Pneumococcal Vaccination Rates in Immunocompromised Patients in Germany: A Retrospective Cohort Study to Assess Sequential Vaccination Rates and Changes Over Time

2021 ◽  
Author(s):  
Ralf Sprenger ◽  
Dennis Häckl ◽  
Nils Kossack ◽  
Julia Schiffner-Rohe ◽  
Jessica Wohlleben ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pneumococcal Vaccination ◽  
Immunocompromised Patients ◽  
Vaccination Rates ◽  
Changes Over Time ◽  
Over Time

scholarly journals Reinfection Rates Among Patients Who Previously Tested Positive for Coronavirus Disease 2019: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Megan M Sheehan ◽  
Anita J Reddy ◽  
Michael B Rothberg
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Symptomatic Infection ◽  
Symptomatic Disease ◽  
Viral Shedding ◽  
History Of ◽  
Polymerase Chain ◽  
Prior Infection ◽  
Over Time

Abstract Background Protection afforded from prior disease among patients with coronavirus disease 2019 (COVID-19) infection is unknown. If infection provides substantial long-lasting immunity, it may be appropriate to reconsider vaccination distribution. Methods This retrospective cohort study of 1 health system included 150 325 patients tested for COVID-19 infection via polymerase chain reaction from 12 March 2020 to 30 August 2020. Testing performed up to 24 February 2021 in these patients was included. The main outcome was reinfection, defined as infection ≥90 days after initial testing. Secondary outcomes were symptomatic infection and protection of prior infection against reinfection. Results Of 150 325 patients, 8845 (5.9%) tested positive and 141 480 (94.1%) tested negative before 30 August. A total of 1278 (14.4%) positive patients were retested after 90 days, and 62 had possible reinfection. Of those, 31 (50%) were symptomatic. Of those with initial negative testing, 5449 (3.9%) were subsequently positive and 3191 of those (58.5%) were symptomatic. Protection offered from prior infection was 81.8% (95% confidence interval [CI], 76.6–85.8) and against symptomatic infection was 84.5% (95% CI, 77.9–89.1). This protection increased over time. Conclusions Prior infection in patients with COVID-19 was highly protective against reinfection and symptomatic disease. This protection increased over time, suggesting that viral shedding or ongoing immune response may persist beyond 90 days and may not represent true reinfection. As vaccine supply is limited, patients with known history of COVID-19 could delay early vaccination to allow for the most vulnerable to access the vaccine and slow transmission.

A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program

2020 ◽  
Vol 17 (9) ◽  
pp. 1787-1794
Author(s):  
Rachel M. Whynott ◽  
Karen Summers ◽  
Riley Mickelsen ◽  
Satish Ponnuru ◽  
Joshua A. Broghammer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Male To Female ◽  
Over Time

scholarly journals Trends in antiepileptic drug treatment and effectiveness in clinical practice in England from 2003 to 2016: a retrospective cohort study using electronic medical records

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032551 ◽  
Author(s):  
Graham Powell ◽  
John Logan ◽  
Victor Kiri ◽  
Simon Borghs
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Electronic Medical Records ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Retrospective Cohort ◽  
First Line ◽  
Nice Guideline ◽  
Treatment Trends ◽  
Over Time

ObjectiveTo assess the evolution of antiepileptic drug (AED) treatment patterns and seizure outcomes in England from 2003 to 2016.Design, setting and participantsRetrospective cohort study of electronic medical records from Clinical Practice Research Datalink and National Health Service Digital Hospital Episode Statistics databases. Patients newly diagnosed with epilepsy were identified and followed until end of data availability. Three eras were defined starting 1 April 2003 (first National Institute for Health and Care Excellence (NICE) guideline); 1 September 2007 (Standard and New Antiepileptic Drugs publication); and 1 January 2012 (second NICE guideline).Outcome measuresTime from diagnosis to first AED; AED sequence; time from first AED to first 1-year remission period (no new AED attempts and no seizure-related healthcare events); time from first AED to refractoriness (third AED attempt regardless of reason); Kaplan-Meier analysis of time-to-event variables.Results4388 patients were included (mean follow-up: 6.8, 4.2 and 1.7 years by era). 84.6% of adults (≥16 years), 75.5% of children (<16) and 89.1% of elderly subgroup (65+) received treatment within 1 year; rates were generally stable over time. Treatment trends included reduced use of carbamazepine (adult first line, era 1: 34.9%; era 3: 10.7%) and phenytoin, earlier line and increased use of levetiracetam (adult first line, era 1: 2.6%; era 3: 26.2%) and lamotrigine (particularly in adults and elderly subgroup), and a larger number of different AEDs used. Valproate use shifted somewhat to later lines. Rates of 1-year remission within 2 years of starting treatment increased in adults (era 1: 71.9%; era 3: 81.4%) and elderly (era 1: 76.1%; era 3: 81.7%). Overall, 55.5% of patients relapsed after achieving 1-year remission. Refractoriness rates remained stable over time (~26% of adults within 5 years).ConclusionTreatment trends often were not aligned with era-relevant guidance. However, our results suggest a slight improvement in epilepsy treatment outcomes over the 13-year period.

scholarly journals Reference Percentiles and Changes over Time for Total Thyroxine in Preterm Infants: A Retrospective Cohort Study

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 475
Author(s):  
Claudia M. Flores-Robles ◽  
Ernesto Roldan-Valadez ◽  
Nayeli Martínez-Cruz ◽  
Lidia Arce-Sánchez ◽  
Ana L. Priego-Zurita ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reference Ranges ◽  
Screening Programs ◽  
Cutoff Values ◽  
Total Thyroxine ◽  
Over Time

Hypothyroxinemia of prematurity increases the rate of false-positive results in total thyroxine (tT4)-based screening programs for congenital hypothyroidism. The use of specific cutoff values for preterm infants has been proposed, but data on tT4 reference ranges in this population are limited. The primary aim was to establish reference percentiles for tT4 in dried blood spots among Mexican preterm infants. Secondary aims included a comparison of the change of tT4 concentrations over time according to gestational age and to discuss its impact on tT4-based screening programs. This was a retrospective cohort study; 1561 preterm infants were included. Percentile 10th for tT4 concentration at 24–27, 28–30, 31–34, and 35–36 weeks of gestational age, measured in the first week of life was: 47.6, 56.6, 82.3, and 117.1 nmol/L, respectively. tT4 concentrations were compared in three different time points: first week of life, 2–3 weeks of life, and term-corrected gestational age (38 weeks of gestation), progressively increased in infants below 30 weeks, remained stable in infants from 31 to 34 weeks, and decreased in late preterm newborns (35–36 weeks). This study suggests that preterm infants may require the use of lower tT4 cutoff values in newborn screening.

scholarly journals Pulse oximetry adoption and oxygen orders at paediatric admission over 7 years in Kenya: a multihospital retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050995
Author(s):  
Timothy Tuti ◽  
Jalemba Aluvaala ◽  
Samuel Akech ◽  
Ambrose Agweyu ◽  
Grace Irimu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pulse Oximetry ◽  
Low Income ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Guideline Development ◽  
Public Hospitals ◽  
Severe Illness ◽  
Patient Factors ◽  
Over Time

ObjectivesTo characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen.DesignA multihospital retrospective cohort study.SettingsAll admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020.OutcomesPulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors.ResultsOverall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia.ConclusionThe adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact.

scholarly journals 2789. Respiratory Syncytial Disease in Hospitalized Adults: A Retrospective Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S985-S986
Author(s):  
Hannah Nam ◽  
Michael G Ison
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Solid Organ ◽  
Cell Transplant ◽  
Immunocompromised Patients ◽  
Transplant Patients ◽  
History Of

Abstract Background Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) and lung transplant recipients. Although RSV is responsible for ~177,000 hospitalizations and 14,000 deaths annually, few epidemiologic studies including all adults including those with immunocompromise have been conducted over multiple seasons. Methods A retrospective cohort study of adults admitted to a large academic medical center in Chicago, IL from 2009 to 2018 was conducted in patients with positive RSV PCR. Specific data on clinical presentation, management, and outcomes were collected by manual chart review. Descriptive statistics were calculated, and Pearson’s Chi-Squared test was utilized to assess association between severe disease status and comorbidities. Results A total of 140 patients* were admitted during part of the study period (2016–2018) with positive PCR for RSV. Most patients had otherwise underlying comorbidities prior to admission (lung 44.2%, heart 40.0%, diabetes 20.7%), history of immunocompromise (36.4%, 51) or history of smoking (39.2%, 55). Cough was the most common symptom among all hospitalized adults (90.7%, 127). However, patients with a history of transplant (both HSCT and SOT) more commonly displayed symptoms of fevers at presentation (50%, 10) when compared with non-immunocompromised patients (36.6%, 36). ICU admission occurred in one-third of the hospitalized patients, with no significant difference amongst transplant patients, immunocompromised patients, and non-immunocompromised patients. Need for mechanical ventilation was highest in patients with co-infections. None of the co-morbidities measured were independent risk factors for severe disease. Most patients (78.5%, 110) were discharged home. Among the 12 fatal cases, all were admitted to the ICU with seven (58.3%) requiring mechanical ventilation. Three (25.0%) were immunocompromised while two (16.7%) were HSCT patients, but none were solid-organ transplant patients. *Ongoing data collection. Conclusion RSV patients were diverse in their demographics, treatment, and outcomes. Large percentages of patients had underlying comorbidities such as immunocompromise due to HSCT, lung and heart disease. Disclosures All authors: No reported disclosures.

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