scholarly journals 4401 Incidence, management, and outcomes of immune-related adverse events (irAEs): an analysis of a multidisciplinary toxicity team for cancer immunotherapy related irAEs

2020 ◽  
Vol 4 (s1) ◽  
pp. 73-73
Author(s):  
Aanika Balaji ◽  
Jiajia Zhang ◽  
Jarushka Naidoo
Keyword(s):  
Chart Review ◽  
Relative Risk Reduction ◽  
Retrospective Chart Review ◽  
Risk Groups ◽  
Hospitalization Rate ◽  
Johns Hopkins Hospital ◽  
Inpatient Hospitalizations ◽  
Study Population ◽  
Patient Referrals ◽  
Historical Controls

OBJECTIVES/GOALS: This study aims to assess the outcomes of a new virtual multidisciplinary immune-related toxicity (IR-tox) team implemented at Johns Hopkins Hospital. In particular, to understand if the IR-tox team’s input reduced the number of inpatient hospitalizations for irAEs for referred patients. METHODS/STUDY POPULATION: Since August 2017, nearly 250 patient referrals to the IR-tox team have been created and stored in an electronic database. Through retrospective chart review, hospitalization and irAE management data will be collected for these patients to assess whether rates for suspected irAEs have decreased. These rates will be compared against historical controls. We will assess the features of hospitalized patients, their immunotherapy regimens, and management to identify high-risk groups who may require early intervention. Additionally, we aim to understand what patient features are associated with IR-Tox team referral and subsequent hospitalization. RESULTS/ANTICIPATED RESULTS: The IR-tox team provided a new multidisciplinary channel to help physicians diagnose and manage complex irAEs. The goal of the team was the reduce the number of irAE-related hospitalizations as, historically, 85% of high-grade irAEs have required hospitalization. A clinically meaningful reduction is defined as lowering the hospitalization rate to 75%. Planned analyses includes calculating the hospitalization rate, using descriptive statistics to summarize patient features, multivariate analyses to understand features associated with both IR-Tox team referral and hospitalization, and computing the relative risk reduction to assess the efficacy of subspecialist referral implementation. DISCUSSION/SIGNIFICANCE OF IMPACT: IrAEs are challenging to diagnose and treat. They contribute to a notable proportion of hospitalizations in those treated with immunotherapy. With expanding use of immunotherapy, widespread implementations of IR-Tox teams may help reduce hospitalizations and costs associated with care for irAEs.

scholarly journals 4225 Evaluation of Neurotransmitters in Channelopathy-Related Epilepsy

2020 ◽  
Vol 4 (s1) ◽  
pp. 95-95
Author(s):  
Sunita N Misra ◽  
Theresa M. Czech ◽  
Jennifer A. Kearney
Keyword(s):  
Mouse Model ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Brain Regions ◽  
Autism Spectrum ◽  
Wild Type ◽  
Voltage Gated Sodium Channels ◽  
Study Population ◽  
Genotype A

OBJECTIVES/GOALS: Variants in voltage-gated sodium channels (VGSC) are a common cause of severe early onset epilepsy. Changes in CSF neurotransmitters (NT) were identified in 2 cases of VGSC-related epilepsy. Here we investigate NT changes in patients and a novel mouse model of VGSC-related epilepsy. METHODS/STUDY POPULATION: We conducted a single site IRB approved retrospective chart review of patients with VGSC-related epilepsy who underwent CSF NT testing for diagnostic purposes. In parallel, we examined NT levels from the brains of wild-type (WT) and a novel VGSC-related epilepsy mouse model after obtaining IACUC approval. We rapidly isolated forebrain, cortex, striatum, and brainstem from 5-6 animals per sex and genotype. A combination of HPLC with electrochemical detection and mass spectrometry were used to quantify NT levels from brain samples. RESULTS/ANTICIPATED RESULTS: We identified 10 patients with VGSC-related epilepsy who received CSF NT testing. Two of these patients had abnormal NT results including changes to dopamine (DA) or serotonin (5-HT) metabolites. We analyzed NT levels from four brain regions from male and female WT and VGSC-related epilepsy mice. We anticipate that most of the NT levels will be similar to WT, however subtle changes in the DA or 5-HT metabolites may be seen in VGSC-related epilepsy. DISCUSSION/SIGNIFICANCE OF IMPACT: Patients with VGSC-related epilepsy often have autism spectrum disorder, sleep, and movement disorders. Understanding the role of aberrant NT levels in VGSC-related epilepsy may provide additional therapeutic targets that address common neuropsychological comorbidities as well as seizures.

Post-operative problems and complications in 313 consecutive cochlear implantations

2008 ◽  
Vol 123 (5) ◽  
pp. 492-496 ◽  
Author(s):  
T Ovesen ◽  
L V Johansen
Keyword(s):  
Cochlear Implantation ◽  
Surgical Planning ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Safe Procedure ◽  
Tertiary Referral Centre ◽  
Antibiotic Resistant ◽  
Danish Patient ◽  
Study Population ◽  
Radical Cavity

AbstractObjective:To describe problems and complications associated with cochlear implantation, and their management, in a Danish patient population comprising both paediatric and adult patients.Design:Retrospective chart review.Setting:Tertiary referral centre.Subjects:Three hundred and thirteen consecutive cochlear implantations were studied. The median age of the study population was 10 years. Sixty per cent of patients were children and 40 per cent were adult; 52 per cent were female and 48 per cent were male.Intervention:Two hundred and ninety-four patients received a Cochlear Nucleus®implant. The remaining 19 received an Advanced Bionics implant.Main outcome measure:Presence of problems and complications after cochlear implantation.Results:Post-operative complications were found in 15.7 per cent of patients. The majority of these complications (11.2 per cent) were minor; 4.5 per cent were major. The major complications included one patient with meningitis, one patient with multiple antibiotic resistantStaphylococcus aureusinfection of a radical cavity, and one diabetic patient who developed a severe skin infection and whose implant became exposed.Conclusion:Cochlear implantation is a safe procedure within the studied setting. However, it is essential that careful attention be paid to surgical planning and technique, and it is important that healthcare staff and patients be aware of the possible problems and complications.

Posttraumatic Resuscitation Affects Stent Graft Sizing in Patients with Blunt Thoracic Aortic Injury

2016 ◽  
Vol 82 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Jordan R. H. Hoffman ◽  
Ritam Chowdhury ◽  
Laura S. Johnson ◽  
Luke P. Brewster ◽  
Yazan Duwayri ◽  
...  
Keyword(s):  
Stent Graft ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Aortic Injury ◽  
Aortic Diameter ◽  
Related Complication ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Study Population ◽  
Level I

Patients with blunt aortic injury often present to the emergency department in a relatively hypovolemic state. These patients undergo extensive inhospital resuscitation. The effect of posttraumatic resuscitation on aortic diameter has implications for stent graft sizing. The potential utility of repeat aortic imaging after resuscitation remains unclear. A retrospective chart review of all adult patients presenting to a Level I trauma center between the years 2007 and 2013 was performed. Fifty-three patients were identified with a diagnosis of traumatic aortic injury. Of those, 10 had 2 CT scans before aortic repair and were selected as the study population for analysis. After resuscitation, there was a significant increase in aortic diameter both proximal and distal to the aortic injury: proximal aortic diameter increase of 1.97 mm and distal aortic diameter increase of 1.48 mm. This retrospective study shows that after resuscitation, there is a significant increase in proximal and distal aortic diameter. Interval reimaging of the thoracic aorta may be beneficial after adequate stabilization of the patient's other injuries. In certain cases, more appropriate sizing may prevent a device-related complication.

scholarly journals High Prevalence of Hypertension in Ethiopian and Non-Ethiopian HIV-Infected Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maya Korem ◽  
Tali Wallach ◽  
Michael Bursztyn ◽  
Shlomo Maayan ◽  
Karen Olshtain-Pops
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chart Review ◽  
Pressure Rise ◽  
Retrospective Chart Review ◽  
Close Monitoring ◽  
Related Factors ◽  
The Metabolic Syndrome ◽  
High Prevalence ◽  
Study Population

Objectives. Prevalence of hypertension has not been studied in the Ethiopian HIV-infected population, which represents 60% of the patients in our AIDS unit. Our aim was to identify risk factors and characterize the prevalence of hypertension in the population monitored at our unit. Methods. A retrospective chart review categorized subjects according to their blood pressure levels. Hypertension prevalence was determined and stratified according to variables perceived to contribute to elevated blood pressure. Results. The prevalence of hypertension in our study population was significantly higher compared to the general population (53% versus 20%, P<0.0001) and was associated with known risk factors and not with patients’ viral load and CD4 levels. Ethiopian HIV-infected adults had a prominently higher rate of blood pressure rise over time as compared to non-Ethiopians (P=0.016). Conclusions. The high prevalence of hypertension in this cohort and the rapid increase in blood pressure in Ethiopians are alarming. We could not attribute high prevalence to HIV-related factors and we presume it is part of the metabolic syndrome. The lifelong cardiovascular risk associated with HIV infection mandates hypertension screening and close monitoring in this population.

scholarly journals Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for In-Hospital Cardiopulmonary Arrest

2021 ◽  
Author(s):  
Abdullah Bakhsh ◽  
Maha Safhi ◽  
Ashwaq Alghamdi ◽  
Amjad Alharazi ◽  
Bedoor Alshabibi ◽  
...  
Keyword(s):  
Chart Review ◽  
Cardiopulmonary Arrest ◽  
Retrospective Chart Review ◽  
Spontaneous Circulation ◽  
Chi Square ◽  
Epinephrine Administration ◽  
Return Of Spontaneous Circulation ◽  
Study Population ◽  
Epinephrine Dose ◽  
The Ideal

Abstract Background intravenous epinephrine has been a key treatment for cardiopulmonary arrest since the early 1960s. Although, many studies have questioned neurological outcome benefit, it remains to be recommended in international guidelines for its benefit on return of spontaneous circulation (ROSC). The ideal timing for the first epinephrine dose is uncertain. We aimed to look at the association of immediate epinephrine administration (within 1-minute of cardiac arrest recognition) with return of spontaneous circulation (ROSC) up to 24-hours and beyond 24-hours. Methods this was a multicenter retrospective chart review of patients undergoing cardiopulmonary resuscitation. Descriptive statistics were used to characterize study population, while t-test and chi-square were used to compare groups and outcomes. Results immediate epinephrine administration (within 1-minute) is associated with higher rates of ROSC up to 24-hours (OR = 2.36, 95% CI; [1.46–3.81]) and beyond 24-hours (OR = 2.26, 95% CI; [1.06–4.83]). Conclusions we encourage immediate administration of epinephrine in conjunction with high-quality CPR, as this is associated with higher rates of ROSC.

scholarly journals Pregnant women admitted with urinary tract infections to a public sector hospital in South Africa: Are there lessons to learn?

2016 ◽  
Vol 31 (3) ◽  
pp. 79-83
Author(s):  
Francois Kamgang ◽  
Hopolang Maise ◽  
Jagidesa Moodley
Keyword(s):  
South Africa ◽  
Urinary Tract ◽  
Pregnant Women ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Public Health Facility ◽  
Public Sector Hospital ◽  
Study Population ◽  
Tract Infections

Background: Urinary tract infection (UTI) is associated with poor maternal and foetal outcomes. There is little information on UTI in pregnancy in South Africa. Objectives: To evaluate the frequency of UTI admissions of pregnant women admitted to a public health facility; and, to describe the outcomes of pregnancies complicated by UTI in our study population. Methods: A retrospective chart review of pregnant women admitted with the diagnosis of UTI during the period of 1 January 2012 to 31 December 2012 was conducted. A midstream urine sample of women admitted with symptoms suggestive of UTI was collected for culture. The diagnosis was confirmed if the culture was positive. The data was analysed using SPSS version 21 and descriptive statistics, viz. percentages, frequency and means were estimated. Results: Of 9,881 admissions, 494 (5%) had a diagnosis of UTI based on clinical features. Sixty had positive cultures and were confirmed as having UTI. Women with UTI had high rates of preterm ruptured membranes (n = 5, 8.3%), preterm deliveries (n = 19, 31.6%), anaemia (n = 26, 43.3%) and renal impairment (n = 4, 6.6%). Two cases of pyelonephritis required admission to an ICU because they developed acute respiratory distress syndrome. The most common pathogen isolated using cultures was Escherichia coli (n = 24, 40%). Only 10% had repeat urine cultures. Conclusion: UTI represents 5% of admissions at the study site. This study highlights the need to improve the quality of care of pregnant women with UTI.

scholarly journals Remdesivir Use in the Setting of Severe Renal Impairment: A Theoretical Concern or Real Risk?

2020 ◽  
Author(s):  
Natasha N Pettit ◽  
Jennifer Pisano ◽  
Cynthia T Nguyen ◽  
Alison K Lew ◽  
Aniruddha Hazra ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Renal Impairment ◽  
Chart Review ◽  
Renal Toxicity ◽  
Severe Renal Impairment ◽  
Retrospective Chart Review ◽  
Small Series ◽  
Real Risk ◽  
Theoretical Risk ◽  
Historical Controls

Abstract Introduction Remdesivir (RDV) is FDA approved for COVID-19, but not recommended for patients with severe renal impairment (SRI, i.e. creatinine clearance &lt; 30ml/min). Few studies have evaluated RDV in patients with SRI due to theoretical toxicity concerns. Methods Hospitalized patients receiving RDV for COVID-19 between 5/1/2020-10/31/2020 were analyzed in a retrospective chart review. We compared incident adverse events (AEs) following RDV in patients with and without SRI, including hepatotoxicity, nephrotoxicity, any reported AE, mortality and length of stay. Results A total of 135 patients received RDV, 20 patients had SRI. Patients with SRI were significantly older (70 vs. 54 years, p=0.0001). The incidence of possible AEs following RDV was 20% among those with SRI versus 11% without (p=0.26). LFT elevations occurred in 10% vs. 4% (p=0.28), and SCr elevations occurred in 20% vs. 6% (p=0.06) of patients with SRI versus those without, respectively. The LFT and SCr elevations were not attributed to RDV in either group. Mortality and length of stay were comparable and consistent with historical controls. Conclusion RDV AEs occurred infrequently with low severity and were not significantly different between those with and without SRI. While a higher percentage of patients with SRI experienced SCr elevations, 3 (75%) patients were in AKI prior to RDV. Overall, the use of RDV in this small series of patients with SRI appeared to be relatively safe, and the potential benefit outweighed the theoretical risk of liver or renal toxicity; however, additional studies are needed to confirm this finding.

History of sexual abuse among HIV- infected women

1997 ◽  
Vol 8 (5) ◽  
pp. 332-335 ◽  
Author(s):  
Ariane Lisann Bedimo ◽  
Patricia Kissinger ◽  
Ruth Bessinger
Keyword(s):  
Sexual Abuse ◽  
Outpatient Clinic ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Intravenous Drug Use ◽  
Childbearing Age ◽  
Factors Associated ◽  
History Of ◽  
Study Population ◽  
The Mean

The objective of this study is to describe the characteristics associated with a history of sexual abuse among HIV-infected women enrolled in a public inner-city HIV outpatient clinic. A retrospective chart review of 238 women of childbearing age enrolled in the HIV outpatient clinic between 1987 and 1995 was performed. Characteristics of the study population were 83% African American, 69% single, and 53% finished high school or were still in school. The mean age was 25.7 years. Of the 238 women, 32% had a history of sexual abuse. Factors associated with sexual abuse history after controlling for age included living in a nonpermanent situation (OR=4.8), history of non-intravenous drug use (OR=4.65), and having dropped out of school (OR=2.2). HIV-infected women should be screened for a history of sexual abuse and carefully counselled regarding their reproductive choices and drug treatment.

scholarly journals Prevalence of Glaucoma in Hospitalized Older Adults with Alzheimer's Disease

2014 ◽  
Vol 41 (2) ◽  
pp. 206-209 ◽  
Author(s):  
Andrée-Anne Pelletier ◽  
Marie-Ève Théorêt ◽  
Tanguy Boutin ◽  
Marie-Jeanne Kergoat ◽  
Fadi Massoud ◽  
...  
Keyword(s):  
Older Adults ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Control Group ◽  
Mixed Dementia ◽  
Chi Square ◽  
Centre Hospitalier ◽  
Comparable Control ◽  
Study Population ◽  
Hospitalized Older Adults

Objective:To determine the prevalence of glaucoma in older adults with dementia of the alzheimer's type (DAT).Methods:retrospective chart review: the prevalence of glaucoma was determined in older adults with a diagnosis of DAT or mixed dementia (DAT with vascular contribution) admitted to the geriatric and neurology units of the Centre hospitalier de l'université de Montréal and the hôpital Maisonneuve-rosemont between april 2008 and april 2009 (n=220; DAT group). they were matched for age and date of hospitalisation to the first 220 individuals without dementia (control group) recruited from other medical units in the same hospitals: gastroenterology, internal medicine or cardiology. a diagnosis of glaucoma was deemed positive if recorded in the chart or if there was a medication compatible with this diagnosis. Chi-square tests were used for between-group comparisons.Results:Subjects' age ranged from 66 to 101 years. the prevalence of glaucoma was 6.8% in our study population (n=30/440). glaucoma was significantly more prevalent in the DAT group (n= 21; 9.5%) than in the control group (n= 9; 4.1%) [χ1 2 = 5.15; p = 0.023].Conclusions:the prevalence of glaucoma was higher in a group of older adults with DAT than in a comparable control group. these results underscore the importance of providing regular eyecare for persons affected by DAT.

Cost Comparison of Treating Uninsured Patients at a Hospital-Based Free Clinic, Emergency Room, and Inpatient Hospitalizations: A Retrospective Chart Review

2013 ◽  
Vol 6 (1) ◽  
pp. 47-52
Author(s):  
Michelle Walker
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Free Clinic ◽  
Inpatient Hospitalization ◽  
Care Services ◽  
Preventative Health ◽  
Inpatient Hospitalizations ◽  
Preventative Health Care

Purpose: The rates of the uncompensated health care services have steadily increased across the nation since 2008. Uninsured individuals are less likely to receive preventative services and are more likely to suffer adverse health outcomes and hospitalization for acute conditions. Providing primary and preventative health care to the uninsured is potentially more cost-effective through free clinics as compared to emergency room (ER) or inpatient care. A retrospective chart review was conducted to compare the cost of treating patients in a free clinic, ER, and inpatient hospitalization at one regional hospital in Pennsylvania. Methods: A descriptive, correlational study was conducted in a rural free clinic and its affiliate hospital in Altoona, Pennsylvania. Patients were selected to participate if they were active patients during the fiscal years of the study. A convenience sample (n = 242) of active clinic patients during the fiscal years of the study was selected for chart review. Consent was obtained to access their records. Medical charts were reviewed for frequency of visits, diagnoses, time, charges of ER, and inpatient hospitalizations for the fiscal years of 2009 and 2010. Direct costs for the free clinic were obtained from the executive director. ER and inpatient hospitalization charges were obtained from the regional hospital chief financial officer. Results/Analysis: The data indicate a decrease in average patient clinic visit cost from 2009 to 2010 from $84 to $74. There was a 54% increase in patient visits within that time frame, with patient comorbidities increasing from 1 in 2009 to 4 in 2010. There was found to be a significant positive correlation between clinic visits, inpatient hospitalizations and ER visits in 2009 and a weaker correlation in 2010. Patients were seen in the clinic 23 times their inpatient visits and 45 times their ER visits in 2010. Conclusion: Implications for practice suggest these clinics can provide primary health care needs to patients without insurance in declining health for a reasonable cost. Overall preventative health care services will decrease ER and inpatient hospitalizations and ultimately health care costs.

Sign in / Sign up

Export Citation Format

Share Document