scholarly journals Ambulatory Risk Models for the Long-Term Prevention of Sepsis: Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Jewel Y Lee ◽  
Sevda Molani ◽  
Chen Fang ◽  
Kathleen Jade ◽  
D Shane O'Mahony ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Organ Damage ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Trade Offs ◽  
Threatening Condition ◽  
Patients At Risk ◽  
Life Threatening

BACKGROUND Sepsis is a life-threatening condition that can rapidly lead to organ damage and death. Existing risk scores predict outcomes for patients who have already become acutely ill. OBJECTIVE We aimed to develop a model for identifying patients at risk of getting sepsis within 2 years in order to support the reduction of sepsis morbidity and mortality. METHODS Machine learning was applied to 2,683,049 electronic health records (EHRs) with over 64 million encounters across five states to develop models for predicting a patient’s risk of getting sepsis within 2 years. Features were selected to be easily obtainable from a patient’s chart in real time during ambulatory encounters. RESULTS The models showed consistent prediction scores, with the highest area under the receiver operating characteristic curve of 0.82 and a positive likelihood ratio of 2.9 achieved with gradient boosting on all features combined. Predictive features included age, sex, ethnicity, average ambulatory heart rate, standard deviation of BMI, and the number of prior medical conditions and procedures. The findings identified both known and potential new risk factors for long-term sepsis. Model variations also illustrated trade-offs between incrementally higher accuracy, implementability, and interpretability. CONCLUSIONS Accurate implementable models were developed to predict the 2-year risk of sepsis, using EHR data that is easy to obtain from ambulatory encounters. These results help advance the understanding of sepsis and provide a foundation for future trials of risk-informed preventive care.

Promoting Patient Safety within Implantable Medical Devices: Patient Alert™

2005 ◽  
Vol 49 (11) ◽  
pp. 1084-1088
Author(s):  
Holly Vitense
Keyword(s):  
Patient Safety ◽  
Ventricular Tachyarrhythmia ◽  
Medical Attention ◽  
Implantable Medical Devices ◽  
System Integrity ◽  
Threatening Condition ◽  
Patients At Risk ◽  
Life Threatening ◽  
Communication Modalities ◽  
Therapy Delivery

Implantable Cardioverter Defibrillator (ICD) systems have been shown to provide lifesaving therapy for patients at risk of sudden cardiac death due to ventricular tachyarrhythmia. In order to assure an ICD system is operating properly, some models of ICDs perform periodic system checks. The Patient Alert™ feature, in Medtronic® ICDs, monitors and alerts patients, via audible tones, to system integrity issues that have the potential to comprise patient safety. The objective of this research was to evaluate: how often patients are being alerted to ICD system issues, and how effective the alerts are at bringing patients into medical clinics for treatment and thus promoting patient safety. An analysis of 14,092 ICDs revealed that the probability of first alert occurrence increased with time since implant, but overall occurrence rates remained low (< 7% per patient year). The average median time from the alert sounding until the patient received medical attention was 4.3 days. Overall, for a life-threatening condition such as ICD therapy delivery being turned off, the majority (76%) of patients with this alert were brought into a clinic within one week to have therapy delivery turned back on. To reach the remaining patients, as well as bring all patients in quicker to seek medial treatment, additional communication modalities are being planned for the next generation of ICD systems.

scholarly journals Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

2020 ◽  
Vol 100 (1) ◽  
pp. 19-25
Author(s):  
Sarina K. Mueller ◽  
Maximilian Traxdorf ◽  
Konstantinos Mantsopoulos ◽  
Antoniu-Oreste Gostian ◽  
Matti Sievert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Surgery ◽  
Transmission Rate ◽  
Medical Personnel ◽  
Human Beings ◽  
Threatening Condition ◽  
Long Time ◽  
Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

scholarly journals Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laura D’Erasmo ◽  
Antonio Gallo ◽  
Angelo Baldassare Cefalù ◽  
Alessia Di Costanzo ◽  
Samir Saheb ◽  
...  
Keyword(s):  
Familial Hypercholesterolemia ◽  
Treatment Algorithm ◽  
Lipid Lowering ◽  
Homozygous Familial Hypercholesterolemia ◽  
Lipoprotein Apheresis ◽  
Term Efficacy ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p < 0.001), age of treatment initiation (p < 0.001), occurrence of cardiovascular disease (p = 0.003) as well as follow-up duration (p < 0.001). The adjunct of lomitapide to conventional lipid-lowering therapies determined an additional 58.0% reduction of last visit LDL-C levels, compared to 37.1% when LA was added (padj = 0.004). Yearly on-treatment LDL-C < 70 mg/dl and < 55 mg/dl goals were only achieved in 45.5% and 13.5% of HoFH patients treated with lomitapide. The long-term exposure to LDL-C burden was found to be higher in LA than in Lomitapide cohort (13,236.1 ± 5492.1 vs. 11,656.6 ± 4730.9 mg/dL-year respectively, padj = 0.002). A trend towards fewer total cardiovascular events was observed in the Lomitapide than in the LA cohort. Conclusions In comparison with LA, lomitapide appears to provide a better control of LDL-C in HoFH. Further studies are needed to confirm this data and establish whether this translates into a reduction of cardiovascular risk.

Hereditary angioedema: Long-term prophylactic treatment

2020 ◽  
Vol 41 (6) ◽  
pp. S35-S37
Author(s):  
Huamin Henry Li
Keyword(s):  
Disease Management ◽  
Hereditary Angioedema ◽  
Clinical Investigation ◽  
Limiting Factors ◽  
Plasma Kallikrein ◽  
Therapeutic Drugs ◽  
Threatening Condition ◽  
Life Threatening ◽  
Risk And Benefit

Hereditary Angioedema (HAE) is a potentially life-threatening condition. With episodic, unpredictable swelling, HAE negatively affect the quality of life for those affected individuals. To reduce the morbidity and mortality of HAE are the primary goal for the disease management. In addition to have access to therapeutic drugs for their acute HAE attacks, many patients require long term prophylaxis (LTP) to reduce their attack frequency and severity. Preventing HAE attack by regular administration of medicine has become an important part of HAE disease management. Over the past few years, growing number of therapeutic options for the HAE LTP have made it possible for physicians to choose the most appropriate and effective treatment for individual patients. C1 INH concentrate and plasma kallikrein inhibitors (IV or SC) have largely replaced the oder modality of treatment consisting different androgen derivatives or antifibrinolytics. Additional options, such as oral kallikrein inhibitor, antisense RNA/plasma kallikrein, anti-Factor 12a, bradykinin receptor blocker or future gene therapy are under clinical investigation. The significant cost and the uncertainty of its long term safety may be the primary limiting factors for its clinical application. The limited data for young children and pregnant women pose additional challenge for physicians to assess the risk and benefit when considering LTP treatment.

Abstract 10992: Machine Learning to Predict In-Hospital Cardiac Arrest in Patients Admitted from the Emergency Department with COVID-19 and Suspected Pneumonia

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Tsung-Chien Lu ◽  
Eric H Chou ◽  
CHIH-HUNG WANG ◽  
Amir Mostafavi ◽  
Mario Tovar ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Arrest ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Early Warning Score ◽  
Gradient Boosting ◽  
Patients At Risk ◽  
End Of Life Decision ◽  
Hospital Cardiac Arrest ◽  
Suspected Pneumonia

Introduction: There are only scarce models developed for stratifying the risk of cardiac arrest from COVID-19 patients presenting to the ED with suspected pneumonia. By using the machine learning (ML) approach, we aimed to develop and validate the ML models to predict in-hospital cardiac arrest (IHCA) in patients admitted from the ED. Hypothesis: We hypothesized that ML approach can serve as a valuable tool in identifying patients at risk of IHCA in a timely fashion. Methods: We included the COVID-19 patients admitted from the EDs of five hospitals in Texas between March and November 2020. All adult (≥ 18 years) patients were included if they had positive RT-PCR for SARS-CoV-2 and also received CXR examination for suspected pneumonia. Patients’ demographic, past medical history, vital signs at ED triage, CXR findings, and laboratory results were retrieved from the EMR system. The primary outcome (IHCA) was identified via a resuscitation code. Patients presented as OHCA or without any blood testing were excluded. Nonrandom splitting strategy based on different location was used to divide the dataset into the training (one urban and two suburban hospitals) and testing cohort (one urban and one suburban hospital) at around 2-to-1 ratio. Three supervised ML models were trained and performances were evaluated and compared with the National Early Warning Score (NEWS) by the area under the receiver operating characteristic curve (AUC). Results: We included 1,485 records for analysis. Of them, 190 (12.8%) developed IHCA. Of the constructed ML models, Random Forest outperformed the others with the best AUC result (0.930, 95% CI: 0.896-0.958), followed by Gradient Boosting (0.929, 95% CI: 0.891-0.959) and Extra Trees classifier (0.909, 95% CI: 0.875-0.943). All constructed ML models performed significantly better than by using the NEWS scoring system (AUC: 0.787, 95% CI: 0.725-0.840). The top six important features selected were age, oxygen saturation at triage, and lab data of APTT, lactic acid, and LDH. Conclusions: The ML approach showed excellent discriminatory performance to identify IHCA for patients with COVID-19 and suspected pneumonia. It has the potential to save more life or provide end-of-life decision making if successfully implemented in the EMR system.

scholarly journals Liver Disease Secondary to Intestinal Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Bassam Abu-Wasel ◽  
Michele Molinari
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Multidisciplinary Approach ◽  
Intestinal Failure ◽  
Term Survival ◽  
Early Referral ◽  
Long Term Survival ◽  
Threatening Condition ◽  
Life Threatening

IFALD is a common and potentially life-threatening condition for patients with SBS requiring long-term PN. There exists the potential for decreasing its incidence by optimizing the composition and the rate of infusion of parenteral solutions, by advocating a multidisciplinary approach, and by early referral for intestinal-liver transplantation to ensure long-term survival of patients with SBS.

Palindromic Rheumatism with Positive Anticitrullinated Peptide/Protein Antibodies Is Not Synonymous with Rheumatoid Arthritis. A Longterm Followup Study

2012 ◽  
Vol 39 (10) ◽  
pp. 1929-1933 ◽  
Author(s):  
RAIMON SANMARTÍ ◽  
SONIA CABRERA-VILLALBA ◽  
JOSÉ A. GÓMEZ-PUERTA ◽  
VIRGINIA RUIZ-ESQUIDE ◽  
M. VICTORIA HERNÁNDEZ ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Characteristic Curve ◽  
Significant Proportion ◽  
Positive Likelihood Ratio ◽  
Outcome Variable ◽  
Palindromic Rheumatism ◽  
The Difference ◽  
Acpa Status

Objective.To analyze longterm progression to rheumatoid arthritis (RA) and the predictive value of anticitrullinated peptide/protein antibodies (ACPA) in palindromic rheumatism (PR).Methods.We selected all patients in our clinic with PR who had at least 1 ACPA measurement. We included only patients with pure PR, defined as no evidence of associated rheumatic disease at the first serum ACPA measurement. Clinical characteristics, serum ACPA levels, duration of PR until serum ACPA measurement, and total followup time were recorded. The outcome variable was the definitive diagnosis of RA. The prognostic value of ACPA status in pure PR for a definite diagnosis of RA was analyzed by different statistical methods.Results.Seventy-one patients (54 women/17 men) with a PR diagnosis were included. Serum ACPA were positive in 52.1%. After a mean followup of 7.6 ± 4.7 years since the first ACPA measurement, 24 patients (33.8%) progressed to chronic disease: 22% RA, 5.6% systemic lupus erythematosus, and 5.6% other diseases. The positive likelihood ratio of ACPA status for RA was 1.45, and the area under the receiver-operating characteristic curve of ACPA titers was 0.60 (95% CI 0.45−0.75). Progression to RA was more frequently seen in ACPA-positive than in ACPA-negative patients (29.7% vs 14.7%), but the difference was not significant (hazard ratio 2.46, 95% CI 0.77−7.86). Mean ACPA levels of patients with pure PR did not differ significantly from those of patients who progressed to RA.Conclusion.ACPA are frequently found in the sera of patients with PR, and a significant proportion of these patients do not progress to RA in the long term.

Three scenarios illustrating ethical concerns when considering bariatric surgery in obese adolescents with Prader-Willi syndrome

2020 ◽  
Vol 46 (11) ◽  
pp. 738-742
Author(s):  
Maria Luisa Di Pietro ◽  
Drieda Zaçe
Keyword(s):  
Bariatric Surgery ◽  
Intellectual Disability ◽  
Therapeutic Option ◽  
Prader Willi Syndrome ◽  
Long Term Effects ◽  
Ethical Concerns ◽  
Severe Intellectual Disability ◽  
Threatening Condition ◽  
Life Threatening

Prader-Willi syndrome (PWS) is one of the 25 syndromic forms of obesity, in which patients present—in addition to different degrees of obesity—intellectual disability, endocrine disturbs, hyperphagia and/or other signs of hypothalamic dysfunction. In front of a severe/extreme obesity and the failure of non-invasive treatments, bariatric surgery is proposed as a therapeutic option. The complexity of the clinical condition, which could affect the long-term effects of bariatric surgery, and the frequent association with a mild to severe intellectual disability raise some ethical concerns in the treatment of obese PWS adolescents. This article analyses these issues referring to the principles of healthcare ethics: beneficence/non-maleficence (proportionality of treatments; minimisation of risks); respect of autonomy; justice. Based on these principles, three hypothetical scenarios are defined: (1) obese PWS adolescent, capable of making an autonomous decision; (2) obese PWS adolescent with a severe intellectual disability, whose parents agree with bariatric surgery; (3) obese PWS adolescent with a life-threatening condition and a severe intellectual disability, whose parents do not agree with bariatric surgery. The currently available evidence on efficacy and safety of bariatric surgery in PWS adolescents with extreme or severe obesity and the lack of adequate long-term follow-up suggests great caution even in a very life-threatening condition. Clinicians must always obtain a full IQ assessment of patients by psychologists. A multidisciplinary team is needed to analyse the clinical, psychological, social and ethical aspects and organise support for patient and parents, involving also the hospital ethical committee or, if necessary, legal authorities.

scholarly journals The Buried Bumper Syndrome: External Bumper Extraction after Radial Mini Incisions and Replacement through an Adjacent Tract

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
M. A. Benatta
Keyword(s):  
Nutritional Support ◽  
Laparoscopic Treatment ◽  
Abdominal Ct ◽  
Endoscopic Gastrostomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Adjacent Site ◽  
Buried Bumper Syndrome ◽  
Peg Tube

Although considered as a safe method to provide long-term nutritional support, percutaneous endoscopic gastrostomy (PEG) may be complicated by a buried bumper syndrome (BBS), a life-threatening condition. Removal of the PEG tube with its buried bumper and reinsertion of a new PEG tube is often necessary. Since its description in 1988, less than 50 cases of BBS managed by external extraction of the buried bumper have been reported. We report a case of buried bumper that was removed by external traction without the need for endoscopic or laparoscopic treatment but with the need of two radial millimeter skin incisions after abdominal CT study and finally immediate PEG replacement but through an adjacent site.

scholarly journals Frequency of ventricular tachyarrhythmias in patients with different risk scores for sudden cardiac death in hypertrophic cardiomyopathy and cardioverter defibrilators implanted in primary prevention

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Brankovic ◽  
NN Radovanovic ◽  
N Vujadinovic ◽  
B Kircanski ◽  
V Sajic ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Risk Scores ◽  
Icd Implantation ◽  
Life Threatening ◽  
Group A ◽  
Group B

Abstract Funding Acknowledgements Type of funding sources: None. Background The European Society of Cardiology’s (ESC) risk calculator for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathies (HCM) is currently a tool that facilitates the decision to implant a cardioverter defibrillator (ICD) in primary prevention, but doubts still exist in everyday clinical practice. Purpose We aimed to determine the incidence of life-threatening ventricular arrhythmias during long-term follow-up in patients with different ESC HCM risk scores for SCD calculated on ICD implantation in primary prevention. Methods This retrospective, observational study was conducted in a tertiary center among adult patients with HCM and ICD devices (ICD-VR, ICD-DR and CRT-ICD) implanted in primary prevention from January 2008 to December 2019. The patients followed up for less than one year were excluded from the analysis. Study group was divided into three subgroups, according to the ESC 5 years risk score of SCD and based on it the estimated need for ICD implantation: group A with risk &lt; 4%, where ICD is generally not indicated; group B with risk 4-6%, where ICD may be considered; group C with risk ≥6%, where ICD should be considered. Regularly, ICD was interrogated twice a year, while emergency controls were performed after delivering of ICD therapy. Follow-up data including information about sustained ventricular tachicardia (VT) and ventricular fibrillation (VF) episodes were collected from patients medical records. Results In the observed period, ICD devices were implanted in 60 adult patients with HCM. Ten of them had history of sustained ventricular arrhythmias and 3 were lost to follow-up. Therefore, we analysed 47 patients (55.3% male, mean age 51.0 ± 15.7 years), 13 from group A, 12 from group B and 22 from group C. Mean follow-up period was 80.6 ± 37.9 months. During the follow-up period ventricular tachyarrhythmias (VT and VF, either in monitoring or therapy zone) were recorded in one patient from group A (7.7%), in two patients from group B (16.7%) and in 7 patients from group C (31.8%). Using Kruskal-Wallis analysis of variance, we did not find a statistically significant difference in the occurrence of ventricular tachyarrhythmias among the observed groups (p = 0.225). Conclusions Patients with HCM and a 5-year risk of SCD ≥ 6% calculated on ICD implantation had more frequent life-threatening ventricular arrhythmias during long-term follow-up, but not statistically significant. There should be an individual approach when deciding on the need for device implantation in all patients with HCM.

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