scholarly journals The Majority of Inpatient Short Synacthen Tests Are Performed Incorrectly, Due to Imprecise Timing, Incorrect Sampling and Failure to Interrupt Steroid Administration

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A98-A99
Author(s):  
Aonghus McCarthy ◽  
Susan McKenna ◽  
Keira Hall ◽  
Aileen Niland ◽  
Gerard P Boran ◽  
...  
Keyword(s):  
Hospital Staff ◽  
Repeat Testing ◽  
Steroid Administration ◽  
Synacthen Test ◽  
The Mean ◽  
Short Synacthen Test ◽  
Mean Time ◽  
Sample Window ◽  
Serum Acth ◽  
Interpretation Of Results

Abstract Introduction: The short synacthen test (SST) is commonly used to assess adrenal function. Accurate timing and appropriate holding of exogenous steroids are essential to ensure correct interpretation of results. Aims & Methods: We reviewed all SSTs performed on inpatients in our hospital over a 1-year period, in order to determine accuracy of testing. Results: 42 patients (Male 15, Female 27), with mean age 68 years (range 43–90), underwent SST. The majority (39/42; 93%) of tests were requested by internal medicine physicians. The indications for testing were; suspected adrenal insufficiency (18), HPA axis suppression (9), fatigue (7), hyponatremia (5), suspected pituitary disease (2) and vomiting (1). 7 (44%) of the 16 patients taking steroids did not have medication appropriately held. 31 (74%) patients did not have serum ACTH measured prior to the test. 28 (66%) tests were not started at the correct time. Only 10 (24%) of the 30 minute samples were completed within the 25-35min sample window. The mean time between the 0min and 30min samples was 42mins (median 62mins; range 0-209mins). 12 (29%) tests involved an unnecessary 60min sample. 8 (19%) tests had no interpretation of results documented in the medical notes. 4 (10%) patients underwent repeat testing, necessitated by an incorrect first test. Discussion: The vast majority of inpatient SSTs (33/42;79%) were performed suboptimally, with the most common errors pertaining to incorrect timing of the test, inaccurate sampling and inappropriate pre-test steroid administration. Considering these errors, some results may have been interpreted incorrectly. Repeat tests were recognised as required in 10% of patients, with associated inconvenience, cost and discomfort. Improved training and guidelines for performing SSTs should be available to hospital staff to ensure more accurate application of the test.

scholarly journals Long Term Monitoring of Patients with Positive Lupus Anticoagulant and Antiphospholipid Antibodies. Are All Cases Persistently Positive?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1452-1452
Author(s):  
Matthew R. Kovacs ◽  
Alejandro Lazo-Langner ◽  
Martha L Louzada ◽  
Michael J. Kovacs
Keyword(s):  
Anticoagulant Therapy ◽  
Antiphospholipid Antibodies ◽  
Research Funding ◽  
Positive Test ◽  
Confirmatory Test ◽  
Repeat Testing ◽  
Repeat Test ◽  
The Mean ◽  
Mean Time

Abstract Background. Lupus Anticoagulants (LA) and Antiphospholipid Antibodies (APLA) are known to be associated with both arterial and venous thromboembolism (VTE). The implications of positive test results often include indefinite anticoagulant therapy and thus accurately identifying these patients is important. Current guidelines for laboratory testing of both LA and APLA, require that initial positive results are confirmed by repeat testing at least 12 weeks after initial positivity to be considered diagnostic. Repeat testing is not routinely performed once a patient is deemed to be positive. If repeat testing is performed years after initial confirmation and is negative, the clinical implications of this are not certain and there are no criteria to determine which patients can safely be considered negative. We aimed to determine the proportion of patients with positive LA or APLA who remained positive at least 2 years after initial confirmation. Methods. We retrospectively reviewed a cohort of patients with positive LA and APLA evaluated at the Thrombosis Clinic of the London Health Sciences Centre (London, Ontario, Canada) between 1998 and 2016 and who had repeat LA/APLA tests done at least 2 years after the initial LA/APLA positive confirmation. LA testing was done as per the International Society on Thrombosis and Haemostasis criteria available at the time of testing, using dilute Russell viper venom time screening and confirmatory tests in all cases. APLA testing was done using commercial enzyme-linked immunosorbent assays (Louisville APL Diagnostics Inc. or Inova Diagnostics Inc.), according to the manufacturers' instructions. Results. We included 73 patients (39 [53.4%] female). The average age at diagnosis of LA or APLA was 49.3 years. The average follow-up was 103.1 months (range 24 to 218 months). At diagnosis, 57 (78%) patients had a VTE (26 deep vein thrombosis [DVT], 16 pulmonary embolism [PE], 17 both DVT and PE), 10 had a stroke or transient ischemic attack (TIA) and 3 myocardial infarction (MI). Warfarin was the most common long-term anticoagulant used (66 of 73 patients). Nine patients were treated with rivaroxaban, 5 with LMWH, and 1 patient was treated with edoxaban. A total of 4 patients did not require anticoagulant therapy. Eleven (15.1%) patients suffered a recurrent thrombotic event while on anticoagulant therapy, (5 DVT, 5 PE, 1 DVT and PE). Nine of the recurrent events occurred while the patient was being treated with warfarin. Four of the 40 female patients suffered at least one miscarriage. One patient died while being followed due to complications from renal failure. The mean time between the first positive test and the first confirmatory test was 8.9 months (range 3 to 132), whereas the mean time between the first confirmatory test and the first repeat test was 68.9 months (range 24 to 207). Thirty-seven (50.6%) patients were negative on the second repeat test. All of them remained on anticoagulants. Conclusion. Our results suggest that up to 50% of patients became negative for LA and/or APLA at least 2 years after initial positivity, particularly if only one type of test was positive at diagnosis. The clinical relevance of this result is not certain including implications about discontinuing anticoagulant therapy. Further research in this relevant matter is warranted. Table Table. Disclosures Lazo-Langner: Pfizer: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Research Funding. Louzada:Pfizer: Honoraria; Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Bayer: Honoraria. Kovacs:Daiichi Sankyo Pharma: Research Funding; LEO Pharma: Honoraria; Bayer: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding.

The Death of a Newborn Twin: An Analysis of Parental Bereavement

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 587-591
Author(s):  
Ann L. Wilson ◽  
Lawrence J. Fenton ◽  
Dennis C. Stevens ◽  
Douglas J. Soule
Keyword(s):  
Emotional Responses ◽  
Hospital Staff ◽  
Depression Symptom ◽  
Inventory Analysis ◽  
Grieving Process ◽  
Significant Difference ◽  
The Mean ◽  
Present Response ◽  
Mean Time ◽  
Over Time

The emotional responses of eight families who lost a singleton newborn were compared with those of eight families who lost a twin. The mean gestational age of the babies in both groups was 31 weeks. At a mean time of 15 months following their loss, parents were sent a questionnaire which requested that they report their responses during the first six weeks following their baby's death and their present response to this experience. Embedded in the questionnaire was a 20-item depression symptom inventory. Analysis of variance indicated that although mothers experienced significantly more depressive symptoms than fathers (F = 59.48, P = .001) and that all symptoms had diminished greatly over time (F = 6.02, P = .032), there was no significant difference between the parents who had lost a twin and those who had lost a singleton. However, family, friends, and hospital staff frequently ignored or downplayed the death of the twin assuming that the grief of the parents would be minimal because of the surviving twin. Results of this study indicate that the presence of a living twin in no way lessens the grieving process and that a conscious effort needs to be made to allow parents to express openly their feelings of loss when a twin dies.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

2021 ◽  
pp. 107815522110160
Author(s):  
Bernadatte Zimbwa ◽  
Peter J Gilbar ◽  
Mark R Davis ◽  
Srinivas Kondalsamy-Chennakesavan
Keyword(s):  
Checkpoint Inhibitors ◽  
Anticancer Therapy ◽  
Mortality Rates ◽  
Feedback Process ◽  
Time To Death ◽  
Cancer Centre ◽  
Haematology Patients ◽  
The Mean ◽  
Regional Cancer Centre ◽  
Mean Time

Purpose To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. Method All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Results Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). Conclusion The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

scholarly journals Surveillance System in Smart Cities: A Dependability Evaluation Based on Stochastic Models

Electronics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 876
Author(s):  
Igor Gonçalves ◽  
Laécio Rodrigues ◽  
Francisco Airton Silva ◽  
Tuan Anh Nguyen ◽  
Dugki Min ◽  
...  
Keyword(s):  
Surveillance System ◽  
Smart Cities ◽  
Heterogeneous Data ◽  
Time To Failure ◽  
Video Streams ◽  
Dependability Evaluation ◽  
The Mean ◽  
Mean Time ◽  
The Internet Of Things

Surveillance monitoring systems are highly necessary, aiming to prevent many social problems in smart cities. The internet of things (IoT) nowadays offers a variety of technologies to capture and process massive and heterogeneous data. Due to the fact that (i) advanced analyses of video streams are performed on powerful recording devices; while (ii) surveillance monitoring services require high availability levels in the way that the service must remain connected, for example, to a connection network that offers higher speed than conventional connections; and that (iii) the trust-worthy dependability of a surveillance system depends on various factors, it is not easy to identify which components/devices in a system architecture have the most impact on the dependability for a specific surveillance system in smart cities. In this paper, we developed stochastic Petri net models for a surveillance monitoring system with regard to varying several parameters to obtain the highest dependability. Two main metrics of interest in the dependability of a surveillance system including reliability and availability were analyzed in a comprehensive manner. The analysis results show that the variation in the number of long-term evolution (LTE)-based stations contributes to a number of nines (#9s) increase in availability. The obtained results show that the variation of the mean time to failure (MTTF) of surveillance cameras exposes a high impact on the reliability of the system. The findings of this work have the potential of assisting system architects in planning more optimized systems in this field based on the proposed models.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

On the absorption probabilities and mean time for absorption for discrete Markov chains

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Nikolaos Halidias
Keyword(s):  
Markov Chain ◽  
Random Walk ◽  
Markov Chains ◽  
Generating Function ◽  
Discrete Time ◽  
Probability Generating Function ◽  
The Mean ◽  
Mean Time ◽  
Absorption Probabilities

Abstract In this note we study the probability and the mean time for absorption for discrete time Markov chains. In particular, we are interested in estimating the mean time for absorption when absorption is not certain and connect it with some other known results. Computing a suitable probability generating function, we are able to estimate the mean time for absorption when absorption is not certain giving some applications concerning the random walk. Furthermore, we investigate the probability for a Markov chain to reach a set A before reach B generalizing this result for a sequence of sets A 1 , A 2 , … , A k {A_{1},A_{2},\dots,A_{k}} .

scholarly journals What is the value of the 60‐minute cortisol measurement in the short synacthen test (SST)? Evidence for the defence

2021 ◽  
Vol 75 (8) ◽  
Author(s):  
Maria Michaelidou ◽  
Ghasem Yadegarfar ◽  
Lauren Morris ◽  
Samantha Dolan ◽  
Adam Robinson ◽  
...  
Keyword(s):  
Synacthen Test ◽  
Short Synacthen Test
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