P728 Initial experience with ertapenem in clinical practice: treatment of twenty patients with chemotherapy-induced low-risk febrile neutropenia in an outpatient setting

e19641 Background: Febrile neutropenia (FN) is usually treated in an inpatient setting with empiric IV antibiotics. Accurate identification of low-risk hematologic malignancy (HM) pts (highest risk for life-threatening events) appropriate for outpatient management may reduce healthcare costs without impacting outcomes adversely. Prior studies using predictive models to identify low risk FN pts have not been validated in HM pts. Aim: To identify low risk HM pts as candidates for safe outpatient management. Methods: To determine parameters associated with an uncomplicated FN course in HM pts we tested the association between Talcott’s criteria (Talcott et al JCO Oct 2011) and additional candidate risk factors with the development of a medical event (ME) requiring urgent intervention. We conducted a retrospective cohort study of stable HM pts, admitted for FN management. Utilizing Cox regression, we examined the following factors: Talcott criteria, age, insurance status, prophylactic G-CSF/antibiotics, vitals signs and organ function. Results: We identified 97 consecutively admitted pts who met eligibility criteria of whom 27 pts developed a ME during the admission (validated by 2 investigators blinded to exposure status). In univariate analysis, Talcott’s criteria successfully identified pts at low risk for developing a ME (HR .4, p=.04 CI .17-.97). Additionally a preserved DPB (>65 mmHg) was also protective (HR .22 p<.01 CI .11-.51). Talcott’s criteria and DBP remained independent predictors of uncomplicated FN in a multivariate cox regression (AUROC curve=75%). Conclusions: This study provides support for the use of Talcott’s criteria in HM pts. The addition of DBP to Talcott’s model further improves its ability to identify low risk HM pts. Once prospectively validated, this approach may have important clinical and financial implications. [Table: see text]

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Initial Experience of the Levodopa–Entacapone–Carbidopa Intestinal Gel in Clinical Practice

Journal of Personalized Medicine ◽

10.3390/jpm11040254 ◽

2021 ◽

Vol 11 (4) ◽

pp. 254

Author(s):

Mezin Öthman ◽

Erik Widman ◽

Ingela Nygren ◽

Dag Nyholm

Keyword(s):

Cardiac Arrest ◽

Clinical Practice ◽

Observational Study ◽

Prospective Studies ◽

Infusion Rate ◽

Treatment Duration ◽

Initial Experience ◽

Morning Dose ◽

Efficacy And Safety ◽

User Friendliness

Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.

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Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.8222 ◽

2008 ◽

Vol 26 (4) ◽

pp. 606-611 ◽

Cited By ~ 105

Author(s):

Linda S. Elting ◽

Charles Lu ◽

Carmelita P. Escalante ◽

Sharon H. Giordano ◽

Jonathan C. Trent ◽

...

Keyword(s):

Febrile Neutropenia ◽

Statistical Tests ◽

Signs And Symptoms ◽

Low Risk ◽

Outpatient Management ◽

Single Episode ◽

Risk Patients ◽

Inpatient Management ◽

The Mean ◽

Mean Cost

Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

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Mo1093 Outpatient Management of Low-Risk Patients With Upper GI Bleeding: Can We Safely Extend the Glasgow Blatchford Score in Clinical Practice?

Gastroenterology ◽

10.1016/s0016-5085(14)62008-4 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-555

Author(s):

Zia Mustafa ◽

Elaine Clark ◽

Neil Campbell ◽

Allan Cameron ◽

Adrian J. Stanley

Keyword(s):

Clinical Practice ◽

Low Risk ◽

Gi Bleeding ◽

Outpatient Management ◽

Upper Gi Bleeding ◽

Upper Gi ◽

Risk Patients

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Clinical practice in febrile neutropenia risk assessment and granulocyte colony-stimulating factor primary prophylaxis of febrile neutropenia in Poland

Współczesna Onkologia ◽

10.5114/wo.2014.47904 ◽

2014 ◽

Vol 6 ◽

pp. 419-424

Author(s):

Marek Wojtukiewicz ◽

Ewa Chmielowska ◽

Emilia Filipczyk-Cisarż ◽

Krzysztof Krzemieniecki ◽

Krzysztof Leśniewski-Kmak ◽

...

Keyword(s):

Risk Assessment ◽

Clinical Practice ◽

Febrile Neutropenia ◽

Primary Prophylaxis ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Stimulating Factor

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For adults with cancer who develop low-risk febrile neutropenia, how does outpatient treatment compare with inpatient treatment?

Cochrane Clinical Answers ◽

10.1002/cca.2504 ◽

2019 ◽

Author(s):

Simone Mocellin

Keyword(s):

Febrile Neutropenia ◽

Outpatient Treatment ◽

Inpatient Treatment ◽

Low Risk

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Febrile neutropenia management and concordance of institutional protocol with clinical practice

Annals of Oncology ◽

10.1093/annonc/mdy300.113 ◽

2018 ◽

Vol 29 ◽

pp. viii638

Author(s):

A.F. Oliveira ◽

L. Bretes ◽

I. Furtado ◽

B.E. Gosalbez Pequeno ◽

J.G. Magalhaes

Keyword(s):

Clinical Practice ◽

Febrile Neutropenia

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Comparison of universal and targeted screening for thyroid dysfunction in pregnant Egyptian women

Acta Endocrinologica ◽

10.1530/eje-14-0100 ◽

2014 ◽

Vol 171 (2) ◽

pp. 285-291 ◽

Cited By ~ 6

Author(s):

Iman Z Ahmed ◽

Yara M Eid ◽

Hussein El Orabi ◽

Hani Refat Ibrahim

Keyword(s):

Clinical Practice ◽

Pregnant Women ◽

Practice Guidelines ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Risk Group ◽

Low Risk ◽

Endocrine Society ◽

Targeted Screening ◽

Egyptian Women

ObjectiveTo compare universal vs targeted screening for thyroid dysfunction and to estimate the prevalence of hypothyroidism in pregnant Egyptian women.Subjects and methodsA total of 168 of pregnant women who attended the outpatient obstetric clinic at Ain Shams University Hospital (Cairo, Egypt) for antenatal care between September 2011 and December 2011 were enrolled. Based on the detailed data collection and results of laboratory testing, they were subdivided into the high- and low-risk group for thyroid disease according to the most recent Endocrine Society clinical practice guidelines, as well as into groups by trimester for application of American Thyroid Association guidelines. The group values were subjected to statistical analysis for estimating the prevalence of clinical and subclinical hypothyroidism and for identifying significant differences.ResultsOf the 168 patients, 104 were classified into the low-risk group and 64 into the high-risk group. Using the trimesteric and normal population cutoff values for thyroid functions, the prevalence of hypothyroidism was found to be 56% (n=94) and 44.6% (n=75) respectively. No statistically significant differences were found between the high- and low-risk group regarding prevalence of either clinical or subclinical hypothyroidism, and no significant differences were found regarding the prevalence of hypothyroidism in the first, second, or third trimester.ConclusionUse of the most recent Endocrine Society clinical practice guidelines led to missed detection of clinical or subclinical hypothyroidism in 34.5% of pregnant women. Universal screening of pregnant women for thyroid dysfunction should thus be adopted throughout Egypt.

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