scholarly journals 684. Risk Stacking for Pneumococcal Disease in Costa Rica

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S247-S247
Author(s):  
Jorge Chaverri-Murillo ◽  
Manuel Ramírez-Cardoce ◽  
José Castro-Cordero
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Costa Rica ◽  
High Risk ◽  
Pneumococcal Disease ◽  
Heart Diseases ◽  
High Risk Factor ◽  
Tertiary Hospitals ◽  
Risk Patients ◽  
Culture Positive

Abstract Background The value of nontraditional high-risk factor stacking is not known in the Costa Rican population. We aim to describe risk factor stacking for pneumococcal disease (PD) in patients seeking care at Social Security Hospitals in Costa Rica Methods Descriptive study of adult patients with microbiological culture-positive Streptococcus pneumoniae disease seeking care at two tertiary hospitals in Costa Rica between years 2014 and 2016. Information on underlying comorbidities (nontraditional) and other risk factors for PD was analyzed and stalked for each age group (G1: <50, G2: 50–64, and G3: ≥65 y/o). Results We included 181 culture-positive patients. We found that patients in G1 predominantly stacked ≥2 risk factors (63%), the proportion of patients with ≥2 risk factor was similar to high-risk patients in G2 (33% vs. 38%). In G3, 18% didn’t stacked any other risk factor and 46% was on high-risk. Most frequent risk factors in G1/G2 were smoking and alcoholism, and in G3 chronic pulmonary and heart diseases. Conclusion We conclude that risk factor stacking is more relevant than high-risk conditions and PD also occurs in persons <50 y/o. We recommend that risk factor stacking should be considered in prevention strategies for PD. Disclosures All authors: No reported disclosures.

scholarly journals Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group

2016 ◽  
Vol 34 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Brenda J. Weigel ◽  
Elizabeth Lyden ◽  
James R. Anderson ◽  
William H. Meyer ◽  
David M. Parham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Bone Marrow Involvement ◽  
High Risk Group ◽  
Historical Cohort ◽  
Dismal Prognosis ◽  
Risk Patients ◽  
Metastatic Sites

Purpose Patients with metastatic rhabdomyosarcoma (RMS), except those younger than 10 years with embryonal RMS, have an estimated long-term event-free survival (EFS) of less than 20%. The main goal of this study was to improve outcome of patients with metastatic RMS by dose intensification with interval compression, use of the most active agents determined in phase II window studies, and use of irinotecan as a radiation sensitizer. Patients and Methods Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites). Results One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies. Conclusion Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.

scholarly journals Monochorionic twin pregnancies increases perinatal risk and is a high risk factor of selective intrauterine growth restriction

2019 ◽  
Author(s):  
Jie Chen ◽  
Yue Lian Yang
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Intrauterine Growth Restriction ◽  
Growth Restriction ◽  
Prenatal Health ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
High Risk Factor ◽  
Twin Pregnancies

Abstract Background Twins pregnancy can cause a lot of disease, especially monochorionic twin pregnancies, the prenatal infant will have many diseases and have high mortality rate. According to analysis and compare of the twin pregnancy, especially pregnant woman and puerpera’s situation and complication and baby’s situation; we hope we can find the reason which causes the fetus growth restrain of monochorionic twin pregnancies. So we can provide some reference for the prenatal health care, complication prevention and prenatal outcome. Methods We divided 489 cases of twin pregnancies into two groups: monochorionic twin and dichorionic twin and compared the clinical features of them. At last, we used the logistic regression analysis method to analyze the risk factors of selective intrauterine growth restriction(sIUGR). Results The incidences of premature rupture of membranes and sIUGR were significant higher in monochorionic twin and twin-twin transfusion syndrome (TTTS) only exists in monochorionic twin. The weight of the newborn babies(both big and small babies)were significant lower in Monochorionic twin. The neonatal transfer rate was significant higher in monochorionic twin. Gestational weeks and weight of newborn babies are the high risk factors of sIUGR. Conclusions The type of chorion has a great influence to the pregnant period and the ending of maternal women. Monochorionic is a high risk factor of the sIUGR, which means that the main cause of sIUGR is from placenta, so it is a kind of “placental origin disease”.

scholarly journals A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

2013 ◽  
Vol 95 (5) ◽  
pp. 345-348 ◽  
Author(s):  
F Yanni ◽  
P Mekhail ◽  
G Morris-Stiff
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Gallstone Disease ◽  
Anaerobic Growth ◽  
Current Evidence ◽  
High Risk Patients ◽  
Risk Patients

Introduction It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. Methods One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. Results Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m2 in the ‘no prophylaxis’ group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. Conclusions This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.

scholarly journals Whom Should We Test for COVID-19? Performance of a Symptom and Risk Factor Questionnaire on COVID-19 Test Results and Patient Outcomes in an Immediate Care Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272098129
Author(s):  
Lauren Oshman ◽  
Amanda Caplan ◽  
Raabiah Ali ◽  
Lavisha Singh ◽  
Rabeeya Khalid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
High Risk ◽  
Effect Size ◽  
Care Setting ◽  
Risk Group ◽  
Low Risk ◽  
Risk Patients ◽  
Assessment Questionnaire

Introduction: The CDC and Illinois Department of Public Health disseminated risk factor criteria for COVID-19 testing early in the pandemic. The objective of this study is to assess the effectiveness of risk stratifying patients for COVID-19 testing and to identify which risk factors and which other clinical variables were associated with SARS-CoV-2 PCR test positivity. Methods: We conducted an observational cohort study on a sample of symptomatic patients evaluated at an immediate care setting. A risk assessment questionnaire was administered to every patient before clinician evaluation. High-risk patients received SARS-CoV-2 test and low-risk patients were evaluated by a clinician and selectively tested based on clinician judgment. Multivariate analyses tested whether risk factors and additional variables were associated with test positivity. Results: The adjusted odds ratio of testing positive was associated with COVID-19-positive or suspect close contact (aOR 1.56, 95% CI 1.15-2.10), large gathering attendance with a COVID-19-positive individual (aOR 1.92, 95% CI 1.10-3.34), and, with the largest effect size, decreased taste/smell (aOR 2.83, 95% CI 2.01-3.99). Testing positive was associated with ages 45-64 and ≥65 (aOR 1.75, 95% CI 1.25-2.44, and aOR 2.78, 95% CI 1.49-5.16), systolic blood pressures ≤120 (aOR 1.64, 95% CI 1.20-2.24), and, with the largest effect size, temperatures ≥99.0°F (aOR 3.06, 95% CI 2.23-4.20). The rate of positive SARS-CoV-2 test was similar between high-risk and low risk patients (225 [22.2%] vs 50 [19.8%]; P = .41). Discussion: The risk assessment questionnaire was not effective at stratifying patients for testing. Although individual risk factors were associated with SARS-CoV-2 test positivity, the low-risk group had similar positivity rates to the high-risk group. Our observations underscore the need for clinicians to develop clinical experience and share best practices and for systems and payors to support policies, funding, and resources to test all symptomatic patients.

scholarly journals A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura van Wijk ◽  
Lizzel van der Snee ◽  
Carlijn I. Buis ◽  
Judith E. K. R. Hentzen ◽  
Marjolein E. Haveman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Iron Deficiency ◽  
Physical Fitness ◽  
Modifiable Risk Factors ◽  
Psychological Resilience ◽  
Preoperative Risk ◽  
Perioperative Morbidity ◽  
Risk Patients

Abstract Introduction Despite improvements in perioperative care, major abdominal surgery continues to be associated with significant perioperative morbidity. Accurate preoperative risk stratification and optimisation (prehabilitation) are necessary to reduce perioperative morbidity. This study evaluated the screening and assessment of modifiable risk factors amendable for prehabilitation interventions and measured the patient compliance rate with recommended interventions. Method Between May 2019 and January 2020, patients referred to our hospital for HPB surgery were screened and assessed on six modifiable preoperative risk factors. The risk factors and screening tools used, with cutoff values, included (i) low physical fitness (a 6-min walk test < 82% of patient’s calculated norm and/or patient’s activity level not meeting the global recommendations on physical activity for health). Patients who were unfit based on the screening were assessed with a cardiopulmonary exercise test (anaerobic threshold ≤ 11 mL/kg/min); (ii) malnutrition (patient-generated subjective global assessment ≥ 4); (iii) iron-deficiency anaemia (haemoglobin < 12 g/dL for women, < 13 g/dL for men and transferrin saturation ≤ 20%); (iv) frailty (Groningen frailty indicator/Robinson frailty score ≥ 4); (v) substance use (smoking and alcohol use of > 5 units per week) and (vi) low psychological resilience (Hospital Anxiety and Depression Scale ≥ 8). Patients had a consultation with the surgeon on the same day as their screening. High-risk patients were referred for necessary interventions. Results One hundred consecutive patients were screened at our prehabilitation outpatient clinic. The prevalence of high-risk patients per risk factor was 64% for low physical fitness, 42% for malnutrition, 32% for anaemia (in 47% due to iron deficiency), 22% for frailty, 12% for smoking, 18% for alcohol use and 21% for low psychological resilience. Of the 77 patients who were eventually scheduled for surgery, 53 (68.8%) needed at least one intervention, of whom 28 (52.8%) complied with 100% of the necessary interventions. The median (IQR) number of interventions needed in the 77 patients was 1.0 (0–2). Conclusion It is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging.

Nghiên cứu mối liên quan giữa các yếu tố nguy cơ tim mạch và điểm MEHRAN với tổn thương thận cấp do thuốc cản quang

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
Independent Risk Factor ◽  
Kidney Injury ◽  
Risk Patients ◽  
Very High

Đặt vấn đề: Tổn thương thận cấp do thuốc cản quang là một trong những biến chứng quan trọng mà nếu dự đoán sớm các YTNC chúng ta có biện pháp phòng ngừa. Gần đây các nhà nghiên cứu còn đề xuất ra nhiều bảng điểm để xác định nguy cơ xuất hiện tổn thương thận cấp do thuốc cản quang như: điểm nguy cơ Mehran tỉ số giữa lượng thuốc cản quang và mức lọc cầu thận ước đoán. Chúng tôi nghiên cứu đề tài với mục tiêu: Đánh giá mối liên quan giữa các yếu tố nguy cơ tim mạch, điểm Mehran với tổn thương thận cấp do thuốc cản quang Đối tượng: 221 BN bệnh động mạch vành có chỉ định chụp, can thiệp động mạch vành. Phương pháp nghiên cứu: Mô tả cắt ngang, tiến cứu. Kết quả: Hạ huyết áp quanh thủ thuật là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 5,299, khoảng tin cậy 95% 1,177-23,854 và P = 0,030. Nồng độ NT-proBNP là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 1,000, khoảng tin cậy 95% 1,000-1,000 và P = 0,018. Điểm nguy cơ Mehran ở nhóm nguy cơ cao (11-15 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 7,983, khoảng tin cậy 95% 1,080-58,990 và P = 0,042. Điểm nguy cơ Mehran ở nhóm nguy cơ rất cao (≥ 16 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 53,821, khoảng tin cậy 95% 3,046-951,033 và P = 0,007. Kết luận: Hạ huyết áp quanh thủ thuật, nồng độ NT-proBNP, điểm Mehran ở nhóm nguy cơ cao và rất cao là YTNC độc lập của tổn thương thận cấp do thuốc cản quang. Từ khóa: Điểm nguy cơ Mehran, tổn thương thận cấp, thuốc cản quang, động mạch vành. ABSTRACT STUDY OF RELATIONSHIP BETWEEN CARDIOVASCULAR RISK FACTORS, MEHRAN SCORE AND CONTRAST - ASSOCIATED ACUTE KIDNEY INJURY Background: Contrast - associated acute kidney injury which is one of the major complications of percutaneous coronary intervention (PCI) can be prevented if it is predicted through risk factors. In recent years, researchers suggest many risk scores to determine the risk of contrast - induced acute kidney injury such as: Mehran risk score, the ratio between the amount of contrast, and estimated GFR. So we implement the study to find out the relationship between cardiovascular risk factors and contrast - associated acute kidney injury Objects: 221 patients who were diagnosed with coronary disease and treated by PCI. Methods: Prospective observational study. Results: Hypotension during the procedure is a independent risk factor of contrast-associated acute kidney injury with OR = 5,299, 95%CI 1,177-23,854 (p = 0,030). NT-proBNP is is a independent risk factor of contrast-associated acute kidney injury with OR = 1,000, 95%CI 1,000-1,000 (p = 0,018). Mehran score for the high risk patients (11-15 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 7,983, 95%CI 1,080-58,990 (P = 0,042). Mehran score for the very high risk patients (≥ 16 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 53,821, 95%CI 3,046-951,033 (P = 0,007). Conclusion: Intraoperative hypotension, NT-proBNP, Mehran score in high and very high risk groups are independent risk factors of contrast-associated acute kidney injury.

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

2020 ◽  
pp. 1358863X2097973
Author(s):  
Fabrizio Losurdo ◽  
Roberto Ferraresi ◽  
Alessandro Ucci ◽  
Anna Zanetti ◽  
Giacomo Clerici ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Lower Limb ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Arterial Calcification ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

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