scholarly journals 859. Same-Day HIV Pre-exposure Prophylaxis (PrEP) Initiation During Drop-in STD Clinic Appointments Is a Safe, Feasible, and Effective Method to Engage Patients at Risk for HIV in PrEP Care

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S20-S20 ◽  
Author(s):  
Kevin Kamis ◽  
Kenneth Scott ◽  
Edward Gardner ◽  
Karen Wendel ◽  
Grace Marx ◽  
...  
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Health Insurance ◽  
Low Income ◽  
Median Income ◽  
Navigation Support ◽  
Patients At Risk ◽  
Exposure Prophylaxis ◽  
Research Grant

Abstract Background Patients at risk for HIV generally do not have immediate access to PrEP. We hypothesized that by offering free, 30-day PrEP starter packs and navigation support during drop-in STD clinic appointments, individuals would be likely to initiate and continue PrEP. Methods Individuals aged ≥18 years presenting for drop-in appointments in the Metro Denver STD Clinic and indicated for PrEP were eligible for the study. Exclusion criteria were history of renal dysfunction, chronic hepatitis B (HBV), HIV, pregnancy, and indications for postexposure prophylaxis. Eligible individuals were provided PrEP education and offered a free, 30-day PrEP starter pack and navigation support for cost assistance. Participants were tested for creatinine, HBV, HIV, and pregnancy at enrollment, and navigated to an appointment for ongoing PrEP care. Participants’ medical records were reviewed for a minimum of 4 months after enrollment. Descriptive statistics and logistic regression were used to characterize the study population and follow-up. Results From April to October 2017, 100 individuals filled a tenofovir–emtricitabine prescription (figure). Median participant age was 28 years, 98% were male, 53% were non-Hispanic White, 8% non-Hispanic Black, and 34% Hispanic. Median annual income was $24,000, 62% had health insurance, 26% had a primary care provider (PCP), and 50% had a recent bacterial STI. No participants had abnormal baseline creatinine or HBV. 77% completed ≥1 PrEP follow-up visit during the study period; 57% completed their first visit within 31 days. 56% completed a second follow-up visit. No HIV seroconversions were detected during follow-up. Factors significantly associated with attending ≥1 follow-up appointment were age ≥ 30 years, higher income, and having health insurance or a PCP at enrollment. In multivariate logistic regression, only higher income was associated with attending ≥1 follow-up appointment (median income for those with ≥1 follow-up visit vs. no follow-up: $24,960 vs. $14,000, P <0.01). Conclusion Providing immediate access to PrEP during drop-in STD clinic visits is a safe and feasible approach to initiation of PrEP care. Additional resources are needed to support PrEP continuity care, particularly for low-income individuals. Disclosures K. Kamis, Gilead Scienes: Research Coordinator, Research grant. S. Rowan, Gilead Sciences: Investigator, Research grant.

A predictive model to identify patients at risk of local recurrence following glansectomy for penile squamous cell cancer (SCC).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 427-427
Author(s):  
Maarten Albersen ◽  
Arie Parnham ◽  
Alex Freeman ◽  
Raj Nigam ◽  
Peter Malone ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Logistic Regression ◽  
Local Recurrence ◽  
Predictive Model ◽  
Resected Specimen ◽  
High Grade ◽  
Multivariate Logistic Regression ◽  
Patients At Risk

427 Background: Penile preserving surgery for penile cancer is associated with a higher risk of local recurrence (LR). This study developed a predictive model for LR following glansectomy and split skin graft reconstruction . Methods: Retrospective review performed of 177 patients undergoing glansectomy over a 10 year period. The clinicopathological features, LR patterns and cancer-specific survival (CSS) were recorded. Univariate and multivariate logistic regression was used to identify prognostic indicators for LR. The hazard ratio (HR) for LR was estimated using a KM analysis and based on these data we designed a postoperative model for the prediction of LR. Results: The median follow-up period following surgery was 41.4 (1.9-155) months. In total, 9.3 % of the patients developed a LR. Univariate, but not multivariate logistic regression identified perineural invasion (PNI), carcinoma in situ and high grade disease, but not basaloid variant, T stage, lymphovascular invasion and positive resection margins on the specimen to be predictors of LR. A risk model was designed using PNI, CIS and high grade disease in the resected specimen. KM analysis and log rank test revealed no significant differences in LR-free survival between patients with 0 vs 1 or 2 vs 3 risk factors whereas the chance of having local recurrence with 2 risk factors was significantly higher (HR = 5,75; 95% CI 1,43 to 23,15) than with 1 risk factor. A risk stratification model based on a cut-off score of > 1 out of 3 risk factors discriminated well between patients with a high vs low chance of recurrence in a Kaplan-Meier analysis (HR 9.18, 95% CI 3.29 to 25.65 P < 0.001). Indeed, ROC-curve analysis showed an optimal cut-off point of > 1 risk factors with an AUC of 0.77 (P < 0.001, specificity 63%, specificity of 85%) for prediction of LR. Conclusions: Although,LR after glansectomy does not affect the CSS, patients at risk of local recurrence can be identified when > 1 of the factors PNI, CIS and high grade are found on histopathological analysis of the glans. These findings can define the frequency of follow-up and -if validated on pre-op biopsy- potentially be helpful in planning the margins of surgical resection in patients with penile SCC.

Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations

2001 ◽  
Vol 116 (6) ◽  
pp. 608-616 ◽  
Author(s):  
Virginia A Cardin ◽  
Richard M Grimes ◽  
Zhi Dong Jiang ◽  
Nancy Pomeroy ◽  
Luther Harrell ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
At Risk ◽  
Low Income ◽  
Minority Women

A Predictive Model of Intrinsic Factors Associated with Long-Stay Nursing Home Care After Hospitalization

2020 ◽  
pp. 105477382098527
Author(s):  
Jane Flanagan ◽  
Marie Boltz ◽  
Ming Ji
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Receiver Operating Characteristic ◽  
Predictive Model ◽  
Operating Characteristic ◽  
Resource Planning ◽  
Term Care ◽  
Intrinsic Factors ◽  
Patients At Risk ◽  
Receiver Operating

We aimed to build a predictive model with intrinsic factors measured upon admission to skilled nursing facilities (SNFs) post-acute care (PAC) to identify older adults transferred from SNFs to long-term care (LTC) instead of home. We analyzed data from Massachusetts in 23,662 persons admitted to SNFs from PAC in 2013. Explanatory logistic regression analysis identified single “intrinsic predictors” related to LTC placement. To assess overfitting, the logistic regression predictive model was cross-validated and evaluated by its receiver operating characteristic (ROC) curve. A 12-variable predictive model with “intrinsic predictors” demonstrated both high in-sample and out-of-sample predictive accuracy in the receiver operating characteristic ROC and area under the ROC among patients at risk of LTC placement. This predictive model may be used for early identification of patients at risk for LTC after hospitalization in order to support targeted rehabilitative approaches and resource planning.

Long-term results of acetabular reconstruction using irradiated allograft bone

2018 ◽  
Vol 100-B (11) ◽  
pp. 1449-1454 ◽  
Author(s):  
C. M. Green ◽  
S. C. Buckley ◽  
A. J. Hamer ◽  
R. M. Kerry ◽  
T. P. Harrison
Keyword(s):  
At Risk ◽  
Aseptic Loosening ◽  
Acetabular Component ◽  
Long Term Results ◽  
Acetabular Reconstruction ◽  
Allograft Bone ◽  
Patients At Risk ◽  
Irradiated Allograft

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

scholarly journals Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

2019 ◽  
Vol 24 (5) ◽  
pp. 1281-1289 ◽  
Author(s):  
Patrick O’Byrne ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
At Risk ◽  
Hiv Prevention ◽  
Qualitative Analysis ◽  
Thematic Analysis ◽  
Prevention Strategy ◽  
Perceptions Of Risk ◽  
Uptake Rates ◽  
Exposure Prophylaxis

AbstractWhile pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, its uptake is limited. To address barriers, we piloted a nurse-led PrEP clinic in an STI clinic and had public health nurses refer patients during STI follow-up. We recorded the number of PrEP offers and declines and clinic uptake. We conducted a thematic analysis of patients’ responses from nursing notes written at the time patients declined PrEP. From August 6, 2018 to August 5, 2019, nurses offered a PrEP referral to 261 patients who met our criteria; only 47.5% accepted. Qualitative analysis identified four themes: (1) perceptions of risk, (2) lack of interest, (3) inability to manage, and (4) concerns about PrEP. Our patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless “other”. This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.

Improving the Identification of Patients at Risk of Postoperative Renal Failure after Cardiac Surgery

2006 ◽  
Vol 104 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Duminda N. Wijeysundera ◽  
Keyvan Karkouti ◽  
W Scott Beattie ◽  
Vivek Rao ◽  
Joan Ivanov
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Renal Insufficiency ◽  
Care Center ◽  
Tertiary Care ◽  
Receiver Operating Curve ◽  
Alternative Measure ◽  
Patients At Risk

Background Preoperative renal insufficiency is an important predictor of the need for postoperative renal replacement therapy (RRT). Serum creatinine (sCr) has a limited ability to identify patients with preoperative renal insufficiency because it varies with age, sex, and muscle mass. Calculated creatinine clearance (CrCl) is an alternative measure of renal function that may allow better estimation of renal reserve. Methods Data were prospectively collected for consecutive patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary care center. The relation between CrCl (Cockcroft-Gault equation) and RRT was initially described using descriptive statistics, logistic regression, and receiver operating curve analysis. Based on these analyses, preoperative renal insufficiency was defined as CrCl of 60 ml/min or less. Preoperative renal function was classified as moderate insufficiency (sCr &gt; 133 microM), mild insufficiency (100 microM &lt; sCr &lt; or = 133 microM), occult insufficiency (sCr &lt; or = 100 microM and CrCl &lt; or = 60 ml/min), or normal function (sCr &lt; or = 100 microM and CrCl &gt; 60 ml/min). The independent association of preoperative renal function with RRT was subsequently determined using multiple logistic regression. Results Of the 10,751 patients in the sample, 137 (1.2%) required postoperative RRT. Approximately 13% of patients with normal sCr had occult renal insufficiency. Occult renal insufficiency was independently associated with RRT (odds ratio, 2.80; 95% confidence interval, 1.39-5.33). The magnitude of this risk was similar to patients with mild renal insufficiency (P = 0.73). Conclusions The inclusion of a simple CrCl-based criterion in preoperative assessments may improve identification of patients at risk of needing postoperative RRT.

scholarly journals Are Low-Income Elderly Patients at Risk for Poor Diabetes Care?

Diabetes Care ◽  
2004 ◽  
Vol 27 (5) ◽  
pp. 1060-1065 ◽  
Author(s):  
D. T. McCall ◽  
A. Sauaia ◽  
R. F. Hamman ◽  
J. E. Reusch ◽  
P. Barton
Keyword(s):  
At Risk ◽  
Elderly Patients ◽  
Low Income ◽  
Diabetes Care ◽  
Patients At Risk

scholarly journals Multicentric survey of patient doses in fluoroscopy guided diagnostic and interventional cardiac procedures: comparison with Diagnostic Reference Levels and follow-up levels for patients at risk for radiation induced skin effects

2020 ◽  
Vol 26 (1) ◽  
pp. 44-52
Author(s):  
Anna Zagorska ◽  
Desislava Ivanova ◽  
Dessislava Kostova-Lefterova ◽  
Filip Simeonov ◽  
Valeri Gelev ◽  
...  
Keyword(s):  
At Risk ◽  
Coronary Intervention ◽  
Fluoroscopy Time ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Cardiac Procedures ◽  
Patients At Risk ◽  
Radiation Induced ◽  
Patient Doses

Introduction. Interventional cardiac procedures are often associated with high patient exposure and therefore require special care in protecting patients from radiation-induced effects. Materials and methods. A retrospective study of typical patients’doses was performed in nine hospitals, with a total number of fourteen angiography systems. The typical values for kerma-area product (KAP), cumulative dose (CD) and fluoroscopy time (FT) for two of the most commonly performed procedures - percutaneous coronary intervention (PCI) and coronary arteriography (CA), were calculated and compared with the Bulgarian National Diagnostic Reference Levels (NDRL). Data analysis, regarding the risk of radiation-induced skin effects due to interventional cardiac procedures, was performed. Aim. 1) to present and analyze the typical KAP values for PCI and CA procedures in cardiology departments with high workload and to compare them with the NDRL; 2) to compare the patient doses with the follow-up levels published in Ordinance 2, to identify patients at risk for radiation-induced effects. Results. The results show that typical values for PCI and CA procedures for some of the angiography systems are higher than the NDRL. In all investigated departments there are patients with at least one exceeded follow-up level for PCI. Conclusions. The results show a potential for optimization in the departments with both high or very low typical dose or FT values. No radiation-induced effect was observed in the followed-up group of patients. The introduction of procedure with "Instruction to the patient after an interventional cardiac procedure(s) with greater complexity and a long fluoroscopy time" for patient follow-up and its regular implementation into the routine clinical practice will help for timely diagnosis and treatment of radiation-induced skin effects after cardiac procedures under fluoroscopy control.

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