Likelihood of a Subsequent Chemotherapy Induced Nausea and Vomiting Event In Patients with Hematologic Malignancies Receiving Chemotherapy.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3819-3819
Author(s):  
Bruce Feinberg ◽  
Lee S. Schwartzberg ◽  
James Gilmore ◽  
Sally Haislip ◽  
James Jackson ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Hematologic Malignancies ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Substantial Impact ◽  
Chemotherapy Administration ◽  
Increased Risk ◽  
Cancer Specialists

Abstract Abstract 3819 Objective: Chemotherapy induced nausea and vomiting (CINV) is a common side effect and can have a substantial impact on patient quality of life and subsequent health-related resource utilization. In addition to other risk factors including chemotherapy emetogenicity, patient age, gender, and alcohol use, patients with prior history of CINV may have an increased risk of CINV. This study assessed the increased likelihood of a subsequent CINV following a first chemotherapy administration CINV in patients with a hematologic cancer diagnosis receiving single-day low emetogenic chemotherapy (LEC), moderately emetogenic chemotherapy (MEC), or high emetogenic chemotherapy (HEC). Methods: A retrospective analysis was conducted utilizing a merged data set comprised of Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN's electronic medical records databases (April 2006 – June 2010). Patients with any hematologic malignancy (those diagnosed with any leukemia, lymphoma, and/or myeloma (ICD-9-CM 200.xx-208.xx) who received at least two single-day chemotherapy administrations (oral or intravenous) and had no chemotherapy 3 months prior to first chemotherapy administration [index date] were included. Two cohorts: 1) patients with a first chemotherapy administration CINV event and 2) those with no first chemotherapy administration CINV event, were identified and followed for six months. Uncontrolled CINV events were identified through ICD-9-CM codes [nausea and vomiting (N&V)], CPT codes (hydration), rescue medications, N&V hospitalizations, and/or antiemetic therapy after last chemotherapy administration of the cycle. A multivariate logistic regression was conducted to assess the likelihood of subsequent CINV. The model controlled for differences in demographic and clinical variables between the two cohorts including age, gender, Charlson comorbidity index, number of chemotherapy administrations, days between chemotherapy administrations, anti-emetic prophylaxis use with first chemotherapy administration, and chemotherapy emetogenicity. Result: A total of 1,121 patients met the inclusion criteria; 247 (22.0%) experienced a CINV within six months. Of those patients with CINV, 68 patients (27.5%) encountered a CINV event with the first chemotherapy administration. These 68 patients were younger [55.9 (SD: 16.5) vs. 60.8 (SD: 16.1) years; p=0.016] and had fewer chemotherapy administrations [6.4 (SD: 3.0) vs. 8.1 (SD: 5.9); p=0.0189] as compared to patients with no CINV with the first chemotherapy administration. Unadjusted subsequent CINV rate was higher for patients with first chemotherapy administration CINV (33.8% vs. 17.0%; p=0.0005) as compared to patients without a CINV event during first chemotherapy administration. After controlling for differences in covariates, patients with first chemotherapy administration CINV were 2.8 times more likely to have a subsequent CINV compared to patients without a first chemotherapy administration CINV [Odds Ratio (OR): 2.84 (95% CI: 1.63 – 4.96); p=0.0002]. Conclusion: In this retrospective analysis using merged electronic medical records data, patients with hematologic malignancies receiving single-day chemotherapy who had a first chemotherapy administration CINV event were at increased risk of a subsequent CINV event versus those without a CINV event during the first chemotherapy administration. Disclosures: Jackson: Xcenda: Xcenda received funding to conduct the study. Jain:Xcenda: Xcenda received funding to conduct the study. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc: Employment.

scholarly journals 58 Overweight and obesity in children with autism spectrum disorder: Findings from primary care electronic medical records

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e24-e24
Author(s):  
Laura M Kinlin ◽  
Sarah Carsley ◽  
Charles Keown-Stoneman ◽  
Natasha Saunders ◽  
Karen Tu ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Weight Status ◽  
Severe Obesity ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Overweight And Obesity ◽  
Typically Developing ◽  
Increased Risk

Abstract Introduction/Background Paediatric overweight and obesity are important public health problems worldwide. Children with autism spectrum disorder (ASD) may be at increased risk compared to their typically-developing peers; however, prevalence estimates in ASD have varied widely and existing studies have largely been limited by use of an external comparison group. Objectives To compare prevalence of overweight and obesity in children and youth (<19 years of age) with and without ASD, using electronic medical record data from paediatric primary care visits. Design/Methods This was a cross-sectional analysis of EMRPC (Electronic Medical Records Primary Care) data, representing 385 family physicians in 43 clinics in Ontario, Canada. Age- and sex-standardized body mass index (BMI) z-scores were calculated using abstracted heights and weights from the most recent visit between January 2011 and December 2015. Weight status was determined using World Health Organization growth reference standards. ASD was defined using a previously-validated algorithm in EMRPC, based on an ASD-related term in the ‘Cumulative Patient Profile.’ Chi-square test statistics and multinomial logistic regression were used to compare weight status of those with and without ASD. Results In total, 44,625 children and youth were included, 632 [1.42%] with ASD. Distribution of weight status was significantly different between those with and without ASD (p<0.001) [Table 1]. Compared to their typically-developing peers, children with ASD had significantly higher odds of overweight (unadjusted odds ratio [OR] 1.52; 95% confidence interval [CI] 1.24-1.87), obesity (unadjusted OR 2.55 (2.00-3.26) and severe obesity (unadjusted OR 3.09; 95% CI 2.08-4.60); these associations persisted after adjusting for sex, age, neighborhood income quintile and rural residence (Table 2). Conclusion Data from a large primary care database suggest that children with ASD are at substantially increased risk of overweight, obesity and severe obesity. Findings support the need for anticipatory guidance, prevention and management strategies specific to this clinical population. Future work will aim to better understand at what age differences in weight status emerge, and what nutritional, behavioural, or medical factors differentially affect weight status in the ASD population.

scholarly journals Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients

QJM ◽  
2020 ◽  
Author(s):  
E Itelman ◽  
A Segev ◽  
L Ahmead ◽  
E Leibowitz ◽  
M Agbaria ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Cohort Analysis ◽  
Surrogate Marker ◽  
Tertiary Hospital ◽  
Big Data Analysis ◽  
Hospitalized Patients ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Overall Mortality

Summary Background Sarcopenia and frailty influence clinical patients’ outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. Aim We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. Design This was a retrospective cohort analysis. Methods We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients’ data were retrieved from their electronic medical records. Results The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT < 10 IU/l in the whole cohort (14.3% vs. 10.4%, P < 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P < 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P < 0.001 and 4.3% vs. 3.2%, P < 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels < 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13–1.29, P < 0.001). Conclusions Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.

Palonosetron Versus Other 5-HT3-Receptor Antagonists for the Prevention of Chemotherapy Induced Nausea and Vomiting In Patients with Hematologic Malignancies Treated In A Hospital Outpatient Setting

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2567-2567
Author(s):  
Chris Craver ◽  
Julie Gayle ◽  
Sanjeev Balu ◽  
Deborah Buchner
Keyword(s):  
Index Date ◽  
Hematologic Malignancies ◽  
Outpatient Setting ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Highly Emetogenic Chemotherapy ◽  
Hospital Outpatient ◽  
Group 2 ◽  
Group 1

Abstract Abstract 2567 Objective: This analysis explored the risk of uncontrolled chemotherapy induced nausea and vomiting (CINV) associated with initiation of palonosetron versus other 5-hydroxy tryptamine3-receptor antagonists (5-HT3-RAs) among patients with leukemia and/or lymphoma receiving chemotherapy (CT) [highly emetogenic chemotherapy, moderately emetogenic chemotherapy, low emetogenic chemotherapy, or minimal emetogenic chemotherapy] treatment in a hospital outpatient setting. Methods: Patients diagnosed with any leukemia and/or lymphoma [identified through appropriate International Classification of Diseases, Clinical Modification, 9th Revision codes (ICD-9-CM)] initiating any CT and anti-emetic prophylaxis with palonosetron (Group 1) or other 5-HT3-RAs (Group 2) for the first time (index date) between April 1, 2007 and March 31, 2009 were identified from the Premier Perspective comparative research database. Other inclusion criteria were patients aged ≥ 18 years, no prior evidence of nausea and vomiting or a hospital charge for a CT or anti-emetic medication in the 6-month pre-index date period, and at least one CINV event in the post-index date follow-up study period. Patients also needed to have at least 36 consecutive months of hospital data submissions. Patients were followed through eight CT cycles or six months post index date, whichever occurred first. The unit of analysis was a CT cycle. Group 1 and Group 2 patients were matched on type of CT, specific CT cycle, and leukemia/lymphoma diagnosis using propensity scoring. A negative binomial distribution generalized linear multivariate regression model estimating the number of CINV events (identified through either ICD-9-CM codes for nausea and/or vomiting and volume depletion or CINV-related rescue medications one day after CT administration) in the follow-up period between the matched groups was developed after adjusting for other significant differences in demographic and clinical variables at index date (baseline) including age, gender, patient weight, payor type, patient race, CT cycle duration, and CT duration in days. Results: Of 1,256 identified patients, 234 initiated with palonosetron (Group 1; 18.6%). Group 1 patients were significantly younger [60.8 (SD: 17.9) vs. 64.4 (14.8) years; p=0.0045], comprised more females [49.6% vs. 43.2%; p<0.0001], received more emetogenic CT (high and moderate) [88.5% vs. 77.1%; p<0.0001], and less African Americans [9.4% vs. 12.7%]. Group 1 also had a lower percentage of patients with leukemia [9.0% vs. 17.6%; p<0.0001], and more patients with lymphoma [82.5% vs. 63.1%; p<0.0001]. In the follow-up period, the unadjusted number of CINV events per patient per CT cycle for Group1 patients was significantly lower versus Group 2 patients (3.4 vs. 4.3 CINV events per patient per CT cycle; p<0.0001). The regression model predicted a 32% reduction in the total CINV events per patient per CT cycle for Group 1 patients versus Group 2 patients; p=0.0003. Other significant variable results from the model included patients aged < 65 years had a 39.9% lower risk of total CINV events per patient per CT cycle versus patients aged ≥ 65 years; p=0.0009 and commercially insured patients had a 44.2% lower risk of total CINV events per patient per CT cycle versus traditional Medicare patients; p=0.0003. Conclusion: In this hospital outpatient retrospective database analysis, patients with hematologic malignancies initiated and maintained on palonosetron were more likely to experience a significantly lower rate of CINV events per patient per CT cycle versus those initiated on other 5-HT3-RAs. Disclosures: Craver: Eisai, Inc.: Research Funding. Gayle:Eisai, Inc.: Research Funding. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc.: Employment. Off Label Use: The study was on hematology patients on all chemotherapy types (high, moderate, low, and minimal) even though the drug (palonosetron) is approved for highly emetogenic chemotherapy and moderately emetogenic chemotherapy in the United States.

Erythropoiesis stimulating agent (ESA) administration at Hb <10 g/dL for chemotherapy-induced anemia (CIA) following the National Coverage Decision (NCD)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20627-e20627
Author(s):  
S. A. Hulnick ◽  
G. Hess ◽  
J. Hill ◽  
H. N. Viswanathan ◽  
R. J. Nordyke
Keyword(s):  
Retrospective Analysis ◽  
Cancer Patients ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Coverage Decision ◽  
Medicare Coverage

e20627 Background: Medicare coverage of ESA treatment for CIA was changed in 7/07 to a hemoglobin (Hb) < 10 g/dL prior to administration. We describe the proportion of ESA administrations at Hb < 10 g/dL over four quarters following the NCD. Methods: A retrospective analysis of ESA administrations from 7/07 - 6/08 using Varian and Impac electronic medical records for 304,654 cancer patients from 91 practice sites across 19 states. Episodes of ESA treatment were identified within chemotherapy episodes. A > 42 day gap in ESA use identified a completed ESA episode and a > 90 day gap in chemotherapy identified a chemotherapy episode. Hb ≤ 7 days prior to ESA administration date was identified for each ESA episode. The percent of ESA administrations at Hb < 10 g/dL was measured from Q3 07 to Q2 08 for darbepoetin alfa (DA) and epoetin alfa (EA) stratified by age. Results: For patients age ≥ 65, the percent of ESAs administered at Hb < 10 g/dL increased from Q3 07 to Q2 08 for initial and maintenance administrations. A less pronounced trend was observed in patients age < 65. Maintenance administrations at Hb < 10 g/dL in patients age < 65 were significantly lower for EA vs. DA. Conclusions: ESA administrations have been increasingly administered at Hb < 10 g/dL. A higher proportion of Medicare-eligible patients received maintenance ESA administrations at Hb < 10 g/dL. [Table: see text] [Table: see text]

scholarly journals Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038013
Author(s):  
Braden O’Neill ◽  
Sumeet Kalia ◽  
Babak Aliarzadeh ◽  
Frank Sullivan ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Increased Risk

ObjectivesIn order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.DesignRetrospective cohort study.SettingEMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.Participants197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.Primary and secondary outcome measuresDocumentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).ResultsDocumentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70–75 vs 45–49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3–5 visits=1.53, 95% CI 1.46 to 1.60).ConclusionsDocumentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.

scholarly journals Impact of Postplacement Adjustment of Peripherally Inserted Central Catheters on the Risk of Bloodstream Infection and Venous Thrombus Formation

2013 ◽  
Vol 34 (8) ◽  
pp. 785-792 ◽  
Author(s):  
Sanjiv M. Baxi ◽  
Emily K. Shuman ◽  
Christy A. Scipione ◽  
Benrong Chen ◽  
Aditi Sharma ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Thrombus Formation ◽  
Central Line ◽  
University Of Michigan ◽  
Venous Thrombus ◽  
System A ◽  
Increased Risk ◽  
Central Catheters

Objective.Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment.Design.Retrospective cohort study.Setting.University of Michigan Health System, a large referral hospital.Patients.Patients who had PICCs placed between February 2007 and August 2007.Methods.The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records.Results.There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P = .04), whereas 2 or 3 or more adjustments had no association with CLABSI (P = .58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P = .59, .85, and .78, respectively). Immunosuppression (P< .01), power-injectable PICCs (P = .05), and 3 PICC lumens compared with 1 lumen (P = .02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P = .03).Conclusions.Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT. Infect Control Hosp Epidemiol 2013;34(8):785-792

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