Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system

2022 ◽  
Author(s):  
Warren Chang ◽  
Danielle Yin ◽  
Charles Li ◽  
Brian Weston ◽  
Albert Sohn ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Relative Risk ◽  
Health System ◽  
Retrospective Analysis ◽  
Aspirin Therapy ◽  
Delayed Hemorrhage

scholarly journals Health system wide “big data” analysis of rheumatologic conditions and scleritis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meghan K. Berkenstock ◽  
Andrew R. Carey
Keyword(s):  
Relative Risk ◽  
Health System ◽  
Systemic Disease ◽  
Autoimmune Disorder ◽  
Future Research ◽  
Inflammatory Conditions ◽  
Autoimmune Conditions ◽  
Icd 10 ◽  
Autoimmune Condition ◽  
Referral Bias

Abstract Background The development of scleritis in the setting of autoimmune conditions has been well documented. Prior series have assessed the relationship between systemic autoimmune disorders and scleritis only in patients referred for rheumatologic or ocular inflammation. This can lead to a referral bias. We reviewed all charts within the electronic medical record (EMR) of a health system for patients with systemic autoimmune and scleritis diagnoses to determine the prevalence of both and which disorders had the highest relative risk of developing scleritis. Methods The EMR was searched for scleritis and systemic inflammatory diagnoses in the past medical history and diagnosis tabs, and for associated disease specific laboratory values. The intersection of scleritis and systemic inflammatory conditions was assessed through searching both SNOMED Clinical Terminology and ICD-10 codes for diagnoses. The prevalence of each autoimmune disorder, scleritis prevalence, the percentage of patients with an autoimmune condition having scleritis, the percentage of patients with scleritis having an autoimmune condition; the relative risk (RR) of scleritis patients having a specific autoimmune disorder were calculated. Results A total of 5.9 million charts were searched with autoimmune conditions identified in 148,993 patients. The most common autoimmune conditions overall were HLA-B27-associated diseases (n = 26,680; prevalence 0.45%); rheumatoid arthritis (RA)(N = 19,923; prevalence 0.34%). Conversely, 2702 patients were identified with scleritis (prevalence 0.05%), of which 31.4% had an associated autoimmune condition. Patients with RA represented the highest percentage of patients with an autoimmune condition having scleritis. Granulomatosis with polyangiitis (GPA) represented the highest the percentage of patients with scleritis having an autoimmune condition. Sjogrens was the third most common condition associated with scleritis- making up 4.5% of cases. An association with juvenile idiopathic arthritis (JIA) was seen in 0.3% of patients. Conclusions While this is the largest retrospective review examining the association between autoimmune disease and scleritis, the findings are similar to prior studies with nearly a third of scleritis patients having an underlying autoimmune diagnosis. Limitations of the study included accurate chart coding; having laboratory results within the searchable EMR. Future research is needed to delineate associations of systemic disease with the anatomic location of scleritis using EMR.

Informed consent in interventional radiology – are we doing enough?

2021 ◽  
pp. 20201368
Author(s):  
Akash Prashar ◽  
Saqib Butt ◽  
Davide Giuseppe Castiglione ◽  
Nadeem Shaida
Keyword(s):  
Interventional Radiology ◽  
Clinical Practice ◽  
Informed Consent ◽  
Blood Transfusion ◽  
Retrospective Analysis ◽  
Patient Information ◽  
Potential Risk ◽  
Current Model ◽  
Consent Form ◽  
Consent Process

Objectives: Obtaining informed consent is a mandatory part of modern clinical practice. The aim of this study was to identify how often complications relating to Interventional Radiology (IR) procedures were discussed with the patient prior to the procedure. Methods: A retrospective analysis of 100 patients who experienced a complication related to an IR procedure was performed. The patient’s procedure consent form was examined to identify whether the complication they experienced had been discussed as a possible risk. Other parts of the consent form relating to need for blood transfusion and the need for further procedures were also examined. Results: 39% of patients who experienced a complication did not have the complication documented as a potential risk on the consent form. 14% of patients required a blood transfusion but were not consented for this. 42% of patients required a further procedure or operation but were not warned of this. Conclusion: The model of gaining informed consent on the day of procedure is no longer valid. Better education and the use of clinics, patient information sheets and other resources is essential. Advances in knowledge: The paper highlights the inadequacies of the current model in gaining consent for IR procedures. A more comprehensive consent process making use of all available resources is essential.

Abstract 392: Warfarin Versus Aspirin in Patients with Systolic Heart Failure and Normal Sinus Rhythm: Insights From a Meta-Analysis

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Rachit Shah ◽  
George Mueller ◽  
Dhavalkumar Patel ◽  
Janos Molnar ◽  
Kalpesh Patel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Sinus Rhythm ◽  
Systolic Heart Failure ◽  
Aspirin Therapy ◽  
Major Hemorrhage ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Aspirin Group

Background: It is unknown whether warfarin or aspirin therapy is superior for the treatment of patients with systolic heart failure who are in sinus rhythm. Methods: We performed a systematic literature search for randomized trials comparing warfarin and aspirin in patients with systolic heart failure which provided the event rates for ischemic stroke, major hemorrhage and death in the two groups. Heterogeneity of the studies was analyzed by Q statistics. The studies were homogeneous for each outcome; therefore the fixed-effect model was used to compute the relative risk based on the number of events and total number of patients in each group. A two-sided alpha error of <0.05 was considered to be statistically significant (p<0.05). Results: We found 4 randomized clinical trials comparing warfarin and aspirin therapy in patients with systolic heart failure with a mean duration of follow up of 2.3 years enrolling a total of 3663 patients. The relative risk for ischemic stroke in patients treated with warfarin was 0.50 with 95% confidence interval (CI) of 0.33 - 0.75 (P= 0.001) while the relative risk for major hemorrhage was 1.94 with 95% CI of 1.40- 2.71 (P= 0.000) in comparison to the aspirin group. The relative risk of death was 1.01 with 95% CI of 0.89- 1.14 (P= 0.871) in the warfarin group compared to the aspirin group. Conclusion: Although warfarin therapy appears to reduce the risk of ischemic stroke in patients with systolic heart failure who are in sinus rhythm, the reduction comes at the cost of higher risk of bleeding and there is no evidence of an overall benefit on mortality.

scholarly journals Cost of diseases related to alcohol consumption in the Brazilian Unified Health System

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Evandro Silva Freire Coutinho ◽  
Luciana Bahia ◽  
Laura Augusta Barufaldi ◽  
Gabriela de Azevedo Abreu ◽  
Thainá Alves Malhão ◽  
...  
Keyword(s):  
Information System ◽  
Relative Risk ◽  
Alcohol Consumption ◽  
Health System ◽  
Health Problem ◽  
Hospital Care ◽  
Meta Analysis ◽  
Direct Costs ◽  
Unified Health System ◽  
Consumption Rates

ABSTRACT OBJECTIVE To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.

scholarly journals Gouty arthritis: decision-making following dual-energy CT scan in clinical practice, a retrospective analysis

2018 ◽  
Vol 37 (7) ◽  
pp. 1879-1884 ◽  
Author(s):  
M. Gamala ◽  
S. P. Linn-Rasker ◽  
M. Nix ◽  
B. G. F. Heggelman ◽  
J. M. van Laar ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Ct Scan ◽  
Retrospective Analysis ◽  
Gouty Arthritis ◽  
Dual Energy ◽  
Dual Energy Ct

The Utility of Virtual Bronchoscopy Using a Computed Tomography Workstation for Conducting Conventional Bronchoscopy: A Retrospective Analysis of Clinical Practice

Respiration ◽  
2018 ◽  
Vol 97 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Shion Miyoshi ◽  
Kazutoshi Isobe ◽  
Hiroshige Shimizu ◽  
Motoko Sunakawa ◽  
Aika Suzuki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
Retrospective Analysis ◽  
Virtual Bronchoscopy

PS-052 Retrospective analysis of bevacizumab plus irinotecan in recurrent gliobastoma multiforme in clinical practice

2016 ◽  
Vol 23 (Suppl 1) ◽  
pp. A236.2-A236
Author(s):  
A Garcia ◽  
A Rodriguez ◽  
G Durán ◽  
E López ◽  
M Touris ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Retrospective Analysis

scholarly journals Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

2020 ◽  
Vol 30 (11) ◽  
pp. 1748-1756
Author(s):  
Charles H Norell ◽  
John Butler ◽  
Rhonda Farrell ◽  
Alon Altman ◽  
James Bentley ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Clinical Practice ◽  
Health System ◽  
Cancer Treatment ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Patterns Of Care ◽  
Debulking Surgery ◽  
Potential Health ◽  
International Differences

IntroductionThe International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65–74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities.ObjectiveTo compare clinical practice guidelines and patterns of care across seven high-income countries.MethodsA comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by ‘distant’ stage using Spearman’s rho.ResultsTwenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/‘ultra-radical’ surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (rs=0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits.DiscussionFindings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.

Vetting the Evidence: Librarian Involvement in a Health System Clinical Practice Council

2019 ◽  
Vol 19 (4) ◽  
pp. 350-356
Author(s):  
Andrew Crow ◽  
Anna Briggs Kleckner
Keyword(s):  
Clinical Practice ◽  
Health System
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