scholarly journals Prognostic Factors Predicting Poor Outcome in Cancer Patients with Febrile Neutropenia in the Emergency Department: Usefulness of qSOFA

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Seung Jae Lee ◽  
Ji Hye Kim ◽  
Seung Baik Han ◽  
Jin Hui Paik ◽  
Areum Durey
Keyword(s):  
Emergency Department ◽  
Prognostic Factors ◽  
Febrile Neutropenia ◽  
Poor Prognosis ◽  
Multiple Logistic Regression Analysis ◽  
Total Bilirubin Level ◽  
Control Group ◽  
Case Group ◽  
Patients With Cancer ◽  
Poor Outcome

Background/Aims. Febrile neutropenia is considered as one of the most important and potentially life-threatening oncologic emergencies, which requires prompt medical assessment and treatment with antibiotics. This was a single-center retrospective study that investigated the prognostic factors predicting poor outcome in patients with cancer who presented with febrile neutropenia at the emergency department (ED). Methods. The medical records of patients diagnosed with febrile neutropenia in the ED from January 2014 to December 2017 were reviewed. Patients aged >18 years who were diagnosed with a malignancy were included in the analysis. Febrile neutropenia was defined as an absolute neutrophil count < 1,000/mm3 with a temperature greater than 38°C. Patients were divided into two groups: those who were admitted at the intensive care unit (ICU) or those who died in the hospital (case group) and those who were admitted at general wards and were discharged (control group). The two groups were compared to determine the factors associated with poor prognosis. Results. We identified 104 patients (25 and 79 from the case and control groups, respectively) with cancer who presented with febrile neutropenia at the ED during the study period. Lower blood pressure, platelet count, and HCO3- level, higher CRP and creatinine level, and the presence of bacteremia were more commonly observed in the case group than in the control group. In the multiple logistic regression analysis, the following independent predictors significantly correlated with ICU admission and in-hospital mortality: quick sequential (sepsis-related) organ failure assessment (qSOFA) score (odds ratio [OR]: 4.62; 95% confidence interval [CI]: 1.17–18.22; p=0.285), hemoglobin level (OR: 0.51; 95% CI: 0.33–0.78; p=0.002), total bilirubin level (OR: 7.69; 95% CI: 1.29–45.8; p=0.025), and respiratory tract infection (OR: 29.65; 95% CI: 3.81–230.7; p=0.0012). Conclusions. The qSOFA can be a useful bedside tool for patients with cancer who present with febrile neutropenia at the ED. Moreover, it can help emergency physicians in identifying patients at risk of poor prognosis and in initiating prompt empirical antimicrobial therapy. Further studies must be conducted to validate the efficacy of the qSOFA in these patients in the ED.

scholarly journals Digital Queuing System in Emergency Department Management

2020 ◽  
Author(s):  
Behrad Ziapour ◽  
Mohammad Faramarzi ◽  
Mohammad Bahadoram ◽  
Mohammad-Reza Mahmoudian-Sani ◽  
Fatemeh Javanmardi
Keyword(s):  
Emergency Department ◽  
Care Facility ◽  
Health Care Facility ◽  
Severity Index ◽  
Queuing System ◽  
Control Group ◽  
Case Group ◽  
Patient Transfers ◽  
Ed Overcrowding ◽  
Emergency Department Management

Abstract BackgroundThe long-standing challenge of emergency department (ED) overcrowding facing central hospitals is often aggravated once inadequate human resources mandate collaboration by companions in terms of laboratory sample transfer, patient transfers within health care facility, or so on. In this study, a digital queuing system (DQS) was developed and evaluated based on the overall goal of triage; thereby, emergency physicians could call companions into the ED, solely on the time they were required to cooperate. Materials and MethodsTo this end, patient arrivals into the ED, wherein this trial was conducted in, were classified using the Emergency Severity Index (ESI) (Version 4) as a five-level ED triage algorithm. Accordingly, patients with triage levels 3 and 4, typically accounting for the majority of the ED overcrowding were included in this trial. At the time of reception, the DQS was also recruited to locate their companions in two different queues. Subsequently, physicians recalled each companion from a station inside the ED, precisely on the time that their patients were being visited. Consecutively, the medical staff filled questionnaires on 30 shifts without the DQS as the control group and on 50 shifts with the DQS as the case group. They correspondingly utilized the Relative Chaos Scale (RCS) to quantify the levels of tension in their shifts from 1 to 10 and to report it in the questionnaires. ResultsThe implementation of the DQS could significantly mitigate the RCS reported by either nurses or residents or interns (p<0.001). ConclusionIt was concluded that DQSs in EDs seem as strong potential tools, which can be developed in accordance with the overall goal of triage. Such modified DQSs can further assist in ED overcrowding control, keeping companions out of EDs until the exact time they are needed.

scholarly journals Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department

2015 ◽  
Vol 11 (6) ◽  
pp. 450-455 ◽  
Author(s):  
Michael K. Keng ◽  
Elaine A. Thallner ◽  
Paul Elson ◽  
Christine Ajon ◽  
Jennifer Sekeres ◽  
...  
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Antibiotic Administration ◽  
Patients With Cancer

The Emergency Department (ED) Febrile Neutropenia Pathway quality initiative demonstrated value by decreasing time to antibiotic administration in patients with cancer presenting to the ED compared with historical and direct admissions controls.

Emergency Department Waiting Times for Patients With Cancer With Febrile Neutropenia: A Pilot Study

2004 ◽  
Vol 31 (4) ◽  
pp. 711-715 ◽  
Author(s):  
Anita Nirenberg ◽  
Lisa Mulhearn ◽  
Susan Lin ◽  
Elaine Larson
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Febrile Neutropenia ◽  
Waiting Times ◽  
Patients With Cancer

scholarly journals Clinical Predictors of Pseudomonas aeruginosa Bacteremia in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Yongsoon Choi ◽  
Jin Hui Paik ◽  
Ji Hye Kim ◽  
Seung Baik Han ◽  
Areum Durey
Keyword(s):  
Emergency Department ◽  
Pseudomonas Aeruginosa ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Agents ◽  
Empirical Treatment ◽  
Control Group ◽  
Case Group ◽  
Clinical Predictors

Objectives. Pseudomonas aeruginosa shows higher mortality rate compared to other bacterial infections and is susceptible to a limited number of antimicrobial agents. Considering inadequate empirical treatment of Pseudomonas bacteremia has been associated with increased mortality, it is important for emergency physicians to identify infections by P. aeruginosa. Methods. This was a single-center retrospective case-control study to investigate the clinical predictors of patients diagnosed as Pseudomonas bacteremia in the emergency department (ED) from June 2012 to December 2016. Patients with blood culture positive for Escherichia coli in the same period were chosen as the control group, and type of infection was matched for each patient. Results. A total of 54 cases with Pseudomonas bacteremia and 108 controls with E. coli bacteremia were included. In the case group, 76% was community-acquired infection, 44% received inappropriate empirical treatment in the ED, and in-hospital mortality was 30%. Multiple logistic regression showed that respiratory tract infection was an independent risk factor for Pseudomonas bacteremia (OR 6.56, 95% CI 1.78-23.06; p = 0.004), whereas underlying diabetes mellitus (OR 0.22, 95% CI 0.07-0.61; p = 0.004) and presentation as urinary tract infection (OR 0.06, 95% CI 0.02-0.18; p < 0.001) were negative clinical predictors. Conclusions. We suggest that antipseudomonal antibiotics should be considered beyond simple coverage of Gram-negative bacteria in the ED, especially if the patient is likely to have pneumonia. Having diabetes or presenting with urinary tract infection could be clinical factors unfavorable to use of antipseudomonal antibiotics.

scholarly journals Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0216835 ◽  
Author(s):  
Christopher W. Baugh ◽  
Mohammad Kamal Faridi ◽  
Emily L. Mueller ◽  
Carlos A. Camargo ◽  
Daniel J. Pallin
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Patients With Cancer ◽  
Emergency Department Patients

scholarly journals Febrile neutropenia in intensive care: a challenge for the modern day intensivist

2019 ◽  
pp. S102-S105
Author(s):  
Saad Ur Rehman ◽  
Ahsun Waqar Khan
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Febrile Neutropenia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Optimal Management ◽  
Common Complication ◽  
Patients With Cancer ◽  
Organ Specific

Febrile Neutropenia (FN) is a fairly common complication of cancer chemotherapy. It leads to delays in cancer treatment and worsens prognosis. Patients with FN are frequently admitted to intensive care with organ specific complications of FN. The optimal management of critically ill patients with FN necessitates expertise in oncology, critical care, and infectious diseases. Intensive care specialists therefore have to be familiar with key principles of care for critically ill patients with cancer and FN. This review provides an overview of the pathophysiology, definition, management and prognostic factors of critically ill patients with FN.Citation: Rehman SU, Khan AW. Febrile neutropenia in intensive care: a challenge for the modern day intensivist. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S102-S105

scholarly journals The effect of SOX4 gene 3′UTR polymorphisms on osteoporosis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Guo Li ◽  
Zuchao Gu ◽  
Yue He ◽  
Chongwen Wang ◽  
JiQiang Duan
Keyword(s):  
Protective Factor ◽  
Multiple Logistic Regression Analysis ◽  
High Mobility ◽  
Control Group ◽  
Case Group ◽  
Single Nucleotide ◽  
Increased Risk ◽  
Gene 4 ◽  
Osteoporosis Risk ◽  
T Haplotype

Abstract Objective This study aimed to explore the correlation between the SRY-related high-mobility-group box gene 4 (SOX4) 3′ untranslated region (UTR) single nucleotide polymorphism (SNP) and osteoporosis susceptibility. Methods The study recruited 330 osteoporosis patients (the case group) and 330 non-osteoporosis patients (the control group) in Sichuan Chengdu First People’s Hospital and Zibo Central Hospital from August 2016 to August 2019. Sanger sequencing was used to analyze the genotypes of SOX4 gene rs79958549, rs139085828, and rs201335371 loci. Multi-factor dimensionality reduction (MDR) was used to analyze the interaction between the SOX4 gene rs79958549, rs139085828, and rs201335371 loci and the clinical characteristics of the subjects. Results The risk of osteoporosis in the carriers of A allele at SOX4 rs79958549 was 5.40 times that in the carriers of the G allele (95% CI 3.25–8.96, P < 0.01). The risk of osteoporosis in the carriers of the A allele at SOX4 rs139085828 was 1.68 times that in the carriers of the G allele (95% CI 1.45–1.85, P < 0.01). The risk of osteoporosis in the carriers of the T allele at SOX4 rs201335371 was 0.54 times that in the carriers of the C allele (95% CI 0.43–0.69, P < 0.01). The SOX4 gene rs79958549, rs139085828, and rs201335371 A-A-C haplotype (OR = 5.14, 95% CI 2.45–10.57, P < 0.01) were associated with increased risk of osteoporosis and G-G-T haplotype was significantly associated with decreased risk of osteoporosis (OR = 0.48, 95% CI 0.38–0.62, P < 0.01). The interaction among the factors of sex, smoking, drinking, rs79958549, rs201335371 was the best model for osteoporosis prediction, and the risk for osteoporosis in ‘high-risk combination’ was 2.74 times that of ‘low-risk combination’ (95% CI 1.01–7.43, P = 0.04). Multiple logistic regression analysis revealed that the risk factors for osteoporosis were BMD (OR = 5.85, 95% CI 2.88–8.94, P < 0.01), T score (OR = 8.54, 95% CI 5.66–10.49, P < 0.01), Z score (OR = 3.77, 95% CI 2.15–8.50, P < 0.01), rs79958549 SNP (OR = 6.92, 95% CI 3.58–8.93, P < 0.01), and rs139085828 SNP (OR = 2.36, 95% CI 1.85–4.27, P < 0.01). The protective factor for osteoporosis was rs201335371SNP (OR = 0.48, 95% CI 0.32–0.75, P < 0.01). Conclusion The SOX4 gene SNPs rs79958549, rs139085828, and rs201335371 loci were significantly associated with osteoporosis risk.

Impact of a Disaster Drill on Waiting Times in a Pediatric Emergency Department

2021 ◽  
pp. 1-3
Author(s):  
Silvia Asenjo ◽  
Aitor López-González ◽  
David Muñoz-Santanach ◽  
Victoria Trenchs ◽  
Carles Luaces ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Times ◽  
Pediatric Emergency ◽  
Optimal Time ◽  
Control Group ◽  
Case Group ◽  
Pediatric Emergency Department ◽  
Real Patients ◽  
Triage Level ◽  
Triage Time

Abstract Objective: Emergency departments should improve their preparedness for mass casualty incidents (MCIs) through periodic drills. These exercises are conducted while maintaining regular care. The aim of this study was to determine the impact of a disaster drill in a pediatric emergency department (PED) on real patients’ waiting times. Methods: On September 10, 2019, a 4-h disaster drill was conducted in the PED of a tertiary pediatric hospital, with minimal staff reinforcement (2 nurses). Cases were real patients that came to the PED during the drill. The patients that visited the PED the day before were the control group. Variables analyzed were: age, sex, destination, triage level, time-to-triage, time-to-physician, length of PED stay, and percentage of patients visited within the optimal time according to triage level. Results: Sixty-eight patients (case group) and 63 patients (control group) were analyzed; both groups were comparable except for the median age. There were no differences in time-to-triage, time-to-physician, and length of PED stay between the 2 groups. The percentage of patients visited within optimal time according to triage level was higher in the case group. Conclusions: Conducting an MCI drill in the PED, with minimal staff reinforcement, was not detrimental to real patients’ waiting times.

scholarly journals The Role of Serum miR-497 on the Predictive Index of Early Diagnosis and Poor Prognosis of Atherosclerosis Cerebral Infarction

2021 ◽  
Author(s):  
Zhiyong Cao ◽  
Han Wang ◽  
Xiangyang Zhu
Keyword(s):  
Prognostic Factors ◽  
Early Diagnosis ◽  
Cerebral Infarction ◽  
Poor Prognosis ◽  
Cox Regression ◽  
Survival Rates ◽  
Clinicopathological Parameters ◽  
Control Group ◽  
Predictive Index ◽  
Cox Regression Analysis

Background: Serum miR-497 can be used as a predictive index of the early diagnosis and poor prognosis of atherosclerosis cerebral infarction (ATCI). Methods: Overall, 135 ATCI patients, treated in The Second Affiliated Hospital of Nantong University, Nantong 226001, P.R.China from Apr 2012 to Jan 2015, were included in ATCI group. Whereas, 77 patients with non-atherosclerosis cerebral infarction were put in the control group. RT-qPCR was performed for detecting serum miR-497 expression, whose relationship with the patients’ clinicopathological parameters was analyzed. Receiver operating characteristic (ROC) curves were plotted to evaluate values of serum miR-497 for diagnosing ATCI patients and their 3-year and 5-year overall survival rates (OSRs). Cox regression analysis was conducted on prognostic factors of ATCI patients. Results: miR-497 remarkably rose in the serum of ATCI patients, and was correlated with histories of hypertension, smoking and diabetes mellitus (DM). Its areas under curves (AUCs) for diagnosing these pathological parameters were 0.803, 0.817 and 0.819, respectively. Its expression was higher in the serum of the patients with recurrence and poor prognoses. Its AUCs for predicting the two conditions were 0.924 and 0.937, respectively. The 3- and 5-year OSRs of patients with low expression were remarkably higher than those of patients with high expression. Conclusion: miR-497 and histories of hypertension, smoking and DM were independent prognostic factors affecting the 3-year OSR of ATCI patients. miR-497 expression rises in ATCI patients, so this miR is expected to become a serum diagnostic marker for ATCI.

scholarly journals THE DETERMINANTS OF ACCESS TO ADOLESCENT- FRIENDLY HEALTH SERVICE: A CASE CONTROL STUDY

2020 ◽  
Vol 8 (2) ◽  
pp. 164
Author(s):  
Izzatul Arifah ◽  
Lenni Ayu Kusumawardani ◽  
Dwi Hendriyaningsih ◽  
Mukti Aji Wibisono ◽  
Estu Puji Lestari
Keyword(s):  
Health Service ◽  
Case Control Study ◽  
Multiple Logistic Regression Analysis ◽  
Sampling Technique ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
Peer Educators ◽  
School Based ◽  
Control Study

Background: Adolescents need to access Adolescent-Friendly Health Service (AFHS) to get it’s benefit in order to improve adolescent health. However, the current adolescent access to that service remains low with the access prevalence under 50%).Aim: This study determined factors that affected adolescents’ access to AFHS.Methods: This school-based case control study was conducted in 9 junior and senior high schools in the area of Sangkrah and Kratonan in Surakarta District. There were 162 cases (who accessed the AFHS by guidance from health professionals and peer educators) and 162 controls (those who did not) who were chosen using total sampling and proportionate random sampling technique, respectively. A multiple logistic regression analysis was used to assess the determinant factors of AFHS access.Results: Access to AFHS was significantly determined by knowledge of the program and perceived demand. A probability of finding adolescents who had knowledge of the program was 6 times higher in the case group than in control group with the OR value of 6.1 (95% CI 3.3-11.1).Conclusion: Overall, the low adolescents’ access was mostly caused because of insufficient knowledge. Broadening information about the program and adolescents’ access to the program through electronic media and peer educators is required. Keywords: access, adolescent, Adolescent-Friendly Health service, AFHS.

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