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Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices?A retrospective study

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World Journal of Gastroenterology 2021年第25期27卷 3877-3887页

作者： Sonali Palchaudhuri Ishita Dhawan Afshin Parsikia Edo Y Birati Joyce Wald Shazia Mehmood Siddique Laurel R Fisher Division of Gastroenterology and Hepatology University of PennsylvaniaPhiladelphiaPA 19104United States Division of Cardiovascular Medicine University of PennsylvaniaPhiladelphiaPA 19104United States

BACKGROUND Patients with left ventricular assist devices(LVADs)are at increased risk for recurrent gastrointestinal bleeding(GIB)and repeat endoscopic *** assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent *** To evaluate for an association between endoscopic intervention and subsequent *** aims were to assess the frequency of GIB in our cohort,describe GIB presentations and sources identified,and determine risk factors for recurrent *** We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011–December 2018 and assessed all hospital encounters for GIB through December *** performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures *** performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent *** In the cohort of 295 patients,97(32.9%)had at least one GIB hospital *** were 238 hospital encounters,with 55.4%(132/238)within the first year of LVAD *** resolved on its own by discharge in 69.8%(164/235)*** GIB occurred in 55.5%(54/97)of patients,accounting for 59.2%(141/238)of all *** the 85.7%(204/238)of encounters that included at least one endoscopic evaluation,an endoscopic intervention was performed in 34.8%(71/204).The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant(odds ratio 1.18,P=0.58).CONCLUSION Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic *** this retrospective cohort study,adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB,thus suggesting the uniqueness of the LVAD pop

关键词： Gastrointestinal bleeding Left ventricular-assist device Endoscopic intervention,Inpatient care hospital readmissions Recurrent bleeding

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Predictive modeling of 30-day readmission risk of diabetes patients by logistic regression,artificial neural network,and EasyEnsemble

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Asian Pacific Journal of Tropical Medicine 2021年第9期14卷 417-428页

作者： Xiayu Xiang Chuanyi Liu Yanchun Zhang Wei Xiang Binxing Fang School of Cyberspace Security Beijing University of Posts and TelecommunicationsBeijingChina School of Computer Science and Technology Harbin Institute of Technology(Shenzhen)ShenzhenChina Institute for Sustainable Industries and Liveable Cities Victoria UniversityMelbourneAustralia Key Laboratory of Tropical Translational Medicine of Ministry of Education Hainan Medical UniversityHaikouChina NHC Key Laboratory of Control of Tropical Diseases Hainan Medical UniversityHaikouChina Cyberspace Security Research Center Peng Cheng LaboratoryShenzhenChina

Objective:To determine the most influential data features and to develop machine learning approaches that best predict hospital readmissions among patients with ***:In this retrospective cohort study,we surveyed patient statistics and performed feature analysis to identify the most influential data features associated with *** of all-cause,30-day readmission outcomes were modeled using logistic regression,artificial neural network,and Easy Ensemble.F1 statistic,sensitivity,and positive predictive value were used to evaluate the model ***:We identified 14 most influential data features(4 numeric features and 10 categorical features)and evaluated 3 machine learning models with numerous sampling methods(oversampling,undersampling,and hybrid techniques).The deep learning model offered no improvement over traditional models(logistic regression and Easy Ensemble)for predicting readmission,whereas the other two algorithms led to much smaller differences between the training and testing ***:Machine learning approaches to record electronic health data offer a promising method for improving readmission prediction in patients with *** more work is needed to construct datasets with more clinical variables beyond the standard risk factors and to fine-tune and optimize machine learning models.

关键词： Electronic health records hospital readmissions Feature analysis Predictive models Imbalanced learning Diabetes

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Randomized intervention and outpatient follow-up lowers 30-d readmissions for patients with hepatic encephalopathy,decompensated cirrhosis

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World Journal of Hepatology 2023年第6期15卷 826-840页

作者： Antoinette Pusateri Kevin Litzenberg Claire Griffiths Caitlin Hayes Bipul Gnyawali Michelle Manious Sean G Kelly Lanla F Conteh Sajid Jalil Haikady N Nagaraja Khalid Mumtaz Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States The Ohio State University College of Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Gastroenterology and Hepatology The Ohio State Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics The Ohio State UniversityColumbusOH 43210United States

BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary *** Adults with DC admitted July 2019 to December 2020 were enrolled and randomized into the intervention(INT) or standard of care(SOC) arms. Weekly phone calls for a month were completed. In the INT arm, case managers ensured outpatient follow-up, paracentesis, and medication compliance. Thirty-day readmission rates and reasons were *** Calculated sample size was not achieved due to coronavirus disease 2019;240 patients were randomized into INT and SOC arms. 30-d readmission rate was 33.75%, 35.83% in the INT vs 31.67% in the SOC arm(P = 0.59). The top reason for 30-d readmission was hepatic encephalopathy(HE, 32.10%). There was a lower rate of 30-d readmissions for HE in the INT(21%) vs SOC arm(45%, P = 0.03). There were fewer 30-d readmissions in patients who attended early outpatient follow-up(n = 17, 23.61% vs n = 55, 76.39%, P = 0.04).CONCLUSION Our 30-d readmission rate was higher than the national rate but reduced by interventions in patients with DC with HE and early outpatient follow-up. Development of interventions to reduce early readmission in patients with DC is needed.

关键词： Decompensated cirrhosis hospital readmissions Interventions

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High Severity of Illness Patients in a Small Metropolitan Area

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Open Journal of Nursing 2016年第3期6卷 186-192页

作者： Ronald Lagoe Louise Pernisi Shelly Littau hospital Executive Council Syracuse NY USA Upstate University hospital—SUNY UMU NY USA

This study evaluated the impact of high severity of illness patients on hospital utilization in the metropolitan area of Syracuse, New York between 2012 and 2015. It employed the All Patients Refined Severity of Illness system developed by 3M™ Health Information Systems. These patients are important for the management and practice of nursing in acute hospitals. The study demonstrated that patients at extreme and major severity of illness generated 60 - 70 percent of the inpatient days for adult medicine and adult surgery in the combined Syracuse hospitals. Mean lengths of stay for patients at extreme severity of illness were two to four times the stays for these services. Inpatient readmission rates for extreme severity of illness patients were more than double the rates for these services. The study data also indicated that the impact of patients at high severity of illness was increasing over time. The study also demonstrated that recent efforts of the Syracuse hospitals have produced reductions in the numbers of excess patient days for adult medicine and surgery, but limited reductions in the mean lengths of stay for these patients. The data suggested that meeting the needs of these patients is especially challenging in a small metropolitan area without an additional level of care within the continuum.

关键词： hospitals Severity of Illness hospital Lengths of Stay hospital readmissions

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Estimating the Potential for Reduction of hospital Capacity at the Community Level

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Advances in Bioscience and Biotechnology 2016年第4期7卷 225-231页

作者： Ronald Lagoe Shelly Littau hospital Executive Council Syracuse NY USA

This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study employed the 3MTM All Patients Refined Diagnosis Group Severity of Illness system to identify inpatients and related utilization with the greatest potential for movement from inpatient to outpatient settings. The study data suggested that the development of additional ambulatory care capacity in Syracuse could support the reduction of an average daily census of approximately 60 - 125 patients with low severity of illness, excluding readmissions. The study data also identified the potential for shifting an average daily census of approximately 9 - 19 patients who were readmitted to hospitals within 30 days of their initial admissions from inpatient to outpatient care. The study data also identified the potential for reduction of an average daily census of approximately 20 - 70 adult medicine and adult surgery patients through continued initiatives for inpatient length of stay reduction. The impact of initiatives in each of these areas could result in a reduction of the combined average daily adult medicine and adult surgery census of the Syracuse hospitals from approximately 90 to 215 patients. This would amount to between 8 and 20 percent of the current inpatient census for adult medicine and adult surgery. These data suggest that planning for initiatives such as ambulatory care development and reduction of readmissions should also include evaluation of their impact on inpatient acute care and related services.

关键词： hospital Utilization hospital Admissions hospital readmissions hospital Lengths of Stay

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