Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study

To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC?≥?10.6 cells?×?10⁹/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥?2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC?≥?10.6 cells?×?10⁹/L and albumin <?32 g/L at discharge and the presence of ≥?2 co-morbidities were independently associated with increased risk of 30-day readmission.     

Antibiotic resistance in hospitals: a ward‐specific random effect model in a low antibiotic consumption environment

Association between previous antibiotic use and emergence of antibiotic resistance has been reported for several microorganisms. The relationship has been extensively studied, and although the causes of antibiotic resistance are multi‐factorial, clear evidence of antibiotic use as a major risk factor exists. Most studies are carried out in countries with high consumption of antibiotics and corresponding high levels of antibiotic resistance, and currently, little is known whether and at what level the associations are detectable in a low antibiotic consumption environment. We conduct an ecological, retrospective study aimed at determining the impact of antibiotic consumption on antibiotic‐resistant Pseudomonas aeruginosa in three hospitals in Norway, a country with low levels of antibiotic use. We construct a sophisticated statistical model to capture such low signals. To reduce noise, we conduct our study at hospital ward level. We propose a random effect Poisson or binomial regression model, with a reparametrisation that allows us to reduce the number of parameters. Inference is likelihood based. Through scenario simulation, we study the potential effects of reduced or increased antibiotic use. Results clearly indicate that the effects of consumption on resistance are present under conditions with relatively low use of antibiotic agents. This strengthens the recommendation on prudent use of antibiotics, even when consumption is relatively low. Copyright © 2012 John Wiley & Sons, Ltd.     

Can Parent Training Alter Parent Practice and Reduce Conduct Problems in Ethnic Minority Children? A Randomized Controlled Trial

A randomized prevention study for ethnic minority mothers assessed the intervention effects of Parent Management Training—Oregon Model (PMTO) on maternal parent practices and child behavior. Ninety-six mothers from Somalia and Pakistan and their children aged 3 to 9 years were randomized to PMTO or a wait-list condition (WLC). Assessments were carried out at the baseline and post-intervention, using standardized measures and a multi-agent approach. All analyses were based on the intention-to-treat principle. Analysis of covariance (ANCOVA) showed that PMTO was effective in enhancing parent practices, with a decrease in harsh discipline and an increase in positive parenting. Moreover, PMTO produced reductions in motherreported child conduct problems. The largest effect sizes were found among mothers who attended more than 50 % of the PMTO group sessions. Teacher reports showed, however, that there were no significant intervention effects on conduct problems and social competence in kindergarten or school. The results emphasize the importance and feasibility of offering PMTO to ethnic minority families.     

Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses

AIM:To evaluate the usefulness of contrast-enhanced harmonic endoscopic ultrasound(CH-EUS)in differentiating between pancreatic adenocarcinomas and other pancreatic disease.METHODS:This retrospective cohort study evaluated90 patients who were seen between November 2010and May 2013.All these patients had solid pancreatic masses that had a hypoechoic appearance on EUS.All patients underwent CH-EUS to evaluate this diagnostic method’s usefulness.The mass lesions observed on CH-EUS were classified into three categories based on their echo intensity:hypoenhanced,isoenhanced,and hyperenhanced lesions.We adjusted the sensitivity and the specificity of each category for detecting malignancies.We also estimated the accuracy of CH-EUS by comparing it to a pathological diagnosis.RESULTS:Of the 90 patients,62 had a pancreatic adenocarcinoma.Fifty-seven out of 62 pancreatic adenocarcinomas showed a hypoenhanced pattern on CHEUS.The sensitivity was 92%,the specificity 68%and the accuracy approximately 82%.The area under the curve of the receiver operating characteristic analysis for CH-EUS was 0.799.There is a significant association between the hypoenhanced pattern on CH-EUS and pancreatic duct adenocarcinoma(χ2=35.264,P<0.001).In pathological examinations,the number of specimens for EUS-fine needle aspiration(EUS-FNA)was considered insufficient for diagnosis in three patients,and in two patients,the results were reported to be negative for malignancy.Pancreatic masses in all five patients revealed a hypoenhanced pattern with CH-EUS.Three patients were diagnosed with pancreatic adenocarcinoma based on the pathology results of a biopsy,and the remaining two patients were clinically diagnosed with malignancy.CONCLUSION:CH-EUS is useful for distinguishing between pancreatic adenocarcinoma and other pancreatic disease.When a pancreatic mass shows a hypoenhanced pattern on CH-EUS but involves either insufficient samples or negative results with EUS-FNA,clinicians might consider performing another pathologic diagnosis on the basis of an EUS-FNA sample or a biopsy.