Acetazolamide to Prevent Adverse Altitude Effects in COPD and Healthy Adults

Furian and colleagues report on the results of two randomized controlled trials testing the use of acetazolamide to prevent the adverse effects of altitude on healthy older persons and in people with COPD. They find that acetazolamide decreased the incidence of altitude related adverse health events (primarily hypoxemia) in both populations with no evidence of adverse events.

Expected Rates of Select Adverse Events following Immunization for COVID-19 Vaccine Safety Monitoring

Background: Knowledge of expected rates of potential adverse events of special interest (AESI) that may occur coincidentally following COVID-19 vaccination is essential for vaccine safety surveillance and assessment. We calculated the expected rates of 21 potential AESI following COVID-19 vaccination among vaccinated persons within 1 day, 7 days, and 42 days of vaccination. Methods: We used meta-analytic methods to estimate background rates of 21 medical conditions considered potential AESI and calculated expected rates of each potential AESI within 1 day, 7 days, and 42 days of vaccination. Results: Background rates of three commonly monitored AESI, Guillain-Barre syndrome (GBS), myopericarditis, and all-cause deaths were 2.0 GBS cases/100,000 person-years, 1.3 myopericarditis cases/100,000 person-years, and 863.8 all-cause deaths/100,000 person-years, respectively. Based on these background rates, if 10,000,000 persons are vaccinated, we would expect 0.5, 3.7, and 22.5 GBS cases; 0.3, 2.4, and 14.3 myopericarditis cases; and 236.5, 1655.5, and 9932.8 all-cause deaths to occur in coincident temporal association (i.e., as a result of background incidence) within 1 day, 7 days, and 42 days of vaccination, respectively. Conclusion: Knowledge of expected rates of potential AESI can help contextualize adverse health events associated temporally with immunization, aid in safety signal detection, guide COVID-19 vaccine public health communication, and inform benefit-risk assessments of COVID-19 vaccines.

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016)

Background: Patient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals.Objectives: To determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016.Method: Data were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register.Results: A total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50–59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs.Conclusion: The study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.

Abstract 16681: Ability of the Intermountain Risk Score Measured in 2019 (pre-COVID) to Predict Major Adverse Health Events in Patients Positive for SARS-CoV-2 in 2020

Background: The Intermountain Risk Sore (IMRS) is a general health clinical decision tool based on the complete blood count (CBC) and basic metabolic profile (BMP). IMRS was developed to predict all-cause mortality. IMRS was validated previously in patients from the US and elsewhere, including in general medical and surgical patients and in diagnosis-specific populations. IMRS has been implemented at Intermountain Healthcare to guide clinical care in hospital settings. IMRS has not been tested as a predictor of major adverse health events after diagnosis of novel coronavirus disease (COVID)-19. Methods: Intermountain patients (ages ≥18 years) with a CBC and BMP measured in 2019 and with a COVID-positive test in 2020 (N=1,025) were evaluated to determine if the pre-2020 IMRS predicted a composite of hospitalization or mortality. All study subjects tested positive for COVID between March 3 and June 8, 2020. IMRS was calculated using original sex-specific variable weightings (see Horne BD et al, Am J Med 2009). Results: Overall, 55 females and 54 males had a composite endpoint, respectively (5 and 10 deaths; 52 and 46 hospitalizations), with c-statistics of c=0.748 for females and c=0.669 for males using IMRS calculations from 2019 (see Table). For n=170 patients, IMRS was also calculated from 2020 CBC/BMP panels obtained at the time of COVID diagnosis, and it also predicted the composite endpoint at that timepoint (for females and males combined, odds ratios= 4.05, 2.46, and 1.53 for high-, moderate-, and mild-risk categories vs. low-risk; see Table for category thresholds). Conclusion: IMRS measured using 2019 CBC and BMP lab results predicted major adverse health events for patients diagnosed with COVID in 2020. Use of IMRS may empower population health with anticipation of COVID outcomes; for higher risk patients, the IMRS result may lead to enhanced preventive measures if the patient is free of COVID and, if COVID is diagnosed, it may lead to earlier, more aggressive care.

Food Insecurity is Directly Associated with the Use of Health Services for Adverse Health Events among Older Adults

ABSTRACT Background In 2018, 14.3 million US households experienced food insecurity, which has been linked to negative health outcomes such as depression and anxiety, diabetes, and hypertension. This connection is particularly important for older adults, who are at greater risk than younger adults for developing certain health conditions. Objective We estimated the association between food insecurity and the use of health services for adverse health events over a 12-mo observation period following survey interview for a nationally representative group of older adults participating in the congregate meal (CM) and home-delivered meal (HDM) programs. Methods We analyzed data from the Nutrition Services Program (NSP) Outcomes Survey matched to Medicare claims and enrollment data in 2015–2016 for a nationally representative sample of 626 CM or HDM recipients ages 67 y and older. We used logistic regression analysis controlling for demographic characteristics, prior health events, and geography to estimate the association between food insecurity and use of health services, including emergency department visits, inpatient stays, skilled nursing facility stays, and home healthcare episodes. We used ordinary least squares regression analysis to estimate the association between food insecurity and Medicare spending. Results Food insecurity was associated with an average increased likelihood of using health services for adverse health events of 16% (95% CI: 1%, 32%) for HDM participants. Food insecurity was associated with an average increased likelihood of emergency department visits of 24% (95% CI: 6%, 41%) for CM participants and 20% (95% CI: 5%, 36%) for HDM participants. There was no observed increase in likelihood of using the other health services. Food-insecure participants were less likely to have a skilled nursing facility stay. Conclusions Food insecurity is associated with an increased likelihood of use of health services for adverse health events in older adult participants in meal service programs.

Causal Modeling of Twitter Activity during COVID-19

Understanding the characteristics of public attention and sentiment is an essential prerequisite for appropriate crisis management during adverse health events. This is even more crucial during a pandemic such as COVID-19, as primary responsibility of risk management is not centralized to a single institution, but distributed across society. While numerous studies utilize Twitter data in descriptive or predictive context during COVID-19 pandemic, causal modeling of public attention has not been investigated. In this study, we propose a causal inference approach to discover and quantify causal relationships between pandemic characteristics (e.g., number of infections and deaths) and Twitter activity as well as public sentiment. Our results show that the proposed method can successfully capture the epidemiological domain knowledge and identify variables that affect public attention and sentiment. We believe our work contributes to the field of infodemiology by distinguishing events that correlate with public attention from events that cause public attention.

The association between an increased reimbursement cap for chronic disease coverage and healthcare utilization in China: an interrupted time series study

Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China’s Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted time series design to examine whether an increase in the monthly reimbursement cap for outpatient visits using chronic disease coverage affects healthcare utilization. The cap was increased by 50 yuan per chronic disease on 1 January 2016, in one of the largest cities in China. Compared with the year before the increase, patients with only hypertension increased their spending using chronic disease coverage by 17.8 yuan (P < 0.001) or 11.6%, and those with only diabetes increased their spending using chronic disease coverage by 19.5 yuan (P < 0.001) or 10.6%, with the differences almost entirely driven by spending on drugs. In addition, these two groups of patients reduced their spending using standard outpatient coverage by 13.9 yuan (P < 0.001) or 5.7% and 14.9 yuan (P = 0.03) or 5.2%, respectively, and thus had no changes in total outpatient spending. Patients with both hypertension and diabetes, meanwhile, increased their spending using chronic disease coverage by 54.8 yuan (P < 0.001) or 18.1% and decreased their spending using standard outpatient coverage by 16.1 yuan (P = 0.002) or 6.1%, with no changes in their probability of hospitalization. Among patients with both hypertension and diabetes who had fewer-than-average outpatient visits in 2015, the hospitalization rate decreased after the 2016 reimbursement cap increase (adjusted odds ratio = 0.702, P = 0.01). These findings suggest that increasing financial protection for patients with hypertension and diabetes may be an important strategy for reducing adverse health events, such as hospitalization, in China.

Self-care convicting adverse reaction: prednisolone instance

Self-medication is a wide spread behavior, particularly among elderly patients. Self-medication involves not only the consumption of over-the-counter products but also the re-use of formerly prescribed drugs without medical supervision. This practice may lead to severe adverse health events. Here we report a case of old female, presented with cushingoid face and hyperglycemia due to self-medication of high dose Prednisolone for longer duration. Symptomatic treatment was given to stabilize the patient. Patient was warned regarding the adverse effects of drugs and strictly advised to use medication only under medical supervision.