Acute care and hydration due to chemotherapy-induced nausea and vomiting (CINV) among patients receiving NEPA prophylaxis for anthracycline + cyclophosphamide (AC).

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 112-112
Author(s):  
Eric Roeland ◽  
Rudolph M. Navari ◽  
Kathryn Jean Ruddy ◽  
Thomas William LeBlanc ◽  
Rebecca Anne Clark-Snow ◽  
...  
Keyword(s):  
Acute Care ◽  
Prospective Trial ◽  
Complete Response ◽  
Symptom Duration ◽  
Study Results ◽  
The Us ◽  
Nausea And Emesis ◽  
Ed Visits ◽  
Rescue Drug ◽  
Clinical Trial Information

112 Background: In the US, the CMS OP-35 oncology outcome measure deems 30-day post-chemotherapy acute care involving nausea and emesis (NV) or 8 other toxicities as avoidable, with studies showing 15% of > 2500 patients receiving anthracycline + cyclophosphamide (AC)-based chemotherapy had avoidable acute care, of which 32% involved NV. Our aim was to evaluate resource use (emergency department [ED] visits, inpatient admissions [IP], or hydration) in a prospective trial of women with breast cancer who received combination netupitant/palonosetron (NEPA) + dexamethasone (DEX) for CINV prophylaxis for AC-based chemotherapy. Methods: Women initiating AC received oral or IV NEPA + DEX. Pre-specified endpoints included safety, complete response, acute care (ED/IP), unplanned IV hydrations (as determined by investigator), days of CINV, and ≥3 days of CINV. We defined CINV as emesis or rescue drug use up to 5 days after AC, and defined concomitant ED/IP or hydrations in the same period as CINV-related. We limited our analysis to the first 2 cycles, the median duration in the NEPA study. Results: 402 patients received ≥1 cycle of AC and 391 completed 2 cycles. Nine patients had IP (none CINV-related), and 5 patients had a total of 6 ED visits (1 CINV-related). Three patients had a CINV-related unplanned hydration. Patients had ≥1 day of CINV in 172 of 793 cycles (21.7%); of these, the majority had symptom duration for 1-2 days, while 78 (9.8%) had ≥3 days of CINV in a cycle. Conclusions: In this prospective CINV prophylaxis study in women receiving AC chemotherapy, < 1% of women receiving NEPA + DEX required acute care for CINV and < 1% required unplanned hydrations for CINV. These rates are below previously reported CINV-related acute care rates for AC suggesting NEPA may help avoid CINV-related acute care. Clinical trial information: NCT03403712.

Is the firearm epidemic in the US getting worse?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Tedesco ◽  
K Y C Adja ◽  
F Rallo ◽  
C Reno ◽  
M P Fantini ◽  
...  
Keyword(s):  
Suicide Attempts ◽  
National Level ◽  
Gun Violence ◽  
Public Health Issue ◽  
Western World ◽  
Diagnostic Code ◽  
The Us ◽  
Icd 10 ◽  
Ed Visits ◽  
Annual Decline

Abstract Background The US is the least regulated firearm market in the Western world and firearm violence is a major public health issue. Firearms account for 40,000 deaths in the US annually, which is higher than other high-income countries. Although most of the gun-related deaths in the US are the result of suicide attempts and self-inflicted injuries, nearly 40% of them come from accidents, assaults, or police intervention. Methods We measured the number of non-self-inflicted firearm-related ED visits, by including patients discharged with diagnostic ICD-9-CM (ICD-10 for 2016) codes of accidents, assaults or legal intervention resulting in firearm injuries between 2006-2016. We used data from the Healthcare Cost and Utilization Project (HCUPnet). From the CDC Wide-ranging Online Data for Epidemiologic Research we obtained data on non-suicidal firearm-related deaths over the period 2006-2017. To identify the cause of death we used the ICD-10 codes. Temporal changes of rates of ED visits and deaths were evaluated using Joinpoint Software. Results In 2006 there were a total of 79,998 ED visits with a diagnostic code of firearm-related injury, and this number showed a non-significant 2.7% annual decline between 2006-2013 (p = 0.06) followed by a significant 19.4% annual increase between 2013-2016 (p &lt; 0.05), resulting in 111.305 visits in 2016. The number of non-suicidal firearm-related deaths showed a significant 2.2% annual decline between 2006-2014 (p &lt; 0.05), followed by a significant 10.3% APC (p &lt; 0.05) between 2014-2017. Conclusions Data showed steady rates until 2013 and a striking increasing trend starting from 2013. Firearm-related deaths followed the same trends. Our data show that in the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities. Analysis limitations: we used national-level aggregate data and coding accuracy may be not consistent nationwide. Key messages In the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities nationwide. The US firearm related deaths epidemic urges for new policies and preventive measures, such as stricter background checks and restrictions on guns ownership.

scholarly journals The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 629-629
Author(s):  
Silke Metzelthin ◽  
Sandra Zwakhalen ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
The Netherlands ◽  
Home Care ◽  
Acute Care ◽  
Long Term Care ◽  
Functional Decline ◽  
Term Care ◽  
The Us ◽  
The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

scholarly journals Antiemetic Prophylaxis for Chemoradiotherapy-induced Nausea and Vomiting (C-RINV) in Locally Advanced Head and Heck Squamous Cell Carcinoma: a Prospective Phase Ⅱ Trial

2021 ◽  
Author(s):  
Zekun Wang ◽  
Wenyang Liu ◽  
Jianghu Zhang ◽  
Xuesong Chen ◽  
Jingbo Wang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Complete Response ◽  
High Dose ◽  
Advanced Head ◽  
Free Response ◽  
Nausea And Emesis

Abstract Background There is sparse research reporting effective interventions for preventing nausea and emesis caused by concurrent chemoradiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This phase Ⅱ trial was conducted to provide the direct evidence for the current practice of prescribing antiemetic in patients with LA-HNSCC receiving CCRT.Methods Treatment-naïve LA-HNSCC patients received intensity-modulated radiotherapy with concomitant cisplatin 100 mg/m² every 3 weeks for two cycles. All patients were given orally aprepitant 125 mg once on d1, then 80mg once on d2-5; ondansetron 8 mg once on d1; and dexamethasone 12 mg once on d1, then 8mg on d2-5. The primary endpoint was complete response (CR). Pursuant to δ=0.2 and α=0.05, the expected CR rate was 80%. Results A total of 43 patients with LA-HNSCC were enrolled. The median age was 53 years old, and 86.0% were male. All patients received radiotherapy and 86.0% of patients completed both cycles as planned. The overall CR rate was 86.0% (95% CI: 72.1-94.7). The CR rates for cycles 1 and 2 were 88.4% (95% CI: 74.9-96.1) and 89.2% (95% CI: 74.6-97.0). The complete protection rate in the overall phase was 72.1% (95% CI: 56.3-84.7). The emesis-free response and nausea-free response in overall phase were 88.4% (95% CI: 74.9-96.1) and 60.5% (95% CI: 44.4-75.0), respectively. The adverse events related to antiemetics were constipation (65.1%) and hiccups (16.3%), but both were grade 1-2. There was no grade 4 or 5 treatment-related adverse event with antiemetic usage. Conclusion The addition of aprepitant into ondansetron and dexamethasone provided effective protection from nausea and emesis in patients with LA-HNSCC receiving radiotherapy and concomitant high-dose cisplatin chemotherapy. Randomised phase 3 studies are required to further define the potential role of NK1RA in chemoradiotherapy setting.Trial registration: ClinicalTrials.gov, number NCT03572829. Registered 28 June 2018, https://clinicaltrials.gov/ct2/show/NCT03572829?term=NCT03572829&draw=2&rank=1.

scholarly journals Characterizing the Effects of Extreme Cold Using Real-time Syndromic Surveillance, Ontario, Canada, 2010-2016

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 48S-52S ◽  
Author(s):  
Nancy VanStone ◽  
Adam van Dijk ◽  
Timothy Chisamore ◽  
Brian Mosley ◽  
Geoffrey Hall ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Cold Temperature ◽  
Syndromic Surveillance System ◽  
Southern Ontario ◽  
Threshold Temperatures ◽  
Ed Visits ◽  
Extreme Cold

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature–related visits collected by the Acute Care Enhanced Surveillance system—a syndromic surveillance system that captures data on ED visits from hospitals in Ontario—for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity—C1, C2, and C3—to determine the temperature at which anomalous counts of cold temperature–related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature–related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.

scholarly journals Interfacility transfers for US ischemic stroke and TIA, 2006–2014

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1561-e1569 ◽  
Author(s):  
Benjamin P. George ◽  
Sara J. Doyle ◽  
George P. Albert ◽  
Ania Busza ◽  
Robert G. Holloway ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Stroke Care ◽  
Hospital Level ◽  
Transfer Rates ◽  
The Us ◽  
Ed Visits ◽  
Low Volume

ObjectiveTo investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA.MethodsWe performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006–2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time.ResultsThe population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 (p trend < 0.001). The rate of IS/TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0–3.8) in 2006 to 7.6 (95% CI 7.2–7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0–10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1–33.3) (2006–2014) (p trend < 0.001). Transfers were more common among IS. Transfer rates were greatest among rural (adjusted odds ratio [AOR] 3.05, 95% CI 2.56–3.64) vs urban/teaching and low-volume EDs (AOR 7.49, 95% CI 6.58–8.53, 1st vs 4th quartile). The adjusted odds of transfer for IS/TIA increased threefold (2006–2014).ConclusionsInterfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system.

Identification of patients at high risk for preventable emergency department visits and inpatient admissions after starting chemotherapy: Machine learning applied to comprehensive electronic health record data.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1511-1511
Author(s):  
Dylan J. Peterson ◽  
Nicolai P. Ostberg ◽  
Douglas W. Blayney ◽  
James D. Brooks ◽  
Tina Hernandez-Boussard
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Electronic Health Record ◽  
Acute Care ◽  
Cancer Care ◽  
Model Performance ◽  
Emergency Department Visits ◽  
Health Record ◽  
Patients At Risk ◽  
Ed Visits

1511 Background: Acute care use is one of the largest drivers of cancer care costs. OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy is a CMS quality measure that will affect reimbursement based on unplanned inpatient admissions (IP) and emergency department (ED) visits. Targeted measures can reduce preventable acute care use but identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data available in the Electronic Health Record (EHR). We hypothesized dense, structured EHR data could be used to train machine learning algorithms to predict risk of preventable ED and IP visits. Methods: Patients treated at Stanford Health Care and affiliated community care sites between 2013 and 2015 who met inclusion criteria for OP-35 were selected from our EHR. Preventable ED or IP visits were identified using OP-35 criteria. Demographic, diagnosis, procedure, medication, laboratory, vital sign, and healthcare utilization data generated prior to chemotherapy treatment were obtained. A random split of 80% of the cohort was used to train a logistic regression with least absolute shrinkage and selection operator regularization (LASSO) model to predict risk for acute care events within the first 180 days of chemotherapy. The remaining 20% were used to measure model performance by the Area Under the Receiver Operator Curve (AUROC). Results: 8,439 patients were included, of whom 35% had one or more preventable event within 180 days of starting chemotherapy. Our LASSO model classified patients at risk for preventable ED or IP visits with an AUROC of 0.783 (95% CI: 0.761-0.806). Model performance was better for identifying risk for IP visits than ED visits. LASSO selected 125 of 760 possible features to use when classifying patients. These included prior acute care visits, cancer stage, race, laboratory values, and a diagnosis of depression. Key features for the model are shown in the table. Conclusions: Machine learning models trained on a large number of routinely collected clinical variables can identify patients at risk for acute care events with promising accuracy. These models have the potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted preventative interventions. Future work will include prospective and external validation in other healthcare systems.[Table: see text]

Durvalumab (D) and PET-directed chemoradiation (CRT) after induction FOLFOX for esophageal adenocarcinoma.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 226-226
Author(s):  
Geoffrey Yuyat Ku ◽  
Abraham Jing-Ching Wu ◽  
Smita Sihag ◽  
Bernard J. Park ◽  
David Randolph Jones ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Type I ◽  
Anastomotic Complication ◽  
Median Length ◽  
Siewert Type ◽  
Pet Ct ◽  
Positive Results ◽  
Clinical Trial Information

226 Background: Based on the positive results of the CALGB 80803 study (J Clin Oncol 2017;35:1 [abstr]), we have added D to induction FOLFOX and pre-op CRT. Methods: Patients (Pts) had TanyN+ or T3-4NanyM0 esophageal and Siewert Type I-III GEJ adenocarcinoma staged by EUS, PET/CT and CT. Pts received mFOLFOX6 ×2 prior to repeat PET/CT. PET responders (PETr) received 5-FU or capecitabine and oxaliplatin with RT to 50.4Gy, while induction PET non-responders (PETnr) received carboplatin/paclitaxel with RT. All Pts received D 1,500 mg q4W ×2 starting 2 wks prior to and during CRT. Esophagectomy was planned 6-8 weeks after CRT. Pts who had R0 resections received adjuvant D 1,500mg q4W ×6. Results: 36 Pts have been enrolled: 25 GEJ, 11 esophageal; 23 N+ and 32 T3/4. 26 of 36 Pts (72%) are PETr. 2 Pts developed metastatic disease after CRT and 9 Pts remain on preop treatment. 25 Pts have had surgery (Table). Pathologic complete response (pCR) was seen in 6 (24%); 5 Pts (20%) had ypT1N0 tumors with 99% response and 2 Pts (8%) had ypT0N1 with 99% response. 20 Pts (80%) had >90% response. 3 Pts had MSI tumors (2 PETr; 1 pCR, 1 T1aN0 99% response, 1 ypT2N0 90% response). Notable grade (gd) 3/4 adverse events (AEs) observed were neutropenia in 8 Pts (22%), diarrhea and vomiting in 2 Pts each (6%). Notable gd 1/2 AEs in ≥20%: anemia (31 Pts), thrombocytopenia (29 Pts), nausea (21 Pts), fatigue (25 Pts), increased AST (20 Pts), constipation and diarrhea (9 Pts), diarrhea (8 Pts). Immune-related AEs noted were gd 2 dermatitis (2 Pts), gd 3 hepatitis and gd 1 hypothyroidism in 1 Pt each. Median length of post-op stay was 8 days, with 12% anastomotic complication rate, including 1 Pt who died of hematemesis 16 days after discharge from 55-day hospitalization. Conclusions: The addition of D to induction FOLFOX and PET-directed CRT is safe and feasible. pCR and near-pCR in ½ of operated Pts is encouraging and compares favorably to the pCR rate of 31% in CALGB 80803 Pts who received induction FOLFOX. The final pCR rate and correlatives for the fully accrued study will be presented. Clinical trial information: NCT02962063. [Table: see text]

High-dose intravenous metoclopramide versus combination high-dose metoclopramide and intravenous dexamethasone in preventing cisplatin-induced nausea and emesis: a single-blind crossover comparison of antiemetic efficacy.

1985 ◽  
Vol 3 (2) ◽  
pp. 245-251 ◽  
Author(s):  
S B Strum ◽  
J E McDermed ◽  
D F Liponi
Keyword(s):  
Patient Preference ◽  
Nausea And Vomiting ◽  
High Dose ◽  
Chemotherapy Response ◽  
Antiemetic Efficacy ◽  
Study Results ◽  
Nausea And Emesis ◽  
To Receive ◽  
Single Blind ◽  
Crossover Comparison

We tested the safety and antiemetic effectiveness of intravenous (IV) dexamethasone (DXM) as an adjunct to high-dose IV metoclopramide (MCP) to prevent nausea and vomiting induced by high-dose cisplatin chemotherapy. Response was determined by using objective and subjective criteria. Thirty patients were randomly assigned to receive MCP alone at a dose of 2 mg/kg IV for three doses or the same dose of MCP plus 20 mg of DXM IV for three doses. Twenty evaluable patients received a second course of cisplatin and were crossed over to the opposite arm. Study results did not show a statistically significant advantage of combination MCP plus DXM over MCP alone using strict objective criteria for antiemetic response. However, patients subjectively preferred MCP plus DXM over MCP alone by nearly a 6:1 ratio, regardless of the randomization sequence. Although the addition of DXM does not appear to objectively improve emetic protection with high-dose MCP, we recommend MCP plus DXM to prevent nausea and vomiting induced by high-dose cisplatin chemotherapy when the use of steroids is not contraindicated, in view of patient preference for the combination.

Blood concentrations of volatile organic compounds in a nonoccupationally exposed US population and in groups with suspected exposure

1994 ◽  
Vol 40 (7) ◽  
pp. 1401-1404 ◽  
Author(s):  
D L Ashley ◽  
M A Bonin ◽  
F L Cardinali ◽  
J M McCraw ◽  
J V Wooten
Keyword(s):  
Volatile Organic Compounds ◽  
Organic Compounds ◽  
Reference Range ◽  
Industrialized Countries ◽  
Blood Concentrations ◽  
Health And Nutrition ◽  
Low Concentrations ◽  
Study Results ◽  
The Us ◽  
Volatile Organic

Abstract Exposure to certain volatile organic compounds (VOCs) commonly occurs in industrialized countries. We developed a method for measuring 32 VOCs in 10 mL of whole blood at low concentration. We used this method to determine the internal dose of these compounds in 600 or more people in the US who participated in the Third National Health and Nutrition Examination Survey. From our study results, we established a reference range for these VOCs in the general population of the US. We found detectable concentrations of 1,1,1-trichloroethane, 1,4-dichlorobenzene, 2-butanone, acetone, benzene, chloroform, ethylbenzene, m,p-xylene, styrene, tetrachloroethane, and toluene in most of the blood samples of nonoccupationally exposed persons. The accuracy of VOC evaluations depends on the ability of investigators to make sensitive and reproducible measurements of low concentrations of VOCs and to eliminate all sources of interference and contamination.

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