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“Length of stay, mortality fall, hospital charges rise in systemic sclerosis with infection - Healio” plus 1 more
“Length of stay, mortality fall, hospital charges rise in systemic sclerosis with infection - Healio” plus 1 more |
| Length of stay, mortality fall, hospital charges rise in systemic sclerosis with infection - Healio Posted: 30 Jul 2020 02:43 AM PDT July 30, 2020 2 min read  Source/Disclosures Disclosures: Singh reports consultant fees from Crealta/Horizon, Medisys, Fidia, UBM, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam Associates, Spherix, Practice Point communications, the NIH and the American College of Rheumatology, as well stock options in Amarin Pharmaceuticals and Viking therapeutics, speaking fees from Simply Speaking, and executive membership with OMERACT. Please see the study for all other relevant financial disclosures. We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Patients with systemic sclerosis who are hospitalized for serious infection have, from 1998 to 2016, experienced a growing number of charges but decreasing lengths of stay and mortality, researchers reported in Arthritis Research & Therapy. "Systemic sclerosis is a systemic autoimmune disease associated with high morbidity and mortality and frequent hospitalizations," Jasvinder A. Singh, MD, of the Birmingham (Ala.) Veterans Affairs Medical Center, told Healio Rheumatology. "Recent studies indicated the infections are becoming an increasingly common contributor to mortality in hospitalized SSc patients. A recent systematic review of infections in connective tissue diseases found that most studies of infections were focused on people with lupus and only one study included people with SSc. Thus, knowledge gaps in the epidemiology of infections exist in SSc."  To analyze the incidence, time trends and outcomes of serious infections among patients with systemic sclerosis, Singh and co-author John D. Cleveland, MD, of the University of Alabama at Birmingham, studied data from the U.S. National Inpatient Sample. According to the researchers, this database includes a 20% stratified sample of discharge records from all participating community hospitals from all participating states, and is the largest publicly available, de-identified, all-payer inpatient health care cohort in the country. Focusing on data from 1998 to 2016, Singh and Cleveland studied the epidemiology, time trends and outcomes of five types of infections among hospitalized patients with systemic sclerosis. These included opportunistic infections, skin and soft-tissue infections, urinary tract infections, pneumonia and sepsis/bacteremia. In all, they identified and analyzed 61,615 cases in patients with systemic sclerosis and 49,904,955 in those without systemic sclerosis. The researchers then conducted multivariable-adjusted logistic regression analyses to examine the independent associations of healthcare use and in-hospital mortality factors.  Jasvinder A. Singh According to the researchers, the most common serious infections among hospitalized patients with systemic sclerosis during the study period were: pneumonia, at 45%; sepsis, at 32%; skin and soft-tissue infections, at 19%; urinary tract infections, with 3%; and opportunistic infections, at 3%. However, during the period from 2013 to 2014, sepsis surpassed pneumonia as the most common serious infection, and by 2015-2016, sepsis was 1.8 times more common than pneumonia. In addition, during the study period, hospital charges increased even as lengths of stay and in-hospital mortality decreased — overall and for each infection. Multivariable-adjusted analyses demonstrated that sepsis, being 80 years of age or older and having a Deyo-Charlson scoreof 2 or greater were associated with a significantly higher likelihood of healthcare use and in-hospital mortality. Meanwhile, Medicare or Medicaid insurance, Northeast location, urban teaching or non-teaching hospital and medium or large hospital bed size were associated with a significantly higher chance of healthcare use. "This epidemiological study of common, serious infections in hospitalized SSc patients, over time, can help clinicians understand the time-trends in serious infections overall and/or specific serious infections compared to each other and over time," Singh said. "Recognition of several modifiable independent risk factors for poorer outcomes in SSc patients hospitalized with serious infections can help the development and testing of new interventions for improving outcomes, and/or the institution of care pathways or algorithms in inpatient settings as quality improvement initiatives to improve outcomes and reduce associated mortality further."  |
| Posted: 26 Jul 2020 11:11 AM PDT  Effective Aug. 1, 2020, a booster dose of meningococcal conjugant vaccine (MenACWY) is required for students entering the 12th grade in public, private or religious schools in North Carolina. Students who do not meet this requirement may not be allowed to attend school until they receive the booster dose. The MenACWY vaccine helps protect against four common strains of meningococcal bacteria (A, C, W and Y) that cause diseases including infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia). "The MenACWY vaccine is the best protection against meningococcal disease, which most often affects young people," said Kelly Kimple, M.D., M.P.H., Chief of the Women's and Children's Health Section of the Division of Public Health. "It is vital that children and adolescents continue to receive all their immunizations on schedule to ensure they are fully protected against all vaccine-preventable diseases, including some of the major causes of meningitis." All 11- through 12-year-old adolescents should receive one dose of meningococcal conjugate vaccine. A booster dose of MenACWY should be given at age 16 for adolescents entering the 12th grade or by 17 years of age, whichever comes first. Adolescents who receive their first dose of MenACWY on or after their 16th birthday do not need a booster dose. There are two age-appropriate vaccines that meet this requirement and provide the necessary protection, Menactra® and Menveo®. If unsure, parents are urged to ask their child's immunizing provider if they are properly protected, or if an additional vaccine is needed. Teens and young adults are at increased risk for infection with meningococcal disease. Infection has two common outcomes: meningitis (infection of the lining of the brain and spinal cord) and sepsis (bloodstream infections). Symptoms include sudden onset of fever, headache and stiff neck. With bloodstream infection, symptoms also include a dark purple rash. About 1 of every 10 people who gets the disease dies from it. Even with treatment, an infection with meningococcal disease can lead to death within a few hours. In non-fatal cases, permanent disabilities can include loss of limbs, hearing loss and brain damage. The bacteria that cause this infection can spread when people have close contact with someone's saliva, such as through kissing, coughing or sharing eating utensils and cups. Recognizing the importance of immunization, Governor Roy Cooper has proclaimed July as Adolescent Immunization Awareness MonthOpen PDF in North Carolina. Now, more than ever, public health reminds us of the importance of continued routine vaccination to keep children healthy and avoid the risk of vaccine-preventable disease. For additional information on meningococcal disease and the updated meningococcal immunization (MenACWY) booster requirement, see the Frequently Asked Questions (FAQ) and our new fact sheet in EnglishOpen PDF or en EspañolOpen PDF. For more information on all vaccine requirements for 12th graders in North Carolina, go to www.immunize.nc.gov/schools. Contributed.   |
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