Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients

Effects and benefits of vitamin D have been heavily studied, yet it seems as though we are only beginning to grasp just how influential vitamin D levels may be in certain medical situations.  A recent study sought to analyze the effects of vitamin D on length of stay in intensive care units, as well as in-hospital mortality, in patients who have recently had surgery.

The study was a prospective, cross-sectional, descriptive study that looked at 70 ICU patients over the course of a year at the Imam Khomeini Hospital in Iran. Basic demographic and health information was collected from the patients, as well as blood samples to determine serum levels. Of the 70 patients, 52 (74.3%) of them had serum vitamin D levels lower than 30 ng/mg. These patients had longer stays than patients with vitamin D levels greater than or equal to 30 ng/mL by roughly 3-4 days, and this was a statistically significant difference. The occurrence of hospital mortality, although higher in vitamin D deficient patients (25% vs. 22.2%), was not significantly different.

As hospital stays, especially in the ICU, require enormous amounts of money and resources, reducing the duration of stay would ease a great financial burden of the hospital, while also allowing patients to recover more quickly. I was very surprised by the findings of this study. We had recently learned about vitamin D and its transformation in the body, so I was surprised to find just how big of an impact it could have on length of hospital stays. I was aware that it was important for many things such as bone health and protecting the body from disease, but I would not have thought it could have such a significant impact on something like length of ICU hospital stays. I think that in the next few years we will continue to uncover many interesting effects and benefits of vitamin D, and we will hopefully be better educated as health professionals in suggesting vitamin D supplementation.

 

Alizadeh N, Khalili H, Mohammadi M, Abdullahi A. Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients. J Res Pharm Pract. 2015;4: 193–198.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645131/

Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012

This study was conducted as part of the 50th anniversary of the first time the surgeon general released a report on smoking and its effects on health.  The purpose of the study was to determine the effects that tobacco control has had on smoking-related mortality.

The study was conducted by estimating the smoking histories of people under actual conditions and under conditions that would have occurred if tobacco control had not happened.  Mortality rates were determined using analytical studies that show the effect smoking has on death rates.  The actual mortalities caused by smoking from the year 1964 through 2012 were then compared to the estimated mortalities that would have occurred with no tobacco control.  The main outcomes of the study were to show the number of deaths avoided, the years of life saved and the change in life expectancy at age 40.

The study showed that 8.0 million fewer premature smoking-related deaths occurred because of tobacco control.  Additionally, 157 million years of life were saved, which divides into an average of 19.6 years per person.  During this 48-year period, the life expectancies of men and women increased by 7.8 and 5.4 years, respectively.  From the study it was found that 2.3 years for men and 1.6 years for women can be connected with tobacco control.

I found this study interesting because it shows the effects of tobacco control on a large scale.  A lot of time and money has been spent on this topic and it is still a heavily talked about issue.  While smoking rates are down, there are people who still smoke and who do not fully understand the consequences.  This study shows that the time and money spent had a purpose and shows that continuing to shine a light on the topic will have real effects.

Holford, Theodore R., Rafael Meza, Kenneth E. Warner, Clare Meernik, Jihyoun Jeon, Suresh H. Moolgavkar, and David T. Levy. “Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012.” Jama 311.2 (2014): 164. Web.

http://jama.jamanetwork.com/article.aspx?articleid=1812962

Interstitial Lung Abnormalities and Mortality

Interstitial lung abnormalities obviously have negative impacts on health due to their effects of causing a lower diffusion capacity for carbon monoxide and a decrease in total lung capacity. However, there had never been a documented study or research conducted to correlate interstitial lung abnormalities with mortality, so Putman and colleagues conducted such research over the span of about ten years. The study included four different locations and trials. The first began in 2002 and included 5320 patients. The second began in 2005 with 1670 patients. The final two began in 2007 and 2008 and had 2068 and 2633 patients respectively. Each patient was evaluated with a CT scan to determine whether they had interstitial lung abnormality, which concluded that in each round of patients, anywhere from seven to nine percent had the abnormalities. After follows ups between three and nine years from the start date, more of the patients with interstitial lung abnormalities had died than those without. The differences ranged from 6% to 95% at the different sites.

Knowing this information for the future is vital in treating patients with interstitial lung abnormalities. Being able to provide patient’s with this specific information and have them able to understand the serious health risk could be both beneficial and detrimental. It would be helpful in that as a medical professional, you would hope that the increased severity would mean that the patient would be more inclined to remember to take their medications and be mindful of all healthy habits. This could also be detrimental in the fact that this may scare patients off and make them worry a lot more than they would have. This may interfere with their quality of life as they are constantly worried about their imminent disease and death it may cause.

JAMA. 2016;315(7):672-681.

Mortality and Readmission Rates between VA and Non-VA Hospitals

I looked at an article that detailed the research of whether there was an increased risk of readmission or mortality depending on whether the patient was admitted to a Veteran Affairs (VA) hospital or a non-VA hospital for heart failure, acute myocardial infarction, and Pneumonia. The study was conducted between 2010 to 2013 and included males that were 65 and older and on Medicare. The study was conducted in metropolitan areas that included both the VA and non-VA hospitals in question.  The study was over a 30 day period to assess mortality rates and the readmission rates of discharged patients at these hospitals.

The study looked at 1513 non-VA hospitals and 104 VA hospitals.  The study was conducted in 92 metropolitan areas. The results found that the VA hospitals had lower mortality rates for acute myocardial infarction (-0.2%) and heart failure by (-0.5%), but a slightly higher mortality risk for pneumonia (+0.4%).  Readmissions rates were higher in all three conditions of anywhere between +0.62% – +0.97%.  The percentage of readmissions and mortality rates were so small that they are almost negligible.  The rates of readmission could have been increased in the VA hospital population for multiple reasons such as the distance needed to travel to a VA hospital or the incentives given to non-VA hospitals to reduce readmission.  VA hospitals are trying to find ways to decrease there readmission rates.  This study also only looked at a small population of males that are 65 and older and also only included three disease states.

This study is not only important to all healthcare providers, but has a specific interest for pharmacists.  Many pharmacy interventions can occur to reduce readmissions into a hospital whether it is a VA or non-VA hospital.  Programs that increase adherence at community pharmacies can help reduce the readmission rates that are seen in the VA hospitals.  I chose this article specifically for the reason of the stigma that comes with VA hospital care in the community setting.  I believe there is a need for more in-depth research that shows the equality of care between VA hospitals and non-VA hospitals so that patients will chose to utilize these facilities.

reference

http://JAMA. 2016;315(6):582-592. doi:10.1001/jama.2016.0278.