ESA use in women with cancer: Consequences of the 2008 FDA clinical alert.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5040-5040
Author(s):  
Kimberly M. Dickinson ◽  
Bachir Joseph Sakr
Keyword(s):  
Blood Transfusion ◽  
Blood Transfusions ◽  
Entire Study ◽  
Time Period ◽  
Increased Risk ◽  
Significant Difference ◽  
Study Population ◽  
Time Periods ◽  
One Year ◽  
First Time

5040 Background: Erythropoietin stimulating agents (ESA) are used clinically as an alternative to blood transfusions in cancer patients suffering from symptoms of anemia. However, more recent randomized controlled trials of ESA usage concluded that its use is associated with an increased risk of tumor progression and death. As a result, in July 2008 the FDA issued a clinical alert restricting the use of ESA. A reduction in the prescribing of ESA was immediately seen but changes in blood transfusion rates have not been examined. Methods: A retrospective chart review was conducted drawing from patients under treatment in the Program in Women’s Oncology at Women and Infant’s Hospital from one year before the clinical alert (August 2007-July 2008) to one year afterward (August 2008-July 2009). The primary outcomes were blood transfusion and ESA administration rates compared across the two time periods. Results: The study population (n=776) included patients with a cancer diagnosis who received chemotherapy during one or both time periods. 165 (21.3%) patients received ESA treatment. The total number of ESA treatments administered in the study period of interest was 1,277, with the majority (60%) given prior to the FDA alert. The mean number of ESA treatments in the first time period was 6.39 per person as compared to 0.61 per person in the second time period. Of the study population, 186 (23.8%) patients received at least one blood transfusion. A total of 463 blood transfusions were administered during the entire study period but a significant difference was not observed in the proportion of those delivered prior to the FDA alert (52%) versus after the FDA alert (48%). The average number of transfusions given in the first time period was 2.34 per person, as compared to 2.17 per person in the second period. Conclusions: Our results indicate that despite a steep decline in the use of ESA for chemotherapy-induced anemia, blood transfusion rates were not significantly different between the two periods. Interestingly, a slight downward trend was observed from before the FDA alert to after the alert. While more work is needed to understand the implications of these findings, it suggests that resource utilization did not increase despite the reduction in ESA use.

Perioperative Clopidogrel is Seven Days Enough?

2009 ◽  
Vol 75 (10) ◽  
pp. 909-913 ◽  
Author(s):  
Dejan Grujic ◽  
David Martin
Keyword(s):  
Blood Transfusion ◽  
Operating Room ◽  
Major Bleeding ◽  
Perioperative Period ◽  
Rate Of Return ◽  
Bleeding Complications ◽  
Blood Transfusions ◽  
Bleeding Events ◽  
Time Period ◽  
Significant Difference

Despite the prevalence of surgical candidates on clopidogrel, no definitive guidelines exist for stopping the drug preoperatively. A 7 day off-clopidogrel period is commonly considered safe with regards to bleeding complications. We sought to put the 7-day window to the test with regards to major bleeding events requiring either blood transfusions or return trips to the operating room. We collected data for patients taking clopidogrel in the perioperative period between 2005 and 2007 (n = 170). This data was then compared with the data of all of the patients undergoing surgery at our institution for the same time period (n = 34,480). Patients taking clopidogrel experienced a significantly higher rate of return trips to the operating room (6.5%) compared with nonclopidogrel patients (0.015%). Interestingly, we found no significant difference between those stopping clopidogrel more than 7 days preoperatively and those that did not (5% and 7.5%, respectively). There did not seem to be a significant difference in blood transfusion rates between the two clopidogrel groups. Patients on perioperative clopidogrel require reoperations for bleeding at a significantly higher rate compared with patients not taking clopidogrel. Discontinuing clopidogrel 7 days before surgery is not enough to negate this difference and these patients still experience a drastically higher rate of reoperations for bleeding.

scholarly journals Changes in Biomass of the Species Cupressus arizonica Affected by Zinc Metal

2016 ◽  
Vol 53 ◽  
pp. 53-56
Author(s):  
Seyed Armin Hashemi
Keyword(s):  
Metal Accumulation ◽  
Polluted Soils ◽  
Zinc Metal ◽  
Time Period ◽  
Time Periods ◽  
One Year ◽  
The One ◽  
Cupressus Arizonica ◽  
First Time ◽  
Growth Of Seedlings

The matter of soil pollution by heavy metals caused to increase of concerns about environment. The present study has been done by the aim of investigation on zinc metal accumulation onCupressus arizonica. To achieving this goal the one-yearCupressus arizonicaspecies seedlings were placed in vases. After the passage of each 55-day time periods from the growth of seedlings, the shoot, root and soil of seedlings were sampled. Results were studied using ANOVA test and Duncan test. The lowest concentration rate of zinc inCupressus arizonicaspecies organs in the first time period in the shoot and root was 5 g and 1.9 g, respectively and in the second time period in the shoot and root was 2 g and 1.6 g, respectively. Based on the researches,Cupressus arizonicaspecies appropriate for refining zinc metal polluted soils.

scholarly journals Antenatal magnesium sulfate treatment and risk of necrotizing enterocolitis in preterm infants born at less than 32 weeks of gestation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ji Young Hong ◽  
Jee Youn Hong ◽  
Yun-Sun Choi ◽  
Yoo-Min Kim ◽  
Ji-Hee Sung ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Necrotizing Enterocolitis ◽  
Retrospective Cohort ◽  
Treatment Protocol ◽  
Period 2 ◽  
Time Period ◽  
Increased Risk ◽  
Significant Difference ◽  
Study Population ◽  
Fetal Neuroprotection

AbstractAntenatal magnesium sulfate (MgSO4) treatment is widely used for fetal neuroprotection in women at risk of preterm delivery. However, some studies have recently suggested that in utero MgSO4 exposure is associated with an increased risk of necrotizing enterocolitis (NEC). This study aimed to investigate the association between antenatal MgSO4 treatment and risk of NEC. This retrospective cohort study included 756 infants born at 24–31 weeks’ gestation. Subjects were classified into three groups: period 1, when MgSO4 treatment protocol for fetal neuroprotection was not adopted (n = 267); period 2, when the protocol was adopted (n = 261); and period 3, when the protocol was withdrawn because of concern of risk of NEC (n = 228). Rates of NEC (≥ stage 2b) were analyzed according to time period and exposure to antenatal MgSO4. Significant difference in the rate of NEC was not found across the three time periods (2.6% vs. 6.5% vs. 4.8% in periods 1, 2 and 3, respectively, p = 0.103). The rate of NEC was comparable between the infants unexposed and exposed to antenatal MgSO4 (5.1% vs. 3.6%, p = 0.369). These results showed that antenatal MgSO4 treatment was not associated with risk of NEC in our study population.

scholarly journals 1533 The Effect of Hip Fracture Anatomy and The Modality of Surgery on Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Greenhalgh ◽  
B Gowers ◽  
K Iyengar ◽  
R Adam
Keyword(s):  
Hip Fracture ◽  
Blood Transfusion ◽  
Hip Fractures ◽  
Blood Transfusions ◽  
Intramedullary Nails ◽  
Subtrochanteric Fractures ◽  
Total Hip ◽  
Increased Risk ◽  
One Year ◽  
Hip Arthroplasties

Abstract Introduction Hip fractures are common, with most requiring surgical management. Blood loss occurs from the fracture and intraoperatively. Often, blood transfusions are required. Hip fractures can be classified by their anatomy: intracapsular, intertrochanteric or subtrochanteric fractures. This study assesses the effect of fracture pattern and operation performed on transfusion rates within our centre. We aim to identify the patients most likely to require transfusion early, to improve outcomes. Method A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from electronic patient records, the local transfusion laboratory, and the national hip fracture database. Results 324 hip fractures were divided into 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) of all patients received a blood transfusion. 28 (15%) of intracapsular, 42 (35%) of intertrochanteric and 5 (33%) of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality in the transfused cohort was 52% and 30.5% in non-transfused. Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an increased risk of mortality. Intertrochanteric fractures most commonly led to a transfusion. The operation most associated with transfusions were long intramedullary nailings, and total hip arthroplasties were the least.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

scholarly journals Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

2018 ◽  
Vol 7 (11) ◽  
pp. 425 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Francesco Virdis ◽  
A. Shapiro
Keyword(s):  
Liver Transplantation ◽  
Blood Transfusion ◽  
Graft Survival ◽  
Meta Analysis ◽  
Donation After Cardiac Death ◽  
Clinical Trial Registry ◽  
Increased Risk ◽  
Increasing Demand ◽  
One Year ◽  
The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

scholarly journals Pattern of Glucose Tolerance among Patients with Peripheral Spondyloarthritis

2020 ◽  
Vol 5 (9) ◽  
pp. 773-777
Author(s):  
A T M Tanveer Hasan ◽  
Al-Mamun .
Keyword(s):  
Diabetes Mellitus ◽  
General Population ◽  
Glucose Tolerance ◽  
Inflammatory Diseases ◽  
Age Groups ◽  
Oral Glucose ◽  
Increased Risk ◽  
Significant Difference ◽  
Study Population ◽  
Peripheral Spondyloarthritis

Peripheral spondyloarthritis is a variant of spondyloarthritis which usually has a chronic course. There is an increased risk of cardiovascular diseases among patients with chronic inflammatory diseases in general. Coexisting diabetes mellitus can potentially add to the risk. The objective of this study was to determine the frequency of glucose intolerance in patients with spondyloarthritis The study was conducted among 35 participants with peripheral spondyloarthritis who visited the Department of Rheumatology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from September, 2018 to January, 2020. The participants underwent either oral glucose tolerance test or estimation of HbA1C. The mean age of participants was 43.96 years. The majority (80%) of them were young to muddle-aged (≤40 years). 22.9% of the participants were prediabetic. Diabetes mellitus was found to be present in 37.1% of the participants. There was no significant difference between the study population and the general population in terms of frequency of prediabetes. But the frequency of diabetes in the study population was higher than that in the general population. There was no significant difference between males and females with regard to the frequencies of prediabetes and DM. Moreover, there was no significant difference in the frequencies of prediabetes and DM between young and middle-aged to elderly population. Considering the greater burden of DM among patients with peripheral spondyloarthritis across all age groups, routine screening for DM may be indicated in these individuals.

scholarly journals Incidence and risk factors of transfusion reactions in postpartum blood transfusions

2019 ◽  
Vol 3 (15) ◽  
pp. 2298-2306 ◽  
Author(s):  
Lars Thurn ◽  
Agneta Wikman ◽  
Magnus Westgren ◽  
Pelle G. Lindqvist
Keyword(s):  
Blood Transfusion ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adverse Reactions ◽  
Study Cohort ◽  
Blood Transfusions ◽  
Birth Registry ◽  
High Resource ◽  
Increased Risk ◽  
Transfusion Reactions

Abstract Postpartum hemorrhages with blood transfusions are increasing in many high-resource countries. Currently, up to 3% of all women receive blood transfusion postpartum. Most blood transfusions are safe and, in many cases, are lifesaving, but there are significant concerns about adverse reactions. Pregnancy is associated with higher levels of leukocyte antibodies and has a modulating effect on the immune system. Our objective was to investigate whether blood transfusions postpartum are accompanied by an increased risk for transfusion reactions (TRs) compared with transfusions given to nonpregnant women. We included all women who gave birth in Stockholm County, Sweden between 1990 and 2011. Data from the Swedish National Birth Registry were linked to the Stockholm Transfusion Database and included information on blood components administered and whether a TR occurred in women who received blood transfusions postpartum. Background controls were nonpregnant women who received blood transfusions during the study period. The study cohort consisted of 517 854 women. Of these, 12 183 (2.4%) received a blood transfusion. We identified 96 events involving a TR postpartum, giving a prevalence of 79 per 10 000 compared with 40 per 10 000 among nonpregnant women (odds ratio, 2.0; 95% confidence interval, 1.6-2.5). Preeclampsia was the single most important risk factor for TRs (odds ratio, 2.1; 95% confidence interval, 1.7-2.6). We conclude that special care should be taken when women with preeclampsia are considered for blood transfusion postpartum, because our findings indicate that pregnancy is associated with an increased risk for TRs.

scholarly journals Induction of labour and its feto-maternal outcome

2019 ◽  
Vol 8 (7) ◽  
pp. 2748
Author(s):  
Mridu Sinha ◽  
Shashi Bala Arya ◽  
Shashi Saxena ◽  
Nitant Sood
Keyword(s):  
Vaginal Delivery ◽  
Statistical Tests ◽  
Post Partum ◽  
Tertiary Care ◽  
Relative Effect ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Time Period ◽  
Increased Risk ◽  
One Year

Background: Induction of labour is an iatrogenic deliberate attempt to terminate the pregnancy in order to achieve vaginal delivery in cases of valid indication. It should be carefully supervised as it is a challenge to the clinician, mother and the fetus. Aim of this study was to find out common indications for IOL in a tertiary care teaching centre and its feto-maternal outcome.Methods: An institutional based retrospective observational study was conducted to describe the prevalence of labour induction and factors associated with its outcome, during the time-period of one year from January 2018 to December 2018, at SRMS IMS, Bareilly. Logistic regression analysis was employed to assess the relative effect of determinants and statistical tests were used to see the associations.Results: Most of the patients were primigravidas of younger age-group. Idiopathic oligohydramnios and postdatism were the commonest indications for induction of labour and Misoprost was the commonest drug used for it. Though majority had vaginal delivery, as the method was changed to combined method it was significantly associated with increased likelihood of LSCS. Similarly there was increased association with maternal cervico-vaginal tear / lacerations as the method was changed to combined type. However there were no association between post-partum hemorrhage, meconium stained liquor or fetal distress.Conclusions: Common indications for induction of labour were oligohydramnios and postdatism. Misoprost can be safely used for induction of labour without any increased risk for LSCS or any fetal / neonatal risks.

A Comparison of Funding Patterns in Professional Occupational Therapy Education Programs

1994 ◽  
Vol 14 (3) ◽  
pp. 157-169 ◽  
Author(s):  
Winnie Dunn ◽  
Mary Ann Boyle
Keyword(s):  
United States ◽  
Occupational Therapy ◽  
The United States ◽  
Education Programs ◽  
Occupational Therapy Education ◽  
Time Period ◽  
Time Periods ◽  
Therapy Education ◽  
Model Programs ◽  
First Time

This study compared data collected from two questionnaires completed by faculty in professional occupational therapy education programs in the United States. The questionnaires asked respondents to describe their funding requests over two time periods; 1985 through 1987 and 1988 through 1990. The data from the first time period was reported elsewhere (Boyle, Dunn, & Kielhofner, 1990); this article presents the data from the second inquiry and compares the data from the two time periods to show trends. Programs submitted a total of 24 requests intramurally and 194 requests extramurally for a total of 218 requests during the second time period. Programs received full or partial funding for 115 proposals, a total of nearly $15 million, which was an increase of approximately $2 million. Research was funded at $1,865,500 ( n=35), a more than $1 million increase from the first time period. Programs received $5,725,790 for training ( n=35), $28,450 for model programs ( n=2), $1,326,614 for research and demonstration ( n=6), and $5,804,689 for other activities ( n=37).

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