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Background and Aim: Kawasaki disease (KD) is a paediatric vasculitis with an unknown aetiology. The aim of this study was to assess the clinical course, treatment and cardiovascular outcomes in children with KD. The secondary purpose of this study was to make a com-parison with the Kawasaki-like disease Multisystem Inflammatory Syndrome in Children (MIS-C), which is triggered by SARS-CoV-2. Method(s): In this observational cohort study, clinical information from KD and MIS-C patients was collected. Data were described and a multivariate analysis was performed to identify risk factors for coronary artery aneurysms (CAAs). Clinical characteristics between KD and MIS-C were compared using chi-squared and Mann-Whitney U tests. Result(s): 1003 KD patients were included. The male-to-female ratio was 3:2, a majority of the patients were lt;5 years old (78.3%), treated with a single dose of intravenous immunoglobulin (IVIG) (90.8%) and treated promptly (lt;10 days) (81.7%). A second dose of IVIG was needed in minority of the patients (24.7%). The main complication of KD were CAAs and known risk factors (i.e., male, young age, delayed treatment) for CAAs were confirmed. A total of 35 MIS-C patients were included for the comparison. These patients were older than the KD patients (Plt;0.0005), more often had an incomplete KD presentation (Plt;0.0005). MIS-C patients mainly presented with acute cardiac dysfunction, with complete recovery after treatment. Conclusion(s): KD and MIS-C are severe post-infectious inflamma-tory diseases. Due to the risk of cardiovascular complications, vigi-lance and prompt treatment are advised to reduce risk of cardiovascular complications.
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AIM: The aim of this study was to examine the quality of manuscripts reporting sepsis health care costs and to provide an overview of hospital-related expenditures for sepsis in adult patients around the world. METHODS: We systematically searched the PubMed, EMBASE, Cochrane and Google Scholar to identify relevant studies between January 2010 and January 2022. We selected articles that provided costs and cost-effectiveness analyses, defined sepsis and described their cost calculation method. All costs were adjusted to 2020 US dollars. Medians and interquartile ranges (IQRs) for various costs of sepsis were calculated. The quality of economic studies was assessed using the Drummond 10-item checklist. RESULTS: Overall, 26 studies met our eligibility criteria. The mean total hospital costs per patient varied largely, between 1101 and 91,951. The median (IQR) of the total sepsis costs per country were 36,191 (17,158 - 53,349), which equals 50 (34 - 84) per capita annually. The relative amount of healthcare budget spent on sepsis was 2.65%, which equals 0.33% of the gross national product (GNP). CONCLUSION: While general sepsis costs are high, there is considerable variability between countries regarding the costs of sepsis. Further studies examining the impact on sepsis costs, especially on the general ward, can help justify, design and monitor initiatives on prevention, diagnosis, and treatment of this time-critical and potentially preventable disease.
Subject(s)
Hospital Costs , Sepsis , Adult , Financial Stress , Health Care Costs , Hospitals , Humans , Sepsis/therapyABSTRACT
Introduction: A subgroup of critically ill COVID-19 patients develops pulmonary fibroproliferation (PF), which is associated with worse outcomes. We explored the kinetics of fibrosis markers and ventilatory parameters prior to and following use of steroids to treat suspected PF. Furthermore, we investigated the effects of early dexamethasone (DEXA) treatment, the current standard-of-care for COVID-19, on the incidence and time to development of PF and clinical outcomes. Methods: We included 191 critically ill COVID-19 patients spanning two treatment cohorts: no DEXA treatment (pre-DEXA cohort, n = 67) and dexamethasone treatment as standard-of-care (DEXA cohort, n = 124). Kinetics of circulating fibrosis markers and ventilatory parameters were analyzed in suspected PF patients prior to and following initiation of steroid therapy as well as in patients in whom PF was not suspected. Furthermore, associations between PF and clinical outcomes were explored. Results: Patients with suspected PF exhibited higher circulating fibrosis markers, lower lung compliance and PaO2/FiO2 ratios, and increased dead space ventilation. Incidence of suspected PF was 28% in the pre-DEXA cohort and 25% in the DEXA cohort (p = 0.61), and time to development of suspected PF was also similar between cohorts (16 [12-21] vs. 19 [14-23] days from ICU admission, p = 0.11). Time on ventilator, LOS in ICU and mortality were significantly higher in suspected PF patients than in no suspected PF patients, with no differences between the cohorts (Fig. 1). Conclusions: Increased circulating fibrosis markers reflect development of PF in critically ill COVID-19 patients, which is associated with prolonged ICU length of stay and high mortality rates. Introduction of dexamethasone as standard-of-care is not associated with altered incidence of PF or improved clinical outcomes in patients with PF. (Figure Presented).
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BACKGROUND: In patients with severe polycystic liver disease (PLD), there is a need for new treatments. Estrogens and possibly other female sex hormones stimulate growth in PLD. In some patients, liver volume decreases after menopause. Female sex hormones could therefore be a target for therapy. The AGAINST-PLD study will examine the efficacy of the GnRH agonist leuprorelin, which blocks the production of estrogen and other sex hormones, to reduce liver growth in PLD. METHODS: The AGAINST-PLD study is an investigator-driven, multicenter, randomized controlled trial. Institutional review board (IRB) approval was received at the University Medical Center of Groningen and will be collected in other sites before opening these sites. Thirty-six female, pre-menopausal patients, with a very large liver volume for age (upper 10% of the PLD population) and ongoing liver growth despite current treatment options will be randomized to direct start of leuprorelin or to 18 months standard of care and delayed start of leuprorelin. Leuprorelin is given as 3.75 mg subcutaneously (s.c.) monthly for the first 3 months followed by 3-monthly depots of 11.25 mg s.c. The trial duration is 36 months. MRI scans to measure liver volume will be performed at screening, 6 months, 18 months, 24 months and 36 months. In addition, blood will be drawn, DEXA-scans will be performed and questionnaires will be collected. This design enables comparison between patients on study treatment and standard of care (first 18 months) and within patients before and during treatment (whole trial). Main outcome is annualized liver growth rate compared between standard of care and study treatment. Secondary outcomes are PLD disease severity, change in liver growth within individuals and (serious) adverse events. The study is designed as a prospective open-label study with blinded endpoint assessment (PROBE). DISCUSSION: In this trial, we combined the expertise of hepatologist, nephrologists and gynecologists to study the effect of leuprorelin on liver growth in PLD. In this way, we hope to stop liver growth, reduce symptoms and reduce the need for liver transplantation in severe PLD. Trial registration Eudra CT number 2020-005949-16, registered at 15 Dec 2020. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2020-005949-16 .
Subject(s)
Leuprolide , Liver Diseases , Cysts , Female , Humans , Leuprolide/therapeutic use , Liver Diseases/drug therapy , Multicenter Studies as Topic , Prospective Studies , Pyridoxal/analogs & derivatives , Randomized Controlled Trials as TopicABSTRACT
Organizations operate in a socio-economic context, and alignment with this context is key for business success. The rate of change and impact of these changes on the operating model of the organization appears to be increasing. Major trends are the aftermath of the financial crisis of 200S, the 'VUCA' aspects (volatility, uncertainty complexity, ambiguity), and the Covid-pandemic. The challenge for organizations is to become resilient or even antifragile to survive (unexpected) external stressors. Antifragility refers to a class of systems that do not deteriorate (fragile) or withstand (robust) stressors, but actually improve as a result of stressors. Our objective is to find attributes that are relevant for an organization to be(come) antifragile. The list of attributes found is based on an extensive survey of available literature, and is validated with domain experts and leaders of various organizations. We dub the list of attributes found the Extended Antifragile Attribute List (EAAL). Considering the current economic and social impact on organizations and people of the Covid-pandemic, the EAAL is relevant as well timely. The EAAL turns out to be extensive and holistic. We consider the EAAL to be a stepping stone in setting the scene of the domain of antifragility. We suspect that the EAAL might also be applied to generic system design including technology infrastructure and software systems. This exploration is part of future research. © 2021 IEEE.
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The need to promote academic activities in telehealth remains a high priority as the discipline expands into new areas of healthcare. Response during 2020 to the COVID-19 pandemic has provided an excellent example of the rapid diversification and impact attainable with telehealth, and may kindle a new momentum for accelerated service design and adoption processes in the future. This book, Telehealth Innovations in Remote Healthcare Services Delivery, is the tenth in the Global Telehealth series. Due to the prevailing COVID-19 pandemic and the restrictions placed on academic gatherings, the organizers issued a general call for contributions, with the intention of attracting a wide cross-section of contributions reflecting the breadth of different aspects of telehealth internationally. The resulting collection offers snapshots of research projects and studies of service experience from five continents, with an emphasis on delivering benefits in regional settings in keeping with the theme of the book's title. Articles range from descriptions of telehealth networks and clinical-service instances such as cardiac health, mental health and pathology, several in Pacific-rim settings, to more generic papers on the evolution of such services, as well as commentaries on innovative considerations for telehealth such as the emergence of the concept of virtual care, the suitability of health apps, and the status of eHealth readiness in the developing world. This book is a valuable contribution to the body of knowledge on current telehealth research interests and trends, and will be of interest to all those working in the field. © 2021 The authors and IOS Press. All rights reserved.