scholarly journals Routine Postpartum Telemetry Increases Detection of Clinically Significant Arrhythmias in Mothers with Cardiac Disease

2022 ◽  
Vol 226 (1) ◽  
pp. S270-S271
Author(s):  
Amrin Khander ◽  
Harsimran Singh ◽  
Sharon E. Abramovitz ◽  
Inna Landres
Keyword(s):  
Cardiac Disease ◽  
Clinically Significant

Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation

Blood ◽  
2011 ◽  
Vol 117 (2) ◽  
pp. 412-418 ◽  
Author(s):  
Shira L. Galper ◽  
James B. Yu ◽  
Peter M. Mauch ◽  
Jon F. Strasser ◽  
Barbara Silver ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Hodgkin Lymphoma ◽  
Cardiac Disease ◽  
Cumulative Incidence ◽  
Excess Risk ◽  
Age At Diagnosis ◽  
Cardiac Events ◽  
Mediastinal Irradiation ◽  
Cardiac Procedures ◽  
Clinically Significant

Abstract This study assessed the cumulative incidence of clinically significant cardiac disease in 1279 Hodgkin lymphoma patients treated with mediastinal irradiation and quantified the standard incidence ratios (SIRs) and absolute excess risks of cardiac procedures compared with a normal matched population. Cox regression analysis was used to explore factors associated with cardiac complications. Poisson regression analysis of SIRs was used to estimate the excess risk of cardiac interventions from mediastinal irradiation. After a median follow-up of 14.7 years, 187 patients experienced 636 cardiac events and 89 patients required a cardiac procedure. 5-, 10-, 15-, and 20-year cumulative incidence rates of cardiac events were 2.2%, 4.5%, 9.6%, and 16%. SIRs for cardiac procedures were increased for coronary artery bypass graft (3.19), percutaneous intervention (1.55), implantable cardioverter defibrillator or pacemaker placement (1.9), valve surgery (9.19), and pericardial surgery (12.91). Absolute excess risks were 18.2, 19.3, 9.4, 14.1, and 4.7 per 10 000 person-years, respectively. Older age at diagnosis and male sex were predictors for cardiac events. However, younger age at diagnosis was associated with excess risk specifically from radiation therapy compared with the general population. These results may help guideline development for both the types and timing of cardiac surveillance in survivors of Hodgkin lymphoma.

Final Results of a Single Arm Phase III Multicenter, Open-Label Study of Rituximab Administered by Faster Infusion in Patients with Previously Untreated Diffuse Large-B Cell (DLBCL) or Follicular Non-Hodgkin's Lymphoma (FL)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2703-2703 ◽  
Author(s):  
Shaker R. Dakhil ◽  
Robert Hermann ◽  
Akiko Chai ◽  
Deborah Hurst ◽  
Gregg Fine ◽  
...  
Keyword(s):  
Sample Size ◽  
Cardiac Disease ◽  
Hodgkin's Lymphoma ◽  
Phase Iii ◽  
Stage Iii ◽  
Open Label ◽  
Non Hodgkin's Lymphoma ◽  
Clinically Significant ◽  
Grade 3 ◽  
Infusion Duration

Abstract Abstract 2703 Introduction: For lymphoma patients (pts) receiving rituximab according to the prescribing information the first rituximab infusion typically requires 4−6 hrs and subsequent infusions require 3−4 hrs. Several pilot studies have investigated the feasibility of faster infusion of rituximab, but no phase III trials have prospectively analyzed safety in a larger population. In order to evaluate whether a faster infusion is feasible for the second and subsequent cycles of rituximab plus chemotherapy treatment, a prospective single arm, open-label phase III multicenter single-arm trial was performed to assess the safety of faster rituximab infusion in previously untreated pts with DLBCL and FL. Methods: Previously untreated pts with DLBCL or FL scheduled to receive R-CHOP and R-CVP respectively were eligible for participation in this study. Pts with a history of clinically significant cardiac disease were excluded. Pts received acetaminophen, an antihistamine and the oral steroid component of their chemotherapy regimen before each rituximab infusion. No additional steroid premedication was permitted. The first rituximab infusion was administered at an initial rate of 50 mg/hr and in the absence of toxicity increased by 50 mg/hr to a maximum of 400 mg/hr. Pts with infusion-related SAEs or grade 3/4 IRRs in the first cycle went off study. Rituximab in subsequent cycles was to be administered over a planned duration of 90 minutes: 20% of the total rituximab dose over 30 minutes, and the remaining 80% over the next 60 minutes. The primary outcome of this study was the rate of grade 3/4 IRRs during or within 24 hrs of Cycle 2 Day 1 in pts who received the faster infusion of rituximab. The definition of infusion-related AE required onset within 24 hrs of the start of infusion and encompassed MedDRA terms mapped to a prespecified list of AE terms derived from previous phase III rituximab studies. Secondary endpoints included other AEs, AEs leading to drug discontinuation, deaths, SAEs, and duration of administration (by cycle). Assuming the point estimate of the incidence of grade 3/4 IRRs was no larger than 5%, a sample size of at least 300 pts receiving faster infusion was needed to estimate the incidence with a margin of error of no greater than 2.5%. This sample size also allowed a fatal IRR rate of 1% or higher to be ruled out with a type I error less than 5% if no fatal IRRs were observed in the study. Results: Between July 2008 and November 2010, 451 pts were enrolled at 93 centers in the U.S. 425 pts received the first dose of rituximab at a median infusion duration of 2–0 minutes (92–390 minutes). Fifty-three pts (12.4%) discontinued prior to receiving the faster infusion: 5.6% discontinued the study because of Grade 3/4 IRRs, SAEs (including 5 deaths) and other AEs; and 6.8% discontinued for other reasons. The faster infusion of rituximab was administered starting at cycle 2 to 363 patients (250 R-CHOP, 113 R-CVP). R-CHOP pts had a median age=64 (range 20–86) and stage III-IV=63.4%. R-CVP pts had a median age=65 (range 33–88) and stage III-IV=77.0%. A total of 1764 infusions were administered at the faster rate. The median infusion duration at cycle 2 was 90 minutes (range 60–233) and was maintained over all subsequent cycles. For pts receiving the faster infusion at Cycle 2 Day 1, the rate of grade 3/4 IRR at cycle 2 was 1.1% (4 patients; 95%CI [0.3%, 2.8%]); the events included rash, bronchospasm, hypersensitivity, and abdominal pain. The rate of grade 3/4 IRRs occurring during cycle 2 or beyond was 2.8% (10 patients; 95%CI [1.3%, 5.0%]). IRR of any grade occurred in 38.3% of pts at Cycle 2 Day 1 with a decreased incidence in subsequent cycles. No fatal IRRs were observed. Thirteen deaths occurred on study outside of the infusion period (5 during cycle 1, 8 during or after cycle 2). Conclusion: The target duration of faster infusion was maintained while observing a rate of grade 3/4 IRRs of 1.1% at Cycle 2 and 2.8% at Cycle 2 and beyond with no fatal IRRs. Based on these results, the faster infusion of rituximab in pts without clinically significant cardiac disease who receive the first cycle of rituximab without a grade 3/4 IRR is feasible and associated with a safety profile comparable to historical data for patients with previously untreated DLBCL or FL who receive either R-CHOP or R-CVP. Disclosures: Off Label Use: Rituximab. Treatment of patients with Non-Hodgkin's Lymphoma (NHL). Chai:Genentech: Employment. Hurst:Genentech: Employment. Fine:Genentech: Employment.

Protocol for the study of drug interferences in laboratory tests: cefotaxime interference in 24 clinical tests.

1983 ◽  
Vol 29 (10) ◽  
pp. 1736-1740 ◽  
Author(s):  
D M Baer ◽  
R N Jones ◽  
J P Mullooly ◽  
W Horner
Keyword(s):  
Liver Disease ◽  
Cardiac Disease ◽  
Laboratory Tests ◽  
Test Results ◽  
Women Patients ◽  
Clinical Tests ◽  
Control Value ◽  
Low Concentrations ◽  
Apparent Concentration ◽  
Clinically Significant

Abstract We developed a protocol to study interference by cefotaxime and one of its major metabolites with 24 common chemical tests. Serum pools simulating specimens from healthy adults of both sexes, pregnant women, patients with liver disease, cardiac disease, or renal disease, and patients receiving gentamicin and tobramycin were supplemented with high and low concentrations of cefotaxime and desacetylcefotaxime. Using a discrete analyzer (the American Monitor Parallel), we tested 12 replicate samples from each condition for 24 analytes. Although statistically significant changes were found in many tests, 85% of the differences were less than 15% of the control value and more than half were less than 5%. The apparent concentration of creatinine was not significantly changed. Test results for phosphorus were increased in patients who were receiving gentamicin and tobramycin. No other changes were considered clinically significant.

Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre

2010 ◽  
Vol 20 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Andreas U. Gerber ◽  
Agnieszka Hompanera Torre ◽  
Guido Büscher ◽  
Stephanie A.K. Stock ◽  
Christine Graf ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Indirect Costs ◽  
Medical Services ◽  
Cardiac Defects ◽  
Congenital Cardiac Disease ◽  
Lost Productivity ◽  
Life Threatening ◽  
Clinically Significant ◽  
Financial Burdens ◽  
Families With Children

AbstractIntroductionParents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified.Materials and methodsIn cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs. Direct non-medical costs include all costs not directly related to medical services such as transportation. Indirect costs include lost productivity measured in lost income from wages. Parents were retrospectively queried on costs and refunds incurred during the child’s first and sixth year of life. The questionnaire was sent out to 198 families with children born between 1980 and 2000. Costs were adjusted for inflation to the year 2006. Children were stratified into five groups according to the severity of their current health status.ResultsFifty-four families responded and could be included into the analysis (27.7%). Depending on severity, total direct non-medical and indirect costs in the first year of life ranged between an average of €1654 in children with no or mild (remaining) cardiac defects and an average €2881 in children with clinically significant (residual/remaining) findings. Mean expenses in the sixth year of life were as low as €562 (no or mild (remaining) cardiac defects) and as high as €5213 (potentially life-threatening findings). At both points in time, the highest costs were lost income and transportation; and day care/ babysitting for siblings was third.DiscussionFamilies of children with congenital cardiac disease and major sequelae face direct non-medical and indirect costs adding up to €3000 per year on average. We should consider compensating families from low socioeconomic backgrounds to minimise under-use of non-medical services of assistance for their children.

scholarly journals Enteral Sodium Chloride Supplementation and Fluid Balance in Children Receiving Diuretics

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 94
Author(s):  
Laura Ortmann ◽  
Teri J. Mauch ◽  
Jean Ballweg
Keyword(s):  
Sodium Chloride ◽  
Fluid Balance ◽  
Cardiac Disease ◽  
Loop Diuretic ◽  
Fluid Retention ◽  
Loop Diuretics ◽  
Thiazide Diuretics ◽  
Single Center ◽  
Before And After ◽  
Clinically Significant

The use of sodium chloride (NaCl) supplementation in children being prescribed diuretics is controversial due to concerns that supplementation could lead to fluid retention. This is a single-center retrospective study in which fluid balance and diuretic dosing was examined in children prescribed enteral NaCl supplements for hyponatremia while receiving loop diuretics. The aim of this study was to determine whether significant fluid retention occurred with the addition of NaCl. Fifty-five patients with 68 events were studied. The median age was 5.2 months, and 82% were hospitalized for cardiac disease. Daily fluid balance the seven days prior to NaCl supplementation was lower than the seven days after, with measurement of: median 17 mL/kg/day (7–26) vs. 22 mL/kg/day (13–35) (p = 0.0003). There was no change in patient weight after supplementation (p = 0.63). There was no difference in the median loop diuretic dose before and after supplementation, with the diuretic dose in furosemide equivalents of 3.2 mL/kg/day (2.3–4.4) vs. 3.2 mL/kg/day (2.2–4.7) (p = 0.50). There was no difference in the proportion of patients receiving thiazide diuretics after supplementation (56% before vs. 50% after (p = 0.10)). NaCl supplementation in children receiving loop diuretics increased calculated fluid balance, but weight was unchanged, and this was not associated with an increase in diuretic needs, suggesting clinicians did not consider the increase in fluid balance to be clinically significant.

EM of human atherosclerosis: Aortic fatty streaks with transitional lesion features

1992 ◽  
Vol 50 (1) ◽  
pp. 622-623
Author(s):  
K. Florian Klemp ◽  
J.R. Guyton
Keyword(s):  
Foam Cell ◽  
Cell Formation ◽  
Processing Technique ◽  
Foam Cell Formation ◽  
Tissue Preparation ◽  
Electron Microscopic ◽  
Extracellular Lipid ◽  
Electron Microscopic Cytochemistry ◽  
Human Atherosclerosis ◽  
Clinically Significant

The earliest distinctive lesions in human atherosclerosis are fatty streaks (FS), characterized initially by lipid-laden foam cell formation. Fibrous plaques (FP), the clinically significant lesions, differ from FS in several respects. In addition to foam cells, the FP also exhibit fibromuscular proliferation and a necrotic core region rich in extracellular lipid. The possible transition of FS into mature FP has long been debated, however. A subset of FS described by Katz etal., was intermediate in lipid composition between ordinary FS and FP. We investigated this hypothesis by electron microscopic cytochemistry by employing a tissue processing technique previously described by our laboratory. Osmium-tannic acid-paraphenylenediamine (OTAP) tissue preparation enabled ultrastructural analysis of lipid deposits to discern features characteristic of mature fibrous plaques.

Supervision: A Case Study

1977 ◽  
Vol 8 (4) ◽  
pp. 256-263
Author(s):  
Roberta Chapey ◽  
Geraldine Chapey
Keyword(s):  
Organizational Communication ◽  
Behavioral Changes ◽  
Personal Problems ◽  
Clinically Significant

Occasionally, it is the responsibility of a supervisor to help a staff speech clinician resolve professional and or personal problems that interfere with the delivery of quality services. To deal with this situation, the supervisor must be equipped with the techniques and procedures for effective organizational communication. This article presents a case study in which a speech clinician demonstrated irresponsibility in various job areas. The supervisor’s philosophy and the procedures used in managing these problems are presented. The behavioral changes suggest that the supervisor’s interventive procedures were clinically significant and warrant further investigation.

Hearing Aid Gain Usage by Children

1989 ◽  
Vol 20 (2) ◽  
pp. 149-152 ◽  
Author(s):  
Kenneth W. Berger
Keyword(s):  
Hearing Aid ◽  
Appreciable Difference ◽  
Significant Difference ◽  
Clinically Significant

Hearing aid gain usage by two groups of children was examined. No appreciable difference was noted between the groups, nor was there a clinically significant difference between gain usage by these children as compared with a sample of adult hearing aid wearers.

Tools & Resources: Impairment and Disability Web Sites

1999 ◽  
Vol 4 (6) ◽  
pp. 5-6
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Interpersonal Relationships ◽  
Web Sites ◽  
Outpatient Psychotherapy ◽  
Obsessive Compulsive ◽  
Not Otherwise Specified ◽  
Cluster B Personality Disorders ◽  
Clinically Significant ◽  
And Behavior

Abstract Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from those expected by the individual's culture; these inflexible and pervasive patterns reflect issues with cognition, affectivity, interpersonal functioning and impulse control, and lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, defines two specific personality disorders, in addition to an eleventh condition, Personality Disorder Not Otherwise Specified. Cluster A personality disorders include paranoid, schizoid, and schizotypal personalities; of these, Paranoid Personality Disorder probably is most common in the legal arena. Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic personality. Such people may suffer from frantic efforts to avoid perceived abandonment, patterns of unstable and intense interpersonal relationships, an identity disturbance, and impulsivity. Legal issues that involve individuals with cluster B personality disorders often involve determination of causation of the person's problems, assessment of claims of harassment, and assessment of the person's fitness for employment. Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive personality. Two case histories illustrate some of the complexities of assessing impairment in workers with personality disorders, including drug abuse, hospitalizations, and inpatient and outpatient psychotherapy.

Sign in / Sign up

Export Citation Format

Share Document