Inpatient Study Research Articles

Machine learning to identify risk factors associated with the development of ventilated hospital-acquired pneumonia and mortality: implications for antibiotic therapy selection.

Among patients with nosocomial bacterial pneumonia, those who decompensated to requiring mechanical ventilation (vHABP) faced the highest mortality followed by ventilator-associated pneumonia (VABP) and non-ventilated hospital-acquired pneumonia (nvHABP). The objectives of this study were to identify risk factors associated with the development and mortality of vHABP and to evaluate antibiotic management. A multicenter retrospective cohort study of adult inpatients with nosocomial pneumonia during 2014-2019 was performed. Groups were stratified by vHABP, nvHABP, and VABP and compared on demographics, clinical characteristics, treatment, and outcomes. Multivariable models were generated via machine learning to identify risk factors for progression to vHABP as well as pneumonia-associated mortality for each cohort. 457 patients (32% nvHABP, 37% vHABP, and 31% VABP) were evaluated. The vHABP and nvHABP groups were similar in age (median age 66.4 years) with 77% having multiple comorbidities but more vHABP patients had liver disease (18.2% vs. 7.7% p = 0.005), alcohol use disorder (27% vs. 7.1%, p < 0.0001), and were hospitalized within the past 30 days (30.4% vs. 19.5%, p = 0.02). An immediate need for ventilatory support occurred in 70% of vHABP patients on the day of diagnosis. Mortality was the highest in vHABP followed by VABP and nvHABP groups (44.6% vs. 36% vs. 14.3%, p < 0.0001). Nearly all (96%) vHABP patients had positive cultures, with Gram-negative pathogens accounting for 58.8% whereby 33.0% were resistant to extended-spectrum β-lactams (ESBLs), ceftriaxone (17.5%), fluoroquinolones (20.6%), and carbapenems (12.4%). Up to half of the vHABP patients with ESBL-Enterobacterales or P. aeruginosa did not receive an effective empiric regimen; over 50% increase in mortality rate was observed among patients whom effective therapy was initiated past the day of pneumonia diagnosis. Risk factors associated with vHABP development were alcohol use disorder, APACHE II score, vasopressor therapy prior to infection, and culture positive for ESBL-Enterobacterales whereas history of hospitalization in the past 30 days, active malignancy, isolation of ceftriaxone-resistant pathogens or Pseudomonas aeruginosa, and vasopressor therapy were risk factors for vHABP-associated mortality. Patients with vHABP experienced an acute and severe decompensation upon diagnosis. The risk factors identified in this study could provide actionable data for clinicians to identify those at risk for vHABP at the onset of pneumonia and to target antimicrobial stewardship efforts to improve treatment success.

Medication reconciliation on admission in paediatric chronic patients: A multicentre study

IntroductionMedication reconciliation (MC) is one of the main strategies to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MC aimed at the adult population, although paediatric patients are not included. In 2018, a study was carried out that led to the subsequent publication of a document with criteria for selecting paediatric patients in whom CM should be prioritised. ObjectivesTo describe the characteristics of paediatric patients most likely to suffer from errors of reconciliation (EC), to confirm whether the results of a previous study can be extrapolated. MethodologyProspective, multicentre study of paediatric inpatients. We analysed the CE detected during the performance of the CM on admission. The best possible pharmacotherapeutic history of the patient was obtained using different sources of information and confirmed by an interview with the patient/caregiver. Results1043 discrepancies were detected, 544 were identified as CD, affecting 317 patients (43%). Omission of a drug was the most common error (51%). The majority of CD were associated with drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polymedication and onco-haematological based disease were the risk factors associated with the presence of CD with statistical significance. ConclusionsThe findings of this study allow prioritisation of CM in a specific group of paediatric patients, favouring the efficiency of the process. Onco-haematological patients and polymedication are confirmed as the main risk factors for the appearance of CD in the paediatric population.

Pleural fluid residue as a diagnostic tool for cytology-negative malignant pleural effusion: A proof-of-concept study.

Pleural fluid residue, or macroscopic tissue, circulating freely in the pleural fluid obtained through direct filtration, may carry diagnostic histopathological information. We aimed to determine the histopathological concordance of pleural fluid residue in diagnosing TPE and MPE, compared with conventional pleural biopsy. This was a prospective cohort study of consecutive inpatients with cytology-negative exudative effusion who underwent pleuroscopy and had their initial suctioned pleural fluid filtered for residue samples. Pleural fluid residue demonstrated malignant cells in four out of seven cases of pleural biopsy-confirmed malignancy. Pleural fluid residue has comparable cytomorphology but reduced cellularity compared with pleural biopsy. No tuberculous histological features were present in the pleural fluid residue samples. In this preliminary study pleural fluid residue provided histopathological information for malignant pleural effusion, but no incremental diagnostic information for tuberculous effusion. However larger and more definitive studies are required to clarify these findings, and to explore the utility and suitability of pleural fluid residue for mutational analysis. This study demonstrates the potential of pleural fluid residue as a non-invasive diagnostic method for confirming malignancy in cytology-negative exudative effusion. In resource-limited settings or patients contraindicated for pleural biopsy, pleural fluid residue may provide a viable diagnostic alternative; however, this observation needs further validation.

2818. Investigating Urinalysis Criteria that Predict UTI: Impact of age, sex, and urine culture thresholds

Abstract Background Urinalysis (UA) results are used by clinicians and laboratories to aid in the diagnosis of UTI. However, optimal UA parameters have not been systematically investigated or validated for different populations. Our objectives were to assess the performance of UA in predicting UTI and to stratify UA performance by age, sex, and culture thresholds. Methods We conducted a retrospective cohort study of adult non-catheterized inpatient and ED encounters with paired UA and urine cultures (24 hours apart) from 5 community and academic hospitals in three states (NC, VA, GA) between 01/01/2017 and 12/31/2019. Trained abstractors collected clinical and demographic data for a random sample of patients. Patients were classified as having UTI, asymptomatic bacteriuria or ‘not UTI’ based on IDSA guidelines using signs/symptoms and microbiology data. We evaluated the performance of relevant UA parameters in predicting UTI by assessing sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria (Figure 1) and used area under receiver operating curves (AUROC) to identify the 5 best-performing models, and stratified results by age, sex, and lower urine culture bacterial threshold (1000 colony forming units). Results Of 219,338 encounters, 3392 charts were included and reviewed; 723 (21.3%) patients met criteria for UTI. Females and older adults had a higher incidence of UTIs and ASB (P&amp;lt; 0.05; Table 1). Absence of pyuria (or leukocyte esterase) had a high NPV for UTI (Table 2). Combined UA parameters performed better than pyuria alone with regards to NPV and AUROC, specifically models 1 and 5 (Table 3). UA parameters used in these models performed differently based on age, sex and urine culture thresholds, with limited utility in older women and UTIs with lower bacterial threshold (Table 4). Conclusion Our review of laboratory and symptom data from a diverse population dataset revealed that combined UA parameters were better at predicting UTI, but performance of UA parameters differs based on age, sex, and urine culture thresholds. Our approach highlights the need to move away from a one-size fits all approach to using population specific UA cut-offs for patients with UTI symptoms. Disclosures Sonali Advani, MBBS, MPH, FIDSA, bioMérieux: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant Nicholas A. Turner, MD, MHSc, PDI: Research contract to assess efficacy of cleaning agent

386. Participant Reflections on Their Experiences Participating in Phase 1 and 2 Inpatient Vaccine Trials and Human Challenge Studies

Abstract Background Volunteers are critical for the success of clinical trials but there is still debate on the ethics surrounding recruitment and enrollment of healthy human subjects who are paid for their participation in such research. This study seeks to examine the experiences and perceptions of risks and benefits of participants in early-phase inpatient studies to gain greater insight into how they feel about participating. Methods An interviewer-administered survey was conducted with 152 healthy volunteers who participated in at least one Phase 1 or 2 inpatient vaccine or challenge clinical trial at the Johns Hopkins Center for Immunization Research, during the years of 2010-2020. Participant characteristics, study experiences, and perceived risks were analyzed. Poisson regression with robust variance was used to examine factors associated with perception of risk before and after participation. Results Most participants who completed the survey were male (62%) and Black or African American (78%). 53% attained at most a high school degree and 42% had an income below $18,500 a year. Compensation was the primary factor for joining a study for 68% of participants; 35% of them relied on clinical trials as a major part of their income. Nevertheless, 32% reported they declined to participate in at least one study and 63% reported that they ask about the side effects before joining a new study. Over 90% of participants agreed or strongly agreed that they enjoyed participating, wanted to participate, and were glad they joined the study. There was a significant reduction in the perceived risk of study participation after study completion compared to perceived risk before joining the study, where before the study 46% thought it was “Not at all risky” compared to 73% afterwards. Conclusion Most participants in our early-phase inpatient studies are males of lower income and compensation was the primary motivator for joining. However, side effects do factor in their decision whether to join. The majority of participants indicated that they were glad they joined the study. Despite the studies having risks and expected side effects, there was also a significant decline in perception of risks related to the study following participation, which implies participants feel safer than they anticipated feeling. Disclosures Lawrence Moulton, PhD, Pfizer Canada ULC: Employee Kawsar R. Talaat, MD, Intralytix: Advisor/Consultant|Merck: Advisor/Consultant|NIAID: DSMB|Pfizer: Grant/Research Support|Pfizer: Pfizer contract with institution|Sanofi: Grant/Research Support|Takeda: Advisor/Consultant

Development of a proteomic signature associated with severe disease for patients with COVID-19 using data from 5 multicenter, randomized, controlled, and prospective studies

Significant progress has been made in preventing severe COVID-19 disease through the development of vaccines. However, we still lack a validated baseline predictive biologic signature for the development of more severe disease in both outpatients and inpatients infected with SARS-CoV-2. The objective of this study was to develop and externally validate, via 5 international outpatient and inpatient trials and/or prospective cohort studies, a novel baseline proteomic signature, which predicts the development of moderate or severe (vs mild) disease in patients with COVID-19 from a proteomic analysis of 7000 + proteins. The secondary objective was exploratory, to identify (1) individual baseline protein levels and/or (2) protein level changes within the first 2 weeks of acute infection that are associated with the development of moderate/severe (vs mild) disease. For model development, samples collected from 2 randomized controlled trials were used. Plasma was isolated and the SomaLogic SomaScan platform was used to characterize protein levels for 7301 proteins of interest for all studies. We dichotomized 113 patients as having mild or moderate/severe COVID-19 disease. An elastic net approach was used to develop a predictive proteomic signature. For validation, we applied our signature to data from three independent prospective biomarker studies. We found 4110 proteins measured at baseline that significantly differed between patients with mild COVID-19 and those with moderate/severe COVID-19 after adjusting for multiple hypothesis testing. Baseline protein expression was associated with predicted disease severity with an error rate of 4.7% (AUC = 0.964). We also found that five proteins (Afamin, I-309, NKG2A, PRS57, LIPK) and patient age serve as a signature that separates patients with mild COVID-19 and patients with moderate/severe COVID-19 with an error rate of 1.77% (AUC = 0.9804). This panel was validated using data from 3 external studies with AUCs of 0.764 (Harvard University), 0.696 (University of Colorado), and 0.893 (Karolinska Institutet). In this study we developed and externally validated a baseline COVID-19 proteomic signature associated with disease severity for potential use in both outpatients and inpatients with COVID-19.

EGS P19 Do Waiting Times for Inpatient Magnetic Resonance Cholangiopancreatography Affect Total Length of Stay? – A Single Centre Experience

Abstract Background Magnetic resonance cholangiopancreatography (MRCP) is an important imaging modality in ruling out choledocholithiasis and thus guide management of patients. However, access to MRI remains limited, which may lead to delays in discharge. Our aim was to analyse the waiting time for inpatient MRCP and its impact on total length-of-stay (LOS). Methods A retrospective cohort study of all consecutive adult inpatients who underwent MRCP in a single surgical unit was conducted from September 2020 to September 2022. Patients being investigated for non-biliary indications including hepato-pancreato-biliary malignancies were excluded. Patient demographics, laboratory results, MRCP indications, results and timestamps from the hospital’s radiology information system were analysed. Peak liver function test (LFT) values before MRCP were used. P-values were calculated using Student T-test. This study was registered with Clinical Quality Project (LanQIP 14736). Results 677 patient has inpatient MRCPs; 22 were excluded. Median age was 66 years (IQR 51-76) and 401 (59.2%) were female. 281 (41.5%) MRCPs were urgent requests. 128 (18.9%) patients were clinically jaundiced and 115 (17.0%) had gallstone pancreatitis. 228 (33.7%) patients had choledocholithiasis on MRCP, of which 192 (84.2%) were known to have gallstones pre-MRCP. Median waiting time for urgent MRCPs from time of order was 1.0 days versus 1.3 for routine requests (p&amp;lt;0.001). Overall, median LOS was 6.7 days (IQR 4.1-10.9). This was 6.1 days (IQR 3.7-10.1) for urgent scans and 7.0 (IQR 4.5-11.5) for routine scans (p=0.106). Conclusions Inpatient MRCP does not significantly delay discharge in our centre. Patients screened for high-risk features of choledocholithiasis should have MRCPs marked as urgent to expedite clinical decision-making and mitigate complications from biliary obstruction. Therefore, it remains useful in determining the need for endoscopic retrograde cholangiopancreatography and/or intra-operative cholangiogram in patients with gallstone disease.

Characteristics of the basal psychoautonomous indicators in patients after coronary artery stent placement at various stages of rehabilitation

Background: Clinically significant psychoautonomous syndrome, along with other modifiable factors (obesity, dyslipidemia, low physical activity, smoking, arterial hypertension, etc.) increases the risk of development and progression of coronary artery disease (CAD). In particular, patients who have undergone coronary interventions and have a higher anxiety level are prone to the development of CAD complications.&#x0D; Aim: To characterize the basal parameters of clinically significant psychoautonomous syndrome and their changes over time under combination therapy, including anxiolytics, at various stages of rehabilitation of the patients after endovascular myocardial revascularization.&#x0D; Materials and methods: This open-label randomized controlled prospective study included 60 patients aged 45 to 75 years admitted to our in-patient department for rehabilitation treatment after coronary stent placement. The patients from the intervention group (n = 30), in addition to basic treatment for CAD, were administered anxiolytic therapy (alimemazine tartrate at daily dose of 12.5 to 25 mg i. m. at the early rehabilitation step and at 5 to 10 mg during their out-patient follow-up). The in-patient study period included 3 study visits (at admittance, i. e., Day 1, at Days 5 or 6, and at discharge at Day 10 to 14). Two further study visits were performed during the out-patient rehabilitation period at Days 30 and 60. At each visit, the emotional state, sleep quality, subjective signs of autonomous dysregulation, autonomous background and suprasegmental vegetative regulation, including temporal and spectral indicators of heart rate variability, were evaluated.&#x0D; Results: After endovascular myocardial revascularization (the in-patient study period, Day 1) patients of the intervention and control groups (n = 30 in both groups) demonstrated comparable moderate levels of state anxiety (median [Q1; Q3]: 42 [40; 46] and 42 [36; 43], respectively) and trait anxiety (45 [41; 48] and 42 [40; 46], associated with insomnia (PSQI score: 8 [6; 12] and 6 [3; 9]) and autonomous imbalance (SDNN: 73 [61; 89] and 70 [44; 95]) with a shift to sympathetic hyperactivity. Addition of an anxiolytic initiated the regression of psychoautonomous abnormalities already by the end of the early in-patient rehabilitation period) (Days 10 to 14), with a subsequent decrease in state anxiety to 36 [33; 39] and trait anxiety to 33 [32; 37] (p 0.001), regression of insomnia according to PSQI to 2 [2; 4] (p 0.001), and an improvement of autonomous balance (SDNN) to 113 [81; 132] (p 0.001) at days 45 to 60 of the outpatient follow-up. The only adverse event in the patients receiving the treatment for psychoautonomous dysfunction was increased sleepiness at daytime, which was registered in most of them at initiation of the therapy for 2 to 3 days and did not require any dose modification. There were no other clinically significant adverse events, including cardiovascular.&#x0D; Conclusion: Patients with an increased level of anxiety after endovascular myocardial revascularization are characterized by an autonomous imbalance with sympathetic hyperactivity. Addition of an anxiolytic to the basic treatment for CAD allows for a reduction of both components of the psychoautonomous syndrome, which may be an additional factor for successful patient rehabilitation and as a consequence for the prevention of CAD progression.

Impact of systemic lupus erythematosus on outcomes in patients hospitalized with acute decompensated heart failure with reduced and preserved ejection fraction: a national inpatient sample study (2016)

Abstract Background Systemic lupus erythematosus (SLE) is known to have an impact on cardiovascular outcomes, but its effect on patients with acute decompensated heart failure (ADHF) with reduced and preserved ejection fraction is not well understood. This study aims to investigate the impact of SLE on in-hospital outcomes in patients with ADHF. Methods This retrospective cohort study analyzed data from the United States National Inpatient Sample Database from 2016 to 2020. Patients hospitalized with ADHF with reduced and preserved ejection fraction were identified using ICD-10 codes and then categorized based on SLE diagnosis. Mortality and in-hospital complications were analyzed using multivariate logistic regression. Results Out of 10,700,000 ADHF hospitalizations, 0.61% (65,270) were associated with SLE. Compared to patients without SLE, those with SLE were younger (61 vs 72 years old, p&amp;lt;0.001), more likely to be female (85% vs 48%, p&amp;lt;0.001), had longer lengths of stay (coefficient: 0.23; p 0.005), and lower total hospital charges (coefficient: -$5,207; p&amp;lt;0.001). Patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke (Figure 1). However, they had higher odds of in-hospital mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. No significant differences were found in respiratory failure and intracranial hemorrhage rates between the two cohorts. Conclusions This study suggests that the presence of SLE in patients hospitalized with ADHF is associated with worse in-hospital outcomes, including higher rates of all-cause mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. However, patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke compared to those without SLE. These findings highlight the importance of early recognition and aggressive management of SLE in patients with ADHF to improve outcomes. Further research is needed to identify potential interventions that could improve the outcomes of this high-risk population.

Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study.

Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Investigating the impact of chronic heart failure on in-hospital outcomes following transcatheter mitral valve repair or replacement: a national inpatient sample study (2016-2020)

Abstract Background Chronic heart failure (CHF) is a global health problem and one of the primary causes of morbidity and mortality worldwide. Transcatheter mitral valve repair or replacement (TMVr or TMVR) is a procedure that has demonstrated improved outcomes in patients with severe mitral valve disease. However, the impact of CHF on in-hospital outcomes following TMVR or TMVr remains unclear. Methods In this retrospective cohort study, we utilized the United States National Inpatient Sample database from 2016 to 2020. We identified patients who underwent TMVR or TMVr using ICD-10 codes and stratified them based on the presence or absence of CHF diagnosis. We assessed in-hospital complications, length of stay, and cost of care as primary and secondary outcomes. We performed multivariate logistic regression analysis to control for potential confounders. Results Our study included 48,885 patients who underwent TMVR or TMVr, of which 16,132 (33%) had a diagnosis of CHF. The cohort was predominantly male (54%) with a mean age of 76 years. Compared to patients without CHF who underwent TMVR/TMVr, those with CHF had lower rates of in-hospital mortality, valvular complications, cardiogenic shock, vascular complications, bleeding, blood transfusions, respiratory failure, acute kidney injury, and acute myocardial infarction (see Figure 1). Additionally, patients with CHF had a reduced length of stay (coefficient -3.48; p &amp;lt;0.001) and cost of care (coefficient -$58749.37; p &amp;lt;0.001). However, there were no significant differences in rates of pericardial tamponade, intracranial hemorrhage, or ischemic strokes. Conclusions Our findings suggest that patients with chronic heart failure (CHF) who underwent transcatheter mitral valve repair or replacement (TMVr or TMVR) had better in-hospital outcomes compared to those without CHF. This may be due to a protective effect of the chronic disease, where compensatory mechanisms developed by the body may help patients with CHF better tolerate the procedure and have decreased in-hospital complications. These results highlight the importance of further investigating the role of CHF in TMVr/TMVR outcomes and tailoring patient selection for these procedures.

Implementation of an electronic medical record order set with an opt-out rule increases utilization of ultrasound enhancing agents with transthoracic echocardiography

Abstract Background Use of ultrasound-enhancing agents (UEA) decreases the frequency of non-diagnostic transthoracic echocardiography (TTE) studies and improves accuracy for identification of potentially life-threatening conditions. However, several logistical barriers have led to UEA underutilization, including the need for a separate order for UEA in electronic medical records (EMR). We sought to determine the impact of implementing an EMR order set on utilization of UEA at the echocardiography laboratory of a tertiary care center. Methods EMR order for all TTE studies (complete, limited) was modified to include the use of UEA by default with an "opt-out" option for ordering physician when UEA is deemed unnecessary. During study performance, sonographers determined the need for UEA use and utilized existing order to dispense perflutren protein-type A microspheres to complete the examination. Internal policy for UEA use was developed in keeping with Intersocietal Accreditation Commission recommendations. We compared rates of UEA utilization 10 months before and after the implementation date (March 2022) for the new EMR rule. Results A total of 10,666 TTE studies were performed prior to, and 11,406 studies after the implementation of the new EMR rule. Of those, 54.3% were performed in outpatient setting, 12% in ICU, and the rest in non-ICU inpatient setting. Prior to the EMR rule implementation, UEA was used in 10% of total studies, 6.0% of outpatient studies, 11.2% of non-ICU inpatient studies, and 24.2% of ICU studies. Following the implementation of the new rule, UEA utilization increased significantly, including 89% increase in total use, 90% increase in outpatient setting, 129% in non-ICU inpatient setting, and 48% increased use in ICU (Figure). No adverse events were reported with UEA during the study period. Conclusions The implementation of a standing order in EMR, including default use of UEA with an "opt-out" option facilitates sonographer-driven use and administration of UEA across all patient care settings. While this approach was safe and significantly increased UEA utilization, whether it would translate to improvement in clinical outcomes or hospital length of stay requires further studies.Impact of EMR rule on UEA utilization

Conciliación de la medicación al ingreso en paciente crónico pediátrico: estudio multicéntrico

IntroductionMedication reconciliation (MR) is one of the main strategies used to reduce medication errors in care transitions. In Spain, several guidelines have been published with recommendations for the implementation and development of MR processes aimed at the adult population, and not applicable to paediatric patients. In 2018, a study was carried out that allowed the subsequent publication of a document establishing criteria for the selection of paediatric patients in whom CM should be prioritised. ObjectivesTo describe the characteristics of the paediatric patients most likely to be subject to reconciliation errors (REs) to confirm whether the results of a previous study could be extrapolated. MethodologyProspective, multicentre study in paediatric inpatients. We analysed the REs detected in the MR at the time of admission. We obtained the best possible medication history of the patient using different sources of information, subsequently confirmed through an interview with the patient/caregiver. Results1043 discrepancies were detected, of which 544 were categorised as REs, affecting 317 patients (43%). Omission of a drug was the most common error (51%). Most REs involved drugs in groups A (31%), N (23%) and R (11%) of the ATC classification. Polypharmacy and oncological/haematological disease were the risk factors that exhibited a statistically significant association with the occurrence of REs. ConclusionsThe findings of this study allow the prioritisation of MR in a specific group of paediatric patients, contributing to improve the efficiency of the process. Oncological/haematological disease and polypharmacy were confirmed as the main risk factors for the occurrence of REs in the paediatric population.

Interaction between valproic acid and meropenem or ertapenem in patients with epilepsy: clinical relevance and results from pharmaceutical intervention

ObjectiveThe literature has described the interaction between valproic acid and carbapenems. This interaction leads to decreases in plasma concentrations of valproic acid. The main objectives of this study were to assess its relevance in clinical practice, to identify variables associated with increased seizure episode rates, and to analyse the impact of pharmaceutical intervention on avoiding the effects of this interaction. MethodAn observational retrospective study of inpatients with epilepsy admitted between 2016 and 2020. Their pharmacological treatment throughout admission was recorded, and the presence of other interactions leading to decreased plasma concentrations of valproic acid was reviewed. The seizure rate during the year prior to admission was compared to that during the interaction period. For every episode in which the interaction was detected, an intervention was conducted by providing the prescriber with information on the interaction and suggesting a change of antibiotherapy as well as the pharmacokinetic monitoring of valproic acid. Results37 episodes were included. 58.1% of the patients were male and median age was 70 years. In total, 56.8% of the patients received meropenem and 43.2% received ertapenem. The median duration of concomitant treatment with valproic acid and carbapenem was 4 days. The incidence rate ratio was 2.60 (95% confidence interval: 1.61-4.21). Thus, this interaction was associated with a higher seizure rate. A statistically significant association was found between higher seizure rates and patients treated with more than one anti-epileptic drug. Hospital pharmacists detected 24 episodes (64.9%). In total, 17 interventions (70.8%) were accepted and 13 combinations were discontinued. Pharmacokinetic monitoring was conducted in 13 episodes (35.1%) and infratherapeutic levels were found in all of them. ConclusionsThe interaction between valproic acid and meropenem or ertapenem is clinically relevant. It is recommended that this combination should be avoided provided that a viable alternative is available. Pharmaceutical intervention may contribute to preventing seizures associated with this combination.

Campylobacter fetus Invasive Infections and Risks for Death, France, 2000-2021.

Campylobacter fetus accounts for 1% of Campylobacter spp. infections, but prevalence of bacteremia and risk for death are high. To determine clinical features of C. fetus infections and risks for death, we conducted a retrospective observational study of all adult inpatients with a confirmed C. fetus infection in Nord Franche-Comté Hospital, Trevenans, France, during January 2000-December 2021. Among 991 patients with isolated Campylobacter spp. strains, we identified 39 (4%) with culture-positive C. fetus infections, of which 33 had complete records and underwent further analysis; 21 had documented bacteremia and 12 did not. Secondary localizations were reported for 7 (33%) patients with C. fetus bacteremia, of which 5 exhibited a predilection for vascular infections (including 3 with mycotic aneurysm). Another 7 (33%) patients with C. fetus bacteremia died within 30 days. Significant risk factors associated with death within 30 days were dyspnea, quick sequential organ failure assessment score >2 at admission, and septic shock.

Understanding factors that impact the length of stay after total hip arthroplasty – A national in-patient sample-based study

BackgroundTotal hip arthroplasty (THA) is increasingly used every year; however, there is currently limited information on factors that impact the length of stay (LOS) following the procedure. Longer LOS following THA is met with an increase in the cost of care, necessitating studies to identify factors that may impact LOS. MethodsIn this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to analyze the preoperative comorbidities and postoperative complications that impact the LOS following THA. We divided our cohort into patients with a LOS greater than two days, and patients with a LOS less than two days. ResultsA total of 367,890 patients were identified in the NIS database who underwent THA during the study period. Of this cohort, 112,288 (30.52%) patients were identified as having a LOS greater than two days, while the remaining 255,602 (69.48%) patients were patients who had a LOS less than two days. Multivariate analysis demonstrated several pre-operative factors, such as diabetes, systemic lupus erythematosus, organ transplant, dialysis, the human immunodeficiency virus, chronic kidney disease, and Parkinson's disease, were independently associated with a higher risk of a LOS greater than two days. The subsequent multivariate analysis for post-operative variables demonstrated that acute renal failure, myocardial infarction, blood loss anemia, blood transfusion, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, periprosthetic mechanical complications, periprosthetic infections, and wound dehiscence were all independently associated with a higher risk of a LOS greater than two days. ConclusionsSeveral pre-operative comorbidities and postoperative complications were found to increase the likelihood of a LOS greater than two days. In addition, the group with a LOS greater than two days incurred a higher cost of care. This information is useful for providers to make informed decisions regarding patient care and resource utilization for patients undergoing THA, potentially reducing LOS.

A prospective study on skin and soft tissue infections: a fact-finding mission from a tertiary centre in north India.

Despite the high prevalence and poor outcome of skin and soft tissue infections (SSTIs), very few studies from India have dealt with the subject. We planned a prospective study of inpatients with SSTIs to study the aetiology, clinical presentation (severity) and outcome of patients with SSTIs in our facility. Patients with SSTIs involving >5% body surface area (BSA) and/or systemic signs were admitted to the surgery department of a teaching tertiary level hospital in Delhi, India, and were clinically classified into cellulitis, necrotising soft tissue infections (NSTIs), pyomyositis, and abscess. Demographic and clinical variables such as: age; sex; occupation; history of trauma/insect or animal bites; duration of illness; presenting symptoms and signs; comorbid conditions; predisposing factors such as lymphoedema or venous disease; hospital course; treatment instituted; complications; hospital outcome; presence of crepitus, bullae, gangrene, muscle necrosis and compartment syndrome were recorded. The chief outcome parameters were death and length of hospital stay; others, such as abscess drainage, the need for plastic surgical procedures and amputations were also noted. Out of 250 patients enrolled in the study, 145 (58%) had NSTIs, 64 (26%) had abscesses, 15 (6%) had cellulitis and 26 (10%) had pyomyositis. Mortality was observed with NSTIs (27/145, 19%) and with pyomyositis (3/26, 11.5%). Factors affecting mortality by univariate analysis in the NSTI group were: abnormal pulse; hypotension; tachypnea; bullae; increased blood urea and serum creatinine; inotrope or ventilator support (all with p<0.001); local tenderness, gangrene, dialysis support and BSA (9.33±6.44 versus 5.12±3.62; p<0.05 for the last four). No factor was found to be significant on multivariate analysis. Variables associated with hospital stay >12 days were immunocompromise, pus discharge, ulceration or gangrene, and after interventions such as blood transfusion, drainage or skin grafting. High prevalence of NSTI and pyomyositis with high mortality was observed in our SSTI patients, often in immunocompetent young individuals. Epidemiological studies focused on virulent strains of Staphylococcus aureus may be required to identify the cause, since Staphylococcal toxins have been implicated in other infections.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States.

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents. To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents. We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm. 807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001). Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

Prevalence of opioid-induced adverse events across opioids commonly used for analgesic treatment in Japan: a multicenter prospective longitudinal study

PurposeAlthough opioids have been shown to be effective for cancer pain, opioid-induced adverse events (AEs) are common. To date, little is known about the differences in risks of AEs by opioid type. This study was performed to compare the prevalence of AEs across opioids commonly used for analgesic treatment in Japan.MethodsThis study was conducted as a preplanned secondary analysis of a multicenter prospective longitudinal study of inpatients with cancer pain who received specialized palliative care for cancer pain relief. We assessed daily AEs until termination of follow-up. We rated the severity of AEs based on the Common Terminology Criteria for Adverse Events version 5.0. We computed adjusted odds ratios for each AE (constipation, nausea and vomiting, delirium, and drowsiness) with the following variables: opioid, age, sex, renal dysfunction, and primary cancer site.ResultsIn total, 465 patients were analyzed. Based on the descriptive analysis, the top four most commonly used opioids were included in the analysis: oxycodone, hydromorphone, fentanyl, and tramadol. With respect to the prevalence of AEs among all analyzed patients, delirium (n = 25, 6.3%) was the most frequent, followed by drowsiness (n = 21, 5.3%), nausea and vomiting (n = 19, 4.8%), and constipation (n = 28, 4.6%). The multivariate logistic analysis showed that no single opioid was identified as a statistically significant independent predictor of any AE.ConclusionThere was no significant difference in the prevalence of AEs among oxycodone, fentanyl, hydromorphone, and tramadol, which are commonly used for analgesic treatment in Japan.

FRI008 Impact Of Sleep Fragmentation And Estradiol Suppression On Leptin, Ghrelin, Satiety And Hunger In Women: An Experimental Menopause Model To Understand Menopause-related Body Fat Gain

Abstract Disclosure: S.A. Rahman: Consulting Fee; Self; Sultan &amp; Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc. Grant Recipient; Self; Seoul Semiconductor Co. Ltd, Biological Innovation and Optimization Systems, LLC, Merck &amp; Co, Inc, Pfizer Inc, Vanda Pharmaceuticals Inc, Lighting Science Group. Speaker; Self; Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, and Seoul Semiconductor Co. Ltd. Stock Owner; Self; Melcort Inc. L.K. Grant: None. A. Cohn: None. M.D. Nathan: None. J. Harder: Consulting Fee; Self; Atman Health; O’Rourke &amp; Hawk, LLP. Grant Recipient; Self; Brigham and Women’s Hospital; President and Fellows of Harvard College. Owner/Co-Owner; Self; Jessica Harder, MD. Stock Owner; Self; Atman Health. Other; Self; Centerfield Media Holding Company. I. Gonsalvez: None. F.A. Scheer: Consulting Fee; Self; University of Alabama at Birmingham. Other; Self; Board of Directors for the Sleep Research Society. E.B. Klerman: Consulting Fee; Self; Circadian Therapeutics, The National Sleep Foundation, Sanofi-Genzynel. Other; Self; Travel support from the Sleep Research Society. S. Crawford: None. T. Luo: None. E. Menezes: None. A. Roy: None. A. Joseph: None. A. Wiley: None. U.B. Kaiser: None. H. Joffe: Consulting Fee; Self; Bayer, Hello Therapeutics. Grant Recipient; Self; National Institutes of Health, Merck, Pfizer. Body fat increases during the menopause transition. In addition to menopause-related estradiol (E2) decline, sleep fragmentation (wake episodes interrupting sleep) due to hot flashes, without a reduction in total sleep time, is common. We examined whether E2 decline and sleep fragmentation decrease the satiety hormone, leptin, increase the orexigenic hormone, ghrelin, and their behavioral correlates satiety and hunger, which would promote positive energy balance and body fat gain. We studied 38 healthy premenopausal female volunteers (mean age [±SD] 29.7±6.7 years) in a 5-night inpatient study under eucaloric conditions, once in the mid-to-late follicular phase (high-E2) and again after gonadotropin-releasing hormone agonist-induced E2-suppression (hypo-E2) in a subset (n=27). Each inpatient study involved 2 nights of unfragmented sleep followed by 3 nights of experimentally induced sleep fragmentation to achieve ∼1hr of wake after sleep-onset without reducing total sleep time. Serum for leptin and acetylated ghrelin assays and self-reported satiety and hunger via visual analog scales were collected fasting ∼1hr after waking each morning. Values were normalized relative to each individual’s baseline (high-E2, unfragmented sleep) and then compared between conditions using generalized linear mixed models. Mean (±SD) levels of leptin and ghrelin at baseline were 38.5±21.2 ng/mL and 640.9±362.0 pg/mL, respectively. Compared to the high-E2 state, omnibus analysis of E2 suppression during both unfragmented and fragmented sleep showed significant reduction from the high-E2 to hypo-E2 state in satiety-promoting leptin levels (least squares mean % of baseline [±SE]: 101.0±1.1% vs. 90.0±3.0%, p=0.001), but unchanged self-rated satiety (109.3±7.8% vs. 102.6±15.6%, p=0.58). E2 suppression also did not change hunger-promoting ghrelin levels (101.0±3.1% vs. 97.0±1.4%, p=0.13) or self-rated hunger (103.3±6.6% vs. 133.2±30.5%, p=0.28). Omnibus analysis of sleep fragmentation during both high-E2 and hypo-E2 states showed that, relative to unfragmented sleep, leptin levels were unchanged (94.0±1.5% vs. 96.7±2.5%, p=0.22), but self-rated satiety was significantly lower (113.1±11.0% vs. 99.2±11.9%, p=0.048) after sleep fragmentation. There was a trend towards the lowest satiety in the hypo-E2 sleep fragmented state (interaction p=0.052). Sleep fragmentation did not change ghrelin levels (100.7±1.8% vs. 97.3±2.7%, p=0.13) or self-rated hunger (103.0±6.2% vs. 133.6±30.0%, p=0.25). These results demonstrate significant adverse changes in leptin and satiety in women induced, respectively, by E2 suppression and sleep fragmentation, independent of aging. Findings support likely independent contributions of E2 decline and sleep fragmentation during the menopause transition toward positive energy balance and body fat gain. Funding: NIH R01AG053838 (PI: H Joffe). Presentation: Friday, June 16, 2023