948 Feasibility Study of a Drive-Through Influenza Vaccination Clinic for Patients-At-Risk & Their Contacts

Abstract Background There are 3-5 million cases of severe influenza-like illness globally each year, and up to 650,000 related deaths. This high prevalence rate proves to be a heavy burden on the healthcare system with >3,000 hospitalisations and >150 ICU admissions annually. Immunisation is gold-standard for the prevention of influenza outbreaks. The HSE Influenza Immunisation Strategy allocates vaccines to be administered in primary care to patients at-risk and their contacts. However, due to the COVID-19 pandemic, this has become a logistical challenge. We aimed to design and test a drive-through influenza vaccine clinic at a large GP practice in Cork. Method We designed and implemented an online booking system for at-risk patients and their contacts. 1-minute drive-through time slots were available to book for up to 6 people per vehicle. The primary measurement was the number of patients vaccinated with a secondary measurement of time spent vaccinating these patients. Results The pilot clinic occurred on 10/10/2020 with over 600 patients-at-risk & their contacts receiving the influenza vaccination over a time period of 10 hours. The capacity of this clinic was limited by the supply of vaccines. We estimate that 1,800 people could be vaccinated over the same time period with adequate vaccine supply. Conclusions A drive-through influenza vaccination clinic can be efficiently run using an online booking system and serves as a safe, efficient, and convenient way for patients-at-risk & their contacts to receive vaccinations. This system can be rolled out efficiently each winter for influenza vaccination and could be expanded to deliver mass vaccination for SARS-CoV-2.

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Identifying those at risk of reattendance at discharge from emergency departments using explainable machine learning

10.1101/2020.12.02.20239194 ◽

2020 ◽

Author(s):

F. P. Chmiel ◽

M. Azor ◽

F. Borca ◽

M. J. Boniface ◽

D. K. Burns ◽

...

Keyword(s):

Machine Learning ◽

At Risk ◽

Emergency Departments ◽

Risk Groups ◽

Machine Learning Algorithms ◽

Care Indicator ◽

Number Of Patients ◽

Increased Risk ◽

Single Centre Study ◽

Patients At Risk

ABSTRACTShort-term reattendances to emergency departments are a key quality of care indicator. Identifying patients at increased risk of early reattendance can help reduce the number of patients with missed or undertreated illness or injury, and could support appropriate discharges with focused interventions. In this manuscript we present a retrospective, single-centre study where we create and evaluate a machine-learnt classifier trained to identify patients at risk of reattendance within 72 hours of discharge from an emergency department. On a patient hold-out test set, our highest performing classifier obtained an AUROC of 0.748 and an average precision of 0.250; demonstrating that machine-learning algorithms can be used to classify patients, with moderate performance, into low and high-risk groups for reattendance. In parallel to our predictive model we train an explanation model, capable of explaining predictions at an attendance level, which can be used to help inform the design of interventional strategies.

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Case Report: Syphilitic Hepatitis–A Rare and Underrecognized Etiology of Liver Disease With Potential for Misdiagnosis

Frontiers in Medicine ◽

10.3389/fmed.2021.789250 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hiba A. Al Dallal ◽

Siddharth Narayanan ◽

Hanah F. Alley ◽

Michael J. Eiswerth ◽

Forest W. Arnold ◽

...

Keyword(s):

At Risk ◽

Case Report ◽

Rare Condition ◽

Liver Function Tests ◽

Sexually Transmitted ◽

Drug Use Disorders ◽

Rare Manifestation ◽

Patients At Risk ◽

Risk Patients ◽

Treponemal Infection

Syphilitic hepatitis (SH) in adults is a rare condition that can be easily misdiagnosed. Clinical and histopathologic manifestations of SH can mimic other infectious and non-infectious conditions, and the diagnosis should be considered in all at-risk patients with abnormal liver function tests. We present an unusual case of SH presenting with seizures and multiple liver lesions. This case report, in line with other newly published reports, promotes awareness of SH as a rare manifestation of treponemal infection and highlights the importance of including SH in the differential diagnosis for patients at risk for sexually transmitted infections and presenting with liver enzyme abnormalities. From a hospital quality control and socioeconomic perspective, our case adds to the growing body of evidence that demonstrates an increasing incidence of patients suffering from venereal diseases and injection drug use disorders, and the burden these conditions place on the healthcare system. Recognition of the clinicopathologic features of SH is required to prevent missed diagnosis and to foster systematic crosstalk between healthcare staff and public health personnel managing this problem.

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Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review

Journal of Clinical Oncology ◽

10.1200/jco.2007.15.0177 ◽

2008 ◽

Vol 26 (16) ◽

pp. 2767-2778 ◽

Cited By ~ 406

Author(s):

Bertrand Coiffier ◽

Arnold Altman ◽

Ching-Hon Pui ◽

Anas Younes ◽

Mitchell S. Cairo

Keyword(s):

At Risk ◽

High Risk ◽

Tumor Lysis Syndrome ◽

The United States ◽

Standards Of Care ◽

Close Monitoring ◽

Tumor Lysis ◽

High Risk Patients ◽

Patients At Risk ◽

Risk Patients

PurposeTumor lysis syndrome (TLS) has recently been subclassified into either laboratory TLS or clinical TLS, and a grading system has been established. Standardized guidelines, however, are needed to aid in the stratification of patients according to risk and to establish prophylaxis and treatment recommendations for patients at risk or with established TLS.MethodsA panel of experts in pediatric and adult hematologic malignancies and TLS was assembled to develop recommendations and guidelines for TLS based on clinical evidence and standards of care. A review of relevant literature was also used.ResultsNew guidelines are presented regarding the prevention and management of patients at risk of developing TLS. The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients. Primary management of established TLS involves similar recommendations, with the addition of aggressive hydration and diuresis, plus allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended. Although guidelines for rasburicase use in adults are provided, this agent is currently only approved for use in pediatric patients in the United States.ConclusionThe potential severity of complications resulting from TLS requires measures for prevention in high-risk patients and prompts treatment in the event that symptoms arise. Recognition of risk factors, monitoring of at-risk patients, and appropriate interventions are the key to preventing or managing TLS. These guidelines should assist in the prevention of TLS and improve the management of patients with established TLS.

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Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001828 ◽

2019 ◽

pp. bmjspcare-2019-001828

Author(s):

Mia Cokljat ◽

Adam Lloyd ◽

Scott Clarke ◽

Anna Crawford ◽

Gareth Clegg

Keyword(s):

At Risk ◽

Palliative Care ◽

Cardiac Arrest ◽

High Risk ◽

Low Risk ◽

Intermediate Risk ◽

Patients At Risk ◽

Risk Patients ◽

Record Review ◽

Hospital Cardiac Arrest

ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.

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Routine Solid Phase Multiplex Anti-HLA Antibody Tests Predict Platelet Refractoriness

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz024 ◽

2019 ◽

Vol 152 (2) ◽

pp. 146-154 ◽

Cited By ~ 1

Author(s):

Jeremy Ryan A Peña ◽

Robert S Makar

Keyword(s):

At Risk ◽

Solid Phase ◽

Human Leukocyte ◽

Hematopoietic Progenitor Cell ◽

Screening Methods ◽

Cell Transplant ◽

Patients At Risk ◽

Risk Patients ◽

Antibody Tests ◽

Hla Antibody

ABSTRACTObjectivesNo validated screening methods identify patients at risk for human leukocyte antigen (HLA) alloimmune-mediated platelet refractoriness (alloPR). We determined if bead-based HLA antibody tests could predict risk of developing HLA alloPR.MethodsHematopoietic progenitor cell transplant patients screened for HLA antibodies without prior refractoriness were identified. Phenotype bead screening results were compared between patients who later did and did not develop alloPR.ResultsSeven of 27 patients identified subsequently developed alloPR. The panel reactive antibody (PRA) and mean fluorescence intensity (MFI) of the 10 most reactive beads in the initial screen were significantly higher among patients who later developed alloPR (P < .001). Specifically, PRA of more than 30% and mean MFI of 1,500 or more in the most reactive beads identified at-risk patients. Administration of HLA-compatible platelets yielded significant posttransfusion count increments compared with routine platelets.ConclusionsHLA antibody screening by phenotype bead assay may prospectively identify at-risk patients for the development of alloPR. However, clinical trials are needed to validate these findings.

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Neuroactive Molecules in the Etiology of Postpartum Depression. An overview

Revista de Chimie ◽

10.37358/rc.19.8.7450 ◽

2019 ◽

Vol 70 (8) ◽

pp. 2885-2888

Author(s):

Mihaela Gabriela Stefan ◽

Carmen Elena Condrat ◽

Lavinia Gusa ◽

Oana Daniela Toader ◽

Andrei-Dennis Voichitoiu ◽

...

Keyword(s):

At Risk ◽

Postpartum Depression ◽

Significant Proportion ◽

Developed Countries ◽

New Mothers ◽

New Methods ◽

High Prevalence ◽

Mother And Child ◽

Risk Patients

Postpartum depression is a serious and frequent condition that affects a significant proportion of new mothers in developed countries. Despite its high prevalence and proven deleterious outcomes for both mother and child, there remains an increasing need to expand our knowledge regarding new methods that ensure the discovery of at-risk patients. Many theories have been developed over the years, mainly focusing on hormonal imbalances that occur after childbirth. This review has the purpose to analyze the existing literature and to summarize the latest findings on neuroactive molecules which may predict postpartum depression in new mothers.

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Case Report: Delayed intra-abdominal bleeding following trans-vaginal ultrasonography guided oocyte retrieval for in vitro fertilization in patients at risk for thrombo-embolic events under anticoagulant therapy

F1000Research ◽

10.12688/f1000research.2-189.v1 ◽

2013 ◽

Vol 2 ◽

pp. 189 ◽

Cited By ~ 2

Author(s):

Roy Mashiach ◽

David Stockheim ◽

Mati Zolti ◽

Raoul Orvieto

Keyword(s):

At Risk ◽

Case Reports ◽

Oocyte Retrieval ◽

Vitro Fertilization ◽

Delayed Bleeding ◽

Abdominal Bleeding ◽

Patients At Risk ◽

Risk Patients ◽

Therapeutic Doses

We report herein, two cases of massive delayed (2 and 4 days) intra abdominal hemorrhage following ovum pick-up (OPU), in patients at risk for thrombo-embolic events, who concomitantly used therapeutic doses of low molecular weight heparin (LMWH). We discuss the possible mechanisms involved in causing the aforementioned delayed bleeding, and call for re-evaluation of the presently accepted anticoagulant co-treatment regimen. These case reports should direct physicians' attention and keep them alert, while conducting IVF treatment to this subgroup of high risk patients.

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Diagnostic Value of Immunocytochemistry in Leptomeningeal Tumor Dissemination

Archives of Pathology & Laboratory Medicine ◽

10.5858/2000-124-0759-dvoiil ◽

2000 ◽

Vol 124 (5) ◽

pp. 759-761

Author(s):

Jean E. Thomas ◽

Evelyn Falls ◽

Manuel E. Velasco ◽

Aiman Zaher

Keyword(s):

At Risk ◽

Cerebrospinal Fluid ◽

Aseptic Meningitis ◽

False Negative ◽

Diagnostic Value ◽

Leptomeningeal Carcinomatosis ◽

Cytologic Examination ◽

Tumor Dissemination ◽

Patients At Risk ◽

Risk Patients

Abstract Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.

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Abstract P077: Missed Opportunities for Behavioral Counseling by Primary Care Providers

Circulation ◽

10.1161/circ.133.suppl_1.p077 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John D Omura ◽

Susan A Carlson ◽

Prabasaj Paul ◽

Kathleen B Watson ◽

Fleetwood Loustalot ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

At Risk ◽

Primary Care Providers ◽

Care Providers ◽

Behavioral Counseling ◽

The Metabolic Syndrome ◽

Patients At Risk ◽

Risk Patients ◽

Counseling Practices

Background: In 2014, the US Preventive Services Task Force recommended adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Hypothesis: We hypothesized that primary care providers (PCPs) who discussed physical activity with most of their at risk patients would have a higher prevalence of offering select components than PCPs who discussed physical activity less frequently. Methods: DocStyles 2015, a Web-based panel survey of 1251 PCPs (response rate=76.8%), assessed physical activity counseling practices with patients at risk for CVD (overweight or obese and with hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). Results: Overall, 55.9% (SE=1.4) of PCPs discussed physical activity with most of their patients at risk for CVD. Among respondents who discussed physical activity with any at risk patients (N=1244), the prevalence of components offered when they counseled ranged from 92.6% encouraging increased physical activity to 15.8% referring to intensive behavioral counseling (Table). PCPs who discussed physical activity with most at risk patients had a higher prevalence of offering all counseling components assessed than PCPs who discussed physical activity less frequently, except for referring to intensive behavioral counseling where no difference was found. Of all PCPs, 8.4% both discussed physical activity with most of their at risk patients and referred them to intensive behavioral counseling. Conclusion: Just over half of PCPs surveyed discussed physical activity with most patients at risk for CVD. These PCPs more frequently offered select components when they counseled with the exception of referral to intensive behavioral counseling. Both the low levels of counseling and referral to intensive behavioral counseling present important opportunities for improving counseling practices.

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Abstract P379: Features to Increase Primary Care Provider Referrals to Intensive Behavioral Counseling for Cardiovascular Disease Prevention

Circulation ◽

10.1161/circ.141.suppl_1.p379 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

John D Omura ◽

Kathleen B Watson ◽

Fleetwood V Loustalot ◽

Janet E Fulton ◽

Susan A Carlson

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Primary Care ◽

At Risk ◽

Task Force ◽

Primary Care Providers ◽

Care Providers ◽

Behavioral Counseling ◽

Patients At Risk ◽

Risk Patients

Background: The US Preventive Services Task Force recommends adults with certain cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling to promote a healthful diet and physical activity for CVD prevention. However, only 1 in 12 primary care providers (PCPs) currently follow this recommendation. This study assessed system and programmatic features PCPs reported would increase their likelihood of referring patients at risk for CVD to intensive behavioral counseling and whether this varied by the percentage of at-risk patients with whom they discuss physical activity. Methods: DocStyles 2018, a web-based panel survey of PCPs, assessed the percentage of at-risk patients with whom PCPs discuss physical activity and the degree to which select features would increase their likelihood of referring to intensive behavioral counseling. Results: Overall, 60.8% of PCPs discussed physical activity with most of their at-risk patients; 21.8% did so with many and 17.4% with few or some. The proportion of PCPs identifying features as increasing their likelihood of referring to intensive behavioral counseling by a great extent ranged from 24.1% for an automated referral in electronic health records, 35.3% for patient progress reports, 41.5% for the program being accredited or evidence-based, to 67.2% for the program having no cost to the patient (Table). These proportions increased for each feature as the percentage of at-risk patients with whom they discuss physical activity increased. Conclusion: PCPs identified programmatic features (i.e. being accredited and of no cost) as having the greatest influence on their likelihood of referring patients at risk for CVD to intensive behavioral counseling, although this varied by the percentage of at-risk patients with whom they discuss physical activity. Findings suggest that the effectiveness of strategies to improve behavioral counseling referrals by PCPs may depend on their current physical activity counseling practices.

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