scholarly journals Veteran adherence to oral versus injectable AUD medication treatment

2021 ◽  
Vol 11 (3) ◽  
pp. 194-199
Author(s):  
Hayden Stewart ◽  
Brian G. Mitchell ◽  
Daniel Ayanga ◽  
Annette Walder
Keyword(s):  
Retrospective Chart Review ◽  
Health Clinic ◽  
First Year ◽  
Readmission Rates ◽  
Medication Treatment ◽  
Admission Rates ◽  
Conflicting Evidence ◽  
Oral Naltrexone ◽  
Intent To Treat ◽  
Treat Analysis

Abstract Introduction AUD medication treatment has been shown to improve outcomes compared with placebo when confined to per-protocol analysis. The same outcomes, however, have not always been maintained in intent-to-treat analysis, thus suggesting adherence may have a significant impact on efficacy outcomes. There is conflicting evidence present in the literature comparing adherence to oral versus injectable AUD pharmacotherapy and a paucity of information in the veteran population on risk factors for low adherence. Methods The primary end point of this retrospective chart review was to determine whether adherence rates differ between oral and injectable AUD treatments in veterans during the first year of treatment (at 3, 6, 9, and 12 months) using the portion of days covered model. Secondary end points were to determine differing characteristics between patients with high versus low adherence and compare alcohol-related readmission rates and discontinuation rates between groups. Results Adherence to injectable extended-release (XR) naltrexone was significantly higher than oral naltrexone at all time points and was significantly higher than disulfiram at 3, 6, and 9 months, but it was not significantly different from acamprosate at any time point. At months 9 and 12, acamprosate had significantly higher adherence compared with oral naltrexone. Patients with higher adherence were seen more frequently in the mental health clinic and had previously tried more AUD medications. The discontinuation rates and alcohol-related admission rates were not significantly different between groups at 1 year. Discussion XR naltrexone may improve adherence rates compared with oral naltrexone or disulfiram, but not acamprosate based on these outcomes. Patients may have increased adherence if they are seen more often in clinic and have trialed more AUD medications.

Comparison of care patterns for hospitalized immune-related adverse events (irAEs) between melanoma patients on combination immune checkpoint inhibitor (ICI) therapy versus ICI monotherapy.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 85-85
Author(s):  
RuiQui Chen ◽  
Elliot Charles Smith ◽  
Sze Wah Samuel Chan ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Chart Review ◽  
Immune Checkpoint Inhibitor ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Readmission Rates ◽  
Admission Rates ◽  
Average Length Of Stay ◽  
Care Patterns ◽  
Melanoma Patients

85 Background: Prior clinical trials in melanoma have demonstrated higher rates of irAEs from combination ICI therapy compared to monotherapy. However, this has not been well studied in the real-world where patients often have greater co-morbidities and less organ reserve. We aim to compare irAEs hospitalizations for melanoma patients on combination vs monotherapy ICIs. Methods: We performed a single centre retrospective chart review (Princess Margaret Cancer Centre, Toronto, ON) for all melanoma patients receiving ICI as standard of care (2012-2017) admitted with irAEs. Data collected include demographics, investigations, management and outcomes of hospitalizations. Descriptive analyses were performed to characterize hospitalizations and compare between ICI combination vs monotherapy groups. Results: Among 381 melanoma patients identified on standard of care ICI, 41 (11%) were admitted for irAE. Among those admitted, 10% received monotherapy with nivolumab, 22% pembrolizumab, 39% ipilimumab and 29% combination ICI. Admission rates were higher among patients receiving combination ICI compared to monotherapy (20% vs 8% p = 0.003). Prevalence of the most common irAEs were similar between combination and monotherapy groups: colitis (58% vs 59%), pneumonitis (8% vs 14%) and hepatitis (8% vs 10%). Less than half received invasive diagnostic tests (i.e, endoscopy) (42% combination vs 35% monotherapy, p = 0.50) with 3 (60%) and 5 (50%) confirming irAEs, respectively. Rates of infliximab use were similar between the combination and monotherapy group (25% vs 21%, p = 0.70). Average length of stay was shorter for patients on combination ICI compared to monotherapy (5 days vs 15 days, p = 0.08). irAE readmission rates were similar between patients receiving combination ICI compared to monotherapy (20% vs 17%, p = 0.65). Conclusions: Despite higher admission rates among patients receiving combination ICI, there was a trend towards shorter hospitalizations. Other outcomes including diagnoses, investigations and management were not significantly different between patients receiving combination vs ICI monotherapy.

scholarly journals Effectiveness of exercise at workplace in physical fitness: uncontrolled randomized study

2014 ◽  
Vol 12 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Antônio José Grande ◽  
Valter Silva ◽  
Sérgio Alencar Parra
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Randomized Study ◽  
Exercise Program ◽  
Employee Health ◽  
Fat Percentage ◽  
Academic Organizations ◽  
Health Related ◽  
Intent To Treat ◽  
Treat Analysis

Objective : To investigate the effectiveness of workplace exercise for employee health by means of health-related physical activity components. Methods : A randomized uncontrolled study with 20 workers was carried out during three months to evaluate a workplace exercise program. The selected outcomes were flexibility, body mass, fat percentage, lean mass, blood pressure, and heart rate. For statistical analysis, the paired t test and the intent-to-treat analysis were used. Results : There was a significant increase in weight, fat percentage, blood pressure, and heart rate. However the clinical significance was 10% in the size of the effect. Conclusion : The changes verified in the outcomes analyzed were not significant; the variables are within normality ranges proposed by academic organizations

Abstract 208: Effects of Gender and BMI on Comorbidities in Patients With Non Hemorrhagic Stroke

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael Ashamalla ◽  
Justin Pieper ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Mikhail Torosoff
Keyword(s):  
Hemorrhagic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Obesity Paradox ◽  
Morbidly Obese ◽  
Academic Medical ◽  
Conflicting Evidence ◽  
Stage Renal Disease ◽  
End Stage

Background: There is conflicting evidence concerning the obesity paradox in stroke patients. We sought to examine the relationship between gender, BMI, and prevalence of comorbidities in patients with non-hemorrhagic stroke. Materials and Methods: Retrospective chart review was performed in 996 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided according to gender and specific BMI groups according to the National Institute of Health. This study was approved by the institutional IRB. Results: Patients with BMI from 0-18.5 and 18.5-24.9 were more likely to be female (63.2% and 58.4% p<.05). Whereas patients with BMI over 25-30 and 30-35 were more likely to be male (60.82% and 59.2% p<.05). Morbidly obese patients (BMI>35) were equally likely to be men or women. In men higher BMI correlated with presentation at younger age. Diabetes was most prevalent in patients with BMI over 35 (40% males, 44% females, p<.05). In females, HTN was associated with BMI 30-34.5 and 35+ (80.5% and 73.3%, P<.05). Males showed a similar though non-significant trend. The prevalence of end stage renal disease, systemic atherosclerosis, and PVD was not significantly correlated with BMI in either gender. Conclusion: Gender and BMI significantly affect associated comorbidities in patients with non-hemorrhagic stroke, possibly suggestive of unique gender specific disease mechanisms. Additional studies investigating the effect of gender and BMI on diagnostic evaluation and treatment of patients with non-hemorrhagic stroke are warranted.

Increasing Incidence of Varicella Hospitalizations in United States Army and Navy Personnel: Are Today's Teenagers More Susceptible? Should Recruits Be Vaccinated?

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 867-873
Author(s):  
Gregory C. Gray ◽  
Lawrence A. Palinkas ◽  
Patrick W. Kelley
Keyword(s):  
United States ◽  
United States Army ◽  
Military Service ◽  
Active Duty ◽  
First Year ◽  
Enlisted Personnel ◽  
Admission Rates ◽  
Military Members ◽  
Teenagers And Young Adults ◽  
Navy Personnel

Hospital records for 10 687 United States Army and Navy adult varicella (chickenpox) admissions were reviewed. Annual hospital admission rates for varicells increased more than fourfold in the active-duty army during 1980 to 1988 and more than 18-fold among active-duty navy enlisted personnel during 1975 to 1988. Fifty-seven percent of vanicella admissions occurred in the most junior military members, aged 17 to 20. More than half of the total vanicella admissions occurred in personnel with less than a year of military service. Multivariate analysis of the navy data confirmed increasing time-related trends of risk, suggesting a national temporal trend of increased vanicella susceptibility in US teenagers and young adults. Administering a safe and effective vanicella vaccine to army and navy recruits could prevent more than 7260 hospital-bed days during the first year of use.

scholarly journals Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time

2016 ◽  
Vol 35 (7) ◽  
pp. 1294-1302 ◽  
Author(s):  
Kumar Dharmarajan ◽  
Li Qin ◽  
Zhenqiu Lin ◽  
Leora I. Horwitz ◽  
Joseph S. Ross ◽  
...  
Keyword(s):  
Readmission Rates ◽  
Admission Rates ◽  
Over Time

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

Blood tests to predict one- to two-year survival of patients with difficult cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16158-e16158
Author(s):  
Robert L. De Jager ◽  
Howard Bruckner ◽  
Fred Bassali ◽  
Elisheva Dusowitz ◽  
AJ Book ◽  
...  
Keyword(s):  
High Risk ◽  
Hospice Care ◽  
Intrahepatic Bile Duct ◽  
Stage Iv ◽  
Neutrophil Lymphocyte Ratio ◽  
Blood Tests ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Intent To Treat ◽  
Treat Analysis

e16158 Background: A sequence of drug combinations produces > 1 median (M) -strong 2-year (yr) survival (S) (Bruckner et al AACR 14 Antica Res (ACR) 16, 18 SIGO 19). Trials included high-risk patients (pts). Each initial series has 5-yr Ss, after pts were referred for hospice care. Prognostic ALAN blood tests (Ts) have been validated for stage IV (Adv) Cholangiocarcinoma (CCA) (Salati et al EuJCa18). Other Ts predict unexpected favorable (F) S of pts with gastric ca, PS 2-3. Bruckner et al JAMA, 82); but, there is little known about Ts for resistant (R) Ca. Methods: Planned Kaplan-Meier intent to treat analysis to find Ts that: expand eligibility (El) for therapy; identify biomarkers that predict therapy can prolong S and identify new hypotheses for therapy. El pts have:R to test drugs, Pancreatic (PC), Intrahepatic bile duct, CCA, Colon, CRC and new (N) APC. All series: -/+ high risk, -/+ aged, PS 0-2. El: Helsinki criteria- consent, recovered from severe (gr3) toxicity; able to reach office, -/+ help, and S > 6 wks. Inel: CNS involved, IV needed, F clinical factors predict 1 yr MST. Ts include A.L.A.N. scores, (AS) (Salati ibid) and other blood Ts (ACR ibid, Lavin et al CTR 82) Therapy GFLIO in mg/M2: gemcitabine 500, leucovorin 180, fluorouracil 1200, 24 hr infusion. Irinotecan 80 D2 Oxaliplatin 40. Then for progression (pg), add docetaxel 20-25, except CRC mitomycin C 4-6; next pg add cetuximab, except APC or KRAS-M, weekly, and next pg replace cetuximab with bevacizumab 10mg/kg ibid ACR 16. Results: At all ages, overall (O) S is > 1 yr for RCRC, and NAPC and sets with any 1 F or UnF T other than < 3.1 Albumin (Alb) or < 2.1 lymph/monocyte ratio (LMR) b For CCA, 17R/16N, OMS > 2 yrs 66% of pts and ≥ 2 yrs for all test sets except UnF, 26% of pts, MS 17 mos, with low Alb. For CRC: 50R OMS is 16.5 mos; 42% S 2 yrs, Fav Ts: MS > ̃ 2yrs, 39-82% of pts have FTs; Neutrophil Lymphocyte Ratio (NLR); < 3.1, 61% S 2 yrs, p < .02; Lymphs > 1.5, 53% S 2 yrs, p < .02; AS 0; 59% S 2 yrs, p < .06; Platelets < 300,000, 54% S 2 yrs, p < .06; Alb: ≥ 3.5, 48% S 2 yrs, p < .11. For N-APC: 53 pts, OS is 14.5 mos and > 12 mos in sets with any 1 UnF T other than Alb or LMR. FTs: MST 16.4-18 mos. 34-77% of pts have FTs; Alb ≥ 3.5, 34% S 2 yrs, p < 0.001; WBC < 10, 29% S 2 yrs, p < .06; AS 0-2, 35% S 2 yrs, p 2.7E-7. For R-PC: 53 pts, OS is 12 mos for 44% of pts, FTs: MST 13.6-17 mos, 21-70% of pts have FTs: Alb ≥ 3.5 30% S 2 yrs, p .0004; AS: 0, 41% S 2 yrs, p .0006; NLR < 3, 37% S 2 yrs, p < .02. GFLIO’s < 5% gr3 induction toxicity, is reversible, with no hospitalization, neutropenic fever or gr3 neuropathy. Conclusions: Robust Ts identify many difficult pts with median > 1 and testable prospective > 2 yr rates of S. Ts warrant development: validation with GFLIO and other therapy and other cancers; to improve Ts, models for eligibility and geriatric criteria; to identify false -/+ trials; and personalize trials to correct UnF Ts. FTs, with GFLIO, can change prognosis and practice for > 50% of pts now advised “against” any therapy due to a clinical estimate of “less than 6 -10 mos to live.” Clinical trial information: NCT01905150.

Abstract WP252: Reduction in Stroke Readmission Rates After Implementing an Emergency Department-based Transient Ischemic Attack Observation Unit

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lori Fayas ◽  
Kathy Polum ◽  
Heather Stanko
Keyword(s):  
Emergency Department ◽  
Comprehensive Evaluation ◽  
Recurrent Stroke ◽  
Retrospective Chart Review ◽  
Rapid Evaluation ◽  
Observation Unit ◽  
Readmission Rates ◽  
Community Based ◽  
Ischemic Attack ◽  
Work Up

Background and Purpose —Diagnosis and treatment of transient ischemic attacks (TIAs) is often delayed by lack of access to immediate comprehensive evaluation of the underlying etiology. Early initiation of treatment can reduce the risk of early recurrent stroke by up to 80%. Up to 40% of people who have experienced a TIA will go on to have a stroke. The purpose of this review was to determine the efficacy of an Emergency Department (ED)-based TIA observation unit using a standardized TIA protocol designed to provide rapid evaluation and treatment of patients presenting with TIA in reducing the rates of readmission with stroke to a community-based hospital. Methods —We did a retrospective chart review of all patients discharged from Bellin Hospital with a diagnosis of stroke before implementing a standardized TIA protocol in our ED-based TIA observation unit (July to December 2010) and after implementation of the TIA observation unit (November 2011 to April 2012). We identified the patients in these cohorts who had previously been evaluated in the ED with signs or symptoms of stroke in the 6 months prior to admission and compared their stroke readmission rates. Patients who received evaluation through the TIA observation unit from November 2011 to April 2012 were monitored for readmission for stroke in the 6 months after evaluation. Results —Prior to use of the TIA observation unit, 7 of 51 (13.7%) patients discharged with a diagnosis of stroke had been seen in the ED in the previous 6 months with stroke-like symptoms. After implementation of the TIA observation unit, 7 of 119 (5.9%) patients discharged with a diagnosis of stroke had been seen in the ED, a 57.1% reduction in stroke readmission at 6 months. Of these, 4 (57.1%) had not completed the work-up during their previous ED visit. 122 patients underwent evaluation using the TIA observation unit. Of these, only 3 (2.5%) patients were readmitted for stroke in the next 6 months. 16 of these 122 (13.1%) patients were diagnosed with stroke during their TIA work-up. Conclusions —Rapid evaluation and treatment of TIA through an ED-based TIA observation unit substantially reduces the risk of readmission for stroke.

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