COVID-19-associated case fatality rates up to 48% were reported among nursing facility residents. During the first wave of the COVID-19 pandemic, routine SARS-CoV-2 testing in long-term care facilities in the Province of Salzburg and centralized hospitalization in the COVID-19 unit of the Paracelsus Medical University Salzburg (Austria) irrespective of symptoms was implemented. Baseline characteristics and the course of COVID-19 disease were assessed among hospitalized long-term care facility residents within the COVID-19 Registry of the Austrian Group Medical Tumor Therapy (AGMT; NCT04351529). Between the 24 of March and the 20 of April 2020, 50 COVID-19-positive residents were hospitalized. The median age was 84.5 years (range: 79-88) and the median number of comorbidities and baseline medication classes was 6 (IQR: 4-7) and 5 (IQR: 3-6), respectively. At admission, 31 residents (62%) were symptomatic, nine residents (18%) pre-symptomatic whereas ten residents (20%) remained asymptomatic. The 30-day mortality rate from hospitalization was 32% and significantly higher in symptomatic residents at admission when compared to asymptomatic residents including pre-symptomatic residents (48% [95% CI: 27-63%] versus 5% [95% CI: 0-15%], p=0.006). The Early Warning Score (EWS) at admission was associated with 30-day mortality: high risk: 100%, intermediate risk: 50% (95% CI: 0-78%), and low risk: 21% (95% CI: 7-32%) (p<0.001). In light of comparably low mortality rates between asymptomatic and pre-symptomatic hospitalized COVID-19-positive residents, we suggest the supply of comparable intensity and quality of monitoring and care in long-term care facilities as an alternative to immediate hospitalization upon a positive COVID-19 test in asymptomatic residents.
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http://dx.doi.org/10.1007/s11357-021-00352-y | DOI Listing |
JAMA Surg
December 2024
Department of Surgery, Stanford University School of Medicine, Stanford, California.
Importance: Surgical quality improvement efforts have largely focused on 30-day outcomes, such as readmissions and complications. Surgery may have a sustained impact on the health and quality of life of patients considered frail, yet data are lacking on the long-term health care utilization of patients with frailty following surgery.
Objective: To examine the independent association of preoperative frailty on long-term health care utilization (up to 24 months) following surgery.
Scand J Pain
January 2024
Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Jan Waldenströms Gata 35, 202 13 Malmö, Sweden.
Objectives: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.
View Article and Find Full Text PDFJ Manag Care Spec Pharm
December 2024
Health Economics and Value Assessment, Sanofi, Boston, MA.
Background: Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy. Caplacizumab is the only treatment approved by the European Medicines Agency and the US Food and Drug Administration for iTTP, to be given in combination with plasma exchange therapy (PEX) and immunosuppression (IS). The National Institute for Health and Care Excellence's independent appraisal committee assessed the cost-effectiveness of caplacizumab and concluded that the addition of caplacizumab to PEX+IS is cost-effective under a patient access scheme in the United Kingdom.
View Article and Find Full Text PDFJ Diabetes Res
December 2024
Liggins Institute, University of Auckland, Grafton 1142, Auckland, New Zealand.
In utero exposure to gestational diabetes mellitus (GDM) is associated with adverse long-term outcomes. Little is known about how mothers perceive these outcomes and the support they need for optimal outcomes for their children. We aimed to explore how women perceive the risk of adverse outcomes for their children exposed to GDM and the support they require for their optimal health.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
March 2024
Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Since the late 1980s, the standard approach for treating D-transposition of the great arteries has been the arterial switch operation (ASO), replacing the Mustard/Senning procedure. Although ASO has shown impressive long-term survival rates, recent case series have revealed late complications such as neoaortic dilation and coronary artery stenosis. New findings emphasize the need for comprehensive evaluation of coronary risk and a deeper understanding of the mechanisms leading to coronary artery stenosis and myocardial ischemia over the long term.
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