scholarly journals Performance of Three Asthma Predictive Tools in a Cohort of Infants Hospitalized With Severe Bronchiolitis

2021 ◽  
Vol 2 ◽  
Author(s):  
Ronaldo C. Fabiano Filho ◽  
Ruth J. Geller ◽  
Ludmilla Candido Santos ◽  
Janice A. Espinola ◽  
Lacey B. Robinson ◽  
...  
Keyword(s):  
Chart Review ◽  
Research Collaboration ◽  
Specific Ige ◽  
Parent Report ◽  
Outcome Data ◽  
High Risk Population ◽  
Likelihood Ratios ◽  
Predictive Index ◽  
Prediction Tools ◽  
Positive Index

Childhood asthma develops in 30–40% of children with severe bronchiolitis but accurate prediction remains challenging. In a severe bronchiolitis cohort, we applied the Asthma Predictive Index (API), the modified Asthma Predictive Index (mAPI), and the Pediatric Asthma Risk Score (PARS) to predict asthma at age 5 years. We applied the API, mAPI, and PARS to the 17-center cohort of infants hospitalized with severe bronchiolitis during 2011–2014 (35th Multicenter Airway Research Collaboration, MARC-35). We used data from the first 3 years of life including parent interviews, chart review, and specific IgE testing to predict asthma at age 5 years, defined as parent report of clinician-diagnosed asthma. Among 875/921 (95%) children with outcome data, parent-reported asthma was 294/875 (34%). In MARC-35, a positive index/score for stringent and loose API, mAPI, and PARS were 24, 68, 6, and 55%, respectively. The prediction tools' AUCs (95%CI) ranged from 0.57 (95%CI 0.54–0.59) to 0.68 (95%CI 0.65–0.71). The positive likelihood ratios were lower in MARC-35 compared to the published results from the original cohorts. In this high-risk population of infants hospitalized with severe bronchiolitis, API, mAPI, and PARS had sub-optimal performance (AUC <0.8). Highly accurate (AUC >0.8) asthma prediction tools are desired in infants hospitalized with severe bronchiolitis.

SARS-CoV-2 in pregnancy: maternal and perinatal outcome data of 34 pregnant women hospitalised between May and October 2020

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mirijam Hall ◽  
David Endress ◽  
Susanne Hölbfer ◽  
Barbara Maier
Keyword(s):  
Critical Care ◽  
Pregnant Women ◽  
Critical Care Unit ◽  
Birth Rate ◽  
Total Population ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Outcome Data ◽  
High Risk Population ◽  
Retrospective Data Collection

AbstractObjectivesTo report clinical data on maternal outcome, mode of delivery and immediate neonatal outcome in women infected with COVID-19.MethodsRetrospective data collection.ResultsA total of 8.6% of the total population of hospitalised SARS-CoV-2 positive pregnant women were admitted to a critical care unit. The premature birth rate for births before 34+0 weeks of gestation among pregnant women who tested positive for SARS-CoV-2 was 7.1%. One newborn (3.6%) tested positive for SARS-CoV-2 two days after birth and showed symptoms.ConclusionsPregnant women with COVID-19 seem to be at higher risk of invasive ventilation, admission to a critical care unit and preterm birth, and should therefore be considered a high-risk-population.

scholarly journals Association between proteinuria and placental pathology in preeclampsia: A retrospective study

2021 ◽  
Vol 9 ◽  
pp. 205031212110580
Author(s):  
Dominique Suzanne Genest ◽  
Dorothée Dal Soglio ◽  
Sylvie Girard ◽  
Evelyne Rey
Keyword(s):  
Chart Review ◽  
Severe Hypertension ◽  
Clinical Information ◽  
Fetal Outcome ◽  
Outcome Data ◽  
Single Centre ◽  
Retrospective Comparison ◽  
The Relationship ◽  
Nephrotic Range Proteinuria ◽  
Singleton Pregnancies

Introduction: Preeclampsia develops due to placental insufficiency and systemic proinflammatory and antiangiogenic mediator release, with ensuing systemic endothelial dysfunction. Nephrotic-range proteinuria appears to be associated with worse pregnancy outcomes. The relationship between differing degrees of proteinuria and the severity of placental alterations has not been studied. Methods: This is a single-centre retrospective comparison of 150 singleton pregnancies complicated by preeclampsia and varying degrees of proteinuria. Maternal demographic, obstetrical and fetal outcome data were obtained from chart review. The placental histologic evaluations were performed by a placental pathologist blinded to all other clinical information. Results: Preeclamptic women with massive proteinuria had evidence of more severe maternal vascular malperfusion lesions. The severity of the lesions was progressive through mild, moderate and massive proteinuria. Women with massive proteinuria had a higher incidence of renal dysfunction and severe hypertension, and had earlier preterm deliveries compared to preeclamptic women with mild and moderate proteinuria (p < 0.05). Conclusion: Preeclampsia with more severe proteinuria is associated with a higher prevalence of placental maternal vascular malperfusion.

scholarly journals A Retrospective Study on the Effectiveness of Ixekizumab After Treatment With Secukinumab for Patients With Active Psoriatic Arthritis

2021 ◽  
pp. 247553032110638
Author(s):  
Saman Darabian ◽  
Maziar Badii ◽  
Jan P. Dutz ◽  
Jonathan Chan
Keyword(s):  
Psoriatic Arthritis ◽  
Chart Review ◽  
Disease Duration ◽  
Outcome Data ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Clinical Center ◽  
Clinical Responses ◽  
Psoriasis Severity ◽  
Axial Involvement

Objectives: This study aims to evaluate clinical responses in patients with active psoriatic arthritis who, despite secukinumab 300 mg subcutaneous monthly, are switched to ixekizumab 80 mg subcutaneous every four weeks. Methods: We conducted a chart review of adult patients with psoriatic arthritis treated at one clinical center. We identified all patients with active inflammatory arthritis who were switched from secukinumab to ixekizumab. Baseline demographics such as disease duration, age, gender, number of previous DMARDs, and previous time on secukinumab were collected. We collected clinical outcome data such as tender and swollen joint count, enthesitis based on SPARCC score, dactylitis, psoriasis severity, CRP, and BASDAI if axial involvement was present. Results: Eight of 10 patients were included in the analysis. Most patients were female, average age 62 years old, and had been on secukinumab for an average of 79 weeks. Twelve weeks following switch to ixekizumab, 6/8 had improvement in tender joint count, 6/8 improved in swollen joint count, 2/2 had resolution of enthesitis, 4/4 had resolution of dactylitis, 5/6 had improvement in psoriasis severity, 1 patient had absolute improvement of 2.3 in BASDAI, and 7/8 had improvement in the CRP level. Conclusions: Patients with active psoriatic arthritis despite treatment with secukinumab may still have a clinical response following treatment with another anti-IL17 agent. Larger studies will be required to confirm this finding, and studies which emphasize dactylitis and enthesitis outcomes will be needed as most patients did not have activity in these domains.

Recombinant Activated Factor VII (rFVIIa) in the Treatment of Non-Hemophilia Patients: Physician Underreporting of Thromboembolic Adverse Events.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3143-3143
Author(s):  
Cyrus C. Hsia ◽  
Joanna H. Zurawska ◽  
Michael Z.Y. Tong ◽  
Kathleen Eckert ◽  
Vivian C. McAlister ◽  
...  
Keyword(s):  
Adverse Events ◽  
Chart Review ◽  
Tertiary Care ◽  
Factor Vii ◽  
High Risk Population ◽  
Tertiary Care Centre ◽  
Recombinant Activated Factor Vii ◽  
Off Label ◽  
Activated Factor Vii

Abstract Background: Recombinant activated factor VII (rFVIIa) is a potent hemostatic agent with a short half-life of 2.6 hours and is approved for various hereditary and acquired bleeding disorders. Its “off-label” utilization has increased and is the focus of a number of ongoing clinical trials. One concern is that its beneficial hemostatic effect may be offset by the potential for thromboembolic adverse events (TAEs). Despite its short half-life, rFVIIa likely produces a sustained hemostatic effect and the potential for thromboembolic events may also be prolonged. A recent review of adverse events reported to the FDA suggested that this risk was substantial. The duration that this risk may be present is unclear. Physicians may only consider adverse events to be causally related in the immediate few hours after administration of rFVIIa leading to underreporting TAEs. We conducted a retrospective review of all off-label uses of rFVIIa comparing physician reporting of TAEs to documented TAEs on chart review. Methods: Chart review of all non-hemophilia adult patients who had received rFVIIa at our tertiary care centre was completed. Following all off-label administration, questionnaires were routinely sent to all treating physicians to report outcomes and adverse reactions with the use of rFVIIa. We included all non-hemophilia adult patients at our tertiary care centre who have received rFVIIa. Exclusion criteria were age < 18 and patients with hemophilia or other bleeding disorders for which rFVIIa use is approved. TAEs identified during chart review were compared to physician reporting on questionnaires. Results: A total of 71 patients, 32 females and 39 males, satisfied study criteria during the period January 1, 2003 to June 30, 2007. Mean age was 54 (range 18–84). This was a high-risk population with 34 (47.9%) deaths. Mean duration of follow-up was 30 days (within 1 day to 312 days). Total doses of rFVIIa administered ranged from 2.4–19.2mg (mean 8.2mg) given in 1 to 4 divided doses. 11 arterial and 5 venous TAEs identified on chart review were deemed possibly or probably related. These occurred on average 25 days (within 2 day to 89 days) after exposure to rFVIIa. In total, 50 physician questionnaires (70%) were completed. There were no TAEs reported to the transfusion safety officer at our institution by the treating physician(s) in these questionnaires. Conclusions: Clinically important thromboembolic events due to recombinant activated factor VII are under-reported in this high-risk population. This review was not designed to determine if rFVIIa alters the rate of TAEs but emphasizes the need for careful follow-up, both immediate as well as longterm, of patients who have hemorrhage or are at risk of hemorrhage. Physicians treating patients with rFVIIa should be vigilant for potential TAEs beyond the immediate treatment period.

Genetic Testing for Hereditary Breast Cancer: The Decision to Decline

2018 ◽  
Vol 84 (1) ◽  
pp. 154-160 ◽  
Author(s):  
V. Brook White ◽  
Kendall K. Walsh ◽  
Kimberly Showers Foss ◽  
Lisa Amacker-North ◽  
Stacy Lenarcic ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Chart Review ◽  
Medical Information ◽  
Retrospective Chart Review ◽  
High Risk Population ◽  
Cancer Syndrome ◽  
Nccn Guidelines ◽  
Management Recommendations ◽  
Cancer Network

Genetic testing is important for comprehensive cancer care. Commercial analysis of the BRCA1/2 genes has been available since 1996, and testing for hereditary breast and ovarian cancer syndrome is well established. The National Comprehensive Cancer Network (NCCN) guidelines identify individuals for whom BRCA1/2 analysis is appropriate and define management recommendations for mutation carriers. Despite recommendations, not all who meet NCCN criteria undergo genetic testing. We assess the frequency that individuals meeting NCCN criteria decline BRCA1/2 analysis, as well as factors that affect the decision-making process. A retrospective chart review was performed from September 2013 through August 2014 of individuals who received genetic counseling at the Levine Cancer Institute. A total of 1082 individuals identified through the retrospective chart review met NCCN criteria for BRCA1/2 analysis. Of these, 267 (24.7%) did not pursue genetic testing. Of the Nontested cohort, 59 (22.1%) were disinterested in testing and 108 (40.4%) were advised to gather additional genetic or medical information about their relatives before testing. The remaining 100 (37.5%) individuals were insured and desired to undergo genetic testing but were prohibited by the expense. Eighty five of these 100 patients were responsible for the total cost of the test, whereas the remaining 15 faced a prohibitive copay expense. Financial concerns are a major deterrent to the pursuit of BRCA1/2 analysis among those who meet NCNN criteria, especially in patients diagnosed with breast or ovarian cancer. These findings highlight the need to address financial concerns for genetic testing in this high-risk population.

scholarly journals Cervical length as a predictor of pre-term birth in twin gestations

Twin Research ◽  
2000 ◽  
Vol 3 (4) ◽  
pp. 213-216 ◽  
Author(s):  
JL Shapiro ◽  
R Kung ◽  
JFR Barrett
Keyword(s):  
Risk Factor ◽  
Preterm Delivery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Cervical Length ◽  
Likelihood Ratios ◽  
Term Birth ◽  
Term Delivery ◽  
A Prospective Study ◽  
Twin Pregnancies

AbstractThe aim of this study was to determine the predictive value of cervical length as a risk factor for spontaneous pre-term birth in twin gestations. A retrospective chart review was carried out on patients with twin pregnancies referred to our multiples' clinic. Cervical length was measured by transvaginal ultrasonography. Patients with an indicated pre-term delivery or intervention were excluded from the analysis. Outcomes included preterm delivery < 28 and < 35 weeks gestation. After extracting the data, 2 × 4 tables were constructed. Likelihood ratios were then generated for cervical lengths ≤2.0 cm, ≤2.5 cm, ≤3.0 cm, and > 3.0 cm. Because of the limited number of measurements taken < 25 weeks gestation, we elected to collapse the tables, thereby achieving more meaningful results. For measurements taken before 30 weeks gestation, a shorter cervix did predict delivery < 28 weeks gestation (likelihood ratios for cervical lengths ≤2.0 cm, ≤2.5 cm, ≤3.0 cm, and > 3.0 cm were 4.43, 1.94, 0.97, and 1.02, respectively). The probability of preterm delivery < 35 weeks gestation increased with decreasing cervical length (likelihood ratios for cervical length ≤2.0 cm, ≤2.5 cm, ≤3.0 cm, and > 3.0 cm were 2.58, 1.66, 1.38, and 0.81, respectively). A shorter cervix measured before 30 weeks gestation was a stronger predictor of preterm delivery < 28 weeks compared to < 35 weeks gestation. Cervical length was not predictive of preterm delivery if measured after 30 weeks. Cervical length is predictive of preterm delivery < 28 weeks and < 35 weeks gestation when measured before 30 weeks gestation. No trend was seen when measured after 30 weeks gestation. A prospective study is currently underway to confirm these results. Twin Research (2000) 3, 213–216.

scholarly journals P.004 Autoimmune Encephalitis: Modifiable and Non-Modifiable Predictors of Relapse

2021 ◽  
Vol 48 (s3) ◽  
pp. S21-S21
Author(s):  
M Hansen ◽  
C Hahn
Keyword(s):  
North America ◽  
Chart Review ◽  
Statistical Significance ◽  
Autoimmune Encephalitis ◽  
Outcome Data ◽  
Factors Associated ◽  
Immune Mediated ◽  
Treatment Use ◽  
Steroid Sparing ◽  
Risk Of Relapse

Background: Approximately 25% of encephalitis cases in North America are immune mediated. For most forms of autoimmune encephalitis (AIE), risk of relapse is unclear and little evidence exists to guide which patients have the highest risk and whether standard treatments reduce this risk. Our objective was to determine the factors associated with AIE relapse. Methods: We performed a chart review consisting of patients with AIE presenting to the Calgary Neuro-Immunology Clinic and Tom Baker Cancer Centre between 2015 and 2020. Predictors of relapse were determined with use of t-test. Results: Outcome data was assessable in 39/40 patients, 17/39 (44%) patients relapsed. Seropositive patients and those with abnormal CSF were more likely to relapse, although neither reached statistical significance (p=0.12, 0.059). Patients with longer duration of steroid and steroid sparing treatment prior to relapse, and those on steroids at the time of relapse, had milder relapses (p=0.024, 0.026, 0.047). There was no difference in steroid or steroid sparing treatment use at 3, 6, and 12 months between groups. Conclusions: Risk of relapse in AIE is high (44%), with most relapses occurring in the first 3 years. Continuous immunosuppression lessens the severity of relapse, although our study did not confirm it reduced the occurrence of relapse.

scholarly journals 707. Infective Endocarditis and Medication Assisted Treatment in Opioid Use Disorder

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S404-S405
Author(s):  
Katherine Loomis ◽  
Catherine Canamar ◽  
Michael Dubè
Keyword(s):  
Infective Endocarditis ◽  
Treatment Adherence ◽  
Chart Review ◽  
Primary Outcome ◽  
Care Facility ◽  
Opioid Use Disorder ◽  
Categorical Variables ◽  
High Risk Population ◽  
Opioid Use ◽  
Medication Assisted Treatment

Abstract Background A challenging feature in those with opioid use disorder-associated infective endocarditis (OUD-IE) is the duration and route of treatment, which often requires long inpatient stays. Those with OUD-IE often experience opioid withdrawal in the hospital, putting them at risk of leaving care prior to completion of treatment. Initiation of medication-assisted treatment (MAT) with opioid agonists, including buprenorphine or methadone, has the potential to mitigate withdrawal and decrease morbidity and mortality among this high-risk population. We hypothesized that inpatient MAT will increase IE treatment adherence. Methods We conducted a single-center retrospective chart review study of adults (age &gt; 18 years) with OUD-IE from 10/2015-09/2019. Vizient database was used to identify cases using ICD-9 and ICD-10 codes for IE and OUD. Manual chart review was done to confirm cases of OUD-IE using the modified Duke criteria for IE (Table 2) and evidence of active opioid use. Our primary outcome was treatment adherence defined as inpatient completion of treatment or transfer to another care facility for completion of treatment. Chi-squared test was used for categorical variables, t-test for continuous variables, and odds ratio (OR) with 95% confidence interval (CI) to evaluate our primary outcome. Table 2 Results There were 49 confirmed patients with 89 unique admissions associated with OUD-IE (Figure 1). Of those, 71% were male, and the median age was 45 years (range 20-72). The majority were homeless (63%) and hepatitis C antibody positive (82%) (Table 1). There were 81 evaluable admissions with 8 (9%) excluded due to intubation. Of those, 18 (22%) received inpatient MAT and 63 (78%) did not. Mortality rate was high, with 11 inpatient deaths. Among those admissions where MAT was given, 14 of 18 (78%) adhered to treatment, compared to 21 of 63 (33%) who did not receive MAT (p&lt; 0.001). Significantly, only 4 of 18 (22%) who received MAT left AMA, compared 39 of 60 (65%) who did not receive MAT (p=0.001), excluding 3 who died. Those who received inpatient MAT were 7 times more likely to adhere to treatment (OR=7.0; 95% CI=2.05, 23.91) compared to those who did not (Table 3). Figure 1 Table 1 Table 3 Conclusion Patients with OUD-IE were more likely to adhere to treatment if they receive inpatient MAT. Disclosures All Authors: No reported disclosures

scholarly journals 281. Detecting bacterial sepsis among allogeneic HCT recipients with population-specific bedside tools

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S140-S141
Author(s):  
Margaret Lind ◽  
Steven A Pergam ◽  
Catherine Liu ◽  
Amanda Phipps ◽  
Stephen Mooney ◽  
...  
Keyword(s):  
High Risk ◽  
Research Study ◽  
Rare Event ◽  
Scientific Research ◽  
Early Warning Score ◽  
High Risk Population ◽  
Cell Transplant ◽  
Bacterial Sepsis ◽  
Prediction Tools ◽  
Study Investigator

Abstract Background Diagnosing sepsis among allogeneic hematopoietic cell transplant (aHCT) recipients remains challenging. Existing criteria, for use in hospitalized patients, have limited predictive accuracy among aHCT recipients and their use may lead to missed events or antibiotic overuse. We developed bedside bacterial sepsis prediction tools (criteria and decision tree [DT]) for aHCT recipients and compared them against Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) criteria. Methods Adult aHCT recipients transplanted between September 2010–2019 with ≥ 1 potential infection (PI) within 100 days post-transplantation were randomly assigned to model/validation (7/3) cohorts. Tools included demographic and clinical factors and were built against a bacterial sepsis endpoint (gram-negative, Staphylococcus aureus, or Streptococcus species bacteremia). The tools were developed using best subset selection with rare event logistic regression (criteria) and classification tree (DT) algorithms. Criteria scores were estimated using a beta/10 integer weighting approach and tool predictive performances were compared against existing criteria. Results Between September 2010–2019, 1571 recipients with ≥ 1 PI contributed 7755 PIs and 238 sepsis events. The DT model included 7 terminal nodes based on 3 predictors: temperature, respiratory rate (RR), and sex. The criteria model contained 10 categories with 4 predictors: RR, temperature, pulse, and diastolic blood pressure (Figure 1). Our criteria and DT had AUCs of 71.1% (95% Confidence Interval (CI): 64.3, 77.9%) and 70.0% (CI: 63.7, 76.2%). SIRS had the highest AUC of existing criteria – 64.7% (CI: 57.1, 71.9%). Our criteria had the highest net benefit (for probabilities &lt; 10%) and, at a 7+ cut-point, had a sensitivity of 73.8% (CI: 61.5–84.0%) and specificity of 55.0% (CI: 52.9, 57.1%) (Figure 2). Conclusion We developed aHCT recipient-specific bedside bacterial sepsis prediction tools with higher AUCs than existing criteria. Tools targeted to high-risk populations may lead to fewer missed sepsis events and, in turn, reduce sepsis related mortality among this high-risk population. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

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