scholarly journals Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre

2021 ◽  
Author(s):  
D Karavadara ◽  
JR Davidson ◽  
L Story ◽  
Y Diab ◽  
M Upadhyaya
Keyword(s):  
Cohort Study ◽  
Pediatric Surgery ◽  
Retrospective Cohort ◽  
Ovarian Tissue ◽  
Adnexal Torsion ◽  
Multivariate Logistic Regression ◽  
Benign Lesions ◽  
Patient Factors ◽  
Missed Opportunities ◽  
Ovarian Pathology

Abstract Introduction The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. Methods A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011–2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. Results Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day–25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75–15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. Conclusion Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.

scholarly journals Pulse oximetry adoption and oxygen orders at paediatric admission over 7 years in Kenya: a multihospital retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050995
Author(s):  
Timothy Tuti ◽  
Jalemba Aluvaala ◽  
Samuel Akech ◽  
Ambrose Agweyu ◽  
Grace Irimu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pulse Oximetry ◽  
Low Income ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Guideline Development ◽  
Public Hospitals ◽  
Severe Illness ◽  
Patient Factors ◽  
Over Time

ObjectivesTo characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen.DesignA multihospital retrospective cohort study.SettingsAll admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020.OutcomesPulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors.ResultsOverall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia.ConclusionThe adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact.

Inhaled Albuterol Use and Impaired Lactate Clearance in Patients With Sepsis: A Retrospective Cohort Study

2020 ◽  
pp. 088506661990109 ◽  
Author(s):  
Tetsuro Maeda ◽  
Janvi Paralkar ◽  
Toshiki Kuno ◽  
Paru Patrawalla
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Lactate Clearance ◽  
Multivariate Logistic Regression

Background: Lactate clearance has become important in the management of sepsis. However, factors unrelated to sepsis-induced hyperlactatemia, including β-2 adrenergic agonists, can interfere with lactate clearance. Objectives: To investigate the association of inhaled albuterol with lactate clearance in patients with sepsis. Methods: This was a single-center retrospective cohort study. Adult patients with sepsis diagnosed in the emergency department from May 2015 to May 2016 with initial lactate levels >2 mmol/L and serial lactate measurements 2 to 6 hours apart were included. Patients were divided into 2 groups based on whether they received inhaled albuterol between lactate measurements. The primary end point was lactate clearance of 10%. Secondary end points included intensive care unit (ICU) consultation and in-hospital mortality. A multivariate logistic regression analysis was performed to assess the effect of inhaled albuterol on lactate clearance. Results: Of 269 patients included, 58 (22%) received inhaled albuterol between lactate measurements. This group had a significantly higher prevalence of pulmonary disease and a lower initial lactate compared to those who did not receive inhaled albuterol. They had a significantly lower rate of lactate clearance (45% vs 77%, P < .001); however, ICU consultation (71% vs 57%, P = .066) and in-hospital mortality (19% vs 22%, P = .64) were not significantly different. A multivariate logistic regression analysis adjusting for age, sex, chronic kidney disease, cirrhosis, cancer, septic shock or severe sepsis, and the amount of intravenous fluids received showed that inhaled albuterol was independently associated with impaired lactate clearance (adjusted odds ratio: 0.26, 95% confidence interval: 0.14-0.50, P < .001). Conclusions: Inhaled albuterol in patients with sepsis was associated with impaired lactate clearance without an increase in ICU consultation or in-hospital mortality. Impaired lactate clearance in patients with sepsis who receive inhaled albuterol should be interpreted with caution.

scholarly journals Earlier onset of proteinuria or hypertension is a predictor of progression from gestational hypertension or gestational proteinuria to preeclampsia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mamoru Morikawa ◽  
Michinori Mayama ◽  
Kiwamu Noshiro ◽  
Yoshihiro Saito ◽  
Kinuko Nakagawa-Akabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Regression Models ◽  
Gestational Hypertension ◽  
P Value ◽  
Hypertensive Disorders Of Pregnancy ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Hypertensive Disorders ◽  
New Onset

AbstractAlthough gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to international criteria, hypertensive disorders of pregnancy include GH but not GP. Previous studies have not revealed the predictors of progression from GP to preeclampsia or those of progression from GH to preeclampsia. We aimed to determine both sets of predictors. A retrospective cohort study was conducted with singleton pregnant women who delivered at 22 gestational weeks or later. Preeclampsia was divided into three types: new onset of hypertension/proteinuria at 20 gestational weeks or later and additional new onset of other symptoms at < 7 days or at ≥ 7 days later. Of 94 women with preeclampsia, 20 exhibited proteinuria before preeclampsia, 14 experienced hypertension before preeclampsia, and 60 exhibited simultaneous new onset of both hypertension and proteinuria before preeclampsia; the outcomes of all types were similar. Of 34 women with presumptive GP, 58.8% developed preeclampsia; this proportion was significantly higher than that of 89 women with presumptive GH who developed preeclampsia (15.7%). According to multivariate logistic regression models, earlier onset of hypertension/proteinuria (before or at 34.7/33.9 gestational weeks) was a predicator for progression from presumptive GH/GP to preeclampsia (odds ratios: 1.21/1.21, P value: 0.0044/0.0477, respectively).

scholarly journals Clinical outcomes after telemedicine abortion with and without ultrasound: a multinational cohort study

2021 ◽  
Author(s):  
Anna Aaltonen ◽  
Margit Endler ◽  
Rebecca Gomperts
Keyword(s):  
Cohort Study ◽  
Northern Ireland ◽  
Clinical Outcomes ◽  
Retrospective Cohort ◽  
Descriptive Statistics ◽  
Multivariate Logistic Regression ◽  
Telemedicine Service ◽  
Incomplete Abortion ◽  
Receive Treatment ◽  
Study Setting

Objective: To evaluate the association between pre- and postabortion ultrasound and clinical outcomes after telemedicine abortion. Design: Cohort study Setting: Chile, Northern Ireland, Poland, South Korea. Population: 5298 women who performed abortion through the telemedicine service Women on Web (WOW), January 1st 2016 – December 31st 2019. Methods: We performed a retrospective cohort study on the associations between use of ultrasound pre-abortion and clinical outcomes using unconditional multivariate logistic regression. Intervention rates following routine or clinically indicated postabortion ultrasound were analysed using descriptive statistics. Main outcome measures: Self-reported rates of heavy bleeding, clinical visits within 2 days of the abortion, treatment for incomplete abortion, continuing pregnancy, and satisfaction. Results: Women with and without a pre-abortion ultrasound had similar rates of heavy bleeding (10.5% vs10%, AOR 0.98, 95% CI= 0.8-1.19), continuing pregnancy (1% vs 1.3%, AOR 0.68, 95% CI= 0.39-1.19), and satisfaction (96.8% vs 97%, AOR 0.95, 95% CI= 0.67-1.35). Women with a pre-abortion ultrasound were more likely to visit a hospital within two days of the abortion (6.6% vs 4.4%, AOR 1.35, 95% CI= 1.04-1.75) and receive treatment for incomplete abortion (13.7% vs 8.7%, AOR 1.58, 95% CI= 1.32-1.9). Overall rates of surgical evacuation for incomplete abortion were 9.8% after routine postabortion ultrasound and 27.6% for clinically indicated ultrasound. Conclusion: Non-use of pre-abortion ultrasound was not associated with higher rates of adverse clinical outcomes or lower satisfaction. Routine postabortion ultrasound may result in unnecessary clinical interventions. The results come from observational data where a certain selection bias is possible.

scholarly journals Renal dysfunction and prognosis of COVID-19 patients: a hospital-based retrospective cohort study

2020 ◽  
Author(s):  
Hui-Xian Xiang ◽  
Ying Xiang ◽  
Jun Fei ◽  
Zheng Xu ◽  
Ling Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Cohort Study ◽  
Renal Dysfunction ◽  
Retrospective Cohort ◽  
Demographic Information ◽  
Multivariate Logistic Regression ◽  
Follow Up Study ◽  
Independent Risk Factors

Abstract Introduction: Increasing evidence indicate that coronavirus disease 2019 (COVID-19) is companied by renal dysfunction. However, the association of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced renal dysfunction with prognosis remains unclear.Materials and methods: This prospective case-cohort study analyzed 154 COVID-19 patients from the Second People’s Hospital of Fuyang City in Anhui Province. Clinical and demographic information were collected. Renal function was evaluated and its prognosis was followed up. Results: Of 154 hospitalized patients with COVID-19, 125 were common and 29 were severe patients. On admission, 16 (10.4%) patients were with renal dysfunction. Serum creatinine and cystatin C were increased, eGFR was decreased in severe patients compared with those in common patients. Renal dysfunction was more common in severe patients. By multivariate logistic regression, male, higher age and hypertension were three importantly independent risk factors of renal dysfunction in COVID-19 patients. Follow-up study found that at least one renal function marker of 3.33% patients remained abnormal in two weeks after discharge. Conclusion: Male elderly COVID-19 patients with hypertension elevates the risk of renal dysfunction. SARS-CoV-2-induced renal dysfunction are not fully recovered in two weeks after discharge.

Neighborhood area-level social determinants and receipt of mammography screening in an area with high deprivation: A retrospective cohort study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18550-e18550
Author(s):  
Amina Dhahri ◽  
Sam Azargoon ◽  
Portia Buchongo ◽  
Tatiana Chicas ◽  
Amrik Singh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Cohort Study ◽  
Social Determinants ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Screening Mammography ◽  
Socioeconomic Deprivation ◽  
Screening Mammogram ◽  
Multivariate Logistic Regression

e18550 Background: Early detection through screening mammography has been shown to decrease breast cancer mortality. Screening mammography rates remains low among racial/ethnic minorities and patients with socioeconomic deprivation (SED). Most studies evaluating the role of area-level social determinants of health and breast cancer screening have included only a small number of variables; in this study, a comprehensive and granular measure of socioeconomic deprivation (SED) which included 17 variables was used to determine an association with screening mammogram completion. Methods: A retrospective cohort study was conducted at an academic hospital system between 2014-2020 to identify asymptomatic female patients who received screening mammogram referrals in their primary care clinic after they were deemed eligible per screening guidelines. Patients were assessed for mammogram completion at their annual visits. SED was evaluated using the area deprivation index (ADI), a measure of 17 variables including education, housing, and income at the census block group level. Other covariates analyzed were insurance status, age, and race. Chi-square test, Kruskal-Wallis test and a multivariate logistic regression model were used for statistical analysis. Results: 856 women were referred for screening mammography. 324 (38%) underwent mammogram. Patients with high, moderate, and low SED comprised 69 (8%), 287 (34%) and 500 (58%) of the cohort, respectively. In multivariable analysis, SED and race were not associated with higher screening rates. Uninsured and self-pay patients had the lowest odds of screening mammography completion (AOR 0.22; 95% 0.08, 0.60) and Medicare patients had decreased odds of mammogram completion relative to privately insured patients (AOR 0.64; 95% CI 0.43, 0.97). Older age was associated with a slightly higher odds of mammography completion (AOR 1.02; 95% CI 1.00, 1.04). Conclusions: The receipt of screening mammography was low among all patients relative to previously published rates. Uninsured/self-pay status was the strongest indicator for completion of mammography. Additional research is needed to understand the barriers that may influence mammography completion in this population with high socioeconomic deprivation. Multivariate Logistic Regression Estimates for Associations Between Mammogram Completion and SED category.[Table: see text]

scholarly journals Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study

PLoS ONE ◽  
2019 ◽  
Vol 14 (3) ◽  
pp. e0214012 ◽  
Author(s):  
Ni Gusti Ayu Nanditha ◽  
Martin St-Jean ◽  
Hiwot Tafessu ◽  
Silvia A. Guillemi ◽  
Mark W. Hull ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Missed Opportunities
Sign in / Sign up

Export Citation Format

Share Document