P–701 Fresh vs frozen PGT-A cycles in donor oocyte recipients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J C Castillo ◽  
J Guerrero ◽  
J Ten ◽  
M Martinez ◽  
J Llacer ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Early Pregnancy ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Ivf Outcomes ◽  
Donor Oocyte ◽  
Frozen Embryos ◽  
The Impact ◽  
Fresh Embryos

Abstract Study question For donor oocyte recipients, are clinical outcomes superior for fresh versus frozen euploid embryos? Summary answer Among donor oocyte recipients receiving euploid embryos, fresh embryos are associated with superior clinical outcomes when compared with frozen embryos. What is known already A recent large retrospective cohort national registry study reported that among donor oocyte recipients, fresh embryos were associated with better clinical outcomes when compared with frozen embryos. This finding contrast with data from autologous oocytes. Since embryo quality at embryo transfer (ET) may introduce a significant confounder, the additional analysis of recipients receiving only euploid embryos may add important information on the subject. Study design, size, duration Retrospective cohort analysis of PGT-A IVF-cycles of women using donor oocytes resulting in fresh blastocyst ET compared to the first frozen blastocyst ET from freeze-all cycles between 2014 and 2020 at Instituto Bernabeu, Alicante, Spain. A total of 349 donor oocyte cycles were analyzed, in which 211 were fresh and 138 were frozen ETs. Thawed oocytes were not excluded. Participants/materials, setting, methods Clinical pregnancy (gestational sac plus embryo heart beating at 6–7 weeks), was the primary outcome measure. Secondary outcomes included pregnancy and early pregnancy loss rate. aCGH platform tested the embryos transferred in fresh whereas either aCGH or NGS platforms were used for embryos submitted to elective frozen cycles. Vitrification was used as cryopreservation technique. Fresh transfers were performed in artificial cycles. Different types of endometrial preparations were used for FET in the study. Main results and the role of chance Recipients in the fresh group were significantly younger and had more embryos transferred compared to the frozen group (41.3 vs 42.5 and 1.2 vs 1.1, respectively). More clinical pregnancies were observed in the fresh compared to the frozen group (108/211 versus 54/138, respectively, odds ratio (ODR) 1.63 [95% CI 1.05–2.52]; p = 0.02). Pregnancy rates were also higher in the fresh compared to the frozen group (128/211 versus 63/138, respectively, odds ratio (ODR) 1.83 [95% CI 1.18–2.83]; p = 0.005). Early pregnancy losses were similar in both groups (p = 0.2). Limitations, reasons for caution Implantation failure and abnormal male tests were the most frequent indications for PGT-A. Because of the observational nature of the results in this limited sample size, a cause–effect relationship should not be assumed; evidence from larger well-designed randomized control trials is still required before clinical advice can be suggested. Wider implications of the findings: When PGT-A analysis is deemed to be necessary in oocyte recipients, cryopreservation may have an adverse impact on IVF outcomes. Future studies exploring ET in natural vs artificial cycles are warranted to further isolate the impact of vitrification and the uterine environment on IVF outcomes. Trial registration number Not applicable

The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

2017 ◽  
Vol 55 (6) ◽  
pp. 651-658 ◽  
Author(s):  
Jonas Daugherty ◽  
Xiwu Lin ◽  
Richard Baxter ◽  
Robert Suruki ◽  
Eric Bradford
Keyword(s):  
Severe Asthma ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Systemic Glucocorticoid ◽  
Retrospective Cohort Analysis ◽  
The Impact

Retrospective cohort analysis of real-world clinical outcomes in nonmetastatic (M0) castration-resistant prostate cancer (CRPC) treated with novel androgen receptor pathway inhibitors (ARPI).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 51-51
Author(s):  
Richard Gagnon ◽  
Nimira S. Alimohamed ◽  
Alexander Watson ◽  
Eugene Batuyong ◽  
Alyssa Chow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Real World ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Progression Free Survival ◽  
Rank Test ◽  
Castration Resistant Prostate Cancer ◽  
Survival Times ◽  
Free Survival

51 Background: The landscape of M0 CRPC has changed with the recent demonstration of metastasis-free survival (MFS) and overall survival (OS) improvements with the use of ARPIs in clinical trial settings. However, the extrapolation of this data to clinical practice is limited by strict exclusion criteria in these trials, including prior or concurrent malignancy, cardiovascular disease, or hypertension. The purpose of this study was to assess real-world outcomes in patients with M0 CRPC treated with ARPIs compared to historical controls. Methods: We designed a retrospective cohort study with the inclusion of patients in Alberta, Canada diagnosed with M0 CRPC between 2001-2020. Via chart review, we identified baseline characteristics, potential confounders, treatment details, and clinical outcomes. The primary outcome of interest was MFS. Secondary outcomes included: second progression-free survival (PFS2) and OS. Median survival times were measured using the Kaplan-Meier method and the log-rank test was used for comparison of outcomes based on ARPI exposure. Cox proportional hazard regression models were used to calculate hazard ratios (HR) accounting for impact of PSA doubling time (PSADT), use of osteoclast inhibiting agents, and presence of pelvic lymphadenopathy. Results: We identified 211 patients across multiple centres in Alberta with M0 CRPC, with 54 having received apalutamide (40/54), enzalutamide (7/54), or darolutamide (7/54). Median age at M0 CRPC diagnosis was 74 years; median PSADT was 4.4 months; and 19% of patients (40/211) had pelvic lymphadenopathy at diagnosis. Median MFS in patients treated with ARPIs was 47.5 months compared to 20.6 months in those not treated with ARPIs (HR, 0.23; 95% confidence interval [CI], 0.11-0.49; p < 0.001). Median PFS2 in ARPI treated patients was 66.3 months compared with 35.6 months (HR, 0.40; 95% CI, 0.18-0.87; p = 0.022). Median OS for patients treated with ARPI was not reached. Conclusions: Given the older age of men with advanced prostate cancer, real-world outcomes that include patients with comorbidities are important adjuncts to the interpretation of clinical trials exploring the benefit of novel therapeutics. Here, we demonstrate that in a real-world, unselected population of men with M0 CRPC, apalutamide, enzalutamide, and darolutamide seem to confer similar MFS and PFS2 benefits to those demonstrated in the SPARTAN, PROSPER, and ARAMIS studies. Real-world OS data remain immature and will be an important addition to these findings.

scholarly journals Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020269 ◽  
Author(s):  
Sarah Forster ◽  
Gemma Housley ◽  
Tricia M McKeever ◽  
Dominick E Shaw
Keyword(s):  
Respiratory Disease ◽  
Early Warning ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Scoring Systems ◽  
University Hospitals ◽  
Retrospective Cohort Analysis ◽  
Early Warning Scores ◽  
The Impact ◽  
Higher Sensitivity

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

scholarly journals Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Benedict Morath ◽  
Andreas Meid ◽  
Johannes Rickmann ◽  
Jasmin Soethoff ◽  
Markus Verch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Function ◽  
Hydroxyethyl Starch ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Retrospective Cohort Analysis ◽  
The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

The Impact of Nighttime on First Pass Success During the Emergent Endotracheal Intubation of Critically Ill Patients

2020 ◽  
pp. 088506662096516
Author(s):  
Daniel G. Fein ◽  
Dawn Zhao ◽  
Kyle Swartz ◽  
Peter Nauka ◽  
Luke Andrea ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Obese Patients ◽  
Effect Modifier ◽  
Related Factors ◽  
Unadjusted Odds Ratio ◽  
First Pass ◽  
The Impact

Background: While numerous investigations have described worse outcomes for patients undergoing emergent procedures at night, few studies have investigated the impact of nighttime on the outcomes of emergent endotracheal intubation (EEI). We hypothesized that for patients requiring EEI at night, the outcome of first pass success would be lower as compared to during the day. Methods: We performed a retrospective cohort study of all patients admitted to our institution between January 1st, 2016 and July 17st, 2019 who underwent EEI outside of an emergency department or operating room. Nighttime was defined as between 7:00 pm and 6:59 am. The primary outcome was the rate of first pass success. Logistic regression was utilized with adjustment for demographic, morbidity and procedure related covariables. Results: The final examined cohort included 1,674 EEI during the day and 1,229 EEI at night. The unadjusted rate of first pass success was not different between the day and night (77.5% vs. 74.6%, unadjusted odds ratio (OR): 0.85; 95% confidence interval (CI): 0.72, 1.0; P = 0.073 though following adjustment for prespecified covariables the odds of first pass success was lower at night (adjusted OR: 0.83, 95% CI: 0.69, 0.99; P = 0.042. Obesity was found to be an effect modifier on first pass success rate for day vs. night intubations. In obese patients, nighttime intubations had significantly lower odds of first pass success (adjusted OR: 0.71, 95% CI: 0.52, 0.98; P = 0.037). Discussion: After adjustment for patient and procedure related factors, we have found that the odds of first pass success is lower at night as compared to the day. This finding was, to some degree, driven by obesity which was found to be a significant effect modifier in this relationship.

scholarly journals Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

2020 ◽  
Vol 70 (695) ◽  
pp. e399-e405
Author(s):  
Rachel Denholm ◽  
Richard Morris ◽  
Sarah Purdy ◽  
Rupert Payne
Keyword(s):  
Hospital Admission ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Post Discharge ◽  
Emergency Hospital ◽  
Obstetrics And Gynaecology ◽  
Emergency Hospital Admission ◽  
Retrospective Cohort Analysis ◽  
The Impact

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

scholarly journals Indirect impact of the COVID-19 pandemic on emergency department presentations and hospital admissions for urgent early pregnancy conditions: a population-based retrospective cohort study

2021 ◽  
Author(s):  
Lisa Hui ◽  
Wanyu Chu ◽  
Elizabeth McCarthy ◽  
Mary McCarthy ◽  
Paddy Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Linear Prediction ◽  
Hospital Admissions ◽  
Population Based ◽  
Termination Of Pregnancy ◽  
The Impact

Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.

The Impact of Lifestyle on Forearm Fractures in Children: A Retrospective Cohort Analysis

Bone ◽  
2021 ◽  
pp. 116149
Author(s):  
Marcus Örgel ◽  
Giulia Zimmer ◽  
Tilman Graulich ◽  
Pascal Gräff ◽  
Christian Macke ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Retrospective Cohort Analysis ◽  
The Impact
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