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Cureus May 2024Our understanding of multiple sclerosis (MS) has led to the development of new therapeutic strategies, including ocrelizumab, a third-generation humanized anti-CD20...
Our understanding of multiple sclerosis (MS) has led to the development of new therapeutic strategies, including ocrelizumab, a third-generation humanized anti-CD20 antibody. Ocrelizumab is largely well tolerated with favorable effectiveness, however, it has been associated with reports of colitis presenting weeks to months following infusion. We present a case of severe localized colitis in the setting of recent surgery and chronic ocrelizumab use. High-dose IV hydrocortisone was initiated, and the patient showed gradual improvement. Repeat imaging after discharge showed near-complete resolution of the patient's condition. This case aims to increase awareness of possible postoperative severe localized colitis in MS patients on Ocrevus.
PubMed: 38947635
DOI: 10.7759/cureus.61353 -
Research Square Jun 2024Background Hospitalizations for exacerbations of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetic ketoacidosis (DKA) are costly...
Development and Optimization of Machine Learning Algorithms for Predicting In-hospital Patient Charges for Congestive Heart Failure Exacerbations, Chronic Obstructive Pulmonary Disease Exacerbations and Diabetic Ketoacidosis.
Background Hospitalizations for exacerbations of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetic ketoacidosis (DKA) are costly in the United States. The purpose of this study was to predict in-hospital charges for each condition using machine learning (ML) models. Results We conducted a retrospective cohort study on national discharge records of hospitalized adult patients from January 1st, 2016, to December 31st, 2019. We used numerous ML techniques to predict in-hospital total cost. We found that linear regression (LM), gradient boosting (GBM) and extreme gradient boosting (XGB) models had good predictive performance and were statistically equivalent, with training R-square values ranging from 0.49-0.95 for CHF, 0.56-0.95 for COPD, and 0.32-0.99 for DKA. We identified important key features driving costs, including patient age, length of stay, number of procedures. and elective/nonelective admission. Conclusions ML methods may be used to accurately predict costs and identify drivers of high cost for COPD exacerbations, CHF exacerbations and DKA. Overall, our findings may inform future studies that seek to decrease the underlying high patient costs for these conditions.
PubMed: 38947079
DOI: 10.21203/rs.3.rs-4490027/v1 -
MedRxiv : the Preprint Server For... Jun 2024While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress...
BACKGROUND
While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown.
METHODS
Sleep health of close family members of consecutive cardiac arrest patients admitted at an academic center (8/16/2021 - 6/28/2023) was self-reported on the Pittsburgh Sleep Quality Index (PSQI) scale. The baseline PSQI administered during hospitalization was cued to sleep in the month before cardiac arrest. It was then repeated one month after cardiac arrest, along with the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions estimated the associations of one-month total PHQ-8 scores with changes in global PSQI scores between baseline and one month with higher scores indicating deteriorations. A prioritization exercise of potential interventions categorized into family's information and well-being needs to alleviate psychological distress was conducted at one month.
RESULTS
In our sample of 102 close family members (mean age 52±15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and one month after cardiac arrest (6.2±3.8 vs. 7.4±4.1; p<0.01). This deterioration was notable for sleep quality, duration, and daytime dysfunction components. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores, after adjusting for family members' age, sex, race/ethnicity, and patient's discharge disposition [β=0.4 (95% C.I 0.24, 0.48); p<0.01]. Most (n=72, 76%) prioritized interventions supporting information over well-being needs to reduce psychological distress after cardiac arrest.
CONCLUSIONS
There was a significant decline in sleep health among close family members of cardiac arrest survivors in the acute phase following the event. Psychological distress was associated with this sleep disruption. Further investigation into their temporal associations is needed to develop targeted interventions to support families during this period of uncertainty.
WHAT IS KNOWN
Sleep health has been identified as a key element in maintaining cardiovascular health.Close family members of critically ill patients experience suboptimal sleep health and psychological distress may contribute to it.
WHAT THE STUDY ADDS
It is breaking new ground in understanding the sleep health dynamics of close family members of cardiac arrest survivors, a critical but often overlooked group of caregivers.The study highlights significant associations between psychological distress and poor sleep that further deteriorates within the first month after a loved one's cardiac arrest.Families of cardiac arrest survivors expressed a high priority for information-based interventions to help alleviate psychological distress during the initial month following the cardiac event emphasizing the need for targeted, accessible, resources to address their psychological and potentially sleep-related challenges.
PubMed: 38946971
DOI: 10.1101/2024.06.18.24309137 -
Acta Dermatovenerologica Croatica : ADC Mar 2024Introduction Telogen effluvium (TE) is a common sequela of SARS-CoV-2 infection. Existing studies are highly heterogeneous. We aimed to assess the prevalence of TE in a...
Introduction Telogen effluvium (TE) is a common sequela of SARS-CoV-2 infection. Existing studies are highly heterogeneous. We aimed to assess the prevalence of TE in a cohort of patients with severe disease hospitalized for acute COVID-19. Methods This prospective cohort study was conducted at the University Clinic of Dermatology, part of the COVID-19 University Hospital Network throughout the pandemic. The acute phase data were extracted from electronic hospital records. Details about hair loss were obtained at two follow-up points, 3 and 6 months after hospital discharge, using telephone interviews. Results A total of 77 patients were successfully followed up, and 40 (48.8%) were male. The mean age was 55.91, SD=10,588. Overall, 68.8% of patients reported TE. Among these, 52.8% reported early onset, and 50.9% reported moderate hair loss. 11 (20.7%) reported complete hair regrowth within three months, and an additional 32 (60.3%) reported complete regrowth within six months. 4 (7.5%) patients have chronic TE. Female sex (p<0.0001), anemia (p=0.019), hypoproteinemia (p=0.037), and severe pneumonia (p=0.004) were associated with TE. Age, fever, SpO2, CRP levels, in-hospital complications, and raised D-dimers were not associated with TE. Discussion Our study confirmed a high prevalence of COVID-19-associated TE in hospitalized patients. Anemia and hypoalbuminemia were associated with TE, shedding new light on the possible pathogenesis. COVID-19-associated TE occurs earlier than classic TE and has a good prognosis in most patients. However, chronic ТЕ was reported by 7.5%. Even a small incidence of long-term sequelae during a pandemic could have substantial health consequences.
Topics: Humans; Male; COVID-19; Female; Middle Aged; Prospective Studies; Adult; Patient Discharge; Aged; Alopecia; Prevalence; Cohort Studies; SARS-CoV-2
PubMed: 38946185
DOI: No ID Found -
Yakugaku Zasshi : Journal of the... 2024In 2020, the Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center started providing information to community pharmacies about patients admitted to...
In 2020, the Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center started providing information to community pharmacies about patients admitted to the acute care ward using discharge medication summaries (the summaries). We conducted an online self-recording survey of 149 pharmacies belonging to the Hirakata City Pharmacists Association to clarify the usability of the summaries, any related issues, and to further discuss future collaboration between hospitals and pharmacies. 46 pharmacies have received the summaries in the past, of which 44 pharmacies answered that they have utilized the summaries with patient instruction and prescription queries of doctors. However, two pharmacies responded they did not utilize the summaries, and the reasons were (a) the information was not timely and (b) patients whom the discharge medical summary was sent for did not come to the pharmacy. There were some requests regarding the summaries such as, "I would like to know what kind of information hospital pharmacists want from community pharmacists." Preference for sharing information other than the summaries (e.g., online tools) with hospital pharmacists was related to whether the pharmacy was providing home pharmaceutical visit services. The survey revealed that, in addition to the usability of the summaries, there are also events that prevent them from being utilized. Some of the challenges include the timing of sending the summaries, the accurate identification of the family pharmacy and the communication of follow-up after discharge from hospital. Collaborating with pharmacies providing home pharmaceutical visit services would be beneficial in creating new system of bidirectional information sharing.
Topics: Humans; Japan; Community Pharmacy Services; Pharmacy Service, Hospital; Surveys and Questionnaires; Patient Discharge; Pharmacists; Patient Discharge Summaries
PubMed: 38945848
DOI: 10.1248/yakushi.23-00214 -
American Journal of Critical Care : An... Jul 2024Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes...
BACKGROUND
Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes and worldwide resource strain.
OBJECTIVES
To determine associations between use of noninvasive ventilation in adult patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia, progression to intubation, and hospital mortality.
METHODS
This retrospective cohort study included patients in an institutional COVID-19 registry. Adult patients were included if they were admitted for COVID-19 between March 1, 2020, and March 31, 2022, and developed moderate to severe ARDS. Primary outcomes were progression to intubation and hospital mortality in patients who received noninvasive ventilation or mechanical ventilation. A secondary outcome was successful treatment with noninvasive ventilation without intubation.
RESULTS
Of 823 patients who met inclusion criteria, 454 (55.2%) did not receive noninvasive ventilation and 369 (44.8%) received noninvasive ventilation. Patients receiving noninvasive ventilation were more likely to require mechanical ventilation than were patients not receiving noninvasive ventilation. Among patients requiring endotracheal intubation, those receiving noninvasive ventilation had a higher likelihood of mortality. Patients receiving noninvasive ventilation had lower severity-adjusted odds of survival to discharge without intubation than did patients not receiving noninvasive ventilation.
CONCLUSION
Patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia treated with noninvasive ventilation had increased likelihood of progression to endotracheal intubation and hospital mortality.
Topics: Humans; COVID-19; Male; Female; Retrospective Studies; Middle Aged; Noninvasive Ventilation; Respiratory Distress Syndrome; Hospital Mortality; Aged; Intubation, Intratracheal; SARS-CoV-2; Severity of Illness Index; Respiration, Artificial; Adult
PubMed: 38945818
DOI: 10.4037/ajcc2024663 -
Journal of Clinical Anesthesia Jun 2024This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and...
Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial.
STUDY OBJECTIVE
This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization.
DESIGN
A prospective randomized controlled trial.
SETTING
Operating room and gynecological ward in Wuhan Union Hospital.
PATIENTS
We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis.
INTERVENTIONS
Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment.
MEASUREMENTS
The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3-4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge.
MAIN RESULTS
The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01-0.72), p = 0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14-5.19),p < 0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], Bristol feces grade 3-4 [PCL-EOF: HR:3.65, 95%CI (2.36-5.63), p < 0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18-10.50), p < 0.001]. Also, the length of postoperative hospital stay (PCL-EOF: 5d vs. PCL: 6d and control: 6d, p < 0.001), the total cost (PCL-EOF: 25052 ± 3650y vs. PCL: 27914 ± 4684y and control: 26799 ± 4775y, p = 0.005), and postoperative VAS pain score values [POD0 (PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p < 0.001), POD1 (PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p < 0.001), POD2 (PCL-EOF: 1 vs. control:2 vs. PCL: 1, p < 0.001), POD3 (PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p < 0.001)] were significantly reduced in PCL-EOF group.
CONCLUSIONS
Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery.
TRIAL REGISTRATION
ChiCTR2300071047(https://www.chictr.org.cn/).
PubMed: 38945059
DOI: 10.1016/j.jclinane.2024.111539 -
Journal of Perinatology : Official... Jun 2024To understand the characteristics of infants admitted to US NICUs.
OBJECTIVE
To understand the characteristics of infants admitted to US NICUs.
STUDY DESIGN
2006-2014 linked birth certificate and hospital discharge data for potentially viable deliveries in Pennsylvania and South Carolina were used. NICU admissions were identified using revenue codes. NICU-admitted infants were categorized by gestational age (GA), birthweight, and condition severity (for GA 35+ weeks). We also assessed total patient days and trends over time.
RESULTS
12% of infants were admitted to a NICU; 13.6% were GA < 32 weeks (45.3% of total days); 36.1% were GA 32-36 weeks (31.2% of total days); and 50.4% were GA 37+ weeks (23.5% of total days). 20% of admissions were for infants with GA 35+ weeks and mild conditions. Admissions increased numerically from 11.2% (2006) to 13.0% (2014), with increases among infants 35+ weeks.
CONCLUSION
Most NICU admissions are for infants 35+ weeks GA, many with mild conditions who may be accommodated in well-baby units.
PubMed: 38944662
DOI: 10.1038/s41372-024-02039-6 -
Journal of Pediatric Nursing Jun 2024The aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge...
The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery.
BACKGROUND
The aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery.
METHODS
This study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention.
RESULTS
The results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001).
CONCLUSION
The H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery.
IMPLICATIONS TO PRACTICE
The results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.
PubMed: 38944620
DOI: 10.1016/j.pedn.2024.06.021 -
International Journal of Surgery Case... Jun 2024Congenital diaphragmatic hernia (CDH) is rare, occurring in 1 in 2000 to 4000 live births, and is typically diagnosed in neonates. Bochdalek hernia is the most common...
INTRODUCTION AND IMPORTANCE
Congenital diaphragmatic hernia (CDH) is rare, occurring in 1 in 2000 to 4000 live births, and is typically diagnosed in neonates. Bochdalek hernia is the most common type, usually presenting as a left-sided posterolateral defect. Adult presentations of CDH are uncommon and often incidental. This report discusses a young adult with an undiagnosed CDH, emphasizing the importance of clinical awareness.
CASE PRESENTATION
A 26-year-old man presented with flu-like symptoms and stable vital signs. He reported chronic postprandial shortness of breath that improved with standing. Physical examination revealed decreased breath sounds on the left side. A chest X-ray identified a left diaphragmatic hernia, confirmed by spiral chest computed tomography. Although advised to undergo surgery, the patient opted for discharge against medical advice.
CLINICAL DISCUSSION
Bochdalek hernia, comprising over 95 % of CDH cases, is usually left-sided due to a defect in the pleuroperitoneal membrane. Adults with CDH often present with nonspecific symptoms or the condition is discovered incidentally. Our patient adapted to his symptoms by standing after meals, which provided relief. Surgical intervention is recommended to prevent organ damage, with various techniques available, including open and endoscopic surgery. This case highlights the necessity of clinical vigilance in diagnosing CDH in adults.
CONCLUSION
Adult congenital diaphragmatic hernia, though rare, requires prompt surgical treatment to prevent organ damage. Recognizing subtle symptoms is crucial for diagnosis. This report contributes to the limited literature on adult-diagnosed CDH, stressing the need for clinical awareness and timely management.
PubMed: 38943942
DOI: 10.1016/j.ijscr.2024.109969