scholarly journals Influenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Benjamin J Smith ◽  
David J Price ◽  
Douglas Johnson ◽  
Bruce Garbutt ◽  
Michelle Thompson ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Antiviral Treatment ◽  
Delayed Diagnosis ◽  
Clinical Decision ◽  
Case Definition ◽  
Influenza B ◽  
Clinical Predictors ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

Abstract Background The Infectious Diseases Society of America influenza guidelines no longer require fever as part of their influenza case definition in patients requiring hospitalization. However, the impact of fever or lack of fever on clinical decision-making and patient outcomes has not been studied. Methods We conducted a retrospective review of adult patients admitted to our tertiary health service between April 2016 and June 2019 with laboratory-confirmed influenza, with and without fever (≥37.8ºC). Patient demographics, presenting features, and outcomes were analyzed using Pearson’s chi-square test, the Wilcoxon rank-sum test, and logistic regression. Results Of 578 influenza inpatients, 219 (37.9%) had no fever at presentation. Fever was less likely in individuals with a nonrespiratory syndrome (adjusted odds ratio [aOR], 0.44; 95% CI, 0.26–0.77), symptoms for ≥3 days (aOR, 0.53; 95% CI, 0.36–0.78), influenza B infection (aOR, 0.45; 95% CI, 0.29–0.70), chronic lung disease (aOR, 0.55; 95% CI, 0.37–0.81), age ≥65 (aOR, 0.36; 95% CI, 0.23–0.54), and female sex (aOR, 0.69; 95% CI, 0.48–0.99). Patients without fever had lower rates of testing for influenza in the emergency department (64.8% vs 77.2%; P = .002) and longer inpatient stays (median, 2.4 vs 1.9 days; P = .015). These patients were less likely to receive antiviral treatment (55.7% vs 65.6%; P = .024) and more likely die in the hospital (3.2% vs 0.6%; P = .031), and these differences persisted after adjustment for potential confounders. Conclusions Absence of fever in influenza is associated with delayed diagnosis, longer length of stay, and higher mortality.

The Impact of a Less Restrictive Poststernotomy Activity Protocol Compared With Standard Sternal Precautions in Patients Following Cardiac Surgery

2020 ◽  
Vol 100 (7) ◽  
pp. 1074-1083
Author(s):  
Caitlyn Holloway ◽  
Neeti Pathare ◽  
Jean Huta ◽  
Dana Grady ◽  
Andrea Landry ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Median Sternotomy ◽  
Clinical Decision ◽  
Functional Mobility ◽  
Pain Rating ◽  
Chi Square ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Alternative Approaches ◽  
The Impact

Abstract Objective Guidelines following median sternotomy typically include strict sternal precautions (SP). Recently, alternative approaches propose less functional restrictions while avoiding excessive stress to the sternum. The study aimed to determine the effect of a less restrictive (LR) approach versus a standard SP protocol after median sternotomy. Methods The study was a cross-sectional design (n = 364; SP: n = 172, 66.3 [SD = 11.2] years; LR: n = 196, 65.2 [SD = 11.2] years). This study ran in 2 consecutive phases and compared 2 groups after median sternotomy at a community-based hospital. The LR group received instructions on the Keep Your Move in the Tube approach. At 2 to 3 weeks after discharge, sternal instability was assessed using the Sternal Instability Scale, and patients completed a self-reported survey (perceived pain rating/frequency, sternal instability, and functional mobility). The 2 groups were compared using the Mann-Whitney U test and chi-square test (P < .05). Results There were no significant differences between the 2 groups for all the outcomes, Sternal Instability Scale, pain rating, pain frequency, perceived sternal instability, difficulty with functional mobility, length of stay, and discharge disposition. Conclusions In our study, the implementation of the LR approach, Keep Your Move in the Tube, had no adverse effect on outcomes 2 to 3 weeks following median sternotomy. Although no statistically significant differences were noted for all outcomes, patients with the LR approach reported less difficulty with functional mobility. Impact Statement These data are useful in clinical decision-making regarding alternative approaches for mobility following sternotomy.

Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Bryan Eckerle ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Matthew Flaherty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Imaging Method ◽  
Chi Square ◽  
Exact Test ◽  
High Prevalence ◽  
Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation

Blood ◽  
2001 ◽  
Vol 97 (6) ◽  
pp. 1604-1610 ◽  
Author(s):  
Johan Maertens ◽  
Jan Verhaegen ◽  
Katrien Lagrou ◽  
Johan Van Eldere ◽  
Marc Boogaerts
Keyword(s):  
High Risk ◽  
Invasive Aspergillosis ◽  
Clinical Decision Making ◽  
Imaging Techniques ◽  
Final Analysis ◽  
Clinical Decision ◽  
Case Definition ◽  
Predictive Values ◽  
Diagnostic Uncertainty ◽  
The Impact

The diagnosis of invasive aspergillosis (IA) in patients with hematologic disorders is not straightforward; lack of sensitive and specific noninvasive diagnostic tests remains a major obstacle for establishing a precise diagnosis. In a series of 362 consecutive high-risk treatment episodes that were stratified according to the probability of IA based on recently accepted case definition sets, the potential for diagnosis of serial screening for circulating galactomannan (GM), a major aspergillar cell wall constituent was validated. After incorporating postmortem findings to allow a more accurate final analysis, this approach proved to have a sensitivity of 89.7% and a specificity of 98.1%. The positive and negative predictive values equaled 87.5% and 98.4%, respectively. False-positive reactions occurred at a rate of 14%, although this figure might be overestimated due to diagnostic uncertainty. More or less stringent criteria of estimation could highly influence sensitivity, which ranged from 100% to 42%; the impact on other test statistics was far less dramatic. All proven cases of IA, including 23 cases confirmed after autopsy only, had been detected before death, although serial sampling appeared to be necessary to maximize detection. The excellent sensitivity and negative predictive value makes this approach suitable for clinical decision making. Unfortunately, given the species-specificity of the assay, some emerging non-Aspergillus mycoses were not detected. In conclusion, serial screening for GM, complemented by appropriate imaging techniques, is a sensitive and noninvasive tool for the early diagnosis of IA in high-risk adult hematology patients.

Integrating a paradigm shift into treatment of renal cell cancer: Effect of online CME on oncologists' knowledge and competence.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 651-651
Author(s):  
Tara Herrmann ◽  
Charlotte Warren ◽  
Haleh Kadkhoda ◽  
Erin Pacheco ◽  
David F. McDermott
Keyword(s):  
Disease Management ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Clinical Decision Making ◽  
Cell Cancer ◽  
Clinical Decision ◽  
Evidence Based ◽  
Chi Square ◽  
The Impact ◽  
Case Based

651 Background: The objective of this study was to determine the effect of online, case-based, continuing medical education (CME) on the knowledge and competence of oncologists regarding the management of metastatic renal cell cancer (mRCC). Methods: Oncologists participated in a text-based online CME activity composed of 2 patient cases with interactive questions. Evidence-based educational feedback was provided following each response. Three multiple-choice knowledge/competence and 1 self-efficacy question were selected from the set of intra-activity questions to be repeated after participation. These were used to assess the impact of the education in the form of a repeated pairs, in which each participant served as his/her own control. The analysis included: For all questions combined, McNemar’s chi-square test assessed the differences from pre- to post-assessment; P values <.05 are considered statistically significant; Effect size was calculated using Cramer’s V by determining the change in proportion of participants who answered questions correctly; The activity launched online 9/2016 and data collected through 10/2016. Results: Upon completion of the activity, an improvement was observed in oncologists’ ability to: Identify the most appropriate evidence-based regimen for a patient with mRCC that has progressed on a first line TKI (60% vs 18%, P =0.019); Recognize the symptoms of an irAE in a patient receiving an immune checkpoint inhibitor (55% vs 85%, P <0.001); Elicit patient preferences, goals, and values to help decide the best course of action in their care and disease management (26% vs 83%, P <0.001); Feel more confident in selecting the most appropriate option for a patient with mRCC whose disease has progressed on therapy (+17%). Conclusions: An online, interactive, case-based CME activity improved the knowledge/competence of oncologists, showing that unique educational methodologies and platforms, available on-demand, can be effective tools for advancing clinical decision making in the rapidly changing environment of mRCC disease management. Additional studies are needed to assess whether improved aptitude translates to improved performance during clinical practice.

scholarly journals Biostatistics in Clinical Decision Making What can We Get from a 2×2 Contingency Table

2021 ◽  
Vol 233 ◽  
pp. 02014
Author(s):  
Shanshan Zhang
Keyword(s):  
Prospective Studies ◽  
Clinical Decision Making ◽  
Contingency Tables ◽  
Roc Curves ◽  
Clinical Decision ◽  
Chi Square ◽  
Predictive Values ◽  
Duodenal Diverticula ◽  
Chi Square Test ◽  
Relationship Of

Biostatistics is an essential part when making clinical decisions. Applications of 2×2 contingency tables playing a key role in conducting analysis involving binary variables. When it comes to analysis based on 2×2 contingency tables, most people are familiar with the concept of sensitivity and specificity for evaluating a new test, but predictive values and receiver operating characteristic (ROC) curves would also provide information. Besides, Odds Ratio (OR), Risk Ratio (RR), and Chi-square test are measures based on 2×2 tables and commonly applied in retrospective and prospective studies. This article will first review the two kinds of application of 2×2 contingency tables, evaluating a new test compared with a reference standard, and exploring the relationship of exposures and outcomes in retrospective or prospective studies. Two clinical examples are presented to demonstrate these basic biostatistical concepts: diagnostic accuracy of 64-slice multidetector computed tomography (64-MDCT) to identify periampullary duodenal diverticula, and a randomized clinical trial (RCT) to examine the effectiveness of Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery. Correctly understanding these concepts will assist clinicians and medical researchers to analyze the data and interpret the results, and therefore make accurate decisions in clinical practice.

scholarly journals PDA Use by Clinicians has a Positive Impact on Clinical Decision Making

2006 ◽  
Vol 1 (2) ◽  
pp. 40
Author(s):  
Suzanne Pamela Lewis
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
The United States ◽  
Teaching Hospitals ◽  
Chi Square ◽  
Convenience Sample ◽  
Attending Physicians ◽  
The Impact

A review of: Dee, Cheryl R., Marilyn Teolis, and Andrew D. Todd. “Physicians’ use of the personal digital assistant (PDA) in clinical decision making.” Journal of the Medical Library Association 93.4 (October 2005): 480-6. Objective – To examine how frequently attending physicians and physicians in training (medical students, interns and residents) used PDAs for patient care and to explore physicians’ perceptions of the impact of PDA use on several aspects of clinical care. Design – User study via a questionnaire. Setting – Teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania in the United States. Subjects – A convenience sample of fifty-nine attending physicians and forty-nine physicians in training (108 total), spread unevenly across the five states. Methods – Subjects were recruited by librarians at teaching hospitals to answer a questionnaire which was distributed and collected at medical meetings, as well as by email, mail, and fax. The subjects were required to have and use a PDA, but prior training on PDA use was not a requirement, nor was it offered to the subjects before the study. Most of the questions required the respondent to choose from five Likert scale answers regarding frequency of PDA use: almost always, often, a few times, rarely, or never. In the reporting of results, the options ‘almost always’ and ‘often’ were combined and reported as ‘frequent’, and the options ‘a few times’ and ‘rarely’, were combined and reported as ‘occasional’. Subjects could also record comments for each question, but only for affirmative responses. Subjects were asked about their frequency of PDA use before, during, or after a patient encounter. They were also asked if PDA use had influenced one or more of five aspects of clinical care – decision making, diagnosis, treatment, test ordering, and in-patient hospital length of stay. Data analysis included chi square tests to assess differences between attending physicians and physicians in training regarding frequency of PDA use and the influence of PDA use on the five aspects of clinical care. The subject population was also divided into frequent and occasional users of PDAs, and chi square testing was used to assess differences between these two groups regarding the influence of PDA use on clinical care. A significance value of P

scholarly journals 1331. Interpretation and Application of Rapid Diagnostic Methodologies: The Positive Impact of Online, Curriculum-Based Learning

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S481-S481
Author(s):  
Simi Thomas. Hurst ◽  
James Martorano ◽  
Catherine Capparelli
Keyword(s):  
Online Education ◽  
Clinical Decision Making ◽  
Positive Impact ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Considerable Effect ◽  
Chi Square ◽  
Noticeable Effect ◽  
Chi Square Test ◽  
Post Assessment

Abstract Background Antibiotic resistance has become one of the most serious public health threats today. Used appropriately, newer rapid diagnostic methodologies have the potential to positively impact care by informing a more targeted treatment approach that can reduce inappropriate antibiotic use, support antimicrobial stewardship, shorten hospital stays, and improve clinical outcomes. Methods To improve ID specialists’ knowledge and application of rapid diagnostic tests, a CME/ABIM MOC/ACCENT certified curriculum was developed. The curriculum comprised a series of 4 educational episodes, each with a video commentary from a clinical expert and each focused on a different site of infection: (a) Episode 1: CNS; (b) Episode 2: Gastrointestinal tract; (c) Episode 3: Respiratory tract; and (d) Episode 4: Bloodstream. The episodes in the curriculum were launched in serial fashion between October 30, 2018 and February 11, 2019, on a website dedicated to continuous professional development. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values of < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Results 15,092 HCPs, including 10,894 physicians have participated in the curriculum. This initial analysis comprises data from the subset of ID specialists from each episode who answered all pre-/post-assessment questions through March 18, 2019; data collection is ongoing. Following participation, significant improvements were observed overall (P ≤ 0.002 for each episode) and on the specific topics assessed in each episode (Graph). Additionally, 51%–55% of ID specialists indicated an intent to modify their diagnostic approach and 15%–29% had increased confidence in applying the rapid diagnostic results into patient care. Conclusion This educational curriculum significantly improved ID specialists’ knowledge of the strengths and limitations of different rapid diagnostic methodologies and improved the applications of test findings into clinical decision-making. These findings highlight the positive impact of well-designed online education. Disclosures All authors: No reported disclosures.

Decipher test’s impact on the postoperative management of prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 146-146
Author(s):  
Brian P. Calio ◽  
Matt Murphy ◽  
Anne Calvaresi ◽  
James Ryan Mark ◽  
Mark Mann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Postoperative Management ◽  
Adjuvant Radiation ◽  
Chi Square ◽  
Cancer Aggressiveness ◽  
The Impact

146 Background: The Decipher Prostate Cancer Test provides risk stratification for prostate cancer aggressiveness and predicts the probability of metastasis after surgery. We aim to determine the impact on clinical decision-making Decipher risk designation has had at our institution since its implementation. Methods: A prospectively maintained single institution database was analyzed for patients who underwent prostate biopsy and prostatectomy between 2006-2017. Patients with pathologic T3 cancer, Gleason ≥3+4, or positive surgical margins were considered for the study. In cohort 1, patients’ Decipher scores were available prior to postoperative decision-making, in cohort 2 patients’ scores were not available. Postoperative management was then compared between cohorts to determine if presence of Decipher score influenced the rate of adjuvant and salvage radiation administered. The EMR was queried for the words “adjuvant”, “RT”, “salvage”, “SRT”, to record rates of radiation given to each patient. Chi Square and Mann Whitney test was used to compare rates between cohorts and Decipher risk categories. Results: 454 patients were included in the study with median (IQR) age of 62.0 (7.0) years. Mean time of follow-up was 2.0 years and 8.2 years in cohorts 1 and 2, respectively. In the cohort that received Decipher scores, rate of adjuvant radiation administered was significantly higher than in patients who did not receive a Decipher score (27.0% vs. 6.8%, p<0.001), and higher Decipher risk was associated with higher rate of adjuvant administration (9% vs 27.8% vs 35.4% for low, average and high risk, respectively; p<0.001). Rate of salvage radiation given was not significantly different between the cohorts (5.2% vs 4.0%; p=0.228). Conclusions: The Decipher Prostate Cancer Test provides valuable data regarding risk stratification of disease. As demonstrated here, the availability of Decipher scores has lead to a demonstrable effect in the postoperative management of prostate cancer.

Religion and Medicine

2020 ◽  
Author(s):  
Jeff Levin ◽  
Stephen G. Post
Keyword(s):  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Religion And Medicine ◽  
Physical And Mental Health ◽  
Faith Based ◽  
Baylor University ◽  
Wide Range ◽  
History Of ◽  
The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

scholarly journals The impact of COVID-19 related national lockdown on ophthalmic emergency in Italy: A multicenter study

2021 ◽  
pp. 112067212110280
Author(s):  
Maria L Salvetat ◽  
Carlo Salati ◽  
Patrizia Busatto ◽  
Marco Zeppieri
Keyword(s):  
Gender Bias ◽  
Tertiary Care ◽  
Lower Number ◽  
Electronic Records ◽  
Chi Square ◽  
Efficient Access ◽  
Chi Square Test ◽  
Unpaired Student ◽  
The Impact ◽  
Wet Amd

Purpose: To assess ocular pathologies admitted to Italian Emergency Eye Departments (EEDs) during the COVID-19 pandemic national lockdown in 2020 in comparison with the same period in 2019. Methods: Electronic records of all patients presenting at EEDs of two tertiary-care Eye Centers during the COVID-19 national lockdown in Italy (March 10–May 3, 2020) were compared with the equivalent period in 2019. Main outcomes were patient age, gender, and diagnoses. Statistical analysis included unpaired Student t-tests, Poisson regression, and chi-square test. Results: Overall EED visits significantly decreased by 54.1% during the 2020 lockdown compared to 2019 (851 vs 1854, p < 0.001). During lockdown, patients showed comparable mean age (52.8 years in 2020 vs 53.3 years in 2019, p = 0.52) and significant male gender bias (61.1% in 2020 vs 55.8% in 2019, p < 0.0001). The most frequent pathologies were eye inflammations, trauma-related incidents, and spontaneous acute vitreous detachment. Patients with inflammation, headache/hemicrania, and spontaneous subconjunctival hemorrhages were significantly less, whereas those with trauma-related diagnoses were significantly higher during the lockdown as compared with 2019 ( p < 0.05). The proportion of non-urgent visits decreased from 17% in 2019 to 8% in 2020 ( p < 0.001). Conclusions: During the 2020 lockdown, there was a significant reduction of accesses to EED, especially for non-urgent pathologies. Potentially visual function threatening conditions, such as trauma-related pathologies, retinal detachment or ruptures, and wet AMD, showed lower number of cases but higher or stable proportion relative to the total caseload, suggesting a correct and efficient access to ophthalmic health care during the pandemic period.

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