Real-World Implications of Updated Surviving Sepsis Campaign Antibiotic Timing Recommendations.

Objective: To evaluate real-world implications of updated Surviving Sepsis Campaign (SSC) recommendations for antibiotic timing.

Design: Retrospective cohort study.

Setting: Twelve hospitals in the Southeastern United States between 2017 and 2021.

Characterizing Program Delivery for an Effective Multicomponent Sepsis Recovery Intervention.

A recent randomized controlled trial revealed that a multicomponent sepsis transition and recovery (STAR) program delivered through specialized nurse navigators was effective in reducing a composite of 30-day readmission and mortality. Better understanding of patterns of care provided by the STAR program is needed to promote implementation and dissemination of this effective program. This study characterizes individual care activities and distinct "packages" of care delivered by the STAR program.

Passing the SNF Test: A Secondary Analysis of a Sepsis Transition Intervention Trial Among Patients Discharged to Post-Acute Care.

Objectives: Sepsis survivors discharged to post-acute care facilities experience high rates of mortality and hospital readmission. This study compared the effects of a Sepsis Transition and Recovery (STAR) program vs usual care (UC) on 30-day mortality and hospital readmission among sepsis survivors discharged to post-acute care.

Design: Secondary analysis of a multisite pragmatic randomized clinical trial.

Clinical Subtypes of Sepsis Survivors Predict Readmission and Mortality after Hospital Discharge.

Sepsis survivors experience adverse outcomes including high rates of postdischarge mortality and rehospitalization. Given the heterogeneity of the condition, using a person-centered framework to identify subtypes within this population with different risks of postdischarge outcomes may optimize postsepsis care. To classify individuals into subtypes and assess the association of subtypes with 30-day rehospitalization and mortality.

Deficits in Identification of Goals and Goal-Concordant Care After Sepsis Hospitalization.

In a recent study, identifying and supporting patients' care goals was named the highest priority in hospital medicine. Although sepsis is one of the leading causes of death and postdischarge morbidity among hospitalized patients, little is known about how frequently care goals are assessed prior to discharge and adhered to in the 90 days after sepsis hospitalization. Evaluating a cohort of 679 high-risk sepsis survivors enrolled in a clinical trial, we found that care goals were documented explicitly in a standardized tool in 130 patients; an additional 139 patients were identified using all available clinical documentation, resulting in only 269 (40%) patients with goals that could be ascertained from the electronic health record (EHR).

Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial.

Objectives: To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization.

Desig: n: Multisite pragmatic randomized clinical trial.

Setting: Three hospitals in North Carolina from January 2019 to March 2020.

First-to-second antibiotic delay and hospital mortality among emergency department patients with suspected sepsis.

Objective: To evaluate whether delay between the first and second antibiotic administered for suspected sepsis is associated with hospital mortality.

Design: Retrospective cohort.

Setting: Twelve hospitals in Southeastern United States from 2014 to 2017.

Resource Use by Hospital Type for Frequent Inpatient Pediatric Conditions.

Background: Children's hospitals (CHs) deliver care to underserved, critically ill, and medically complex patients. However, non-CHs care for the majority of children with frequently occurring conditions. In this study, we aimed to examine resource use across hospitals where children receive care for frequent inpatient conditions.

The Association Between Antibiotic Delay Intervals and Hospital Mortality Among Patients Treated in the Emergency Department for Suspected Sepsis.

Objectives: Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. We quantified time intervals comprising the task of antibiotic delivery and evaluated the association between interval delays and hospital mortality among patients treated in the emergency department for suspected sepsis.

Design: Retrospective cohort.

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation.

Prone positioning is an appealing therapeutic strategy for nonintubated hypoxic patients with coronavirus disease (COVID-19), but its effectiveness remains to be established in randomized controlled trials. To identify contextual factors relevant to the conduct of a definitive clinical trial evaluating a prone positioning strategy for nonintubated hypoxic patients with COVID-19. We conducted a cluster randomized pilot trial at a quaternary care teaching hospital.

Where Is the Implementation Science? An Opportunity to Apply Principles During the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic represents a global crisis that has received extraordinary response from healthcare workers and scientists. One critical but potentially overlooked field in a pandemic is implementation science-the study of methods to reduce the research-to-practice gap. In this Viewpoint, we discuss the important role of implementation science during this and future pandemics and highlight considerations to maximize the utility of implementation research.

Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study.

Background: Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities.

Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis.

Postsepsis care recommendations target specific deficits experienced by sepsis survivors in elements such as optimization of medications, screening for functional impairments, monitoring for common and preventable causes of health deterioration, and consideration of palliative care. However, few data are available regarding the application of these elements in clinical practice. To quantify the delivery of postsepsis care for patients discharged after hospital admission for sepsis and evaluate the association between receipt of postsepsis care elements and reduced mortality and hospital readmission within 90 days.

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.

Objectives: Evaluate the accuracy of the quick Sequential Organ Failure Assessment tool to predict mortality across increasing levels of comorbidity burden.

Design: Retrospective observational cohort study.

Setting: Twelve acute care hospitals in the Southeastern United States.

Association between Time on Protease Inhibitors and the Incidence of Squamous Cell Carcinoma of the Anus among U.S. Male Veterans.

Protease inhibitors (PIs) have been shown to have anti-tumor activity in addition to their antiretroviral properties. We sought to assess the association between PI use and the incidence of squamous cell carcinoma of the anus (SCCA) in HIV-infected individuals. We performed a retrospective cohort study among male US veterans diagnosed with HIV who were diagnosed between 1985 and 2010, using the Veterans Affairs HIV Clinical Case Registry (CCR).

Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home.

Purpose: Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives.

Methods: We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child's primary care practice completed the Medical Home Index (MHI) self-assessment.

Use of boosted protease inhibitors reduces Kaposi sarcoma incidence among male veterans with HIV infection.

Background: Kaposi sarcoma (KS) incidence has decreased since combination antiretroviral therapy (cART). However, effects of cART type and duration on KS remain difficult to interpret secondary to KS-associated immune reconstitution inflammatory syndrome (IRIS).

Methods: We performed a retrospective study of Veterans Affairs Human Immunodeficiency Virus Clinical Case Registry data from 1985 to 2010.

The effect of HIV viral control on the incidence of hepatocellular carcinoma in veterans with hepatitis C and HIV coinfection.

Background: HIV increases the risk of progression to hepatic fibrosis and cirrhosis among individuals coinfected with hepatitis C virus (HCV). However, the impact of HIV-related immune suppression on the risk of hepatocellular carcinoma (HCC) is currently unknown.

Methods: We used the Veterans Affairs HIV Clinical Case Registry to identify patients with HIV infection between 1985 and 2010 and HCV coinfection (positive HCV RNA or genotype test) between 1995 and 2010.

Examining sexual dysfunction in non-muscle-invasive bladder cancer: results of cross-sectional mixed-methods research.

Introduction: More than 70,000 new cases of bladder cancer are diagnosed in the United States annually; with 75% being non-muscle-invasive (NMIBC). Research examining sexual dysfunction in bladder cancer survivors is limited, and previous studies have focused on cystectomy patients.

Aims: To evaluate the impact of sexual dysfunction on NMIBC survivors.

Trends in hospitalizations and resource utilization for pediatric pertussis.

Background And Objective: Pertussis is a serious and preventable childhood illness often necessitating hospitalization. The objective was to describe national trends in pediatric pertussis hospitalizations and resource utilization and factors associated with increased length of stay (LOS).

Methods: This was a cross-sectional analysis of the 1997 to 2009 Healthcare Cost and Utilization Project Kids' Inpatient Databases.