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41.
42.
《Vaccine》2015,33(42):5647-5653
Although studies have described factors associated with pertussis hospitalization in children, data on adult hospitalization are sparse. We examined the association between patient characteristics and hospitalization among older adults with pertussis. We conducted a nested case–control study of participants in the 45 and Up prospective cohort in New South Wales, Australia, with an incident pertussis diagnosis during 2006–2012. Cases were defined as those with a hospitalization coded as ‘whooping cough’ or ‘non-specific respiratory disease/cough’ between a week prior and 6 weeks after the diagnosis of pertussis based on laboratory tests. Controls were participants diagnosed with pertussis but not hospitalized. Among 265,287 participants, the incidence of pertussis and pertussis hospitalization was 83.9 (95% [confidence interval] CI, 78.7–89.6) and 2.9 (95% CI, 2.1–4.1)/100,000 person-years, respectively. Among 33 cases and 882 controls, factors associated with hospitalization were increasing age (compared to those 45–54 years, adjusted odds ratio [aOR] 5.4 (95% CI, 1.6–18.2) and 8.9 (95% CI, 2.3–34.7) in those aged 65–74 years and 75+ years, respectively) and smoking (ever versus never, aOR 2.37 (95% CI, 1.11–5.06)). The risk of pertussis hospitalization is substantially higher in ≥65 years old. A booster dose of diphtheria–tetanus–pertussis vaccine could be readily integrated into routine vaccination for this age group. 相似文献
43.
目的 探究临床护理路径对慢性阻塞性肺疾病患者的影响。方法 选择靖江市人民医院呼吸内科2016年7月至2017年6月收治的60例慢性阻塞性肺疾病患者为研究对象,随机分为实验组和对照组。实验组患者进行临床护理路径干预,对照组患者进行常规护理干预,比较两组患者护理前后的生活质量(GQOLI-74量表评分)、护理满意度、住院时间及治疗费用。结果 住院时两组患者的GQOLI-74量表中躯体、心理、社会、物质功能评分及总分差异均无统计学意义(P>0.05);护理干预后,实验组患者各领域得分及总分提高明显,与对照组比较差异有统计学意义(P<0.05);对照组护理干预前后各领域得分及总分提高不明显(P>0.05)。实验组的护理满意度高于对照组(P<0.05),住院时间和治疗费用均低于对照组(P<0.05)。结论 临床护理路径能够提高COPD患者的生活质量,减少住院时间和治疗费用,同时提高了患者对护理的满意度。 相似文献
44.
N. Erkut Kucukboyaci Coralynn Long Michelle Smith Joseph F. Rath Tamara Bushnik 《Archives of physical medicine and rehabilitation》2018,99(11):2365-2369
Objective
To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.Design
Cluster analysis of historical patient data obtained from inpatient visits.Setting
Inpatient rehabilitation unit in a large urban university hospital.Participants
Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury.Interventions
Not applicable.Main Outcome Measures
We examined the membership of patients with traumatic brain injury in various “vulnerable group” clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge).Results
The cluster analysis revealed 4 major clusters (ie, clusters A–D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.Conclusions
Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various “at-risk” groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training, and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation after traumatic brain injury. 相似文献45.
46.
S. Boisrobert L. Jakubiec J. Thevenin P.-L. Diennet O. Jacquiez D. Mete B. Maechler-Durand M. Fatséas M. Auriacombe 《L'Encéphale》2021,47(3):203-214
IntroductionThe medical identification of an addiction (use disorder) often results in inpatient admission with a view to its definitive suspension. However, for other chronic diseases, inpatient admission is indicated for specific situations and the objective is not the definitive suspension of the chronic disease. Our goal was to clarify addiction as a chronic disease and to determine explicit indications for inpatient admission.MethodThree-stage face validity study: (1) from the analysis of consensual definitions, search by the subset theory whether addiction can be considered as a chronic disease; (2) Develop generic indications for inpatient admissions based on the analysis of chronic disease care pathways validated by the HAS (French Health Agency) and apply them to addiction; (3) Validate by Delphi expert consensus method the determined indications.ResultsStep (1) showed that the definition of addiction allowed to include it in that of chronic disease. Step (2) determined 7 indications for inpatient admission of a patient with a chronic disease, and its application to addiction identified 15 indications for inpatient admission of a patient with addiction. In step (3), the Delphi method yielded consensus on 14 of the 15 indications.ConclusionBy clarifying addiction as a chronic disease, we were able to determine 14 indications for inpatient admission of a person with an addiction and to distinguish them from the long-term care of addiction. These explicit indications can help the general practitioner or community psychiatrist to better manage patients with addiction on the basis of their expertise with chronic diseases management. 相似文献
47.
《Clinical microbiology and infection》2021,27(12):1820-1825
ObjectivesChanging microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteraemia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland.MethodsWe conducted a nationwide, observational study on bacteraemia using ANRESIS data from 1 January 2008 to 31 December 2017. We analysed data on bacteraemia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during hospitalization for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus.ResultsWe included 28 318 bacteraemia isolates from 90 Swiss hospitals. The most common aetiology was E. coli (33.4%, 9459), followed by S. aureus (16.7%, 4721), K. pneumoniae (7.1%, 2005), Enterococcus faecalis (5.2%, 1473), P. aeruginosa (4.3%, 1228), Streptococcus pneumoniae (4.3%, 1208) and Enterococcus faecium (3.9%, 1101). We observed 489 (1.73%) S. marcescens isolates. We observed an increasing trend for E. faecium (from 1.5% at day 0 to 13.7% at day 30; p < 0.001), K. pneumoniae (from 6.1% to 7.8%, p < 0.001) and P. aeruginosa (from 2.9% to 13.7%, p < 0.001) with increasing duration of hospitalization; and decreasing trends for E. coli (from 41.6% to 21.6%; p < 0.001) and S. aureus (p < 0.001). Ceftriaxone resistance among E. coli remained stable for the first 15 days of hospitalization and then increased. Ceftriaxone resistance among K. pneumoniae and S. marcescens and oxacillin resistance among S. aureus increased linearly during the hospitalization. Cefepime resistance among P. aeruginosa remained stable during the hospitalization.DiscussionWe showed that hospitalization duration is associated with a species- and antibiotic class-dependent pattern of antimicrobial resistance. 相似文献
48.
Elad Goldberg Haim Ben Zvi Liron Sheena Summer Sofer Ilan Krause Ella H. Sklan Amir Shlomai 《Clinical microbiology and infection》2021,27(6):917.e1-917.e4
ObjectivesThe effectiveness of remdesivir, a Food and Drug Administration-approved drug for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been repeatedly questioned during the current coronavirus disease 2019 (COVID-19) pandemic. Most of the recently reported studies were randomized controlled multicentre clinical trials. Our goal was to test the efficiency of remdesivir in reducing nasopharyngeal viral load and hospitalization length in a real-life setting in patients admitted to a large tertiary centre in Israel.MethodsA total of 142 COVID-19 patients found to have at least three reported SARS-CoV-2 quantitative RT-PCR tests during hospitalization were selected for this study. Of these, 29 patients received remdesivir, while the remaining non-treated 113 patients served as controls.ResultsAmong the tested parameters, the control and remdesivir groups differed significantly only in the intubation rates. Remdesivir treatment did not significantly affect nasopharyngeal viral load, as determined by comparing the differences between the first and last cycle threshold values of the SARS-CoV-2 quantitative RT-PCR tests performed during hospitalization (cycle threshold 7.07 ± 6.85 vs. 7.08 ± 7.27, p 0.977 in the control and treated groups, respectively). Remdesivir treatment shortened hospitalization length by less than a day compared with non-treated controls and by 3.1 days when non-intubated patients from both groups were compared. These differences, however, were not statistically significant, possibly because of the small size of the remdesivir group.DiscussionRemdesivir was not associated with nasopharyngeal viral load changes, but our study had a significant disease severity baseline imbalance and was not powered to detect viral load or clinical differences. 相似文献
49.
《Journal of infection and chemotherapy》2021,27(12):1735-1742
IntroductionThe risk factors in pediatric influenza immediately before the COVID-19 era are not well understood. This study aims to evaluate the risk factors for hospitalization in pediatric influenza A and B for the recent seasons.MethodsChildren with a fever of ≥38 °C and laboratory-confirmed influenza at 20 hospitals in outpatient settings in Japan in the 2013/14 to 2019/20 seasons were retrospectively reviewed. Possible risk factors, including gender, age, comorbidities, nursery school or kindergarten attendance, earlier diagnosis, no immunization, lower regional temperature, earlier season, and period of onset, were evaluated using binary logistic regression methods.ResultsA total of 13,040 (type A, 8861; B, 4179) children were evaluated. Significant risk factors (p < 0.05) in multivariate analyses were young age, lower regional temperature, earlier season, respiratory illness (adjusted odds ratio [aOR]:2.76, 95% confidence interval [CI]:1.84–4.13), abnormal behavior and/or unusual speech (aOR:2.78, 95% CI:1.61–4.80), and seizures at onset (aOR:16.8, 95% CI:12.1–23.3) for influenza A; and young age, lower regional temperature, respiratory illness (aOR:1.99, 95% CI:1.00–3.95), history of febrile seizures (aOR:1.73, 95% CI:1.01–2.99), and seizures at onset (aOR:9.74, 95% CI:5.44–17.4) for influenza B.ConclusionsIn addition to previously known factors, including young age, seizures, and respiratory illness, abnormal behavior and/or unusual speech and lower regional temperature are new factors. Negative immunization status was not a risk factor for hospitalization. A better understanding of risk factors may help improve the determination of indications for hospitalization during the future co-circulation of influenza and COVID-19. 相似文献
50.
Yuan W Sørensen HT Basso O Olsen J 《Alcoholism, clinical and experimental research》2004,28(5):765-768
BACKGROUND: Asthma may have a prenatal origin. We examined whether maternal alcohol consumption during pregnancy increases the risk of hospitalization with asthma in children. METHODS: We conducted a follow-up study on 10,440 singletons born at approximately 36 weeks of gestation or later to mothers attending midwife centers between April 1984 and April 1987 in Denmark. The mothers completed a questionnaire regarding lifestyle and socioeconomic factors, including alcohol consumption. The children were followed up through the Danish Hospital Discharge Registry. We determined the first hospitalization with a discharge diagnosis of asthma as recorded in the Danish Hospital Discharge Registry. RESULTS: Most pregnant women (81.5%) drank at least some alcohol during pregnancy, but only a few (2.1%) consumed 120 g or more per week. In total, 307 children were hospitalized at least once with a discharge diagnosis of asthma during follow-up (the cumulative incidence risk was 3.5% from birth to 12 years of age or the end of follow-up). After adjusting for maternal socioeconomic factors, dietary components, and other lifestyle factors, children whose mothers drank alcohol during pregnancy did not have an increased risk of hospitalization with asthma compared with the children of mothers who reported no alcohol consumption during pregnancy (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.70-1.29). Further analyses showed no association with the dose and type of alcohol or with binge drinking. CONCLUSIONS: The study provides no support for a causal link between maternal alcohol intake during pregnancy and asthma in childhood. 相似文献