ABSTRACT
To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.
ABSTRACT
Study Objectives: Emergency department (ED) chief complaint data has several potential applications, including quality measurement, syndromic surveillance, operations, research, and education. However, there are no consistent methods to categorize ED chief complaints or evaluate their association with other ED outcomes, which has limited the utility of this type of data. To advance chief complaint data standardization, we report the initial results of a novel national ED chief complaint dataset under development in the Veteran Health Administration (VA). We identified common presenting ED chief complaints, characterized their associations with an ED discharge diagnosis of an emergent condition, and related admission rates. Method(s): This was a retrospective observational study of VA ED visits in FYs 2018-2020. A Natural Language Processing (NLP) program based on cTAKES, an Apache open source project, was applied to the original text of VA ED chief complaints. Results were mapped to Concept Unique Identifiers (CUI) in the Unified Medical Language System (UMLS). Multiple concepts could be identified from a chief complaint text entry. ED discharge diagnoses were defined by ICD-10 codes. Emergent diagnoses were selected based on a previously established list of codes for Emergency Care Sensitive Conditions (ECSCs), which are acute illnesses that require timely, quality emergency care to improve morbidity and mortality. Result(s): A total of 5,898,684 VA ED visits were identified with at least one ED chief complaint and a discharge diagnosis. 59% of visits had 1 chief complaint concept, 26% of visits had 2 concepts, 10% had 3 concepts, 4% had 4 concepts, and 1% had 5 concepts. The 10 most common chief complaints, associated rates of an ECSC discharge diagnosis, and respective admission rates for both ECSC and non-ECSC ED visits are depicted in Table 1. Among the most common chief complaints, dyspnea had a majority of ED visits with an ECSC diagnosis, likely due to the COVID-19 pandemic. Otherwise, rates of ECSC visits varied from 24% (coughing) to 5% (back pain). However, admission rates for ECSC visits ranged from 67% (abdominal pain) to 15% (pharmaceutical preparations). Conclusion(s): To our knowledge, this national ED chief complaint dataset is the largest in the country, and representative of a diverse patient population (ie by age, region, rurality). Initial work has highlighted areas for refinement of this dataset. Further work is ongoing to examine combinations of chief complaints to better predict ECSC diagnosis and admission rate given the variation in initial findings. Additionally, ongoing work to improve context detection and reduce mapping errors is underway, and will improve utility in multiple applications. [Formula presented] No, authors do not have interests to disclose Copyright © 2022
ABSTRACT
This was presented as the Food Systems Theme highlight. Diet related inequalities in the UK food system have been exacerbated by the Covid-19 pandemic, with low-income families experiencing more food insecurity(1) and purchasing less fruit and vegetables(2). To improve access to affordable and nutritious foods, UK supermarkets voluntarily increased weekly 4.25 Healthy Start voucher (HSV) amounts. Notably, one supermarket provided an additional 2 top- up voucher, redeemable against fruit and vegetables (FV) from 15th February - 31st August 2021. Investigating supermarket loyalty card transaction records, this study aimed to assess how increased HSV value affected FV purchases. Loyalty card transaction and redemption records from 150 opted in regular shoppers living in the Yorkshire and the Humber region and engaging in the HSV scheme were analysed. 133 of these shoppers' records were assessed from two equivalent time periods to the scheme in 2019 and 2020 and were analysed using a pre-post study design. The vouchers could be used on four different FV categories, plain fresh and prepared fruit and vegetables, and plain frozen, canned and packaged fruit and vegetables, according to internal definitions. The purchasing patterns of other FV were also analysed. Wilcoxon matched-pairs signed-rank tests were used to compare purchasing behaviour within the scheme period at a basket level, and against pre-scheme periods ata household level. A Spearman's Rho test was used to assess the association between behaviour and level of deprivation around stores. Examining 21,707 transactions from 133 households for 20 months before and during the scheme, showed that 0.8 more portions of FV per day per household were purchased during the scheme period compared to 2019 (pre-pandemic) baseline (2.6 in 2019 to 3.4 in 2021;P = 0.0017). The percentage of total FV weights within total food and drink baskets also increased by 1.6% (P = 0.0242), although the percentage of total FV spend did not change. Within the scheme period, 0.4% (P = 0.0012) and 1.6% (P = 0.0062) more FV was purchased according to price and weight respectively in top-up redeeming baskets compared to baskets with at least one FV item. This finding was associated with 5.5 more FV portions in top-up redeeming baskets during the scheme period (P < 0.0001). There was a higher proportion of top-up redeeming baskets in stores located in more deprived areas (r = -0.3288, P = 0.0373).In conclusion, this study provides novel data into how low-income households shop and how an increased HSV amount is associated with FV purchases. The data show that low-income families purchased more FV when supplied with an additional 2 to their HSV and provides evidence for a benefit to increasing support given to low-income families.