Browsing by Subject "trends"
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Item Open Access Contemporary trends and predictors of postacute service use and routine discharge home after stroke.(J Am Heart Assoc, 2015-02-23) Prvu Bettger, Janet; McCoy, Lisa; Smith, Eric E; Fonarow, Gregg C; Schwamm, Lee H; Peterson, Eric DBACKGROUND: Returning home after the hospital is a primary aim for healthcare; however, additional postacute care (PAC) services are sometimes necessary for returning stroke patients to their pre-event status. Recent trends in hospital discharge disposition specifying PAC use have not been examined across age groups or health insurance types. METHODS AND RESULTS: We examined trends in discharge to inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without services for 849 780 patients ≥18 years of age with ischemic or hemorrhagic stroke at 1687 hospitals participating in Get With The Guidelines-Stroke. Multivariable analysis was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH) versus discharge home without services. From 2003 to 2011, there was a 2.1% increase (unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%, respectively. The 2 strongest clinical predictors of PAC use after acute care were patients not ambulating on the second day of their hospital stay (ambulation odds ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37 to 2.59). CONCLUSIONS: Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes.Item Open Access Influence of Modes of Climate Variability on Global Precipitation Extremes(2010) Kenyon, Jesse; Hegerl, Gabriele CThe probability of climate extremes is strongly affected by atmospheric circulation This study quantifies the worldwide influence of three major modes of circulation on station based indices of intense precipitation the El Nino-Southern Oscillation the Pacific interdecadal variability as characterized by the North Pacific index (NPI) and the North Atlantic Oscillation Northern Annular Mode The study examines which stations show a statistically significant (5%) difference between the positive and negative phases of a circulation regime Results show distinct regional patterns of response to all these modes of climate variability however precipitation extremes are most substantially affected by the El Nino-Southern Oscillation The effects of the El Nino-Southern Oscillation are seen throughout the world, including in India Africa South America, the Pacific Rim North America and weakly Europe The North Atlantic Oscillation has a strong continent wide effect on Eurasia and affects a small but not negligible percentage of stations across the Northern Hemispheric midlatitudes This percentage Increases slightly if the Northern Annular Mode Index is used rather than the NAO index In that case a region of increase in intense precipitation can also be found in Southeast Asia The NPI influence on precipitation extremes is similar to the response to El Nino and strongest in landmasses adjacent to the Pacific Consistently indices of more rare precipitation events show a weaker response to circulation than indices of moderate extremes, the results are quite similar but of opposite sign for negative anomalies of the circulation indicesItem Open Access Lessons Learned from the Anaerobe Survey: Historical Perspective and Review of the Most Recent Data (2005-2007)(2010) Snydman, David R; Jacobus, Nilda V; McDermott, Laura A; Golan, Yoav; Hecht, David W; Goldstein, Ellie JC; Harrell, Lizzie; Jenkins, Stephen; Newton, Duane; Pierson, Carl; Rihs, John D; Yu, Victor L; Venezia, Richard; Finegold, Sydney M; Rosenblatt, Jon E; Gorbach, Sherwood LBackground. The rationale and lessons learned through the evolution of the National Survey for the Susceptibility of Bacteroides fragilis Group from its initiation in 1981 through 2007 are reviewed here. The survey was conceived in 1980 to track emerging antimicrobial resistance in Bacteroides species. Methods. Data from the last 11 years of the survey (1997-2007), including 6574 isolates from 13 medical centers, were analyzed for in vitro antimicrobial resistance to both frequently used and newly developed anti-anaerobic agents. The minimum inhibitory concentrations of the antibiotics were determined using agar dilution in accordance with Clinical and Laboratory Standards Institute recommendations. Results. The analyses revealed that the carbapenems (imipenem, meropenem, ertapenem, and doripenem) and piperacillin-tazobactam were the most active agents against these pathogens, with resistance rates of 0.9%-2.3%. In the most recent 3 years of the survey (2005-2007), resistance to some agents was shown to depend on the species, such as ampicillin-sulbactam against Bacteroides distasonis (20.6%) and tigecycline against Bacteroides uniformis and Bacteroides eggerthii (similar to 7%). Very high resistance rates (>50%) were noted for moxifloxacin and trovafloxacin, particularly against Bacteroides vulgatus. During that period of study, non-B. fragilis Bacteroides species had >40% resistance to clindamycin. Metronidazole-resistant Bacteroides strains were also first reported during that period. Conclusions. In summary, resistance to antibiotics was greater among non-B. fragilis Bacteroides species than among B. fragilis and was especially greater among species with a low frequency of isolation, such as Bacteroides caccae and B. uniformis. The emergence of resistance among the non-B. fragilis Bacteroides species underscores the need for speciation of B. fragilis group isolates and for clinicians to be aware of associations between species and drug resistance.