scholarly journals Impact of COVID-19 Infection Among Myasthenia Gravis Patients- a Cerner Real-world DataTM Study 

Author(s):  
Lakshmi Digala ◽  
Shivika Prasanna ◽  
Praveen Rao ◽  
Adnan Qureshi ◽  
Raghav Govindarajan

Abstract Background: Myasthenia gravis (MG) is an auto-immune disease, and the mainstay of therapy is immunomodulation. Such patients are at high risk of acquiring any infections. Hence, we sought to determine the impact of the current global pandemic COVID-19 infection in MG patients.Methods: For our study, we used Cerner Real-World DataTM that was provided through Cerner’s HealtheDataLab research tool. We ran a database query from January 2019 to July 2020 in our study. To extract these patients’ data, we used ICD 9-CM, ICD-10, and SNOMED-CT codes. We report data using means, range, and prevalence rates. The p-values were calculated using the two-sample t-test and Pearson’s chi-squared test. Results:In the COVID-19 data set, a total of twenty-seven myasthenia patients were identified with a positive COVID-19 infection, and four diagnosed with an exacerbation. Male to female ratio was equal and one unknown gender (3.7%) with a mean (± SD) age of 64.33 ± 18.42 years. This study group was compared with a non-COVID-19 data set in which a total of sixty-four myasthenia patients were identified, and twenty-three had an exacerbation. Among the hospitalized patients in the two groups, the mean length of hospitalization for all the myasthenia patients in the COVID-19 data set was 8.28 days (n=7), and the non-COVID-19 set was 4.33 days (n=6), and it was statistically significant (p-value= 0.007). Conclusion: The mean length of hospital stay is prolonged in Myasthenia patients who tested positive for COVID-19.

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1455
Author(s):  
Sunny R. K. Singh ◽  
Sindhu J. Malapati ◽  
Rohit Kumar ◽  
Christopher Willner ◽  
Ding Wang

Background: The incidence of invasive melanoma is rising, and approval for the first immune checkpoint inhibitor (ICI) to treat metastatic melanoma occurred in 2011. We aim to describe the epidemiology and outcomes in recent years, sociodemographic factors associated with the presence of metastasis at diagnosis, and the real‐world impact of ICI approval on survival based on melanoma subtype and race. Methods: This is a retrospective analysis of the National Cancer Database (NCDB) from the years 2004–2015. The primary outcome was the overall survival of metastatic melanoma by subtype. Secondary outcomes included sociodemographic factors associated with the presence of metastasis at diagnosis and the impact of treatment facility type and ICI approval on the survival of metastatic melanoma. Results: Of the 419,773 invasive melanoma cases, 93.80% were cutaneous, and 4.92% were metastatic at presentation. The odds of presenting with metastatic disease were higher in African Americans (AA) compared to Caucasians (OR 2.37; 95% CI 2.11–2.66, p < 0.001). Treatment of metastatic melanoma at an academic/research facility was associated with lower mortality versus community cancer programs (OR 0.75, 95 % CI 0.69–0.81, p-value<0.001). Improvement in survival of metastatic melanoma was noted for Caucasians after the introduction of ICI (adjusted HR 0.80, 95% CI 0.78–0.83, p < 0.001); however, this was not statistically significant for AA (adjusted HR 0.80, 95% CI 0.62–1.02, p‐value = 0.073) or ocular cases (HR 1.03, 95% CI 0.81–1.31, p‐value 0.797). Conclusion: Real‐world data suggest a 20% improvement in survival of metastatic melanoma since the introduction of ICI. The disproportionately high odds of metastatic disease at presentation in AA patients with melanoma suggest the need for a better understanding of the disease and improvement in care delivery.


2019 ◽  
Vol 10 (03) ◽  
pp. 409-420 ◽  
Author(s):  
Steven Horng ◽  
Nathaniel R. Greenbaum ◽  
Larry A. Nathanson ◽  
James C. McClay ◽  
Foster R. Goss ◽  
...  

Objective Numerous attempts have been made to create a standardized “presenting problem” or “chief complaint” list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Graby ◽  
A Carpenter ◽  
R Medland ◽  
S Brown ◽  
C Sowerby ◽  
...  

Abstract Introduction Severe left ventricular systolic dysfunction (LVSD) is associated with worse outcomes in heart failure (HF) patients. Persistent atrial fibrillation (AF) is common in this patient group. As part of a nurse-led cardioversion service at a district general hospital we assessed the impact of elective cardioversion (DCCV) for AF in patients with LVSD on their ejection fraction (EF), and compared outcomes in patients selectively pre-treated with amiodarone for their DCCV. Methods A retrospective analysis was undertaken of DCCV for AF over 5 years, recording demographic, medication, serial echocardiogram (TTE), and outcome data. Significant LVSD was classified as moderate (ejection fraction [EF] 35–45%) or severe (EF<35%). All patients treated with amiodarone had baseline and serial thyroid, liver, renal function monitored, were counselled on side effects and followed up. Results 103 patients with significant LVSD and follow-up TTE underwent DCCV, with a median age of 66 (IQR 58–73) and mean CHA2DS2-VASc 2.5. Overall mean baseline EF was 30% (SD ±11), overall follow-up EF (regardless of repeat TTE rhythm) was 42% (SD ±12), and the mean delta EF +12% improvement (SD ±11). At follow-up TTE, 66% (68/103) of patients were in sinus rhythm (SR) and 34% (35/103) in AF. 62/68 (91%) patients in SR at follow-up TTE were also treated with HF medications, vs 33/35 (94%) of those in AF. 61/68 (90%) of patients in SR at follow-up TTE had any improvement in EF vs 21/35 (60%) patients in AF (p=0.0007). For patients in SR the mean baseline EF was 31% (SD ±10) and mean follow-up EF 47% (SD ±9), vs the AF at repeat TTE patients' mean baseline EF 27% (SD ±12) and mean follow-up EF 35% (SD ±13). The mean delta EF of patients still in SR at follow-up scan was 15% (SD ±10) vs 8% (SD ±11) for patients who had reverted to AF (p=0.0004). Prior analysis of our data-set including patients awaiting repeat TTE demonstrated a significant improvement in 6 month AF recurrence rate. Table 1. Comparing outcomes with amiodarone pre-treatment for patient with follow-up EF data Acute DCCV Success Mean Baseline EF Mean Repeat EF Mean Delta EF AF Recurrence to 6 months Amiodarone 17/17 (100%) 29% (SD 11) 45% (SD 11) 15% (SD 13) 6/17 (35%) No Amiodarone 80/86 (93%) 30% (SD 11) 42% (SD 12) 12% (SD 10) 50/86 (58%) P value 0.59 0.22 0.11 Conclusion Restoration of SR in a cohort of patients with AF, severe LVSD, on good medical therapy significantly improves left ventricular EF. This reinforces the importance of maintaining SR for HF patients. There was also a trend towards improved medium term outcomes in patients pre-treated with amiodarone. Further study into long-term rhythm control and ablation outcomes is needed.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Alan D Rogers ◽  
Plast Surg

Abstract Introduction The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care. Methods A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years. Results Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours). Table 1. Selected burn center data comparing 2020 with 2019 and 2018. Conclusions This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 796.3-797
Author(s):  
P. G. Conaghan ◽  
L. Abraham ◽  
P. Graham-Clarke ◽  
L. Viktrup ◽  
J. C. Cappelleri ◽  
...  

Background:Osteoarthritis (OA) is a chronic joint disease associated with pain and impaired activity. With increasing obesity trends and an ageing population, the prevalence of OA is expected to rise in the future. This represents an increasing societal problem which will lead to an increased burden on healthcare services.Objectives:To understand the pattern of healthcare resource utilisation (HCRU) across France, Germany, Italy, Spain and the UK, as OA disease severity increases.Methods:Data were drawn from the Adelphi OA Disease Specific Programme (2017-18), a point-in-time study of physicians and their OA patients. OA disease severity was reported by physicians, who categorised patients’ OA severity as mild, moderate or severe. Patients were excluded from the analyses if they suffered from back and neck OA only, and shoulder OA that had not been diagnosed by X-ray. Physicians provided information, on a patient record form, about OA-related visits to healthcare professionals (HCPs), tests/scans conducted, emergency room (ER) visits and surgeries. Statistical comparisons among disease severity groups were made by analysis of variance and chi-squared tests.Results:The study included 489 physicians (primary care physicians, rheumatologists, orthopaedists) reporting on 3596 of their patients with OA: 24% mild (n=874), 53% moderate (n=1904) and 23% severe (n=818). Over the last 12 months, the mean number of consultations with HCPs increased with disease severity (3.7 mild, 4.2 moderate and 5.7 severe [<0.001]). This pattern was also observed in relation to the mean number of tests/scans conducted in the last 12 months (6.9 mild, 7.9 moderate and 9.3 severe [<0.001]). More than a quarter of severe patients visited the ER in the last 12 months (26% vs. 4% mild; 9% moderate [<0.001]) and visits to hospital increased with disease severity (Table 1). The proportion of patients that have had a surgery due to their OA rose with worsening disease severity (11%, 13% and 27% for mild, moderate and severe, respectively [<0.001]).Table 1.Physician-reported healthcare burden by OA disease severityMild(n=874)Moderate(n=1904)Severe(n=818)Number of patient visits to ER in the last 12 months, mean (SD)0.1 (0.4)0.1 (0.6)0.5 (1.0)Patients with ≥1 emergency visit in the last 12 months, n (%)13 (1.5)43 (2.3)79 (9.7)Patients with ≥1 hospitalisation in the last 12 months, n (%)11 (0.1)9 (0.5)26 (3.2)Number of patient outpatient hospital visits in the last 12 months, mean (SD)0.5 (1.4)0.6 (1.1)1.2 (1.4)Conclusion:This real-world data demonstrated an increase in visits to HCPs, monitoring tests and scans, hospitalisations, ER visits and surgery as OA disease severity worsened.Disclosure of Interests:Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer, Lucy Abraham Shareholder of: Pfizer, Employee of: Pfizer, Peita Graham-Clarke Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co, Lars Viktrup Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Craig Beck Shareholder of: Pfizer, Employee of: Pfizer, Andrew G Bushmakin Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Niall Hatchell: None declared, Emily Clayton: None declared, James Jackson: None declared


2021 ◽  
Vol 161 ◽  
pp. S608
Author(s):  
I. Fornacon-Wood ◽  
H. Mistry ◽  
C. Johnson-Hart ◽  
J.P.B. O’Connor ◽  
C. Faivre-Finn ◽  
...  

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