scholarly journals Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S396
Author(s):  
Matthew Ziegler ◽  
Daniel Landsburg ◽  
David Pegues ◽  
Kevin Alby ◽  
Cheryl Gilmar ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Tertiary Care ◽  
Positive Test ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Test Results ◽  
Exact Test ◽  
Academic Center ◽  
Chi Squared ◽  
Record Review

Abstract Background C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate characteristics of patients with toxin enzyme immunoassay (EIA) vs. PCR positive C. difficile test results. Methods A retrospective review of inpatients at a tertiary care academic center with hematologic malignancy and a positive C. difficile test from 1/2015 to 1/2016 was performed. Data on demographics, comorbidities, clinical features, and outcomes were collected using medical record review. Characteristics were compared between patients with EIA vs. PCR positive test results using chi-squared or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Results A total of 130 patients were included: 51% and 49% had a PCR positive and EIA positive result, respectively. Diagnoses included AML (42%), multiple myeloma (22%), and Non-Hodgkin’s lymphoma (13%). Antibiotic exposure was similar, with a median of 4 days of anti-pseudomonal antibiotics received in the prior 30 days. There was no difference in history of a positive C. difficile test in the prior year (12% in the EIA group, 10% in the PCR group, P = 0.71). Patients with EIA positive results were more likely to have a WBC ≥15/mm3 (18% vs. 6%, P = 0.02). However, there were no differences in presence of fever, stool frequency, or imaging evidence of colitis at the time of testing. Medications in the prior 72 hours were similar, including the use of proton pump inhibitors of ~40% and of laxatives of 28%. Clinical outcomes were also similar between patients with EIA vs. PCR positive tests: all-cause death (22% vs. 20%), recurrent CDI (9% vs. 13%), colectomy (1% vs. 4%), and megacolon (0% vs. 3%). Most patients received treatment with oral vancomycin for a median duration of 14 days. Conclusion In patients with hematologic malignancy, those with EIA vs. PCR positive C. difficile test results were clinically similar. These findings suggest that algorithms for testing and treatment of C. difficile in hematologic malignancy patients will need to be specifically targeted towards this immunocompromised population. Disclosures All authors: No reported disclosures.

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

scholarly journals Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Audrey M. Uong ◽  
Michael D. Cabana ◽  
Janet R. Serwint ◽  
Carol A. Bernstein ◽  
Elaine E. Schulte
Keyword(s):  
Emotional Exhaustion ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Academic Rank ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Exact Test ◽  
Faculty Burnout ◽  
Student’S T ◽  
The Impact

OBJECTIVES To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children’s hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student’s t or Mann–Whitney tests, and categorical variables were analyzed by using χ2 or Fisher’s exact test, as appropriate. RESULTS Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

scholarly journals Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

2020 ◽  
Vol 17 (2) ◽  
pp. 657
Author(s):  
Mark L. Vickers ◽  
Emma L. Ballard ◽  
Patrick N. A. Harris ◽  
Luke D. Knibbs ◽  
Anjali Jaiprakash ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Categorical Variables ◽  
Multi Drug Resistance ◽  
Continuous Variables ◽  
Exact Test ◽  
Chi Squared ◽  
The Relationship ◽  
Epidemiological Cohort

We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher’s Exact test, and continuous variables with the Student t-test or Mann–Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species.

scholarly journals Single Center Outcomes of Status Epilepticus at a Paediatric Intensive Care Unit

2015 ◽  
Vol 43 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Samir Shah ◽  
Namrata Shah ◽  
Robert Johnson ◽  
Alina Nico West ◽  
Narayan Prasad
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Paediatric Intensive Care ◽  
Categorical Variables ◽  
Admission Diagnosis ◽  
Continuous Variables ◽  
Exact Test ◽  
Refractory Seizures

AbstractBackground:Status epilepticus (SE) is a frequent admission diagnosis to paediatric intensive care units (PICUs) and is associated with variable outcomes. We have audited our experience of patients presenting in SE at a Canadian PICU to determine unfavorable outcome variables.Methods:Charts of patients <18 years of age presenting in SE to a tertiary care PICU over a 10-year period were audited. Data were analyzed at three care-points: transport, the emergency department (ED) and the PICU. Patient outcome before PICU discharge was categorized as “favorable” for return to pre-status functioning level or “unfavorable” for new deficit/death. Student’st-test andthe Kruskal-Wallis test were used for analysis of normal and skewed continuous variables, respectively, and either Chi-square test or Fisher’s exact test for categorical variables.Results:189 patients (54% males) were identified with a median age of 1.9 years. Idiopathic SE had the highest incidence; infectious/vascular etiologies were associated with more unfavorable outcomes. Progression to refractory SE in the ED had a higher incidence of death (p<0.05). Patients with an unfavorable outcome had a higher incidence of apnea during transport (p=0.01), longer hospital stays (p<0.05), need for therapeutic coma (p=0.01), longer duration of therapeutic coma (p<0.05), need for mechanical ventilation (p<0.05), and recurrent or refractory seizures during inpatient stay (p<0.05). Multivariate analysis of unfavorable outcomes of patients in SE presenting to the PICU included renal failure, cerebral edema, apnea during transport, refractory seizures, and recurrent seizures.Conclusions:Refractory seizures in children presenting with SE are associated with worsened outcomes in the PICU.

scholarly journals Histomorphology of germ cell tumors at various anatomic sites: a 5 years study at a tertiary care centre

2021 ◽  
Vol 9 (10) ◽  
pp. 3079
Author(s):  
Manal A. Lateef ◽  
M. I. Lone
Keyword(s):  
Germ Cell ◽  
Malignant Tumors ◽  
Tertiary Care ◽  
Germ Cell Tumors ◽  
Cystic Teratoma ◽  
The Body ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Tertiary Care Centre ◽  
Exact Test

Background: Germ cell tumors (GCTs) are a heterogeneous group of neoplasms, which occur in the gonads, and at extra gonadal sites of the body. The aim of the study was to observe the different histopathological patterns of various GCTs in the body at all possible sites and to know their IHC staining patterns.Methods: The study was conducted for a period of 5 years from 2015 to 2019 and was an observational study. The recorded data was compiled and entered in a spreadsheet and then exported to data editor of SPSS Version 20.0. Continuous variables were expressed as mean SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams Chi-square test or Fisher’s exact test was applied for comparing categorical values. P<0.05 was considered statistically significant. All p values were 2 tailed.Results: A total of 93 cases were analyzed and the mean age of the patients was 27.8 years. Mature cystic teratoma was the most common histopathological variant and was mostly seen in the ovaries. There was a difference in age predilection of benign and malignant tumors. Most of the malignant GCTs were gonadal while EGCTs were likely to be benign. MGCTs (mixed GCTs) were mostly testicular in origin with only one MGCT being extragonadal.Conclusions: Mature cystic teratomas were the most frequent GCTs with frequent site being in ovaries. Out 0f 18 EGCTs only 2 were malignant, rest all were mature cystic teratomas. 

Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children

2018 ◽  
Vol 127 (10) ◽  
pp. 687-693 ◽  
Author(s):  
Colleen B. Heffernan ◽  
Mallory G. McKeon ◽  
Sasha Molony ◽  
Kosuke Kawai ◽  
Derek J. Stiles ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Care Center ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Loss To Follow Up ◽  
Institutional Review ◽  
Diagnosis Codes ◽  
Icd 10

Objective(s): The objective was to describe the characteristics of hearing losses documented in patients treated with clarithromycin alone for nontuberculous mycobacterial NTM lymphadenitis in a pediatric tertiary care center over a 12-year period. Methods: An institutional review board (IRB) approval was obtained. A database search was performed using the ICD-10 diagnosis codes 31.0, 31.1, and 31.8 between January 2004 and January 2017. A REDCap database was created to record variables. Patients were included if they received clarithromycin alone and had, at the minimum, a baseline audiology assessment, and 1 further evaluation during treatment. Fisher’s exact test was used to analyze categorical variables, and Wilcoxon rank sum test was used to analyze continuous variables. Results: A total of 167 patients with cervicofacial NTM were identified. Of them, 42 patients fulfilled inclusion criteria. Three children (7%) developed a hearing loss (HL) between 25 and 63 days after starting treatment. HL was unilateral in 2 children. HL persisted in 1 child following cessation of treatment. However, this patient had Rubinstein Taybi syndrome, limiting our ability to attribute the HL solely to clarithromycin. Conclusion: We noted a 7% hearing loss rate in our series. Confounding issues, such as 1 patient with a syndrome potentially contributing to HL, and limitations to this study, including retrospective design and loss to follow-up, temper our ability to conclude that clarithromycin was the sole cause of these HL. However, enough supporting data for a role in clarithromycin causing HL exist that testing should be considered for patients undergoing long-term clarithromycin treatment.

scholarly journals Clinical profile of persistent pulmonary hypertension in new born: experience in an extramural institution

2018 ◽  
Vol 5 (6) ◽  
pp. 2193
Author(s):  
Harish S. ◽  
Kamalarathnam C. N.
Keyword(s):  
Pulmonary Hypertension ◽  
Tertiary Care ◽  
Oxygenation Index ◽  
Severity Of Illness ◽  
Pulmonary Artery Hypertension ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
New Born

Background: Persistent pulmonary artery hypertension of the new born (PPHN) has an incidence of 1.9 per 1000 live births with a mortality of 12 to 29%. In our tertiary care referral institute, the mortality was relatively high. A department audit was undertaken which will help us to introspect and to reason out the factors favouring survival and mortality in our NICU.Methods: Neonates with the diagnosis of PPHN from January 2016 to December 2016 were identified from our department database. After excluding cardiac causes of pulmonary hypertension, transport, prenatal, perinatal and post-natal data, treatment details and outcome information was collected from case records. The statistical analysis was calculated with SPSS software. Mean, standard deviation was calculated for continuous variables. Chi square test and Fischer’s exact test was used to test the association between categorical variables and t test for continuous variables.Results: The incidence PPHN in our unit was 1.5%. The average duration of hospital stay was 17 days. Among the 45.7 % of babies, PPHN was secondary to MAS, followed by CDH (22.3 %). Based on oxygenation index, 15 babies, 42.3% had mild, 10 babies, 28.6% had moderate, 8 babies, 22.3% had severe PPHN and 3 babies ,8.6% had severe PPHN. Overall mortality was 42.3%. SpO2 on arrival at emergency room, adequacy of cardiorespiratory during transport and presence of shock is significantly associated with mortality.Conclusions: This study show MAS and CDH are common causes of PPHN. Severity of illness at arrival was predictive of high mortality. Prior stabilization and adequate transport may improve outcomes.

Ultrasound Employed to Detect Breast Lumps among Symptomatic Patients in Tertiary Care Hospital

2020 ◽  
Vol 10 (4) ◽  
pp. 296-300
Author(s):  
Ameet Jesrani ◽  
Pari Gul ◽  
Nida Khan ◽  
Seema Nayab ◽  
Fahmida Naheed
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Ultra Sound ◽  
Categorical Variables ◽  
Breast Lesions ◽  
Care Hospital ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Breast Lumps

Objective: To assess different pathological breast lesions in ultra sound in a subgroup of population. Study design and setting: It was a cross sectional study conducted at Bolan Medical Complex Hospital Quetta, Pakistan from June 2018 to January 2019. Methodology: Total 103 patients with breast swelling, pain and discharge were targeted. Gray scale and Doppler Ultrasound of breast followed by FNAC/biopsy of breast lesion was performed. Data presented as mean ± standard deviation for continuous variables and frequency with percentages for categorical variables. Results: Out of 48 clinically palpable lumps US detected all of 48 lumps and additionally 12 clinically non palpable masses were detected on US examination. Thus, overall sensitivity of ultrasound in detecting breast lumps was 100%. Fibroadenoma of the breast was diagnosed accurately in 80.3% of women. Ultrasound reliably differentiated cystic from solid breast masses (100%). The sensitivity of ultrasound for detecting breast carcinoma was 63.4% with a positive predictive value of 87.5%, a negative predictive value of 99.5% and accuracy of 58.33%. US findings most suggestive of benign lesions were oval or round shape in 88.3%, well defined margin in 84%, absent lobulation in 86.04% and wider than taller ratio in 90.69% of the cases.US findings of most predictive for malignancy were of irregular shape in 81.8%, ill-defined margin in 90.9% and length to height ratio in 63.6% of cases. Conclusion: Ultrasound is simple, cheap, safe and relatively accessible imaging modality for evaluation of breast pathologies. Due to its high sensitivity in diagnosing benign breast lesions particularly cystic lesions and fibroadenoma unnecessary interventions can be avoided

Outcomes For Hand Burns Treated With Autologous Skin Cell Suspension In 20% Tbsa And Smaller Injuries

2021 ◽  
Author(s):  
G Malcolm Taylor ◽  
Scott A Barnett ◽  
Charles T Tuggle ◽  
Jeff E Carter ◽  
Herb A Phelan
Keyword(s):  
Wound Closure ◽  
Exclusion Criterion ◽  
Categorical Variables ◽  
Dermal Substitute ◽  
Continuous Variables ◽  
Exact Test ◽  
Skin Cell ◽  
Returning To Work ◽  
Hand Burns ◽  
Sheet Graft

Abstract Hypothesis In order to address the confounder of TBSA on burn outcomes, we sought to analyze our experience with the use of autologous skin cell suspensions (ASCS) in a cohort of subjects with hand burns whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with 2:1 meshed autograft for the treatment of hand burn injuries would provide comparable outcomes to hand burns treated with sheet or minimally meshed autograft alone. Methods A retrospective review was conducted for all deep partial and full thickness hand burns treated with split thickness autograft (STAG) at our urban verified burn center between April, 2018 to September, 2020. Exclusion criterion was a TBSA greater than 20%. The cohorts were those subjects treated with ASCS in combination with STAG (ASCS(+)) versus those treated with STAG alone (ASCS(-)). All ASCS(+) subjects were treated with 2:1 meshed STAG and ASCS overspray while all ASCS(-) subjects had 1:1, piecrust, or unmeshed sheet graft alone. Outcomes measured included demographics, time to wound closure, proportion returning to work (RTW), and length of time to RTW. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as medians and 25 th and 75 th interquartile ranges. Results Fifty-one subjects fit the study criteria (ASCS(+) n=31, ASCS(-) n=20). The ASCS(+) group was significantly older than the ASCS(-) cohort (44 yrs [32, 54] vs 32 [27.5, 37], p=0.009) with larger %TBSA burns (15% [9.5, 17] vs 2% [1, 4], p &lt;0.0001), and larger size hand burns (190 cm2 [120, 349.5] vs 126 cm2 [73.5, 182], p=0.015). Comparable results were seen between ASCS(+) and ASCS(-), respectively, for time to wound closure (9 days [7, 13] vs 11.5 [6.75, 14], p=0.63), proportion RTW (61% vs 70%, p=0.56), and days for RTW among those returning (35 [28.5, 57] vs 33 [20.25, 59], p=0.52). The ASCS(+) group had two graft infections with no reoperations, while ASCS(-) had one infection with one reoperation. No subjects in either group had a dermal substitute placed. Conclusion Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure, proportion of returning to work, and time to return to work as subjects treated with 1:1 or pie-crust meshed STAG. Our group plans to follow this work with scar assessments for a more granular picture of pliability and reconstructive needs.

The Compliance of Prescribed Activity Restriction in Women at High Risk for Preterm Birth

2020 ◽  
Author(s):  
Ghamar Bitar ◽  
Anthony Sciscione
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Medical Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Activity Restriction ◽  
The Impact

Objective Despite lack of evidence to support efficacy, activity restriction is one of the most commonly prescribed interventions used for the prevention of preterm birth. We have a departmental policy against the use of activity restriction but many practitioners still prescribe it in an effort to prevent preterm birth. We sought to evaluate the rate and compliance of women who are prescribed activity restriction during pregnancy to prevent preterm birth. Study Design This was a single-site retrospective questionnaire study at a tertiary care, academic affiliated medical center. Women with a history of preterm delivery or short cervix were included. Once patients were identified, each patient was contacted and administered a questionnaire. We assessed the rates of activity restriction prescription and compliance. Secondary outcomes included details regarding activity restriction and treatment in pregnancy. Continuous variables were compared with t-test and categorical variables with Chi-square test. The value p < 0.05 was considered significant. Results Among the 52 women who responded to the questionnaire, 18 reported being placed on activity restriction by a physician, with 1 self-prescribing activity restriction, giving a rate of our primary outcome of 19 of 52 (36.5%). All women reported compliance with prescribed activity restriction (100%). Gestational age at delivery was not different in women placed on activity restriction. Conclusion This questionnaire suggests that approximately one in three high-risk women were placed on activity restriction during their pregnancy despite a departmental policy against its use. The 100% compliance rate in patients placed on activity restriction is a strong reminder of the impact prescribing patterns of physicians can have on patients. Key Points

Sign in / Sign up

Export Citation Format

Share Document