RESUMO
The Surviving Sepsis Campaign recommends standard operating procedures for patients with sepsis. Real-world evidence about sepsis order set implementation is limited. OBJECTIVES: To estimate the effect of sepsis order set usage on hospital mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Fifty-four acute care hospitals in the United States from December 1, 2020 to November 30, 2022 involving 104,662 patients hospitalized for sepsis. MAIN OUTCOMES AND MEASURES: Hospital mortality. RESULTS: The sepsis order set was used in 58,091 (55.5%) patients with sepsis. Initial mean sequential organ failure assessment score was 0.3 lower in patients for whom the order set was used than in those for whom it was not used (2.9 sd [2.8] vs 3.2 [3.1], p < 0.01). In bivariate analysis, hospital mortality was 6.3% lower in patients for whom the sepsis order set was used (9.7% vs 16.0%, p < 0.01), median time from emergency department triage to antibiotics was 54 minutes less (125 interquartile range [IQR, 68-221] vs 179 [98-379], p < 0.01), and median total time hypotensive was 2.1 hours less (5.5 IQR [2.0-15.0] vs 7.6 [2.5-21.8], p < 0.01) and septic shock was 3.2% less common (22.0% vs 25.4%, p < 0.01). Order set use was associated with 1.1 fewer median days of hospitalization (4.9 [2.8-9.0] vs 6.0 [3.2-12.1], p < 0.01), and 6.6% more patients discharged to home (61.4% vs 54.8%, p < 0.01). In the multivariable model, sepsis order set use was independently associated with lower hospital mortality (odds ratio 0.70; 95% CI, 0.66-0.73). CONCLUSIONS AND RELEVANCE: In a cohort of patients hospitalized with sepsis, order set use was independently associated with lower hospital mortality. Order sets can impact large-scale quality improvement efforts.
RESUMO
BACKGROUND: Individuals with diabetes are using social media as a method to share and gather information about their health via the diabetes online community. Infoveillance is one methodological approach to examine health care trends. However, infoveillance, while very effective in identifying many real-world health trends, may miss opportunities that use photographs as primary sources for data. We propose a new methodology, photosurveillance, in which photographs are analyzed to examine real-world trends. OBJECTIVE: The purpose of this research is to (1) assess the use of photosurveillance as a research method to examine real-world trends in diabetes and (2) report on real-world use of continuous glucose monitoring (CGM) on Instagram. METHODS: This exploratory mixed methods study examined all photographs posted on Instagram that were identified with the hashtag #dexcom over a 3-month period-December 2016 to February 2017. Photographs were coded by CGM location on the body. Original posts and corresponding comments were textually coded for length of CGM device wear and CGM failure and were analyzed for emerging themes. RESULTS: A total of 2923 photographs were manually screened; 12.08% (353/2923) depicted a photograph with a CGM site location. The majority (225/353, 63.7%) of the photographs showed a CGM site in an off-label location, while 26.2% (92/353) were in an FDA-approved location (ie, abdomen) and 10.2% (36/353) were in an unidentifiable location. There were no significant differences in the number of likes or comments based on US Food and Drug Administration (FDA) approval. Five themes emerged from the analysis of original posts (N=353) and corresponding comments (N=2364): (1) endorsement of CGM as providing a sense of well-being; (2) reciprocating information, encouragement, and support; (3) reciprocating CGM-related frustrations; (4) life hacks to optimize CGM use; and (5) sharing and learning about off-label CGM activity. CONCLUSIONS: Our results indicate that individuals successfully used CGM in off-label locations, posting photos of these areas with greater frequency than of the abdomen, with no indication of sensor failure. While these photographs only capture a snapshot in time, these posts can be used to inform providers and industry leaders of real-world trends in CGM use. Additionally, there were instances in which sensors were worn beyond the FDA-approved 7-day period; however, they represented the minority in this study.
RESUMO
The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.
