Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network)

BackgroundOngoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons.MethodsThe Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada. A test-negative design was employed: cases were polymerase chain reaction (PCR)-positive for influenza; controls were PCR-negative for influenza and were matched to cases by date, admission site, and age (≥65 y or <65 y). All cases and controls had demographic and clinical characteristics (including influenza immunization status) obtained from the medical record. VE was estimated as 1-OR (odds ratio) in vaccinated vs. unvaccinated patients × 100%. The primary outcome was VE of TIV for preventing laboratory-confirmed influenza-related hospitalization; secondary outcomes included VE of TIV for preventing influenza-related intensive care unit (ICU) admission/mechanical ventilation, and influenza-related death.ResultsOverall, 3394 cases and 4560 controls were enrolled; 2078 (61.2%) cases and 2939 (64.5%) controls were ≥65 y. Overall matched, adjusted VE was 41.7% (95% Confidence Interval (CI): 34.4–48.3%); corresponding VE in adults ≥65 y was 39.3% (95% CI: 29.4–47.8%) and 48.0% (95% CI: 37.5–56.7%) in adults <65 y, respectively. VE for preventing influenza-related ICU admission/mechanical ventilation in all ages was 54.1% (95% CI: 39.8–65.0%); in adults ≥65 y, VE for preventing influenza-related death was 74.5% (95% CI: 44.0–88.4%).ConclusionsWhile effectiveness of TIV to prevent serious outcomes varies year to year, we demonstrate a statistically significant and clinically important TIV VE for preventing hospitalization and other serious outcomes over three seasons. Public health messaging should highlight the overall benefit of influenza vaccines over time while acknowledging year to year variability.ClinicalTrials.gov Identifier: NCT01517191.     

老年急性上消化道出血患者93例住院费用分析

目的分析老年急性上消化道出血（acute upper gastrointestinal bleeding,AUGIB）患者住院费用的影响因素及近5年变化趋势,为加强医疗费用管理、控制住院费用提供参考。方法选择2005年1月~2009年12月急诊收住我院的AUGIB患者93例作为研究对象,采用Logistic回归分析方法对住院费用的影响因素进行筛选、运用单因素方差分析法比较年度间住院费用差异、用Excel 2003分析住院费用变化趋势。结果影响我院老年AUGIB患者住院费用的主要因素为患者年龄、住院天数、合并疾病及血红蛋白含量（P〈0.05）,OR值分别为0.900、1.642、0.779和2.453,5年内住院费用的平均增长速度为-0.96%,年度间住院费用的ANOVA结果表明其差异无统计学意义（F=0.50,P=0.73）。结论高龄、住院天数延长、合并其他疾病及血红蛋白含量显著降低是导致老年AUGIB患者住院费用增加的重要危险因素,近5年老年AUGIB患者的住院费用总体呈下降趋势,但仍维持在相对较高的水平,降低其住院费用重点应从老年患者的健康教育及老年性疾病防控、缩短住院天数等方面入手。     

Preventing COPD: Evidence of Progress

Abstract

Lightweight ambulatory oxygen devices are provided on the assumptions that they enhance compliance and increase activity, but data to support these assumptions are lacking. We studied 22 patients with severe chronic obstructive pulmonary disease receiving long-term oxygen therapy (14 men, average age = 66.9 y, FEV₁ = 33.6%pred, PaO₂ at rest = 51.7 torr) who were using E-cylinders as their portable oxygen. Subjects were recruited at 5 sites and studied over a 2-week baseline period and for 6 months after randomizing them to either continuing to use 22-lb E-cylinders towed on a cart or to carrying 3.6-lb aluminum cylinders. Utilizing novel electronic devices, ambulatory and stationary oxygen use was monitored continuously over the 2 weeks prior to and the 6 months following randomization. Subjects wore tri-axial accelerometers to monitor physical activity during waking hours for 2–3 weeks prior to, and at 3 and 6 months after, randomization. Seventeen subjects completed the study. At baseline, subjects used 17.2 hours of stationary and 2.5 hours of ambulatory oxygen daily. At 6 months, ambulatory oxygen use was 1.4 ± 1.0 hrs in those randomized to E-cylinders and 1.9 ± 2.4 hrs in those using lightweight oxygen (P = NS). Activity monitoring revealed low activity levels prior to randomization and no significant increase over time in either group. In this group of severe chronic obstructive pulmonary disease patients, providing lightweight ambulatory oxygen did not increase either oxygen use or activity. Future efforts might focus on strategies to encourage oxygen use and enhance activity in this patient group. This trial is registered at ClinicalTrials.gov (NCT003257540).     

Comparison of hospitalization rates in patients with community-acquired pneumonia treated with 10 days of telithromycin or clarithromycin

SUMMARY

Aims: To compare the impact on hospitalization rates and the clinical efficacy of oral telithromycin and clarithromycin treatment in patients with community-acquired pneumonia (CAP).

Patients and methods: Outpatients aged >18 years (n?=?448) with CAP were enrolled in a randomized, double-blind, multinational study and received telithromycin 800?mg once daily (n?=?224) or clarithromycin 500?mg twice daily (n?=?224) for 10 days. The primary outcome measure was clinical efficacy at post-therapy/test of cure (Days 17–24) in the per-protocol population. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use were compared by treatment group (intent to treat population) up to the late post-therapy visit (Days 31-36). Study investigators who were blinded to the treatment arm assessed whether hospital admissions were CAP related or not. Hospitalization costs (US$) associated with telithromycin and clarithromycin treatment were compared.

Results: Per-protocol clinical cure rates for telithromycin and clarithromycin were statistically equivalent (88.3% [143/162] vs 88.5% [138/156] - difference: ?0.2%; 95% CI: ?7.8, 7.5). There were four CAP-related hospitalizations (1.8 events/100 patients) among patients treated with telithromycin vs eight (3.6 events/100 patients) among clarithromycin patients (p?=?0.281). The total number of CAP-related hospital days for telithromycin and clarithromycin patients was 23 vs 64 days (10.3 vs 28.6 days/100 patients), respectively (p?=?0.177). CAP-related hospitalization costs per 100 telithromycin and clarithromycin patients were $20360 vs $70567, respectively (difference: ?25182; 95% CI: ?49531; 9168).

Conclusions: This study demonstrates that telithromycin is an effective therapy for outpatients with CAP. There were no significant differences in hospitalization rates between treatments; however, a tendency towards a numerically reduced number of hospitalizations/days required in hospital among telithromycin patients was observed. This could potentially translate into reduced hospitalization costs for telithromycin vs clarithromycin in the treatment of CAP.     

母乳喂养与婴儿因腹泻和呼吸道感染住院之间的关系研究

[目的]评估母乳喂养对出生后8月内的婴儿因腹泻和下呼吸道感染住院的影响。[方法]调查2005年1月~2010年2月出生的1589例单胎、健康、足月婴儿的喂养、健康状况以及其他的混杂因素,通过患儿父母的报告以获取主要的研究结果,即婴儿出生后8月内因腹泻或下呼吸道感染住院的情况。[结果]70%的婴儿为母乳喂养或曾经接受母乳喂养,34%的婴儿接受母乳喂养至少4月,1.2%的婴儿为纯母乳喂养至少6月。至出生后8月龄时,有12%的婴儿住过院(1.1%因为腹泻,3.2%因为下呼吸道感染)。按出生月龄对资料进行分析,并调整混杂因素的影响之后所得到的结果显示,与非母乳喂养相比,纯母乳喂养可保护婴儿免于因腹泻和下呼吸道感染而住院。在部分的母乳喂养婴儿中,这种影响较小。人群归因分值(population attributable fraction)提示,如果采取纯母乳喂养,则每月可预防约53%的婴儿因腹泻发生的住院,给予部分母乳喂养则可降低31%因腹泻发生的住院。与此类同,采取纯母乳喂养和部分母乳喂养每月可分别减少27%和25%因下呼吸道感染发生的住院。母乳喂养的保护效应随着母乳喂养的终止逐渐减弱。[结论]母乳喂养,尤其是长期的纯母乳喂养,可以降低婴儿罹患重大疾病的概率。增加整个人群的长期纯母乳喂养比例会对公众健康带来相当大的潜在裨益。     

Predictability of rehospitalization for schizophrenia

This analysis examines the predictability of the course of schizophrenia using long-term follow-up data on hospital episodes in a cohort of patients from a psychiatric case register in Denmark. We focus on whether clinical and sociodemographic data collected during the first episode are related to the number of hospitalizations during follow-up and the association of patients' course of hospitalizations with the risk of being rehospitalized. A Poisson regression model and a proportional hazards model were used to address these questions. Age of onset and time to the first rehospitalization were strong early predictors of chronicity of course, as measured by the number of psychiatric hospitalizations for each schizophrenic patient. The results also show that the risk of rehospitalization depends on the previous tenures in the community.     

慢性病住院少儿的人生取向及影响因素的研究

目的 在比较上海市慢性病住院少儿和同龄健康少儿人生取向的基础上，分析慢性病住院少儿人生取向发展的影响因素。方法 采用问卷法对118例慢性病住院少儿和121名在校读书的同龄健康少儿进行调查。结果 慢性病住院少儿的人生取向受住院次数、年龄、性别、疾病类型的影响；其人生取向水平明显低于同龄健康少儿；女性少儿的人生取向水平明显低于男性少儿；高年龄组少儿的人生取向水平明显高于低年龄组少儿；白血病少儿的人生取向水平显著低于其他疾病的少儿；住院次数超过四次后，慢性病住院少儿的人生取向水平明显下降。结论 护理工作者应特别关注病情严重、多次住院的女性少儿，帮助其建立积极的人生取向，以促进其心理、情感的健康发展。     

Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status

Objective

Elicit patients’ perceptions of factors that facilitate their engagement in care

Corticosteroids for alleviating dyspnea in patients with terminal cancer

Dyspnea is a common symptom in patients with cancer, particularly those with advanced disease. Although corticosteroids can provide effective symptom relief to such patients, the effects of these drugs on dyspnea have not been evaluated. Therefore, we retrospectively evaluated the effect of corticosteroids on dyspnea in patients with terminal cancer through a surrogate third-party evaluation intended to overcome the difficulties of self-evaluation. We investigated the electronic medical records of 693 patients who were hospitalized at Kasugai Municipal Hospital between January and December 2015 and subsequently died. After excluding patients whose deaths were not directly cancer-related and 214 patients remained eligible, 19 of 34 remaining patients with dyspnea were ultimately included in the survey. Eleven patients in the final sample received corticosteroid treatment. Among the 11 patients who received corticosteroids, 9 (81.8%), 1 (9.1%), and 1 (9.1%) received betamethasone, dexamethasone, and prednisolone. The expression of the intended effect was observed in 6 of 11 patients in the steroid group. The median time to effect expression in the steroid group was 2 days. The median durations of effect in the steroid group were 3 days. After eliminating the opioid effect, we confirmed that steroid administration improved patients’ STAS-J scores and possibly alleviated dyspnea.