98 research outputs found
Reply to comment on: Haubitz et al. Outcome of Clostridioides difficile infections treated in a Swiss tertiary care hospital: an observational study
No full textThe vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study
No full textObjectives: midregional pro-adrenomedullin (MR-proADM) is a vasoactive peptide with key roles in reducing vascular hyperpermeability and thereby improving endothelial stability during infection. While MR-proADM is useful for risk stratification in patients with sepsis, clinical data about prediction accuracy in patients with severe acute respiratory syndrome coronavirus 2 disease (COVID-19) is currently missing.Methods: we included consecutively adult patients hospitalized for confirmed COVID-19 at a tertiary care center in Switzerland between February and April 2020. We investigated the association of MR-proADM levels with in-hospital mortality in logistic regression and discrimination analyses.Results: of 89 included COVID-19 patients, 19% (n=17) died while in the hospital. Median admission MR-proADM levels (nmol/L) were increased almost 1.5-fold increased in non-survivors compared to survivors (1.3 [interquartile range IQR 1.1-2.3]) vs. 0.8 [IQR 0.7-1.1]) and showed good discrimination (area under the curve 0.78). An increase of 1 nmol/L of admission MR-proADM was independently associated with a more than fivefold increase in in-hospital mortality (adjusted odds ratio of 5.5, 95% confidence interval 1.4-21.4, p=0.015). An admission MR-proADM threshold of 0.93 nmol/L showed the best prognostic accuracy for in-hospital mortality with a sensitivity of 93%, a specificity of 60% and a negative predictive value of 97%. Kinetics of follow-up MR-proADM provided further prognostic information for in-hospital treatment.Conclusions: increased levels of MR-proADM on admission and during hospital stay were independently associated with in-hospital mortality and may allow a better risk stratification, and particularly rule-out of fatal outcome, in COVID-19 patients.</p
Handrub Consumption Mirrors Hand Hygiene Compliance
No full textWe assessed handrub consumption as a surrogate marker for hand hygiene compliance from 2007 to 2014. Handrub consumption varied substantially between departments but correlated in a mixed effects regression model with the number of patient-days and the observed hand hygiene compliance. Handrub consumption may supplement traditional hand hygiene observations. Infect. Control Hosp. Epidemiol. 2016;1-4
Medical patients’ affective well-being after emergency department admission: The role of personal and social resources and health-related variables
No full textBackgroundMedical emergency admissions are critical life events associated with considerable stress. However, research on patients’ affective well-being after emergency department (ED) admission is scarce. This study investigated the course of affective well-being of medical patients following an ED admission and examined the role of personal and social resources and health-related variables.MethodsIn this longitudinal survey with a sample of 229 patients with lower respiratory tract infections and cardiac diseases (taken between October 2013 and December 2014), positive and negative affect was measured at ED admission (T1) and at follow-up after 7 days (T2), and 30 days (T3). The role of personal and social resources (emotional stability, trait resilience, affect state, and social support) as well as health-related variables (self-rated health, multimorbidity, and psychological comorbidity) in patients’ affective well-being was examined by controlling for demographic characteristics using regression analyses.ResultsThe strength of the inverse correlation between positive and negative affect decreased over time. In addition to health-related variables, higher negative affect was predicted by higher psychological comorbidity over time (T1–T3). In turn, lower positive affect was predicted by lower self-rated health (T1–T2) and higher multimorbidity (T3). In terms of personal and social resources, lower negative affect was predicted by higher emotional stability (T2), whereas higher positive affect was predicted by stronger social support (T1–T2).ConclusionKnowledge about psychosocial determinants–personal and social resources and health-related variables–of patients’ affective well-being following ED admission is essential for designing more effective routine screening and treatment.</div
Comparative quality measures of emergency care: an outcome cockpit proposal to survey clinical processes in real life
No full textSusanne Burgemeister,1 Alexander Kutz,1 Antoinette Conca,2 Thomas Holler,3 Sebastian Haubitz,1 Andreas Huber,4 Ulrich Buergi,5 Beat Mueller,1 Philipp Schuetz1 1University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Basel, 2Department of Clinical Nursing Science, 3Department of Controlling and Quality Management, 4Department of Laboratory Medicine, 5Emergency Department, Kantonsspital Aarau, Aarau, Switzerland Background: Benchmarking of real-life quality of care may improve evaluation and comparability of emergency department (ED) care. We investigated process management variables for important medical diagnoses in a large, well-defined cohort of ED patients and studied predictors for low quality of care. Methods: We prospectively included consecutive medical patients with main diagnoses of community-acquired pneumonia, urinary tract infection (UTI), myocardial infarction (MI), acute heart failure, deep vein thrombosis, and COPD exacerbation and followed them for 30 days. We studied predictors for alteration in ED care (treatment times, satisfaction with care, readmission rates, and mortality) by using multivariate regression analyses.Results: Overall, 2986 patients (median age 72 years, 57% males) were included. The median time to start treatment was 72 minutes (95% CI: 23 to 150), with a median length of ED stay (ED LOS) of 256 minutes (95% CI: 166 to 351). We found delayed treatment times and longer ED LOS to be independently associated with main medical admission diagnosis and time of day on admission (shortest times for MI and longest times for UTI). Time to first physician contact (–0.01 hours, 95% CI: –0.03 to –0.02) and ED LOS (–0.01 hours, 95% CI: –0.02 to –0.04) were main predictors for patient satisfaction. Conclusion: Within this large cohort of consecutive patients seeking ED care, we found time of day on admission to be an important predictor for ED timeliness, which again predicted satisfaction with hospital care. Older patients were waiting longer for specific treatment, whereas polymorbidity predicted an increased ED LOS. Keywords: quality measures, quality of care, emergency department, length of stay, patient satisfaction, benchmarking, health care servic
The glory of the age is the wisdom of grey hair: association of physician appearance with outcomes in hospitalised medical patients – an observational study
No full textINTRODUCTION
The physical appearance of a physician may influence patients’ perceptions of that physician’s quality of care. There is a lack of studies investigating whether physician appearance is indeed associated with patient satisfaction and mortality.
METHODS
This observational study included adult medical inpatients treated at a Swiss tertiary care hospital between 2013 and 2016. We investigated associations of gender and physician appearance (hair colour, wearing of glasses) with in-hospital mortality and perceived quality of care, assessed by a telephone interview 30 days after admission. Regression models were adjusted for patient age, patient gender, and the Charlson Comorbidity Index.
RESULTS
We included 18,259 inpatients treated by 494 different physicians during their hospital stay. We had full information regarding patient-perceived quality of care for 9917 patients. Overall, 860 patients (4.7%) died in the hospital and 1479 (14.9%) reported low satisfaction with their care. After multivariable adjustment, there was no difference in mortality or patient-perceived quality of care whether physicians did or did not wear glasses and whether they were male or female. The hair colour of residents was also not associated with outcomes. However, patients treated by grey-haired attending physicians, compared to those with dark or blond hair, had significantly lower in-hospital mortality (adjusted odds ratio 0.70, 95% confidence interval 0.53–0.92, p = 0.011).
CONCLUSIONS
This analysis suggests that physician gender or appearance has little influence on the quality of care provided to hospitalised medical patients. Whether the small but significant mortality benefit observed for grey-haired attending physicians is possibly confounded by age and physician experience clearly needs further investigation. Nevertheless, our analysis provides empirical evidence that having at least some grey-haired attending physicians in the medical physician team seems to be beneficial for patients, even if patients do not recognise the clear superiority of their care
Streamlining antibiotic therapy with procalcitonin protocols: consensus and controversies
No full textAccumulating evidence supports procalcitonin (PCT) as an accurate surrogate biomarker for likelihood and severity of bacterial infections. In community-acquired pneumonia and other respiratory infections, PCT-guided antibiotic therapy algorithms resulted in reduced antibiotic exposure while maintaining a similar or even better level of safety compared with standard care. Reductions in antibiotic use translate into lower treatment costs, decreased risk of side effects and decreased bacterial multiresistance. This is especially important, as acute respiratory infections represent the most frequent reason for antibiotic prescriptions worldwide. Still, there is some controversy about the benefits of PCT measurement in sepsis patients in the intensive care unit and for nonrespiratory infections. Highly sensitive PCT assays are readily available in many hospitals today, and point-of-care assays with high enough sensitivity for antibiotic guidance are expected to be available soon. Herein, the authors provide an overview of recent studies evaluating PCT in different clinical situations and an outlook of currently enrolling or upcoming interventional trials
Influence of Matrix Type on Marginal Gap Formation of Deep Class II Bulk-Fill Composite Restorations
No full textBackground: To test the hypothesis that transparent matrices result in more continuous margins of bulk-fill composite (BFC) restorations than metal matrices. Methods: Forty standardized MOD cavities in human molars with cervical margins in enamel and dentin were created and randomly assigned to four restorative treatment protocols: conventional nanohybrid composite (NANO) restoration (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (NANO-METAL) versus transparent matrix (NANO-TRANS), and bulk-fill composite restoration (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (BFC-METAL) versus transparent matrix (BFC-TRANS). After artificial aging (2500 thermal cycles), marginal quality was evaluated by scanning electron microscopy using the replica technique. Statistical analyses were performed using the Mann–Whitney U-test and Wilcoxon test. The level of significance was p < 0.05. Results: Metal matrices yielded significantly (p = 0.0011) more continuous margins (46.211%) than transparent matrices (27.073%). Differences in continuous margins between NANO (34.482%) and BFC (38.802%) were not significant (p = 0.56). Matrix type did not influence marginal gap formation in BFC (p = 0.27) but did in NANO restorations (p = 0.001). Conclusion: Metal matrices positively influence the marginal quality of class II composite restorations, especially in deep cavity areas. The bulk-fill composite seems to be less sensitive to the influence of factors such as light polymerization and matrix type
Unraveling the Link between Malnutrition and Adverse Clinical Outcomes: Association of Acute and Chronic Malnutrition Measures with Blood Biomarkers from Different Pathophysiological States.
No full textBACKGROUND AND AIMS
Malnutrition is associated with poor clinical outcomes. Whether there is a causal relationship or it merely mirrors a severe patient condition remains unclear. We examined the association of malnutrition with biomarkers characteristic of different pathophysiological states to better understand the underlying etiological mechanisms.
METHODS
We prospectively followed consecutive adult medical inpatients. Multivariable regression models were used to investigate the associations between malnutrition - as assessed using the Nutritional Risk Screening (NRS 2002) - and biomarkers linked to inflammation, stress, renal dysfunction, nutritional status and hematologic function.
RESULTS
A total of 529 patients were included. In a fully adjusted model, malnutrition was significantly associated with the inflammatory markers procalcitonin (0.20, 95% CI 0.03-0.37), proadrenomedullin (0.28, 95% CI 0.12-0.43) and albumin (-0.39, 95% CI -0.57 to -0.21), the stress marker copeptin (0.34, 95% CI 0.17-0.51), the renal function marker urea (0.23, 95% CI 0.07-0.38), the nutritional markers vitamin D25 (-0.22, 95% CI -0.41 to -0.02) and corrected calcium (0.29, 95% CI 0.10-0.49) and the hematological markers hemoglobin (-0.27, 95% CI -0.43 to -0.10) and red blood cell distribution width (0.26, 95% CI 0.07-0.44). Subgroup analysis suggested that acute malnutrition rather than chronic malnutrition was associated with elevated biomarker levels.
CONCLUSION
Acute malnutrition was associated with a pronounced inflammatory response and an alteration in biomarkers associated with different pathophysiological states. Interventional trials are needed to prove causality
Moins, c’est souvent mieux: une antibiothérapie sur mesure grâce au dosage de la procalcitonine
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