Development of an Emergency Revisit Score for Patients With Drug-Related Problems

2021 ◽  
pp. 875512252110117
Author(s):  
Jesus Ruiz Ramos ◽  
Laura Gras-Martin ◽  
Ana María Juanes Borrego ◽  
Marta Blazquez-Andion ◽  
Mireia Puig Campmany ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Receiver Operating Curve ◽  
Drug Related Problems ◽  
Derivation Cohort ◽  
Factors Associated ◽  
Final Score ◽  
Anticholinergic Burden ◽  
Risk Categories ◽  
Frequent Reason

Background: Drug-related problems (DRPs) are a frequent reason for emergency departments (EDs) visits. However, data about the risk factors associated with EDs revisits are limited. Objective: To develop and validate a predictive model indicating the risk factors associated with EDs revisit within 30 days of the first visit. Methods: A retrospective cohort study was conducted involving patients who attended an ED for DRPs related to cardiovascular drugs. A 30-day prediction model was created in a derivation cohort by logistic regression. An integer score proportional to the regression coefficient was assigned to the variables with P < .100 in the multivariate analysis. Results: 581 patients (mean age: 80.0 [12.6] years) were included, 133 (22.9%) revisited the ED within 30 days from discharge. Six factors (chronic kidney disease, chronic heart failure, visit to an ED in the preceding 3 months, high anticholinergic burden, DRPs associated with heparin, and safety-related DRPs) were identified as risk factors and combined into a final score, termed the DREAMER score. The model reached an area under the receiver operating curve values of 0.72 (95% confidence interval [CI] = 0.67-0.77) in the referral cohort and 0.71 (95% CI = 0.65-0.74) in the validation cohort ( P = .273). Three risk categories were generated, with the following scores and estimated risks: low risk (0-8 points): 11.6%; intermediate risk (9-14 points): 21.3%; and high risk (>14 points): 41.2%. Conclusion and Relevance: The DREAMER score identifies patients at high risk for ED revisit within 30 days from the first visit for a DRPs, being a useful tool to prioritize interventions on discharge.

scholarly journals High-risk human papillomavirus infection and associated factors in the anal canal of HIV-positive patients in Medellín, 2017–2018

2020 ◽  
Vol 54 ◽  
pp. 93
Author(s):  
Daniela Herrera Posada ◽  
Lucia Stella Tamayo Acevedo ◽  
Marleny Valencia Arredondo ◽  
Gloria Inéz Sánchez Vásquez
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Human Papillomavirus ◽  
High Risk ◽  
Elementary Education ◽  
Associated Factors ◽  
Casual Sex ◽  
Hiv Positive ◽  
Factors Associated ◽  
High Risk Hpv

OBJECTIVE: To estimate the prevalence of high-risk human papillomavirus (HR-HPV) anal infection and associated factors in human immunodeficiency virus (HIV) positive patients in Medellín. METHODS: Descriptive cross-sectional study in 300 HIV-positive patients, adults, with history of anal intercourse, treated in two health care services of Medellín 2017–2018. We conducted a structured survey on sociodemographics, sexual behavior and medical history. HPV was detected in anal swabs tested by the COBAS 4800 system. Exploratory data analysis of risk factors associated with HR-HPV was conducted by chi-square test of independence and both raw and adjusted prevalence ratios used the Poisson regression model, at a 95% confidence interval. RESULTS: The high-risk HPV had a prevalence of 82.7%; HPV16 had a prevalence of 32.7%, HPV18 a prevalence of 21.7% and other HPV types scored 78.3%. The high-risk HPV prevalence in women was of 68.2% and 83.8% in men. The risk factors associated with high-risk HPV after adjustment were age under 30 years, elementary education, casual sex partners, and first sexual activity before 18 years old. CONCLUSIONS: The high incidence of high-risk HPV, along with the occurrence of coinfections by multiple types in the study population shows their susceptibility to develop some type of anal intra-epithelial neoplasia. It is important to establish sexual health programs focused on primary health care.

scholarly journals PARAMETERS OF ECG DISPERSION MAPPING AMONG STUDENTS OF NORTHERN UNIVERSITY

2019 ◽  
pp. 98-104 ◽  
Author(s):  
I. A Pogonysheva ◽  
D. A Pogonyshev ◽  
I. I Lunyak
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Questionnaire Survey ◽  
Cardiac Activity ◽  
State University ◽  
Men And Women ◽  
Factors Associated ◽  
Far North ◽  
Pathological Characteristics

The cardiac activity of students who have been born and live in the territory equated to regions of Far North was assessed. In total, 132 students of Nizhnevartovsk State University were examined using the CardioVisor-06c analyser that helps to diagnose dysfunctions of the cardiovascular system at preclinical level. The authors conducted a questionnaire survey to identify risk factors associated with cardiovascular diseases in students and analyzed the results of ECG dispersion mapping. The deterioration of the functional state of the myocardium was more pronounced among students with a high risk of developing cardiovascular diseases. The young men and women with pre-pathological characteristics of electrophysiological indicators were referred for additional examination and cardiology consultation.

scholarly journals Simple electrocardiographic measures improve sudden arrhythmic death prediction in coronary disease

2020 ◽  
Vol 41 (21) ◽  
pp. 1988-1999 ◽  
Author(s):  
Neal A Chatterjee ◽  
Jani T Tikkanen ◽  
Gopi K Panicker ◽  
Dhiraj Narula ◽  
Daniel C Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Stratification ◽  
Validation Cohort ◽  
Clinical Risk Factors ◽  
Left Ventricular Ejection ◽  
Derivation Cohort ◽  
Arrhythmic Death ◽  
Clinical Risk ◽  
Ecg Score

Abstract Aims To determine whether the combination of standard electrocardiographic (ECG) markers reflecting domains of arrhythmic risk improves sudden and/or arrhythmic death (SAD) risk stratification in patients with coronary heart disease (CHD). Methods and results The association between ECG markers and SAD was examined in a derivation cohort (PREDETERMINE; N = 5462) with adjustment for clinical risk factors, left ventricular ejection fraction (LVEF), and competing risk. Competing outcome models assessed the differential association of ECG markers with SAD and competing mortality. The predictive value of a derived ECG score was then validated (ARTEMIS; N = 1900). In the derivation cohort, the 5-year cumulative incidence of SAD was 1.5% [95% confidence interval (CI) 1.1–1.9] and 6.2% (95% CI 4.5–8.3) in those with a low- and high-risk ECG score, respectively (P for Δ &lt; 0.001). A high-risk ECG score was more strongly associated with SAD than non-SAD mortality (adjusted hazard ratios = 2.87 vs. 1.38 respectively; P for Δ = 0.003) and the proportion of deaths due to SAD was greater in the high vs. low risk groups (24.9% vs. 16.5%, P for Δ = 0.03). Similar findings were observed in the validation cohort. The addition of ECG markers to a clinical risk factor model inclusive of LVEF improved indices of discrimination and reclassification in both derivation and validation cohorts, including correct reclassification of 28% of patients in the validation cohort [net reclassification improvement 28 (7–49%), P = 0.009]. Conclusion For patients with CHD, an externally validated ECG score enriched for both absolute and proportional SAD risk and significantly improved risk stratification compared to standard clinical risk factors including LVEF. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01114269. ClinicalTrials.gov ID NCT01114269.

scholarly journals EVALUATION OF CEFOPERAZONE/SULBACTAM AND VITAMIN K USE IN PATIENTS WITH BACTERIAL INFECTIONS

2019 ◽  
pp. 191-193 ◽  
Author(s):  
THEERAPONG SEESIN ◽  
PITIPONG PENGSUPSIN ◽  
SARAWUT WEESAPHEN ◽  
PEERAYA SRIPHONG ◽  
UAEPONG LIMPAPANASIT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Vitamin K ◽  
Bacterial Infections ◽  
Drug Allergy ◽  
High Risk Patient ◽  
General Medicine ◽  
Drug Related Problems ◽  
High Doses

Objective: The objectives of this study were to evaluate the effects of Vitamin K use for bleeding or coagulopathies prevention and to assess theoccurrence of drug-related problems in patients receiving cefoperazone/sulbactam.Methods: The prospective study was conducted between January and April 2018 at 5 general medicine wards in Mahasarakham Hospital, Thailand.Patients above 18 years of age with bacterial infections who received cefoperazone/sulbactam concurrent with Vitamin K were included. Rate ofbleeding, coagulopathies, and drug-related problems were evaluated.Results: Forty-three eligible patients enrolled in this study. Most were women (72.1%), average ages were 64.7 years old and 93.0% had comorbidities(most were diabetes, hypertension, and chronic kidney disease). High doses of cefoperazone/sulbactam have been used in 35 patients (81.4%).Gastrointestinal bleeding occurred in one patient (8.3%), 24 patients had prolonged prothrombin time (55.8%), and 8 patients had prolongedactivated partial thromboplastin time (18.6%). Anticipated risk factors were not associated with bleeding. Drug-related problems were missing ofdose adjustment for cefoperazone/sulbactam in patients with renal impairment (4.7%), drug interactions between warfarin and Vitamin K (4.7%),and drug allergy (2.3%).Conclusion: This study found that cefoperazone/sulbactam aggravated bleeding and coagulopathies despite using Vitamin K for prevention. Wesupport the use of Vitamin K for the prevention of bleeding in high-risk patient such as elderly who receive cefoperazone/sulbactam.

Calreticulin Mutation Does Not Modify the International Prognostic Score for Predicting the Risk of Thrombosis Among 1,150 Patients with Essential Thrombocythemia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 404-404
Author(s):  
Guido Finazzi ◽  
Alessandra Carobbio ◽  
Paola Guglielmelli ◽  
Elisa Rumi ◽  
Silvia Salmoiraghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Prognostic Score ◽  
Low Risk ◽  
Intermediate Risk ◽  
Thrombotic Risk ◽  
Exon 9 ◽  
International Prognostic Score ◽  
Risk Categories ◽  
Calr Mutation

Abstract Background An International Prognostic Score for the risk of thrombosis (IPSET-thrombosis) in Essential Thrombocythemia (ET) was developed (Barbui et al. Blood, 2012;120:5128). Risk factors included: age >60 years (1 point), cardiovascular (CV) risk factors (1 point), previous thrombosis (2 points) and the presence of JAK2V617F mutation (2 points). Low, intermediate and high risk categories were identified by scores 0-1; 2; and ≥ 3, respectively. Mutations in the exon 9 of CALreticulin (CALR) gene were recently identified in about 50-60% of patients with JAK2V617F negative ET and associated with a reduced thrombotic risk as compared with JAK2V617F positive patients. Aim To evaluate whether the identification of CALRmutation in patients with ET has any impact on the IPSET-thrombosis score Patients and Methods Under the auspices of AGIMM (AIRC Gruppo Italiano Malattie Mieloproliferative), four Italian centers with recognized experience in myeloproliferative neoplasms participated in the current study. Overall, 1,150 patients who met the 2008 WHO criteria for ET and were molecularly characterized for JAK2V617F, MPLW515L/K and CALR exon 9 mutations were included. The JAK2 and MPL mutations were assessed by real-time quantitative polymerase chain reaction and by high-resolution melting analysis followed by bidirectional Sanger sequencing. Mutations in exon 9 of CALRwere assessed by bidirectional sequencing or next generation sequencing. Results Presenting features of the study population were: median age 58 years (range 5th-95th percentile 27-82 years; 65% females), median hemoglobin 14.1 g/dL (range 5th-95th percentile 11.8-16.3), median leukocyte count 8.7x109/L (range 5th-95th percentile 5.4-14.7), median platelet count 718x109/L (range 5th-95th percentile 486-1313). CV risk factors (at least one among smoke, diabetes and hypertension) were present in 568 (49%) patients. Arterial or venous thrombosis history before or at diagnosis was documented in 167 (15%) patients. JAK2V17F, MPLW515L/K and CALRmutations were detected in 744 (65%), 44 (4%) and 164 (14%) patients respectively. The remaining 198 patients (17%) were wild-type for all three mutations. During a median follow-up of 4.1 years (range 0-29), 104 patients developed an arterial or venous thrombotic event, with a total incidence rate of 1.59% patients/year (pt-ys). The IPSET-thrombosis ability to discriminate the thrombotic risk was confirmed. In fact, in the low risk (reference category), the rate was 0.57% pt-ys; in the intermediate risk was 1.60% pt-ys (Hazard Ratio (HR) 3.10, 95% Confidence Interval (CI) 1.55-6.18, p=0.001) and in the high risk group was 2.34% pts-yr (HR 4.59, 95% CI 2.41-8.77 p<0.0001). As to the impact of CALR mutation in the three categories of the IPSET-thrombosis score, we observed that CALR mutated patients were more frequently distributed in the low risk (48%) and intermediate risk (46%) than in the high risk IPSET groups (6%). In univariate analysis, patients carrying CALR mutation had a lower incidence of thrombosis than those with JAK2V617F (HR 0.61, 95% CI 0.34-1.09, p=0.093). However, CALR mutated patients were significantly younger (median age 53.5 versus 60.8 years, p=0.001) and presented with less previous thrombosis (8% versus 17%, p=0.005) than JAK2V617F mutated patients. This could explain why in multivariable models, CALR mutation did not retain the association with the risk of thrombosis. This was demonstrated in the whole population (HR 0.81, 95% CI 0.30-2.17, p=0.674), as well as in the low risk (HR 1.01, range 0.27-3.81, p=0.987) and intermediate risk categories (HR 1.80, range 0.57-5.72, p=0.317); the high risk category was not evaluable for the low proportion of CALRmutated patients in this group. Conclusions CALR mutation does not have a significant impact on the IPSET-thrombosis prognostic score. The score can be used as it is to predict the risk of thrombosis in molecularly-annotated, WHO-2008 diagnosed ET patients. Disclosures Vannucchi: Novartis Pharmaceuticals Corporation: Consultancy, Honoraria, Research Funding.

Seroprevalence of brucellosis in bovines of Chhattisgarh, India

2018 ◽  
Author(s):  
Lata Jain ◽  
Vinay Kumar ◽  
Sameer Chaturvedi ◽  
Goutam Roy ◽  
Sukhadeo B. Barbuddhe
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Human Population ◽  
Animal Health ◽  
Dairy Industry ◽  
Zoonotic Disease ◽  
Economic Losses ◽  
Serum Samples ◽  
Factors Associated

Brucellosis is an important zoonotic disease causing reproductive problems and abortions in bovines leading to huge economic losses to the dairy industry. Seroepidemiology and risk factors associated with brucellosis were investigated in cattle and buffaloes of Chhattisgarh, India. A total of 374 serum samples from bovines were collected randomly from 94 villages of six districts of Chhattisgarh state with different attributes and were screened by i-ELISA for the detection of antibodies. The overall true seroprevalence for brucellosis was observed to be 14.17%. Brucellosis was significantly more prevalent in animals of organized farms, cross bred, age above 7 years, clinically ailing ones particularly cases of abortion and repeat breeding compared to apparently health animals. The finding represented a major impact on animal health and productivity as well as a high risk to the human population.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19 Pneumonia: A Multicenter Study

2020 ◽  
Author(s):  
Yun Yang ◽  
Xiaofei Zhu ◽  
Jian Huang ◽  
Cui Chen ◽  
Yang Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatal Outcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.862, [95% CI 0.763-0.961], sensitivity 92.9%, specificity 64.5%); in validation cohort 2 (AUC 0.811, [95% CI 0.698-0.924], sensitivity 77.3%, specificity 73.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients.

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