Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background: We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children. Methods: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown). Outcome data was censored at 28-days. Results: In 331 patients of both sexes, 179 (54.1%) were CONFIRMED, 4.2% (14) died. AKI occurred in 124 (37.5%) and severe AKI occurred in 63 (19.0%). Incidence of AKI in CONFIRMED was 74/179 (41.3%) versus 50/152 (32.9%) for SUSPECTED; severe AKI occurred in 35 (19.6%) of CONFIRMED and 28 (18.4%) of SUSPECTED. Mortality was 6.2% (n = 11) in CONFIRMED, but 9.5% (n = 7) in those CONFIRMED with AKI. On multivariable analysis, only Hispanic ethnicity (relative risk 0.5, 95% CI 0.3-0.9) was associated with less AKI development among those CONFIRMED. Conclusions: AKI and severe AKI occur commonly in critically ill children with SARS-CoV2 infection, more than double the historical standard. Further investigation is needed during this continuing pandemic to describe and refine the understanding of pediatric AKI epidemiology and outcomes. Trial registration: NCT01987921. Impact: What is the key message of the article? AKI occurs in children exposed to the novel SARS-CoV2 virus at high prevalence (~40% with some form of AKI and 20% with severe AKI). What does it add to the existing literature? Acute kidney injury (AKI) occurs commonly in adult patients with SARS-CoV2 (COVID), very little data describes the epidemiology of AKI in children exposed to the virus. What is the impact? A pediatric vaccine is not available; thus, the pandemic is not over for children. Pediatricians will need to manage significant end-organ ramifications of the novel SARS-CoV2 virus including AKI

Overcoming the \u27What-Ifs\u27: Combating Post-Purchase Anticipated Regret in an Online Retail Setting

This research proposes a new construct, post-purchase anticipated regret (PPAR), to expand the existing retailing and regret theory literature streams. Specifically, the purpose of this research is to understand the antecedents and consequences of post-purchase anticipated regret in an online retailing context. Study 1 uses qualitative data drawn from depth-interviews with online shoppers to investigate the pre-purchase factors that contribute to PPAR formation. Building from these results, studies 2 and 3 empirically test an original conceptual model to holistically understand PPAR. Additionally, the role of online shopping self-affirmation and regret coping strategies are explored as means to combat PPAR formation. Managerial and theoretical implications are offered, as well as research limitations and future research directions

Flint Hills Sonata

Flint Hills Sonata by Cally Krallman is included in the 2009 Symphony in the Flint Hills Field Journal.https://newprairiepress.org/sfh_gallery/1010/thumbnail.jp

The relationship between patient satisfaction with hospitalization and outcomes up to 6 months post-discharge in cardiac patients

Little is known about the relationship between patient satisfaction with inpatient care and post-discharge outcomes. This study examined inpatient hospital satisfaction after a cardiac event and outcomes through 6 months post-discharge. We examined 327 cardiac patients from the Bridging the Discharge Gap Effectively database who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process correlated with fewer readmissions at 90 days post-discharge. Higher patient satisfaction with hospital staff management of personal issues correlated with fewer emergency department visits at 6 months post-discharge. Higher patient satisfaction with overall assessment of care and hospitalization correlated with lower mortality rate at 6 months post-discharge. Being nonwhite correlated with lower nursing care satisfaction. Associations between cardiac patient satisfaction and outcomes exist. In this population, higher patient satisfaction correlated with better outcomes. Patient satisfaction data may be able to inform areas for health system improvement

Insights into hospital readmission patterns of atrial fibrillation patients

© The European Society of Cardiology 2020. Introduction: Patients admitted to the hospital with atrial fibrillation have associated morbidity and mortality and incur significant costs. Data characterizing atrial fibrillation patients at high risk for readmission are scarce. We sought to inform this area by characterizing and categorizing unplanned readmissions of atrial fibrillation patients. Methods: Retrospective data were abstracted from the charts of patients discharged from 2008 to 2012 after an index hospitalization for atrial fibrillation and referred to the nurse practitioner-led transitional care program, Bridging the Discharge Gap Effectively. Unplanned readmissions were dichotomized as early (⩽30 days) or late (31–180 days) and further classified as either “atrial fibrillation/atrial fibrillation-related” (AF/AF-related), “Cardiac; not AF/AF-related,” or “Not cardiac-related.” Case classifications were adjudicated by a senior cardiologist. Patient demographics and readmission characteristics were then compared. Results: Of 255 patients, 97 (38.0%) had unplanned readmissions within 180 days of discharge; 45 (46.4%) were early and 52 (53.6%) were late. Atrial fibrillation and cardiac causes accounted for 68.9% (n=31) of early readmissions and 65.4% (n=34) of late. Patients with late readmissions were more likely to have diabetes (32.7% vs. 17.7%, p=.022) and higher CHA2DS2VASc scores (3.63 vs. 2.98, p=0.026) than those not readmitted. No other differences in baseline characteristics were seen within or between groups. The 30-day all-cause readmission rate in this sample was 17.6% (n=45). Conclusion: Readmissions following hospital discharge for atrial fibrillation are common; approximately 50% of these readmissions are for reasons unrelated to atrial fibrillation. In order to reduce atrial fibrillation-related readmissions, further research is needed to characterize predictors of readmission and to develop effective transitional care interventions

Trends in calcium channel blocker use in patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation

Background: Heart failure with reduced ejection fraction and atrial fibrillation commonly coexist. Most calcium channel blockers are not recommended in heart failure with reduced ejection fraction, but their use has been seldom evaluated. For patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation, we sought to 1) determine the proportion discharged on contraindicated calcium channel blockers, 2) describe how clinicians’ use of these medications at discharge have changed over time, and 3) identify predictors for contraindicated calcium channel blocker prescription at discharge. Methods: We analyzed 395 patients discharged with heart failure with reduced ejection fraction and atrial fibrillation between 2008 and 2018. Discharge on a contraindicated calcium channel blocker (any calcium channel blocker except amlodipine) was the primary outcome. Changes in calcium channel blocker prescription over time were evaluated with a Cochran-Armitage trend test. Multivariable logistic regression was used to identify predictors of calcium channel blocker prescription at discharge. Results: Twenty-nine (7.3%) patients were discharged on a contraindicated calcium channel blocker without change over time (Ptrend = .38). Of these, 26 (86.7%) were discharged on multiple atrioventricular nodal blocking medications. Hypertension (odds ratio [OR] 7.87; 95% confidence interval [CI], 1.04-59.40) and female sex (OR 3.01; 95% CI, 1.36-6.67) were both associated with contraindicated calcium channel blocker prescription at discharge while diabetes mellitus was negatively associated with this outcome (OR 0.34; 95% CI, 0.14-0.88). Conclusion: One in 14 patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation were discharged on a contraindicated calcium channel blocker, without change over time. Most patients were discharged on multiple atrioventricular nodal blockers, highlighting potential need for greater coordination between discharging physicians, pharmacists, and electrophysiology