Incidence Of Hospitalization Research Articles

Risk factors associated with air embolism following computed tomography-guided percutaneous lung biopsy: a retrospective case-control study.

Retrospective analysis to identify the risk factors for air embolism following computed tomography (CT)-guided percutaneous transthoracic needle biopsy (TNB). A retrospective analysis of patients who underwent CT-TNB at The First Affiliated Hospital of Zhengzhou University and Xuzhou Cancer Hospital from January 2017 to December 2021 was performed. A total of 21 factors relevant to air embolisms were collected. Risk factors associated with air embolisms were determined by the least absolute shrinkage and selection operator (LASSO). The receiver-operator characteristic (ROC) was used to assess the ability of these factors to identify air embolisms. Of these 32,748 patients, 28 experienced air embolisms (19 at The First Affiliated Hospital of Zhengzhou University (incidence, 1.46%) and nine at Xuzhou Cancer Hospital (incidence, 0.69%); total incidence, 2.16%). Only seven patients exhibited symptoms (symptom rate, 25.00%). A total of 21 patients were asymptomatic at the time of swept-source CT. No deaths occurred. We found through univariate and multivariate analysis that eight out of these 21 factors are associated with the occurrence of air embolism. The area under the ROC curve was 0.721, indicating good predictive power (P<0.05). Cough during the procedure, hemoptysis during the procedure, the distance between the mass and the pulmonary vein, the presence of a cavity in the lesion, lesion location, number of samples, abnormalities in the patient's coagulation mechanism, and the puncture position may be the risk factors for air embolism in CT-TNB.

Incidence of Hospitalizations Involving Alcohol Withdrawal Syndrome in a Primary Care Population

Alcohol withdrawal syndrome (AWS) is an important cause and complication of hospitalizations. Although common and preventable, the incidence of AWS during hospitalizations is poorly described. To evaluate the incidence and proportional incidence of hospitalizations involving AWS in an adult primary care population overall and across patient characteristics. This retrospective cohort study used electronic health records and insurance claims from Kaiser Permanente Washington (KPWA) between July 1, 2018, and June 30, 2022. The study included adults with 1 or more primary care visits during this period or the year prior, where primary care included annual standardized alcohol screening using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Age, sex, race, Hispanic ethnicity, AUDIT-C scores, and comorbid diagnoses. Hospitalizations involving AWS were defined by diagnosis codes documented during hospitalizations (incidence numerator). Time enrolled in KPWA determined person-enrolled-years (incidence denominator). Proportional incidence was calculated as the incidence of hospitalizations involving AWS divided by the incidence of all-cause hospitalizations. Proportional incidence was also estimated for hospitalizations involving other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension), which were also defined using hospital diagnosis codes. Among 544 825 adults engaged in primary care (mean [SD] age, 47.0 [17.9] years; 310 069 [56.9%] female; 3656 [0.7%] American Indian or Alaska Native, 55 206 [10.1%] Asian, 25 406 [4.7%] Black, 5204 [1.0%] Native Hawaiian or Other Pacific Islander, 365 780 [67.1%] White, 19 791 [3.6%] multiracial, 15 963 [2.9%] other races, and 53 819 [9.9%] unknown race; 33 987 [6.2%] Hispanic, 414 269 [76.0%] not Hispanic, and 96 569 [17.7%] unknown ethnicity), incidence of hospitalizations involving AWS was 169 (95% CI, 159-179) per 100 000 person-enrolled-years overall but as high as 15 347 (95% CI, 13 502-17 331) in patients with other alcohol-attributable diagnoses. The proportional incidence of hospitalizations involving AWS was 2.3% overall, with variation by age, sex, and AUDIT-C scores (eg, 9%-11% in male patients aged 30-49 years and 23%-44% in patients with high-risk AUDIT-C scores of 7-12 points). In most cases, among adults younger than 60 years, proportional incidence of hospitalizations involving AWS matched or surpassed that of other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension). In this cohort study of a large primary care population served by an integrated health system, AWS hospitalizations were common, especially in male patients, younger age groups, and individuals with high-risk alcohol use. During hospitalizations, the burden of AWS was similar to or exceeded complications of other chronic diseases that receive greater medical attention.

The effect of using low dose norepinephrine before hypotensive resuscitation in hemorrhagic shock; a randomized controlled trial

Background &amp; Objectives: Hemorrhagic shock is not a very rare occurrence in big hospitals. It might be encountered in the emergency room (ER) or in the operating rooms (OR). A rapid response and systematic management will save the life of the victim. The objective of this research was to investigate the impact of a low dose of norepinephrine (NE) administered prior to the initiation of hypotensive resuscitation in patients with hemorrhagic shock. Methodology: This randomized controlled trial was conducted on 200 participants, at least 18 years old, classified as severely traumatized and had significant hemorrhage with mean arterial pressure ranging from 65 to 75 mmHg. We divided the patients into two equal groups. Group I received a low dose of NE (&lt; 0.3 µg/kg/min) concurrently with resuscitation fluids. Group II received resuscitative fluids only. If the resuscitative fluids failed to keep mean arterial pressure (MAP) &gt; 65 mmHg, the patient was progressively administered NE even with high doses (0.05 to more than 0.3 µg/kg/min). The primary outcome was 24-hour mortality. In-hospital mortality, incidence of acute kidney injury (AKI), and duration of hospital and intensive care unit (ICU) stay constituted the secondary outcomes. Results: Group I had lower 24-hour mortality compared to Group II (3% vs 13%; P &lt; 0.05). Compared to Group II, Group I needed reduced amount of fluid resuscitation within 24 h, had lower serum lactate levels at 6 and 12 h, and lower serum creatinine at 6, 12, and 18 h (P &lt; 0.001). Group I had a lower incidence of mechanical ventilation (13% vs 27%), hospital and ICU stays, and in-hospital mortality (9% vs 21%) (P &lt; 0.05). There was a lack of disparity seen in the incidence of AKI and duration of mechanical ventilation. Conclusion: Low-dose norepinephrine infusion during the early period of hypotensive resuscitation reduces resuscitative fluid requirement, improves tissue perfusion, preserves renal function, and lowers mortality in hemorrhagic shock patients. Abbreviations: AKI - acute kidney injury; APACHE III - Acute Physiology And Chronic Health Evaluation III; HS - hemorrhagic shock; ICU - intensive care unit; MAP - mean arterial pressure; NE - Norepinephrine Keywords: Hemorrhagic Shock; Hypotensive Resuscitation; Norepinephrine; Fluid Therapy; Renal Protection; Mortality; Low Dose Citation: Mohamed RM, Anwar AG, Eid AA. The effect of using low dose norepinephrine before hypotensive resuscitation in hemorrhagic shock; a randomized controlled trial. Anaesth. pain intensive care 2024;28(5):914−921; DOI: 10.35975/apic.v28i5.2560 Received: April 17, 2024; Reviewed: August 03, 2024; Accepted: September 04, 2024

Continuity of care and hospitalization frequency for ambulatory care-sensitive conditions after hearing-disability onset: a retrospective cohort study

We assessed the effect of continuity of care (COC) on the frequency of hospitalization for Ambulatory care-sensitive conditions (ACSCs) to estimate the impact of COC and hearing disability relative to the controls. This retrospective cohort study used claim data of Korean National Health Insurance Service – National Sample Cohort 2.0 DB. We used propensity score matching to determine a control group for the hearing disability group by age, sex, and the Charlson Comorbidity Index. The hearing-impaired group included 720 participants, and the non-disabled control group, consisting of individuals without any form of disability, had 1,423 individuals. We used the frequency of hospitalization for ACSCs during one-year follow-up as the dependent variable for Poisson regression. We measured COC with the Bice–Boxerman Continuity of Care Index (COCI); higher COCI values represent better continuity of care, with COCI values ranging from 0 to 1. Poisson regression showed that disability status modifies the effect of COCI on the incidence of hospitalization. COCI = 1 reduced hospitalizations in people with hearing disabilities (adjusted Incidence Rate Ratio [aIRR]: 0.30, 95% CI: 0.20–0.44) but was not statistically significant for controls. In the COCI = 1 group, the effect of disability was not significant(aIRR: 1.10, 95% CI: 0.83–1.44). Compared to people without disabilities, enhanced COC for people with hearing disabilities was more effective in preventing hospitalizations for ACSCs.

Real-time Predictive Health Monitoring using Ai-driven Wearable Sensors: Enhancing Early Detection and Personalized Interventions in Chronic Disease Management

The use of artificial Intelligence in wearable health sensor has brought a great change in the way chronic diseases are being managed since it monitors the health and gives prompt prediction of diseases coupled with recommendations. This paper seeks to investigate the part played by AI wearables in augmenting early detection &amp; proactive plans relating to chronic illnesses, including diabetics, cardiovascular diseases, and hypertension. Implicitly, the purpose of this study is to update the current understanding of the subject by examining the effect that predictive analytics has on patient outcomes and cost. Technologically, the concepts of the research rely on the data collected from different kinds of wearable devices and analyze by machine learning and real time analytic to examine the abnormal of vital signs before symptoms occur. Analysis is carried out on the outcomes which reveals a 25 percent decrease in hospitalization incidences per early diagnosis of chronic diseases and a 30 percent enhancement in the adherence to treatment provided formed by precautions embraced from various sensors data. This research also increases the stock of knowledge on the role of artificial intelligence in healthcare by presenting empirical evidence regarding the use of wearable devices in chronic diseases. The uniqueness of this concept is in the synchrony of monitoring processes with the application of the predictive model in providing proactive health care solutions. Some potential future research and development considerations in AI-assisted technologies in healthcare are also described.

Long-term opioid prescribing and the incidence of opioid-related hospitalizations or emergency department visits among patients with metastatic cancer.

200 Background: Many patients with metastatic cancer experience cancer-related pain which is commonly managed using opioids. Although opioids are an effective tool for cancer pain management, their use can result in adverse effects which may be related to long-term use and are understudied in this population. Therefore, we aimed to describe long-term opioid prescribing (LTOP) practices among patients with metastatic cancer and investigate the incidence of opioid-related hospitalizations and emergency department (ED) visits among recipients of long-term prescribing. Methods: This retrospective cohort study used population-based data from Alberta, Canada to identify patients diagnosed with stage IV cancers between 2004-2017 who had at least 1-year of follow-up and were opioid naïve at diagnosis. LTOP was defined as receipt of a ≥90-day supply of opioids with less than a 30-day gap in supply within a 180-day period. Prescribing practices were characterized according to timing (early vs. end-of-life [EoL] onset), morphine equivalent dose, duration, and concurrent medication use. The EoL phase of disease was defined as the year preceding death. The incidence rate of opioid-related encounters was compared between different characteristics of LTOP. Results: The study included a total of 10927 patients, 2521 (23%) of whom received long-term opioid prescribing after diagnosis. LTOP became more common as patients approached EoL, with most patients (53%) having LTOP initiated only within their last year of life. 85 patients (3.4%) experienced an opioid-related hospitalization or ED visit after initiation of LTOP, with an incidence rate of 2.36 (95% CI 1.92, 2.86) encounters per 100 person-years. Higher opioid dosage and concurrent prescribing of anxiolytics, benzodiazepines, antidepressants, and neuroleptic medications were significantly associated with a higher incidence of opioid-related encounters. Conclusions: Long-term opioid prescribing is commonly experienced by patients living with metastatic cancer as a chronic disease. The concurrent use of psychoactive drugs during LTOP was associated with experiencing opioid-related hospitalizations/ED visits.

Biological therapy, surgery, and hospitalization rates for inflammatory bowel disease: An observational Latin American comparative study between adults and pediatric patients

ObjectiveCompare the proportions of use of biological therapy, surgeries, and hospitalizations between adults and pediatric inflammatory bowel disease (IBD)—Crohn's disease (CD) and ulcerative colitis (UC)—patients. Patients and methodsObservational, retrospective, and multicenter study. Data were collected from all consecutive IBD patients seen as outpatients or admitted to hospital, during 2015–2021, in two IBD tertiary centers in a South Brazilian capital. Patients with unclassified colitis diagnosis were excluded from this study. Patients were classified as having CD or UC and sub-categorized as adult or pediatric according to age. Data were analyzed using frequency, proportion, Fisher's exact test, and Chi-square test. ResultsA total of 829 patients were included: 509 with CD (378 adults/131 pediatric) and 320 with UC (225/95). Among patients with CD, no differences were observed for proportions of use of biological therapy (80.2% in pediatric vs. 73.3% in adults; P=0.129), surgery (46.6% vs. 50.8%; P=0.419), or hospitalization (64.9% vs. 56.9%; P=0.122). In UC, significant differences were observed for biological therapy (40.0% vs. 28.0%; P=0.048) and hospitalization (47.4% vs. 24.0%; P<0.001). No significant difference was observed in surgery rates (17.9% vs. 12.4%; P=0.219). ConclusionsBiological therapy and incidence of hospitalization were greater among pediatric patients with UC, compared with adults; no difference was observed in the need for abdominal surgery. In CD, no significant difference was observed in the three main outcomes between the age groups.

Incidence and Risk of Coronavirus Disease 2019 Hospitalization Among Unvaccinated Children.

The aim of this study is to determine the incidence and risk factors associated with COVID-19 hospitalization among unvaccinated children. Children aged 0- < 18 years, members of Kaiser Permanente Northern California (KPNC), were followed from March 1, 2020, until the earliest occurrence of: chart-confirmed COVID-19 hospitalization, disenrollment from KPNC, age 18 years, receipt of COVID-19 vaccine, death, or study end (December 31, 2022). We calculated the incidence rate of hospitalization by SARS-CoV-2 variant period and by age group. We determined risk factors for hospitalization using Poisson regression. We also conducted descriptive analyses of hospitalized cases. Among 1,107,799 children, 423 were hospitalized for COVID-19 during follow-up. The incidence of hospitalization increased with each new SARS-CoV-2 variant and was highest among children aged < 6 months. Among the < 6-month-olds, the incidence rate per 100,000 person-months was 7 during predelta, 13.3 during delta, and 22.4 during omicron. Black (RR = 2.05, 95% CI: 1.33-3.16) and Hispanic children (RR = 1.82, 95% CI: 1.34-2.46) and children with any comorbidities were at high risk of hospitalization (RR = 3.81, 95% CI: 2.94-4.95). Overall, 20.3% of hospitalized children were admitted to an intensive care unit (ICU), but ICU admission was 36.1% among 12- < 18-year-olds. The majority of ICU admits (91.8%) had no comorbidities. Children too young to be vaccinated had the highest incidence of COVID-19 hospitalization, while adolescents had the highest proportion of ICU admissions. To prevent severe disease in children and adolescents, everyone eligible should be vaccinated.

TCT-625 A Lower Ratio of Regurgitant Volume to Left Atrium Volume Is Associated With a Higher Incidence of Heart Failure Hospitalization in Patients With Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry

TCT-625 A Lower Ratio of Regurgitant Volume to Left Atrium Volume Is Associated With a Higher Incidence of Heart Failure Hospitalization in Patients With Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry

ACUTE PANCREATITIS IN AKMOLA REGION ACCORDING TO EMERGENCY SURGERY

Background: Acute pancreatitis is a major issue in surgical practice, with high complications and mortality rates. It severely affects patient quality of life and places a significant economic strain on healthcare systems, making its study crucial for public health. This study aims to analyze trends in acute pancreatitis incidence in the Akmola region from 2009 to 2022. Materials and methods: The study is based on a retrospective analysis of data from the Ministry of Health of the Republic of Kazakhstan according to the International Classification of Diseases-10 code: K85. Methods of health statistics and time series analysis were used to assess the dynamics of morbidity. Results: There was an increase in the total number of hospitalizations from 865 cases in 2009 to 1.061 in 2022. The percentage of surgical interventions decreased from 5.7% to 4.2%, while the share of conservative treatment increased to 95.8%. The mortality rate among operated patients was 20.4% in 2019 and increased to 33.3% in 2022. The incidence of hospitalization increased from 117.1 per 100000 population in 2009 to 144.6 per 100000 population in 2022, with a decrease in the rate of late visits from 42.6 to 36.1 per 100000 population, respectively. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings. Conclusion. The study highlights the need to improve medical approaches to acute pancreatitis in the Akmola region. The results indicate the critical importance of early diagnosis and timely hospitalization to reduce complications and mortality. Additional research is needed to develop more effective clinical protocols.

Risk factors and characteristics of intraoperative pressure injuries caused by medical devices and adhesives: A case-control retrospective study

Background: Undesirable injuries during the intraoperative period, such as pressure injuries caused by improper positioning, medical devices, or adhesive tapes, can lead to patient harm and decreased satisfaction. This study aims to identify the risk factors of pressure injuries during the intraoperative period and the characteristics of these injuries. Methods: A retrospective case-control study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. Data were collected from the hospital incident reporting system and electronic medical records for incidents reported from January 1, 2022 to December 31, 2022. Inclusion criteria consisted of all patients with a reported pressure injury, including pressure ulcers, medical adhesive-related skin injuries, or medical device-related pressure injuries, occurring at least once during surgery. Results: Among the 113 patients, 57 (50.44%) had intraoperative pressure injuries (cases), while 56 (49.56%) did not (controls). The most common locations for pressure injuries were the lips (33.33%). Most of these injuries were classified as Medical Adhesive-Related Skin Injury (61.40%). Stage 1 injuries were observed in 47 cases (82.46%), while Stage 2 injuries were observed in 10 cases (17.54%). Duration of surgery and device tightness were identified as significant risk factors (P &lt; 0.001). Conclusion: This case-control study identified the duration of surgery and device tightness as significant risk factors for intraoperative pressure injuries. The findings emphasize the importance of implementing evidence-based prevention strategies. Healthcare professionals should prioritize staff education and training, while future research should focus on conducting prospective, multicenter studies and developing risk assessment tools and innovative medical devices.

Clinical and economic inpatient burden of respiratory syncytial virus (RSV) infections in children < 2 years of age in Germany, 2014-2019: a retrospective health claims analysis.

Respiratory syncytial virus (RSV) is a common cause for severe lower respiratory tract infections (LRTI) in children < 2 years of age in Germany - though little is known about the clinical and economic burden of RSV in children with and without risk factors per month of life. In a retrospective health claims analysis, we identified RSV inpatient cases between 2014 and 2019. We assessed incidence rates, mortality rate, healthcare resource utilization, associated direct costs per case and excess costs for 30, 90 and 365 days after hospital admission matched to a control group. The outcomes are reported separately for the first and second year of life (i.e., for infants and toddlers) and were stratified by month of life, preterm and risk status (i.e., presence of underlying disease: chronic respiratory or cardiac disease, immunosuppression, neurological diseases, diabetes, conditions originating in the perinatal period). RSV-attributable hospital incidence rate was higher in infants (30.25/1,000) than toddlers (14.52/1,000), highest in the first three months of life (44.21/1,000), in infants born preterm (64.76/1,000) or with any underlying disease (54.85/1,000). Mortality rate was also higher for infants (0.08/1,000) than toddlers (0.04/1,000). Mean 30-day excess costs ranged from 2,953 € for infants born full-term at no risk, hospitalized for 5 days, to 6,694 € for infants born extremely premature, hospitalized for 7 days. In Germany, the clinical and economic burden of RSV is substantial, especially in the most vulnerable population, that is, very young infants, those born premature and/or those with an underlying disease.

Relationship between Complementary use of Herbal Medicines and Diabetes Mellitus Treatment Outcomes: A Cross-Sectional Study in Two Tertiary Healthcare Facilities in Jos Metropolis

In Nigeria, the use of herbal medicines to complement diabetes treatment is common, though their impact on treatment outcomes is not well understood. This cross-sectional questionnaire study, conducted in Jos metropolis, Nigeria, assessed the prevalence of herbal medicines use among 141 diabetes patients and its relationship with treatment outcomes. Most of the study participants were females (60.3%) with a family history of diabetes (70%). The findings showed that 58.9% of participants used herbal remedies like Moringa oleifera, Vernonia amygdalina and Allium sativum to complement treatment for diabetes mellitus without guidance from conventional clinicians. There were higher incidences of hospitalizations and hypoglycemia in the group that complemented their treatments with herbal medicines (P &lt;0.05). However, fasting blood glucose levels remained unaffected (P &gt; 0.05). The study highlights the common use of herbal medicines in Nigeria and underscores both the prospect for herbal medicine integration and the challenges of poor clinical data to inform ration use.

Long-Term Oxygen Therapy for 24 or 15 Hours per Day in Severe Hypoxemia

BackgroundLong-term oxygen supplementation for at least 15 hours per day prolongs survival among patients with severe hypoxemia. On the basis of a nonrandomized comparison, long-term oxygen therapy has been recommended to be used for 24 hours per day, a more burdensome regimen.MethodsTo test the hypothesis that long-term oxygen therapy used for 24 hours per day does not result in a lower risk of hospitalization or death at 1 year than therapy for 15 hours per day, we conducted a multicenter, registry-based, randomized, controlled trial involving patients who were starting oxygen therapy for chronic, severe hypoxemia at rest. The patients were randomly assigned to receive long-term oxygen therapy for 24 or 15 hours per day. The primary outcome, assessed in a time-to-event analysis, was a composite of hospitalization or death from any cause within 1 year. Secondary outcomes included the individual components of the primary outcome assessed at 3 and 12 months.ResultsBetween May 18, 2018, and April 4, 2022, a total of 241 patients were randomly assigned to receive long-term oxygen therapy for 24 hours per day (117 patients) or 15 hours per day (124 patients). No patient was lost to follow-up. At 12 months, the median patient-reported daily duration of oxygen therapy was 24.0 hours (interquartile range, 21.0 to 24.0) in the 24-hour group and 15.0 hours (interquartile range, 15.0 to 16.0) in the 15-hour group. The risk of hospitalization or death within 1 year in the 24-hour group was not lower than that in the 15-hour group (mean rate, 124.7 and 124.5 events per 100 person-years, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.72 to 1.36; 90% CI, 0.76 to 1.29; P=0.007 for nonsuperiority). The groups did not differ substantially in the incidence of hospitalization for any cause, death from any cause, or adverse events.ConclusionsAmong patients with severe hypoxemia, long-term oxygen therapy used for 24 hours per day did not result in a lower risk of hospitalization or death within 1 year than therapy for 15 hours per day. (Funded by the Crafoord Foundation and others; REDOX ClinicalTrials.gov number, NCT03441204.)

A Model-Based Estimation of RSV-Attributable Incidence of Hospitalizations and Deaths in Italy Between 2015 and 2019.

Respiratory syncytial virus (RSV) incidence is known to be underestimated in adults due to its infrequent diagnostic testing and lower sensitivity of single nasal/nasopharyngeal swab PCR testing outside of the early childhood period. RSV can trigger acute cardiac events as well as cause respiratory disease. Consequently, we used a model-based study to estimate RSV-attributable hospitalization and mortality incidence among adults in Italy between 2015 and 2019. Through a database predisposed by CREA Sanità, by extracting monthly data from the Italian hospitalization collection data of the Ministry of Health and the Italian National Institute of Statistics (ISTAT) data (mortality), we estimated yearly RSV-attributable incidence of events for different cardiorespiratory outcomes. We used a quasi-Poisson regression model, which accounted for periodic and aperiodic time trends and viral activity proxies. The yearly RSV-attributable cardiorespiratory hospitalization incidence increased with age and was highest among adults aged≥75 years (1064-1527 cases per 100,000 person-years). Similarly, the RSV-attributable cardiorespiratory mortality rate was highest among persons aged≥75 years (59-85 deaths per 100,000 person-years). Incidence rates for RSV-attributable hospitalizations and RSV-attributable mortality were on average 2-3 times higher for cardiorespiratory than respiratory disease alone. Incidence rate based on RSV-specific ICD codes only were 405-1729 times lower than modeled estimates accounting for untested events. RSV causes a substantial disease burden among adults in Italy and contributes to both respiratory and cardiovascular conditions. Our results emphasize the need for effective RSV prevention strategies, particularly among older adults.

Evaluation of adverse clinical outcomes in patients with inflammatory bowel disease receiving different sequences of first- and second-line biologic treatments: findings from ROTARY

BackgroundPatients with inflammatory bowel disease (IBD) are at risk of developing dysplasia and, subsequently, colorectal cancer (CRC) owing to chronic inflammation. Patients may also experience other severe disease complications, such as hospitalization and surgery. Several biologics are available for the treatment of patients with IBD and some patients require multiple lines of treatment owing to loss of response or tolerability to their prescribed biologic. Previous studies suggest that the choice of initial biologic treatment may impact the outcomes of later treatment lines. In this study, we assessed adverse clinical outcomes in patients with Crohn’s disease (CD) or ulcerative colitis (UC) who received different biologic treatment sequences.MethodsROTARY part B was a retrospective cohort study using the Optum® Clinical Database that evaluated the incidences of IBD-related hospitalization, IBD-related surgery, dysplasia, CRC, and infections in patients with CD or UC who received two biologics successively. First-line biologics included adalimumab, infliximab, ustekinumab (CD only), and vedolizumab; second-line biologics included infliximab and adalimumab.ResultsIn patients with CD, the treatment sequence of ustekinumab to infliximab was associated with the highest overall incidences of hospitalization (51.9%), surgery (40.7%), CRC (3.7%), and infection (37.0%). Vedolizumab followed by an anti-tumor necrosis factor alpha (anti-TNFα) treatment was associated with a significantly lower risk of experiencing an adverse medical event (hospitalization, surgery, or infection) than two successive anti-TNFα treatments (odds ratio, 1.526; 95% confidence interval, 1.004–2.320; P < 0.05). In patients with UC, the treatment sequence of vedolizumab to adalimumab resulted in the lowest overall incidence of adverse outcomes (20.3%, 6.3%, 0.0%, 6.3%, and 4.7% for hospitalization, surgery, CRC, dysplasia, and infection, respectively).ConclusionsWe describe differences in adverse clinical outcomes associated with sequencing of biologics in patients with CD or UC and demonstrate favorable results in patients who received vedolizumab as a first-line biologic. These results provide potential guidance to clinicians choosing sequences of biologic treatments in patients with IBD.

The Supporting Emerging Adults With Diabetes (SEAD) Program: An Adult-Based Real-World Clinical Model That Improves Hospitalizations, Diabetes Technology Uptake, and Glycemic Outcomes in Underserved Young Adults With Type 1 Diabetes.

Underserved young adults (YA) with type 1 diabetes (T1D) experience the worst outcomes across the life span. We developed and integrated the Supporting Emerging Adults with Diabetes (SEAD) program into routine endocrinology care to address unmet social and medical challenges. This study was designed as a longitudinal cohort study, with prospective data collection over 4 years on YA in SEAD compared with usual endocrine care. We used propensity-weighted analysis to account for differences in baseline characteristics, and multivariate regression and Cox proportional hazard models to evaluate change in outcomes over time. Primary outcomes included incidence of hospitalizations, diabetes technology uptake, and annual change in HbA1c levels. We included 497 YA with T1D in SEAD (n = 332) and usual endocrine care (n = 165); mean age 25 years, 27% non-Hispanic Black, 46% Hispanic, 49% public insurance, mean HbA1c 9.2%. Comparing YA in SEAD versus usual care, 1) incidence of hospitalizations was reduced by 64% for baseline HbA1c >9% (HR 0.36 [0.13, 0.98]) and 74% for publicly insured (HR 0.26 [0.07, 0.90]); 2) automated insulin delivery uptake was 1.5-times higher (HR 1.51 [0.83, 2.77]); and 3) HbA1c improvement was greater (SEAD, -0.37% per year [-0.59, -0.15]; usual care, -0.26% per year [-0.58, 0.05]). SEAD meaningfully improves clinical outcomes in underserved YA with T1D, especially for publicly insured and high baseline HbA1c levels. Early intervention for at-risk YA with T1D as they enter adult care could reduce inequity in short and long-term outcomes.

Effectiveness of inactivated COVID-19 vaccines in preventing COVID-19-related hospitalization during the Omicron BF.7-predominant epidemic wave in Beijing, China: a cohort study

BackgroundTo estimate vaccine effectiveness(VE) against COVID-19-related hospitalization for inactivated vaccines during the Omicron BF.7-predominant epidemic wave in Beijing, China.MethodsWe recruited a cohort in Beijing on 17 and 18 December 2022, collected status of vaccination and COVID-19-related hospitalization since 1 November 2022 and prospectively followed until 9 January 2023. A Poisson regression model was used to estimate the VE.Results16(1.15%) COVID-19-related hospitalizations were reported in 1391 unvaccinated participants; 7(0.25%) in 2765 participants with two doses, resulting in a VE of 70.89%(95% confidence interval[CI] 26.25 to 87.73); 32(0.27%) in 11,846 participants with three doses, with a VE of 65.25%(95% CI 32.24 to 81.83). The VE of three doses remained above 64% at 1 year or more since the last dose. Elderly people aged ≥ 60 years had the highest hospitalization incidence(0.66%), VE for two doses was 74.11%(95%CI: − 18.42 to 94.34) and VE for three doses was 80.98%(95%CI:52.83 to 92.33). We estimated that vaccination had averted 65,007(95%CI: 12,817 to 97,757) COVID-19-related hospitalizations among people aged ≥ 60 years during the BF.7-predominant period in Beijing.ConclusionInactivated COVID-19 vaccines were effective against COVID-19-related hospitalization, especially for the elderly population who have increased risk of severe disease owing to SARS-CoV-2 infection.

Comparative assessment of the clinical effectiveness of direct-acting antiviral drugs in outpatient patients with acute respiratory viral infections

To evaluate the clinical effectiveness, safety and compare the incidence of hospitalization during treatment with antiviral drugs with a direct mechanism of action (riamilovir and umifenovir) in people with acute respiratory viral infections (ARVI) in an outpatient setting. The study included 150 outpatients with ARVI aged 18-27 years: 50 patients received riamilovir 250 mg 3 times a day for 5 days, the second group included 50 patients who received umifenovir 200 mg 4 times a day for 5 days, 50 individuals received only pathogenetic treatment. The use of direct-acting antiviral drugs was characterized by the least severity of pain and aches in the body, general weakness, and in the group of patients receiving riamilovir, the lowest severity of rhinitis, cough, and the lowest morning body temperature were recorded compared to other groups. In riamilovir group reduction in the duration of the disease was observed. The lowest frequency of ARVI pathogens detection was observed on the 6th day in riamilovir group. Outpatient treatment with riamilovir was accompanied by a minimal number of cases of the disease requiring hospitalization. The use of direct antiviral drugs contributes to the rapid relief of ARVI symptoms in patients receiving medical care on an outpatient basis. The antiviral drug riamilovir showed the most pronounced effectiveness (clinical and laboratory).

Complications leading to hospitalisation 12 months after brachytherapy or high-intensity focused ultrasound for localized prostate cancer: French national from the PMSI-MCO data, 2019 and 2020

Background and purposeProstate cancer can be treated using either brachytherapy or high-intensity focused ultrasound (HIFU), which are less invasive than surgery. Although both approaches have proved effective, few studies have looked at the specific causes of hospitalisation due to complications, following these treatments. The aim of this study was to compare the causes of hospitalisation. MethodsA retrospective study was carried out examining the records of patients who had undergone brachytherapy or HIFU treatment for localized prostate cancer in 2019 and 2020, using the French national database: Programme de Médicalisation du Système d’Information − Médecine, Chirurgie, Obstétrique (PMSI-MSO). Data on post-treatment hospitalisations were analyzed. Results3090 patients were included in the study, of whom 1699 underwent brachytherapy and 1391 HIFU procedures. The incidence of hospitalisation was much higher after HIFU than after brachytherapy, notably due to a higher rate of obstructive complications (12.94% vs 2.77%). Large differences were also found for infections (8.20% vs 1.47%) and bleeding (6.76% vs 2.18%) leading to hospitalisation. Most of the complications occurred at the initial hospitalization: 12% for HIFU, and 1.4% for brachytherapy. ConclusionComplications were more frequent after treatment with HIFU than with brachytherapy in the year following treatment for localized prostate cancer. Further the causes of hospitalisation differed between the two treatments. These differences need to be taken into account in the therapeutic strategy, as well as in post-treatment management.