scholarly journals Assessing the Risk of Nephrotoxicity Associated With Non-renally Adjusted Intravenous Polymyxin B Compared with Traditional Dosing

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S299-S300
Author(s):  
Bejoy Maniara ◽  
Thien-Ly Doan ◽  
Lauren Healy
Keyword(s):  
Ascorbic Acid ◽  
Chart Review ◽  
Potential Role ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Polymyxin B ◽  
Respiratory Arrest ◽  
Chi Square ◽  
Chi Square Test

Abstract Background Prior data states that polymyxin B is renally cleared and thus required renal adjustments, however newer data suggests that polymyxin B undergoes non-renal clearance. With more aggressive dosing, potential for increased nephrotoxicity is of concern. This study aims to determine whether time to acute kidney injury (AKI) differs between renally adjusted and non-adjusted doses of intravenous (IV) polymyxin B. Secondary objectives aim to evaluate incidence of AKI, length of stay (LOS), adverse reactions, and potential role of ascorbic acid in decreasing nephrotoxicity. Methods This retrospective chart review compared time to AKI in patients receiving renally adjusted and non-adjusted IV polymyxin B between Jan 2012 and Nov 2016. This study included patients who are at least 18 years old, received IV polymyxin B, and have creatinine clearance below 80 mL/minute. Patients were excluded if they had AKI (RIFLE criteria), received renal replacement therapy, or are pregnant prior to receipt of IV polymyxin B. Fine and Gray’s model for competing risks was used to predict the cumulative incidence function of AKI. Descriptive statistics, two-sample t-test, and Chi-square test were used as appropriate. Results Of the 132 patients screened, 54 met inclusion criteria (23 in the renally adjusted vs. 31 in the non-adjusted group). There was no statistical association between dosing type and time to AKI (P = 0.13). Incidence of nephrotoxicity was higher in the renally adjusted vs. non-adjusted groups (21.7% vs. 6.5% respectively). Mortality was higher in the renally adjusted vs. non-adjusted groups (17.4% vs. 6.5% respectively). LOS was greater in the renally adjusted vs. non-adjusted groups (16 vs. 14 days respectively, P = 0.26). All patients in the study received concomitant nephrotoxic agents (e.g., vancomycin, aminoglycosides). Ascorbic acid use was infrequent but, in the 4 patients who did receive it, none developed AKI. No difference in neurotoxicity, respiratory arrest, Clostridium difficile infections was seen. Conclusion No significant association between IV polymyxin B dosing type and time to AKI was found. Incidence of AKI, LOS, and mortality was higher in the renally adjusted group compared with the non-adjusted group. Ascorbic acid may mitigate the nephrotoxic potential of IV polymyxin B, but further studies are needed. Disclosures All authors: No reported disclosures.

Risk of Nephrotoxicity Associated With Nonrenally Adjusted Intravenous Polymyxin B Compared to Traditional Dosing

2018 ◽  
Vol 33 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Bejoy P. Maniara ◽  
Lauren E. Healy ◽  
Thien-Ly Doan
Keyword(s):  
Acute Kidney Injury ◽  
Ascorbic Acid ◽  
Renal Replacement Therapy ◽  
Renal Impairment ◽  
Chart Review ◽  
Package Insert ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Polymyxin B ◽  
Statistical Association

Background: Polymyxin B’s package insert recommends renal adjustment. Contemporary studies suggest it does not require renal adjustment. Objective: To determine whether time to acute kidney injury (AKI) differs between renally adjusted and nonadjusted intravenous (IV) polymyxin B. Methods: This retrospective chart review compared time to AKI after renally adjusted and nonadjusted IV polymyxin B administration. It included patients who were 18 years or older, received IV polymyxin B, and had creatinine clearance below 80 mL/min, and excluded ones who had AKI, received renal replacement therapy, or were pregnant. Results: Fifty-four patients were included. There was not any statistical association between dosing type and time to AKI ( P = .13). Incidence of nephrotoxicity, mortality, and length of stay (LOS) were higher in the renally adjusted arm (21.7% vs 6.5%, 17.4% vs 6.5%, and 16 vs 14 days, respectively). Four patients received concomitant ascorbic acid; not one developed AKI. Conclusion: A significant association between IV polymyxin B dosing type and time to AKI was not found. Adverse events were higher in the renally adjusted arm. This suggests that nonadjusted IV polymyxin B may be preferred in patients with renal impairment. Ascorbic acid may mitigate IV polymyxin B's nephrotoxic potential. Further studies are needed to corroborate these findings.

Abstract 3235: Low LDL is Associated with Hematoma Expansion in Chronic Daily Alcohol Users with Intracranial Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Gayle R Pletsch ◽  
Christopher Burns ◽  
Karen C Albright ◽  
Amelia K Boehme ◽  
T. M Beasley ◽  
...  
Keyword(s):  
Chart Review ◽  
Ldl Cholesterol ◽  
Independent Predictor ◽  
Retrospective Chart Review ◽  
Platelet Inhibition ◽  
Demographic Variables ◽  
Hematoma Expansion ◽  
Chi Square ◽  
Alcohol Users

Background: Prior studies have reported elevated blood pressure, platelet inhibition, and low LDL cholesterol in chronic daily alcohol users (CDA). Each of these has been shown to be associated with intracerebral hemorrhage (ICH) growth. We hypothesized that CDA patients with ICH and low LDL were at higher risk for ICH growth than CDA users with high LDL. Methods: Retrospective chart review was performed on patients who presented to Tulane University from 7/1/08-12/31/10 with a spontaneous ICH. Patients who underwent hematoma evacuation were excluded. Clinical and demographic variables were abstracted. Hemorrhages volumes were calculated based on ABC/2 method. LDL was dichotomized into low (<100mg/dl) and high (≥100mg/dl) values. Comparisons were made using t-tests, Chi-square and non-parametric equivalents where appropriate. ICH growth in 24 hours and CDA use were evaluated using linear regression. Results: Of the 99 patients with spontaneous ICH, 25.3% were CDA users. No significant differences were observed when comparing baseline demographics of CDA users with LDL<100 and CDA users with LDL>=100 ( Table 1). Patients with low LDL had larger baseline ICH volumes (21.4 vs. 7.5, p=.03) and were more likely to experience ICH growth (87.5% vs. 57.1%, p=0.0002). Initial LDL was an independent predictor for 24 hour ICH growth. Every 10 points the initial LDL was below 100 predicted 1 cc of growth. LDL did not predict ICH growth in non-CDA users (p=0.9430). Discussion: Our data suggest that initial LDL level in chronic daily alcohol users can be used to predict ICH growth. The role of LDL in the importance of vessel fragility and clot stabilization needs to be further explored as this appears be important in patients who are chronic daily alcohol users.

Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Prabhas. P Giri ◽  
Shakil Akhtar ◽  
Somrita Laha ◽  
Rajiv Sinha
Keyword(s):  
Acute Kidney Injury ◽  
Chart Review ◽  
Creatine Phosphokinase ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
High Morbidity ◽  
Childhood Diabetes ◽  
Precipitating Factors ◽  
Serum Creatine Phosphokinase

AbstractObjectivesAlthough Acute Kidney Injury (AKI) has been described among childhood diabetes ketocidosis (cDKA) there is scarcity of literature on the role of concomitant rhabdomyolysis.MethodA retrospective chart review was undertaken (2014–2018) to identify cDKA who developed AKI and had evidence of rhabdomyolysis defined by serum creatine phosphokinase (CPK) > 5 times upper limit of normal.Result46 cDKA were identified. Ten (22%) developed AKI with 6/10 reaching peak AKI Stage 3 and 8/10 had co-current rhabdomyolysis. In comparison to non rhabdomyolysis group, cDKA with rhabdomyolysis were at presentation significantly more likely to be hypotensive and have higher corrected sodium and calculated osmolality. Subsequently they were more likely to develop lower trough potassium levels during treatment. Five patients, all with rhabdomyolysis, needed dialysis: median duration 9 days (range 4–35). Three children in our cohort died, all from infection complications during treatment, one in AKI only group who did not receive dialysis and two in AKI with rhabdomyolysis on dialysis.ConclusionRhabdomyolysis was common among our cohort of cDKA with AKI and was associated with high morbidity and mortality. Rapid flux in electrolytes and osmolality may be important precipitating factors. We recommend larger prospective studies exploring the importance of rhabdomyolysis among cDKA with AKI.

scholarly journals Retrospective Chart Review Comparing CKD COVID-19 Positive Patient Outcomes to non-CKD Patient Outcomes

2020 ◽  
Vol 3 ◽  
Author(s):  
Nicole Eckert ◽  
Safiya Sankari ◽  
Katie Allen ◽  
Siu Lui Hui ◽  
Eneida Mendonca
Keyword(s):  
Patient Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Inpatient Admission ◽  
Control Group ◽  
Chi Square ◽  
Visitation Rates ◽  
Significant Difference ◽  
Chi Square Test

Background/Objective:  Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD.     Methods:   This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes.       Results:  The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p<0.05) in all clinical outcomes tested of CKD patients diagnosed with COVID-19 compared to non-CKD patients. The CKD population had increased mortality, inpatient admission, and ED visitation rates when compared.     Discussion:  This study demonstrates that comorbidities, more specifically CKD, may be associated with a higher severity of COVID-19 than those without. Future studies are needed to explore the relationship more extensively, analyze other outcomes, and manage confounding variables.  

scholarly journals Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henrik Cam ◽  
Thomas Gerardus Hendrik Kempen ◽  
Helena Eriksson ◽  
Kanar Abdulreda ◽  
Kristin Franzon ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Health Records ◽  
Hospitalised Patients ◽  
Medication Reviews ◽  
Chi Square Test ◽  
Electronic Health

Abstract Background The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. Methods We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. Results A total of 699 patients were included. The patients’ mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). Conclusions The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.

Breastfeeding practices among mothers of infants in Peringara Panchayat in Pathanamthitta District

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Aswathy S. ◽  
Lakshmi M. K.
Keyword(s):  
Exclusive Breastfeeding ◽  
Cross Sectional Study ◽  
Community Based ◽  
Chi Square ◽  
Cross Sectional ◽  
Breastfeeding Practices ◽  
Chi Square Test ◽  
Type Of Delivery ◽  
Initiation Of Breastfeeding

The study was aimed to assess the breastfeeding practices among mothers of infants in Peringara Gramapanchayat in Kerala. Study was a community based cross-sectional study among mothers of infants in Peringara gramapanchayat using a pretested questionnaire. 142 breastfeeding mothers of infants in Peringara gramapanchayat were studied and mothers who were not present at home during the study were excluded from the study. Study period consisted of 18 days between December 2015 and January 2016. Study variables includes type of delivery, initiation of breastfeeding, breastfeeding practices and role of ASHAs in promoting good breastfeeding practices. Statistical analysis was done using Pearson’s Chi-square test and T test. The study found that exclusive breastfeeding has been done by 68.3% of mothers. There is no practice of giving pre-lacteal feed, 95.8% of mothers have given colostrum to the new born. Statistically significant association was found between the type of delivery and time of initiation of breastfeeding (p less than 0.05). Time of initiation of breastfeeding was prolonged in case of Caesarean section. 49.3% of mothers have breastfed the baby within one hour. 55.6% of mothers were informed about importance of breastfeeding by ASHAs and only 20.4% of mothers were informed about period of exclusive breastfeeding and period of complimentary feeding by ASHAs.

scholarly journals Association of cervical carcinogenesis risk with HPV16 E6 and E7 variants in the Taizhou area, China

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mei-Zhen Dai ◽  
Yi Qiu ◽  
Xing-Hong Di ◽  
Wei-Wu Shi ◽  
Hui-Hui Xu
Keyword(s):  
Cervical Cancer ◽  
Cervical Carcinogenesis ◽  
Chi Square ◽  
Major Health Problem ◽  
Hpv16 E6 ◽  
Exact Test ◽  
Chi Square Test ◽  
E6 And E7

Abstract Background Human papillomavirus (HPV) type 16 accounts for a larger share of cervical cancer and has been a major health problem worldwide for decades. The progression of initial infection to cervical cancer has been linked to viral sequence properties; however, the role of HPV16 variants in the risk of cervical carcinogenesis, especially with longitudinal follow-up, is not fully understood in China. Methods We aimed to investigate the genetic variability of HPV16 E6 and E7 oncogenes in isolates from cervical exfoliated cells. Between December 2012 and December 2014, a total of 310 single HPV16-positive samples were selected from women living in the Taizhou area, China. Sequences of all E6 and E7 oncogenes were analysed by PCR-sequencing assay. Detailed sequence comparison, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed with BioEdit Sequence Alignment Editor and MEGA X software. Data for cytology tests and histological diagnoses were obtained from our Taizhou Area Study with longitudinal follow-up for at least 5 years. The relationship between HPV16 variants and cervical carcinogenesis risk was analysed by the chi-square test or Fisher’s exact test. Results In this study, we obtained 64 distinct variation patterns with the accession GenBank numbers MT681266-MT681329. Phylogenetic analysis revealed that 98.3% of HPV16 variants belong to lineage A, in which the A4 (Asian) sublineage was dominant (64.8%), followed by A2 (12.1%), A1 (11.4%), and A3 (10.0%). The A4 (Asian) sublineage had a higher risk of CIN2+ than the A1–3 (European) sublineages (OR = 2.69, 95% CI = 1.04–6.97, P < 0.05). Furthermore, nucleotide variation in HPV16 E6 T178G is associated with the development of cervical cancer. Conclusion These data could provide novel insights into the role of HPV16 variants in cervical carcinogenesis risk in China.

scholarly journals Leadership and Motivation as Important Aspects of the International Company’s Corporate Culture

2021 ◽  
Vol 13 (7) ◽  
pp. 3916
Author(s):  
Ingrida Košičiarová ◽  
Zdenka Kádeková ◽  
Peter Štarchoň
Keyword(s):  
Corporate Culture ◽  
Rank Correlation ◽  
Chi Square ◽  
Exact Test ◽  
Main Research ◽  
Leadership Motivation ◽  
Kendall Rank Correlation ◽  
Friedman's Test ◽  
Chi Square Test

Although the issue of corporate culture has been taken over and addressed in the literature from various perspectives, there are very few researchers about the role of leadership and motivation in it, respectively very few researchers have addressed them as important components of the international company’s corporate culture. The present paper aims to point out that leadership and motivation can be perceived as important aspects of the international company’s corporate culture. The object of the investigation was an international company (situated in Italy) and its five subsidiaries (situated in Italy, Czech Republic, Germany, and Turkey). As the main research method, there was chosen the method of the questionnaire survey, which was attempted by all the company’s employees (totally 270 respondents). The questionnaire was divided into three separate, but logically related parts—leadership, motivation, and corporate culture, and submitted to two groups of respondents—the company’s management and its employees. In total 11 hypotheses were formulated and further evaluated by the methods of Pearson Chi-square Test, Fisher’s Exact Test, Cramer’s V coefficient, Kendall rank correlation coefficient, Eta coefficient, Spearman coefficient, Mann–Whitney U test and Wilcoxon W statistics, Kruskal–Wallis test, and Friedman’s test. The results of the research have proven that leadership and motivation are important parts of the corporate culture.

Determining the Role of Customer Satisfaction in Gaining Customer Loyalty among Cafés

2020 ◽  
Vol 8 (1) ◽  
pp. 74-85
Author(s):  
Allen Joshua P. Cuñado ◽  
Cathlyn Mae Painagan ◽  
Jeshnin Ann L. Cuñado ◽  
Ella Marie D. Palmada ◽  
Zenar Jane A. Mumar ◽  
...  
Keyword(s):  
Customer Satisfaction ◽  
Customer Loyalty ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Significant Degree ◽  
Business Success ◽  
Research Approach ◽  
Chi Square ◽  
Chi Square Test

Café as an establishment primarily sells refreshing drinks, snacks, and light meals, with coffee being their flagship product. This type of business is steadily multiplying around the city of Tagbilaran, Bohol, Philippines. Customers have linked to business success as well as customer satisfaction and customer loyalty. This study was implemented to analyze the role of customers’ satisfaction in gaining customers’ loyalty, specifically among purposively selected cafés. The quantitative method of research approach was used with the aid of questionnaires. The data gathered were statistically treated making use of frequency, composite means, weighted mean, chi-square test, and Pearson correlation coefficients. The respondents included 210 customers from the purposively selected cafés. Results showed respondents to be very satisfied (VS) for the Product; for the price; for the place; for the service quality; and moderately satisfied (MS) for promotion. Results further showed that there is a significant degree of relationship between customer satisfaction and customer loyalty.

Risk and Protective Factors Affecting Children in Foster Care: A Pilot Study of the Role of Siblings*

1992 ◽  
Vol 37 (9) ◽  
pp. 616-622 ◽  
Author(s):  
M.B. Thorpe ◽  
G.T. Swart
Keyword(s):  
Foster Care ◽  
Protective Factors ◽  
School Performance ◽  
Extracurricular Activities ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Factors Affecting ◽  
Children In Foster Care ◽  
High Risk Children

A retrospective chart review of 115 siblings (from 48 families) simultaneously taken into the care of a Children's Aid Society was conducted. These children were a very neglected group at great risk of developing mental illness. There was a significant correlation between the number of symptoms the child had while in the receiving home and the time spent in foster care. Protective factors correlated with fewer symptoms at home but not while the child was in care. Being in care resulted in better performance at school, fewer symptoms and involvement in more extracurricular activities. High risk children made up their losses. While in foster care, 53% were eventually separated from their siblings. Children were more likely to be separated from their siblings if they were older, their father was physically ill or their parents were separated. Children who were separated from their siblings had more risk factors and placements while in care. However, they had fewer symptoms and better school performance while they were in foster care and fewer symptoms at discharge than the siblings who stayed together.

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