scholarly journals Predictors of the Response to Dopaminergic Therapy in Patients With Prolactinoma

2020 ◽  
Vol 105 (12) ◽  
pp. e4558-e4566
Author(s):  
Camille Hage ◽  
Roberto Salvatori
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Term Treatment ◽  
Tumor Diameter ◽  
Dopaminergic Therapy ◽  
Academic Medical ◽  
Long Term Treatment ◽  
Baseline Characteristics

Abstract Purpose Withdrawal of dopamine agonist (DA) therapy in patients with prolactinoma who are controlled by a small dose of medication is recommended by several guidelines. So far, the likelihood of reaching withdrawal conditions based on baseline characteristics remains uncertain. Methods We retrospectively examined early clinical, radiological, or biochemical features that may predict the likelihood of reaching withdrawal conditions in prolactinoma patients. Data were obtained in a single academic medical center in the United States from patients seen between 2000 and 2018. Using multiple logistic regression, we compared patients who reached withdrawal conditions with those who did not. Results Of 213 patients, 78 (36.6%) reached withdrawal conditions after at least 2 years of DA treatment. Initial maximal tumor diameter was significantly smaller in those who reached withdrawal conditions than in those who did not. Percent prolactin change at the first check from initiation of DA therapy and parasellar invasiveness were predictors of reaching withdrawal conditions. With constant independent variables, there was a 7% increase in odds for reaching withdrawal conditions for every 1% decrease in percent prolactin change at first check after DA therapy start (P = 0.0000). Parasellar invasion decreased the odds of reaching withdrawal conditions by 84% (P = 0.0000). Conclusions DA remains a potential life-long treatment modality for most prolactinoma patients. Patients with parasellar invasiveness and low prolactin percent change from baseline to first prolactin check are more likely to require long-term treatment.

Long-Term Results of Radiofrequency Volumetric Tissue Reduction of the Palate for Snoring

2003 ◽  
Vol 112 (3) ◽  
pp. 276-279 ◽  
Author(s):  
Bassem Said ◽  
Marshall Strome
Keyword(s):  
Patient Satisfaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Term Treatment ◽  
Response To Treatment ◽  
Long Term Results ◽  
Long Term Treatment ◽  
Radiofrequency Volumetric Tissue Reduction ◽  
Tissue Reduction

To assess the long-term efficacy and morbidity of radiofrequency volumetric tissue reduction (RFVTR) of the soft palate for snoring, we examined the medical records of 39 patients who received this treatment at an academic medical center. Telephone interviews were conducted with the patients to evaluate the long-term subjective efficacy and sequelae. The average follow-up was 14 months (range, 3 to 26 months). Twenty-eight patients (72%) responded to treatment, defined as a 4-point decrease on a 10-point scale. The self-reported snoring score decreased an average of 52% (8.8 ± 1.9 to 4.2 ± 2.9). Sixty-seven percent of the patients were satisfied. The response to treatment did not always correlate with patient satisfaction. The snoring relapse rate was 11% among responders. No significant differences were identified between responders and nonresponders. No significant complications or long-term sequelae were observed. We conclude that RFVTR of the palate is a relatively safe and effective long-term treatment for snoring. Defining realistic pretreatment expectations is important in maximizing patient satisfaction.

Abstract WP225: Prognosis of Cerebral Venous Thrombosis and Provoking Risk Factors

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Eun-Jae Lee ◽  
Sang-Mi Noh ◽  
Dong-Wha Kang ◽  
Jong S Kim ◽  
Sun U Kwon
Keyword(s):  
Risk Factors ◽  
Sinus Thrombosis ◽  
Medical Center ◽  
Underlying Disease ◽  
Term Treatment ◽  
Dural Sinus ◽  
Cerebral Vein ◽  
Long Term Treatment ◽  
Baseline Characteristics

Background and hypothesis: Little is known about the relationships between the presence/type of provoking risk factors and the prognosis and optimal duration of anticoagulation in patients with cerebral vein and dural sinus thrombosis (CVT). We aimed to analyze data of treatment and long-term prognosis in patients with CVT classified by the presence and type of provoking risk factors. Methods: Prospectively recorded data of a tertiary medical center were retrospectively reviewed. Patients with CVT were categorized into three groups by risk factors: unprovoked, those with possibly resolved provoking factors (PR), and those with persistent provoking factors (PP). The baseline characteristics, treatment, and prognosis of these three groups were analyzed. Results: From 2000 to 2015, 61 patients were registered for CVT, 19 (31.1%) with unprovoked, 11 (18.0%) with PR, and 31 (50.9%) with PP. Median follow-up and duration of anticoagulation were 35 and 8 months, respectively. The PR group consisted of patients with causative drugs or arteriovenous fistula successfully treated. Despite the similarities in baseline characteristics of the three groups, deaths (n=3; P = 0.256) and recurrences (n=7; P = 0.020) were observed only in the PP group. The median interval to death and recurrence were 9 and 13 months, respectively. Death was associated with underlying disease activity, not with CVT progression. Recurrences were associated with lack of initial administration of anticoagulation (P = 0.028); of the seven patients with recurrence, five (71.4%) did not receive anticoagulation at the second event. Conclusions: Although the prognosis of CVT is generally benign, recurrence and death were observed in the patients with persistent risk factors, suggesting their need for long-term treatment with anticoagulants.

Abstract P44: Does Race Influence Disability and Hospital Disposition After Cerebral Hemorrhage? Results From a Community Wide Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Dilip K Pandey ◽  
Venkatesh Aiyagari
Keyword(s):  
Hospital Mortality ◽  
Racial Differences ◽  
The United States ◽  
Term Treatment ◽  
Severe Disability ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Long Term Treatment ◽  
Mortality Incidence

Background: Compared to Non-Hispanic whites (NHW), intracerebral hemorrhage (ICH) has a higher incidence among African Americans (AA) where it also occurs at a younger age. Previous studies have concluded that there are no racial differences in hospital mortality after ICH, but the influence of race on disability and discharge disposition after ICH has not been studied. Methods: The Illinois Capture-Stroke registry is a prospectively collected database of patients admitted with a stroke to 56 acute care hospitals in Illinois. We performed a retrospective analysis of the association between race, and in-hospital mortality, modified Rankin Scale (mRS) score at discharge and discharge disposition in 804 patients with ICH enrolled in the registry between 2005 and 2007. Results: We studied 530 NHW and 175 AA patients with radiologically proven ICH. Compared to NHW, AA patients were younger (mean age NHW: 73±14 vs AA: 58±12 yrs, p <0.001) and had a higher incidence of hypertension, smoking and coronary artery disease. Although there was no racial difference in hospital mortality, incidence of moderate to severe disability (mRS 4-5) was significantly higher in NHW (69%) compared to AA (55%). Among patients <65 years old, a trend (p=0.102) towards a higher disability in NHW was observed (60% in NHW vs. 45% in AA). In this age group, 41% of NHW and 33% of AA were discharged to rehabilitation facilities while 37% of NHW and 44% of AA were discharged home. Conclusion: A very large proportion of patients with ICH are discharged from hospitals with moderate or severe disability. Compared to NHW, a higher proportion of younger AA patients are discharged home after ICH. The long term outcomes of survivors after ICH in the United States is not well studied, and the influence of racial and socioeconomic factors on long-term treatment and outcome after ICH needs to be explored.

scholarly journals Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Joesph R Wiencek ◽  
Carter L Head ◽  
Costi D Sifri ◽  
Andrew S Parsons
Keyword(s):  
United States ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibody Test ◽  
The United States ◽  
Molecular Testing ◽  
Antibody Testing ◽  
Academic Medical ◽  
Public Health Epidemiology ◽  
Testing Costs

Abstract Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P &lt; .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.

scholarly journals Healthcare personnel absenteeism, presenteeism, and staffing challenges during epidemics

2020 ◽  
pp. 1-4
Author(s):  
Douglas W. Challener ◽  
Laura E. Breeher ◽  
JoEllen Frain ◽  
Melanie D. Swift ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Seasonal Influenza ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Healthcare Personnel ◽  
Linear Regression Models ◽  
Influenza Like Illness ◽  
Healthcare Workforce ◽  
Academic Medical ◽  
Hourly Employees

Abstract: Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Design: Retrospective cohort study. Setting: Large academic medical center in the United States. Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities

2020 ◽  
pp. 10.1212/CPJ.0000000000000906 ◽  
Author(s):  
Roy E. Strowd ◽  
Lauren Strauss ◽  
Rachel Graham ◽  
Kristen Dodenhoff ◽  
Allysen Schreiber ◽  
...  
Keyword(s):  
Rural Communities ◽  
Urban Communities ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Urban Status ◽  
Rural And Urban ◽  
Academic Medical ◽  
Black Patients ◽  
Rural Appalachia

ABSTRACTObjective:To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States.Methods:A retrospective cohort of consecutive patients seen in the first four weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video and when unable phone-only visits were scheduled. Patients were divided into two groups based on the telehealth visit type: video or phone-only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured post-visit telephone call.Results:Of 1011 telehealth patient-visits, 44% were video and 56% phone-only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p<0.001), more likely to be female (63% vs 55%, p<0.007), be White or Caucasian (p=0.024), and not have Medicare or Medicaid insurance (p<0.001). The most common barrier to scheduling video visits was technology limitations (46%). While patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p=0.05).Conclusion:Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, black patients with Medicare or Medicaid insurance were less likely to adopt video visits.

Atezolizumab (atezo) in patients with metastatic urothelial carcinoma (mUC): A 2-year clinical update from a phase Ia study.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 290-290 ◽  
Author(s):  
Daniel Peter Petrylak ◽  
Thomas Powles ◽  
Joaquim Bellmunt ◽  
Fadi S. Braiteh ◽  
Yohann Loriot ◽  
...  
Keyword(s):  
Objective Response ◽  
The United States ◽  
Term Treatment ◽  
Long Term Results ◽  
Platinum Based Chemotherapy ◽  
Long Term Treatment ◽  
Previously Treated ◽  
Ecog Ps

290 Background: Atezo (anti–PD-L1) has demonstrated safety and efficacy in a broad range of cancers and is approved in the United States for mUC previously treated with platinum-based chemotherapy. Here we report long-term results in mUC from Phase Ia study NCT01375842 (PCD4989g). Methods: Previously treated mUC patients received atezo 15 mg/kg or 1200 mg IV q3w. Enrollment in this Phase Ia expansion cohort initially required PD-L1–selected status and later opened to patients regardless of PD-L1 expression on tumor-infiltrating immune cells. The primary endpoint was safety/tolerability. Secondary endpoints included investigator-assessed RECIST v1.1 ORR (confirmed), DOR and OS. Results: 95 patients were safety evaluable (Table). Median age was 66 years, 76% were male and 80% had primary bladder tumors. 61% had ECOG PS 1. 52% received ≥ 3 prior systemic therapies for mUC (70% platinum). Median treatment duration was 3 months (range: 0-32 months); 24% were treated for ≥ 1 year. Treatment-related AEs occurred in 66% (all Grade) and 8% (Grade 3-4) of patients. No treatment-related deaths were reported. In 94 objective response–evaluable patients (follow-up ≥ 12 weeks), the ORR was 27% (95% CI: 18, 37%), and the CR rate was 10%; the SD rate was 19%. mDOR was 22.1 months (95% CI: 12.1, NE months) in all patients; 56% of responses (7/9 CRs and 7/16 PRs) were ongoing at the December 15, 2015 data cutoff. With a 24-month median follow-up duration (range: 1+ to 32 months), the 1-year OS rate was 47% (95% CI: 36, 58%), and the 2-year rate was 29% (19, 40%); mOS is in the Table. Updated clinical data with further follow-up and analyses by PD-L1 status will be presented. Conclusions: Long-term treatment with atezo was well tolerated, without new safety signals in heavily pre-treated mUC patients. The durability of responses, including CRs, along with extended OS, confirm atezo as a new standard for previously treated mUC patients. Clinical trial information: NCT01375842. [Table: see text]

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