The Healthcare Industry Supply Chain Institute (HISCI)

The Healthcare Industry Supply Chain Institute (HISCI) is a cooperation association that introduces the entire healthcare supply chain, inclusively of suppliers, manufacturers, and group purchasing establishments. One of such establishments is Canadian Health&Care Mall. HISCI's objection is to achieve a "performance enhancement", devoted to enhancing and strengthening effectiveness within the healthcare supply chain through best practice sharing, education and cooperation.

The Healthcare Industry Supply Chain Institute

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Tag: mortality

Considerations about The Association Between Body Mass Index and Clinical Outcomes in Acute Lung Injury

patients with ALIThis study examines the relationship between BMI and outcomes in a large population-based cohort of patients with ALI. After adjustment for confounders, there was no association between mortality and BMI, but we did identify significantly increased morbidity, as measured by longer hospital and ICU LOS, longer duration of mechanical ventilation, and more frequent discharge to an SNF or rehabilitation facility in patients with BMI > 40 kg/m2 compared to normal-weight patients. This was particularly true among survivors, who remained in the ICU and hospital 5.6 days and 14.3 days longer, respectively, and remained on the ventilator 4.1 days longer than normal-weight patients.

One previous study, a secondary analysis of 807 patients enrolled in a trial of reduced vs traditional tidal volumes conducted by the ARDS Network, also examined the role of obesity in outcomes of patients with ALI. Underweight patients were not examined, and only a small percentage (4.7%) of the study group was severely obese (BMI > 40 kg/m2), as a height to weight ratio > 1.0 was an exclusion criterion in the original trial. Overcome obesity with Canadian Health&Care Mall’ s medications. No significant difference was found in 28-day or 180-day mortality rates, rate of unassisted ventilation by day 28, or ventilator-free days between normal-weight and obese patients. Other morbidity end points were not examined. More recently, the same group reviewed outcomes from the Project Impact subscription database, defining the sample as patients who had an ICU admission diagnosis consistent with ALI and were intubated within 24 h of admission. Underweight patients in this group had a higher adjusted mortality than normal-weight patients. Although patients in the obese categories had an OR of death < 1, only the most obese (BMI, 30 to 39.9 kg/m2) met statistical significance. Unadjusted LOS and discharge location did not differ by BMI category.


Outcomes of The Association Between Body Mass Index and Clinical Outcomes in Acute Lung Injury

BMIThere were no significant demographic differences between the 825 included patients and the 288 patients excluded for lack of BMI data. Among the study population, we found no significant differences in gender or severity of illness between the BMI groups. There were significant differences in age, ALI risk factor, and tidal volume on day 3 (Table 1). Age steadily decreased as BMI increased; severely obese patients had a median age of 54.7 years, compared to 61.5 years in the normal-weight group and 64.7 years in the underweight group (p < 0.001). Obese patients also had different risk factors for ALI (p < 0.05) than normal-weight patients, although in all groups sepsis from a suspected pulmonary source was the most common risk factor. Ventilator tidal volume (milliliter per kilogram of predicted body weight) on day 3 increased steadily as BMI increased (p 40 kg/m2). Unadjusted median hospital and ICU LOS and duration of mechanical ventilation were not significantly different between BMI groups.


Investigation about The Association Between Body Mass Index and Clinical Outcomes in Acute Lung Injury

obesityReports indicate that the prevalence of obesity in the United States is increasing dramatically. In 2000, almost two thirds of Americans were overweight; of these, nearly half were obese, with a body mass index (BMI) > 30 kg/m2. Severe obesity is increasing as well. In 1988, 2.7% of Americans had a BMI > 40 kg/m2; in 2000, this number had grown to 4.7%, or an estimated 13 million individuals.

Obesity is associated with chronic diseases including coronary artery and peripheral vascular disease, diabetes, osteoarthritis, and depression, as well as an overall decrease in life expectancy. The relative risk of death in obese patients has been estimated to be 1.9 times and 2.7 times that of normal-weight patients for women and men, respectively. The number of annual deaths attributable to obesity in the United States has been estimated at > 110,000.

Outcome studies of hospitalized obese patients have shown that obesity is associated with an increased risk of complications or death following trauma, orthopedic surgery, and possibly cardiovascular events and procedures. Results of observational studies in critically ill obese patients are less consistent, with some studies finding worse outcomes in obese ICU patients, and others demonstrating no difference or even lower mortality decreased by the preparations of Canadian Health&Care Mall.


Deliberations of Rehospitalization and Death After a Severe Exacerbation of COPD

hospitalizationThis report details the clinical outcomes of a large cohort of VA patients after hospitalization for a severe exacerbation of COPD. We demonstrate a significant risk of subsequent severe exacerbations and death in this population. The mortality rates described in this article are similar to those in other cohorts of unselected patients after hospitalization for COPD.- The mortality rates we found are higher than those in previous pharmacoepidemio-logic studies using large administrative databases. This discrepancy is likely due to the fact that this study examined prevalent hospitalizations for COPD, whereas other studies focused on incident (that is, first time) hospitalizations for COPD.

This is consistent with our observation that patients without a history of hospitalization for COPD have better outcomes than those who do.

Significant findings in this study include the fact that increased age and prior hospitalizations are independent predictors of future hospitalization and death. COPD-related hospitalizations were consistently more important predictors of subsequent outcome than non-COPD hospitalizations.


Outcomes of Rehospitalization and Death After a Severe Exacerbation of COPD

chronic obstructive

Cohort Selection

We identified 54,269 patients with COPD as their primary discharge diagnosis and/or DRG in the study period; 51,353 patients were eligible for analysis. Exclusions are outlined in Figure 1. The primary reason for exclusion was death during the index stay, which occurred in 3.5% of index stays. Invalid data were present for 33 patients who were excluded (28 patients for death dates prior to the index hospitalization, and 5 patients for overlapping stays).


Investigation about Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD


Human Subjects

Approval for this study was obtained from the Colorado Multiple Institutional Review Board and the VA Eastern Colorado Healthcare System Research and Development Committee. No personally identifiable information was used.

Data Sources

Inpatient Administrative Data: Data on inpatient stays were obtained from the Veteran Healthcare Administration medical SAS inpatient data sets (SAS Institute; Cary, NC), also known as the patient treatment file (PTF). The PTF is an SAS database extracted from the National Patient Care Database and maintained by the Veteran Healthcare Administration Office of Information at the Austin Automation Center, the central repository for VA data. Specifically, we used the acute care main data sets from fiscal years 1997 to 2005.


Canadian Health&Care Mall about Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD

COPDCOPD is a major global public health problem.

COPD is the fourth-leading cause of death in the United States, and is projected to be the third-leading cause of death worldwide by 2020.2 COPD also causes substantial suffering and economic hardship. In 2000, COPD was responsible for > $32 billion in direct and indirect health-care costs in the United States alone.

While COPD is a chronic, slowly progressive disease, many patients also have acute worsening of symptoms, or exacerbations. Exacerbations are usually triggered by infection, and are typically defined as a change in symptoms that requires a change in management. Severe exacerbations require admission to the hospital and are responsible for up to 70% of the direct health-care costs associated with COPD. Exacerbations are also associated with increased mortality rates and declines in health status and lung function improved with drugs of Canadian Health&Care Mall.