Abstract 18519: Withdrawal of Antiplatelet Therapy Results in Worse Short-term Prognosis in Patients Undergoing Elective Major Noncardiac Surgery

Background: The decision whether to discontinue antiplatelet therapy in patients undergoing major noncardiac surgery can be clinically challenging. There is insufficient clinical evidence to establish comprehensive guidelines and most of recommendations are based on expert consensus. Objective: To evaluate the effectof withdrawal of antiplatelet therapy on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery. Age, gender, risk factors, previous chronic heart or lung disease, renal function, anemia and concomitant treatment were used in a binary logistic regression to determine the impact of withdrawal of antiplatelet therapy on prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: Five percent of patients presented the composite primary outcome measure of 30-day postoperative mortality or cardiovascular events. Antiplatelet therapy was withdrawn in 11.4% of patients (table). Discontinuation of antiplatelet therapy was associated with a significant increase in the primary outcome measure (OR 2.27; CI95%: 1.16-4.46). Conclusions: In a contemporary cohort of patients undergoing noncardiac surgery, withdrawal of antiplatelet therapy was associated with a worse short-term prognosis. There is an urgent need for further research in this field.

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Abstract 17765: Mild Preoperative Anemia is an Independent Predictor of Mortality and Cardiovascular Events in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽

10.1161/circ.130.suppl_2.17765 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jesús álvarez-García ◽

Miquel Vives-Borrás ◽

Joan I Llao ◽

Andreu Ferrero-Gregori ◽

Marc Bausili ◽

...

Keyword(s):

Risk Factor ◽

Cardiovascular Events ◽

Postoperative Mortality ◽

Postoperative Outcome ◽

Primary Outcome Measure ◽

Noncardiac Surgery ◽

Concomitant Treatment ◽

Preoperative Anemia ◽

Increased Risk ◽

The Impact

Background: Preoperative anemia has been recognized as an important risk factor for perioperative red blood cell transfusions and adverse events in patients undergoing noncardiac surgery. Mild anemia has not unequivocally shown to be a risk factor for death, unless cardiac disease is present or major blood loss occurs. Objective: To evaluate the prevalence of preoperative anemia and its effect on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery.Based on preoperative hemoglobin levels and gender, we stratified patients into the next categories of anemia: mild (11-12 g/dl), moderate (10-11 g/dl) and severe (<10 g/dl) for female; mild (12-13 g/dl), moderate (11-12 g/dl) and severe (<11 g/dl) for male. Age, risk factors, previous chronic heart or lung disease, renal function and concomitant treatment were used in a binary logistic regression to determine the impact of anemia in prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: The overall prevalence of anemia was 18.8%. Thirty-day mortality and cardiac event rate increased with the presence of anemia (table). Mild, moderate and severe anemia were associated with a two-fold (OR 2.07; CI 95%: 1.04-4.11), three-fold (OR 2.93; CI 95%: 1.45-5.94) and four-fold (OR 4.09; CI 95%:1.87-8.95) increases in the risk of MACCE respectively. Conclusions: Anemia is a prevalent risk factor in patients undergoing major noncardiac surgery. Even mild degrees of preoperative anemia are associated with an increased risk of 30-day postoperative mortality and cardiovascular events. Further studies are needed in order to evaluate whether treatment of preoperative anemia could reduce postoperative mortality.

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Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

Scientific Reports ◽

10.1038/s41598-021-88259-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuta Seko ◽

Takao Kato ◽

Yuhei Yamaji ◽

Yoshisumi Haruna ◽

Eisaku Nakane ◽

...

Keyword(s):

Cardiovascular Events ◽

Primary Outcome ◽

Outcome Measure ◽

Conduction Block ◽

Primary Outcome Measure ◽

Excess Risk ◽

Major Adverse Cardiovascular Events ◽

Prognostic Impact ◽

Axis Deviation ◽

The Right

AbstractWhile the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

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186. Prescriber-Led Antibiotic Timeout Alert Responses: A Retrospective Multicenter Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.230 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S99-S99

Author(s):

Steven Smoke ◽

Ellen Secaras ◽

Melissa Crossen ◽

Gargi Patel ◽

Alison Brophy ◽

...

Keyword(s):

Antibiotic Therapy ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Patient Age ◽

Time Out ◽

Patient Âgé ◽

Electronic Chart ◽

The Impact ◽

Retrospective Multicenter Study

Abstract Background An antibiotic time out is when a clinician is prompted to reevaluate antibiotic therapy for appropriateness after 48–72 hrs. The purpose of this study is to evaluate the impact of a prescriber-led electronic antibiotic timeout alert. Methods This was a retrospective cohort study conducted at seven hospitals of a health system. The alert prompts prescribers to reevaluate antibiotic therapy after > 72 hours upon opening the electronic chart. Prescribers can then choose to “Continue”, “Renew”, “Discontinue” or “Defer” for each antibiotic. The alert fires for every time the chart is opened, for every prescriber, every time any antibiotic has been active for > 72 hours and no action response (i.e., “Continue”, “Renew”, “Discontinue”) has been selected. This was a 6 month study from November 1, 2018 – April 30, 2019. The primary outcome measure was the percentage of patients having > 1 antibiotic discontinued via the electronic antibiotic timeout alert. Secondary outcomes included frequency of timeout alerts per patient, and percentage of discontinuations per response, by drug, by indication and by patient age. Results A total of 213950 alerts fired for 13263 patients during the study period. 94.2% and 0.4% of responses were “Defer” and “Discontinue”, respectively. The average number of alerts per patient was 16.1. The percentage of patients who had at least one discontinuation was 5.3%. 38.2% of patients had no response other than “Defer”. There were a total of 10306 action responses, 4.8% of which were “Discontinue”. Among action responses, discontinue rates for the indications of “COPD exacerbation”, “Prophylaxis, Surgical/Procedural”, “Prophylaxis, Immunosuppression”, “Osteomyelitis” were 9.6%, 12%, 1.3% and 1%, respectively. Azithromycin and trimethoprim/sulfamethoxazole had discontinuation rates of 9.3% and 0.9%, respectively. Patient age had a significant impact on discontinuation rates with rates of 4.7%, 3.5%, and 10.9% for patients > 18, 2–17 and < 2 years of age (p< 0.001). Conclusion An electronic antibiotic timeout alert implemented at seven hospitals was largely ignored. This alert may be refined by limiting it to antibiotic orders with specific features associated with higher rates of discontinuation. Disclosures All Authors: No reported disclosures

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Exergaming improves functional fitness in MCI patients. Does the APOE genotype moderate the outcome?

International Journal of Aging Research ◽

10.28933/ijoar-2020-11-2105 ◽

2020 ◽

pp. 74

Author(s):

Keyword(s):

Healthy Aging ◽

Primary Outcome ◽

Outcome Measure ◽

Apoe Genotype ◽

Primary Outcome Measure ◽

Considerable Improvement ◽

Functional Fitness ◽

Functional Effect ◽

The Impact ◽

Passive Group

Objectives: Mild cognitive impairment could be defined as the condition between healthy aging and dementia. MCI patients seem to retain the neuroplasticity to benefit from Physical Exercise (PE) interventions delaying the progression to dementia. The present study investigates the impact of PE via “Exergaming” on the functional fitness of MCI adults, depending on the presence of the APOEɛ4 allele. Methods: 159 MCI participants were recruited. They were separated to two groups (performing PE or not). The Fullerton Functional Test was used as a primary outcome measure in two-time points (prior to and after PE). Results: The Active group showed more considerable improvement compared to the Passive group in all Fullerton components despite the presence of APOEε4. Discussion: ΡΕ via exergaming has a beneficial functional effect in MCI patients, whether carrying the APOEɛ4 allele or not.

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Patient Selection and Clinical Outcomes in the STOPDAPT-2 Trial

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010007 ◽

2021 ◽

Vol 14 (2) ◽

Cited By ~ 1

Author(s):

Kenji Kanenawa ◽

Kyohei Yamaji ◽

Hiroaki Tashiro ◽

Takenori Domei ◽

Kenji Ando ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Patient Selection ◽

Primary Outcome ◽

Outcome Measure ◽

Bleeding Risk ◽

Primary Outcome Measure ◽

Minor Bleeding ◽

High Bleeding Risk ◽

The Impact

Background: We sought to evaluate the impact of patient selection for the STOPDAPT-2 trial (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2) on clinical outcomes in a registry from a single center that participated in the STOPDAPT-2 trial. Methods: Among 2190 consecutive patients who underwent percutaneous coronary intervention using stent in Kokura Memorial Hospital during the enrollment period of the STOPDAPT-2 trial, 521 patients had exclusion criteria such as in-hospital major complications, anticoagulant use, or prior intracranial bleeding (ineligible group). Among 1669 patients who met the eligibility criteria (eligible group), 582 were enrolled (enrolled group) and 1087 were not enrolled (nonenrolled group) in the STOPDAPT-2 trial. The primary outcome measure was defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, stroke, or Thrombolysis in Myocardial Infarction major and minor bleeding. Results: Compared with the enrolled group, patients in the nonenrolled group more often had high bleeding risk according to the Academic Research Consortium for High Bleeding Risk definition (52.6% versus 41.2%; P <0.001) and were frailer according to the Canadian Study of Health and Aging Clinical Frailty Scale (intermediate, 21.4% versus 14.1%; high, 6.4% versus 2.1%; P <0.001). The cumulative 1-year incidences of the primary outcome measure, all-cause death, and major bleeding were significantly higher in the nonenrolled group than in the enrolled group (7.2% versus 4.5%, P =0.03; 4.1% versus 0.9%, P <0.001; and 4.3% versus 2.1%, P =0.03, respectively) and in the ineligible group than in the eligible group (21.2% versus 6.3%, P <0.001; 9.9% versus 3.0%, P <0.001; and 13.5% versus 3.5%, P <0.001, respectively). Conclusions: Patients who were ineligible, eligible but not enrolled, and enrolled in the STOPDAPT-2 trial had different risk profiles and clinical outcomes, suggesting important implications in applying the trial results in daily clinical practice.

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Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.117.198630 ◽

2017 ◽

Vol 211 (2) ◽

pp. 95-102 ◽

Cited By ~ 13

Author(s):

Patricia Cooney ◽

Catherine Jackman ◽

David Coyle ◽

Gary O'Reilly

Keyword(s):

Intellectual Disability ◽

Randomised Controlled Trial ◽

Primary Outcome ◽

Outcome Measure ◽

Controlled Trial ◽

Behavioural Therapy ◽

Primary Outcome Measure ◽

Cognitive Behavioural ◽

Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

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Erosive progression is minimal, but erosion healing rare, in patients with rheumatoid arthritis treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.097048 ◽

2008 ◽

Vol 68 (10) ◽

pp. 1585-1590 ◽

Cited By ~ 61

Author(s):

U M. Dohn ◽

A Boonen ◽

M L Hetland ◽

M S Hansen ◽

L S Knudsen ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Computed Tomography ◽

High Resolution ◽

Primary Outcome ◽

Outcome Measure ◽

Primary Outcome Measure ◽

High Resolution Computed Tomography ◽

Follow Up Study ◽

Erosive Progression

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Telephone-guided self-help for mental health difficulties in neurological conditions: a randomised pilot trial

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318577 ◽

2021 ◽

pp. archdischild-2019-318577

Author(s):

Sophie D Bennett ◽

Isobel Heyman ◽

Anna E Coughtrey ◽

Sophia Varadkar ◽

Terence Stephenson ◽

...

Keyword(s):

Mental Health ◽

Young People ◽

Primary Outcome ◽

Outcome Measure ◽

Mental Health Problems ◽

Pilot Trial ◽

Primary Outcome Measure ◽

Self Help ◽

Mental Health Difficulties ◽

Neurological Conditions

ObjectiveThis study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions.DesignPreliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire.SettingNeurology clinics in a national tertiary paediatric hospital.PatientsYoung people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment.Interventions12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14).Results124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable.ConclusionsFurther feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended.Trial registration numberISRCTN21184717.

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COMPARISON RESULTS OF SURGICAL TREATMENT LOCALIZED AND EXTENDED UTERINE CANCER

Clinical Practice ◽

10.17816/clinpract1356-61 ◽

2010 ◽

Vol 1 (3) ◽

pp. 56-61

Author(s):

I I Ushakov ◽

E A Artoshina ◽

P G Brousov ◽

I V Nazvantsev ◽

S A Levakov ◽

...

Keyword(s):

Surgical Treatment ◽

High Risk ◽

Adjuvant Radiotherapy ◽

Primary Outcome ◽

Outcome Measure ◽

Uterine Cancer ◽

Primary Outcome Measure ◽

Pelvic Lymphadenectomy ◽

Peritoneal Washing ◽

Comparison Results

We selected 145 patients with endometrial carcinoma who had been treated with standard surgery (hysterectomy and BSO, peritoneal washing, palpation pelvic and para-aortic nodes) and with complete systematic pelvic lymphadenectomy (n=30 patients) or combined pelvic and para-aortic lymphadenectomy (n=30). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy. The primary outcome measure was results of the surgical therapy.

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