Background The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. Methods R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one‐year post‐transplant; secondary outcomes included other herpesvirus infections and mortality. Results CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p < .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p < .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01–.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p = .005). Conclusions CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.
Purpose This study aims to investigate the factors that influence South African customers to potentially switch from one bank to another. Instead of using established models and survey techniques, the research measured social media sentiment to measure threats to switch. Design/methodology/approach The research involved a 12-month analysis of social media sentiment, specifically customer threats to switch banks (churn). These threats were then analysed for co-occurring themes to provide data on the reasons customers were making these threats. The study used over 1.7 million social media posts and focused on all five major South African retail banks (essentially the entire sector). Findings This study concluded that seven factors are most significant in understanding the underlying causes of churn. These are turnaround time, accusations of unethical behaviour, billing or payments, telephonic interactions, branches or stores, fraud or scams and unresponsiveness. Originality/value This study is unique in its measurement of unsolicited social media sentiment as opposed to most churn-related research that uses survey- or customer-data-based methods. In addition, this study observed the sentiment of customers from all major retail banks across 12 months. To date, no studies on retail bank churn theory have provided such an extensive perspective. The findings contribute to Susan Keaveney’s churn theory and provide a new measurement of switching threat through social media sentiment analysis.
:To describe the use of levosimendan in a quaternary referral center with a dedicated heart failure service and compare its efficacy and safety to continuous outpatient support with inotropes (COSI) among patients with advanced heart failure (AHF) who require bridge-to-decision (BTD) or bridge-to-transplant (BTT) therapy. This study was a retrospective, single-center, descriptive study of patients with AHF who received either a single levosimendan infusion or COSI between 2018 and 2021. A total of 23 patients received a levosimendan infusion, and 14 were started on COSI. Three indications for levosimendan were identified: (1) to facilitate weaning of continuous inotropes, (2) to augment diuresis in cardiorenal syndrome, and (3) as first-line therapy for cardiogenic shock in selected patients. Eighty-three percent (19 of 23) of patients who received levosimendan survived to discharge, and there were few clinically significant adverse events. Overall survival at 12 months among patients who received levosimendan was 74%. No statistically significant difference in survival was observed at 12 months (P = 0.68) or beyond (P = 0.63) between patients who received levosimendan and were discharged with a plan for BTD or BTT and those who received COSI. Levosimendan is a safe and effective short-term therapy in AHF and offers comparable long-term survival to COSI in patients who require BTD or BTT therapy.
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