scholarly journals ENvironmental Dynamics Underlying Responsive Extreme Survivors (ENDURES) of Glioblastoma: a Multi-disciplinary Team-based, Multifactorial Analytical Approach

2018 ◽  
Author(s):  
Sandra K. Johnston ◽  
Paula Whitmire ◽  
Susan Christine Massey ◽  
Priya Kumthekar ◽  
Alyx B. Porter ◽  
...  
Keyword(s):  
Brain Cancer ◽  
Analytical Approach ◽  
Conflicts Of Interest ◽  
Outcome Data ◽  
Patient Specific ◽  
Number Of Patients ◽  
Final Manuscript ◽  
Novel Targets ◽  
The Creation ◽  
Multi Disciplinary Team

AbstractAlthough glioblastoma is a fatal primary brain cancer with a short median survival of 15 months, a small number of patients survive more than 5 years after diagnosis; they are known as extreme survivors (ES). Due to their rarity, very little is known about what differentiates these outliers from other glioblastoma patients. For the purpose of identifying unknown drivers of extreme survivorship in glioblastoma, we developed the ENDURES consortium (ENvironmental Dynamics Underlying Responsive Extreme Survivors of glioblastoma). This consortium is a multicenter collaborative network of investigators focused on the integration of multiple types of clinical data and the creation of patient-specific models of tumor growth informed by radiographic and histological parameters. Leveraging our combined resources, the goals of the ENDURES consortium are two-fold: (1) to build a curated, searchable, multilayered repository housing clinical and outcome data on a large cohort of ES patients with glioblastoma and (2) to leverage the ENDURES repository for new insights on tumor behavior and novel targets for prolonging survival for all glioblastoma patients. In this article, we review the available literature and discuss what is already known about ES. We then describe the creation of our consortium and some of our preliminary results.FundingThis review was financially supported by a grant from the James S. McDonnell FoundationConflicts of InterestThe authors have declared that no conflicts of interest exist.AuthorshipConceptualized consortium: LW, RG, KME, PC, and KRS. Built consortium: SKJ, PK, NR, JS, KME, PC, and KRS. Wrote the manuscript: SKJ, PW, SCM, PK, AP, and KME. Reviewed and edited the manuscript: LFGC, MMM, AHD, PRJ, and LSH. Contributed to writing, provided feedback, and approved of final manuscript: All authors.Link to website for ENDUREShttp://mathematicalneurooncology.org/?page_id=2125

scholarly journals Pneumococcal Vaccination (PCV13) Prior to Initiation of Immunosuppressive Therapy in Patients with Hematological Malignancies Is Associated with Decrease Morbidity and Decrease Hospitalizations

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5919-5919
Author(s):  
Regina Draliuk ◽  
Iveta Mintsman ◽  
Alla Shnaider ◽  
Shuras Viky ◽  
Rotem Benami ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Intervention Program ◽  
Conflicts Of Interest ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Pneumococcal Vaccination ◽  
Standard Operating Procedure ◽  
Improvement Project ◽  
Number Of Patients ◽  
The Creation

Abstract Introduction: Pneumococcus is a common bacterium that can cause serious infections, such as pneumonia, meningitis or blood stream infection in patients receiving immunosuppressive therapy. Infection by pneumococcus bacteria can be life-threatening leading to hospitalizations, complications and even death. In this work we have established a system base intervention that provides pneumococcal vaccine (Prevenar 13) for patients before starting chemotherapy and/or biological treatment. Methods: The intervention program included a set of measures: 1. Standard operating procedure (SOP) for vaccination of patients with hematological disorders. 2. Increasing the awareness of the medical and nursing staff regarding the importance of administering the vaccine before chemotherapy/biological treatments. 3. Purchasing vaccines by the hospital. 4.Coaching patients about the importance of receiving the vaccine before starting treatment. 5. Building a computerized record for monitoring and controlling the administration of the vaccine before starting treatment. 6. Transferring the information about the vaccine to the patient outpatient providers. 7. Documentation of the vaccine in the patient's electronic medical record. 8. Monthly review of new patients and vaccination before starting treatment. Results: In 2015, before intervention, only about 25% of patients were vaccinated appropriately against pneumococcus. With the start of the quality improvement project in April 2016, there was a gradual increase in the number of vaccinated patient before starting treatment. In December 2016, all new patients before starting treatment were properly vaccinated against pneumococcus. Although there was a significant increase in the number of patients at the institute in 2017 there was a 35% decrease in the number of patients hospitalized for pneumonia or sepsis compared to 2015. In addition, there was a 41% decrease in the number of hospitalizations with pneumonia or sepsis in the institute's patients. There was also a significant trend towards decrease in mortality (11% vs. 7%). Conclusions: The intervention program included: The creation of cooperation at several levels, medical, nursing and pharmacological that created cooperation between the medical center and the outpatient community clinics which led to the creation of a system that ensures that the patient will be vaccinated prior to starting immunosuppressive therapy. As a result of the intervention at the Institute and the data that was examined over 3 years, there has been a significant decrease in the rate of hospitalizations of patients due to pneumonia or sepsis. Disclosures No relevant conflicts of interest to declare.

scholarly journals Intensity and Duration of Anticoagulation in Non-Cirrhotic, Non-Malignant Portal Vein Thrombosis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2534-2534
Author(s):  
Senthil Sukumar ◽  
Yu-Min Shen
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Outcome Data ◽  
Response To Therapy ◽  
Apparent Difference ◽  
Vein Thrombosis ◽  
Cavernous Transformation ◽  
Number Of Patients

Abstract Introduction: Portal vein thrombosis (PVT) can result in significant morbidity and mortality. There are currently no clinical studies reviewing either the intensity or duration of anticoagulant therapy. There is a paucity of data to guide the overall management of this entity and current practice is extrapolated from studies on management of deep vein thrombosis of the lower extremities and pulmonary embolism. Methods: All available electronic medical records with a diagnosis of PVT were reviewed from 2005-2016 at hospitals affiliated with the University of Texas Southwestern Medical Center. Patients with cirrhosis, active malignancy, or procedure within the preceding 3 months were excluded. Eighty-four patients met inclusion criteria. The charts were screened for patient demographics, etiology of PVT, type of anticoagulation therapy, and duration and response to therapy. Results: Demographic, treatment and outcome data is summarized in table 1. Patient ages ranged 18-84 years; 49 male. Etiology identified include Infectious (18%), Locally Inflammatory (34%), Systemic Hypercoagulable State (24%), or Idiopathic (24%). The majority of patients were treated with Vitamin K Antagonist (61%) followed by no treatment (17%). Average duration of therapy was categorized by months: <3 (20%), 3-6 (15%), 6-12 (16%), or >12 (49%). Outcome of treatment included resolved (28%), chronic (34%), or not reported (39%). When outcomes were stratified by etiology, intensity (in those patients treated with VKA for whom INR data was available), or duration there was no apparent difference in rate of clot resolution compared with progression to chronic cavernous transformation (tables 2-4). Conclusions: This first retrospective review studying the efficacy of treatment in PVT reveals that a similar number of patients develop cavernous transformation (indicating chronic PVT) regardless of the etiology, intensity, or duration of treatment. This data suggests that treatment with anticoagulation may not be impactful in this select group of patients. However, it is still recommended to pursue treatment in those patients presenting with a symptomatic acute thrombus given risk of mortality associated with clot progression. Furthermore, no single modality of anticoagulation has shown to be superior in the presented outcome data. Larger prospective studies are needed to further clarify if anticoagulation is effective in this clinical entity. Disclosures No relevant conflicts of interest to declare.

scholarly journals Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 188
Author(s):  
Daniel C. Santana ◽  
Matthew J. Hadad ◽  
Ahmed Emara ◽  
Alison K. Klika ◽  
Wael Barsoum ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Recent Literature ◽  
Patient Specific ◽  
Antithrombotic Agents ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Post Operative Period ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

scholarly journals Aromatic L-amino Acid Decarboxylase (AADC) deficiency: results from an Italian modified Delphi consensus

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Carlo Fusco ◽  
◽  
Vincenzo Leuzzi ◽  
Pasquale Striano ◽  
Roberta Battini ◽  
...  
Keyword(s):  
Amino Acid ◽  
Diagnostic Delay ◽  
Steering Committee ◽  
Outcome Data ◽  
Diagnosis And Treatment ◽  
Acid Decarboxylase ◽  
Delphi Consensus ◽  
Amino Acid Decarboxylase ◽  
Modified Delphi ◽  
Number Of Patients

Abstract Background Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare and underdiagnosed neurometabolic disorder resulting in a complex neurological and non-neurological phenotype, posing diagnostic challenges resulting in diagnostic delay. Due to the low number of patients, gathering high-quality scientific evidence on diagnosis and treatment is difficult. Additionally, based on the estimated prevalence, the number of undiagnosed patients is likely to be high. Methods Italian experts in AADC deficiency formed a steering committee to engage clinicians in a modified Delphi consensus to promote discussion, and support research, dissemination and awareness on this disorder. Five experts in the field elaborated six main topics, each subdivided into 4 statements and invited 13 clinicians to give their anonymous feedback. Results 100% of the statements were answered and a consensus was reached at the first round. This enabled the steering committee to acknowledge high rates of agreement between experts on clinical presentation, phenotypes, diagnostic work-up and treatment strategies. A research gap was identified in the lack of standardized cognitive and motor outcome data. The need for setting up an Italian working group and a patients’ association, together with the dissemination of knowledge inside and outside scientific societies in multiple medical disciplines were recognized as critical lines of intervention. Conclusions The panel expressed consensus with high rates of agreement on a series of statements paving the way to disseminate clear messages concerning disease presentation, diagnosis and treatment and strategic interventions to disseminate knowledge at different levels. Future lines of research were also identified.

scholarly journals Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shinjo Yada
Keyword(s):  
Neural Network ◽  
Clinical Trials ◽  
Precision Medicine ◽  
Early Phase ◽  
Patient Specific ◽  
Specific Gene ◽  
Cancer Type ◽  
Background Characteristics ◽  
Number Of Patients ◽  
Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

Abstract WP374: Implementation of the Stroke Transition Discharge Center Improves 30-day Readmission Rate

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susan Quimby ◽  
Javicia Peterson-Cole
Keyword(s):  
Readmission Rate ◽  
Inverse Correlation ◽  
Signs And Symptoms ◽  
Patient Specific ◽  
Readmission Rates ◽  
Hospital System ◽  
Practice Nurses ◽  
Time Period ◽  
Number Of Patients ◽  
Discharge Center

Background: Stroke patients and their caregivers require formalized education, medications, testing and rehabilitation to assist in prevention of recurrence and of post-stroke complications for optimal outcomes. Objective: The purpose of this program was to evaluate the effect of the Stroke Transition Discharge Center (STDC) on stroke readmission. Methods: The Advanced Practice Nurses (APN) see all stroke and TIA patients one week after discharge from hospital to home or one week after discharge from rehab to home. During the hour encounter, the APN reviews medications, test results, signs and symptoms of stroke, complete education including patient specific risk factors and ensure appropriate follow up. The APN coordinates and facilitates multiple services and disciplines impacting the patient, assuring the most efficient and effective goal-directed activities are provided at the right time and in partnership with all other disciplines providing care. Results: Implementation of the STDC enhances patient outcomes and improves 30-day readmission rates. Prior to our intervention, the readmission rate was 15.3%. After the implementation of the STDC, there was a 61% reduction in 30-day readmission rates to 6%, which is significantly below the hospital system benchmark of 11%. There was an increase in the readmission rate in the first two quarters of 2016 noted. There is an inverse correlation with the number of patients seen in the STDC during the same time period. Further analysis demonstrates that only one readmission in this time period had been seen prior in the STDC. Conclusion: Implementing the Stroke Transition Discharge Center demonstrated a dramatic reduction in 30-day readmission rates. Our data suggests that utilization of the clinic and participation by the patients has a direct and inverse effect on readmissions. Further data will need to be collected to determine if this is a sustained response.

Factors associated with pressure ulcer onset after knee replacement

2021 ◽  
Vol 30 (11) ◽  
pp. 924-929
Author(s):  
Cristiana Forni ◽  
Nicola Cerantola ◽  
Gianfranco Ferrarelli ◽  
Luana Lombrosi ◽  
Andrea Bolzon ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Predictive Factors ◽  
Conflicts Of Interest ◽  
Area Under The Curve ◽  
Factors Associated ◽  
Replacement Surgery ◽  
Braden Scale ◽  
Combined Use ◽  
Number Of Patients ◽  
Knee Replacements

Objective: The aim of this study was to find the rate of pressure ulcers (PUs) in patients with knee replacements and identify predictive factors. The ability of the Braden scale to predict the onset of PUs was also investigated. Method: A retrospective prognostic cohort study was carried out involving all consecutive patients undergoing knee replacement surgery. The data were collected from patient records. The variables collected were grouped into two categories: those connected to the patient's own characteristics; and those linked to the care methods used. Results: The total number of patients included in the study was 565. Of these, 2.3% had developed a PU: 0.5% at the heel and 1.8% at the sacrum. Multivariate analysis showed that the variables actually correlated to the outcome were age (p=0.074; odds ratio (OR)=1.08), body mass index (BMI, p=0.037; OR=1.13) and Braden scale (p=0.029; OR=0.72). A combination of these three parameters showed better predictivity of PUs (area under the curve (AUC) 84%). Conclusion: Age, BMI and preoperative Braden score were shown to be independent predictive factors of the onset of PUs in patients with knee replacements. The combined use of all three variables increased the ability to identify the patients at most risk of developing a PU. Declaration of interest: The study was financed by the Professional Nurse Register of Bologna as winner of a competition for research projects in the province of Bologna. The authors declare no conflicts of interest.

Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

2020 ◽  
pp. 104990912096997
Author(s):  
Ricardo Diaz Milian
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Quality Care ◽  
Surgical Intensive Care Unit ◽  
Care Needs ◽  
Surgical Intensive Care ◽  
Quality Reporting ◽  
Number Of Patients ◽  
Hospice And Palliative Care

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

scholarly journals LOCAL MEDIA IN THE CORONA CRISIS: SIGNIFICANCE AND CHALLENGES ON THE EXAMPLE OF POŽEGA 034 PORTAL

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ante Mandarić ◽  
Goran Matijević
Keyword(s):  
Public Health ◽  
Digital Media ◽  
Crisis Communication ◽  
The State ◽  
Public Research ◽  
The Public ◽  
Number Of Patients ◽  
Local Media ◽  
The World ◽  
The Creation

The epidemic of the disease COVID-19, in Požeština in relation to China, where it originated in other parts of Croatia, appeared somewhat later, while Požega-Slavonia County in terms of total share in relation to other counties in Croatia remained relatively well , 16th place, out of a total of 20 counties, ie a smaller number of patients was recorded. In the conditions of public health danger to the health and lives of people with expressed uncertainty, citizens around the world were flooded with numerous information, about the disease, ways of prevention, treatment that at one point threatened to turn into an infodemia, as warned by the WHO. The importance of crisis communication in such conditions is of great importance, and how governments and headquarters communicate messages about the crisis to the public, which is discussed in the first parts of the paper and points out several inconsistencies and illogicalities in the actions of the state headquarters. prohibition and permission to make recommendations contrary to the epidemiologist’s recommendations. But more important than the recommendations of headquarters and governments, today are the recommendations and news transmitted by digital media, and especially the local ones that bring news and recommendations for the area where we live. Therefore, the aim of this paper was to investigate in the central part the significance of the local 034 Portal in the Corona crisis, and its monitoring of the crisis and its impact on the public. Research through several segments, it was found that the portal maintained the level of reporting on regular events and adjusted reporting on the Crown to the conditions and situation in the county, not leading to sensationalism, concern, fear, but was a carrier of preventive activities and a good ally in the fight. against the epidemic, that is, he followed the guidelines for informing the WHO and did not contribute to the creation of an infodemia.

Sign in / Sign up

Export Citation Format

Share Document