The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Juliana Cepelowicz Rajter - One of the best experts on this subject based on the ideXlab platform.
-
Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The Ivermectin in COVID Nineteen Study.
Chest, 2020Co-Authors: Naaz Fatteh, Michael Sherman, Fabio Vogel, Jamie Sacks, Juliana Cepelowicz RajterAbstract:Background Ivermectin was shown to inhibit severe acute respiratory syndrome coronavirus 2 replication in vitro, which has led to off-label use, but clinical efficacy has not been described previously. Research Question Does ivermectin benefit hospitalized coronavirus disease 2019 (COVID-19) patients? Study Design and Methods Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician's discretion. The primary outcome was all-cause in-hospital Mortality. Secondary outcomes included Mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for Fio2 ≥ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders. Results Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed Lower Mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P = .03). Mortality also was Lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P = .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P = .07) or length of stay. After multivariate adjustment for confounders and Mortality risks, the Mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P = .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly Lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P Interpretation Ivermectin treatment was associated with Lower Mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings.
-
ICON (Ivermectin in COvid Nineteen) study: Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID19
2020Co-Authors: Naaz Fatteh, Michael Sherman, Fabio Vogel, Jamie Sacks, Juliana Cepelowicz RajterAbstract:Abstract Importance: No therapy to date has been shown to improve survival for patients infected with SARS-CoV-2. Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in vitro but clinical response has not been previously evaluated. Objective: To determine whether Ivermectin is associated with Lower Mortality rate in patients hospitalized with COVID-19. Design and Setting: Retrospective cohort study of consecutive patients hospitalized at four Broward Health hospitals in South Florida with confirmed SARS-CoV-2. Enrollment dates were March 15, 2020 through May 11, 2020. Follow up data for all outcomes was May 19, 2020. Participants: 280 patients with confirmed SARS-CoV-2 infection (mean age 59.6 years [standard deviation 17.9], 45.4% female), of whom 173 were treated with ivermectin and 107 were usual care were reviewed. 27 identified patients were not reviewed due to multiple admissions, lack of confirmed COVID results during hospitalization, age less than 18, pregnancy, or incarceration. Exposure: Patients were categorized into two treatment groups based on whether they received at least one dose of ivermectin at any time during the hospitalization. Treatment decisions were at the discretion of the treating physicians. Severe pulmonary involvement at study entry was characterized as need for either FiO2 ≥50%, or noninvasive or invasive mechanical ventilation. Main Outcomes and Measures: The primary outcome was all-cause in-hospital Mortality. Secondary outcomes included subgroup Mortality in patients with severe pulmonary involvement and extubation rates for patients requiring invasive ventilation. Results: Univariate analysis showed Lower Mortality in the ivermectin group (25.2% versus 15.0%, OR 0.52, 95% CI 0.29-0.96, P=.03). Mortality was also Lower among 75 patients with severe pulmonary disease treated with ivermectin (38.8% vs 80.7%, OR 0.15, CI 0.05-0.47, P=.001), but there was no significant difference in successful extubation rates (36.1% vs 15.4%, OR 3.11 (0.88-11.00), p=.07). After adjustment for between-group differences and Mortality risks, the Mortality difference remained significant for the entire cohort (OR 0.27, CI 0.09-0.85, p=.03; HR 0.37, CI 0.19-0.71, p=.03). Conclusions and Relevance: Ivermectin was associated with Lower Mortality during treatment of COVID-19, especially in patients who required higher inspired oxygen or ventilatory support. These findings should be further evaluated with randomized controlled trials.
-
use of ivermectin is associated with Lower Mortality in hospitalized patients with covid 19 icon study
Chest, 2020Co-Authors: Fabio Vogel, Naaz Fatteh, Jamie Sacks, Michael S Sherman, Juliana Cepelowicz RajterAbstract:Background Ivermectin was shown to inhibit SARS-CoV-2 replication in-vitro, which has led to off-label use, but clinical efficacy has not been previously described Research Question Does ivermectin benefit hospitalized COVID-19 patients? Study Design and Methods: Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 through May 11, 2020 treated with or without ivermectin were reviewed Hospital ivermectin dosing guidelines were provided but treatment decisions were per treating physician’s discretion The primary outcome was all-cause in-hospital Mortality Secondary outcomes included Mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay Severe pulmonary involvement was defined as need for FiO2 ≥50%, noninvasive ventilation, or invasive ventilation at study entry Logistic regression and propensity score matching were used to adjust for confounders Results 280 patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed Most patients in both groups also received hydroxychloroquine and/or azithromycin Univariate analysis showed Lower Mortality in the ivermectin group (15 0% versus 25 2%, OR 0 52, CI 0 29-0 96, P=0 03) Mortality was also Lower among ivermectin-treated patients with severe pulmonary involvement (38 8% vs 80 7%, OR 0 15, CI 0 05-0 47, p=0 001) There were no significant differences in extubation rates (36 1% vs 15 4%, OR 3 11 (0 88-11 00), p=0 07) or length of stay After multivariate adjustment for confounders and Mortality risks, the Mortality difference remained significant (OR 0 27, CI 0 09-0 80, p=0 03) 196 patients were included in the propensity-matched cohort Mortality was significantly Lower in the ivermectin group (13 3% vs 24 5%, OR 0 47, CI 0 22-0 99, p<0 05);an 11 2% (CI 0 38%-22 1%) absolute risk reduction, with a number needed to treat of 8 9 (CI 4 5-263) Interpretation Ivermectin treatment was associated with Lower Mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement Randomized controlled trials are needed to confirm these findings
-
ICON (Ivermectin in COvid Nineteen) Study: Use of Ivermectin Is Associated with Lower Mortality in Hospitalized Patients with COVID-19
SSRN Electronic Journal, 2020Co-Authors: Naaz Fatteh, Michael Sherman, Fabio Vogel, Jaime Sacks, Juliana Cepelowicz RajterAbstract:Background: No therapy to date has been shown to improve survival for patients infected with SARS-CoV-2. Ivermectin has been shown to inhibit replication of SARS-CoV-2 in-vitro, which has led to off-label use, but clinical in-vivo efficacy has not been previously described. Methods: This is a retrospective cohort study of consecutive patients hospitalized at four Broward Health hospitals in South Florida with confirmed SARS-CoV-2 between March 15, 2020 through May 11, 2020. 280 patients with confirmed SARS-CoV-2 infection, of whom 173 were treated with ivermectin and 107 with usual care, were reviewed. Treatment decisions were at the discretion of the treating physicians. Severe pulmonary involvement at baseline was defined as need for either FiO2 ≥50%, noninvasive ventilation, or invasive mechanical ventilation. The primary outcome was all-cause in-hospital Mortality. Secondary outcomes included subgroup Mortality in patients with severe pulmonary involvement, extubation rates for patients requiring invasive ventilation, and length of hospital stay. Logistic regression and propensity score matching were used to adjust for confounders. Findings: Univariate analysis showed Lower Mortality in the ivermectin group (15·0% versus 25·2%, OR 0·52, CI 0·29-0·96, P=0·03). Mortality was also Lower among patients with severe pulmonary involvement treated with ivermectin (38·8% vs 80·7%, OR 0·15, CI 0·05-0·47, p=0·001), but there were no significant differences in successful extubation rates (36·1% vs 15·4%, OR 3·11 (0·88-11·00), p=0·07) or length of stay. After multivariate adjustment for confounders and Mortality risks, the Mortality difference remained significant (OR 0·27, CI 0·09-0·85, p=0·03). 194 patients were included in the propensity-matched cohort; Mortality was again significantly Lower in the ivermectin group (12.4% vs 25.8%, OR 0·41, CI 0·19-0·87, p=0·02). Interpretation: Ivermectin treatment was associated with Lower Mortality during treatment of COVID-19, especially in patients who required higher inspired oxygen or ventilatory support. These findings should be further evaluated with randomized controlled trials. Funding: None Declaration of Interests: All authors declare none. Ethics Approval Statement: The protocol was approved by the institutional review board for the Broward Health hospital system.
Juan Antonio Marquezvacaro - One of the best experts on this subject based on the ideXlab platform.
-
de escalation of empirical therapy is associated with Lower Mortality in patients with severe sepsis and septic shock
Intensive Care Medicine, 2014Co-Authors: Jose Garnachomontero, Antonio Gutierrezpizarraya, Ana Escorescaortega, Yael Corciapalomo, Esperanza Fernandezdelgado, I Herreramelero, Carlos Ortizleyba, Juan Antonio MarquezvacaroAbstract:We set out to assess the safety and the impact on in-hospital and 90-day Mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock. We carried out a prospective observational study enrolling patients admitted to the ICU with severe sepsis or septic shock. De-escalation was defined as discontinuation of an antimicrobial agent or change of antibiotic to one with a narrower spectrum once culture results were available. To control for confounding variables, we performed a conventional regression analysis and a propensity score (PS) adjusted-multivariable analysis. A total of 712 patients with severe sepsis or septic shock at ICU admission were treated empirically with broad-spectrum antibiotics. Of these, 628 were evaluated (84 died before cultures were available). De-escalation was applied in 219 patients (34.9 %). By multivariate analysis, factors independently associated with in-hospital Mortality were septic shock, SOFA score the day of culture results, and inadequate empirical antimicrobial therapy, whereas de-escalation therapy was a protective factor [Odds-Ratio (OR) 0.58; 95 % confidence interval (CI) 0.36–0.93). Analysis of the 403 patients with adequate empirical therapy revealed that the factor associated with Mortality was SOFA score on the day of culture results, whereas de-escalation therapy was a protective factor (OR 0.54; 95 % CI 0.33–0.89). The PS-adjusted logistic regression models confirmed that de-escalation therapy was a protective factor in both analyses. De-escalation therapy was also a protective factor for 90-day Mortality. De-escalation therapy for severe sepsis and septic shock is a safe strategy associated with a Lower Mortality. Efforts to increase the frequency of this strategy are fully justified.
-
de escalation of empirical therapy is associated with Lower Mortality in patients with severe sepsis and septic shock
Intensive Care Medicine, 2014Co-Authors: Jose Garnachomontero, Antonio Gutierrezpizarraya, Ana Escorescaortega, Yael Corciapalomo, Esperanza Fernandezdelgado, I Herreramelero, Carlos Ortizleyba, Juan Antonio MarquezvacaroAbstract:Purposes We set out to assess the safety and the impact on in-hospital and 90-day Mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock.
Jose Garnachomontero - One of the best experts on this subject based on the ideXlab platform.
-
de escalation of empirical therapy is associated with Lower Mortality in patients with severe sepsis and septic shock
Intensive Care Medicine, 2014Co-Authors: Jose Garnachomontero, Antonio Gutierrezpizarraya, Ana Escorescaortega, Yael Corciapalomo, Esperanza Fernandezdelgado, I Herreramelero, Carlos Ortizleyba, Juan Antonio MarquezvacaroAbstract:We set out to assess the safety and the impact on in-hospital and 90-day Mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock. We carried out a prospective observational study enrolling patients admitted to the ICU with severe sepsis or septic shock. De-escalation was defined as discontinuation of an antimicrobial agent or change of antibiotic to one with a narrower spectrum once culture results were available. To control for confounding variables, we performed a conventional regression analysis and a propensity score (PS) adjusted-multivariable analysis. A total of 712 patients with severe sepsis or septic shock at ICU admission were treated empirically with broad-spectrum antibiotics. Of these, 628 were evaluated (84 died before cultures were available). De-escalation was applied in 219 patients (34.9 %). By multivariate analysis, factors independently associated with in-hospital Mortality were septic shock, SOFA score the day of culture results, and inadequate empirical antimicrobial therapy, whereas de-escalation therapy was a protective factor [Odds-Ratio (OR) 0.58; 95 % confidence interval (CI) 0.36–0.93). Analysis of the 403 patients with adequate empirical therapy revealed that the factor associated with Mortality was SOFA score on the day of culture results, whereas de-escalation therapy was a protective factor (OR 0.54; 95 % CI 0.33–0.89). The PS-adjusted logistic regression models confirmed that de-escalation therapy was a protective factor in both analyses. De-escalation therapy was also a protective factor for 90-day Mortality. De-escalation therapy for severe sepsis and septic shock is a safe strategy associated with a Lower Mortality. Efforts to increase the frequency of this strategy are fully justified.
-
de escalation of empirical therapy is associated with Lower Mortality in patients with severe sepsis and septic shock
Intensive Care Medicine, 2014Co-Authors: Jose Garnachomontero, Antonio Gutierrezpizarraya, Ana Escorescaortega, Yael Corciapalomo, Esperanza Fernandezdelgado, I Herreramelero, Carlos Ortizleyba, Juan Antonio MarquezvacaroAbstract:Purposes We set out to assess the safety and the impact on in-hospital and 90-day Mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock.
Linda H Aiken - One of the best experts on this subject based on the ideXlab platform.
-
Lower Mortality in magnet hospitals
Journal of Nursing Administration, 2013Co-Authors: Matthew D Mchugh, Lesly A Kelly, Herbert L Smith, Jill M Vanak, Linda H AikenAbstract:Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.
-
Lower Mortality in magnet hospitals
Medical Care, 2013Co-Authors: Matthew D Mchugh, Lesly A Kelly, Herbert L Smith, Jill M Vanak, Linda H AikenAbstract:Nurses are key players in the effective functioning of complex hospital organizations and their ability to provide good patient care is influenced by the context in which they practice. Hallmarks of successful organizations include flat organizational structure with accessible and informed managers, decentralized decision-making, and the empowerment of front line workers to make decisions.1-2 Managerial strategies that reduce the negative effects of organizational complexity on employee productivity, work quality, and retention have emerged in a variety of industries and settings. The concept of Magnet hospitals—hospitals identified by their reputations for being good places for nurses to work—evolved from observations that hospitals that were successful in attracting and retaining qualified nurses resembled the most highly ranked U.S. corporations.3 In 1994, Medical Care published the first paper on patient outcomes in Magnet hospitals, documenting Lower risk-adjusted Mortality among Medicare patients in the original Magnet hospitals.4 Magnet hospital designation was formalized with the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® in the 1990s.5 The voluntary process was subsequently shown to identify hospitals that were as good as the original “reputational” Magnet hospitals of the 1980s in terms of having excellent work environments and nurse outcomes such as Lower levels of burnout and higher job satisfaction.6 With few exceptions,7 studies since have shown that care environments in Magnet recognized hospitals are different from non-Magnet hospitals.8-10 These differences are associated with higher levels of nurse satisfaction, less nurse burnout,11-12 Lower patient fall rates,13 and Lower Mortality among very low birth weight infants.14 The number of Magnet recognized hospitals has grown to nearly 400— about 8% of hospitals nationally. The Magnet Recognition Program® has also achieved status and visibility; Magnet recognition is now an indicator for national hospital ranking and quality benchmarking programs like U.S. News and World Report Best Hospitals rankings and the Leapfrog Group hospital ratings.15-17 During the period of evolution and replication of Magnet hospitals, research emerged documenting associations between hospitals with exemplary nurse practice environments and patient outcomes. Lower risk-adjusted Mortality and death following complication among surgical patients have been associated with Lower patient-to-nurse ratios,18-20 a more educated nurse workforce,21 more specialty-certified nurses,22 and better nurse work environments.12, 23-24 The Magnet Recognition Program® does not specify nurse staffing levels or educational or specialty certification requirements for bedside nurses. Instead, the program requires evidence-based processes aimed at organizational reform of nurses’ work environment in relation to desired patient outcomes. Hospitals are evaluated for evidence of achieving goals in five areas: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. Thus, a follow-up to the 1994 paper must go beyond determining whether a Mortality advantage can be documented for formally designated Magnet hospitals. Our inquiry must delve into the possible explanations for such an advantage, if found, because there is now a substantial scientific base documenting the association between nursing and patient outcomes. In the 1994 paper, Magnet designation was used as a proxy for good nursing because details of nurse staffing, education, qualifications, and work environments could not be measured with available data. That is no longer the case. A multi-state survey of nurses in California, Pennsylvania, New Jersey, and Florida provides direct measures of key elements of nursing organization and practice across all general, acute care hospitals in these four large states.23 Additionally, Magnet designation is now a formal process involving evidence-based criteria, on-site evaluations, and re-designation every four years with higher standards required the longer the designation is held.25 We use the data from the four states to examine this new environment and to determine whether Magnet hospitals continue to evince organizational characteristics that differentiate them from other hospitals, and if so, the extent to which these characteristics are associated with Lower risk-adjusted Mortality and failure-to-rescue. Our hypothesis is that Magnet hospitals should “out-perform” non-Magnet hospitals. Differences in patient outcomes should be associated with the organizational features of nursing that can be measured. However, there may be a Magnet effect above and beyond the effect attributable to the measured nursing features alone.
John A Spertus - One of the best experts on this subject based on the ideXlab platform.
-
body mass index and Mortality in acute myocardial infarction patients
The American Journal of Medicine, 2012Co-Authors: Emily M Bucholz, Saif S Rathore, Kimberly J Reid, Philip G Jones, Paul Chan, Michael W Rich, John A SpertusAbstract:Background Previous studies have described an “obesity paradox” with heart failure, whereby higher body mass index (BMI) is associated with Lower Mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction.
