Appropriateness in Echocardiography

2012 ◽  
Vol 8 (1) ◽  
pp. 23
Author(s):  
Rosa Sicari ◽  
Lauro Cortigiani ◽  
◽  
Keyword(s):  
Clinical Practice ◽  
Clinical Outcomes ◽  
Present Article ◽  
Healthcare System ◽  
Routine Clinical Practice ◽  
Appropriateness Criteria ◽  
Inappropriate Use ◽  
Non Invasive ◽  
Contemporary Medicine ◽  
The Impact

Appropriateness is the new imperative of contemporary medicine. In the words of the American College of Cardiology Foundation (ACCF), ‘Appropriate echocardiograms are those that are likely to contribute to improving patients’ clinical outcomes, and importantly, inappropriate use of echocardiography may be potentially harmful to patients and generate unwarranted costs to the healthcare system’. The appropriateness criteria issued by the ACCF stem from a real practical need to reduce costs and avoid the abuse and misuse of non-invasive imaging technologies. Even though very often cited and referred to, these criteria have not yet had a real impact on routine clinical practice. The present article assesses the impact of the ACCF criteria on the basis of the available evidence.

scholarly journals The impact of dose modification and temporary interruption of ibrutinib on outcomes of chronic lymphocytic leukemia patients in routine clinical practice

2020 ◽  
Vol 9 (10) ◽  
pp. 3390-3399 ◽  
Author(s):  
Sameer A. Parikh ◽  
Sara J. Achenbach ◽  
Timothy G. Call ◽  
Kari G. Rabe ◽  
Wei Ding ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chronic Lymphocytic Leukemia ◽  
Routine Clinical Practice ◽  
Lymphocytic Leukemia ◽  
Dose Modification ◽  
The Impact

Clinical outcomes and patient (pt) profiles in REASSURE: An observational study of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 32-32
Author(s):  
Celestia S. Higano ◽  
Fred Saad ◽  
A. Oliver Sartor ◽  
Kurt Miller ◽  
Peter Conti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Practice ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Bone Fractures ◽  
Bone Marrow Suppression ◽  
Routine Clinical Practice ◽  
Metastatic Sites

32 Background: Ra-223 is a targeted alpha therapy that showed a survival advantage and favorable safety profile in the phase 3 ALSYMPCA trial in pts with mCRPC. REASSURE (NCT02141438) is evaluating the long-term safety of Ra-223 in routine clinical practice in pts with mCRPC over a 7-year follow-up period. Methods: In this global, prospective, single-arm, observational study, the second prespecified interim analysis (data cut-off March 2019) evaluated safety and clinical outcomes of Ra-223 in pts with mCRPC. Primary outcome measures were incidence of second primary malignancies (SPM), bone marrow suppression and short- and long-term safety in pts who had ≥1 Ra-223 dose. Secondary outcomes included overall survival (OS). Results: For 1465 pts in the safety analysis, median follow up was 11.5 months. Median PSA (n=1053), ALP (n=1048), and LDH (n=555) levels at baseline were 59 ng/mL, 135 U/L, and 269 U/L, respectively. 81% of pts had bone metastases only at baseline; 19% of pts had other metastatic sites, mostly in the lymph nodes. 19% of pts had <6 metastatic sites, 47% had 6–20 sites, 20% had >20 lesions but not a superscan, and 6% had a superscan. 45%, 38%, 37%, 9%, and 8% of pts received prior abiraterone, docetaxel, enzalutamide, cabazitaxel, or sipuleucel-T as prior therapies, respectively. Median number of Ra-223 doses received was 6; 67% of pts had ≥5 doses. SPM occurred in 1% of pts. The most common treatment-emergent drug-related adverse event (AE) of any grade was diarrhea (11%). 10% of pts had a bone-associated event, 5% had fractures, and 15% had a hematological AE. Median OS was 15.6 months (95% CI 14.6–16.5). Conclusions: In REASSURE, there was a low incidence of SPM, bone fractures, and bone marrow suppression after Ra-223 treatment, with no new AEs identified. This study confirms that in routine clinical practice, Ra-223 AE rates were low, and pts generally received ≥5 doses. Clinical trial information: NCT02141438. [Table: see text]

scholarly journals Auricular Neuromodulation for Mass Vagus Nerve Stimulation: Insights From SOS COVID-19 a Multicentric, Randomized, Controlled, Double-Blind French Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Claire-Marie Rangon ◽  
Régine Barruet ◽  
Abdelmadjid Mazouni ◽  
Chloé Le Cossec ◽  
Sophie Thevenin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vagus Nerve ◽  
Clinical Outcomes ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Treated Patient ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Non Invasive ◽  
The Impact

Importance: An exacerbated inflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is believed to be one of the major causes of the morbidity and mortality of the coronavirus disease 2019 (COVID-19). Neuromodulation therapy, based on vagus nerve stimulation, was recently hypothesized to control both the SARS-CoV-2 replication and the ensuing inflammation likely through the inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells pathway and could improve the clinical outcomes as an adjunct treatment. We proposed to test it by the stimulation of the auricular branch of the vagus nerve, i.e., auricular neuromodulation (AN), a non-invasive procedure through the insertion of semipermanent needles on the ears.Objective: The aim of this study was to assess the effect of AN on the clinical outcomes in patients affected by COVID-19.Design, Setting, and Participants: A multicenter, randomized, placebo-controlled, double-blind clinical trial included 31 patients with respiratory failure due to COVID-19 requiring hospitalization. Within 72 h after admission, patients received either AN (n = 14) or sham neuromodulation (SN, n = 15) in addition to the conventional treatments.Main Outcome and Measures: The primary endpoint of the study was the rate of a clinical benefit conferred by AN at Day 14 (D14) as assessed by a 7-point Clinical Progression Scale. The secondary endpoint of the study was the impact of AN on the rate of transfer to the intensive care unit (ICU) and on the survival rate at D14.Results: The AN procedure was well-tolerated without any reported side effects but with no significant improvement for the measures of both primary (p &gt; 0.3) and secondary (p &gt; 0.05) endpoints at the interim analysis. None of the AN-treated patients died but one in the SN group did (81 years). Two AN-treated patients (73 and 79 years, respectively) and one SN-treated patient (59 years) were transferred to ICU. Remarkably, AN-treated patients were older with more representation by males than in the SN arm (i.e., the median age of 75 vs. 65 years, 79% male vs. 47%).Conclusion: The AN procedure, which was used within 72 h after the admission of patients with COVID-19, was safe and could be successfully implemented during the first two waves of COVID-19 in France. Nevertheless, AN did not significantly improve the outcome of the patients in our small preliminary study. It is pertinent to explore further to validate AN as the non-invasive mass vagal stimulation solution for the forthcoming pandemics.Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [NCT04341415].

THE IMPACT OF NUCLEAR IMAGING IN PATIENTS WITH ‘POSSIBLE’ INFECTIVE ENDOCARDITIS IN ROUTINE CLINICAL PRACTICE

2019 ◽  
Vol 73 (9) ◽  
pp. 1657
Author(s):  
Amit Kaura ◽  
Margaret Gunning ◽  
Amanda Fife ◽  
Ranjit Deshpande ◽  
Max Baghai ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infective Endocarditis ◽  
Nuclear Imaging ◽  
Routine Clinical Practice ◽  
The Impact

P054 Clinical outcomes in people with cystic fibrosis treated with lumacaftor/ivacaftor in routine clinical practice in Sweden

2021 ◽  
Vol 20 ◽  
pp. S54-S55
Author(s):  
A. Lindblad ◽  
I. de Monestrol ◽  
M. Gilljam ◽  
U. Lindberg ◽  
C. Krantz ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Routine Clinical Practice

scholarly journals 968. Effect of Outpatient Antibiotic Ordering Restrictions on Antibiotic Prescribing Patterns at a State-wide VA Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S32-S32
Author(s):  
Rohini Dave ◽  
Jacqueline Bork
Keyword(s):  
Healthcare System ◽  
Respiratory Infections ◽  
Outpatient Setting ◽  
Unintended Consequences ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Inappropriate Use ◽  
Amoxicillin Clavulanate ◽  
Rural Clinics ◽  
The Impact

Abstract Background Approximately 30% of antibiotics prescribed in the outpatient setting are inappropriate, mostly due to unnecessary prescriptions (Rx) for upper respiratory infections. Ordering restrictions is one approach to curtail inappropriate use. However, this approach may cause unintended consequences, such as increases in Rx of higher level antibiotics. This study evaluated the downstream effect of an azithromycin (AZM) ordering restriction. Methods This was a pre–post evaluation of the impact of an AZM removal (October 2017) on prescribing patterns of common outpatient antibiotics at the VA Maryland Healthcare System. AZM restriction was placed >10 years ago for concerns of emerging AZM resistance and overuse. During the study period, fluoroquinolone (FQ) use was scrutinized due to increasing toxicity risk. The proportion of several outpatient antibiotic Rx were compared between October 2017 and September 2018 (FY17) and October 2018 and September 30, 2018 (FY18) using χ 2 and logistic regression. FQ and AZM Rx were also stratified by location of prescribing clinic (urban vs. rural) and duration (≤14 days vs. >14 days). Results There were 15,972 and 14,451 prescriptions in FY17 and FY18, respectively. AZM Rx increased from 1,247 (7%) Rx in FY17 to 1,734 (11%) in FY18 (P < 0.0001) with an OR of 1.8 (95% CI 1.65–1.94). There was a greater effect on shorter than longer duration (OR 1.9 vs. 1.3, P < 0.0001), but no significant effect difference for urban and rural clinics (OR 1.8 vs. 1.9, P = 0.6). Conversely, FQ Rx decreased from 2,414 (15%) in FY17 to 1,731 (11%) in FY18 (P < 0.0001) with an OR of 0.7 (95% CI 0.66–0.76). There was a greater effect on shorter than longer duration (0.6 vs. 1.2, P < 0.0001) and also a greater effect on urban than rural clinics (OR 0.6 vs. 0.97, P < 0.0001). Doxycycline, amoxicillin–clavulanate and trimethoprim–sulfamethoxazole did not change significantly. Conclusion Removal of AZM restriction led to a significant decrease in FQ Rx, with greater effect in shorter duration and urban clinics, and an increase in AZM Rx, with greater effect in shorter duration, but no difference in clinic setting. Disparity of rural prescribers needs further exploration, as do other interventions outside of restrictive ordering, which needs periodic evaluation of risk and benefit if implemented. Disclosures All Authors: No reported Disclosures.

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