The Premature Infant

2018 ◽  
pp. 213-222
Author(s):  
Jeana E. Havidich ◽  
Rebecca H. Evans
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Airway Management ◽  
Preterm Neonates ◽  
High Risk Population ◽  
Critical Component ◽  
Metabolic Functions ◽  
Increased Risk ◽  
Therapeutic Procedures ◽  
Sedative Drugs

Preterm and former preterm infants present unique challenges for sedation providers. These children represent a heterogeneous high-risk population who frequently require sedation or anesthesia for diagnostic and therapeutic procedures. They have limited physiologic reserve and immature metabolic functions. Prematurity is associated with an increased risk for sedation adverse events, including death. Understanding the anatomic and physiologic differences between preterm and term children is necessary for the development of a sedation plan. One of the most important differences pertains to the airway and respiratory system, so airway management is a critical component of the sedation plan. Preterm neonates have altered pharmacokinetics and pharmacodynamics, so titration of sedative drugs is recommended.

Armed and prohibited: characteristics of unlawful owners of legally purchased firearms

2020 ◽  
pp. injuryprev-2019-043479 ◽  
Author(s):  
Veronica A Pear ◽  
Christopher D McCort ◽  
Yueju Li ◽  
Laurel Beckett ◽  
Daniel Tancredi ◽  
...  
Keyword(s):  
High Risk ◽  
Random Sample ◽  
High Risk Population ◽  
Bivariate Statistics ◽  
Felony Conviction ◽  
Increased Risk ◽  
Hispanic People ◽  
The Usa ◽  
The Mean ◽  
Race Ethnicity

BackgroundA substantial proportion of individuals who lawfully purchase firearms later become unlawful owners ('prohibited firearm owners'), usually following events associated with an increased risk for future violence. This high-risk population has not previously been described. We aimed to characterise all individuals in California's Armed and Prohibited Persons System (APPS), a statewide programme for recovering firearms from individuals who legally purchased them and later became prohibited from ownership.MethodsWe used univariate and bivariate statistics to describe and compare prohibited firearm owners in APPS with a random sample of non-prohibited firearm owners in relation to age, sex, race/ethnicity and type of firearms owned as of 1 February 2015. We also characterised the geographical distribution of prohibited firearm owners and described their prohibitions.ResultsOf the 18 976 prohibited firearm owners, most were men (93%), half were white (53%) and the mean age was 47 years. Prohibited firearm owners were more likely to be male and to be black or Hispanic people than non-prohibited owners. Both prohibited and non-prohibited firearm owners had an average of 2.6 firearms, mostly handguns. Nearly half (48%) of prohibited firearm owners had a felony conviction. Extrapolating from our findings, we estimated that there are approximately 100 000 persons in the USA who unlawfully maintained ownership of their firearms following a felony conviction.ConclusionsRetention of firearms among persons who become lawfully prohibited from possessing them is common in California. Given the nationwide dearth of a programme to recover such weapons, this is likely true in other states as well.

scholarly journals P0255THE SHORT TERM MATERNAL OUTCOME OF PREGNANT CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Christopher thiam seong Lim ◽  
Yun Jin Ong ◽  
Shao Wei Yong ◽  
Wee Ven Hing [email protected] ◽  
Mohammad Zulkarnain Bidin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Blood Pressure Monitoring ◽  
Post Partum ◽  
Antibiotic Usage ◽  
High Risk Population ◽  
Multiple Pregnancies ◽  
Fetal Outcomes ◽  
Increased Risk

Abstract Background and Aims Pregnancy in chronic kidney disease (CKD) is associated with increased risk of adverse maternal outcomes and fetal outcomes. The risks are noticeable even in early stages of CKD. Despite the rising concern, there are few follow-up studies in this high-risk group. Method We followed up and analysed 538 pregnancies in 173 women with pre-existing of primary renal disease who were seen at a tertiary nephrology centre from January 2007 until December 2015. We sought to investigate the changes in laboratory and clinical parameters, maternal and fetal outcomes. Results Figure 1 showed the changes of parameters intra and post-partum period. Increase in weight (p=0.034, OR 1.135, 95% CI 1.01-1.276), antibiotics consumption (p=0.022, OR 0.088, 95% CI 0.011-0.0703), pregnancy-related hypertension (p=0.056, OR 0.161, 95% CI 0.025-1.05) and gromerulonephritis (p=0.049, OR 14.22, 95% CI 1.009- 200.52) were associated with worsening of proteinuria intra-pregnancy and post-pregnancy period. Age more than 30-year-old (p=0.024, OR 0.644, 95% CI 0.439-0.945), multiple pregnancies (p = 0.032, OR 14.4, 95% CI 1.25-165 , antibiotics usage (p=0.033, OR 27.59, 95% CI 1.302-585.169), diuretic usage (p=0.034, OR 0.003, 95% CI 1.26-0.646), pregnancy-related hypertension (p=0.06, OR 21.838, 95% CI 0.878-543.376) and proteinuria (> 1.5g/d) (p=0.025, OR 0.235 95% CI 0.067-0.717) and fetal complications such as fetal death (p=0.013, OR 3.608 95% CI 1.311-9.930) was associated with rapid renal function decline of 25-50% . Elevation of serum uric acid is associated with a higher risk of adverse fetal outcome (r=0.845 p=0.004). Conclusion Multiple pregnancies, antibiotic usage, pregnancy-related hypertension are strong predictors of rapid maternal rapid function decline. Pre-conception counselling, minimization of antibiotic usage and aggressive blood pressure monitoring and treatment should be part of the standard treatment for this high-risk population.

scholarly journals Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample

2008 ◽  
Vol 193 (5) ◽  
pp. 378-382 ◽  
Author(s):  
Ian Kelleher ◽  
Michelle Harley ◽  
Fionnuala Lynch ◽  
Louise Arseneault ◽  
Carol Fitzpatrick ◽  
...  
Keyword(s):  
Domestic Violence ◽  
High Risk ◽  
Childhood Trauma ◽  
Psychotic Disorders ◽  
Traumatic Events ◽  
High Risk Group ◽  
Traumatic Experiences ◽  
Psychotic Symptoms ◽  
High Risk Population ◽  
Increased Risk

BackgroundChildren and adolescents who report psychotic symptoms appear to be at increased risk for psychotic disorders in adulthood – a putative ‘symptomatic’ high-risk group. However, little research has investigated whether those in this high-risk population have increased rates of exposure to traumatic events in childhood, as seen in patients who have a psychotic illness.AimsTo examine whether adolescents with psychotic symptoms have an increased rate of traumatic experiences.MethodPsychiatric interviews were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about a number of early traumatic events including physical and sexual abuse, exposure to domestic violence and bullying.ResultsFourteen adolescents (6.6% of those interviewed) reported experiencing at least one psychotic symptom. Adolescents who reported psychotic symptoms were significantly more likely to have been physically abused in childhood, to have been exposed to domestic violence and to be identified as a bully/victim (that is, both a perpetrator and victim of bullying) than those who did not report such symptoms. These findings were not confounded by comorbid psychiatric illness or family history of psychiatric history.ConclusionsOur findings suggest that childhood trauma may increase the risk of psychotic experiences. The characteristics of bully/victims deserve further study.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

2004 ◽  
Vol 8 (5) ◽  
pp. 303-309 ◽  
Author(s):  
Anatoli Freiman ◽  
John Yu ◽  
Antoine Loutfi ◽  
Beatrice Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
High Risk Population ◽  
Awareness Campaigns ◽  
Number Of Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
And Behavior ◽  
Attitudes And Behavior

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

scholarly journals Polypharmacy in the Older Adult: Medication Review in the Community

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 208-209
Author(s):  
Staci Pacetti ◽  
Margaret Avallone ◽  
Elyse Perweiler
Keyword(s):  
High Risk ◽  
Affordable Housing ◽  
Medication Management ◽  
The United States ◽  
Daily Basis ◽  
High Risk Population ◽  
Second Phase ◽  
Beers Criteria ◽  
Undergraduate Nursing ◽  
Increased Risk

Abstract Polypharmacy remains a significant healthcare issue in the United States, resulting in drug interactions, adverse drug reactions, and potentially dangerous complications. Polypharmacy, often defined as the simultaneous use of five or more medications, may lead to adherence problems and an increased risk of hospitalizations and death, particularly in the older population. Medication management was incorporated into undergraduate nursing clinical experience in an affordable housing urban community as part of the New Jersey Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA. This paper will describe the first phase of this project, which involved the determination of the prevalence of polypharmacy and high-risk medications in this setting. The charts of sixty residents were reviewed and along with demographic information, the following data was collected: total number of medications (prescription, non-prescription and herbal supplements), high-risk medications using Beers criteria and identification of common themes or issues. The average age of the residents was 72 years, with cardiovascular diseases and diabetes mellitus being the most common comorbidities. Fifty-two of the sixty residents (86%) received five or more medications daily, meeting the definition of polypharmacy. The average number of medications taken on a daily basis was 8.9. Among the residents, centrally-active agents such as gabapentin, tramadol and lorazepam were the most commonly prescribed medications. The second phase of this project will include implementation of a medication reconciliation process to identify potential issues using the Beers criteria and implement appropriate interventions to ensure safe medication practices in this high-risk population.

scholarly journals Characterization of plasma lipidomics in adolescent subjects with increased risk for type 1 diabetes in the DiPiS cohort

Metabolomics ◽  
2020 ◽  
Vol 16 (10) ◽  
Author(s):  
Agnes Andersson Svärd ◽  
◽  
Simranjeet Kaur ◽  
Kajetan Trôst ◽  
Tommi Suvitaival ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
High Risk ◽  
High Performance ◽  
Plasma Lipids ◽  
High Risk Population ◽  
Cross Sectional ◽  
Flight Mass Spectrometry ◽  
Insulin Autoantibody ◽  
Increased Risk

Abstract Introduction Type 1 diabetes (T1D) is caused by the destruction of pancreatic islet beta cells resulting in total loss of insulin production. Recent studies have suggested that the destruction may be interrelated to plasma lipids. Objectives Specific lipids have previously been shown to be decreased in children who develop T1D before four years of age. Disturbances of plasma lipids prior to clinical diagnosis of diabetes, if true, may provide a novel way to improve prediction, and monitor disease progression. Methods A lipidomic approach was utilized to analyze plasma from 67 healthy adolescent subjects (10–15 years of age) with or without islet autoantibodies but all with increased genetic risk for T1D. The study subjects were enrolled at birth in the Diabetes Prediction in Skåne (DiPiS) study and after 10–15 years of follow-up we performed the present cross-sectional analysis. HLA-DRB345, -DRB1, -DQA1, -DQB1, -DPA1 and -DPB1 genotypes were determined using next generation sequencing. Lipidomic profiles were determined using ultra-high-performance liquid chromatography quadrupole time-of-flight mass spectrometry. Lipidomics data were analyzed according to genotype. Results Variation in levels of several specific phospholipid species were related to level of autoimmunity but not development of T1D. Five glycosylated ceramides were increased in insulin autoantibody (IAA) positive adolescent subjects compared to adolescent subjects without this autoantibody. Additionally, HLA genotypes seemed to influence levels of long chain triacylglycerol (TG). Conclusion Lipidomic profiling of adolescent subjects in high risk of T1D may improve sub-phenotyping in this high risk population.

CORRELATION OF ABNORMAL UTERINE ARTERY DOPPLER IN THE SECOND TRIMESTER OF PREGNANCY WITH MATERNAL AND FETAL OUTCOME.

2021 ◽  
pp. 18-19
Author(s):  
Sangeetha Menon ◽  
Jyotsna Nalinan
Keyword(s):  
High Risk ◽  
Uterine Artery ◽  
Subsequent Development ◽  
High Risk Population ◽  
Age Group ◽  
Second Trimester ◽  
Risk Population ◽  
Uterine Artery Doppler ◽  
Increased Risk ◽  
Doppler Indices

Introduction: Maternal – fetal circulation can be studied non-invasively by using doppler which can be used as a screening tool for fetal and maternal disease. Morphological changes in the uterine vasculature can be demonstrated by colour and pulsed doppler studies. The majority of the studies on uterine artery doppler have focused on a high risk population. The effectiveness of the uterine artery doppler to predict pre eclampsia or FGR in a low risk population has been shown to have a low to moderate predictive value1. Also the criteria for normal and abnormal uterine artery doppler continue to vary with no well accepted denition. Aim: To nd out the correlation between abnormal uterine artery doppler in the second trimester of pregnancy between 18-22 weeks, with the subsequent development of pre eclampsia and FGR. Materials and methods: This is a prospective cohort study carried out in the Department of Obstetrics and Gynecology for a period of one year. Antenatal patients in the age group of 18-35 years, between 18-22 weeks of gestation, who were included in the study underwent a uterine artery doppler. They were followed up until delivery. SPSS software was used to analyze the data. Results: 193 Obstetric patients in the age group 18-35 years were evaluated with uterine artery doppler. 77.7% had normal doppler indices. In the abnormal doppler group, 81.4% were in the high risk category and 48.8% of those with abnormal dopplers developed pre eclampsia and 34.9% with abnormal dopplers developed FGR. Conclusion: Patients with abnormal uterine artery doppler indices in the second trimester of pregnancy, had an 18 times increased risk of developing pre eclampsia and a 6 times increased risk of developing FGR when compared to those with normal doppler indices.

Safety and Efficacy of Fecal Microbiota Transplantation for Recurrent Clostridium Infection in Patients with Hematologic Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3599-3599
Author(s):  
Mehrdad Hefazi ◽  
Mrinal M Patnaik ◽  
William J Hogan ◽  
Mark R Litzow ◽  
Darrell S Pardi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Broad Spectrum ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Fecal Microbiota Transplantation ◽  
Hematologic Malignancies ◽  
Fecal Microbiota ◽  
High Risk Population ◽  
Safety And Efficacy ◽  
Increased Risk

Abstract Background: Patients with hematological malignancies are at an increased risk for developing both primary and recurrent Clostridium difficile Infection (RCDI) along with complications such as toxic mega colon and treatment failure likely due to underlying immunosuppression and frequent use of broad spectrum antibiotics that lead to altered gut microbiome. Fecal Microbiota Transplantation (FMT) is an effective treatment for RCDI (Brandt et. al; 2012). However, experience in patients with hematologic malignancies is sparse and most clinical trials exclude these patients due to potential complications. We report the largest case series to date from a single institution evaluating the safety and efficacy of FMT for RCDI in patients with hematologic malignancies. Methods: After IRB approval, a database of 452 RCDI patients treated with FMT between August 2012 and June 2016 was reviewed to identify those with an underlying hematologic malignancy. Data regarding demographics, hematologic disease, C. difficile history, treatments, and outcomes were retrospectively abstracted from the electronic medical record. Results: Sixteen patients (median age 74 years; male 50%) with known hematologic malignancies underwent FMT during the study period. The underlying diagnoses are outlined in Table 1. Five patients had received hematopoietic cell transplantation (3 allogeneic and 2 autologous) prior to FMT. Patients had a median of 4.5 (range 2-9) CDI episodes before FMT, and 4 of them had severe/severe-complicated CDI at some stage. Prior treatments included a median of 3 (range 1-5) standard vancomycin/metronidazole courses, median of 2 (range 0-4) vancomycin taper courses, fidaxomicin in 3 patients, and chronic vancomycin suppression in one patient. Diarrheal symptoms were in remission in all but 3 patients in the week before FMT. FMT was performed via colonoscopy in all patients. At the time of FMT, hematologic malignancies were in complete remission in 9 patients, stable on active treatment in 4, stable off treatment in 2, and relapsed awaiting treatment in 1 patient. Median time from last anti-neoplastic treatment (n = 14) and from last neutropenia (n = 8) to FMT were 10 (range 0-301) and 9.5 (0-68) months, respectively. One patient with hairy cell leukemia was still neutropenic and on prophylactic oral trimethoprim/sulfamethoxazole at the time of FMT. Five patients were on active immunosuppressive medications, including prednisone (n = 2), methotrexate (n = 2), sirolimus (n =1), and cyclosporine (n =1) for related comorbidities at the time of FMT (Table 2). At last follow up (median 12, range 0-32 months), 6 patients had active/relapsed hematological disease, 6 had received additional antineoplastic treatments, and 7 had received additional antibiotics. RCDI developed in two (12%) patients at 8 and 22 months post FMT secondary to exposure to broad spectrum antimicrobials. These patients were successfully treated with a second FMT and with metronidazole, respectively. Severe adverse events included death in one patient that occurred 3 days post FMT due to unexpected cardiac arrest and was deemed unrelated to the procedure. Another patient developed community-acquired pneumonia 15 days post FMT and was treated successfully with oral azithromycin. Minor adverse events within the first two weeks post FMT were noted in 6 (38%) patients (self-limited diarrhea in 3, fecal urgency in 2, abdominal cramps in 2, and constipation in one patient) (Table 3). Only one patient had persistent diarrhea shortly after FMT, with the cause attributed to underlying Crohn's disease. No complications related to the colonoscopy procedure were noted. Conclusion: FMT appears to be a safe and effective therapeutic option for RCDI in patients with hematological malignancies. Considering very few adverse events and particularly no infectious complications in our series, we conclude that immunosuppression should not preclude the use of FMT for treatment of RCDI in this high risk population. These results need prospective validation. Disclosures No relevant conflicts of interest to declare.

scholarly journals Patients Considered “High Risk” For Carotid Endarterectomy are at Increased Risk of Adverse Events After Carotid Artery Stenting

2011 ◽  
Vol 54 (4) ◽  
pp. 1230-1231
Author(s):  
Shunsuke Yoshida ◽  
Christoph S. Nabzdyk ◽  
Julia D. Glaser ◽  
Rodney P. Bensley ◽  
Allen D. Hamdan ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Adverse Events ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Increased Risk
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