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Frontiers in Pediatrics 2020Non-anesthesiologist-administered propofol (NAAP) has been found to have an acceptable safety profile in adult endoscopy, but its use remains controversial and...
Non-anesthesiologist-administered propofol (NAAP) has been found to have an acceptable safety profile in adult endoscopy, but its use remains controversial and pediatric data is limited. Our aim was to examine the safety and efficacy of NAAP provided by pediatric hospitalists in pediatric endoscopy. We retrospectively reviewed 929 esophagogastroduodenoscopy (EGD), colonoscopy, and combined EGD/colonoscopy cases in children aged 5-20 years between April 2015 and December 2016 at a large children's hospital. We analyzed the data for adverse events in relation to demographics and anthropometrics, American Society of Anesthesiologists physical classification score, presence of a trainee, comorbid conditions, and procedure time. A total of 929 cases were included of which 496 (53%) were completed with NAAP. Seventeen (3.4%) of NAAP cases had an adverse event including the following: 12 cases of hypoxia, 2 cardiac, and 3 gastrointestinal adverse events. General anesthesia cases had 62 (14.3%) adverse events including the following: 54 cases of hypoxia, 1 cardiac, 7 gastrointestinal, and 1 urologic adverse event. No adverse events in either group required major resuscitation. NAAP vs. general anesthesia had a lower overall adverse event rate (3.4 vs. 14.3%, < 0.0004) and respiratory adverse event rate (2.4% vs. 12.5%, < 0.0004). Overall, cardiac and gastrointestinal adverse event rates between the two groups were comparable. When accounting for all captured factors via logistic regression, both younger age ( < 0.001) and general anesthesia ( < 0.0001) remained risk factors for an adverse event. The overall adverse event rate of NAAP was low (3.4%) with none requiring major resuscitation or hospitalization. This is comparable to studies of NAAP in adult endoscopy and suggests that NAAP provided by pediatric hospitalists has an acceptable safety profile.
PubMed: 33604318
DOI: 10.3389/fped.2020.619139 -
The Journal of Cardiovascular NursingHeart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been...
BACKGROUND
Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined.
AIM
The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables.
METHOD
This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF.
RESULTS
There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation.
CONCLUSION
These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.
Topics: Humans; Male; Female; Middle Aged; Aged; Progression-Free Survival; Sex Characteristics; Disease-Free Survival; Prospective Studies; Inflammation; Heart Failure
PubMed: 37707972
DOI: 10.1097/JCN.0000000000000831 -
Preventive Medicine Reports Aug 2022Urban-rural disparity constitutes a major source of health inequity also in high-income countries. This study aimed to compare the distribution of deaths due to medical...
Urban-rural disparity constitutes a major source of health inequity also in high-income countries. This study aimed to compare the distribution of deaths due to medical adverse events across urbanization levels among US hospital inpatients. An open dataset from the National Center for Health Statistics (NCHS) comprised all certified deaths of US inpatients over the period 2010-2019. The urbanization level of each decedent was determined in accordance with the 2013 NCHS Urban-Rural Classification Scheme (large metropolitan, medium or small metropolitan, or nonmetropolitan). The outcome was death due to a medical adverse event (ICD-10 codes Y40-Y84) proportional to total inpatient deaths. The data were standardized for sex, ethnicity, and age, and analyzed with linear mixed models. Of the 8 071 907 certified inpatient deaths during the study period, 21 444 (0.27%) were primarily attributed to medical adverse events. Decedents who resided in medium or small metropolitans and nonmetropolitans had approximately 0.5 units higher rate of adverse events per 1000 deaths (corresponding to a relative differece of 20%) when compared to decedents who resided in large metropolitans. Moreover, the urban-rural gradients showed an increasing trend towards the end of the study period, as the difference was found to increase at a rate of approximately 0.1 units per year (3%). There were no statistically significant differences between decedents from medium or small metropolitans and nonmetropolitans. The present findings highlight gradients in adverse event deaths between geographic areas, providing a basis for targeted preventive efforts. Future studies are invited to elucidate the underlying phenomena.
PubMed: 35832639
DOI: 10.1016/j.pmedr.2022.101888 -
Cureus Jun 2023Patients with olmesartan-induced enteropathy, a rare illness, frequently endure prolonged diarrhea and weight loss with no apparent cause. Because this adverse event's...
Patients with olmesartan-induced enteropathy, a rare illness, frequently endure prolonged diarrhea and weight loss with no apparent cause. Because this adverse event's clinical and histological characteristics mimic those of other small intestine illnesses, it can be challenging to recognize it in a timely manner. We report a case of olmesartan-induced enteropathy in a 58-year-old male who had been on olmesartan for several years. Recently, during his travel to Greece, he developed diarrhea lasting several weeks. This was accompanied by a significant weight loss of 35 lbs, acute kidney injury, and hypokalemia. Extensive negative workup, including esophagogastroduodenoscopy (EGD) with normal biopsy of esophagus, stomach, duodenum, and terminal ileum, and colonoscopy with biopsies, autoimmune serologies, and infectious disease workup, led to a diagnosis of olmesartan-induced enteropathy as a diagnosis of exclusion. Diarrhea improved/resolved within a few days after stopping olmesartan in our patient.
PubMed: 37456382
DOI: 10.7759/cureus.40342 -
European Journal of Cardiovascular... Apr 2022Left ventricular assist devices (LVAD) are used to treat advanced heart failure, and the use of these devices in ever increasing, with over 19 000 people having had a...
AIMS
Left ventricular assist devices (LVAD) are used to treat advanced heart failure, and the use of these devices in ever increasing, with over 19 000 people having had a device. However, during device therapy over 50% of patients will have some type of major adverse event. The aim of this study was to examine whether having a major adverse event, including major infection and major bleed, would alter patient-reported outcomes over time, including depressive symptoms and health-related quality of life.
METHODS AND RESULTS
T-tests and χ2 analyses were used to determine significant differences between patients who had an adverse event and those who did not. Latent curve growth modelling was used to evaluate change over time in those patients with and without and adverse event. The only difference between those with and without an adverse event was pre-implant depressive symptoms and health-related quality of life. The trajectories of both groups were also similar, with only differences at the pre-implant time point.
CONCLUSION
In response to an adverse event occurring post-LVAD implantation, we found that patient-reported outcomes, including depressive symptoms and health-related quality of life were not significantly impacted.
Topics: Heart Failure; Heart-Assist Devices; Hemorrhage; Humans; Patient Reported Outcome Measures; Quality of Life; Retrospective Studies
PubMed: 34453523
DOI: 10.1093/eurjcn/zvab070 -
Journal of Healthcare Engineering 2021Adverse nursing events occur suddenly, unpredictably, or unexpectedly during course of clinical diagnosis and treatment processes in the hospitals. These events...
Adverse nursing events occur suddenly, unpredictably, or unexpectedly during course of clinical diagnosis and treatment processes in the hospitals. These events adversely affect the patient's diagnosis and treatment results and even increase the patient's pain and burden. Additionally, It is high likely to cause accidents and disputes and affect normal medical work and personnel safety and is not conducive to the development of the health system. Due to the rapid development of modern medicine, health and safety of patients have become the most concerned issue in society and patient safety is an important part of medical care management. Research and events have shown that classified management of adverse nursing events, event analysis, and improvement measures are beneficial, specifically to the health system, to continuously improve the quality of medical care and reduce the occurrence of adverse nursing events. In the management of adverse nursing events, it is very important to categorize the text reports of adverse nursing events and divide these into different categories and levels. Traditional reports of adverse nursing events are mostly unstructured and simple data, often relying on manual classification, which is difficult to analyze. Furthermore, data is relatively inaccurate and practical reference significance is not obvious. In this paper, we have extensively evaluated various deep learning-based classification methods which are specifically designed for the healthcare systems. It becomes possible with the development of science and technology; text classification methods based on deep learning are gradually entering people's field of vision. Additionally, we have proposed a text classification model for adverse nursing events in the health system. Experiments and data comparison test of both the proposed deep learning-based method and existing methods in the text classification of nursing adverse events effect are performed. These results show the exceptional performance of the proposed mechanism in terms of various evaluation metrics.
Topics: Deep Learning; Delivery of Health Care; Drug-Related Side Effects and Adverse Reactions; Hospitals; Humans; Patient Safety
PubMed: 34840707
DOI: 10.1155/2021/9800114 -
World Journal of Hepatology Jul 2021Drug use during pregnancy is not common. Drug-induced liver injury (DILI) is a potential complication that is rare but can adversely affect both the mother and the... (Review)
Review
Drug use during pregnancy is not common. Drug-induced liver injury (DILI) is a potential complication that is rare but can adversely affect both the mother and the fetus. Although many drugs can directly cause hepatotoxicity, idiosyncratic liver injury is common in pregnancy. Underreporting of adverse drug reactions, lack of adequate literature regarding drug safety in pregnancy, and the inherent difficulty in diagnosing DILI during pregnancy make the management of this condition challenging. This review attempts to describe the existing literature regarding DILI in pregnancy, which is mainly in the form of case reports; several studies have looked at the safety of antithyroid drugs, antiretroviral drugs, and paracetamol, which have an indication for use in pregnancy; the relevant data from these studies with regard to DILI has been presented. In addition, the review describes the diagnosis of DILI, grading the disease severity, assessment of causality linking the drug to the adverse event, regulatory guidelines for evaluating the potential of drugs to cause liver injury, efforts to ensure better participation of women in clinical trials and studies in pregnant women population in particular, and the challenges involved in generating adequate research evidence. The establishment of DILI registries in various countries is an encouraging development; however, there is a need for promoting active, spontaneous reporting of adverse events during pregnancy to ensure rapid generation of evidence regarding the safety of a drug in pregnant women.
PubMed: 34367496
DOI: 10.4254/wjh.v13.i7.747 -
Preventive Medicine Reports Dec 2021Although medical error has been estimated as a major cause of death in the US, the capability of current diagnostic coding systems and standard death certificates to...
Although medical error has been estimated as a major cause of death in the US, the capability of current diagnostic coding systems and standard death certificates to capture these events has been criticized. This register-based study aimed to scrutinize medical adverse event deaths (i.e., deaths due to adverse events occurring within the healthcare practice, avoidable or unavoidable, including late complications and sequelae of such events) in the US National Vital Statistics 2018 mortality dataset. Individual-level data on underlying and multiple causes of death according to the tenth revision of the International Classification of Diseases (ICD-10) coding system were extracted together with the decedents' sex, age, ethnicity and education level. Adverse event deaths were identified by ICD-10 codes Y40-Y84 and Y88. The dataset comprised a total of 2 846 305 certified deaths. An adverse event ICD-10 code was used as the underlying cause of death in 0.16% (n = 4620) of the cases, and appeared on the list of multiple causes in 1.13% (n = 32 226) of the cases. Odds for adverse event death were higher among younger than elderly individuals, among those of black than white ethnicity, and among individuals with higher education level. The present data indirectly support previous evidence that a large number of adverse events remain underrecognized or misclassified. Future analyses are needed to reveal the root causes behind underreporting and to analyze whether it occurs at random or in a systematic way.
PubMed: 34976638
DOI: 10.1016/j.pmedr.2021.101574 -
Revista Brasileira de Enfermagem 2023to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil. (Observational Study)
Observational Study
OBJECTIVES
to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil.
METHODS
observational, analytical, retrospective study based on medical records review.
RESULTS
medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events.
CONCLUSIONS
this study's results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.
Topics: Adult; Humans; Retrospective Studies; Hospitalization; Emergency Service, Hospital; Hospitals, Public; Incidence; Medical Errors
PubMed: 37436233
DOI: 10.1590/0034-7167-2022-0025 -
Health Informatics Journal Sep 2019This study sought to determine how the proportion of physicians using electronic prescribing in nine US states was associated with the hospitalization rate for adverse...
This study sought to determine how the proportion of physicians using electronic prescribing in nine US states was associated with the hospitalization rate for adverse drug events among older adult patients. A discharge-level analysis of the relationship between county electronic prescribing and adverse drug event hospitalization rates was conducted. Data from the 2011 State Inpatient Databases, the Office of the National Coordinator Health IT Dashboard, and the Area Health Resource File were obtained for nine US states. The analysis examined the odds that a discharge for older adults would have been adverse drug event associated, versus other causes, using multivariable logistic regression models. After adjusting for patient, provider, health infrastructure, and community factors, the lowest county electronic prescribing rate quartile was associated with significantly greater odds of an adverse drug event hospitalization (odds ratio: 1.10; 95% confidence interval: 1.02-1.19). Early results indicate greater odds of adverse drug event hospitalizations among older adults living in counties with low electronic prescribing rates when compared to those in high electronic prescribing counties.
Topics: Aged; Databases, Factual; Drug-Related Side Effects and Adverse Reactions; Electronic Prescribing; Female; Hospitalization; Humans; Male; Medical Informatics; Patient Discharge; United States
PubMed: 28737062
DOI: 10.1177/1460458217720396