Chronic anticoagulation is not associated with a reduced risk of acute kidney injury in hospitalised Covid-19 patients

From Springer Nature via Jisc Publications RouterHistory: received 2020-12-23, accepted 2021-04-26, registration 2021-06-10, pub-electronic 2021-06-16, online 2021-06-16, collection 2021-12Publication status: PublishedAbstract: Background: Coronavirus-19 (COVID-19) has been declared a global pandemic by the World Health Organisation. Severe disease typically presents with respiratory failure but Acute Kidney Injury (AKI) and a hypercoagulable state can also occur. Early reports suggest that thrombosis may be linked with AKI. We studied the development of AKI and outcomes of patients with COVID-19 taking chronic anticoagulation therapy. Methods: Electronic records were reviewed for all adult patients admitted to Manchester University Foundation Trust Hospitals between March 10 and April 302,020 with a diagnosis of COVID-19. Patients with end-stage kidney disease were excluded. AKI was classified as per KDIGO criteria. Results: Of the 1032 patients with COVID-19 studied,164 (15.9%) were taking anticoagulant therapy prior to admission. There were similar rates of AKI between those on anticoagulants and those not anticoagulated (23.8% versus 19.7%) with no difference in the severity of AKI or requirement of renal replacement therapy between groups (1.2% versus 3.5%). Risk factors for AKI included hypertension, pre-existing renal disease and male sex. There was a higher mortality in those taking anticoagulant therapy (40.2% versus 30%). Patients taking anticoagulants were less likely to be admitted to the Intensive Care Unit (8.5% versus 17.4%) and to receive mechanical ventilation (42.9% versus 78.1%). Conclusion: Patients on chronic anticoagulant therapy did not have a reduced incidence or severity of AKI suggesting that AKI is unlikely to be thrombotic in nature. Therapeutic anticoagulation is currently still under investigation in randomised controlled studies to determine whether it has a potential role in COVID-19 treatment

Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

Background: Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design. The study will be conducted in three phases:. 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation,. 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and. 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion. The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system

Measuring and improving quality of life in long-term care for the elderly

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN013661 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Interventions for dysphagia in acute stroke (Review)

Background It is unclear how dysphagic patients should be fed and treated after acute stroke. Objectives The objective of this review was to assess the effect of different management strategies for dysphagic stroke patients, in particular how and when to feed, whether to supplement nutritional intake, and how and whether to treat dysphagia. Search strategy We searched the Cochrane Stroke Group trials register, Medline, Embase, ISI, and existing review articles.We contacted researchers in the field and equipment manufacturers. Date of the most recent searches: March 1999. Selection criteria Unconfounded truly or quasi randomised controlled trials in dysphagic patients with acute/subacute (within 3 months) stroke. Data collection and analysis Three reviewers independently applied the trial inclusion criteria. Two reviewers assessed trial quality and extracted the data. Main results Percutaneous endoscopic gastrostomy (PEG) versus nasogastric tube (NGT) feeding: two trials (49 patients) suggest that PEG reduces end-of-trial case fatality (Peto Odds Ratio, OR 0.28, 95% CI 0.09 to 0.89) and treatment failures (OR 0.10, 95% CI 0.02 to 0.52), and improves nutritional status, assessed as weight (Weighted Men Difference, WMD +4.1 kg, 95% CI -4.3 to +12.5), mid-arm circumference (WMD +2.2 cm, 95% CI -0.5 to +4.9) or serum albumin (WMD + 7.0 g/l, 95% CI +4.9 to +9.1) as compared with NGT feeding; two larger studies are ongoing. Timing of feeding: no completed trials; one large study is ongoing. Swallowing therapy for dysphagia: two trials (85 patients) suggest that formal swallowing therapy does not significantly reduce end-of-trial dysphagia rates (OR 0.55, 95%CI 0.18 to 1.66). Drug therapy for dysphagia: one trial (17 patients); nifedipine did not alter end-of-trial case fatality or the frequency of dysphagia. Nutritional supplementation: one trial (42 patients) found a non-significant trend to a lower case fatality, and significantly increased energy and protein intake; one large trial is ongoing and data is awaited from two other studies. Fluid supplementation: one trial (20 patients) found that supplementation did not alter the time to resolution of dysphagia. Authors’ conclusions Too few studies have been performed, and these have involved too few patients. PEG feeding may improve outcome and nutrition as compared with NGT feeding. Further research is required to assess how and when patients are fed, and the effect of swallowing or drug therapy on dysphagia

Performance indicators for hospital services for older people.

Background: standardised assessment is recommended in geriatric practice to improve patient care and generate quality data for audit and research. High level indicators used to measure performance of rehabilitation units suggested that more patients were discharged to long-term residential care from one of two hospitals in a Health Authority in South East England. Objectives: to test whether the information provided by standardised assessment could inform performance indicators used to compare outcomes between hospitals. Design: prospective observational study. Subjects: consecutive patients admitted for rehabilitation to two general geriatric rehabilitation wards in each of two nearby district general hospitals. Methods: patients were assessed using standard tools (Barthel and Abbreviated Mental Test score) and various scales of the interRAI MDS assessment system (mental and physical functioning, pressure ulcers, continence, falls, mood), within a week of admission and up to one week before discharge. Place of residence prior to admission and discharge destination were determined. Results: on bivariate analysis there was a significant difference in discharge to residential and nursing homes between hospitals. Results from multivariate logistic regression analysis showed an increased risk for institutionalisation at discharge for women [odds ratio 2.42 (95% CI 1.41-4.14)] and patients with impaired cognitive function [odds ratio 1.53 (95% CI 1.28-1.82) for each point increase in MDS cognitive performance scale] and physical function [odds ratio 1.15 (95% CI 1.08-1.22) for each point increase in MDS short ADL scale]. Barthel and Abbreviated Mental Test showed similar odds ratios. Hospital did not remain a significant predictor of discharge destination following adjustment for patients' physical and cognitive function. Conclusions: comparisons of outcomes between hospitals could be misleading unless informed by standardised data on physical and mental functioning of rehabilitation patients