HbA1C variability and hypoglycemia hospitalization in adults with type 1 and type 2 diabetes: A nested case-control study

Aims

To determine association between HbA_1C variability and hypoglycemia requiring hospitalization (HH) in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D).

Pre‐discharge and early post‐discharge troponin elevation among patients hospitalized for heart failure with reduced ejection fraction: findings from the ASTRONAUT trial

Aims

Troponin levels are commonly elevated among patients hospitalized for heart failure (HF), but the prevalence and prognostic significance of early post‐discharge troponin elevation are unclear. This study sought to describe the frequency and prognostic value of pre‐discharge and post‐discharge troponin elevation, including persistent troponin elevation from the inpatient to outpatient settings.

Methods and results

The ASTRONAUT trial (NCT00894387; http://www.clinicaltrials.gov ) enrolled hospitalized HF patients with ejection fraction ≤40% and measured troponin I prior to discharge (i.e. study baseline) and at 1‐month follow‐up in a core laboratory (elevation defined as >0.04 ng/mL). This analysis included 1469 (91.0%) patients with pre‐discharge troponin data. Overall, 41.5% and 29.9% of patients had elevated pre‐discharge [median: 0.09 ng/mL; interquartile range (IQR): 0.06–0.19 ng/mL] and 1‐month (median: 0.09 ng/mL; IQR: 0.06–0.15 ng/mL) troponin levels, respectively. Among patients with pre‐discharge troponin elevation, 60.4% had persistent elevation at 1 month. After adjustment, pre‐discharge troponin elevation was not associated with 12‐month clinical outcomes. In contrast, 1‐month troponin elevation was independently predictive of increased all‐cause mortality [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.18–2.13] and cardiovascular mortality or HF hospitalization (HR 1.28, 95% CI 1.03–1.58) at 12 months. Associations between 1‐month troponin elevation and outcomes were similar among patients with newly elevated (i.e. normal pre‐discharge) and persistently elevated levels (interaction P ≥ 0.16). The prognostic value of 1‐month troponin elevation for 12‐month mortality was driven by a pronounced association among patients with coronary artery disease (interaction P = 0.009).

Conclusions

In this hospitalized HF population, troponin I elevation was common during index hospitalization and at 1‐month follow‐up. Elevated troponin I level at 1 month, but not pre‐discharge, was independently predictive of increased clinical events at 12 months. Early post‐discharge troponin I measurement may offer a practical means of risk stratification and should be investigated as a therapeutic target.

     

程序化护理干预在急性心肌梗死患者中的应用研究

目的:分析急性心肌梗死患者实施程序化护理的效果。方法:选择在本院接受治疗的72例急性心肌梗死患者作为研究对象,分别给予常规护理及程序化护理干预,比较2组患者的死亡率及平均住院时间。结果:程序化护理的观察组平均住院时间12.31±3.94天明显短于对照组(t=3.242,p0.05);患者死亡率(5.56%)明显低于对照组(x2=2.486,P0.05)。结论:程序化护理可以有效降低急性心肌梗死患者的死亡率,加快其康复速度,缩短住院时间。     

唐山市某钢厂炼铁工人住院率及其影响因素分析

目的在于调查分析唐山某钢厂炼铁工人住院率及其影响因素。方法采用自行设计的调查问卷对唐山市某钢厂全体炼铁北区2325名工人进行一对一问卷调查。结果问卷有效回收率为93．96％。结果显示年龄、工龄和饮酒情况对住院率的影响差异有统计学意义（P〈0．05）,性别、婚姻状况和吸烟情况对其影响不显著（P〉0．05）。结论调查对象中年龄较大和工龄较长的住院率较高,建议可适当对年龄大工龄长的职工增加健康教育和健康促进等干预措施。     

Longitudinal Analysis of Hospitalization After Spinal Cord Injury: Variation Based on Race and Ethnicity

Objective

To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury.

Design

Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI.

Setting

Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database.

Participants

Patients with traumatic SCI (N= 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems.

Interventions

Not applicable.

Main Outcome Measures

Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems.

Results

Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites (P=.011) and Hispanics (P=.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days (P=.036) at 10 years versus 5 years postinjury.

Conclusions

Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.     

Impact of Resistance Training in Chronic Obstructive Pulmonary Disease Patients During Periods of Acute Exacerbation

Objective

To evaluate the effects of whole-body resistance training on exercise capacity, health-related quality of life (HRQOL), and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease.

Design

Randomized controlled trial.

Setting

University hospital.

Participants

Patients (N=46) were randomized to either a control group (CG) or training group (TG), and 29 patients completed the study.

Intervention

Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs (2 sets of 8 repetitions each), and the initial load was set at 80% of the 1-repetition maximum load.

Main Outcome Measures

Patients were evaluated on the second day of hospitalization, at hospital discharge, and 30 days postdischarge. Patients were evaluated on the basis of the 6-minute walking distance (6MWD), HRQOL, muscle strength, systemic inflammatory markers, and level of physical activity in daily life (PADL).

Results

The CG showed a reduction in the strength of lower-limb muscles (P<.05) but not in the 6MWD (P>.05). In contrast, patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization (P<.05). The TG also improved the impact domain in HRQOL after hospitalization. No improvement in PADL was observed in the TG. Finally, a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization.

Conclusions

Our results suggest that resistance training during hospitalization improves the 6MWD, HRQOL, and lower-limb muscle strength, without altering the levels of systemic inflammation. However, future research should explore this intervention in larger randomized trials.     

Disease burden of respiratory syncytial virus infection in the pediatric population in Japan

IntroductionRespiratory syncytial virus (RSV) is one of the most common causes of lower respiratory tract infections in children aged <5 years and is associated with long-term respiratory morbidities such as recurrent wheezing and asthma, decreased lung function, and allergic sensitization. The objective of this review was to evaluate the epidemiology and burden of RSV infection in the pediatric population in Japan.MethodsStudies indexed in PubMed and ICHUSHI databases during January 2010–December 2020 were manually reviewed. Data on proportion of RSV infections, seasonality, length of stay (LoS), mortality, medical expenses, and palivizumab use were extracted from the selected articles.ResultsNinety-three articles were included (PubMed, 64; ICHUSHI, 29). The proportion of patients/samples with an RSV infection was 5.5%–66.7%, and 6.0%–29.9% in the inpatient and outpatient departments, respectively. RSV infections generally occurred during autumn/winter; however, recently the peak has shifted to summer. The LoS was variable and depended on factors such as age, infection severity, wheezing, and RSV subgroups. Mortality rates varied from <1% to 19% depending on the infection severity. The average daily hospitalization and intensive care unit cost was JPY 34,548 while intensive care unit incurred an additional cost of JPY 541,293. Palivizumab was indicated for high-risk infants and 0%–3% of patients required hospitalization despite palivizumab use.ConclusionsRSV imposes a significant burden on the Japanese healthcare system, suggesting a need to create awareness among caregivers of children, pregnant women and healthcare professionals to ensure early recognition of infection and adequate treatment or prophylaxis.     

Clinical manifestations of hospitalized influenza patients without risk factors: A prospective multicenter cohort study in Japan via internet surveillance

IntroductionInfluenza remains a clinically heavy burden worldwide. It is well known that some populations are at high risk of complications from influenza, whereas, even previously healthy people might suffer from severe influenza.The objective of this study was to clarify clinical manifestations of hospitalized patients without risk factors infected with influenza.MethodsThe clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2020 (6 influenza seasons) using an internet-surveillance system. Among them, the patients who had no risk factors of complications from influenza were extracted.ResultsFinally, a total of 91 patients (9.0% of all influenza-related hospitalizations) without risk factors were analyzed. The no risk group was younger than the risk group, though other significant differences of clinical characteristics were not recognized between the groups. Pneumonia was the most common cause of hospitalization in the no risk group, and primary influenza viral pneumonia was the most common pneumonia. Antiviral drugs were administered in 96.7% of the no-risk group, and artificial ventilation was performed in 18.7%. In-hospital death was recorded for 3 patients without risk factors.ConclusionsSevere complications of influenza which required hospitalization may occur in a certain degree of patients with no risk factors. Efforts are needed to diagnose and treat influenza appropriately even in previously healthy younger patients. Continuous nationwide surveillance will be required to clarify risk factors for severe influenza even in previously healthy younger patients.(UMIN000015989).     

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

Background

Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting.

Objectives

To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope.

Methods

A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011.

Results

Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified.

Conclusions

Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.