Abstract
Background
Protection afforded from prior disease among patients with coronavirus disease 2019 (COVID-19) infection is unknown. If infection provides substantial long-lasting immunity, it ...may be appropriate to reconsider vaccination distribution.
Methods
This retrospective cohort study of 1 health system included 150 325 patients tested for COVID-19 infection via polymerase chain reaction from 12 March 2020 to 30 August 2020. Testing performed up to 24 February 2021 in these patients was included. The main outcome was reinfection, defined as infection ≥90 days after initial testing. Secondary outcomes were symptomatic infection and protection of prior infection against reinfection.
Results
Of 150 325 patients, 8845 (5.9%) tested positive and 141 480 (94.1%) tested negative before 30 August. A total of 1278 (14.4%) positive patients were retested after 90 days, and 62 had possible reinfection. Of those, 31 (50%) were symptomatic. Of those with initial negative testing, 5449 (3.9%) were subsequently positive and 3191 of those (58.5%) were symptomatic. Protection offered from prior infection was 81.8% (95% confidence interval CI, 76.6–85.8) and against symptomatic infection was 84.5% (95% CI, 77.9–89.1). This protection increased over time.
Conclusions
Prior infection in patients with COVID-19 was highly protective against reinfection and symptomatic disease. This protection increased over time, suggesting that viral shedding or ongoing immune response may persist beyond 90 days and may not represent true reinfection. As vaccine supply is limited, patients with known history of COVID-19 could delay early vaccination to allow for the most vulnerable to access the vaccine and slow transmission.
Patients with a confirmed history of infection with severe acute respiratory syndrome coronavirus 2 are less likely to be retested or reinfected more than 90 days after their initial infection. Protectiveness of prior infection against subsequent infection is high.
Complications of seasonal and pandemic influenza Rothberg, Michael B; Haessler, Sarah D
Critical care medicine,
2010-April, Volume:
38 Suppl, H1N1 Novel Influenza: Pandemic Issues for Critical Care Practitioners, Issue:
4 Suppl
Journal Article
Peer reviewed
Open access
Influenza is a seasonal viral infection associated with significant morbidity and mortality. In 2009, a novel H1N1 influenza A virus emerged and has been classified as a pandemic. In contrast to ...seasonal influenza, severe disease from pandemic H1N1 seems concentrated in older children and young adults, with almost no cases reported in patients older than 60 yrs. Although patients with underlying cardiopulmonary disease remain at risk, most complications have occurred among previously healthy individuals, with obesity and respiratory disease as the strongest risk factors. Pulmonary complications are common. Primary influenza pneumonia occurs most commonly in adults and may progress rapidly to acute lung injury requiring mechanical ventilation. Secondary bacterial infection is more common in children. Staphylococcus aureus, including methicillin-resistant strains, is an important cause of secondary bacterial pneumonia with a high mortality rate. Treatment of pneumonia should include empirical coverage for this pathogen. Neuromuscular and cardiac complications are unusual but may occur.
This study assesses the association between antibiotic prescribing for respiratory tract infections and satisfaction ratings among patients using a direct-to-consumer telemedicine platform.
OBJECTIVES:To assess trends in number of hospitalizations, outcomes, and costs of severe sepsis in the United States.
DESIGN:Temporal trends study using the Nationwide Inpatient Sample.
...PATIENTS:Adult patients with severe sepsis (defined as a diagnosis of sepsis and organ dysfunction) diagnosed between 2003 and 2007.
MEASUREMENTS AND MAIN RESULTS:We determined the weighted frequency of patients hospitalized with severe sepsis. We calculated age- and sex-adjusted population-based mortality rates for severe sepsis per 100,000 population and also used logistic regression to adjust in-hospital mortality rates for patient characteristics. We calculated inflation-adjusted costs using hospital-specific cost-to-charge ratios. We identified a rapid steady increase in the number of cases of severe sepsis, from 415,280 in 2003 to 711,736 in 2007 (a 71% increase). The total hospital costs for all patients with severe sepsis increased from $15.4 billion in 2003 to $24.3 billion in 2007 (57% increase). The proportion of patients with severe sepsis and only a single organ dysfunction decreased from 51% in 2003 to 45% in 2007 (p < .001), whereas the proportion of patients with three or four or more organ dysfunctions increased 1.19-fold and 1.51-fold, respectively (p < .001). During the same time period, we observed 2% decrease per year in hospital mortality for patients with severe sepsis (p < .001), as well as a slight decrease in the length of stay (9.9 days to 9.2 days; p < .001) and a significant decrease in the geometric mean cost per case of severe sepsis ($20,210 per case in 2003 and $19,330 in 2007; p = .025).
CONCLUSIONS:The increase in the number of hospitalizations for severe sepsis coupled with declining in-hospital mortality and declining geometric mean cost per case may reflect improvements in care or increases in discharges to skilled nursing facilities; however, these findings more likely represent changes in documentation and hospital coding practices that could bias efforts to conduct national surveillance.
PURPOSETo identify correlates of physician empathy and determine whether physician empathy is related to standardized measures of patient experience.
METHODDemographic, professional, and empathy data ...were collected during 2013–2015 from Cleveland Clinic Health System physicians prior to participation in mandatory communication skills training. Empathy was assessed using the Jefferson Scale of Empathy. Data were also collected for seven measures (six provider communication items and overall provider rating) from the visit-specific and 12-month Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) surveys. Associations between empathy and provider characteristics were assessed by linear regression, ANOVA, or a nonparametric equivalent. Significant predictors were included in a multivariable linear regression model. Correlations between empathy and CG-CAHPS scores were assessed using Spearman rank correlation coefficients.
RESULTSIn bivariable analysis (n = 847 physicians), female sex (P < .001), specialty (P < .01), outpatient practice setting (P < .05), and DO degree (P < .05) were associated with higher empathy scores. In multivariable analysis, female sex (P < .001) and four specialties (obstetrics–gynecology, pediatrics, psychiatry, and thoracic surgery; all P < .05) were significantly associated with higher empathy scores. Of the seven CG-CAHPS measures, scores on five for the 583 physicians with visit-specific data and on three for the 277 physicians with 12-month data were positively correlated with empathy.
CONCLUSIONSSpecialty and sex were independently associated with physician empathy. Empathy was correlated with higher scores on multiple CG-CAHPS items, suggesting improving physician empathy might play a role in improving patient experience.
) To examine trends in the use of diabetes medications and
) to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA).
We conducted a ...retrospective, cross-sectional analysis of 2003-2016 National Health and Nutrition Examination Survey (NHANES) data. We included people ≥18 years who had ever been told they had diabetes, had an HbA
>6.4%, or had a fasting plasma glucose >125 mg/dL. Pregnant women and patients aged <20 years receiving only insulin were excluded. We assessed trends in use of ADA's seven preferred classes from 2003-2004 to 2015-2016. We also examined use by hypoglycemia risk (sulfonylureas, insulin, and meglitinides), weight effect (sulfonylureas, thiazolidinediones TZDs, insulin, and meglitinides), cardiovascular benefit (canagliflozin, empagliflozin, and liraglutide), and cost (brand-name medications and insulin analogs).
The final sample included 6,323 patients. The proportion taking any medication increased from 58% in 2003-2004 to 67% in 2015-2016 (
< 0.001). Use of metformin and insulin analogs increased, while use of sulfonylureas, TZDs, and human insulin decreased. Following the 2012 ADA recommendation, the choice of drug did not vary significantly by older age, weight, or presence of cardiovascular disease. Patients with low HbA
, or HbA
<6%, and age ≥65 years were less likely to receive hypoglycemia-inducing medications, while older patients with comorbidities were more likely. Insurance, but not income, was associated with the use of higher-cost medications.
Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics. Substantial opportunities exist to improve pharmacologic management of diabetes.
Abstract
Gamma-ray bursts (GRBs) are classified into long and short events. Long GRBs (LGRBs) are associated with the end states of very massive stars, while short GRBs (SGRBs) are linked to the ...merger of compact objects. GRB 200826A was a peculiar event, because by definition it was an SGRB, with a rest-frame duration of ∼0.5 s. However, this event was energetic and soft, which is consistent with LGRBs. The relatively low redshift (
z
= 0.7486) motivated a comprehensive, multiwavelength follow-up campaign to characterize its host, search for a possible associated supernova (SN), and thus understand the origin of this burst. To this aim we obtained a combination of deep near-infrared (NIR) and optical imaging together with spectroscopy. Our analysis reveals an optical and NIR bump in the light curve whose luminosity and evolution are in agreement with several SNe associated to LGRBs. Analysis of the prompt GRB shows that this event follows the
E
p,i
–
E
iso
relation found for LGRBs. The host galaxy is a low-mass star-forming galaxy, typical of LGRBs, but with one of the highest star formation rates, especially with respect to its mass (
log
M
*
/
M
⊙
=
8.6
, SFR ∼ 4.0
M
⊙
yr
−1
). We conclude that GRB 200826A is a typical collapsar event in the low tail of the duration distribution of LGRBs. These findings support theoretical predictions that events produced by collapsars can be as short as 0.5 s in the host frame and further confirm that duration alone is not an efficient discriminator for the progenitor class of a GRB.
American Thoracic Society/Infectious Diseases Society of America guidelines recommend against routine Legionella pneumophila testing, but recommend that hospitalized patients with community-acquired ...pneumonia receive empiric treatment covering Legionella. Testing, empiric treatment, and outcomes for patients with Legionella have not been well described.
Is testing for Legionella pneumophila appropriate, and could it impact treatment?
We conducted a large retrospective cohort analysis using Premier Healthcare Database data from 2010 to 2015. We included adults with a principal diagnosis code for pneumonia (or a principal diagnosis of respiratory failure or sepsis with secondary diagnosis of pneumonia) if they also received treatment for pneumonia on hospital days 1-3. We categorized Legionella-tested patients by test result, identified patient characteristics associated with testing and test result, and examined seasonal and regional patterns of Legionella pneumonia (LP) diagnoses. Empiric therapy for LP was defined as a macrolide, quinolone, or doxycycline, administered on each of the first two hospital days.
Of 166,689 eligible patients, 43,070 (26%) were tested for Legionella, and 642 (1.5%) tested positive. Although only 36% of tests were ordered from June to October, 70% of positive test results occurred during this time. Only 30% of patients with hyponatremia, 32% with diarrhea, and 27% in the ICU were tested. Of patients with positive test results, 495 of 642 (77%) had received empiric Legionella therapy. Patients with LP did not have more severe presentation. They had more frequent late decompensation, but similar mortality to patients without LP.
Legionella is an uncommon cause of community-acquired pneumonia, occurring primarily from late spring through early autumn. Testing is uncommon, even among patients with risk factors, and many patients with positive test results failed to receive empiric coverage for LP.
Previous infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provides strong protection against future infection. There is limited evidence on whether such protection extends ...to the Omicron variant.
This retrospective cohort study included 635 341 patients tested for SARS-CoV-2 via polymerase chain reaction from 9 March 2020 to 1 March 2022. Patients were analyzed according to the wave in which they were initially infected. The primary outcome was reinfection during the Omicron period (20 December 2021-1 March 2022). We used a multivariable model to assess the effects of prior infection and vaccination on hospitalization.
Among the patients tested during the Omicron wave, 30.6% tested positive. Protection of prior infection against reinfection with Omicron ranged from 18.0% (95% confidence interval CI, 13.0-22.7) for patients infected in wave 1 to 69.2% (95% CI, 63.4-74.1) for those infected in the Delta wave. In adjusted models, previous infection reduced hospitalization by 28.5% (95% CI, 19.1-36.7), whereas full vaccination plus a booster reduced it by 59.2% (95% CI, 54.8-63.1).
Previous infection offered less protection against Omicron than was observed in past waves. Immunity against future waves will likely depend on the degree of similarity between variants.
Complications of Viral Influenza Rothberg, Michael B., MD, MPH; Haessler, Sarah D., MD; Brown, Richard B., MD
The American journal of medicine,
04/2008, Volume:
121, Issue:
4
Journal Article
Peer reviewed
Open access
Abstract Viral influenza is a seasonal infection associated with significant morbidity and mortality. In the United States more than 35,000 deaths and 200,000 hospitalizations due to influenza occur ...annually, and the number is increasing. Children aged less than 1 year and adults aged more than 65 years, pregnant woman, and people of any age with comorbid illnesses are at highest risk. Annual vaccination is the cornerstone of prevention, but some older patients may derive less benefit from immunization than otherwise fit individuals. If started promptly, antiviral medications may reduce complications of acute influenza, but increasing resistance to amantadine and perhaps neuraminidase inhibitors underscores the need for novel prevention and treatment strategies. Pulmonary complications of influenza are most common and include primary influenza and secondary bacterial infection. Either may cause pneumonia, and each has a unique clinical presentation and pathologic basis. Staphylococcus aureus , including methicillin-resistant strains, is an important cause of secondary bacterial pneumonia with high mortality. During influenza season, treatment of pneumonia should include empiric coverage for this pathogen. Neuromuscular and cardiac complications are unusual but may manifest in persons of any age.
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