ID: 76: AVOIDING TRANSTHORACIC ECHOCARDIOGRAPHY (TTE) AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) FOR PATIENTS WITH VARIABLE BODY MASS INDEXES (BMI) IN INFECTIVE ENDOCARDITIS

2016 ◽  
Vol 64 (4) ◽  
pp. 916.3-917
Author(s):  
R Sogomonian ◽  
H Alkhawam ◽  
N Vyas ◽  
J Jolly ◽  
A Ashraf ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Body Mass ◽  
Sensitivity And Specificity ◽  
Transthoracic Echocardiography ◽  
Small Sample Size ◽  
The United States ◽  
Small Sample ◽  
Blood Cultures ◽  
True Negative

BackgroundEchocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Dukes' criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m2 and less than 25.MethodsA single-centered, retrospective study of 198 patients between the years of 2005 and 2012 diagnosed with IE based on modified Dukes' criteria. Patients were required to be above the age of 18, undergone an echocardiogram study and had blood cultures to be included in the study.This study was conducted at a major hospital in one of the most diverse communities in the United States, providing a cultural and epidemiologically significant advantage. An approved chart analysis using QuadraMed Computerized Patient Record (QCPR) was retrospectively accessed with data-input and calculations formulated in computerized software.ResultsAmong 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared to TEE results for true negative and positives to isolate valvular vegetations Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI less than or equal to 25 kg/m2 and the subsequent group with a BMI<25. Patients with a BMI less than or equal to 25 that underwent a TTE study had a sensitivity and specificity of 54% and 92, respectively. On the contrary, patients with a BMI<25 had a TTE sensitivity and specificity of 78% and 95, respectively. Furthermore, we obtained the sensitivities of specific valves diseased from vegetations, visualized by TTE (figure 1). Lastly, we were able to demonstrate a correlation between the different modalities of echocardiography used to the specific organism identified on blood cultures (figure 2).ConclusionCalculating a BMI in patients with suspicion for IE may provide benefit in reducing further diagnostic imaging. Our study demonstrated that patients having a BMI <25 kg/m2 with a negative TTE should refrain from further diagnostic studies with TEE, given the findings of increased sensitivities (figure 3). Patients with a BMI less than or equal to 25 may proceed directly to a TEE, possibly avoiding an additional study with a TTE given the low sensitivities identified in this population. Clinicians should be aware that this study has several limitations, one of which a small sample size that may be increased with a multi-centered study. Further investigations with a larger population may improve and possibly provide similar findings, reinforcing the study.

Trends in glassy cell cervical cancer in the United States from 1973-2015: Analysis based on SEER database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17502-e17502
Author(s):  
Anahat Kaur ◽  
Shuai Wang ◽  
Tarek N. Elrafei ◽  
Lewis Steinberg ◽  
Abhishek Kumar
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Small Sample Size ◽  
Black Population ◽  
The United States ◽  
Small Sample ◽  
Cervix Uteri ◽  
Kaplan Meier

e17502 Background: Glassy cell carcinoma of cervix (GCCC) is a rare histological subtype of cervical cancer which has historically been associated with rapidly progressive disease, early development of metastases and overall poor prognosis. We attempt to define real-world trends in GCCC in the United States based on data from SEER (Surveillance, Epidemiology and End Results) database. Methods: We extracted data from the US National Cancer Institute's SEER 2018 dataset using ICD-O code for ‘Cervix Uteri Glassy Cell Carcinoma’. All patients who were diagnosed between 1973-2015 were included. Statistical analysis was done using SPSS 26. Kaplan Meier curve was used for survival analysis. Results: Data for a total of 57 patients with GCCC was available from 1975 to 2017. Median age at diagnosis was 38 years (range 30.5-44.5). Increased frequency of cases was noted in white females (77.2%) as compared to black population (22.2%). Most cases initially presented with localized or regional spread (47.4% and 40.4% respectively) with distant metastasis seen in only 10.5% patients. Data analysis revealed that 63.2% patients had Grade III poorly differentiated carcinoma, 66.7% received radiation therapy, 57.9% underwent chemotherapy and 59.6% had cancer direceted surgery performed. Calculated mean overall survival was 121.9 months. We were unable to calculate 5 year and 10 year median overall survival due to small sample size and censored data. Conclusions: GCCC is a rare histologic type of cervical cancer that presents at a younger age, is more frequently seen in white females and is commonly associated with localized or regional spread at time of initial presentation.[Table: see text]

Exploring the Relationship between Demographic Isolation and Professional Experiences of Black and Latinx Teachers

2021 ◽  
Author(s):  
Susan Kemper Patrick ◽  
Francisco Arturo Santelli
Keyword(s):  
Small Sample Size ◽  
The United States ◽  
Black Teachers ◽  
Small Sample ◽  
Continuous Measure ◽  
Professional Experiences ◽  
Workplace Experiences ◽  
Perceived Satisfaction ◽  
Ordinal Measure ◽  
Qualitative Work

Educational leaders throughout the United States have repeatedly emphasized the importance of increasing the number of Black and Latinx teachers in American schools. Prior qualitative work suggests that Black and Latinx teachers who are demographically isolated in their schools often report negative experiences. Drawing on theories of proportional representation in organizations, we use Tennessee statewide survey and administrative data to examine whether self-reported professional experiences of Black and Latinx teachers are different when they are demographically isolated. We estimate models using two measures of demographic isolation: a continuous measure and a theoretically generated ordinal measure. We find that, for Black teachers, the percentage of Black teachers in the school is positively associated with teachers’ perceived satisfaction and support and with the frequency of collaboration. There is also some evidence of threshold effects of demographic isolation for Black teachers, as Black teachers in schools in which at least 60% of fellow teachers are Black report significantly higher satisfaction and support than other Black teachers. Our models do not find any associations between isolation and professional experience for Latinx teachers, but a small sample size and lack of variation in demographic isolation among Latinx teachers makes it difficult to estimate these associations. Our findings suggest that both ordinal and continuous measures of demographic isolation may be useful when examining relationships between demographic isolation and workplace experiences. Because we study factors linked to turnover in prior research, these analyses can contribute to the broader discussion about the retention of Black and Latinx teachers.

scholarly journals Subjective Social Status Is Associated with Dysregulated Eating Behaviors and Greater Body Mass Index in an Urban Predominantly Black and Low-Income Sample

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3893
Author(s):  
Monika M. Stojek ◽  
Paulina Wardawy ◽  
Charles F. Gillespie ◽  
Jennifer S. Stevens ◽  
Abigail Powers ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Social Status ◽  
Body Mass ◽  
Low Income ◽  
Emotional Eating ◽  
Eating Behaviors ◽  
Small Sample Size ◽  
Food Addiction ◽  
Subjective Social Status ◽  
Small Sample

Background: Higher subjective social status (SSS) or a person’s perception of their social standing is related to better health outcomes, but few studies examined SSS in relation to obesity. Emotional eating and food addiction have been linked to obesity. Some studies indicated that manipulating SSS may lead to altered food intake, but the relationship between SSS and dysregulated eating, such as emotional eating and food addiction (FA), has not been examined. The goal of this study was to examine the associations between SSS in the community and the larger society, dysregulated eating (emotional eating and FA), and body mass index (BMI) in a majority racial minority sample. Methods: The participants (N = 89; 93% Black, 86% women, and 56% with obesity; 72% income lower than USD 2000), recruited from a publicly funded hospital in Atlanta, GA, completed the MacArthur Scale, Dutch Eating Behaviors Questionnaire, Yale Food Addiction Scale, Beck Depression Inventory, PTSD Symptom Checklist, and demographics questionnaire. Results: Twenty-two percent of the sample met the criteria for FA; those with FA had significantly higher BMI than those without (p = 0.018). In the hierarchical linear regression, the SSS community (but not in society) predicted higher severity of emotional eating (β = 0.26, p = 0.029) and FA (β = 0.30, p = 0.029), and higher BMI (β = 0.28, p = 0.046), independent from depression and PTSD symptoms. Conclusions: The findings indicate that, among Black individuals with predominantly low income in the U.S., perceived role in their community is associated with eating patterns and body mass. Given the small sample size, the results should be interpreted with caution.

scholarly journals Impact of antibiotic pretreatment on cultures in children with osteomyelitis and septic arthritis: a retrospective review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda Lansell ◽  
Yasasvi Vasili ◽  
Parminder S. Suchdev ◽  
Janet Figueroa ◽  
Anjali Kirpalani
Keyword(s):  
Septic Arthritis ◽  
Pediatric Patients ◽  
Small Sample Size ◽  
Positive Culture ◽  
Small Sample ◽  
Blood Cultures ◽  
Pathogen Identification ◽  
Culture Positivity ◽  
Antibiotic Duration ◽  
Bone Cultures

Abstract Background In the management of pediatric osteomyelitis or septic arthritis, delay in treatment may affect outcome, while receipt of antibiotics prior to culture may affect culture results. We aimed to determine if pathogen identification decreased in cultures that were pretreated with antibiotics. Methods We conducted a retrospective cohort study of 584 hospitalized children between 30 days and 18 years of age admitted to two tertiary children’s hospitals. Logistic regression assessed the effect of antibiotic duration on blood, bone, joint aspirate, and “other” culture positivity. Results Overall, 42% of blood cultures, 70% of bone cultures, 39% of joint cultures, and 70% of “other” cultures were positive. Compared with children who did not receive antibiotics prior to culture, there were no significant differences in odds of a positive culture in children whose cultures were pretreated with antibiotics for any of the culture types [OR (95% CI) 0.90 (0.56–1.44) for blood cultures, 0.77 (0.25–2.34) for bone cultures, 0.71 (0.39–1.28) for joint cultures, 1.18 (0.58–2.41) “for other” cultures; all p > 0.05]. Furthermore, the duration (hours) of antibiotics in the pretreated cultures was also not a significant predictor of culture positivity (OR ranged from 0.99–1.00 for all cultures, p > 0.05). Conclusions Culture positivity was not associated with antibiotic pretreatment in any of the samples, even for longer duration of antibiotics prior to culture, though the small sample size of subgroups is an important limitation. In pediatric patients hospitalized with osteomyelitis and/or septic arthritis, early initiation of antibiotics may not affect culture positivity.

Impact of race on biomarker testing among HER2- advanced breast cancer (ABC) patients (pts) in the United States: Results from a real-world study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10598-10598
Author(s):  
Reshma L. Mahtani ◽  
Alexander Niyazov ◽  
Katie Lewis ◽  
Lucy Massey ◽  
Alex Rider ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapies ◽  
Small Sample Size ◽  
The United States ◽  
Small Sample ◽  
Access To Treatment ◽  
History Of ◽  
Biomarker Testing ◽  
Abstract Data ◽  
The Impact

10598 Background: African Americans (AA) have the highest breast cancer (BC) mortality rate. Access to treatment is a known contributing factor. In the past 4 years, several targeted therapies for HER2- BC have become available which require testing for specific biomarkers. This study assessed the impact of race on biomarker testing rates in HER2- ABC pts receiving treatment in the US. Methods: Oncologists were recruited to abstract data from medical charts for the next 8-10 pts receiving treatment with HER2- ABC during Sept 2019-Apr 2020. Pts records were stratified by race and categorized into 3 mutually exclusive cohorts [White/Caucasian (White), AA, Other]. The other race cohort was excluded from this analysis due to small sample size. Differences in pt demographics/clinical characteristics were analyzed via Fisher’s exact tests. Testing rates for actionable biomarkers (i.e. BRCA1/2, PIK3CA, PD-L1) were compared between White and AA pts utilizing logistic regressions controlling for age, known family history of a BRCA-related cancer, hormone receptor (HR) status and practice setting (academic vs. community). Further analyses by age will be presented. Results: This analysis included 378 pts records, provided by 40 oncologists. Mean age was 64 years; 77% had HR+/HER2- ABC; 20% had advanced triple negative breast cancer (TNBC), 3% had ABC with an unknown HR status. Compared to White pts, AA pts were significantly more likely to have advanced TNBC (27% vs. 18%, p<0.05). Compared to White pts, AA pts had significantly lower BRCA1/2 mutation (mut) testing rates (Table). Numerically lower rates of PIK3CAmut and PD-L1 testing were observed among AA pts (Table). BRCA1/2mut positivity rate (germline [g] and/or somatic [s]) was higher among AA vs. White pts (30% vs. 22%). Positivity rate for PIK3CAmut was lower for AA vs. White pts (8% vs. 11%). Conclusions: A higher than expected BRCA1/2mut positivity rate was observed than previously reported in the literature. This is likely because this analysis included s BRCA1/2mut and represented a high risk pt population. Across all biomarkers assessed, AA pts had lower testing rates than White pts. This suggests racial disparities in testing rates of actionable biomarkers. Consistent with guidelines, and with the increased availability of targeted therapies, focused efforts should be developed to increase biomarker testing in AA pts. Funding: Pfizer Biomarker Testing Rates by Race.[Table: see text]

Subgroup analysis of patients enrolled in the United States in the CORRECT phase 3 trial of the multikinase inhibitor regorafenib (REG) in metastatic colorectal cancer (mCRC).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 767-767
Author(s):  
Heinz-Josef Lenz ◽  
Eric Van Cutsem ◽  
Udit N. Verma ◽  
Marc Saltzman ◽  
Jyotsna Fuloria ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Small Sample Size ◽  
The United States ◽  
Small Sample ◽  
Wild Type ◽  
Correct Trial ◽  
Multikinase Inhibitor ◽  
Kras Status ◽  
The Us ◽  
Dose Modifications

767 Background: The CORRECT trial (NCT01103323) showed that REG improves overall survival (OS) vs placebo (PBO) in patients with mCRC who failed approved therapies (OS HR 0.77; 1-sided p=0.0052; Grothey 2013). A total of 760 patients were randomized to REG (n=505) or PBO (n=255) in more than 100 centers across North America, Europe, Asia, and Australia. We conducted a post-hoc exploratory subgroup analysis of the 83 (11%) patients from 18 US centers. Methods: Eligible patients had an ECOG PS ≤1 and had received approved therapies, including a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab, and if KRAS wild-type cetuximab and/or panitumumab. Data from the overall cohort, including US patients, are provided for perspective. Descriptive statistics are shown. Results: Of the 83 US patients, 36 (43%) were randomized to PBO and 47 (57%) to REG. Baseline characteristics of the US group were consistent with the overall cohort: median age in the US was 58 yr (range, 34 – 85) vs 61 (22 – 85) overall, 49% of US patients were ECOG PS1 (vs 46%), and 46% received ≤ 3 treatments for mCRC (vs 52%). KRAS status mutant/wild-type was 57%/34% in the US vs 57%/39% overall. All patients in the trial had prior bevacizumab and 57% of US patients also had prior cetuximab and/or panitumumab (vs 51% overall). However, higher proportion of patients in the US were Black (11% vs 2%), KRAS status unknown (10% vs 4%), and had colon as the primary disease site (82% vs 65%). Mean percentages of planned REG dose were similar (76% US vs 79% overall) and mean REG treatment duration was 3.1 mos in US vs 2.8 mos overall. Rates of dose modifications REG/PBO were 87%/47% in the US vs 76%/38% overall and grade ≥3 adverse events REG/PBO were 74%/64% vs 78%/49%, respectively. Based on 44 total death events, the HR for OS in the US subgroup was 0.46 (95%CI 0.25 – 0.84) favoring REG; median OS was 4.7 mos for PBO, but could not be estimated for REG due to censored data. However, this analysis was based on a relatively small sample size and event count. Conclusions: Patients treated in the CORRECT study in the US appear similar to the overall cohort and results are generally consistent with the overall findings of the trial. Clinical trial information: NCT01103323.

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