Decrease In Hospitalization Rates Research Articles

6766 Cortisol Pumps: Hospitalizations And Quality Of Life

Abstract Disclosure: A. Tiwari: None. R. Berry: None. A. Mokbel: None. A. Abotouk: None. A.R. Alrifai: None. J. Waleed: None. O. Alzohaili: None. Introduction: Oral regimens of exogenous cortisol fail to mimic physiologic levels. The discrepancy leads to complications, notably nausea, hyperglycemia, and susceptibility to infection. Finer control over cortisol delivery may be achievable with infusion pumps. While international groups have published their experiences with cortisol pumps, these studies often include less than ten patients. We share the largest, single-center cohort ever documented and the first from an American clinic. Methods: We conducted a retrospective cohort study. Through chart review, we identified all patients who received a cortisol pump at a private clinic; these pumps were originally designed to deliver insulin, but we repurposed them for patients with adrenal insufficiency. Clinic notes allowed collection of cortisol dosing pre- and post-exposure to the cortisol pump. We supplemented this information with telephone and digital surveys on the frequency of hospitalization, symptoms, and quality of life; patients provided verbal consent before participation. A Wilcoxon signed rank test and Fisher exact test evaluated significant differences between groups. Results: We identified thirty patients who received a cortisol infusion pump. Our study revealed a statistically significant decrease in hospitalization rate after exposure to a cortisol pump (n=26, mean difference = -5.94 hospitalizations per year, p=0.003), a decrease in the frequency of fatigue (n=25, p=0.0001) and a decrease in the frequency of hypotension (n=25, p=0.005). A validated, quality of life survey corroborated these findings with improvement in twenty-seven out of twenty-eight questions (n=22, p<0.05). However, we did not detect a statistically significant difference in the frequency of eighteen other symptoms nor cortisol dosing between pre- and post-exposure groups. Conclusion: Infusion pumps can better mimic physiological variations in cortisol than oral dosing regimens. We show the extent to which cortisol dosing may reduce hospitalization rate - and therefore cost - as well as improve quality of life. We hope our findings encourage the availability of infusion pumps for adrenal insufficiency, a smaller market that may not otherwise attract commercial investment for a dedicated, randomized trial. Presentation: 6/3/2024

Review of EmPATH Units for Behavioral Health Casualties in Prolonged Field Care Environments.

Psychiatric conditions are one of the leading non-battle injury diseases resulting in medical evacuation (MEDEVAC) from combat environments. The challenge of limited MEDEVAC capability necessitating prolonged field care in future large-scale combat operations must be addressed. Therefore, a robust program is needed to address frontline care of behavioral health (BH), maximizing service members returning to duty and minimizing MEDEVAC. This review summarizes the literature on the impacts of the Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) Unit program as a solution to the challenges of treating behavioral health in future wars. We conducted a systematic literature search and review, and a non-systematic literature critique. We then used the Johns Hopkins evidence appraisal tool to appraise the strength and quality of the evidence. The following electronic databases were utilized for the search: Google Scholar, Embase, CINAHL, and PubMed. Search terms included: included "EmPATH," "prolonged field care," and "operational," alone and combined. The literature review found that the EmPATH unit, a recently developed civilian hospital-based program, can work with higher acuity psychiatric crisis patients who would otherwise be admitted to an inpatient unit, showing promising results in avoiding the need for inpatient hospitalization. EmPATH units help decrease hospitalization rates, reduce restraints and violence, and shorten the patients' boarding time in a holding area. Such findings support the use of the EmPATH unit as a tactic for prolonged field care of psychiatric patients in a combat operational environment. This is the first literature review to consider EmPATH units for psychiatric prolonged field care based on its advantages demonstrated in the civilian sector. Studies have yet to be done on EmPATH units' usefulness in the military, showing a knowledge gap in current evidence supporting its suitability. Thus, this review recommends further studies of EmPATH units in military settings, especially prolonged field care environments.

Understanding trends of US breast cancer hospitalization, mortality and costs using the National Inpatient Sample database.

11162 Background: Studies have shown a rising breast cancer incidence in the US. However, its impact on healthcare utilization is unclear. Our study delves into the previously unexplored territory of hospitalization and cost trends among breast cancer patients, aiming to shed light on resource allocation and potential areas for improvement. Methods: To investigate trends in breast cancer admissions and costs, we queried the National Inpatient Sample database. Patients admitted between January 2011 and December 2019 with following criteria were included in the analysis: female gender, age ≥ 18, and ICD diagnosis code corresponding to unspecified malignant neoplasm of the breast as their primary reason for admission. Our primary outcome was defined as the temporal trends in the number of admissions, discharge rates, length of stay, and cost of hospitalization and mortality rates. Analyses were performed using Stata version 15.1 College station TX: StataCorp LP 2017. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of <0.05 was considered statistically significant. Results: Between 2011 and 2019, hospital admissions for breast cancer as the primary diagnosis declined significantly, from 32,126 to 12,742 (P < 0.001). However, while average length of stay increased slightly from 4.3 to 4.9 days (P < 0.01), hospital charges for breast cancer rose dramatically. Adjusted for inflation, mean charges per patient rose 38.8%, from $50,663.86 in 2011 to $70,334.11 in 2019 (P < 0.001). Despite this surge, the total aggregate cost ("national burden") of hospitalizations with breast cancer as main discharge diagnosis decreased, falling from $1.63 billion in 2011 to $896 million in 2019 (inflation adjusted) (P < 0.001). Discharges for breast cancer peaked in women between 45 and 64, followed by the 65-84 demographic. Compared to the overall decrease in hospitalization rates, the declines in the above age groups were notably steeper with declines of 62% for 45-64 and 48% for 65-84 (p<0.001). Although absolute number of breast cancer deaths decreased from 2011 to 2019, the mortality rate paradoxically increased from 4.3% to 5.8% over the same period (P < 0.001). This seemingly contradictory trend warrants further investigation to better understand contributing factors. Conclusions: While breast cancer diagnoses are on the rise in women, our study reveals a fascinating paradox: significant declines in hospitalization, associated costs, and overall mortality. This encouraging trend likely stems from widespread surveillance mammography with increases in early stage, curable disease diagnosis, and the flourishing landscape of outpatient therapies, including targeted treatments, with more tolerable toxicity profiles allowing for majority of breast cancer care to be completed in the outpatient setting.

Alemtuzumab induction is associated with decreased hospitalization rates in pediatric kidney transplant: A UNOS data review for safety and outcomes with common induction regimens.

We hypothesized that alemtuzumab use is safe in pediatric kidney transplant recipients (KTRs) with equivalent long-term outcomes compared to other induction agents. Using pediatric kidney transplant recipient data in the UNOS database between January 1, 2000, and June 30, 2022, multivariate logistic regression, multivariable Cox regression, and survival analyses were utilized to estimate the likelihoods of 1st-year and all-time hospitalizations, acute rejection, CMV infection, delayed graft function (DGF), graft loss, and patient mortality among recipients of three common induction regimens (ATG, alemtuzumab, and basiliximab). There were no differences in acute rejection or graft failure among induction or maintenance regimens. Basiliximab was associated with lower odds of DGF in deceased donor recipients (OR 0.77 [0.60-0.99], p = .04). Mortality was increased in patients treated with steroid-containing maintenance (HR 1.3 [1.005-1.7] p = .045). Alemtuzumab induction correlated with less risk of CMV infection than ATG (OR 0.76 [0.59-0.99], p = .039). Steroid-containing maintenance conferred lower rate of PTLD compared to steroid-free maintenance (HR 0.59 [0.4-0.8] p = .001). Alemtuzumab was associated with less risk of hospitalization within 1 year (OR 0.79 [0.67-0.95] p = .012) and 5 years (HR 0.54 [0.46-0.65] p < .001) of transplantation. Steroid maintenance also decreased 5 years hospitalization risk (HR 0.78 [0.69-0.89] p < .001). Pediatric KTRs may be safely treated with alemtuzumab induction without increased risk of acute rejection, DGF, graft loss, or patient mortality. The decreased risk of CMV infections and lower hospitalization rates compared to other agents make alemtuzumab an attractive choice for induction in pediatric KTRs, especially in those who cannot tolerate ATG.

Evolving Epidemiology of Pediatric Respiratory Syncytial Virus (RSV) Cases Around COVID-19 Pandemic: Impact and Clinical Insights, Retrospective Cohort Study

BackgroundThe burden of respiratory syncytial virus (RSV) in high-risk pediatric patients remains unclear. Therefore, this study aims to characterize pediatric RSV cases from January 2019 to December 2022 and assess the impact of the COVID-19 pandemic on RSV burden and RSV-related outcomes. In addition, examining factors influencing RSV-related hospitalization.MethodsThis is a retrospective study that included pediatric patients (aged 14 and below) who presented at King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh, Saudi Arabia with RSV infection identified using real-time reverse-transcriptase polymerase chain reaction assays. Statistical analyses were performed using STATA.ResultsA total of 885 RSV cases were reported; (56.05%) were males and (43.95%) were females with a median age of 24 months [interquartile range (IQR): 11–60]. 534 (60.34%) required hospitalization. As for RSV seasonality, there was a significant increase in RSV prevalence following the COVID-19 pandemic, escalating from 205 cases in 2019 to 425 cases in 2022. The increase in 2022 was evident in January and persisted from September to December, reaching its peak during the months of October (20.70% − 88 cases) and November (32.00% − 136 cases). About (27.12%) of RSV infected children were medically free patients. Symptomatic patients exhibited various clinical manifestations, with ventilation necessary in (13.11%) of cases. Further analysis revealed significant changes in RSV-related outcomes post-COVID-19, including a decrease in hospitalization rates, an increase in medically free patients, and a lower need for ventilation (p < 0.05). Notably, a significant proportion of RSV admissions occurred within the first 6 months of life, with (77.69%) in the age group of 0 to 5 months. In addition, previous RSV infection, prematurity, low birth weight, renal disease, congenital heart disease, endocrine/metabolic disease, neuro/neuromuscular diseases, and genetic disorders were positively associated with hospitalization (P < 0.05). Interestingly, asthma and bone marrow transplantation were negatively associated with hospitalization (P < 0.05). The mortality rate in this study is (2.37%) (21/885).ConclusionThis study provides a comprehensive understanding of the demographic and clinical factors influencing RSV outcomes, highlighting the impact of the COVID-19 pandemic and shedding light on potential risk factors for RSV-related hospitalization. The highest prevalence of RSV during (September to January), aligning with global patterns and emphasizing the importance of timing in preventive strategies.

Innovations: Using telemedicine to improve care of predominantly non-white youth with suboptimal insulin dependent diabetes control

AimDespite advances in diabetes treatments, youth commonly fail to meet glucose targets. Telehealth support may help youth meet diabetes related goals. The objective of the project was to assess whether intensive telehealth support in a group of poorly controlled youth with diabetes would help improve glycated hemoglobin (HbA1c) levels and decrease hospitalization rates over a 12-month time frame. MethodsThis quality improvement project included youth aged 8–18 with suboptimal insulin dependent diabetes control and Medicaid insurance, who were willing to use continuous glucose monitoring (CGM). Participants received weekly contact (phone or video) with a certified diabetes educator and monthly video visits with a nurse practitioner. ResultsYouth (N = 27, 63 % female, 89 % Non-Hispanic Black), diabetes duration 6.2 ± 4.3 years, had baseline mean HbA1c 12.4 ± 1.8 % (112 mmol/mol); 22 % were on pump therapy (majority were non-automated insulin delivery systems). There was a sustained improvement between baseline HbA1c (mean 12.4 %±1.8) (112 mmol/mol) and 3 months (mean 11.5 %±2.8) (102 mmol/mol) (p = 0.03), 6 months (mean 11.1 %±2.1) (98 mmol/mol) (p = 0.01), 9 months (mean 11.4 %±2.3) (101 mmol/mol) (p = 0.04) and 12 months (mean 10.8 %±2.2) (95 mmol/mol) (p = 0.02). ConclusionThis intensive telehealth intervention provided interim glycemic improvement in a high-risk patient cohort. Further efforts to increase connection in vulnerable pediatric patient groups could help long-term diabetes management.

A Large-Scale Online Survey on Clinical Severity and Associated Risk Factors for SARS-CoV-2 Omicron Infection - China, April-May 2023.

Individuals who initially contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack significant mixed immunity. Therefore, it is crucial to monitor the clinical characteristics and associated factors of these individuals in order to inform policy-making. The common symptoms reported were fever, cough, and sore throat. Reinfections and receiving four vaccination doses within a 6-month period were found to be associated with a shorter duration of virus shedding, decreased hospitalization rate, and reduced risk of pneumonia. Individuals aged 60 years and older, as well as those with underlying medical conditions, had a higher risk of developing pneumonia. Online surveys conducted through social media platforms have the potential to complement disease surveillance and data collection efforts. In terms of vaccination prioritization, it is recommended to prioritize older individuals and those with underlying diseases.

Trends in Diarrhea Hospitalization among Children &lt;5 Years Old Before and During the Covid-19 Season in Fako Division, Cameroon: A Situation Clouded by Sociopolitical Conflict

Diarrhea is a major cause of illness and death for children under 5 in sub-Saharan Africa, with around 500k deaths annually. COVID-19 affected hospitalization rates for diarrhea. This study was done in four hospitals in Fako Division on diarrhea hospitalization records of children under 5 from 2013 to 2022. Stratified sampling was used, and data was summarized using means, standard deviations, frequencies, and percentages. Differences were evaluated using chi square with a significance level of P&lt;0.05. Diarrhea hospitalization rate was high at 30.9%, with more cases reported during Covid-19 than before. Peak hospitalization occurred in 2019 and 2020. However, there was a significant decrease in hospitalization rates in 2021 and 2022. Children aged 0-5 months had the highest rates of diarrhea hospitalization at 29.4%. High diarrhea rates in the study area were due to conflict-related population influx. COVID-19 season saw higher hospitalization rates due to virus-induced diarrhea and population influx. Infants under 5 are most vulnerable to diarrhea. More diarrhea hospitalizations in COVID-19 season due to influx of displaced families and COVID-19 - induced diarrhea caused unusual data. Keywords: Age, COVID-19, Children, Coverage, Diarrhea, Rotavirus, Vaccine, Vaccination, Sub-Saharan Africa.

Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada.

The Period of PURPLE Crying Program® (PURPLE) is a universal parent education program that is delivered by nurses and health care providers to all parents/caregivers of newborns in British Columbia (B.C.). The aim of the program is to reduce the incidence of Traumatic Head Injury -Child Maltreatment (THI-CM), a form of child physical abuse. To determine if the PURPLE program had an impact on the rate of physical abuse hospitalizations for children less than or equal to 24 months of age in B.C. since implementation in 2009. The analysis measured physical abuse hospitalization rates for the period January 1, 1999 to December 31, 2019 and excluded any cases of confirmed Traumatic Head Injury-Child Maltreatment. Data were divided into pre-implementation period January, 1999 to December, 2008, and post-implementation period January, 2009 to December, 2019. Data were obtained from the Discharge Abstract Database and B.C. THI-CM Surveillance System to capture information on infant child abuse. Poisson regression and ANCOVA was applied to model the change in rates pre and post program implementation. Physical abuse hospitalization rates decreased by 30% post-implementation period (95% CI: -14%, 57%, p = 0.1561). The decreasing linear trend in the post-implementation period was significantly different than the increasing linear trend in the pre-implementation period (F1,17 = 4.832, p = 0.042). Nurses' role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a decrease in physical abuse hospitalization rates since the implementation of PURPLE.

Heavy industry regulations, hospitalization, and medical expenditures: Evidence from micro-level medical records in a northeast Chinese city

Heavy industry regulations are expected to significantly contribute to enhancing public health and reducing social health costs. Based on microlevel medical records from a northeast Chinese city, we prove that environmental regulations targeting heavy industry plants significantly decrease hospitalization rates and medical expenditures. Specifically, the rate of hospitalization decreases by 0.165 per 10,000 population per day for respiratory, cardiovascular, cerebrovascular, pulmonary, brain disease and adverse pregnancies, especially for those aged 0–15 years or older than 45 years. Our mechanistic analysis highlights that the reduction in hospitalization rates is attributed to the decreased concentrations of SO2 and NOx. Further analysis shows that heavy industry regulations lead to a reduction of 100,000 CNY in total medical expenditures within a span of 15 days for each plant. However, the benefits in medical costs remain significantly lower than the economic costs incurred by the policies.

Prescribing trends of sodium-glucose cotransporter 2 Inhibitors in patients with heart failure with preserved, mildly reduced and reduced ejection fraction

Abstract Background Numerous randomized controlled trials have evaluated the efficacy of SGLT2i and demonstrated decreased hospitalization rates for HF and a better cardiorenal outcome in diverse heart failure (HF) populations comprising HF patients with reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) ejection fraction. Since the beneficial effects of SGLT2i in HF patients are well known, real-world data on the clinical implementation of these agents following availability of CV outcome trial data seems of utmost importance. Methods We identified patients presenting with HF who were hospitalized at a university affiliated tertiary care center, between 01/2017 and 10/2022. All prescriptions of SGLT2i (dapagliflozin and empagliflozin) – including marketed fixed-dose combinations with other glucose-lowering drugs – were identified. Results In total, 2,673 patients with HF (median age 75, 39.9% female, 23.1% with diabetes) were included in the present analyses. Among the 2,637 patients with signs and symptoms suggestive of HF, 1086 (40.6%) had a documented left ventricular ejection fraction (LVEF) ≤ 40% (HFrEF), 445 (16.6%) a LVEF between 40-50% (HFmrEF) and 1142 (42.7%) a LVEF &amp;gt; 50% (HFpEF). In the overall cohort, 382 (14.3%) patients received an SGLT2i. As shown in Figure 1, the prescription of SGLT2i significantly increased from the beginning to the end of the inclusion period. In detail, it climbed from 6.8% in 2017 to 56.6% in 2022 in the HFrEF group (p-trend &amp;lt;0.001), from 3.3% to 49.2% in the HFmrEF group (p-trend &amp;lt;0.001) and from 1.9% to a still very low 26.4% in the HFpEF group (p-trend &amp;lt;0.001). While prescription of SGLT2i in HFrEF patients started to increase after the presentation of the DAPA-HF trial, the SGLT2i prescription in HFmrEF and HFpEF patients showed a marked rise after the presentation of the new HF ESC guidelines (2021) and the EMPEROR-Preserved trial. Conclusion The prescription of SGLT2i is constantly rising due to greater awareness among cardiologists and other specialists in internal medicine. Nevertheless, despite a growing evidence on the reduction of CV events by SGLT2i, our data show that there is still room for improvement in prescribing of these cardioprotective agents, especially in patients with HFpEF.Prescription trend of SGLT2i.

Evaluating Immune-Related Adverse Events Using PRO-CTCAE in a Phase II Study of Ipilimumab for Hormone-Sensitive Prostate Cancer.

Use of the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) during chemotherapy is associated with decreased hospitalization rates, improved quality of life, and longer survival. Limited data exist on the benefit of this symptom assessment tool for monitoring immune-related adverse events (irAEs). We incorporated irAE-related items from the National Cancer Institute's (NCI) PRO-CTCAE in a trial evaluating ipilimumab in combination with androgen deprivation therapy in 16 patients with hormone-sensitive prostate cancer. For comparison, NCI's CTCAE version 4.0 was used by clinicians. IrAE-related PRO-CTCAE surveys and matched CTCAEs (184 pairs) reporting abdominal pain, diarrhea, fatigue, anorexia, nausea, vomiting, rash, and pruritus were collected at each treatment administration and during follow-up. Fatigue, diarrhea, rash, and pruritus were the symptoms most frequently reported by both patients and clinicians. Agreement was lowest for pruritus (κ = 0.10) and highest for rash (κ = 0.64). IrAEs were more commonly reported and of higher grade with PRO-CTCAE scores compared with CTCAE grades. PRO-CTCAEs focused on irAEs capture the patient's immunotherapy experience while complementing the clinician's toxicity assessment measures. Further study is needed to assess PRO-CTCAE's utility in identifying and managing irAEs.

The potential use of Lucilla sericata larvae in the local treatment of wounds in diabetic foot syndrome – a literature review

Introduction: The increasing prevalence of diabetes poses a heightened risk of vascular complications in the lower limbs. The costs associated with wound management are substantial, accounting for approximately 1-3% of total healthcare expenditures in developed countries. Implementing and maintaining preventative, interdisciplinary, and comprehensive care have become prioritized objectives for scientific societies.&#x0D; Purpose: This study conducts a literature review and analysis concerning the application of Lucilia sericata larvae in the local treatment of wounds in diabetic foot syndrome.&#x0D; Method: Literature analysis spanning from 2012 to 2023 was conducted, utilizing PubMed and Termedia databases with keywords such as diabetic foot ulcer, Lucilia sericata, and maggot debridement therapy. Exclusion criteria comprised studies that treated wounds locally using methods other than larval therapy.&#x0D; Conclusions: Larval therapy in patients with diabetic foot syndrome accelerates wound debridement by stimulating reparative processes within the wound. The use of Lucilia sericata larvae may contribute to the reduction of antibiotic therapy duration, decreased hospitalization rates, and lowered amputation risks.

Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis.

Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings. The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care.

Mesenchymal Stem Cell Therapy for a Better Prognosis of Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Mesenchymal stem cell (MSC) therapy is a frequently used treatment option for achieving a better prognosis in patients with heart failure (HF). However, due to reported adverse effects, patients are often hesitant to consider this treatment. Consequently, the aim of this systemic review and meta-analysis is to further investigate the effects of MSCs on survival outcomes, hospital readmissions, and left ventricular ejection fraction (LVEF) in individuals with pre-existing HF. We systematically searched PubMed, Web of Science, Embase, and Cochrane Library to review studies published up until July 16, 2023. Risk ratios were generated using the extracted data for all the outcomes except LVEF. The mean difference was generated for LVEF. Sensitivity analysis was performed to investigate heterogeneity, and the risk of bias tool was used to assess the quality of the included studies. Fourteen randomized controlled trials were included in the meta-analysis. Pooled results revealed that the MSC therapy group did not significantly affect the outcomes of cardiovascular death, rehospitalization rate, myocardial infarction, recurrence of HF, and total death when compared to a control group. However, MSC therapy was significantly associated with an increased LVEF (RR = 3.35; 95% CI: 0.79-5.72; p = 0.010; I2 = 95%). Upon sensitivity analysis, MSC therapy was significantly associated with a decreased hospitalization rate (RR = 0.46; 95% CI: 0.34-0.64; p < 0.00001; I2 = 0%). MSC transplantation results in a significantly improved LVEF and rehospitalization rate.

#3356 COVID-19 PANDEMIC EFFECT ON HOSPITALIZATION OF HEMODIALYSIS PATIENTS

Abstract Background and Aims During the COVID-19 pandemic many facets of our lives were affected, including the healthcare systems worldwide. We aimed to assess the hospitalization rates of hemodialysis (HD) patients with confirmed COVID-19 infection (COVID-19+) versus other patients (i.e., patients with no documented COVID-19 infection in the European Clinical Database (EuCliD®)) in 2020 and their relation to HD patients from the pre-pandemic era in 2019. Method We included 63,216 HD patients treated in 2019-2020 in NephroCare centers from 23 countries from EuCliD® in the Europe, Middle East, and Africa (EMEA) region. Monthly hospitalization rates (hospital admission per 10,000 patients) were estimated separately for COVID-19+ and other HD patients in 2020, and HD patients treated in 2019, with COVID-19+ status as a time-varying variable. The number of COVID-19 cases and deaths were extracted from data released by the European Commission Joint Research Centre (ECJRC)[1]. The correlation between the monthly hospitalization rates and numbers of COVID-19 cases and deaths in general population (GP) were evaluated. Results Characteristics of the approximately 42,000-43,000 monthly treated HD patients were comparable between 2019 and 2020 (Table 1). The hospitalization rates were much higher for COVID-19+ HD patients throughout 2020 compared to other HD patients in 2020 and HD patients in 2019. The hospitalization rates were highest in the spring of 2020 for COVID-19+ HD patients. However, in 2020 other HD patients’ hospitalization rates were lower than the 2019 HD patients’ hospitalization rates. Interestingly the hospitalization rates of other HD patients in 2020 dipped even more below hospitalizations for HD patients in 2019 following the GP pandemic waves (Figure 1). Hospital admission for both COVID-19+ and other HD patients were inversely correlation with the pandemic conditions in GP (Figure 2; spearman correlation coefficients [ρ] with COVID-19 cases/deaths in GP, -0.77/-0.22 and -0.29/-0.64, respectively, for COVID-19+ and other HD patients). Conclusion Our study indicated the COVID-19 pandemic had an impact on hospitalization rates of both HD patients with a COVID-19 diagnosis and those patients without a documented COVID-19 infection. Potential reasons of decreased hospitalization rates in patients without a documented COVID-19 diagnosis could be healthcare resource constraints or regarding patient concerns about exposure to COVID-19 in hospital settings [2].

The impact of COVID-19 pandemic on decreasing hospitalization rates and management of acute coronary syndrome: a study from single centre hospital in Yogyakarta, Indonesia

The Corona virus disease-2019 (COVID-19) pandemic has an impact on the medical field, one of which is service for patients with acute coronary syndrome (ACS). Studies in other countries showed a sudden decrease in admission rates, and percutaneous coronary intervention (PCI), one of ACS treatments, has an impact due to this pandemic. This study aimed to ascertain the effect of COVID-19 on the admissions and management of patients with ACS in Yogyakarta, Indonesia. It was an observational single center study conducted by collecting data for ACS patients at Dr. Sardjito General Hospital, Yogyakarta. Admission data for March 2019 to February 2020 were pre pandemic data, while those gathered from March to December 2020 were pandemic data. Data from 864 (pre pandemic period) and 338 patients (during the pandemic period) were further analyzed. The results showed a decrease in ACS patients’ admission during the pandemic. The most remarkable reduction occurred in those with ST-segment elevation myocardial infarction (STEMI), followed by non-STEMI (NSTEMI) and unstable angina pectoris (UAP) (63.4, 61.4, and 40.9%, respectively). Furthermore, the PCI procedure decreased compared to the period before the pandemic. No significant differences in patients’ characteristics was observed (p&gt;0.05), except for the incidence of pneumonia (p &lt;0.001). Finally, the mortality rate was higher during the pandemic than before (14.8 vs 13.2%), although it was not significant (p&gt;0.05). This study showed that COVID-19 caused a sensible reduction in the admission rates for ACS patients and the number of PCI procedures have been performed. On the other hand, their mortality rate did not increase significantly. However, it is essential to improve healthcare services for ACS patients considering the uncertainty of ending the COVID-19 outbreak.

Thymosin alpha 1 restores the immune homeostasis in lymphocytes during Post-Acute sequelae of SARS-CoV-2 infection.

The complex alterations of the immune system and the immune-mediated multiorgan injury plays a key role in host response to SARS-CoV-2 infection and in the pathogenesis of COVID-19, being also associated with adverse outcomes. Thymosin alpha 1 (Tα1) is one of the molecules used in the treatment of COVID-19, as it is known to restore the homeostasis of the immune system during infections and cancer. The use of Tα1 in COVID-19 patients had been widely used in China and in COVID-19 patients, it has been shown to decrease hospitalization rate, especially in those with greater disease severity, and reduce mortality by restoring lymphocytopenia and more specifically, depleted T cells. Persistent dysregulation with depletion of naive B and T cell subpopulations and expansion of memory T cells suggest a chronic stimulation of the immune response in individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Our data obtained from an ex vivo study, showed that in PASC individuals with a chronically altered immune response, Tα1 improve the restoration of an appropriate response, most evident in those with more severe illness and who need respiratory support during acute phase, and in those with specific systemic and psychiatric symptoms of PASC, confirming Tα1 treatment being more effective in compromised patients. The results obtained, along with promising reports on recent trials on Tα1 administration in patients with COVID-19, offer new insights into intervention also for those patients with long-lasting inflammation with post-infectious symptoms, some of which have a delayed onset.

Hospitalization Rates for Inflammatory Bowel Disease Are Decreasing Over Time: A Population-based Cohort Study.

Recent advances in the management of inflammatory bowel disease (IBD) striving for new treatment targets may have decreased rates of hospitalization for flares. We compared all-cause, IBD-related, and non-IBD-related hospitalizations while accounting for the rising prevalence of IBD. Population-based, administrative health care databases identified all individuals living with IBD in Alberta between fiscal year 2002 and 2018. Hospitalization rates (all-cause, IBD-related, and non-IBD-related) were calculated using the prevalent Alberta IBD population. Hospitalizations were stratified by disease type, age, sex, and metropolitan status. Data were age and sex standardized to the 2019 Canadian population. Log-linear models calculated Average Annual Percentage Change (AAPC) in hospitalization rates with associated 95% confidence intervals (CIs). From 2002-2003 to 2018-2019, all-cause hospitalization rates decreased from 36.57 to 16.72 per 100 IBD patients (AAPC, -4.18%; 95% CI, -4.69 to -3.66). Inflammatory bowel disease-related hospitalization rate decreased from 26.44 to 9.24 per 100 IBD patients (AAPC, -5.54%; 95% CI, -6.19 to -4.88). Non-IBD-related hospitalization rate decreased from 10.13 to 7.48 per 100 IBD patients (AAPC, -1.82%; 95% CI, -2.14 to -1.49). Those over 80 years old had the greatest all-cause and non-IBD-related hospitalization rates. Temporal trends showing decreasing hospitalization rates were observed across age, sex, IBD type, and metropolitan status. Hospitalization rates are decreasing for all-cause, IBD-related, and non-IBD-related hospitalizations. Over the past 20 years, the care of IBD has transitioned from hospital-based care to ambulatory-centric IBD management.

Increased rhinovirus/enterovirus infections including Ev-D68 in the United States, a challenge for healthcare providers amidst influenza virus infection and the COVID-19 pandemic.

In March 2020, WHO declared SARS-CoV-2 a global pandemic and lockdowns were enforced in most of the United States. Self-protective measures and travel restrictions were implemented, and schools/universities initiated online learning. Consequently, the global incidence and hospitalization rates of seasonal respiratory infections decreased significantly up to early 2021. Despite the decrease in hospitalization rates due to respiratory illnesses other than Covid-19, hospitals and healthcare providers faced huge stressors regarding workload dueto the pandemic. Furthermore, higher vaccination rates across the United States decreased non pharmaceutical interventions (NPI) implementation increasing the risk of major seasonal viral outbreaks. This editorial discusses the increased Rhinovirus/Enterovirus infections in the United States, challenges faced by healthcare providers and provides recommendations to address the issue.