A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain

Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2–5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively

retrospective cohort study

BACKGROUND: The utilization of emergency department (ED) during the post-discharge period may provide relevant insights to reduce fragmentation of care, particularly in a context of general intense use. We aimed to describe frequency and patient attributes associated with emergency department (ED) visits within 30 days of inpatient discharge in a Portuguese health region-Algarve. METHODS: Secondary data on inpatient and emergency care, for adult patients discharged in 2016. To analyse the association between outcome-ED visit within 30 days of discharge-and selected variables (admission type and groups of or individual illnesses/conditions), we used age- and sex-adjusted odds ratios (aOR). We included all adult patients (aged ≥18 years) discharged during 2016 from the region's public hospital inpatient departments. The period for ED visits also included January 2017. RESULTS: For 21,744 adults discharged in 2016 (mean age: 58 years; 60% female), 23 percent visited ED at least once within 30 days of discharge. Seventy-five percent of those visits were triaged with high clinical priority. Patients with more comorbidities or specific groups of illnesses/conditions had a significant increased risk of returning ED (aOR and 95% confidence intervals-endocrine: 1.566; 1.256-1.951; mental illness: 1.421; 1.180-1.713; respiratory: 1.308; 1.136-1.505). CONCLUSION: Patients returned ED after inpatient discharge frequently and for severe reasons. Patients with more comorbidities or specific groups of illnesses/conditions (endocrine, mental illness or respiratory) had an increased risk of returning ED, so these groups may be prioritized in further research and health system initiatives to improve care before and after discharge.publishersversionpublishe

a retrospective cohort study

Background Metastasis of colorectal cancer (CRC) is directly linked to patient survival. We previously identified the novel gene Metastasis Associated in Colon Cancer 1 (MACC1) in CRC and demonstrated its importance as metastasis inducer and prognostic biomarker. Here, we investigate the geographic expression pattern of MACC1 in colorectal adenocarcinoma and tumor buds in correlation with clinicopathological and molecular features for improvement of survival prognosis. Methods We performed geographic MACC1 expression analysis in tumor center, invasive front and tumor buds on whole tissue sections of 187 well-characterized CRCs by immunohistochemistry. MACC1 expression in each geographic zone was analyzed with Mismatch repair (MMR)-status, BRAF/KRAS- mutations and CpG-island methylation. Results MACC1 was significantly overexpressed in tumor tissue as compared to normal mucosa (p < 0.001). Within colorectal adenocarcinomas, a significant increase of MACC1 from tumor center to front (p = 0.0012) was detected. MACC1 was highly overexpressed in 55% tumor budding cells. Independent of geographic location, MACC1 predicted advanced pT and pN-stages, high grade tumor budding, venous and lymphatic invasion (p < 0.05). High MACC1 expression at the invasive front was decisive for prediction of metastasis (p = 0.0223) and poor survival (p = 0.0217). The geographic pattern of MACC1 did not correlate with MMR-status, BRAF/KRAS- mutations or CpG-island methylation. Conclusion MACC1 is differentially expressed in CRC. At the invasive front, MACC1 expression predicts best aggressive clinicopathological features, tumor budding, metastasis formation and poor survival outcome

A Retrospective Cohort Study

Purpose Graves' disease (GD) is an autoimmune disorder caused by the presence of antibodies to the thyroid stimulating hormone (TSH) receptor (TRAbs), usually presenting with clinical signs of hyperthyroidism. Previous evidence suggests that higher serum levels of thyroid peroxidase antibodies (TPOAbs) may lead to more sustained remission of hyperthyroidism after treatment with antithyroid drugs (AT). However, doubts about the influence of TPOAbs in Graves' disease outcomes still remain. Methods A retrospective, unicenter cohort study was performed. All patients with GD (TRAbs > 1.58U/L), biochemical primary hyperthyroidism (TSH < 0.4 µUI/mL), and TPOAbs measurement at diagnosis, treated with AT between January 2008 and January 2021, were included for analysis. Results One hundred and forty-two patients (113 women) with a mean age of 52 ± 15 years old were included. They were followed up for 65.4 ± 43.8 months. TPOAbs positivity was present in 71.10% (n=101) of those patients. Patients were treated with AT for a median of 18 (IQR (12; 24)) months. Remission occurred in 47.2% of patients. Patients with remission presented with lower TRAbs and free thyroxine (FT4) levels at the diagnosis. (p-value <0.001, p-value 0.003, respectively). No association was found in the median TPOAbs serum levels of patients who remitted and those who maintained biochemical hyperthyroidism after the first course of AT. Relapse of hyperthyroidism occurred in 54 patients (57.4%). No difference was found in TPOAbs serum levels regarding the patient's relapse. Moreover, a time-based analysis revealed no differences in the relapse rate after 18 months of AT therapy between patients with and without TPOAbs positivity at the diagnosis (p-value 0.176). It was found a weak positive correlation (r=0.295; p-value <0.05) between TRAbs and TPOAbs titters at the moment of Graves' diagnosis. Conclusion In this study, a correlation between TRAbs measurements and TPOAbs titter was described, although no significant association was found between the presence of TPOAbs and the outcomes of patients with GD treated with AT. These results do not support the use of TPOAbs as a useful biomarker to predict remission or relapse of hyperthyroidism in GD patients.publishersversionpublishe

a retrospective cohort study

Objective: To analyse the variation in the rate of adverse events (AEs) between acute hospitals and explore the extent to which some patients and hospital characteristics influence the differences in the rates of AEs. Design: Retrospective cohort study. Chi-square test for independence and binary logistic regression models were used to identify the potential association of some patients and hospital characteristics with AEs. Setting: Nine acute Portuguese public hospital centres. Participants: A random sample of 4250 charts, representative of around 180 000 hospital admissions in 2013, was analysed. Intervention: To measure adverse events based on chart review. Main Outcome Measure: Rate of AEs. Results: Main results: (i) AE incidence was 12.5%; (ii) 66.4% of all AEs were related to Hospital-Acquired Infection and surgical procedures; (iii) patient characteristics such as sex (female 11%; male 14.4%), age (≥65 y 16.4%; <65 y 8.5%), admission coded as elective vs. urgent (8.6% vs. 14.6%) and medical vs. surgical Diagnosis Related Group code (13.4% vs. 11.7%), all with p < 0.001, were associated with a greater occurrence of AEs. (iv) hospital characteristics such as use of reporting system (13.2% vs. 7.1%), being accredited (13.7% vs. non-accredited 11.2%), university status (15.9% vs. non-university 10.9%) and hospital size (small 12.9%; medium 9.3%; large 14.3%), all with p < 0.001, seem to be associated with a higher rate of AEs. Conclusions: We identified some patient and hospital characteristics that might influence the rate of AEs. Based on these results, more adequate solutions to improve patient safety can be defined.publishe

A retrospective cohort study

학위논문 (박사) -- 서울대학교 대학원 : 의과대학 의학과, 2021. 2. 오아영.Background: The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. Methods: This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis and severe pulmonary complications requiring additional intervention) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. Results: In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, p = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. Conclusions: In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.서론: 신경근 차단제 사용으로 인한 수술 후 잔여 근이완은 호흡기계 합병증을 유발하는 것으로 알려져 있다. 신경근 차단제 역전제인 수가마덱스는 네오스티그민에 비하여 잔여 근이완을 현저히 줄여주는 것으로 알려져 있다. 따라서 수가마덱스의 사용이 호흡기계 합병증을 줄여줄 것이라는 가설을 세울 수 있으나, 이 두 가지의 직접적인 상관관계는 아직 불분명하다. 방법: 본 후향적 코호트 연구는 2013년 1월부터 2017년 12월까지의 전자의무기록, 영상 검사 결과를 검토하여 일차 유효성 평가 변수인 수술 후 폐 합병증 (폐렴, 호흡 부전, 흉막 삼출, 무기폐, 기흉, 흡인성 폐렴, 침습적 치료가 필요한 중증 폐 합병증), 이차 유효성 평가 변수인 중환자실 입실률, 30일 내 재입원 혹은 응급실 내원률, 재원기간, 90일내 재수술 혹은 사망을 측정하였다. 통계적으로 선택 오차를 줄이기 위하여 propensity score matching을 시행하였다. 결과: 총 3802명의 코호트 중 541명이 제외되었고, propensity score matching 후 군당 616명의 환자가 최종 분석에 포함되었다. 분석 결과, 수가마덱스 군에서 네오스티그민 군에 비하여 흉막 삼출의 발생률이 유의미하게 낮았다 (네오스티그민 23.4% vs. 수가마덱스 18%, p=0.02). 다른 폐 합병증, 이차 유효성 평가 변수에는 두 군간 차이가 나지 않았다. 결론: 복강경 위절제술에서 수가마덱스의 사용이 네오스티그민과 비교하여 수술 후 흉막 삼출 발생률의 감소와 연관이 있다.Chapter 1. Introduction 1 Chapter 2. Materials and Methods 3 Chapter 3. Results 10 Chapter 4. Discussion 18 Chapter 3. Conclusion 22 Bibliography 23 Abstract in Korean 30Docto

Outcomes following laminoplasty or laminectomy and fusion in patients with myelopathy caused by ossification of the posterior longitudinal ligament: A systematic review

Study Design Systematic review. Objective To compare laminoplasty versus laminectomy and fusion in patients with cervical myelopathy caused by OPLL. Methods A systematic review was conducted using PubMed/Medline, Cochrane database, and Google scholar of articles. Only comparative studies in humans were included. Studies involving cervical trauma/fracture, infection, and tumor were excluded. Results Of 157 citations initially analyzed, 4 studies ultimately met our inclusion criteria: one class of evidence (CoE) II prospective cohort study and three CoE III retrospective cohort studies. The prospective cohort study found no significant difference between laminoplasty and laminectomy and fusion in the recovery rate from myelopathy. One CoE III retrospective cohort study reported a significantly higher recovery rate following laminoplasty. Another CoE III retrospective cohort study reported a significantly higher recovery rate in the laminectomy and fusion group. One CoE II prospective cohort study and one CoE III retrospective cohort study found no significant difference in pain improvement between patients treated with laminoplasty versus patients treated with laminectomy and fusion. All four studies reported a higher incidence of C5 palsy following laminectomy and fusion than laminoplasty. One CoE II prospective cohort and one CoE III retrospective cohort reported that there was no significant difference in axial neck pain between the two procedures. One CoE III retrospective cohort study suggested that there was no significant difference between groups in OPLL progression. Conclusion Data from four comparative studies was not sufficient to support the superiority of laminoplasty or laminectomy and fusion in treating cervical myelopathy caused by OPLL

Transverse myelitis: retrospective cohort study

Introducere. Mielita transversă (MT) este un sindrom clinic eterogen determinat de diverse etiologii, caracterizat prin disfuncția măduvei spinării. Scopul lucrării. Evaluarea și analiza cazurilor clinice de mielită transversă la subiecții spitalizați și tratați în Institutul de Neurologie și Neurochirurgie „Diomid Gherman”. Material și metode. Analiza retrospectivă a 26912 fișe medicale electronice din perioada februarie 2018 până în ianuarie 2023, dintre care 50 fișe ce au fost eligibile, incluse în studiu și analizate. Rezultate. Lotul de studiu a inclus 50% femei, cu vârsta medie 50,8±13,5 ani, au fost în tratament timp de 15,5±12 zile, iar la 20% din prodrom a fost infecțios. Leziunea la nivel toracic (82%). Tabloul clinic: tulb. sensibilitate (76%), tulb. motilitate (94%), parestezii în membre (46%), dereglări sfincteriene (74%), cefalee (16%), dureri de spate (20%), amețeli (14%), depresie (10%), dureri musculare și insomnie la 8% . Examinarea imagistică cerebrală efectuată în 52%. Examinarea medulară a prezentat leziuni longitudinale lungi - 44%, modificări degenerativ atrofice (32%), protruzii de disc (28%), edem al măduvei spinării (12%) și leziuni demielinizante - 10%. S-a efectuat puncția lombară (70%). Puls terapia a fost efectuată în 58% cu o ameliorare în 75,8%, iar administrarea de corticosteroizi a fost recomandată și la externare (44%). Anticorpii au fost examinați la 32%. Complicații: infecție urinară (52%), disfuncție sfincteriană (74%), pneumonie (8%). mRS la externare a fost de 3,75±1,7 puncte. Concluzii. Mielita transversă s-a dezvoltat mai frecvent la adulții de vârsta medie, în mod egal la bărbați și femei. Inițierea puls-terapiei a fost cu ameliorare majoră pentru majoritatea pacienților. Au fost necesare investigații imagistice, inclusiv IRM toracic, puncția lombară cu examen LCR pentru confirmarea diagnosticului de MT.Background. Transverse myelitis (TM) is a heterogeneous clinical syndrome determined by various etiology, characterized by dysfunction of the spinal cord. Objective of the study. Evaluation and analysis of clinical cases of transverse myelitis in subjects hospitalized and treated in the Diomid Gherman Institute of Neurology and Neurosurgery. Methods and materials: A retrospective study of 26912 electronic medical records from February 2018 until January 2023 was done, and 50 eligible was included and analyzed. Results. The study group included 50% women, with a mean age of 50.8±13.5 years, they were on treatment for 15.5±12 days, and 20% of prodromal was infectious. The lesion at the thoracic level (82%). Clinical presentation: sensitivity (76%), motility (94%), paresthesia in the limbs (46%), sphincterian disorders (74%), headache (16%), back pain (20 %), dizziness (14%), depression (10%), muscle pain, and dyssomnia in 8%. Brain examination performed in 52%. Long longitudinal lesions - 44% of cases, degenerative atrophic changes (32%), disc protrusions (28%), edema of Spinal Cord (12%) and demyelinating lesions in 10%. Lumbar tap was performed (70%). Pulse therapy was performed in 58% with an improvement in 75.8%, and the administration of corticosteroids was recommended at discharge (44%). Antibodies were examined in 32%. Complications: urinary infection (52%), sphincter dysfunction (74%), pneumonia (8%). mRS at discharge was 3.75±1.7 points. Conclusions. Transverse myelitis developed more frequently in middleaged adults, equally in men and women. The initiation of pulse therapy was with major improvement for most patients. Imaging investigations including thoracic MRI, lumbar puncture with CSF examination were necessary to confirm the diagnosis of MT

Suicide in Scottish military veterans: a 30-year retrospective cohort study

Background: Although reassuring data on suicide risk in UK veterans of the 1982 Falklands conflict and 1991 Gulf conflict have been published, there have been few studies on long-term overall suicide risk in UK veterans. Aims: To examine the risk of suicide in a broad population-based cohort of veterans in Scotland, irrespect ive of length of service or exposure to conflict, in comparison with people having no record of military service. Methods: A retrospective 30-year cohort study of 56205 veterans born 1945–85 and 172741 matched non-veterans, using Cox proportional hazard models to compare the risk of suicide and fatal self-harm overall, by sex, birth cohort, length of service and year of recruitment. Results: There were 267 (0.48%) suicides in the veterans compared with 918 (0.53%) in non-veterans. The difference was not statistically significant overall [adjusted hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.86–1.13]. The incidence was lower in younger veterans and higher in veterans aged over 40. Early service leavers were at non-significantly increased risk (adjusted HR 1.13; 95% CI 0.91–1.40) but only in the older age groups. Women veterans had a significantly higher risk of suicide than non-veteran women (adjusted HR 2.44; 95% CI 1.32–4.51, P &lt; 0.01) and comparable risk to veteran men. Methods of suicide did not differ significantly between veterans and non-veterans, for either sex. Conclusions: The Scottish Veterans Health Study adds to the emerging body of evidence that there is no overall difference in long-term risk of suicide between veterans and non-veterans in the UK. However, female veterans merit further study

Breast feeding practices and views among diabetic women: a retrospective cohort study

Objective: to explore the pattern and experiences of breast-feeding practices among diabetic women. Design: retrospective cohort study using maternal records and postal questionnaires in a Baby-Friendly hospital. Participants: diabetic mothers including women with gestational diabetes, and type 1 and 2 diabetes mellitus. Findings: from the total group of respondents, 81.9% intended to breast feed. The actual breast feeding rates were 81.9% at birth, 68.1% at 2 weeks and 28.7% at 6 months postpartum. Major themes that were identified from women's experiences included information and advice, support vs. pressure, classification and labelling, and expectations. Conclusions: more than two-thirds of the diabetic women intended to breast feed and actually did breast feed in this study. For both the total study population and the type 1 and 2 diabetics alone, more than half were still breast feeding at 2 weeks postpartum, and approximately one-third were still breast feeding at 6 months postpartum. Implications for practice: structured support, provided for women through Baby-Friendly initiatives, was appreciated by the diabetic women in this study. The extent to which this support influenced the highly successful breast feeding practices in this group of women needs focused investigation. The need for a delicate balancing act between pressure and advice in order to prevent coercion was noted.</p