations showed a positive correlation to the number of cases per million. In contrast, NS8_L84S and NSP12_A97V mutations showed a negative correlation to the number of cases per million. In addition, among the identified clades, none showed a significant correlation to CFR. The G, GR, GV, S clades showed a significant positive correlation to deaths per million. The GR and S clades showed a positive correlation to number of cases per million. The clades having the highest frequencies among continents were G, followed by GH and GR. These findings should be taken into consideration during epidemiological surveys of the virus and vaccine development.

scholarly journals Comparative Evaluation of Adenoids, Upper Airway, and Tongue Using “Predictors of Difficult Airways” in Class II Division 1 and Division 2 Cases with Class I Cases: Prospective In Vivo Observational Study

2021 ◽  
pp. 030157422096341
Author(s):  
Smita Mangesh Choudhari ◽  
Sunita Shrivastav
Keyword(s):  
Significant Positive Correlation ◽  
Upper Airway ◽  
Class Ii ◽  
Class I ◽  
Positive Correlation ◽  
Division 1 ◽  
Difficult Airways ◽  
Mandibular Protrusion ◽  
Division 2 ◽  
Class Ii Division 1

Introduction: Altered nasorespiratory function leads to altered craniofacial growth. Thus, airway evaluation is important for preventive, interceptive, and corrective orthodontic treatment. The aim of this study was to evaluate and compare adenoids, the upper airway, the tongue, and mandibular dimensions using “predictors of difficult airways” in class II division 1 and class II division 2 cases with class I cases. Method: Sixty subjects of age 15 to 18 years were divided into 3 groups (group 1: class I cases; group 2: class II division 1 cases; and group 3: class II division 2 cases) based on cephalometric parameters, with 20 cases in each group. Cephalometric evaluation of adenoids and the nasopharyngeal airway was done using the Handelman–Osborne area method. Upper and lower airway evaluation was done using McNamara’s linear method. “Predictors of difficult airways” were used for evaluation of the airway, which included nasal competency, the Mallampati scale, mandibular length, mandibular protrusion, and the thyromental distance. Results: The present study found a significant positive correlation between the grades of nasal competency and percentage adenoid wall area, and a significant negative correlation between the grades of nasal competency and the upper airway. There was a significant positive correlation between the grades of nasal competency and mandibular length, and a significant positive correlation between the grades of mandibular protrusion and mandibular length. There was a significant positive correlation between the grades of the thyromental distance and mandibular length. Conclusion: It was concluded that the “predictors of difficult airways” would be helpful in early diagnosis and identification of potential risk factors that may cause “breathing disorders”–related malocclusions and later on increase the risk of developing OSA.

scholarly journals Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

2021 ◽  
Author(s):  
Jeremy R. Huddy ◽  
Matthew Crockett ◽  
A Shiyam Nizar ◽  
Ralph Smith ◽  
Manar Malki ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Length Of Stay ◽  
Elective Surgery ◽  
Standard Operating Procedure ◽  
Major Surgery ◽  
Renal Surgery ◽  
Increased Risk ◽  
Acute Hospitals ◽  
Da Vinci Si

AbstractThe recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

Changes in duplex ultrasound parameters during maturation according to arteriovenous access types in incident hemodialysis patients

2021 ◽  
pp. 112972982110052
Author(s):  
Jae Jin Lee ◽  
Sun Ryoung Choi ◽  
Eun Ju Lee ◽  
Ha Youn Yang ◽  
Seon Ha Baek ◽  
...  
Keyword(s):  
Pulsatility Index ◽  
Significant Positive Correlation ◽  
Duplex Ultrasound ◽  
Hemodialysis Patients ◽  
Hemodynamic Parameters ◽  
Positive Correlation ◽  
Arteriovenous Access ◽  
Artery Flow ◽  
Ultrasound Parameters ◽  
Av Graft

Background: Little is known about the changes in hemodynamic parameters during arteriovenous (AV) access maturation using duplex ultrasound according to radiocephalic fistula (RCF), brachiocephalic fistula (BCF), and AV graft (AVG) in incident hemodialysis (HD) patient. The objective of this study was to evaluate changes and differences in brachial artery flow rate (BAFR) and related parameters affecting maturation by duplex ultrasound in incident HD patients according to access type. Methods: This study was an observational study conducted from March 2019 to October 2020. During the study period, 109 incident patients underwent new AV access creation, of which 100 were included in the study. The duplex ultrasound was performed on the day prior to access creation, further, day 1, 2 weeks, and 4 weeks later after access creation in incident HD patients. Results: Among all the patients, 38 (38%) received BCF, while 26 (26%) underwent RCF. Of the patients with AVG, 18 (50%) had a forearm loop AVG. The overall mean age was 62.2 ± 13.8 years (range, 32–89). The BAFR increased about 6.9 times in the RCF, 17.4 times in the BCF, and 19.5 times in the AVG at day 1. The median BAFR measured on day 1 was 580.4 mL/min for RC, 1029.0 mL/min for BC, and 1133.0 mL/min for AVG. Relative to the values measured in week 4, the BAFR on day 1 was 69.5% in RCF, 90.6% in BCF, and 93.9% in AVG. The acceleration decreased most significantly on day 1( p < 0.05). The acceleration time increased significantly on day 1 ( p < 0.05) and beyond during maturation in the RCF and BCF. The BAFR of the RCF had a significantly negative correlation with the pulsatility index. The BAFR of the BCF showed a significantly positive correlation with the systolic and diastolic blood pressure but negatively correlated with pulse rate. The BAFR of the AVG showed a significant positive correlation with the diameter of the outflow vein. Conclusions: There were differences in the clinical and duplex parameters during maturation according to access type. The most dramatic changes of duplex parameters were on the day after AV access creation regardless of AV access types. Though RCF had a lower BAFR rate compared to BCF and AVG, it already had a sufficient BAFR required for adequate HD treatment the day after creation. The BAFR of BCF was not different from that of AVG.

Relationship Between Gas Emissions and Dry Matter Intake in Mature Angus Cows

2021 ◽  
Vol 99 (Supplement_2) ◽  
pp. 32-33
Author(s):  
Amanda Holder ◽  
Megan A Gross ◽  
Alexi Moehlenpah ◽  
Paul Beck
Keyword(s):  
Dry Matter ◽  
Significant Positive Correlation ◽  
Crossover Design ◽  
Dry Matter Intake ◽  
Data Set ◽  
Gas Emissions ◽  
Positive Correlation ◽  
Wide Range ◽  
Carbon Dioxide Co2 ◽  
Second Period

Abstract The objective of this study was to examine the effects of diet quality on greenhouse gas emissions and dry matter intake (DMI). We used 42 mature, gestating Angus cows (600±69 kg; and BSC 5.3±1.1) with a wide range in DMI EPD (-1.36 to 2.29). Cows were randomly assigned to 2 diet sequences forage-concentrate (FC) or concentrate-forage(CF) determined by the diet they consumed in each period (forage or concentrate). The cows were adapted to the diet and the SmartFeed individual intake units for 14 d followed by 45 d of intake data collection for each period. Body weight was recorded on consecutive weigh days at the beginning and end of each period and then once every two wk for the duration of a period. Cows were exposed to the GreenFeed Emission Monitoring (GEM) system for no less than 9 d during each period. The GEM system was used to measure emissions of carbon dioxide (CO2) and methane (CH4). Only cows with a minimum of 20 total &gt;3-m visits to the GEM were included in the data set. Data were analyzed in a crossover design using GLIMMIX in SASv.9.4. Within the CF sequence there was a significant, positive correlation between TMR DMI and CH4 (r=0.81) and TMR DMI and CO2 (r=0.69), however, gas emissions during the second period on the hay diet were not correlated with hay intake. There was a significant, positive correlation between hay DMI and CO2 (r=0.76) and hay DMI and CH4 (r=0.74) when cows first consumed forage (FC). In comparison to the CF sequence, cows on the FC sequence showed a positive correlation between CO2 and TMR DMI during the second period. There was also a significant positive correlation between hay and TMR DMI when assessed across (r=0.43) or within sequence (FC r=0.41, CF r=0.47).

scholarly journals Radio-adaptive response and correlation of non-homologous end joining repair gene polymorphisms [XRRC5 (3R/2R/1R/0R), XRCC6(C/G) and XRCC7 (G/T)] in human peripheral blood mononuclear cells exposed to gamma radiation

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Shridevi Shelke ◽  
Birajalaxmi Das
Keyword(s):  
Dna Damage ◽  
Mrna Expression ◽  
Adaptive Response ◽  
Gene Polymorphisms ◽  
Significant Positive Correlation ◽  
Human Pbmcs ◽  
Mrna Expression Level ◽  
Repair Gene ◽  
Positive Correlation ◽  
Nhej Repair

Abstract Background Radio-adaptive response (RAR) is transient phenomena, where cells conditioned with a small dose (priming) of ionizing radiation shows significantly reduced DNA damage with a subsequent high challenging dose. The role of DNA double strand break repair gene polymorphism in RAR is not known. In the present study attempt was made to find out the influence of NHEJ repair gene polymorphisms [a VNTR; XRCC5 (3R/2R/1R/0R); two single nucleotide polymorphisms (SNPs); XRCC6 (C/G) and XRCC7 (G/T)] with DNA damage, repair and mRNA expression in human PBMCs in dose and adaptive response studies. Genomic DNA extracted from venous blood samples of 20 random healthy donors (16 adaptive and 4 non-adaptive) and genotyping of NHEJ repair genes was carried out using PCR amplified length polymorphism. Results The dose response study revealed significant positive correlation of genotypes at XRRC5 (3R/2R/1R/0R), XRCC6(C/G) and XRCC7 (G/T) with DNA damage. Donors having genotypes with 2R allele at XRCC5 showed significant positive correlation with mRNA expression level (0R/2R: r = 0.846, P = 0.034; 1R/2R: r = 0.698, P = 0.0001 and 2R/2R: r = 0.831, P = 0.0001) for dose response. Genotypes C/C and C/G of XRCC6 showed a significant positive correlation (P = 0.0001), whereas, genotype T/T of XRCC7 showed significant negative correlation (r = − 0.376, P = 0.041) with mRNA expression. Conclusion Interestingly, adaptive donors having C/G genotype of XRCC6 showed significantly higher (P < 0.05) mRNA expression level in primed cells suggesting their role in RAR. In addition, NHEJ repair gene polymorphisms play crucial role with radio-sensitivity and RAR in human PBMCs.

scholarly journals Evaluation of serum adropin and irisin levels and its association with anthropometric obesity indices and biochemical parameters in Type 2 diabetic patients

2021 ◽  
pp. 1-8
Author(s):  
Foad Alzoughool ◽  
Huda Al Hourani ◽  
Manar Atoum ◽  
Sajedah Bateineh ◽  
Hanan Alsheikh ◽  
...  
Keyword(s):  
Negative Correlation ◽  
Biochemical Parameters ◽  
Significant Positive Correlation ◽  
Glycosylated Hemoglobin ◽  
Significant Negative Correlation ◽  
Diabetic Patients ◽  
Positive Correlation ◽  
Obesity Indices ◽  
Group Serum

BACKGROUND/AIM: The newly described proteins adropin and irisin are a highly conserved polypeptide that plays essential roles in metabolic and energy homeostasis, insulin resistance, and fat browning. The aim of this study is to evaluate the circulating levels of serum adropin and irisin in type 2 diabetes mellitus (T2DM) patients and also to elucidate possible relationships between serum adropin and irisin levels with anthropometric obesity indices and biochemical parameters. SUBJECTS AND METHODS: Single-center prospective observational study included 90 T2DM patients referred to the diabetes outpatient clinic. Height, weight, and waist circumference (WC) were measured. Body mass index (BMI) and waist to height ratio (WHtR) were calculated. Fasting blood glucose, glycosylated hemoglobin, serum lipids, creatinine, urea, and blood urea nitrogen were evaluated. Estimated glomerular filtration rate (GFR) was calculated, serum adropin and irisin were evaluated. RESULTS: The results showed a significant positive correlation between adropin and irisin in females but not in males (r = 0.311; P = 0.042). In males’ group, serum adropin levels showed significant negative correlation with serum glucose (–0.423, P = <  0.05), HbA1C (–0.364, P = <  0.05), and GFR (–0.355, P = <  0.05). In contrast, creatinine was showed a significant positive correlation with adropin in males (0.381, P = <  0.05). In females’ group, adropin showed a significant negative correlation with weight (–0.371, P = <  0.05), BMI (–0.349, P = <  0.05), WC (–0.402, P = <  0.01), and WHtR (–0.398, P = <  0.01). Contrary, in males’ group, serum irisin levels showed significant positive correlation with weight (0.338, P = <  0.05), BMI (0.332, P = <  0.05), WC (0.409, P = <  0.01), and WHtR (0.432, P = <  0.01). CONCLUSION: This study demonstrated that, in T2DM patients, circulating serum adrpoin correlated negatively with anthropometric obesity indices of obesity in females, while serum irisin was positively correlated with anthropometric obesity indices of obesity in males.

scholarly journals European survey shows poor association between soil organic matter and crop yields

2020 ◽  
Vol 118 (3) ◽  
pp. 325-334
Author(s):  
Wytse J. Vonk ◽  
Martin K. van Ittersum ◽  
Pytrik Reidsma ◽  
Laura Zavattaro ◽  
Luca Bechini ◽  
...  
Keyword(s):  
Organic Matter ◽  
Soil Organic Matter ◽  
Sugar Beet ◽  
Significant Positive Correlation ◽  
Agricultural Land ◽  
Crop Yields ◽  
Carbon Sink ◽  
Significant Negative Correlation ◽  
Positive Correlation ◽  
Farm Survey

AbstractA number of policies proposed to increase soil organic matter (SOM) content in agricultural land as a carbon sink and to enhance soil fertility. Relations between SOM content and crop yields however remain uncertain. In a recent farm survey across six European countries, farmers reported both their crop yields and their SOM content. For four widely grown crops (wheat, grain maize, sugar beet and potato), correlations were explored between reported crop yields and SOM content (N = 1264). To explain observed variability, climate, soil texture, slope, tillage intensity, fertilisation and irrigation were added as co-variables in a linear regression model. No consistent correlations were observed for any of the crop types. For wheat, a significant positive correlation (p < 0.05) was observed between SOM and crop yields in the Continental climate, with yields being on average 263 ± 4 (95% CI) kg ha−1 higher on soils with one percentage point more SOM. In the Atlantic climate, a significant negative correlation was observed for wheat, with yields being on average 75 ± 2 (95%CI) kg ha−1 lower on soils with one percentage point more SOM (p < 0.05). For sugar beet, a significant positive correlation (p < 0.05) between SOM and crop yields was suggested for all climate zones, but this depended on a number of relatively low yield observations. For potatoes and maize, no significant correlations were observed between SOM content and crop yields. These findings indicate the need for a diversified strategy across soil types, crops and climates when seeking farmers’ support to increase SOM.

Detection of circulating immune complexes in the sera of dogs infected with Dirofilaria immitis, by Clq-binding enzyme-linked immunosorbent assay

1986 ◽  
Vol 60 (3) ◽  
pp. 239-243 ◽  
Author(s):  
K. Matsumura ◽  
Y. Kazuta ◽  
R. Endo ◽  
K. Tanaka ◽  
T. Inoue
Keyword(s):  
Immunosorbent Assay ◽  
Immune Complexes ◽  
Dirofilaria Immitis ◽  
Significant Positive Correlation ◽  
Age Distribution ◽  
Circulating Immune Complexes ◽  
Enzyme Linked Immunosorbent Assay ◽  
Positive Correlation ◽  
Infection Age

AbstractThe presence of circulating immune complexes (CIC) in the sera of dogs infected with Dirofilaria immitis was detected by using a Clq-binding enzyme-linked immunosorbent assay. Specificity of this assay with different concentrations of heat-aggravated canine IgG (ACG) was observed, i.e., the ELISA readings, expressed as ug equivalents ACG/ml, increased with increasing amounts of ACG. The intra-assay variability was below 10%. The CIC levels of infected and uninfected dogs were 177–0± 104–7 ug/ml and 22–8±45–8 ng/ml (mean±SD), respectively. The highest level was observed in 12 dogs with amicrofilaraemic infection. Age distribution of CIC levels in the 23 infected dogs also showed a significant positive correlation. These findings suggested that the CIC are present in the sera of dogs with dirofilariasis and may relate to canine glomerulonephritis.

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