Patients’ Knowledge Of Anticoagulation and Its Association With Clinical Characteristics, INR Control and Warfarin-Related Adverse Events

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1738-1738 ◽  
Author(s):  
Poupak Rahmani ◽  
Charlotte L. Guzman ◽  
Mark D Blostein ◽  
Ashley Tabah ◽  
Alla Muladzanov ◽  
...  
Keyword(s):  
Adverse Events ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
Mechanical Heart Valve ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Bleeding Events ◽  
Chi Square ◽  
Level Of Knowledge ◽  
One Year

Abstract Background Whether level of knowledge of anticoagulation (AC) among patients on warfarin plays a role in maintenance of therapeutic INR or in warfarin-related adverse events is controversial. Most studies conducted on this subject had small patient sample sizes and did not use validated questionnaires to assess patients’ knowledge of AC. Objectives To use the validated Oral Anticoagulation Knowledge (OAK) test (Zeolla MM, 2006) to assess knowledge of AC among patients attending a busy AC clinic, and to examine associations between level of knowledge, INR control and adverse events. We hypothesized that patients with higher OAK test scores (i.e. greater knowledge) would have better INR control (primary outcome) and fewer bleeding and thrombosis events (secondary outcomes). Methods Consecutive patients who had been followed in our AC clinic (tertiary care, university-affiliated hospital, 20,000 patient-visits per year) for at least one year and consented to participate were asked to complete the OAK test. The OAK test is a 20-question multiple-choice questionnaire that assesses patients’ knowledge of warfarin AC. A passing score is ≥15 correct responses. Patient charts were reviewed to obtain data on clinical and demographic characteristics, and information on INR values and any thrombosis or bleeding events during the preceding 1 year period. Associations between OAK scores and patient characteristics, INR control and bleeding/thrombosis events were assessed by chi-square and t-tests, as appropriate. Results Among 252 patients screened for participation, 225 met the inclusion criteria and completed the OAK test. Mean (SD) age was 70 (13.4) years, 53% were male and 75% were on warfarin for >3 years. Indications for AC were atrial fibrillation in 65%, VTE in 8%, mechanical heart valve in 10%, and other in 19%. The mean OAK score was 12/20, and 64% failed the OAK test. Predictors of a pass score on the OAK test were younger age (p= 0.01) and higher level of education (p=0.03). Over the preceding year, 57.3% of INRs were therapeutic, 25.1% subtherapeutic and 17.4% supratherapeutic, and there were 22 bleeding events and 5 thrombosis events. There was no association between OAK score and INR control, or OAK score and bleeding or thrombosis events. Conclusion To our knowledge, this is the first study to use the validated OAK test to assess patients’ AC knowledge. We found that younger and more educated patients were more likely to pass the OAK test; however, OAK test result did not predict INR control or occurrence of bleeding or thrombotic events. The OAK test may not be sensitive enough to capture the standard of care practiced in different anticoagulation clinics (e.g. differences in teaching material, frequency of INR checks in stable patients). Also, for some patients, AC knowledge among their caretakers may be more important than self-knowledge. Further research is needed to assess the relationship between AC knowledge, INR control and adverse clinical outcomes. Disclosures: No relevant conflicts of interest to declare.

PS01.054: GASTROESOPHAGEAL REFLUX DISEASE PHENOTYPES IN THE MODERN ERA: CLINICAL, ENDOSCOPIC, MANOMETRIC AND PH TESTING PROPERTIES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 65-65
Author(s):  
Patrick Hoversten ◽  
David Katzka ◽  
Magnus Halland
Keyword(s):  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Care Center ◽  
Tertiary Care ◽  
Acid Group ◽  
Esophageal Physiology ◽  
Patient Groups ◽  
Endoscopic Characteristics ◽  
One Year ◽  
Modern Era

Abstract Background Reflux phenotypes have classically been divided into supine, upright, and bipositional predominant reflux. Recent data on clinical, endoscopic, and manometric features in these patient groups are scant and most prior reports occurred prior to the advent of high resolution impedance manometry and prolonged wireless pH monitoring. We aimed to evaluate the distribution, demographic, manometric, and endoscopic characteristics of the reflux phenotypes in this modern era of testing. Methods Patients who had esophageal physiology testing at a single tertiary care center over a one year period were retrospectively reviewed for demographic, clinical, endoscopic, manometric and pH impedance data. We included consecutive patients who had undergone pH-impedance or wireless pH testing with an EGD within 6 months. Results 139 patients were included and 91 (65.5%) patients were women was mean age of 51.9 + /- 15.2 years and mean BMI of 29.1 + /- 6.4. The most common reflux pattern was bipositional (46% of patients), followed by supine (25%). Baseline characteristics, endoscopic and manometric data across groups are included in Table 1. Barrett's esophagus was most common in the non-acid group. Endoscopically, esophagitis was most common in the supine and bipositional groups. Manometric findings were similar across groups. Conclusion The epidemiology of GERD patients appears to be changing as evidenced by a higher mean BMI than in the largest prior study from 1999. Despite demographic changes in GERD and more widespread use of advanced esophageal physiology testing, the manometric and endoscopic characteristics of GERD phenotypes remains fairly similar. Disclosure All authors have declared no conflicts of interest.

Platelet Usage Trends-Could It Be Less?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4343-4343
Author(s):  
Ulker Kocak ◽  
Fatma Burcu Belen ◽  
Arzu Okur ◽  
Ferit Kulali ◽  
Odul Egritas ◽  
...  
Keyword(s):  
Platelet Count ◽  
Platelet Transfusion ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
Transfusion Practice ◽  
Care Hospital ◽  
Platelet Concentrates ◽  
Single Donor ◽  
Life Saving ◽  
One Year

Abstract Abstract 4343 Thrombocytopenia as a risk factor for major bleeding is a life threatening complication of critical disease situations. Prophylactic or therapeutic platelet transfusions are widely used for hemorrhagic problems. The aim of this study was to find out the indications, the threshold for platelet transfusion for the pediatric patients in a tertiary care hospital throughout one year to determine the optimal platelet transfusion practice. The study was conducted upon the records of the hospital's blood bank and the files of the patients were retrospectively reviewed. A total of 378 platelet units were used in 104 patients with an age range of 0–18 years. The majority (48.1 %) of the transfusions were in mainly leukemia patients in the hematology department. Transfusions per patient were higher in hematology (mean 4.8 ± 7.4 transfusions) and neonatology (mean 4.8 ± 7.6 transfusions) (p > 0.05) departments. 256 (67.7 %) of the transfusions were single donor apheresis whereas 122 (32.3 %) were random donor platelet products. About 1/3 of the apheresis products were given when the platelet count was below 10 × 109/L and 1/3 were given when the platelet count was between 10–20 × 109/L. 118 (31.2 %) of the transfusions were used for prophylaxis in hematology and oncology departments when the platelet levels were below 10×109/L (mean platelet count of 9.8 ± 7.7 × 109/L and 8.8 ± 5.2 × 109/L). These levels are lower than other departments (p < 0.001). 59 % of the apheresis units were preferred for therapeutic reasons. The highest platelet levels were observed when platelet concentrates were used for treatment of bleeding or prior to any procedure (Table 1). Platelet usage shows a discrepancy between the departments of pediatrics. Hematology and oncology patients were the major consumers of the platelet concentrates. Although it is known that when given in appropriate dosage no difference was observed between the platelet concentrates in terms of increasing the platelet counts, there was a tendency for using apheresis products which are the most expensive (188.61 dollars) among all. This practice could be abandoned by continuous education. Besides the guidelines should be reviewed periodically to remind the physicians the dilemma of transfusion; life saving on one hand and the risks on the other. Disclosures: No relevant conflicts of interest to declare.

Outcomes Of Relapse Of AML Post Allogeneic Transplantation In The Era Of Hypomethylating Agents: An Analysis Of 162 Allogeneic Transplants From a Single Center

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2086-2086
Author(s):  
Justin LaPorte ◽  
Xu Zhang ◽  
Zaamin Hussain ◽  
Stacey Brown ◽  
Connie A. Sizemore ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Patient Characteristics ◽  
Hypomethylating Agents ◽  
Term Survival ◽  
Long Term Outcome ◽  
Post Transplant ◽  
Hypomethylating Agent ◽  
One Year ◽  
Relapse Therapy

Abstract Allogeneic hematopoietic cell transplantation (allo-HCT) can be curative in many patients with intermediate and high risk AML. However, post-transplant relapse remains an important cause of treatment failure. Patients with AML who relapse post allo-HCT typically have a dismal prognosis with limited therapeutic options. Hypomethylating agents alone are increasingly being used to treat AML in patients who are elderly or otherwise unfit for chemotherapy. They may also be used for maintenance/consolidation following induction chemotherapy. The activity and minimal toxicity associated with hypomethylating agents makes them potentially useful in the management of AML patients who relapse following allo-HCT. However, their use in this setting has not been well studied. We assessed one hundred and sixty two consecutive patients who underwent a first allo-HCT for AML at our center during a period when hypomethylating agent therapy was widely available (February 2005 through May 2013). Patient characteristics were: median age, 53 (range18-74); M=75, F=87; donor-matched-sibling (MRD) =59, matched-unrelated (MUD) =67, HLA-haploidentical (Haplo) =36; ablative conditioning=98, RICT/NST=64; PBSC=142, BM=20; CIBMTR risk category- high=53, intermediate=28, low=74, unknown=7. Post-relapse therapy was determined by the attending physician and patient preference. Patient characteristics, post-relapse therapy, GVHD and survival were prospectively collected as part of our comprehensive HCT database. With a median follow-up for surviving patients of 22.4 months, relapse of AML post-allo-HCT was experienced by fifty-five patients (22 MRD, 24 MUD, 9 Haplo; cytogenetic risk 23 poor, 31 intermediate, 1 unknown) at a median of 113 days (range 25-1106) post-transplant. Thirty-four patients (62%) were treated with a hypomethylating agent post-relapse (17 azacitidine, 10 decitabine, 7 both) (12 hypomethylating agent alone, 11 combined with chemotherapy, 11 sequentially with chemotherapy). Median number of cycles of hypomethylating agent therapy was 2 (range 1-9). Of the 23 patients that received at least 2 cycles of hypomethylating agents, 14 achieved CR or CRi. Donor lymphocyte infusions (DLI) were administered in 15 of the 55 relapsed patients and 16 patients received a second allo-HCT. Estimated Kaplan-Meier probability of post-relapse survival (PRS) at 6, 12 and 24 months post-relapse for all patients was 53%, 36% and 19% and was not significantly different for patients who developed any versus no GVHD following post-relapse therapy. However, PRS at 6 and 12 months was 62% (95% CI 43-76%) and 38% (95% CI 22-54%) in patients who received hypomethylating agent therapy post-relapse versus 38% (95% CI 18-58%) and 33% (95% CI 15-53%) in patients who did not (p=0.063 Gehan’s test). PRS was not different between the two groups at 24 months. Survival > 1 year post relapse was achieved in 19 of 55 relapsing patients (35%). Of these patients, 9 received a second allo-HCT, 9 received DLI and 12 were treated with a hypomethylating agent. At the time of writing 6 patients are alive and in complete remission at a median of 49 months (10-72) following relapse. Of the 6 patients (5 MRD, 1 MUD; cytogenetic risk 2 poor, 4 intermediate), 4 received hypomethylating agents, 3 received a second transplant, 1 received DLI, and 4 have active GVHD. These data demonstrate that relapse post allo-HCT remains a major obstacle to long-term survival in patients transplanted for AML. Hypomethylating agents can be used in the majority of relapsed patients in this setting and appear effective in inducing responses. The use of hypomethylating agents may be associated with a prolongation of early post-relapse survival although it does not appear to increase survival beyond one year post-relapse. Survival beyond one year post-relapse can be achieved even without a second allogeneic transplant, but is only achieved in a minority of relapsing patients. Combination of therapy with hypomethylating agents and novel agents may be necessary to impact long-term outcome. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Diagnostic dermoscopic features and the correlation between dermoscopic and histopathologic features in lichen planus

2020 ◽  
Vol 6 (5) ◽  
pp. 637
Author(s):  
Sherin Jose ◽  
George Kurien
Keyword(s):  
Lichen Planus ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Care Hospital ◽  
Chi Square ◽  
Non Invasive ◽  
Kappa Value ◽  
Chi Square Test ◽  
One Year ◽  
Histopathologic Features

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">Lichen planus (LP) is an autoimmune dermatosis characterized by pruritic violaceous flat-topped polygonal papules predominantly over the extremities but can also affect trunk, mucosa, scalp, palms, soles and nails. Dermoscopy is a novel non-invasive imaging modality and the presence of salient dermoscopic features will help to obviate the need for skin biopsies in many doubtful cases.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong><span lang="EN-US">This was a descriptive study of 108 cases of classical lichen planus cases conducted at a tertiary care hospital in South India over a period of one year. Dermoscopic examination of the LP lesions were carried out using DermLite DL3N and histopathological samples were analyzed in 35 cases.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">The dermoscopic features were blue globules in 100%, Wickham’s striae in 92.6% and comedo like openings in 49.1%. Vascular patterns were noted only in 13%. On correlating Wickham’s striae in dermoscopy with wedge shaped hyper granulosis on histopathology using the chi-square test we found agreement (kappa value 0.242). We also found that dermoscopy was 93.75% sensitive and 33.33% specific regarding Wickham’s striae in relation to wedge shaped hyper granulosis. In 85% of cases blue globules were present dermoscopically and dermal melanophages were found histopathologically.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong><span lang="EN-US">Wickham’s striae can be considered as a diagnostic dermoscopic finding in lichen planus whereas findings like bluish pigmentation and vascular structures depended on the skin colour of the patient. We also found agreement between dermoscopic and histopathologic features namely Wickham’s striae with wedge shaped hyper granulosis and blue globules with dermal melanophages.<strong></strong></span></p>

scholarly journals Patient Feedback on Pharmacist Prescribing for Minor Ailments in a Canadian Province

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Jeff G Taylor ◽  
Kerry Mansell
Keyword(s):  
Online Survey ◽  
Conflicts Of Interest ◽  
Standard Of Care ◽  
Original Research ◽  
Minor Ailment ◽  
Minor Ailments ◽  
Financial Interests ◽  
Canadian Provinces ◽  
One Year ◽  
A Minor

Background: Pharmacists have been given authority in many Canadian provinces to go beyond simply recommending over-the-counter medicines to patients with minor ailments. In Saskatchewan, they can prescribe medicines normally under the sole control of physicians for 17 conditions. An evaluation program is underway to assess the value of the program. Methods: Adults were recruited over a one-year period and were eligible for inclusion if prescribed an agent for an applicable condition. Pharmacists from 40 pharmacies participated in identifying people who received the service. Of patients agreeing to participate, a link to an online survey was provided. The survey included items on clinical improvement, care options, and patient confidence in knowing when to seek a physician for a minor ailment. Results: Forty-eight people were involved in prescribing encounters, with the majority seeking help for themselves. All but one saw their symptoms improve subsequent to pharmacist assistance, most often to a significant extent. Satisfaction with the service was high. Convenience and trust in pharmacists were primary reasons for choosing the service over medical care (rather than an issue potentially more worrisome such as not having a family physician). Had this service not been in place, 30.6% of those asking for help would have gone to a medical clinic or emergency room. Seventy-five percent were (at least) very confident in knowing when to seek a physician (rather than a pharmacist) for such conditions. Conclusion: Information on the clinical outcomes of pharmacist-led minor ailment care is starting to accrue in Saskatchewan. While the numbers are extremely low to date, what has become available suggests the service is of value to the citizens of the province, it is chosen for appropriate reasons, and is of an acceptable standard of care. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. However, the authors are pharmacists licensed within the province and bring this perspective to this evaluation of a pharmacy-based program.   Type: Original Research

Abstract T P197: Early Improvement In NIHSS Is Common During Inter-hospital Transfer And Is Associated With Lower In-hospital Mortality

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Khawja A Siddiqui ◽  
Abigail S Cohen ◽  
Syed F Ali ◽  
Lee H Schwamm
Keyword(s):  
Tertiary Care ◽  
Patient Characteristics ◽  
Stroke Severity ◽  
Inhospital Mortality ◽  
Chi Square ◽  
Altered Level ◽  
Early Improvement ◽  
Stroke Registry ◽  
Interhospital Transfer ◽  
Number Of Patients

Introduction: A significant number of patients are transferred from outside referral hospitals (OSH) to larger tertiary care centers for specialized care or post-tPA management. As efforts to risk adjust stroke mortality and patient outcomes increase, better understanding of early changes in stroke severity are needed, especially changes in stroke severity that occur during interhospital transfer. We evaluated the percentage of patients with significant early improvement after transfer and associated patient characteristics and outcomes. Method: Using our Get with the Guidelines-Stroke registry, we identified 302 acute ischemic stroke transfer patients with documented initial NIHSS at the OSH from 12/10 - 12/13. Patients with early improvement after interhospital transfer (≥ 4 points improvement in NIHSS between initial NIHSS at receiving hospital minus initial at OSH) were compared to those without (< 4 points improvement or worsening). Baseline clinical characteristics, tPA treatment and outcomes were compared with Chi-square test and student's t-test. Results: There were 76/302 (25.2%) patients with ≥ 4 points improvement in NIHSS. Compared to those without early improvement, those with early improvement were less likely to have history of hyperlipidemia and carotid stenosis, presented with altered level of consciousness less often, and had higher median initial NIHSS at OSH. They had substantially lower inhospital mortality (3.9% vs. 12.4%). Discussion: Early improvement in stroke severity during interhospital transfer is common, and is not confined to patients receiving thrombolysis. These early improvement patients have very low mortality, and it is substantially lower than in those without early improvement, despite higher initial NIHSS. This has important implications for assessing the safety and efficacy of drip and ship thrombolysis or other pre-transfer interventions. Further research is warranted.

Treatment Trade-Offs in Myeloma: a Survey of Consecutive Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2059-2059
Author(s):  
Brian L. Burnette ◽  
Angela Dispenzieri ◽  
Shaji Kumar ◽  
Jeff Sloan ◽  
Jon Tilburt ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Financial Burden ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Maintenance Cost ◽  
Trade Offs ◽  
One Year ◽  
The Cost ◽  
First Time ◽  
Mild Toxicity

Abstract Abstract 2059 Introduction: Two randomized trials have demonstrated a benefit in progression free survival (PFS) of 18–20 mofor maintenance treatment with lenalidomide after auto-PBSCT for multiple myeloma (MM). Although results on survival benefit are conflicting and quality of life (QOL) data is lacking, some have begun to recommend maintenance. No study has evaluated patient perceptions of maintenance. We conducted a systematic survey of MM patients (pts) regarding what constitutes a meaningful benefit that would make burdens of maintenance (toxicity and cost) acceptable. Methods: We mailed a brief self-administered survey in 3 waves to 1159 consecutive living pts evaluated at Mayo Clinic. The survey provided background on the standard of care for MM in transplant eligible pts and data on maintenance. Pts were asked to estimate the magnitude of OS benefit that would be acceptable for varying degrees of toxicity and cost. Results: Of the 1159 surveys sent, 886 pts (83.2%) responded, including 150 notifying us of a decision not to participate. 736 pts returned a completed survey (66% raw response rate). (56%) male, 407 (55%) had undergone auto-PBSCT, 467 (63%) had discussed maintenance with a physician, and 9 (1%) pts had received no treatment. 10% of pts had MM for 3–12 mo, 14% for 1–2 yr, 13% for 2–3 yr, 20% for 3–5 yr, 44% for 5 yr or more. Pt age: 4% 18–49 yr, 24% 50–59 yr, 40% 60–69 yr, 27% 70–79 yr, and 6% >80 yrs. The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of pts, cytopenias by 24%, LE DVT 20%, fatigue 15%, nausea 8%, diarrhea/constipation 7%. In response to a question about whether they would choose maintenance if there was a PFS benefit but no improvement in OS, 92% would opt for maintenance if it were known to cause mild toxicity, while 77% would opt for maintenance despite moderate toxicity. Subsequent questions included cost and toxicity considerations and required pts to identify minimum acceptable duration of OS benefit to estimate more precisely a meaningful clinical benefit. If treatment was free, had no toxicity, and the OS benefit was 1 yr or less, 49% would choose maintenance (see Figure). In the same scenario, if toxicities were mild, the proportion of pts who choose maintenance was similar (46%). If pts experienced moderate toxicity, 42% choose maintenance. With rising financial burden (out-of-pocket) and toxicity, the proportion of pts who choose maintenance declined (see Table). For example, if the cost was $25/mo, mild toxicity experienced, and the OS benefit was one year or less, 46% would choose maintenance, while 39% of pts would choose maintenance if it cost $250/month and there was moderate toxicity. If maintenance cost $10,000/mo and was associated with mild or moderate toxicity, 18% and 17% of pts would choose treatment, respectively. Conclusions: For the first time, we have described the broad range of patient perspectives regarding trade-offs in the treatment of MM with maintenance therapy. We found that willingness to be treated with maintenance declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The discrepancy between the 92% of pts choosing to undergo maintenance if free and mild toxicity when there is a PFS benefit but no OS benefit, compared to 49% of pts choosing maintenance if free, mild toxicity, and associated with an OS benefit of 1 yror less; suggests pts have difficulty understanding the concept of PFS. We also found that the magnitude of benefit required to consider maintenance was affected by cost and toxicity. In our experience, pts typically incur a cost of approximately $25/mo and experience mild toxicity. In this study, nearly half (46%) of such pts would opt for maintenance if the OS benefit was 1 year or less while only 33% of pts would opt for maintenance if the OS benefit was 6 months or less. Our data implies that good care in MM requires detailed conversations about each and every patient's priorities and expectations prior to making recommendations for or against such treatments. Disclosures: No relevant conflicts of interest to declare.

Presenting symptoms and patient prognosticators in neoplastic meningitis: A single institution experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13593-e13593
Author(s):  
Shilpa Ghatnekar ◽  
Hilal Hachem ◽  
Rima Patel ◽  
Richard Dowd ◽  
Amandeep Godara ◽  
...  
Keyword(s):  
Karnofsky Performance Status ◽  
Performance Status ◽  
Patient Characteristics ◽  
Neoplastic Meningitis ◽  
Single Institution ◽  
Primary Malignancy ◽  
Chi Square ◽  
Presenting Symptoms ◽  
The Difference ◽  
One Year

e13593 Background: Neoplastic meningitis (NM) occurs in 5-15% of cancer patients, with less than 15% surviving one year. Untreated, median survival is estimated at 1.5-2 months. The purpose of this study is to identify the presenting symptoms of NM disease and the patient characteristics which are prognostic of overall survival (OS). Methods: We performed a single-institution retrospective analysis of 123 patients diagnosed with NM disease at TMC between January 2006 and January 2016. Patients were identified via cytopathology and radiology. Patient data was obtained from the hospital electronic medical record. Survival analysis was generated using Kaplan-Meier methods and chi square tests for categorical data. Results: Breast cancer was the most common primary malignancy (22%, n = 27), followed by lymphoma (19%, n = 23), and lung cancer (15%, n = 18). The most common presenting symptoms were headache (33%, n = 41), extremity weakness (33%, n = 41), and gait abnormalities (25%, n = 31). Median age and Karnofsky performance status (KPS) at diagnosis were 56 years [18-93] and 58 [10-100], respectively. Median OS was 4.08 months [0-130], with a 23% one-year survival rate. Higher KPS was associated with a significantly improved OS (p < 0.05). Although survival was worse in the age group > 67 yrs compared to < 45 yrs the difference was not significant (p = 0.053, 95% CI (0.994- 2.944)). Conclusions: To our knowledge, this is one of the largest analyses of patient characteristics and outcomes in NM. Results show that KPS, when adjusted for confounders, is an important prognostic biomarker. In contrast to other studies, age was not a significant prognosticator of survival. Headaches combined with extremity weakness were the most common presenting symptoms of NM disease. When present together in the cancer patient, the treating physician should strongly consider further workup for the presence of NM disease.

scholarly journals A single institution’s experience with using dabigatran, rivaroxaban and warfarin for prevention of thromboembolism in atrial fibrillation

2017 ◽  
Vol 27 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Li Xin Chan ◽  
Yee May Wong ◽  
Pow-Li Chia ◽  
Zhen Liang Kek
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Oral Anticoagulants ◽  
Tertiary Hospital ◽  
Minor Bleeding ◽  
Systemic Embolism ◽  
Bleeding Events ◽  
Warfarin Group ◽  
One Year

Background: Although non-vitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in atrial fibrillation (AF) patients, their use in the local clinical setting has not been well studied. This study aims to evaluate the clinical outcomes of dabigatran, rivaroxaban and warfarin in a tertiary hospital in Singapore. Methods: This is a retrospective cohort study with one-year follow-up. A total of 383 patients recruited between June 2011 and December 2014 were studied. Incidents of stroke, systemic embolism and clinically relevant bleeding events were compared between dabigatran, rivaroxaban and warfarin. Results: Stroke rates were 5.47% per year with warfarin, 7.27% per year with dabigatran (HR=1.32; 95% CI 0.48−3.64; p=0.591) and 2.76% per year with rivaroxaban (HR=0.49; 95% CI 0.14−1.69; p=0.261). The warfarin group had significantly higher incidence of minor bleeding (62.4% vs 3.64% for dabigatran vs 13.79% for rivaroxaban; p<0.001), major bleeding (3.91% for warfarin, 0.91% for dabigatran, 0% for rivaroxaban; p=0.028) and other adverse events (51.18% for warfarin, 3.64% for dabigatran, 8.28% for rivaroxaban; p<0.001). Incidence of dyspepsia was higher in both NOAC groups compared to warfarin (0% for warfarin, 7.27% for dabigatran, 5.52% for rivaroxaban; p=0.003). Conclusion: Stroke and venous thromboembolism rates after one year were comparable among dabigatran, rivaroxaban and warfarin. Warfarin was associated with more bleeding and adverse events while both NOACs were associated with higher rates of dyspepsia. Further study is needed to assess the clinical benefit of NOACs in the Singaporean population.

Impact of Timing of Adjuvant Chemoradiation for Glioblastoma in a Large Hospital Database

Neurosurgery ◽  
2017 ◽  
Vol 83 (5) ◽  
pp. 915-921 ◽  
Author(s):  
Virginia W Osborn ◽  
Anna Lee ◽  
Elizabeth Garay ◽  
Joseph Safdieh ◽  
David Schreiber
Keyword(s):  
Cox Regression ◽  
Multivariable Analysis ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Rank Test ◽  
Time Interval ◽  
Chi Square ◽  
Large Hospital ◽  
Methyl Transferase ◽  
Exact Test

Abstract BACKGROUND Although the standard of care for glioblastoma remains maximal safe resection followed by chemoradiation, conflicting reports have emerged regarding the importance of the time interval between these 2 treatments. OBJECTIVE To assess whether differences in the duration between surgery and initiation of chemoradiation for glioblastoma had an impact on overall survival (OS) in a large hospital-based database. METHODS The National Cancer Database was queried to identify patients diagnosed with glioblastoma between 2010 and 2012 treated with surgery followed by chemoradiation. Patients who received biopsy only were excluded. The time from surgery to initiation of radiation therapy was divided into 4 equal quartiles of ≤24, 25 to 30, 31 to 37, and &gt;37 d. Patient characteristics were compared between groups using Pearson Chi Square and Fisher's Exact test. OS was analyzed via the Kaplan–Meier method and compared via the log-rank test. Univariable and multivariable Cox regression were performed to assess for impact of covariables on OS. RESULTS A total of 11 652 patients were included in the analysis. Median duration from surgery to radiation was 30 d. On multivariable regression, black race, larger tumor, gross-total resection, methyguanine-methyl transferase (MGMT+), and treatment at an academic facility were associated with a duration &gt;30 d. On multivariable analysis, there were no significant differences when comparing start within 24 d to 25 to 30 d (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.90-1.01, P = .13) or &gt; 37 d (HR 0.97, 95% CI 0.91-1.03, P = .26), although a small OS improvement was seen if initiated within 31 to 37 d (HR 0.93, 95% CI 0.88-0.99, P = .02). CONCLUSION There was no clear association between duration from surgery to initiation of chemoradiation on OS.

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