Tag: nevin manimala

BMC Geriatr. 2022 Sep 2;22(1):724. doi: 10.1186/s12877-022-03407-7.

ABSTRACT

INTRODUCTION: People with dementia have high rates of hospitalization, and a share of these hospitalizations might be avoidable with appropriate ambulatory care, also known as potentially preventable hospitalization (PAH). This study investigates the associations between continuity of care and healthcare outcomes in the following year, including all-cause hospitalization, PAHs, and healthcare costs in patients with dementia.

METHODS: This is a longitudinal retrospective cohort study of 69,658 patients with dementia obtained from the Taiwan National Health Insurance Research Database. The Continuity of Care Index (COCI) was calculated to measure the continuity of dementia-related visits across physicians. The PAHs were classified into five types as defined by the Medicare Ambulatory Care Indicators for the Elderly (MACIEs). Logistic regression models were used to examine the effect of COCI on all-cause hospitalizations and PAHs, while generalized linear models were used to analyze the effect of COCI on outpatient, hospitalization, and total healthcare costs.

RESULTS: The high COCI group was significantly associated with a lower likelihood of all-cause hospitalization than the low COCI group (OR = 0.848, 95%CI: 0.821-0.875). The COCI had no significant effect on PAHs but was associated with lower outpatient costs (exp(β) = 0.960, 95%CI: 0.941 ~ 0.979), hospitalization costs (exp(β) = 0.663, 95%CI: 0.614 ~ 0.717), total healthcare costs (exp(β) = 0.962, 95%CI: 0.945-0.980).

CONCLUSION: Improving continuity of care for dementia-related outpatient visits is recommended to reduce hospitalization and healthcare costs, although there was no statistically significant effect of continuity of care found on PAHs.

PMID:36056303 | DOI:10.1186/s12877-022-03407-7

Matern Child Health J. 2022 Sep 2. doi: 10.1007/s10995-022-03505-3. Online ahead of print.

NO ABSTRACT

PMID:36056294 | DOI:10.1007/s10995-022-03505-3

J Pharm Pharm Sci. 2022;25:266-273. doi: 10.18433/jpps32891.

ABSTRACT

PURPOSE: Intravenous drug use (IVDU) is an independent risk factor for infective endocarditis (IE). IVDU-related IE is associated with poor clinical outcomes, such as infection-related and drug abuse-related readmissions and mortality. Critical interventions to treat addiction, such as medication for opioid use disorder (MOUD) with buprenorphine, may prevent these unfavorable outcomes. This study aimed to establish the effectiveness of buprenorphine prescriptions at hospital discharge for patients admitted for IVDU-related IE.

METHODS: A single center, retrospective cohort study evaluated the effectiveness of discharge prescriptions of buprenorphine in adult patients (≥18 years of age) with OUD and IVDU-related IE. Outcomes of 30-day readmissions, 180-day readmissions, and mortality were compared to a cohort of patients who were not prescribed buprenorphine at hospital discharge.

RESULTS: The primary endpoint of all cause 30-day readmission was lower in patients who received buprenorphine (n=11/122, 9%) at hospital discharge for IVDU-related IE compared to those who did not (n=9/48, 19%), although not statistically significant (unadjusted OR 0.429, 95% CI 0.165-1.138, p=0.082). After accounting for intensive care admission, infusion unit admission, and psychiatry consultation, the odds of all cause 30-day readmission were statistically lower in patients prescribed buprenorphine (adjusted OR 0.337, 95% CI 0.125-0.909, p=0.029). Additionally, significantly more patients prescribed buprenorphine at discharge followed-up in an outpatient treatment program, 57% and 15% respectively (p<0.001). Incidence of readmission at 180 days and mortality was similar between the two cohorts.

CONCLUSIONS: This study demonstrated that buprenorphine prescriptions at hospital discharge in patients with OUD admitted for IVDU-related IE were effective at decreasing readmission rates at 30 days and increasing outpatient treatment follow-up. Therefore, it is imperative that an emphasis on addiction-focused interventions, such as initiating buprenorphine, be considered in this patient population at hospital discharge to decrease hospital readmissions and engage patients in outpatient treatment for OUD. This study is the first to evaluate the effects of MOUD on readmission rates for patients hospitalized with IVDU-related IE and contributes to the growing body of evidence to support addiction-focused interventions for this unique patient population.

PMID:36054929 | DOI:10.18433/jpps32891

J Craniofac Surg. 2022 Sep 1;33(6):1762-1768. doi: 10.1097/SCS.0000000000008728. Epub 2022 Jul 26.

ABSTRACT

BACKGROUND: The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting.

METHODS: Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics.

RESULTS: During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039).

CONCLUSIONS: Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.

PMID:36054889 | DOI:10.1097/SCS.0000000000008728

J Clin Oncol. 2022 Sep 2:JCO2200710. doi: 10.1200/JCO.22.00710. Online ahead of print.

ABSTRACT

PURPOSE: Secondary myeloid neoplasms (sMNs) remain the most serious long-term complications in patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH). However, sMNs lack specific predictors, dedicated surveillance measures, and early therapeutic interventions.

PATIENTS AND METHODS: We studied a multicenter, retrospective cohort of 1,008 patients (median follow-up 8.6 years) with AA and PNH to assess clinical and molecular determinants of clonal evolution.

RESULTS: Although none of the patients transplanted upfront (n = 117) developed clonal complications (either sMN or secondary PNH), the 10-year cumulative incidence of sMN in nontransplanted cases was 11.6%. In severe AA, older age at presentation and lack of response to immunosuppressive therapy were independently associated with increased risk of sMN, whereas untreated patients had the highest risk among nonsevere cases. The elapsed time from AA to sMN was 4.5 years. sMN developed in 94 patients. The 5-year overall survival reached 40% and was independently associated with bone marrow blasts at sMN onset. Myelodysplastic syndrome with high-risk phenotypes, del7/7q, and ASXL1, SETBP1, RUNX1, and RAS pathway gene mutations were the most frequent characteristics. Cross-sectional studies of clonal dynamics from baseline to evolution revealed that PIGA/human leukocyte antigen lesions decreased over time, being replaced by clones with myeloid hits. PIGA and BCOR/L1 mutation carriers had a lower risk of sMN progression, whereas myeloid driver lesions marked the group with a higher risk.

CONCLUSION: The risk of sMN in AA is associated with disease severity, lack of response to treatment, and patients’ age. sMNs display high-risk morphological, karyotypic, and molecular features. The landscape of acquired somatic mutations is complex and incompletely understood and should be considered with caution in medical management.

PMID:36054881 | DOI:10.1200/JCO.22.00710

Int J Biostat. 2022 Sep 5. doi: 10.1515/ijb-2022-0056. Online ahead of print.

ABSTRACT

In this paper, we review some important early developments on causal inference in medical statistics and epidemiology that were inspired by questions in oncology. We examine two classical examples from the literature and point to a current area of ongoing methodological development, namely the estimation of optimal adaptive treatment strategies. While causal approaches to analysis have become more routine in oncology research, many exciting challenges and open problems remain, particularly in the context of censored outcomes.

PMID:36054829 | DOI:10.1515/ijb-2022-0056

Glob Chang Biol. 2022 Aug 23. doi: 10.1111/gcb.16404. Online ahead of print.

ABSTRACT

Large-scale reforestation can potentially bring both benefits and risks to the water cycle, which needs to be better quantified under future climates to inform reforestation decisions. We identified 477 water-insecure basins worldwide accounting for 44.6% (380.2 Mha) of the global reforestation potential. As many of these basins are in the Asia-Pacific, we used regional coupled land-climate modelling for the period 2041-2070 to reveal that reforestation increases evapotranspiration and precipitation for most water-insecure regions over the Asia-Pacific. This resulted in a statistically-significant increase in water yield (p < 0.05) for the Loess Plateau-North China Plain, Yangtze Plain, Southeast China and Irrawaddy regions. Precipitation feedback was influenced by the degree of initial moisture limitation affecting soil moisture response and thus evapotranspiration, as well as precipitation advection from other reforested regions and moisture transport away from the local region. Reforestation also reduces the probability of extremely dry months in most of the water-insecure regions. However, some regions experience non-significant declines in net water yield due to heightened evapotranspiration outstripping increases in precipitation, or declines in soil moisture and advected precipitation.

PMID:36054815 | DOI:10.1111/gcb.16404

Nephrol Nurs J. 2022 Jul-Aug;49(4):351-358.

ABSTRACT

This project examined the effect of an educational intervention on blood pressure control among minority patients with chronic kidney disease (CKD). Adherence to a low-sodium diet is crucial for blood pressure control. It is also vital to assess food insecurity to improve diet adherence, especially among high-risk underrepresented populations. Participants were recruited from a public hospital renal clinic. Knowledge and food access was assessed using CKD and food insecurity questionnaires. Food frequency and 24-hour 3-day food diaries were completed and analyzed. Eighteen patients were enrolled (Black, non-Hispanic = 66.6%, Hispanic = 27.7%, uninsured = 33.3%, and Medicaid recipients = 27.7%). Eighty-nine percent of participants screened positive for food insecurity and received vouchers for healthy food from a food depository. Paired t tests showed statistically significant increase in knowledge (p < 0.00) and self-efficacy, and systolic blood pressure improved post-intervention. This study suggests that Black non-Hispanic and Hispanic patients with CKD have limited access to healthy food and consume higher sodium. Patient education, screening for food insecurity, and access to a food depository enhanced adherence to low sodium diet and improved blood pressure control.

PMID:36054808

Geriatr Gerontol Int. 2022 Aug 30. doi: 10.1111/ggi.14469. Online ahead of print.

ABSTRACT

AIM: To compare the predictive abilities of the FRAIL scale (FS), frailty screening questionnaire (FSQ) and clinical frailty scale (CFS) for adverse outcomes in older adults in the emergency department.

METHODS: In total, 317 older adults aged ≥65 years attending emergency department was screened for frailty using the FS, FSQ and CFS. Outcome measures included all-cause 28-day mortality and intensive care unit readmission. Cox proportional hazards model was used for survival comparison. Logistic regression was used to analyze risk factors for readmissions. In addition, we calculated the C-statistic, net reclassification improvement and integrated discrimination improvement to evaluate the predictive value of three scales.

RESULTS: The prevalence of frailty was 55.2% (FS), 47.0% (FSQ) and 69.4% (CFS). Cox regression and logistic regression analysis revealed that frailty screening by FS, FSQ and CFS was an independent risk factor for all-cause 28-day mortality and 30- and 90-day readmission after adjustment. Incorporation of FS, FSQ and CFS into a basic model with other risk factors significantly improved C-statistic. For all-cause 28-day mortality, the model including FS had the highest C-statistic from 0.786 (95% confidence interval: 0.706-0.865) to 0.854 (95% confidence interval: 0.802-0.907) and the improvements in risk prediction were also confirmed by category-free net reclassification improvement and integrated discrimination improvement, suggesting FS was significantly better than CFS and FSQ. The three tools had a low predictive ability for readmission (all C-statistics <0.7).

CONCLUSIONS: All three frailty scales showed a predictive ability for 28-day mortality and readmission but FS may be the most valid tool in the emergency department. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

PMID:36054799 | DOI:10.1111/ggi.14469

Res Synth Methods. 2022 Aug 10. doi: 10.1002/jrsm.1597. Online ahead of print.

ABSTRACT

Meta-analysis allows researchers to combine evidence from multiple studies, making it a powerful tool for synthesizing information on the safety profiles of new medical interventions. There is a critical need to identify subgroups at high risk of experiencing treatment-related toxicities. However, this remains quite challenging from a statistical perspective as there are a variety of clinical risk factors that may be relevant for different types of adverse events, and adverse events of interest may be rare or incompletely reported. We frame this challenge as a variable selection problem and propose a Bayesian hierarchical model which incorporates a horseshoe prior on the interaction terms to identify high-risk groups. Our proposed model is motivated by a meta-analysis of adverse events in cancer immunotherapy, and our results uncover key factors driving the risk of specific types of treatment-related adverse events.

PMID:36054779 | DOI:10.1002/jrsm.1597