Background: Several techniques were developed for managing hemorrhoidal disease, but their use in clinical practice and the general management of the condition seems highly variable in Saudi Arabia.
Consensus panel: To develop consensus recommendations that ensure the best possible diagnosis and treatment of hemorrhoidal disease in Saudi Arabia, the consensus panel consisted of experts in surgery in Saudi Arabia who met from December 2017 to September 2018.
Consensus findings: The discussions focused on the need: to set up a proctology society in Saudi Arabia to assess the prevalence of hemorrhoidal disease and to regulate the role of health-care professionals (HCPs) in the management of the disease; to initiate guidelines to ensure proper diagnosis (considering symptoms, medical history, and physical/clinical examination) and treatment (topical creams and suppositories should be limited as no strong evidence supports their efficacy); to educate patients on diet and lifestyle modifications using education materials and social media during and after the treatment (regular physical activity, drinking enough fluids, regular meal time with food rich in fibers, and regular bowel habit with non-straining defecation); to refer patients to a general/colorectal surgeon when needed; and to teach junior surgeons the best use of surgical techniques.
Conclusion: These recommendations can be a step forward toward a recognized guidance for all HCPs in Saudi Arabia for a better management of hemorrhoidal disease. They will be of a great value for general practitioners, family medicine doctors, junior surgeons, and pharmacists who are the gate keepers and first contact with patients.
{"title":"Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia.","authors":"Mohamed Zaki El-Kelani, Raouf Kerdahi, Samir Raghib, Mohamed Ashraf Shawkat, Naser Abdelnazer, Ishag Mudawi, Magdy Mahmoud, Wassim Abi Hussein, Mohamed Tawfik, Waleed Wahdan","doi":"10.1080/21548331.2022.2042150","DOIUrl":"https://doi.org/10.1080/21548331.2022.2042150","url":null,"abstract":"<p><strong>Background: </strong>Several techniques were developed for managing hemorrhoidal disease, but their use in clinical practice and the general management of the condition seems highly variable in Saudi Arabia.</p><p><strong>Consensus panel: </strong>To develop consensus recommendations that ensure the best possible diagnosis and treatment of hemorrhoidal disease in Saudi Arabia, the consensus panel consisted of experts in surgery in Saudi Arabia who met from December 2017 to September 2018.</p><p><strong>Consensus findings: </strong>The discussions focused on the need: to set up a proctology society in Saudi Arabia to assess the prevalence of hemorrhoidal disease and to regulate the role of health-care professionals (HCPs) in the management of the disease; to initiate guidelines to ensure proper diagnosis (considering symptoms, medical history, and physical/clinical examination) and treatment (topical creams and suppositories should be limited as no strong evidence supports their efficacy); to educate patients on diet and lifestyle modifications using education materials and social media during and after the treatment (regular physical activity, drinking enough fluids, regular meal time with food rich in fibers, and regular bowel habit with non-straining defecation); to refer patients to a general/colorectal surgeon when needed; and to teach junior surgeons the best use of surgical techniques.</p><p><strong>Conclusion: </strong>These recommendations can be a step forward toward a recognized guidance for all HCPs in Saudi Arabia for a better management of hemorrhoidal disease. They will be of a great value for general practitioners, family medicine doctors, junior surgeons, and pharmacists who are the gate keepers and first contact with patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39802792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01Epub Date: 2022-02-28DOI: 10.1080/21548331.2022.2045132
Israel Abebrese Sefah, Frederick Mensah, Amanj Kurdi, Brian Godman
Background: HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness toward viral suppression leading to disease progression, greater risk of death, and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups.
Method: A mixed method approach was used comprising a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analyzed using bivariate and multivariate methods while qualitative data were analyzed using thematic framework approach.
Results: Adherence levels were found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR = 0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times, and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was suboptimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.
{"title":"Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study.","authors":"Israel Abebrese Sefah, Frederick Mensah, Amanj Kurdi, Brian Godman","doi":"10.1080/21548331.2022.2045132","DOIUrl":"https://doi.org/10.1080/21548331.2022.2045132","url":null,"abstract":"<p><strong>Background: </strong>HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness toward viral suppression leading to disease progression, greater risk of death, and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups.</p><p><strong>Method: </strong>A mixed method approach was used comprising a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analyzed using bivariate and multivariate methods while qualitative data were analyzed using thematic framework approach.</p><p><strong>Results: </strong>Adherence levels were found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR = 0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times, and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. <b>Conclusion</b>: Adherence to ART among patients living with HIV was suboptimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39941649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01Epub Date: 2021-04-12DOI: 10.1080/21548331.2021.1893065
Steven G Chrysant, George S Chrysant
Objectives: The objectives of the study are to investigate the causes of diuretic resistance in patients with advanced congestive heart failure (CHF), since diuretics are the cornerstone of treatment of these patients. Several studies have shown that diuretic resistance in patients with advanced CHF is common, ranging from 25% to 50% in hospitalized patients.
Methods: In order to get a current perspective as to the magnitude of diuretic resistance in such patients, a focused Medline search of the English language literature was conducted between 2015 and 2020 using the search terms, CHF, diuretics, treatment, resistance, frequency, and 30 papers with pertinent information were selected.
Results: The analysis of data from the selected papers demonstrated that diuretic resistance is common in hospitalized patients with advanced CHF and frequently associated with renal failure, which is secondary to CHF.
Conclusions: Diuretic resistance appears to be common in patients with advanced CHF and it is mostly due to decreased cardiac output, low blood pressure, decreased glomerular filtration rate, decreased filtration of sodium, and increased tubular reabsorption of sodium. Diuretic resistance in such patients can be overcome with the combination of loop diuretics with thiazide and thiazide-like diuretics, aldosterone antagonists, as well as other agents. The data from these studies in combination with collateral literature will be discussed in this review.
{"title":"The pathophysiology and management of diuretic resistance in patients with heart failure.","authors":"Steven G Chrysant, George S Chrysant","doi":"10.1080/21548331.2021.1893065","DOIUrl":"https://doi.org/10.1080/21548331.2021.1893065","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study are to investigate the causes of diuretic resistance in patients with advanced congestive heart failure (CHF), since diuretics are the cornerstone of treatment of these patients. Several studies have shown that diuretic resistance in patients with advanced CHF is common, ranging from 25% to 50% in hospitalized patients.</p><p><strong>Methods: </strong>In order to get a current perspective as to the magnitude of diuretic resistance in such patients, a focused Medline search of the English language literature was conducted between 2015 and 2020 using the search terms, CHF, diuretics, treatment, resistance, frequency, and 30 papers with pertinent information were selected.</p><p><strong>Results: </strong>The analysis of data from the selected papers demonstrated that diuretic resistance is common in hospitalized patients with advanced CHF and frequently associated with renal failure, which is secondary to CHF.</p><p><strong>Conclusions: </strong>Diuretic resistance appears to be common in patients with advanced CHF and it is mostly due to decreased cardiac output, low blood pressure, decreased glomerular filtration rate, decreased filtration of sodium, and increased tubular reabsorption of sodium. Diuretic resistance in such patients can be overcome with the combination of loop diuretics with thiazide and thiazide-like diuretics, aldosterone antagonists, as well as other agents. The data from these studies in combination with collateral literature will be discussed in this review.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21548331.2021.1893065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25376831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01Epub Date: 2022-02-23DOI: 10.1080/21548331.2022.2045133
Gerasimos Panagiotis Milas, Vasileios Issaris, Nicholas Zareifopoulos
Hospital physicians in Greece were assigned care of numerous COVID-19 patients in addition to their usual caseload, resulting in excess morbidity and mortality for both COVID and non-COVID patients. In this article we focus on the challenges faced by resident physicians during the pandemic, emphasizing a critical view of the hospital-centric healthcare system of Greece and the necessity of reforms to strengthen primary care and reduce the burden placed on hospitals.
{"title":"Burnout for medical professionals during the COVID-19 pandemic in Greece; the role of primary care.","authors":"Gerasimos Panagiotis Milas, Vasileios Issaris, Nicholas Zareifopoulos","doi":"10.1080/21548331.2022.2045133","DOIUrl":"https://doi.org/10.1080/21548331.2022.2045133","url":null,"abstract":"Hospital physicians in Greece were assigned care of numerous COVID-19 patients in addition to their usual caseload, resulting in excess morbidity and mortality for both COVID and non-COVID patients. In this article we focus on the challenges faced by resident physicians during the pandemic, emphasizing a critical view of the hospital-centric healthcare system of Greece and the necessity of reforms to strengthen primary care and reduce the burden placed on hospitals.","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) frequently present with a febrile illness that may progress to pneumonia and hypoxic respiratory failure. Aerosolized epoprostenol (aEPO) has been evaluated in patients with acute respiratory distress syndrome and refractory hypoxemia. A paucity of literature has assessed the impact of aEPO in patients with SARS-CoV-2 receiving oxygen support with high flow nasal cannula (HFNC). The objective of this study was to evaluate whether aEPO added to HFNC prevents intubation and/or prolong time to intubation compared to controls only treated with HFNC, guided by oxygen saturation goals.
Methods: This was a single-center, retrospective study of adult patients infected with coronavirus 2019 (COVID-19) and admitted to the medical intensive care unit. A total of 60 patients were included. Thirty patients were included in the treatment, and 30 in the control group, respectively. Among patients included in the treatment group, response to therapy was assessed. The need for mechanical ventilation and hospital mortality between responders vs. non-responders was evaluated.
Results: The primary outcome of mechanical ventilation was not statistically different between groups. Time from HFNC initiation to intubation was significantly prolonged in the treatment group compared to the control group (5.7 days vs. 2.3 days, P = 0.001). There was no statistically significant difference between groups in mortality or length of stay. Patients deemed responders to aEPO had a lower rate of mechanical ventilation (50% vs 88%, P = 0.025) and mortality (21% vs 63%, P = 0.024), compared with non-responders.
Conclusion: The utilization of aEPO in COVID-19 patients treated with HFNC is not associated with a reduction in the rate of mechanical ventilation. Nevertheless, the application of this strategy may prolong the time to invasive mechanical ventilation, without affecting other clinical outcomes.
{"title":"Evaluation of aerosolized epoprostenol for hypoxemia in non-intubated patients with coronavirus disease 2019.","authors":"Vivek Kataria, Klayton Ryman, Ginger Tsai-Nguyen, Yosafe Wakwaya, Ariel Modrykamien","doi":"10.1080/21548331.2022.2047310","DOIUrl":"https://doi.org/10.1080/21548331.2022.2047310","url":null,"abstract":"<p><strong>Objectives: </strong>Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) frequently present with a febrile illness that may progress to pneumonia and hypoxic respiratory failure. Aerosolized epoprostenol (aEPO) has been evaluated in patients with acute respiratory distress syndrome and refractory hypoxemia. A paucity of literature has assessed the impact of aEPO in patients with SARS-CoV-2 receiving oxygen support with high flow nasal cannula (HFNC). The objective of this study was to evaluate whether aEPO added to HFNC prevents intubation and/or prolong time to intubation compared to controls only treated with HFNC, guided by oxygen saturation goals.</p><p><strong>Methods: </strong>This was a single-center, retrospective study of adult patients infected with coronavirus 2019 (COVID-19) and admitted to the medical intensive care unit. A total of 60 patients were included. Thirty patients were included in the treatment, and 30 in the control group, respectively. Among patients included in the treatment group, response to therapy was assessed. The need for mechanical ventilation and hospital mortality between responders vs. non-responders was evaluated.</p><p><strong>Results: </strong>The primary outcome of mechanical ventilation was not statistically different between groups. Time from HFNC initiation to intubation was significantly prolonged in the treatment group compared to the control group (5.7 days vs. 2.3 days, P = 0.001). There was no statistically significant difference between groups in mortality or length of stay. Patients deemed responders to aEPO had a lower rate of mechanical ventilation (50% vs 88%, P = 0.025) and mortality (21% vs 63%, P = 0.024), compared with non-responders.</p><p><strong>Conclusion: </strong>The utilization of aEPO in COVID-19 patients treated with HFNC is not associated with a reduction in the rate of mechanical ventilation. Nevertheless, the application of this strategy may prolong the time to invasive mechanical ventilation, without affecting other clinical outcomes.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935453/pdf/IHOP_0_2047310.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01Epub Date: 2022-01-31DOI: 10.1080/21548331.2022.2032073
Osama Y Alshogran, Esraa A Shatnawi, Shoroq M Altawalbeh, Anan S Jarab, Randa I Farah
Objectives: Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients.
Methods: A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016-2017) were also retrieved from patients' medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy.
Results: More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05).
Conclusion: The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.
目的:贫血在血液透析(HD)患者中普遍存在。关于贫血HD患者药物依从性不相关因素的数据有限。本研究考察了HD患者药物依从性的决定因素及其与贫血措施治疗目标实现的关系。方法:在约旦一组有代表性的HD患者中进行横断面研究。采用Morisky Green Levine药物依从性量表(MGL)评估药物依从性。其他使用的工具包括改良Charlson共病指数(mCCI)、一般健康相关生活质量(HRQoL) eq - 5d - 5l和医院焦虑抑郁量表(HADS)。2016-2017年期间的药房索赔数据也从患者的医疗记录中检索。Logistic回归分析与药物依从性及贫血治疗目标的达成相关的因素。结果:超过三分之二(69.1%)的受试者出现非依从性,MGL量表平均得分为2.4±1.4分。使用补充数据测量的不依从率(69.6%)与使用自我报告的MGL仪器观察到的不依从率相当。大学及以上教育水平与较低的不坚持服药几率显著相关(or = 0.365, p = 0.036),而抱怨头痛与2.5倍的不坚持服药风险相关(or = 2.5, p = 0.017)。铁指数治疗目标的更好实现的趋势是观察到改善依从性使用补充数据测量。提高对处方药物的了解等多种因素与实现贫血治疗目标显著相关(p结论:研究结果表明贫血患者的药物依从性较差。卫生保健提供者未来的干预措施应针对可改变的因素,以改善HD伴贫血患者的药物依从性,从而改善其健康结果。
{"title":"Medication non-adherence and the achievement of therapeutic goals of anemia therapy among hemodialysis patients in Jordan.","authors":"Osama Y Alshogran, Esraa A Shatnawi, Shoroq M Altawalbeh, Anan S Jarab, Randa I Farah","doi":"10.1080/21548331.2022.2032073","DOIUrl":"https://doi.org/10.1080/21548331.2022.2032073","url":null,"abstract":"<p><strong>Objectives: </strong>Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016-2017) were also retrieved from patients' medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy.</p><p><strong>Results: </strong>More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05).</p><p><strong>Conclusion: </strong>The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01Epub Date: 2022-01-06DOI: 10.1080/21548331.2021.2022357
Mercy Buckman, Amanda Grant, Sally Henson, Julia Ribeiro, Katie Roth, Derek Stranton, Michael Korvink, Laura H Gunn
Background: Risk-adjustment models are widely used methodological approaches within the healthcare industry to measure hospital performance and quality of care. However, the Centers for Medicare and Medicaid Services (CMS) do not fully adjust for socioeconomic status (SES) in acute myocardial infarction (AMI) models. A review and evidence synthesis was conducted to identify associations of SES factors with hospital readmission and mortality in AMI patients.
Methods: Multiple electronic databases were queried to identify studies assessing risk for AMI-related mortality or hospital readmissions and SES factors. Identified studies were screened by title and abstract. Full-text reviews followed for articles meeting the inclusion criteria, including quality assessments. Data were extracted from all included studies, and evidence synthesis was performed to identify associations between SES factors and outcome variables.
Results: Ten studies were included in the review. One study showed that Black patients had higher AMI-related readmission rates compared to White patients (mean difference 4.3% [SD 1.4%], p < 0.001). Another study showed that income inequality was associated with increased risk of AMI-related readmissions (RR 1.18 [95% CI], 1.13-1.23). One study found that unemployed individuals experienced significantly greater rates of AMI-related mortality than those working full-time (HR 2.08, 1.51-2.87). According to another study, lack of health insurance was associated with worse rates for in-hospital AMI-related mortality (OR 1.77, 1.72-1.82). Based on one study, AMI-related mortality was higher in those with <8 years of education compared to those with >16 years (17.5% vs. 3.5%, p < 0.0001). Five of six studies found a significant association between ZIP code/neighborhood/location and AMI-related readmission or mortality.
Conclusion: Race, ZIP code/neighborhood/location, insurance status, income/poverty, and education comprise SES factors found to be associated with AMI-related mortality and/or readmission outcomes. Including these SES factors in future updates of CMS's risk-adjusted models has the potential to provide more appropriate compensation mechanisms to hospitals.
背景:风险调整模型是在医疗保健行业中广泛使用的方法方法,用于衡量医院的绩效和护理质量。然而,医疗保险和医疗补助服务中心(CMS)在急性心肌梗死(AMI)模型中并没有完全调整社会经济地位(SES)。我们进行了一项综述和证据综合,以确定SES因素与AMI患者再入院和死亡率的关系。方法:对多个电子数据库进行查询,以确定评估ami相关死亡率或再入院风险和SES因素的研究。通过题目和摘要筛选已确定的研究。随后对符合纳入标准的文章进行全文审查,包括质量评估。从所有纳入的研究中提取数据,并进行证据综合以确定SES因素与结果变量之间的关联。结果:纳入10项研究。一项研究表明,与白人患者相比,黑人患者与ami相关的再入院率更高(平均差异为4.3% [SD 1.4%], p 16年(17.5% vs. 3.5%), p结论:种族、邮政编码/社区/位置、保险状况、收入/贫困和教育程度构成与ami相关死亡率和/或再入院结果相关的SES因素。在CMS风险调整模型的未来更新中包括这些SES因素有可能为医院提供更合适的补偿机制。
{"title":"A review of socioeconomic factors associated with acute myocardial infarction-related mortality and hospital readmissions.","authors":"Mercy Buckman, Amanda Grant, Sally Henson, Julia Ribeiro, Katie Roth, Derek Stranton, Michael Korvink, Laura H Gunn","doi":"10.1080/21548331.2021.2022357","DOIUrl":"https://doi.org/10.1080/21548331.2021.2022357","url":null,"abstract":"<p><strong>Background: </strong>Risk-adjustment models are widely used methodological approaches within the healthcare industry to measure hospital performance and quality of care. However, the Centers for Medicare and Medicaid Services (CMS) do not fully adjust for socioeconomic status (SES) in acute myocardial infarction (AMI) models. A review and evidence synthesis was conducted to identify associations of SES factors with hospital readmission and mortality in AMI patients.</p><p><strong>Methods: </strong>Multiple electronic databases were queried to identify studies assessing risk for AMI-related mortality or hospital readmissions and SES factors. Identified studies were screened by title and abstract. Full-text reviews followed for articles meeting the inclusion criteria, including quality assessments. Data were extracted from all included studies, and evidence synthesis was performed to identify associations between SES factors and outcome variables.</p><p><strong>Results: </strong>Ten studies were included in the review. One study showed that Black patients had higher AMI-related readmission rates compared to White patients (mean difference 4.3% [SD 1.4%], p < 0.001). Another study showed that income inequality was associated with increased risk of AMI-related readmissions (RR 1.18 [95% CI], 1.13-1.23). One study found that unemployed individuals experienced significantly greater rates of AMI-related mortality than those working full-time (HR 2.08, 1.51-2.87). According to another study, lack of health insurance was associated with worse rates for in-hospital AMI-related mortality (OR 1.77, 1.72-1.82). Based on one study, AMI-related mortality was higher in those with <8 years of education compared to those with >16 years (17.5% vs. 3.5%, p < 0.0001). Five of six studies found a significant association between ZIP code/neighborhood/location and AMI-related readmission or mortality.</p><p><strong>Conclusion: </strong>Race, ZIP code/neighborhood/location, insurance status, income/poverty, and education comprise SES factors found to be associated with AMI-related mortality and/or readmission outcomes. Including these SES factors in future updates of CMS's risk-adjusted models has the potential to provide more appropriate compensation mechanisms to hospitals.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39622388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01Epub Date: 2022-01-02DOI: 10.1080/21548331.2021.2022383
Anna Luise Calderon, Geoffrey Lamb
Objectives: Readmissions occurring within a few days of discharge are more likely due to a problem from the patient's original admission and may be preventable by interventions in the hospital setting. As part of a quality improvement project intended to reduce readmissions within 72 hours of discharge our objective was to explore patient and physician perspectives of reasons for readmissions and to identify potential indicators of readmission during the index admission.
Methods: A retrospective chart review of all readmissions within 72 hours between 2/1/2019 and 6/7/2019 in our healthcare system comprised of an academic medical center and 2 smaller community hospitals. As part of a hospital protocol, patients readmitted within 30 days were interviewed by a social worker regarding reasons for readmission and their perspective on what might have prevented it. These answers, physician notes relevant to the reason for readmission and the clinical course of the index admission were abstracted from patient charts. For the subset of patients identified by themselves or their physicians as potentially benefitting from a longer hospitalization, their index admission was reviewed for indicators of readmission. Reasons for readmission, potential preventive measures, and indicators of readmission were independently reviewed by two authors then grouped into common themes by consensus.
Results: One hundred and thirty-one patients readmitted within 72 hours were identified. Most patients were readmitted for infection related, cardiac or pulmonary reasons. Extending the initial admission was the most common factor suggested by both patients and physicians to prevent readmission. Focusing on 70 patients who may have benefited from a longer admission, indicators included patients not returning to their baseline health status, inadequate management of a known issue, or new symptoms developing during the index admission.
Conclusions: Patients should be evaluated for indicators of readmission, which may help guide decisions to discharge patients and decrease rates of 72-hour readmissions.
{"title":"Why did you come back to the hospital? A qualitative analysis of 72-hour readmissions.","authors":"Anna Luise Calderon, Geoffrey Lamb","doi":"10.1080/21548331.2021.2022383","DOIUrl":"https://doi.org/10.1080/21548331.2021.2022383","url":null,"abstract":"<p><strong>Objectives: </strong>Readmissions occurring within a few days of discharge are more likely due to a problem from the patient's original admission and may be preventable by interventions in the hospital setting. As part of a quality improvement project intended to reduce readmissions within 72 hours of discharge our objective was to explore patient and physician perspectives of reasons for readmissions and to identify potential indicators of readmission during the index admission.</p><p><strong>Methods: </strong>A retrospective chart review of all readmissions within 72 hours between 2/1/2019 and 6/7/2019 in our healthcare system comprised of an academic medical center and 2 smaller community hospitals. As part of a hospital protocol, patients readmitted within 30 days were interviewed by a social worker regarding reasons for readmission and their perspective on what might have prevented it. These answers, physician notes relevant to the reason for readmission and the clinical course of the index admission were abstracted from patient charts. For the subset of patients identified by themselves or their physicians as potentially benefitting from a longer hospitalization, their index admission was reviewed for indicators of readmission. Reasons for readmission, potential preventive measures, and indicators of readmission were independently reviewed by two authors then grouped into common themes by consensus.</p><p><strong>Results: </strong>One hundred and thirty-one patients readmitted within 72 hours were identified. Most patients were readmitted for infection related, cardiac or pulmonary reasons. Extending the initial admission was the most common factor suggested by both patients and physicians to prevent readmission. Focusing on 70 patients who may have benefited from a longer admission, indicators included patients not returning to their baseline health status, inadequate management of a known issue, or new symptoms developing during the index admission.</p><p><strong>Conclusions: </strong>Patients should be evaluated for indicators of readmission, which may help guide decisions to discharge patients and decrease rates of 72-hour readmissions.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39857836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01Epub Date: 2022-02-07DOI: 10.1080/21548331.2022.2030564
Cássia Cristina Pinto Mendicino, Alícia Amanda Moreira Costa, Gabriella Jomara da Silva, Letícia Penna Braga, Gustavo Machado Rocha, Ricardo Andrade Carmo, Mark Drew Crosland Guimarães, Cristiane A Menezes de Pádua
Objective: Our objective was to estimate the frequency of comorbidities and assess its relationship with exposure factors after long-term ART use.
Methods: A cross-sectional study with PLHIV (≥18 years-old), who initiated ART between 2001 and 2005 and attended an HIV/AIDS public referral center (Belo Horizonte/Brazil), was performed. Demographic, clinical, therapeutic, and lifestyle data were obtained through interviews, medical charts, public database, routine laboratory examinations, and bone densitometry. The outcome was the number of comorbidities: hyperglycemia, dyslipidemia, systemic arterial hypertension (SAH), and low bone mineral density (BMD). Absolute/relative frequencies were calculated. Factors associated with the outcome were assessed by quasi-Poisson regression. RESULTS: Of the 98 participants, 53% were male and 79% and over 43 years-old. Moderate physical activity was observed in 82%, overweight/obesity in 50%, and 58% used ART based on two nucleoside reverse transcriptase inhibitors (NRTIs) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI). After a mean of 15.6 years of ART exposure, 207 comorbidities were identified and 93% participants presented at least one comorbidity (mean = 2.1/participant). The most frequent overlapping constituted two co-occurrences: dyslipidemia + hyperglycemia or dyslipidemia + SAH, n = 36 for each co-occurrence. The quasi-Poisson regression showed an increase of 3% in the number of comorbidities per year of age (OR = 1.03; 95%CI = 1.02-1.04) and 84% among PLHIV on moderate physical activity (ref = heavy physical-activity) (OR = 1.84; 95%CI = 1.08-3.13).
Conclusions: Our study shows that the aging slightly contributed to comorbidities. However, the practice of physical-activities is crucial to prevent chronic-diseases. Treatment and preventive measures should be encouraged to diminish the burden of disease and improve quality of life among PLHIV.
{"title":"Metabolic comorbidities and systemic arterial hypertension: the challenge faced by HIV patients on long-term use of antiretroviral therapy.","authors":"Cássia Cristina Pinto Mendicino, Alícia Amanda Moreira Costa, Gabriella Jomara da Silva, Letícia Penna Braga, Gustavo Machado Rocha, Ricardo Andrade Carmo, Mark Drew Crosland Guimarães, Cristiane A Menezes de Pádua","doi":"10.1080/21548331.2022.2030564","DOIUrl":"https://doi.org/10.1080/21548331.2022.2030564","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to estimate the frequency of comorbidities and assess its relationship with exposure factors after long-term ART use.</p><p><strong>Methods: </strong>A cross-sectional study with PLHIV (≥18 years-old), who initiated ART between 2001 and 2005 and attended an HIV/AIDS public referral center (Belo Horizonte/Brazil), was performed. Demographic, clinical, therapeutic, and lifestyle data were obtained through interviews, medical charts, public database, routine laboratory examinations, and bone densitometry. The outcome was the number of comorbidities: hyperglycemia, dyslipidemia, systemic arterial hypertension (SAH), and low bone mineral density (BMD). Absolute/relative frequencies were calculated. Factors associated with the outcome were assessed by quasi-Poisson regression. RESULTS: Of the 98 participants, 53% were male and 79% and over 43 years-old. Moderate physical activity was observed in 82%, overweight/obesity in 50%, and 58% used ART based on two nucleoside reverse transcriptase inhibitors (NRTIs) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI). After a mean of 15.6 years of ART exposure, 207 comorbidities were identified and 93% participants presented at least one comorbidity (mean = 2.1/participant). The most frequent overlapping constituted two co-occurrences: dyslipidemia + hyperglycemia or dyslipidemia + SAH, n = 36 for each co-occurrence. The quasi-Poisson regression showed an increase of 3% in the number of comorbidities per year of age (OR = 1.03; 95%CI = 1.02-1.04) and 84% among PLHIV on moderate physical activity (ref = heavy physical-activity) (OR = 1.84; 95%CI = 1.08-3.13).</p><p><strong>Conclusions: </strong>Our study shows that the aging slightly contributed to comorbidities. However, the practice of physical-activities is crucial to prevent chronic-diseases. Treatment and preventive measures should be encouraged to diminish the burden of disease and improve quality of life among PLHIV.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39828652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-01Epub Date: 2022-01-20DOI: 10.1080/21548331.2022.2029452
Jesus M Villa, Tejbir S Pannu, Nicolas S Piuzzi, Viktor Krebs, Aldo M Riesgo, Carlos A Higuera
Objectives: The first known COVID-19 patient in the United States was reported on 1/20/2020. Since then, we noted increased thromboembolic events among our THA/TKA patients. Therefore, we sought to determine: (1) monthly incidences of pulmonary embolism (PE)/deep vein thrombosis (DVT) before and after January/2020 and (2) thromboembolic event rates for primary and revision patients.
Methods: We retrospectively obtained from our electronic-medical-records the total monthly number of patients (December/2018-March/2021) who underwent primary or revision THA/TKA, and among them, those who had PE/DVT during each month. Monthly rates of thromboembolic events were calculated and figures were created showing rates throughout time. The cutoff month to define before and after COVID-19 was January/2020.
Results: During the study period, 1.6% of patients (312/19068) had PE/DVT [PE (n = 102), DVT (n = 242), both (n = 32)]. Overall rate of PE/DVT before January/2020 was 1.2% (119/9545) and it was 2.0% (193/9523) after that month. Incidences of PE/DVT on April/June/July of 2020 were 3.4%, 3%, 3.4%, respectively. A major increase, when compared to 2019 (1.3%, 1%, 1%, respectively). An unusually high rate of PE was observed on April/2020 (3.4%), more than three times the one observed in any other month. After January/2020, there was an overall major increase of PE/DVT rates, but particularly among revision patients: 6% in five different months including 11.5% on November/2020.
Conclusion: There was a major increase of thromboembolic events among THA/TKA patients during the COVID-19 pandemic, predominantly in revision patients. Patients need counseling about this increased risk. It remains uncertain whether more aggressive thromboprophylactic regimes should be followed.
{"title":"A major increase of thromboembolic events in total hip and knee arthroplasty patients during the COVID-19 pandemic.","authors":"Jesus M Villa, Tejbir S Pannu, Nicolas S Piuzzi, Viktor Krebs, Aldo M Riesgo, Carlos A Higuera","doi":"10.1080/21548331.2022.2029452","DOIUrl":"https://doi.org/10.1080/21548331.2022.2029452","url":null,"abstract":"<p><strong>Objectives: </strong>The first known COVID-19 patient in the United States was reported on 1/20/2020. Since then, we noted increased thromboembolic events among our THA/TKA patients. Therefore, we sought to determine: (1) monthly incidences of pulmonary embolism (PE)/deep vein thrombosis (DVT) before and after January/2020 and (2) thromboembolic event rates for primary and revision patients.</p><p><strong>Methods: </strong>We retrospectively obtained from our electronic-medical-records the total monthly number of patients (December/2018-March/2021) who underwent primary or revision THA/TKA, and among them, those who had PE/DVT during each month. Monthly rates of thromboembolic events were calculated and figures were created showing rates throughout time. The cutoff month to define before and after COVID-19 was January/2020.</p><p><strong>Results: </strong>During the study period, 1.6% of patients (312/19068) had PE/DVT [PE (n = 102), DVT (n = 242), both (n = 32)]. Overall rate of PE/DVT before January/2020 was 1.2% (119/9545) and it was 2.0% (193/9523) after that month. Incidences of PE/DVT on April/June/July of 2020 were 3.4%, 3%, 3.4%, respectively. A major increase, when compared to 2019 (1.3%, 1%, 1%, respectively). An unusually high rate of PE was observed on April/2020 (3.4%), more than three times the one observed in any other month. After January/2020, there was an overall major increase of PE/DVT rates, but particularly among revision patients: 6% in five different months including 11.5% on November/2020.</p><p><strong>Conclusion: </strong>There was a major increase of thromboembolic events among THA/TKA patients during the COVID-19 pandemic, predominantly in revision patients. Patients need counseling about this increased risk. It remains uncertain whether more aggressive thromboprophylactic regimes should be followed.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}