scholarly journals Factors associated with treatment delays in pediatric refractory convulsive status epilepticus

Neurology ◽  
2018 ◽  
Vol 90 (19) ◽  
pp. e1692-e1701 ◽  
Author(s):  
I. Sánchez Fernández ◽  
M. Gaínza-Lein ◽  
N.S. Abend ◽  
A.E. Anderson ◽  
R. Arya ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Continuous Infusion ◽  
Pediatric Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Convulsive Status Epilepticus ◽  
Treatment Delays ◽  
Factors Associated

ObjectiveTo identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE).MethodsThis prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model.ResultsWe studied 219 patients (53% males) with a median (25th–75th percentiles [p25–p75]) age of 3.9 (1.2–9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p25–p75) time from seizure onset to treatment was 16 (5–45) minutes to first benzodiazepine (BZD), 63 (33–146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107–539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14–2.09; p = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11–2.04; p = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32–2.4; p = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67–3.02; p < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion.ConclusionIntermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.

scholarly journals Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

2016 ◽  
Vol 10 (9-10) ◽  
pp. 321 ◽  
Author(s):  
R. Christopher Doiron ◽  
Melanie Jaeger ◽  
Christopher M. Booth ◽  
Xuejiao Wei ◽  
D. Robert Siemens
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Long Term Outcomes ◽  
Cancer Specific Survival ◽  
Factors Associated ◽  
Provider Volume

Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice.Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use.Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75‒0.96) and male sex (female sex RR 0.89, 95% CI 0.79‒0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87‒1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80‒1.03; p=0.136).Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC.

scholarly journals Predictors of infection, symptoms development, and mortality in people with SARS-CoV-2 living in retirement nursing homes

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248009
Author(s):  
Andrea De Vito ◽  
Vito Fiore ◽  
Elija Princic ◽  
Nicholas Geremia ◽  
Catello Mario Panu Napodano ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Chronic Obstructive ◽  
Angiotensin Ii Receptor ◽  
Neurological Syndrome ◽  
Factors Associated ◽  
Increased Risk

Introduction Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. Methods and findings We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student’s t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables’ influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab’s positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients’ autonomy and early heparin treatment were related to lower mortality risk. Conclusions We evidenced factors associated with infection’s risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.

scholarly journals Factors Associated With U.S. Army Physician Service After Obligation Completion

2018 ◽  
Vol 184 (7-8) ◽  
pp. e329-e336 ◽  
Author(s):  
Andrew R Wiesen ◽  
Rodd E Marcum ◽  
Michele A Soltis ◽  
Kris A Peterson
Keyword(s):  
Medical School ◽  
Military Service ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Physician Service ◽  
Factors Associated ◽  
Significant Difference ◽  
Active Service

Abstract Introduction Approximately, 320 physicians enter active duty in the U.S. Army each year, replacing a similar number separating from service. Despite the significant costs involved in educating and training physicians, factors associated with continued active service after completing obligations have not been well studied. Materials and Methods A retrospective cohort study was conducted of all U.S. Army physicians who graduated medical school in 1987 or later and entered active physician service on or before December 31, 2015. A Cox proportional hazards model was used to evaluate the likelihood of continued service after initial obligations to the Army were satisfied. A logistic regression model examined the likelihood of reaching retirement eligibility for the subgroup entering service before October 1998. Results Of the 10,490 physicians who met inclusion criteria, 8,009 physicians completed their service obligation by the end of the study. There were 4,524 physicians who entered service before October 1998 and were eligible for the retirement analysis. Several factors were found to be independently associated with a higher likelihood of continued post-obligation service and reaching retirement eligibility. These factors were: years of active service accumulated when obligations were complete; preventive medicine and infectious disease specialization; and male gender. Conclusions The physicians most likely to continue serving after completion of their obligation and ultimately retire are those who had the most years of service accumulated when they could leave the Army. Graduates from the Uniformed Services University of the Health Sciences (USU) incur an obligation of 7 years vs. 4 years for most other programs. USU also attracts a higher proportion of applicants with prior military service and pre-medical school service obligations. The lack of significant difference in service after obligation completion or achievement of retirement eligibility between USU and non-USU graduates was explained by the greater total service of USU graduates when their obligations were complete. Changing the obligation and incentives, such as salary, for other accessioning programs to mirror the USU model would likely minimize service differences between USU and non-USU graduates.

scholarly journals Unplanned Reoperation After Trapeziometacarpal Arthroplasty: Rate, Reasons, and Risk Factors

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. 446-452 ◽  
Author(s):  
Suzanne C. Wilkens ◽  
Zichao Xue ◽  
Jos J. Mellema ◽  
David Ring ◽  
Neal Chen
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Persistent Pain ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Hazards Model ◽  
Kaplan Meier

Background: Trapeziometacarpal (TMC) arthritis is an expected part of ageing to which most patients adapt well. Patients who do not adapt to TMC arthritis may be offered operative treatment. The factors associated with reoperation after TMC arthroplasty are incompletely understood. The purpose of this study was to determine the rate of, the underlying reasons for, and the factors associated with unplanned reoperation after TMC arthroplasty. Methods: In this retrospective study, we included all adult patients who had TMC arthroplasty for TMC arthritis at 1 of 3 large urban area hospitals between January 2000 and December 2009. Variables were inserted into a multivariable Cox proportional hazards model to determine factors associated with unplanned reoperation, and the Kaplan-Meier curve was used to estimate and describe the probability of unplanned reoperation over time. Results: Among 458 TMC arthroplasties, 19 (4%) had an unplanned reoperation; 16 of 19 (84%) for persistent pain and two-thirds within the first year. The multivariate Cox regression analysis showed that unplanned reoperation was independently associated with younger age, surgeon inexperience, and index procedure type. Conclusions: Surgeons should be aware as well as patients should be informed that as many as 4% are offered or request a second surgery, usually for persistent pain and often within the 1-year window when additional improvement is anticipated.

Abstract TP341: Risk Factors of Seizure Recurrence in First-ever Post-stroke Seizure

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shinya Tomari ◽  
Tomotaka Tanaka ◽  
Takayuki Matsuki ◽  
Kazuki Fukuma ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Clinical Characteristics ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Neurological Deterioration ◽  
Seizure Recurrence ◽  
Post Stroke

Background: Both early seizure (ES) and late seizure (LS) are common complications after stroke. However, clinical characteristics, treatments and recurrences after ES/LS remain unclarified. Methods: We enrolled the patients with first-ever post-stroke seizures between July 2010 and June 2014, and followed up until June 2015. Seizures were classified into ES (within one week after stroke) and LS (the second week or later). We compared baseline clinical characteristics, status epilepticus, surgery (removal of hematoma, ventricular drainage), neurological deterioration by index stroke (defined as an increase of the NIHSS score by one or more between the baseline and at hospital discharge), and duration of antiepileptic drug (AED) therapy between two groups. We also investigated factors (patients’ background and treatment of seizure) that determined the seizure recurrence after discharge. Results: Clinical data were collected for 153 patients (82 men; age, 73.7±12.3, 73 intracerebral hemorrhage and 80 ischemic stroke). ES occurred in 62 and LS in 91 patients. Patients with LS more commonly received surgery (ES 3% vs. LS 17%, p=0.008) and more commonly had neurological deterioration (ES 71% vs. LS 87%, p=0.02) than those with ES. LS received AED therapy more frequently both during hospitalization (ES 71% vs. LS 94%, p=0.0003) and after hospitalization (ES 49% vs. LS 92%, p<0.0001). Seizure recurred in 56 patients (14 ES, 41 LS) after discharge during a median follow-up of 29 months. In a multivariate Cox proportional-hazards model of these patients, independent predictors of recurrence included status epilepticus (HR 2.28,95% CI 1.08-5.17) and LS (HR 3.62,95% CI 1.11-10.09)(p<0.05, respectively). Conclusion: Status epilepticus and LS were risk factors of seizure recurrence in first-ever post-stroke seizure.

scholarly journals Timing of syrinx reduction and stabilization after posterior fossa decompression for pediatric Chiari malformation type I

2020 ◽  
Vol 26 (2) ◽  
pp. 193-199
Author(s):  
Silky Chotai ◽  
Emily W. Chan ◽  
Travis R. Ladner ◽  
Andrew T. Hale ◽  
Stephen R. Gannon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Hazards Model

OBJECTIVEThe aim of this study was to determine the timeline of syrinx regression and to identify factors mitigating syrinx resolution in pediatric patients with Chiari malformation type I (CM-I) undergoing posterior fossa decompression (PFD).METHODSThe authors conducted a retrospective review of records from pediatric patients (< 18 years old) undergoing PFD for the treatment of CM-I/syringomyelia (SM) between 1998 and 2015. Patient demographic, clinical, radiological, and surgical variables were collected and analyzed. Radiological information was reviewed at 4 time points: 1) pre-PFD, 2) within 6 months post-PFD, 3) within 12 months post-PFD, and 4) at maximum available follow-up. Syrinx regression was defined as ≥ 50% decrease in the maximal anteroposterior syrinx diameter (MSD). The time to syrinx regression was determined using Kaplan-Meier analysis. Multivariate analysis was conducted using a Cox proportional hazards model to determine the association between preoperative, clinical, and surgery-related factors and syrinx regression.RESULTSThe authors identified 85 patients with CM-I/SM who underwent PFD. Within 3 months post-PFD, the mean MSD regressed from 8.1 ± 3.4 mm (preoperatively) to 5.6 ± 2.9 mm within 3 months post-PFD. Seventy patients (82.4%) achieved ≥ 50% regression in MSD. The median time to ≥ 50% regression in MSD was 8 months (95% CI 4.2–11.8 months). Using a risk-adjusted multivariable Cox proportional hazards model, the patients who underwent tonsil coagulation (n = 20) had a higher likelihood of achieving ≥ 50% syrinx regression in a shorter time (HR 2.86, 95% CI 1.2–6.9; p = 0.02). Thirty-six (75%) of 45 patients had improvement in headache at 2.9 months (IQR 1.5–4.4 months).CONCLUSIONSThe maximum reduction in syrinx size can be expected within 3 months after PFD for patients with CM-I and a syrinx; however, the syringes continue to regress over time. Tonsil coagulation was associated with early syrinx regression in this cohort. However, the role of surgical maneuvers such as tonsil coagulation and arachnoid veil identification and sectioning in the overall role of CM-I surgery remains unclear.

scholarly journals 442. Sex-Related Differences in Mortality from COVID-19: Survival Analysis of Patients from an Urban Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S323-S323
Author(s):  
Mamta Sharma ◽  
Susan M Szpunar ◽  
Ashish Bhargava ◽  
Leonard B Johnson ◽  
Louis Saravolatz
Keyword(s):  
Risk Factors ◽  
Survival Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Factors Associated ◽  
Hazards Model ◽  
Cox Proportional Hazards Models ◽  
Failure Assessment

Abstract Background Mortality from COVID-19 is associated with male sex, older age, black race, and comorbidities including obesity. Our study identified risk factors for in-hospital mortality from COVID-19 using survival analysis at an urban center in Detroit, MI. Methods This was a single-center historical cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase-chain-reaction assay, who were admitted between 3/8-6/14/20. We assessed risk factors for mortality using Kaplan-Meier analysis and Cox proportional hazards models. Results We included 565 patients with mean age (standard deviation) 64.4 (16.2) years, 52.0% male (294) and 77.2% (436) black/African American. The overall mean body mass index (BMI) was 32.0 (9.02) kg/m2. At least one comorbidity was present in 95.2% (538) of patients. The overall case-fatality rate was 30.4% (172/565). The unadjusted mortality rate among males was 33.7% compared to 26.9% in females (p=0.08); the median time to death (range) for males was 16.8 (0.3, 33.9) compared to 14.2 (0.32, 47.7) days for females (p=0.04). Univariable survival analysis with Cox proportional hazards models revealed that age (p=&lt; 0.0001), admission from a facility (p=0.002), public insurance (p&lt; 0.0001), respiratory rate ≥ 22 bpm (p=0.02), lymphocytopenia (p=0.07) and serum albumin (p=0.007) were additional risk factors for mortality (Table 1). From multivariable Cox proportional hazards modeling (Table 2), after controlling for age, Charlson score and qSofa, males were 40% more likely to die than females (p=0.03). Table 1. Univariate analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19 Abbreviations: HR: Hazard ratio, CI: Confidence interval Table 2. Multivariable analysis with Cox proportional hazards model on factors associated with mortality in patients with COVID-19 Abbreviations: HR: Hazard ratio, CI: Confidence interval, CWIC: Charlson weighted index of comorbidity, qSOFA: Quick sepsis related organ failure assessment Conclusion After controlling for risk factors for mortality including age, comorbidity and sepsis-related organ failure assessment, males continued to have a higher hazard of death. These demographic and clinical factors may help healthcare providers identify risk factors from COVID-19. Disclosures All Authors: No reported disclosures

scholarly journals Understanding the Correlates of Under-five Mortality in Sudan Using Survey Survival Models

2020 ◽  
pp. 55-68
Author(s):  
Dawit Getnet Ayele ◽  
Ali Satty ◽  
Temesgen Zewotir
Keyword(s):  
Public Health ◽  
Child Mortality ◽  
Urban Areas ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Under Five ◽  
Factors Associated ◽  
Hazards Model

Under-five mortality is among the major public health problems in developing countries, the rate of which is an important factor for a country’s development. For this reason, under-five mortality status is an important outcome to measure for children’s health. This study uses the Cox proportional-hazards model to identify risk factors associated with under-five mortality in Sudan. This study uses the 2014 Sudan Multiple Indicator Cluster Survey (MICS) conducted by the Central Bureau of Statistics in collaboration with several national institutions. The survival Cox proportional-hazards model was used to identify factors that affect under-five child mortality in Sudan. The results show that the weight of a child at birth is positively associated with the under-five child mortality rate. Under-five children who have both small and large weights at birth are at a higher risk of dying before reaching five years. Based on demographic factors associated with under-five mortality, our analysis showed that mothers who were married at the time of the survey are most likely to have higher under-five child mortality as compared to formerly married mothers. In addition to this, that mother’s age at the time of the birth is significantly associated with under-five mortality. Based on the result, the lack of important policies targeting the reduction of socioeconomic inequalities between rural and urban areas is the major problem of public health interventions to improve child health and survival in Sudan.

Predictors of falls and fractures in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with apalutamide (APA) plus ongoing androgen deprivation therapy (ADT).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5025-5025 ◽  
Author(s):  
YaoYao Guan Pollock ◽  
Matthew Raymond Smith ◽  
Fred Saad ◽  
Simon Chowdhury ◽  
Stephane Oudard ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Older Age ◽  
Free Survival ◽  
Factors Associated ◽  
Hazards Model ◽  
Low Serum

5025 Background: SPARTAN, a phase 3 study of APA vs placebo (PBO) added to ongoing ADT in pts with nmCRPC, demonstrated that APA significantly prolongs metastasis-free survival, time to symptomatic progression, and second progression free survival (Smith et al. NEJM 2018), with no decline in health-related quality of life (Saad et al. Lancet Oncol 2018). SPARTAN pts who received APA, vs PBO, with ongoing ADT had higher rates of falls (15.6% vs 9.0%) and fractures (11.7% vs 6.5%). An analysis was performed to identify clinical characteristics associated with falls and fractures in APA-treated SPARTAN pts. Methods: Of 1207 pts enrolled, 806 were randomized to APA. Univariate Cox proportional hazards model (UVA) assessed the association of 47 baseline clinical characteristics (demographics, comorbidities, and medication use, including bone-sparing agents) with time to fall or time to fracture. Characteristics with p values < 0.10 were included in a multivariate Cox proportional hazards model (MVA) to determine independent factors associated with these outcomes (p < 0.05). Results: Factors associated with time to both fall and fracture on UVA (p < 0.10) included older age, low serum albumin, and poor ECOG performance status (PS). Additional factors associated with time to fall were cerebrovascular accidents/transient ischemic attacks, neuropathy, depression, α-blocker use, and antidepressant use. On MVA, older age, poor ECOG PS, history of neuropathy, and α-blocker use were independently associated with falls; older age and low serum albumin were independently associated with fractures (Table). Conclusions: At initiation of APA added to ongoing ADT, nmCRPC pts with higher risk of falls and fractures can be identified and are candidates for intervention to reduce the risk for these events. Clinical trial information: NCT01946204. [Table: see text]

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