scholarly journals Association of Different Interventions to Increase Leukocyte Testing During Treatment With Dimethyl Fumarate

2021 ◽  
Author(s):  
Paul Heidenreich ◽  
Anju Sahay ◽  
Shoutzu Lin ◽  
Parisa Gholami ◽  
Mary Goldstein ◽  
...  
Keyword(s):  
At Risk ◽  
Blood Cell ◽  
White Blood Cell ◽  
Action Plan ◽  
Dimethyl Fumarate ◽  
Academic Detailing ◽  
Provider Education ◽  
Patients At Risk ◽  
The Mean ◽  
Clinical Reminders

Abstract Background: Dimethyl fumarate (DMF), a treatment for multiple sclerosis, may cause leukopenia and infection. Accordingly, periodic white blood cell (WBC) monitoring is recommended. We sought to evaluate the VA Medication Use Evaluation Tracker (MUET) initiative which provides VA facilities with a list of patients prescribed DMF therapy without a documented white blood cell count (WBC).Methods: We identified 118 VA facilities with patients treated with DMF from 1/1/2016 through 9/30/2016. We determined WBC measurements within three months of the first filled prescription. The lead pharmacist at each facility was surveyed asking if any of seven intervention types were used to improve WBC monitoring (academic detailing, provider education without academic detailing, electronic clinical reminders, request for provider action plan, draft orders for WBC monitoring, patient mailings, and patient calls).Results: The facility response rate for the survey was 78% (92 of 118 facilities). For the 92 included facilities (1,115 patients) the mean rate of WBC monitoring was 54%. Use of the at-risk patient lists was noted in 55% (51/92) of facilities. In multivariate analysis, only academic detailing and provider education remained significantly associated with higher WBC monitoring. From a base WBC monitoring rate of 46%, academic detailing increased the rate by 17% (95% CI 4 to 30%, p=0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, p=0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2%-6.4%, p=0.005).Conclusions: Interventions focused on the physician, including academic detailing, were associated with improved WBC monitoring for patients at risk for leukopenia from dimethyl fumarate treatment.

scholarly journals Interventions to Increase Leukocyte Testing during Treatment with Dimethyl Fumarate

2021 ◽  
Vol 18 (19) ◽  
pp. 10312
Author(s):  
Paul A. Heidenreich ◽  
Shoutzu Lin ◽  
Parisa Gholami ◽  
Von R. Moore ◽  
Muriel L. Burk ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Action Plan ◽  
Dimethyl Fumarate ◽  
Academic Detailing ◽  
Provider Education ◽  
Department Of Veteran Affairs ◽  
The Us ◽  
Patients At Risk ◽  
The Mean

Dimethyl fumarate (DMF), a treatment for multiple sclerosis, may cause leukopenia and infection. Accordingly, periodic white blood cell (WBC) monitoring is recommended. We sought to evaluate the US Department of Veteran Affairs’ safety program which provides facilities with a list of patients prescribed DMF therapy without a documented white blood cell count (WBC). We identified 118 sites with patients treated with DMF from 1/1/2016 through 9/30/2016. Each site was asked if any of seven interventions were used to improve WBC monitoring (academic detailing, provider education without academic detailing, electronic clinical reminders, request for provider action plan, draft orders for WBC monitoring, patient mailings, and patient calls). The survey response rate was 78%. For the 92 responding sites (78%) included sites (1115 patients) the mean rate of WBC monitoring was 54%. In multivariate analysis, academic detailing increased the rate by 17% (95% CI 4 to 30%, p = 0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, p = 0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2–6.4%, p = 0.005). Interventions focused on the physician, including academic detailing, were associated with improved WBC monitoring for patients at risk for leukopenia from DMF treatment.

scholarly journals Decrease in white blood cell counts after thiopentone barbiturate therapy for refractory intracranial hypertension: A common complication

2013 ◽  
Vol 04 (S 01) ◽  
pp. S31-S34 ◽  
Author(s):  
Shin Yi Ng ◽  
Ki Jinn Chin ◽  
Tong Kiat Kwek
Keyword(s):  
Statistical Analysis ◽  
Blood Cell ◽  
Intracranial Hypertension ◽  
White Blood Cell ◽  
Retrospective Review ◽  
T Test ◽  
Barbiturate Coma ◽  
Barbiturate Therapy ◽  
The Mean ◽  
Wbc Count

ABSTRACT Background: Leucopenia has been reported after induction of thiopentone barbiturate therapy for refractory intracranial hypertension. However, the incidence and characterisitics are not well described. Aims: We performed a retrospective review to describe the incidence and characteristics of leucopenia after induction of thiopentone barbiturate therapy. Setting and Design: Our centre is a national referral centre for neurotrauma and surgery in a tertiary medical institution.Materials and Methods: We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18 month period from January 2004 to June 2005 in our neurosurgical intensive care unit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 15.0. All data are reported as mean ± standard deviation or median (interquartile range). The Chi square test was used to analyze categorical data and student t test done for comparison of means. For paired data, the paired t?test was used.-test was used. Results: Thirty eight (80.9%) out of 47 patients developed a decrease in white blood cell (WBC) count after induction of thiopentone barbiturate coma. The mean decrease in WBC from baseline to the nadir was 6.4 × 10 9 /L (P <lt; 0.001) and occurred 57 (3-147) h after induction. The mean nadir WBC was 8.6 < 3.6 × 10 9 /L. Three (6.4%) patients were leucopenic, with a WBC count of 2.8, 3.1, and 3.6 < 10 9 /L. None of them were neutropenic. We did not find an association between decrease in WBC count and clinical diagnosis of infection. We did not find any association between possible risk factors such as admission GCS, maximum ICP prior to induction of barbiturate coma, APACHE II score, total duration and dose of thiopentone given, and decrease in WBC count. Conclusions: Decrease in WBC count is common, while development of leucopenia is rare after thiopentone barbiturate coma. Regular monitoring of WBC counts is recommended.

Early and Late Hypocalcaemia After Total Thyroidectomy Prospective Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Emad EL-Deen Farid Ibrahim ◽  
Osama Mohamed Abdo Abo Gazya ◽  
Hesham Mohamed Ali Omran ◽  
Amr Hamed Afifi Ali ◽  
Mina Gad Shenouda
Keyword(s):  
At Risk ◽  
Total Thyroidectomy ◽  
Calcium Level ◽  
Ionized Calcium ◽  
Thyroid Resection ◽  
Patients At Risk ◽  
The Mean ◽  
Not At Risk ◽  
Symptoms And Signs ◽  
Postoperative Hypocalcaemia

Abstract Background Hypocalcaemia post total thyroidectomy, is one of the most common complication observed in patients who undergo bilateral thyroid resection. Although hypocalcaemia is self-limiting in most patients and does not require treatment, symptomatic hypocalcaemia is of particular concern. We aimed to evaluate the incidence of hypocalcaemia post total thyroidectomy with evaluation of serum calcium levels as a cheap and available method so we can identify patients at risk of postoperative hypocalcaemia who require supplementation treatment, and those not at risk who can be safely discharged without any supplementation treatment. Objective To assess the incidence of postoperative hypocalcaemia post total thyroidectomy wither it’s temporary or permanent. Methods prospective analysis of 100 patients undergoing total thyroidectomy. Preservation of parathyroid glands and their blood supply was attempted in all cases. The patients were assessed for manifestations of hypocalcaemia after thyroidectomy. The assessment was done through: (1) monitoring the total and ionized calcium level 24 hours postoperatively, (2) Total and ionized calcium level was measured in the third week postoperative, (3) clinical examination and detection of symptoms and signs of hypocalcaemia, (4) In resistant cases assessment of total and ionized calcium and PTH at 3 and 6 months. Results The study included 87 females and 13 males, 37 was the mean age; 15 patients developed symptoms of hypocalcaemia (15%), 8 of them were asymptomatic but 7 of them developed symptoms, 85 patients did not develop any clinically manifested symptoms of hypocalcaemia (85%). all of them recovered from hypocalcaemia except 2 patients, one of them recovered at 3 months postoperative and the other one didn’t recover from hypocalcaemia so we diagnose it’s case as a permanent hypocalcaemia post total thyroidectomy. Conclusion Results of this study indicate that measuring calcium postoperative is a cheap and available lab investigation to indicate hypocalcaemia post total thyroidectomy, and as we mentioned before that we don’t need to prescribe calcium or vitamin D to all the patients underwent total thyroidectomy as an empirical treatment to prevent hypocalcaemia but we prescribe it just to patients developed symptoms of hypocalcaemia as it will be costly to the patient.

scholarly journals 262 Training and Use of the 4AT by a Multi-disciplinary Team to Screen for Delirium in the Frail Adult

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siobhan Ryan ◽  
Eamonn Cooney ◽  
Karen Sayers ◽  
Aine O'Reilly ◽  
Jennifer Maher ◽  
...  
Keyword(s):  
At Risk ◽  
Visual Impairment ◽  
Functional Decline ◽  
Interdisciplinary Team ◽  
Interdisciplinary Teams ◽  
Community Dwelling ◽  
Patients At Risk ◽  
The Mean ◽  
The Relationship ◽  
Multi Disciplinary Team

Abstract Background Detection of delirium risk may improve outcomes. We assessed the prevalence of patients at risk of delirium assessed by a trained interdisciplinary team. Methods An interdisciplinary team: dietitian, physiotherapist and speech and language therapist was trained to use the 4AT. Community dwelling patients, identified as frail during triage in a hospital emergency department, were assessed including a 4AT, over a 2 month period. Age, gender, Clinical Frailty Score (CFS), 4AT, Modified Barthel index (mBI), polypharmacy (as defined by 5 or more medications) and presence of hearing or visual impairment were entered onto Excel. Performance of the 4AT was at the discretion of the assessor. Results 150 consecutive patients were assessed. The mean(SD) age was 83(5.1). Female to male ratio was 1.2:1. Mean(SD) CFS was 5.6(1.0). 29(19%) patients did not have a 4AT performed. 63(42%) patients had a 4AT of 1-3. 16(11%) patients had a 4AT of 4 or greater. 42(28%) had a 4AT of zero. Patients with a 4AT 4 or greater were older, mean(SD) age 86(4.2)years. Polypharmacy was present in 10(60%) patients with 4AT 4 or greater and 40(38%) with 4AT less than 4. 10(60%) of patients with 4AT 4 or greater had hearing and visual impairment. 16(15%) patients with a 4AT less than 4 had hearing and visual impairment. 10(60%) of patients with 4AT 4 or greater had a reduction in mBI. 33(31%) of patients with a 4AT less than 4 had a reduction in mBI. Conclusion Interdisciplinary teams can screen for delirium risk in ED. Frail patients at risk of delirium are older, have higher rates of polypharmacy, visual and hearing impairment and functional decline. It is possible to evaluate delirium in ED. Further work is needed to explore the relationship between the 4AT and frailty.

scholarly journals Usefulness of measuring radiographic density of axis vertebra in patients at risk of osteoporosis: A cone-beam computed tomography study

2018 ◽  
Vol 12 (04) ◽  
pp. 496-501
Author(s):  
Mustafa Alkhader ◽  
Mohammad S. Alrashdan ◽  
Yousef Khader
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
High Risk ◽  
Cone Beam Computed Tomography ◽  
Predictive Power ◽  
Mean Value ◽  
Low Risk ◽  
Cone Beam ◽  
Patients At Risk ◽  
The Mean

ABSTRACT Objective: Using cone-beam computed tomography (CBCT) images, the aim of the study was to evaluate the usefulness of measuring radiographic density of the axis vertebra (RDAV) in patients at risk of osteoporosis. Materials and Methods: Two hundred and forty-seven old patients (109 males and 138 females) aged between 50 and 80 years (mean age: 59.68 ± 7.27) were examined by CBCT. Using InVivoDental, v. 5.0 (Anatomage Inc., San Jose, CA), RDAV and mental index (MI) were measured twice and correlated using Pearson's correlation coefficients. Patients were divided into two categories: high risk and low risk of osteoporosis using 3.1 mm of MI as a cutoff value, and the mean value of RDAV was compared and correlated using independent samples' t-test and regression analysis. Receiver-operating characteristic (ROC) curve analysis was also used to examine the predictive power of RDAV. Results: The mean value of RDAV was moderately correlated with MI (r = 0.32), and in patients at low risk of osteoporosis, the mean value of RDAV was significantly higher than in patients at high risk of osteoporosis. In multivariate binary logistic regression, the odds of being at risk of osteoporosis decreased by 1% with one unit increase in RDAV (odds ratio = 0.988, 95% confidence interval: 0.983–0.993; P < 0.005). ROC analysis showed that the mean value of RDAV had a high predictive power for predicting patients at risk of osteoporosis (area under the curve = 0.761 for females and 0.649 for males). Conclusions: Measuring RDAV is considered useful in predicting patients at risk of osteoporosis.

scholarly journals A Comparison of Hematologic Parameters in Patients with Sickle Cell Disease Undergoing Red Cell Exchange Using Terumo BCT Spectra Optia and COBE Spectra Apheresis Systems

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4743-4743
Author(s):  
Nahal Rose Lalefar ◽  
Ward Hagar
Keyword(s):  
Sickle Cell Disease ◽  
Blood Cell ◽  
Sickle Cell ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Adult Patients ◽  
Cell Disease ◽  
Blood Cell Count ◽  
Platelet Counts ◽  
The Mean

Abstract Introduction: Therapeutic red blood cell exchange (RBCX) is a process by which diseased red cells are replaced by healthy donor red blood cells. In patients with sickle cell disease, RBCX has been used to treat acute stroke, severe acute chest syndrome, multiorgan failure, priapism and splenic sequestration. It is also being used more commonly in the prevention of vaso-occlusive pain crises and for stroke prophylaxis for patients considered to be at high risk of stroke based on abnormal transcranial Doppler flow rates. In May 2014, we transitioned from the COBE Spectra apheresis system (Terumo BCT) to the next-generation Spectra Optia apheresis system (Terumo BCT) for all red cell exchange transfusions performed on our patients with sickle cell disease. A previous small study (n = 33 RBCX transfusions) compared the two instruments (Caridian BCT) and showed no difference between exchange volumes, processing time, pre and post-exchange hematocrit and HbS levels (Perseghin et al. Transfusion and Apheresis Science, 2013). However, other clinical parameters such as changes in white blood cell count and platelet counts were not examined. In order to determine if there were any differences in hematologic parameters between the 2 apheresis instruments, we measured the differences between pre and post-exchange HbS levels, white blood cell count (WBC), hematocrit (Hct), and platelet counts for all of our adult patients who underwent RBCX transfusions on both instruments. Methods: This was a single institution, retrospective chart review of all adult patients with sickle cell disease (HbSS n=17, HbS/β0 thalassemia n = 1, HbSC n =1) who underwent routine, monthly RBCX at Children's Hospital and Research Center Oakland between November 2013 and February 2015. Indications for RBCX included a risk of stroke or a history of stroke, acute chest syndrome, or renal failure. All patients received RBCX transfusions on the COBE Spectra prior to May 2014 and were then transitioned to Spectra Optia in May 2014. Pre and post-exchange transfusion HbS levels, WBC, Hct, and platelet counts were measured for each procedure. All exchange transfusions were non-emergent and well tolerated. Statistical analyses using the student's t test and rank sum test were performed with Stata 14.0 software (College Station, Texas). Results: A total of 19 adult patients (mean average age 25 years old) underwent 153 red blood cell exchange transfusions (Spectra Optia n =87, COBE Spectra n = 66). There was a small increase in mean hematocrit percentage for both instruments (28.33 + 4.3 % to 29 + 3.06 % and 28.16 + 4.29% to 29.2 + 3.04% on the Spectra Optia and COBE Spectra, respectively). All other post-RBCX parameters decreased. The mean changes are shown in Table I. The HbS percent decreased from a combined mean of 39.86 + 12.11 % to 20.26 + 8.43 % for both instruments. The WBC decreased from a combined mean of 12.72 + 3.13 x 1000/ mm3 to 8.67 + 2.15 x 1000/ mm3. The platelet count decreased from a combined mean of 368.82 + 125.75 x 1000/ mm3 to 191.01 + 62.78 x 1000/ mm3. The mean parameter values for each patient correlated with the mean changes for each instrument based on statistical analysis using both the student's t test and rank sum test. Conclusions: The starting hematologic values were similar between the two instruments. There was no statistical difference between the raw pre and post-RBCX HbS, Hct, WBC, or platelet values or the mean changes in these parameters between the COBE Spectra and Spectra Optia instruments. There was also no statistical difference in the mean changes between the pre and post RBCX hematologic parameters amongst the 19 patients. Both instruments allowed for effective reduction in HbS percentage with comparable decreases in WBC and platelet counts while maintaining adequate hematocrit values for all 19 adult patients with sickle cell disease. Table 1. Mean changes between Pre-RBCX and Post-RBCX. Instrument Change in % HbS Change in WBC x1000/mm3 Change in % Hct Change in platelet count x1000/mm3 Spectra Optia N 84 87 87 85 Mean -20.28 -4.01 0.67 -172.44 SD 7.02 2.55 2.86 76.98 COBE Spectra N 66 66 66 66 Mean -19.18 -4.12 1.09 -178.02 SD 7.89 2.26 2.57 81.02 p-value 0.37 0.78 0.34 0.67 There are 3 missing values for HbS and 2 missing values for platelet count for Spectra Optia. SD = standard deviation, WBC = white blood cell count, Hct = hematocrit Disclosures No relevant conflicts of interest to declare.

scholarly journals Surgical Site Infections in a Tertiary Referral Obstetric and Gynecologic Clinic Center in Istanbul and Review of the Literature

2018 ◽  
Vol 24 (1) ◽  
pp. 37
Author(s):  
Hale Goksever Celik ◽  
Engin Celik ◽  
Selin Dikmen ◽  
Merve Konal ◽  
Ali Gedikbasi
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Psychological Health ◽  
Wound Care ◽  
Surgical Site Infections ◽  
Abdominal Hysterectomy ◽  
Blood Cell Count ◽  
The Mean

<p><strong>Objective:</strong> The present study aimed to define characteristics of the patients who were readmitted with the diagnosis of surgical site infections after gynecologic or obstetric procedures and management of these patients. We also reviewed the literature in this context.</p><p><strong>Study design:</strong> We examined 120 patients with surgical site infections that had been hospitalized and managed medically and/or surgically between April 2014 and April 2015. Characteristics of the patients were recorded and analyzed.</p><p><strong>Results:</strong> The mean age of the patients was 33.4±11.8 years. The patients were readmitted for surgical site infections on the mean of 9.6±5.4 days after the first operation. The most frequent procedures resulted with SSI were cesarean delivery, abdominal hysterectomy and vaginal birth. When patients were compared according to these procedures, there were statistically significant differences regarding age, gravida, parity, preoperative white blood cell count, postoperative white blood cell count and antibiotics usage.</p><p><strong>Conclusion:</strong> Combining evidence-based surgical site infections prevention practices and clinician and patient cooperation will result in reduction in surgical site infections incidence following obstetric and gynecologic procedures. Because of economic burden and threat to the physical and psychological health of the patients, these modifiable risks should be recognized and surgical site infections should be minimized. After surgical site infections occurred, diagnosis and proper management with antibiotics and wound care with debridement and secondary suturing is important.</p>

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