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1
Hanlon, Cory T., Alexandra K. Medoro, Pablo J. Sanchez, Demi R. Beckford, Sydney Schoenbeck, and Grace Purkey. "1140. Awareness of Cytomegalovirus (CMV) Among Postpartum Mothers: Education Needed!" Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S598. http://dx.doi.org/10.1093/ofid/ofaa439.1326.
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Abstract Background Congenital cytomegalovirus (cCMV) infection is the leading cause of non-genetic sensorineural hearing loss and affects approximately 0.5%-1% of all live births in the United States. Despite its substantial burden, maternal awareness of congenital CMV disease is limited. In addition, there is no information on CMV awareness among postpartum women who ultimately would consent for CMV newborn screening. Thus our objective of this study was to determine the proportion and characteristics of postpartum women who had knowledge of CMV in an academic medical center in Columbus, OH. Methods From May - December 2019, 276 postpartum women who delivered a newborn at the Ohio State University Wexner Medical Center, Columbus, OH were asked if they had prior knowledge of CMV. Eligible mothers had delivered an infant who was admitted to the Newborn Nursery, were ≥ 35 weeks’ gestational age, and had no signs of congenital CMV infection. These mothers had consented for enrollment of their newborn into the University of Alabama’s Collaborative Antiviral Study Group multicenter study on CMV screening (saliva) of asymptomatic infants. Pertinent demographic and clinical data were collected and subsequently managed using REDCap electronic data capture tools hosted at Nationwide Children’s Hospital, Columbus, OH. Statistical analyses were performed using GraphPad Prism. Results 505 eligible infants were born during the study period and 276 (55%) of the mothers were asked about their awareness of CMV infection. Of the 276 mothers (62%, white; 24%, Black; 3%, Asian; 0.4%, Native Hawaiian or Pacific Islander; 3%, biracial; 8%, not known), 30 (10%) had prior knowledge of CMV. Mothers who were aware of CMV did not differ from mothers who did not know about CMV in primigravida status (12/30 [40%] vs. 84/246 [34%], P=.55) or age (median, IQR; 33 years [29-35] vs. 31 years [26-34], P=.11). All infants had a normal physical examination, and none had congenital CMV infection. Conclusion Among postpartum mothers who consented to saliva screening of their newborns for congenital CMV infection, only 10% were previously aware of CMV. Such a knowledge gap should be addressed to better inform both universal and targeted newborn CMV screening among postpartum mothers. Disclosures All Authors: No reported disclosures
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Boudoulas, Konstantinos Dean, Bryan A. Whitson, David P. Keseg, Scott Lilly, Cindy Baker, Talal Attar, Quinn Capers, et al. "Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation." Journal of Interventional Cardiology 2020 (July 17, 2020): 1–9. http://dx.doi.org/10.1155/2020/6939315.
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Background. Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods. From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results. From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion. ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.
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El Rassi, Fuad, Martha Arellano, Leonard T. Heffner, Edmund K. Waller, Elliott F. Winton, Kevin Ward, and H. Jean Khoury. "Incidence and Geographic Distribution of Adult Acute Lymphoblastic Leukemia in the State of Georgia." Blood 120, no. 21 (November 16, 2012): 4309. http://dx.doi.org/10.1182/blood.v120.21.4309.4309.
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Abstract Abstract 4309 We investigated an apparent increase in acute lymphoblastic leukemia (ALL) referral from north Georgia to Emory University Hospital, a tertiary care center located in Atlanta, Georgia. Cases reported between 1999 and 2008 to the Georgia Comprehensive Cancer Registry (GCCR) and the national Surveillance Epidemiology and End Results (SEER) cancer registry were analyzed. Age-adjusted incidence rates were calculated for all counties and public health regions within the state of Georgia and compared to national rates calculated using SEER 17 data for those ages 20 and above. Cases of adult acute myeloid leukemia (AML) served as control for health referral patterns, completeness of data collection and healthcare availability. The associations between geographic residence and acute leukemia were analyzed using Poisson regression analysis, and additional models were created to control for the effects of race and ethnicity. The age-adjusted incidence rate of adult ALL (0.8/100,000) and AML (4.6/100,000) for the state of Georgia were comparable to the national rates (0.9/100,000 and 5.2/100,000 respectively). Overall, the rate of ALL observed in parts of the North Georgia region (1.1 (95% CI 0.8, 1.5) were similar when compared to the rest of the state; and not affected after adjusting for race. We conclude that the higher number of cases of ALL cases referred from North Georgia is likely related to a physician-related referral pattern rather than an increased incidence. Age-adjusted incidence rate of ALL by state and public health region and rate ratios comparing the rate of ALL within each region to the pooled rates demonstrated in all other Georgia public health regions. Region of Georgia (GA) Rate SE Lower CI Upper CI Count Pop GA: Clayton (Jonesboro) 1.1 0.3 0.6 1.8 17 1,715,865 GA: DeKalb 0.8 0.1 0.5 1.1 37 5,111,685 GA: Fulton 0.6 0.1 0.4 0.8 37 6,565,834 GA: Northwest (Rome) 0.9 0.1 0.6 1.2 35 3,962,399 GA: North Georgia (Dalton) 0.9 0.2 0.6 1.4 23 2,632,276 GA: North (Gainesville) 1.1 0.2 0.8 1.5 41 3,723,276 GA: Cobb-Douglas 0.8 0.1 0.5 1.1 38 5,357,377 GA: Gwinnett 0.7 0.1 0.5 1 38 5,712,772 GA: LaGrange 0.8 0.1 0.5 1.1 37 4,818,090 GA: South Central (Dublin) 0.3 0.2 0.1 0.9 4 1,009,356 GA: North Central (Macon) 0.7 0.1 0.4 1 24 3,476,472 GA: East Central (Augusta) 0.7 0.2 0.4 1.1 20 3,017,677 GA: West Central (Columbus) 0.6 0.2 0.3 1 14 2,492,172 GA: South (Valdosta) 0.3 0.1 0.1 0.8 5 1,638,741 GA: Southwest (Albany) 0.9 0.2 0.5 1.3 22 2,500,405 GA: Coastal (Savannah) 0.8 0.2 0.6 1.2 29 3,568,163 GA: Northeast (Athens) 0.9 0.2 0.6 1.3 26 2,903,745 GA: All Georgia 0.8 0 0.7 0.8 463 62,540,286 Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25–1130) standard; Confidence intervals (Tiwari mod) are 95% for rates. Disclosures: Waller: Outsuka: Research Funding.
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Clark, Anna. "Presidential Address: The 1890s Debate over the Democratic Control of Hospitals in Britain and New Zealand." Journal of British Studies 60, no. 1 (January 2021): 1–28. http://dx.doi.org/10.1017/jbr.2020.191.
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AbstractAnna Clark's presidential plenary to the 2018 North American Conference on British Studies in Vancouver, British Columbia, compares scandals over the mistreatment of patients and nurses that led to demands for popular control of hospitals in both Britain and New Zealand in the 1890s. A high death rate at the Chelsea Hospital for Women in London, located near a Pasteur Institute for animal research on vaccination, incited fears of human vivisection. The high death rate of nurses at the London Hospital provoked newspaper exposés and parliamentary investigations and calls for the municipalization of voluntary hospitals. In Christchurch, New Zealand, a debate over the rudeness of doctors and nurses enraged citizens. The flames of these scandals were sparked by newspaper agitation but fanned by feminists, socialists, trade unionists, and animal-rights organizations. In response to fears around experimentation, Fabian socialists Havelock Ellis, Harry Roberts, and Honnor Morten proposed democratic control of hospitals. These demands, focusing on patients’ rights and nurses’ health, differed from the hospital reform movement that urged hospitals to become more economical by forcing patients to pay. They also diverged from Beatrice and Sidney Webb's admonitions that the state must oversee citizens’ health for the nation to function efficiently. Although the calls for the democratic control of hospitals did not succeed, they might be seen as germs of a patient-centered approach to hospital care.
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Wik, Amanda, Vera Hollen, and William H. Fisher. "Forensic patients in state psychiatric hospitals: 1999–2016." CNS Spectrums 25, no. 2 (June 21, 2019): 196–206. http://dx.doi.org/10.1017/s1092852919001044.
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Introduction.In recent years mental health officials have reported a rise in the number of forensic patients present within their state psychiatric hospitals and the adverse impacts that these trends had on their hospitals. To date there have been no large-scale national studies conducted to determine if these trends are specific only to a few states or representative of a more global trend. The purpose of this study was to investigate these reported trends and their national prevalence.Methods.The forensic directors of each state behavioral health agency (including the District of Columbia) were sent an Excel spreadsheet that had two components: a questionnaire and data tables with information collected between 1996 and 2014 from the State Profiling System maintained by the National Association of State Mental Health Program Directors Research Institute. They were asked to verify and update these data and respond to the questionnaire.Results.Responses showed a 76% increase nationally in the number of forensic patients in state psychiatric hospitals between 1999 and 2014. The largest increase was for individuals who were court-committed after being found incompetent to stand trial and in need of inpatient restoration services.Discussion.The data reviewed here indicate that increases in forensic referrals to state psychiatric hospitals, while not uniform across all states, are nonetheless substantial.Conclusion.More research is needed to determine whether this multi-state trend is merely a coincidence of differing local factors occurring in many states, or a product of larger systemic factors affecting mental health agencies and the courts.
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Cottini, Francesca, Nita Williams, Naresh Bumma, Abdullah Mohammad Khan, Maria Chaudhry, Srinivas Devarakonda, Yvonne A. Efebera, Don M. Benson, and Ashley E. Rosko. "Daratumumab-Mediated Lymphocyte Kinetics Predict Adverse Events and Survival Outcomes in Patients with Multiple Myeloma." Blood 134, Supplement_1 (November 13, 2019): 5501. http://dx.doi.org/10.1182/blood-2019-129128.
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Background: Daratumumab, a human monoclonal antibody that binds CD38, has been recently approved to treat patients with Multiple Myeloma (MM), a disease of clonal plasma cells. Daratumumab is generally well-tolerated; however, lymphopenia and neutropenia can occur while on treatment. Hereby, we report real-world experience of rates, trends, and outcomes of patients who developed lymphopenia while being treated with Daratumumab in our institution. Methods: Patients who received Daratumumab between November 2015 and July 2019 at the Ohio State University in Columbus, Ohio were identified, retrospectively. Data pertaining to patient demographics, prior lines of therapy, MM staging, absolute lymphocyte count (at start, nadir, and end of treatment), infections, ED visits, and hospital stays were collected. Absolute Lymphocyte count (ALC) of less or equal to 500 cells/μL was considered severe lymphopenia. Results: One hundred patients who completed Daratumumab treatment in our institution between November 2015 and July 2019 were included. Fifty-nine patients (59%) developed severe lymphopenia with an absolute lymphocyte count (ALC) nadir equal to or less than 500 lymphocytes/μL. Sixty-one percent of them (36/59) recovered on therapy to ALC >500 lymphocyte/μL with 16 of them recovering to normal ALC (>1000 lymphocyte/μL). The median time to become severely lymphopenic was 31 days, with an average of 64 days (range 0-453). The median time to recover was 14 days (average 43 days; range 1-453). Patients with severe lymphopenia had a higher rate of infections (52.5%) compared to patients without lymphopenia (41.4%). Among the patients who had infections, patients with severe lymphopenia required hospital stays in 83.8% of the cases compared to 52.9% of the cases for the patients without severe lymphopenia (p-value= 0.03, Odd Ratio-OR: 4.6; 95% CI, 1.186 to 17.70). The most common infections were viral upper respiratory tract infections and pneumonias (22/31-71%). However, more serious infections, such as CMV/EBV reactivation, influenza A/B infection, fungal meningitis, and bacteremia occurred in our patient population. No statistically significant difference in terms of progression-free survival (PFS), overall survival (OS), or overall response rate (ORR) (58.5% versus 50.8%) was noted between patients who did or did not develop severe lymphopenia. However, when the severe lymphopenic group was stratified based on the presence of recovery, those who did not recover their ALC had worst OS (p= 0.0019) and PFS (p<0.0001; median PFS 8.7 months vs 14.7 months vs 68 months), possibly due to better immune-mediated anti-tumoral effects. Average age (64.9 vs 66.1), number of prior lines of treatment (4.1 vs 3.8) or prior transplant (72.8% vs 65.8%) were not associated with development of severe lymphopenia. Patients older than 65 had similar ALC nadir values (median 425, range 0-2250 vs median 400, range 0-1940), rates of lymphopenia (55.7% vs 62.5%, OR, 1.322; 95% CI, 0.5774 to 2.845) and time to severe lymphopenia (75.3, range 7-453 vs 58.88, range 0-254) than younger patients. However, they tended to recover slower than younger patients (average: 52 days vs 24 days). Only 26 of our patients received Daratumumab as single agent, while fifty-five of them were treated in combination with immunomodulatory drugs (IMIDs- lenalidomide or pomalidomide) and sixteen in combination with proteasome inhibitors (PIs). When patients were divided by combination strategy, no statistical difference was noted in ALC nadir values; however, IMID combination caused severe lymphopenia in 38/55 patients (69%) compared to 11/26 patients (42.3%) treated with single agent regimen (p= 0.05, OR: 2.8). Patients treated with Bortezomib combination had a slower time to severe lymphopenia (p= 0.05 and p=0.01, respectively) but longer recovery time (p= 0.0081) than patients treated with single agent or IMIDs. Conclusions: In our patient population, we discovered an elevated rate of severe lymphopenia, hospital utilization and infections. IMID combination was associated with increased rates of lymphopenia, while PI-combination caused more prolonged lymphopenia. Age more than 65 was associated with longer ALC recovery time. Interestingly, patients who did not recover their ALC had worst OS and PFS compared to patients who never became severly lymphopenic or patients who recovered their ALC count. Disclosures Efebera: Takeda: Honoraria; Janssen: Speakers Bureau; Akcea: Other: Advisory board, Speakers Bureau. Rosko:Vyxeos: Other: Travel support.
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McGuckin, Maryanne, John Govednik, David Hyman, and Bernard Black. "Public Reporting of Healthcare-Associated Infections: Epidemiologists' Perspectives." Infection Control & Hospital Epidemiology 34, no. 11 (November 2013): 1201–3. http://dx.doi.org/10.1086/673458.
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Public reporting of healthcare-associated infections is pervasive, with 33 states and the District of Columbia mandating public disclosure. We surveyed hospital epidemiologists on the perceived value of state public reports. Respondents believed consumers are unaware and do not consider the information important, but they indicated that epidemiologists have a role in consumer education.
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Lynch, Julie Ann, Louis Fiore, Michael J. Kelley, Ann Borzecki, Christopher S. Lathan, Michael Hassett, Hope S. Rugo, Muin J. Khoury, and Andrew N. Freedman. "Current status of the implementation of gene expression testing in breast cancer management in the United States." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6562. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6562.
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6562 Background: Data on implementation of genetic diagnostic (GDx) tests are lacking yet are crucial to evaluate population differences in access and outcomes. Previous studies identified substantial underuse of GDx tests. Greater access existed in states with NCI cancer centers. This pattern of diffusion may exacerbate disparities. Since 2008, the 21-gene recurrence score (21-gene RS), which assesses the 10-year risk of breast cancer (BC) recurrence in ER+, node-negative, early-stage disease, has been recommended by ASCO/NCCN to guide chemotherapy decisions. This study examines regional and site-of-care differences in use. We report national implementation rate and state-level differences in utilization. Methods: Hospital level data on 2011 orders for the test were provided by Genomic Health. We aggregated this dataset at the state-level and linked it to public datasets (Census and CDC State Cancer Profiles). Using Surveillance Epidemiology End Results (SEER) data, we estimated number of guideline-directed BC cases. The outcome variable, state utilization ratio, was calculated by dividing the number of tests ordered by guideline-directed BC cases. For some states utilization ratios may be higher than 1 because patients may have crossed state boundaries to obtain care. Results: Of approximately 101,702 guideline-directed BC cases nationally, 59,053 patients had the test; a utilization ratio of 0.58. Utilization ratio by state ranged from 0.21 to 1.71 (25th/75thpercentile range 0.48-0.64). The District of Columbia had the highest utilization ratio at 1.71 (8 institutions ordered 367 tests on an estimated 213 patients); Iowa had the lowest at 0.21 (39 institutions, 458 tests, 2094 patients). Only 7 states had utilization ratios <0.45. Conclusions: In contrast to other GDx tests, 21-gene RS has achieved notable market penetration. Overall, utilization across states is remarkably consistent, especially considering potential variations in age, comorbidities, stage, and incidence of ER+ BC. Despite widespread use, there are likely county-level and site-of-care differences in use. Hospital level analysis is ongoing and will be presented at the meeting.
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Warburton, Katherine, Barbara E. McDermott, Anthony Gale, and Stephen M. Stahl. "A survey of national trends in psychiatric patients found incompetent to stand trial: reasons for the reinstitutionalization of people with serious mental illness in the United States." CNS Spectrums 25, no. 2 (January 9, 2020): 245–51. http://dx.doi.org/10.1017/s1092852919001585.
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Objective.Recent information indicates that the number of forensic patients in state hospitals has been increasing, largely driven by an increase in patients referred to state hospitals as incompetent to stand trial (IST). This survey was intended to broaden the understanding of IST population trends on a national level.Methods.The authors developed a 30-question survey to gather specific information on IST commitments in each state and the District of Columbia. The survey was administered to all 50 states and the District of Columbia via email. Specific individuals identified as primary administrators responsible for the care and evaluation of IST admissions in each state were contacted.Results.A total of 50 out of the 51 jurisdictions contacted completed the survey. Fully 82% of states indicated that referrals for competency evaluation were increasing. Additionally, 78% of respondents thought referrals for competency restoration were increasing. When asked to rank factors that led to an increase, the highest ranked response was inadequate general mental health services in the community. Inadequate crisis services were the second ranked reason. Inadequate number of inpatient psychiatric beds in the community was the third highest, with inadequate assertive community treatment services ranking fourth.Conclusions.Understanding the national trend and causes behind the recent surge in referrals for IST admissions will benefit states searching for ways to remedy this crisis. Our survey indicates most states are facing this issue, and that it is largely related to insufficient services in the community.
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Castner, Jessica, and Lenore Boris. "State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Cross-Sectional Survey Study." Policy, Politics, & Nursing Practice 21, no. 4 (September 11, 2020): 233–43. http://dx.doi.org/10.1177/1527154420954457.
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Introduction State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments. Methods A cross-sectional approach was used with a nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, X-rays, over-the-counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. Results A total of 350 participants returned surveys from 48 states and the District of Columbia. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with the scope of practice prohibitions. Four categories emerged such as advantages, approval, prohibition, and conditions under which the protocols can be used. Prohibitive language was associated with less protocol use for emergency care. Conclusion State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.
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Frogel, Michael, George Foltin, and Arthur Cooper. "Pediatric Outpatient/Urgent-Care Emergency and Disaster Planning." Prehospital and Disaster Medicine 34, s1 (May 2019): s155—s156. http://dx.doi.org/10.1017/s1049023x19003510.
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Introduction:Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.Aim:After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.Methods:The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.Results:Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.Discussion:An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.
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Cimino, J. J. "Terminology Tools: State of the Art and Practical Lessons." Methods of Information in Medicine 40, no. 04 (2001): 298–306. http://dx.doi.org/10.1055/s-0038-1634425.
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Summary Objectives: As controlled medical terminologies evolve from simple code-name-hierarchy arrangements, into rich, knowledge-based ontologies of medical concepts, increased demands are placed on both the developers and users of the terminologies. In response, researchers have begun developing tools to address their needs. The aims of this article are to review previous work done to develop these tools and then to describe work done at Columbia University and New York Presbyterian Hospital (NYPH). Methods: Researchers working with the Systematized Nomenclature of Medicine (SNOMED), the Unified Medical Language System (UMLS), and NYPH’s Medical Entities Dictionary (MED) have created a wide variety of terminology browsers, editors and servers to facilitate creation, maintenance and use of these terminologies. Results: Although much work has been done, no generally available tools have yet emerged. Consensus on requirement for tool functions, especially terminology servers is emerging. Tools at NYPH have been used successfully to support the integration of clinical applications and the merger of health care institutions. Conclusions: Significant advancement has occurred over the past fifteen years in the development of sophisticated controlled terminologies and the tools to support them. The tool set at NYPH provides a case study to demonstrate one feasible architecture.
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Moss, Patrick T., David R. Greenwood, and S. Bruce Archibald. "Regional and local vegetation community dynamics of the Eocene Okanagan Highlands (British Columbia Washington State) from palynology." Canadian Journal of Earth Sciences 42, no. 2 (February 1, 2005): 187–204. http://dx.doi.org/10.1139/e04-095.
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Palynofloras from the middle Early to early Middle Eocene Okanagan Highlands (northern Washington State and southern British Columbia) are used to reconstruct vegetation across a broad upland Eocene landscape. In this preliminary report, forest floristic composition is reconstructed using palynological analysis of sediments from Republic, Washington; localities of the Allenby Formation in the Princeton region (Hospital Hill, One Mile Creek and Summers Creek Road), Hat Creek, McAbee, Falkland, Horsefly, and Driftwood Canyon, British Columbia. Wind-dispersed taxa were dominant in all samples, consistent with floras preserved in lacustrine and paludal depositional environments. Pseudolarix was dominant in five of the floras, but Abies (Falkland) or Ulmus (Republic Corner Lot site) were dominant in individual samples for some floras. Betulaceae were dominant for McAbee (Alnus) and Allenby Formation (Betula), matching megafloral data for these sites. Some taxa common to most sites suggest cool conditions (e.g., Abies, other Pinaceae; Alnus, other Betulaceae). However, all floras contained a substantive broad-leaved deciduous element (e.g., Fagaceae, Juglandaceae) and conifers (e.g., Metasequoia) indicative of mesothermal conditions. Palms were only abundant in the Hat Creek coal flora, with very low counts recorded for the Falkland, McAbee, and Allenby Formation sites, suggesting that they were rare in much of the landscape and likely restricted to specialized habitats. Thermophilic (principally mesothermal) taxa, including palms (five sites) and "taxodiaceous" conifers, may have occurred at their climatic limits. The limiting factor controlling the regional distribution of thermophilic flora, which include primarily wetlands taxa, may be either climatic or edaphic.
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Patel, Payal K., Jennifer Meddings, David P. Calfee, Kyle Popovich, Jeff Rohde, Andrew J. Rolle, Karen E. Fowler, et al. "2469. A National Intervention to Improve Infection Prevention Efforts in Hospitals with High Rates of Clostridioides difficile infection, Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection and/or Methicillin-Resistant Staphylococcus aureus." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S854—S855. http://dx.doi.org/10.1093/ofid/ofz360.2147.
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Abstract Background To strengthen state collaborative efforts and reduce common healthcare-associated infections (HAIs) in short-stay and long-term acute care hospitals, the Centers for Disease Control and Prevention (CDC) launched “States Targeting Reduction in Infections via Engagement” (STRIVE) - a national quality improvement program. Methods STRIVE consisted of a multimodal intervention implemented from November 2016 to May 2018 (Figure 1). Hospitals with excess Clostridioides difficile infection (CDI) and a high burden of at least one of the following HAIs - central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI) or methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection were targeted. Monthly aggregate HAI and device utilization ratios - according to CDC National Healthcare Safety Network definitions - were measured during the pre vs. post-intervention periods. Thematic analysis of qualitative interviews with state partners was conducted to understand the influence of the intervention. Results Overall, 387 hospitals from 23 states and the District of Columbia participated. Changes in HAI rates and catheter utilization are illustrated in Figure 2. From pre- to post-intervention, substantial changes in HAI rates above temporal trends were not observed (CDI, 7.0 to 5.7 per 10000 patient-days; CLABSI, 0.88 to 0.80 per 1000 catheter days; CAUTI, 1.12 to 1.04 per 1000 catheter days; MRSA bloodstream infection, 0.075 to 0.071 per 1,000 patient-days) Similarly, catheter utilization did not differ substantially between the pre- and post-intervention periods (24.05 to 22.07 central line days per 100 patient-days; 21.46 to 19.83 urinary catheter days per 100 patient-days). Qualitative analysis of 17 interviews with state partners showed that relationships among state partners and hospitals were strengthened, potentially facilitating collaboration on future infection prevention efforts. Conclusion Though HAI reductions were observed during STRIVE, these reductions were consistent with temporal trends. Hospitals struggling with high HAI rates may require additional novel approaches. Disclosures All authors: No reported disclosures.
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Simmons, Christine E., Elaine Wai, Scott Tyldesley, Maria Lorenzi, Dongdong Li, and Mary L. McBride. "Risk of hospital-related morbidity among survivors of breast cancer in British Columbia, Canada." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 1551. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.1551.
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1551 Background: Long-term consequences of cancer diagnosis and treatment are of increasing concern, as therapeutic interventions improve survival. Various survivorship programs exist; few address the importance of bridging oncology and primary care. This study assesses risk of late hospital-related morbidity among a population-based cohort of 39,436 3-year survivors of female breast cancer in British Columbia, Canada and compares the risk of morbidity to a similarly-aged comparison group. Methods: Demographic and clinical records of breast cancer survivors diagnosed between 1986 and 2005 were linked to inpatient records from provincial administrative databases. A comparison group from the provincial health insurance plan registry, frequency-matched by birth cohort was identified. Morbidity was ascertained from diagnosis codes listed on hospital records, and categorized by organ system. Poisson regression was used to assess the relative risk of morbidity, adjusting for sociodemographic factors. Results: Compared to controls, non-relapsed survivors diagnosed age 18-39 (N=1158) had more than twice the risk of morbidity (RR 2.57, 95%CI 2.21-2.98); those with a relapse (N=580) had eight times the risk (95% CI 6.78-9.44). Among those diagnosed age ≥40, non-relapsed survivors (N=20473) had a 62% increase in risk RR 1.62, 95% CI 1.57-1.68; relapsed survivors (N=5223) had triple the risk of morbidity (RR 2.89, 95% CI 2.78-3.01). In both cohorts, excess risks were statistically significant for most types of non-neoplastic morbidity, with highest rates seen for disorders of the blood, endocrine, skin and circulatory systems. Among survivors, those diagnosed with a higher stage cancer had increased risk of morbidity. Type of treatment received did not correlate with increased risk of morbidity (RR 1.05, 95% CI 1.00–1.11 for combination of surgery, radiation and systemic therapy vs surgery alone); majority of the risk increase is likely related to the impacts of cancer itself rather than treatment. Conclusions: Survivors of breast cancer are at an increased risk of a wide range of morbidities years after diagnosis. This underscores calls for improved models of survivorship care and continued survivorship research.
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K. Jarallah, Husain, D. K. Paul, and Yogendra Singh. "SEISMIC EVALUATION AND RETROFIT ON AN EXISTING HOSPITAL BUILDING." Journal of Engineering and Sustainable Development 24, no. 06 (November 1, 2020): 1–21. http://dx.doi.org/10.31272/jeasd.24.6.1.
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The nonlinear pushover analysis was used to evaluate an existing 8-storey reinforced concrete framed hospital building under seismic force and presented in this manuscript. The ‘Guru Teg Bahadur Hospital' is one of the important hospitals at Delhi-India, it was selected for this research. The three-dimensional frame model was used to model the building with a fixed base. The beams and columns were modeled by using three-dimension line frame elements with the centre lines joined at nodes. Diagonal strut elements were used to model the brick masonry infills. The slabs were considered as rigid diaphragms. The plastic hinge rotation capacities as per Federal Emergency Management Agency 356 (FEMA 356) with Performance Levels were adopted in this study, considering the axial force-moment and shear force-moment interactions. The nonlinear pushover analysis of the selected building was done with infills and it was observed that the infills (due to their small number in the considered building) do not make any appreciable effect on the performance level, except their failure at an early stage. The Capacity Spectrum Method (CSM) and Displacement Coefficient Method (DCM) were used to estimate the performance point of the building. The values of various coefficients as per Federal Emergency Management Agency 440 (FEMA 440) were adopted. The DCM was observed to give slightly higher target displacements, as compared to CSM. It was observed in the nonlinear pushover analysis that the unreinforced masonry (URM) infills collapse before the performance point of the building for the Maximum Considered Earthquake (MCE). As the intervention inside the functioning hospital is extremely difficult, it was explored whether it is possible to safeguard the infills by stiffening the building by providing external buttresses. Two cases of retrofitting schemes with 1.2m wide and 3m wide buttresses in transverse direction were used and analysed. It was found that this is not a practicable approach, as the infills collapse even with 3m wide buttresses.
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Saran, O., S. Celik, S. Guloksuz, and D. Cakmak. "Electroconvulsive therapy treated patients’ and their relatives’ attitudes toward electroconvulsive therapy." European Psychiatry 26, S2 (March 2011): 1153. http://dx.doi.org/10.1016/s0924-9338(11)72858-9.
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IntroductionElectroconvulsive therapy (ECT), which is a safe and effective treatment option for many of the psychiatric illnesses, is still negatively perceived by lay public. It could be hypothesized this negative view can affect the patients and their relatives. This study aimed to evaluate the attitudes of patients’ and their relatives’ toward ECT.MethodsSixty-four ECT treated patients were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were evaluated with Clinical Global Impression Scale, Mini Mental State Examination and Columbia ECT Subjective Side Effects Schedule. Both patients and their relatives were interviewed by using a questionnaire for assessing attitudes toward ECT.ResultsThe mean number of ECT sessions was 8.50 ± 1.85. The most common side effects according to the patients were subjective feeling of slowed down and memory problems. The majority of both patients and their relatives stated that they had not received adequate information about ECT. Moreover, their knowledge about technique and mechanism of ECT was very limited. However, their overall perception of ECT was very positive. The relatives of the patients were more satisfied with the benefits of ECT than the patients.DiscussionAlthough perception of ECT among patients and their relatives was very positive, it should be noted that this was mostly subjective in regard to inadequate knowledge about ECT. Thus, clinicians should pay utmost attention to inform both patients and their relatives about ECT.
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Reville, Patrick J. "Supreme Court Guns Down State Firearm Restrictions, The Chicago Way." Journal of Business Case Studies (JBCS) 7, no. 3 (April 28, 2011): 1. http://dx.doi.org/10.19030/jbcs.v7i3.4258.
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It was February 14, 1929. The United States was still experiencing the Roaring Twenties. The stock market had not yet crashed, and Prohibition, that noble experiment, was nearing the end of a tumultuous decade. A group of five apparent law enforcement personnel, some in uniform, some not, paid a visit to a warehouse on the north side of Chicago. Illegal/bootlegged booze trafficking was the ostensible target. When the visit was over, 6 men lay dead, and the apparent lone survivor, rushed to the hospital where he declined to elaborate on the incident, promptly passed away. The departed were part of the George Bugs Moran organization, while the visiting police contingent was actually made up of members of the Al Scarface Capone mob. The event would go down in history as The St. Valentines Day Massacre, and the main method of communication at the warehouse was the Thompson submachine gun. In the aftermath of that notorious gangland rubout, and other instances of outlaw use of machine guns, the automatic weapon was virtually taxed and legislated out of legal existence. Along with the abolishment of legal automatic weapons, restrictions on all types of firearms became a cause and a reality. Yet, in 2008, a group of five black-robed members of a Washington, D.C., organization took aim at the outright restriction on handguns in the District of Columbia. The result was a rubout of the D.C. restrictions.(1) Then, two years later, the same Gang of Five donned their black robes, and, in essence, paid the City of Chicago a visit regarding its ban of firearms. The outcome was a bloodbath that may end up being remembered by Gun Control enthusiasts on the same level as the St. Valentines Day Massacre.(2)
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Sacks, Gordon S. "Copper decreases ascorbic acid stability in total parenteral nutrition solutions JC BURGE, L FLANCBAUM, B HOLCOMBE Ohio State University, Columbus, and University of North Carolina Hospitals, Chapel Hill." Nutrition in Clinical Practice 10, no. 5 (October 1995): 194. http://dx.doi.org/10.1177/088453369501000508.
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Wong, Alyson WM, Wen Q. Gan, Jane Burns, Don D. Sin, and Stephan F. van Eeden. "Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Influence of Social Factors in Determining Length of Hospital Stay and Readmission Rates." Canadian Respiratory Journal 15, no. 7 (2008): 361–64. http://dx.doi.org/10.1155/2008/569496.
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BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.OBJECTIVES: To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.METHODS: Using the Providence Health Records, a retrospective review of patients admitted to St Paul’s Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.RESULTS: Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05).CONCLUSIONS: The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD.
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Bailie, Kiera, Lisa Jacques, Angele Phillips, and Paula Mahon. "Exploring Perceptions of Education for Central Venous Catheter Care at Home." Journal of Pediatric Oncology Nursing 38, no. 3 (February 22, 2021): 157–65. http://dx.doi.org/10.1177/1043454221992293.
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Pediatric oncology patients with an external central venous catheter (CVC) in situ can be discharged from the hospital. Caregivers are expected to learn how to care for the CVC prior to discharge while also dealing with their child's new cancer diagnosis. This study aimed to evaluate the perceptions of a CVC education program received by caregivers to identify opportunities for improvement. A qualitative study was conducted in 3 stages, using an evidence-based co-design approach, involving caregivers and one adolescent patient discharged from the British Columbia Children's Hospital Oncology/Hematology/BMT inpatient unit. Stage I involved semi-structured interviews to gain feedback on the existing CVC education program. In Stage II, educational resources were updated or developed and implemented. For Stage III, the revised CVC education program was evaluated through a focus group and semi-structured interviews. Interview transcripts were analyzed using QSR NVivo®. The original CVC education program was overall well received. Repeated instruction and support provided by nurses was reported to have increased confidence with performing CVC skills. Participants appreciated the multimodal approach to meet learning needs and expressed interest in additional visual aids. Inconsistencies in nurses’ practice and offers of “tips and tricks” were identified to be challenging for caregivers while learning a new skill. Videos depicting CVC care were developed to provide an additional visual tool, decreased inconsistencies in care, and support to caregivers at home. Caring for a CVC at home is challenging and overwhelming for caregivers. A standardized multimodal education program is required to support caregivers at home.
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Chan, Angela, Ryan Woods, and Sharlene Gill. "Factors associated with delayed time to adjuvant chemotherapy (AC) in stage III colon cancer: British Columbia Cancer Agency (BCCA) cohort experience." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 574. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.574.
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574 Background: The current standard for resected stage 3 colon cancer after surgical resection is adjuvant 5FU-based chemotherapy. In trials, AC is mandated within 8 weeks after surgery, but outside the trial setting, up to 19% of patients do not receive treatment within 8 weeks. A recent meta-analysis confirms that AC started more than 8 weeks after surgery results in significantly decreased overall survival. Our objective was to ascertain logistical and patient factors associated with delayed AC delivery (defined as >56 days from surgery) in referred patients with resected stage 3 colon cancer. Methods: A population-based cohort of patients diagnosed with stage 3 colon cancer between January 2008 to December 2009 referred to the BCCA and treated with at least one cycle of AC were identified. Patient characteristics, and time intervals between surgery, referral, medical oncology consultation (MOC) and AC were assessed. Differences in patient characteristics and time intervals between patients were assessed using the Chi-square and Wilcoxon Rank-sum tests. Results: Median time from surgery to AC was 58 days with 54% of patients receiving AC beyond 56 days. Temporal differences were identified in all intervals between the between the timely and delayed groups (see table 1). Referral was most commonly initiated after hospital discharge. The only patient factors associated with delayed initiation included poorer ECOG status and being treated at the most urban centre within BCCA. Age, gender, comorbidity index, T stage and tumour location were not different between the groups. Conclusions: 54% of patients with stage 3 colon cancer had a delayed AC initiation. Process related delays at each step of the referral process need to be addressed including timely referral, MOC triage and addressing chemotherapy waitlists. [Table: see text]
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Thorley, Virginia. "Accounts of infant-feeding advice received by mothers: Queensland, Australia, 1945-1965." Nursing Reports 2, no. 1 (October 31, 2012): 12. http://dx.doi.org/10.4081/nursrep.2012.e12.
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In the period 1945-1965 most women in the state of Queensland, Australia, gave birth in hospitals and thereafter they used a variety of services and individuals for advice on infant feeding. The services available were similar throughout the period. As mothers rarely worked outside the home, being <em>good mothers</em> was important to their identity. In this historical study, telephone interviews and written responses involving 44 mothers and former nurses from every region of this geographically vast state were used in order to investigate sources of personal advice on infant feeding used during this period, mothers’ experience relating to this advice, and the extent to which they followed the advice. The free, nurse-run well-baby clinics and related services conducted by the state’s Maternal and Child Welfare service were the most commonly mentioned services. However, the uptake of advice from this source showed considerable variation as women also drew upon family members, their general practitioners, advice columns, radio broadcasts, other mothers and their own judgment. Only rarely was a specialist pediatrician consulted. A minority of mothers was advised by pharmacists, private baby nurses, or entered residential mothercraft facilities. An important finding is that attendance at the baby clinics did not necessarily equate with compliance, especially as mothers became more experienced.
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Wong, Ivan, Jawhar Bouabid, William Graf, Charles Huyck, Allan Porush, Walter Silva, Timothy Siegel, Gilles Bureau, Ronald Eguchi, and John Knight. "Potential Losses in a Repeat of the 1886 Charleston, South Carolina, Earthquake." Earthquake Spectra 21, no. 4 (November 2005): 1157–84. http://dx.doi.org/10.1193/1.2083907.
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A comprehensive earthquake loss assessment for the state of South Carolina using HAZUS was performed considering four different earthquake scenarios: a moment magnitude ( M) 7.3 “1886 Charleston-like” earthquake, M 6.3 and M 5.3 events also from the Charleston seismic source, and an M 5.0 earthquake in Columbia. Primary objectives of this study were (1) to generate credible earthquake losses to provide a baseline for coordination, capability development, training, and strategic planning for the South Carolina Emergency Management Division, and (2) to raise public awareness of the significant earthquake risk in the state. Ground shaking, liquefaction, and earthquake-induced landsliding hazards were characterized using region-specific inputs on seismic source, path, and site effects, and ground motion numerical modeling. Default inventory data on buildings and facilities in HAZUS were either substantially enhanced or replaced. Losses were estimated using a high resolution 2- km×2- km grid rather than the census tract approach used in HAZUS. The results of the loss assessment indicate that a future repeat of the 1886 earthquake would be catastrophic, resulting in possibly 900 deaths, more than 44,000 injuries, and a total economic loss of $20 billion in South Carolina alone. Schools, hospitals, fire stations, ordinary buildings, and bridges will suffer significant damage due to the general lack of seismic design in the state. Lesser damage and losses will be sustained in the other earthquake scenarios although even the smallest event could result in significant losses.
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Barlogie, B., W. S. Velasquez, R. Alexanian, and F. Cabanillas. "Etoposide, dexamethasone, cytarabine, and cisplatin in vincristine, doxorubicin, and dexamethasone-refractory myeloma." Journal of Clinical Oncology 7, no. 10 (October 1989): 1514–17. http://dx.doi.org/10.1200/jco.1989.7.10.1514.
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Based on remarkable activity in refractory lymphomas, a combination of etoposide, cisplatin (both administered by 4-day continuous infusions), cytarabine (Ara-C), and dexamethasone (EDAP) was evaluated in 20 patients with advanced myeloma refractory to standard melphalan and prednisone (MP) and/or vincristine, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and dexamethasone (VAD) and even to high doses of melphalan (HDM) (seven patients). Forty percent of patients responded regardless of previously recognized risk factors (eg, duration of drug resistance, tumor mass, and serum lactic dehydrogenase [LDH] level). While the median survival was only 4.5 months, patients with good performance (Zubrod less than 2) and low or intermediate tumor stage survived more than 14 months compared with only 2 months for the remaining group. EDAP could be readily administered in the outpatient clinic, but neutropenic fever prompted hospital admission in 80% of patients, half of whom developed penumonia and sepsis, a fatal outcome in four patients. Severe myelosuppression was of short duration, so that subsequent cycles could be administered every 3 to 4 weeks. No serious extramedullary toxicity, including renal toxicity, was encountered. Marrow toxicity and hence infectious complications may be reduced by elimination of Ara-C without compromising treatment efficacy. We conclude that the lack of cross-resistance with VAD and even HDM makes EDAP or a similar combination an attractive regiment to be formally explored in an alternating sequence with VAD in high-risk myeloma.
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Sitton, S. C. "RICHARD L. LAEL, BARBARA BRAZOS, and MARGOT FORD MCMILLEN. Evolution of a Missouri Asylum: Fulton State Hospital, 1851-2006. Columbia: University of Missouri Press. 2007. Pp. xvii, 252. $39.95." American Historical Review 112, no. 4 (October 1, 2007): 1168–69. http://dx.doi.org/10.1086/ahr.112.4.1168.
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Burke, Michael, Jennifer Willert, Sunil J. Desai, and Richard Kadota. "Pediatric Treatment Guidelines for Philadelphia Positive (Ph+) Chronic Myelogenous Leukemia (CML): What Are They in Today’s Imatinib Era?" Blood 112, no. 11 (November 16, 2008): 4399. http://dx.doi.org/10.1182/blood.v112.11.4399.4399.
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Abstract Background: The treatment of pediatric Philadelphia positive (Ph+) chronic myelogenous leukemia (CML) in the era of the tyrosine kinase inhibitors (TKI) continues to evolve with the role of allogeneic hematopoietic cell transplantation (allo-HCT) in these patients becoming more controversial. Imatinib has completely replaced allo-HCT for adult CML patients presenting in first chronic phase, reserving HCT for TKI resistant and/or advanced stage patients (accelerated phase and blast crisis). Whether treatment strategies in 2008 have changed for CML in pediatrics, from heavily allo-HCT based to TKI based medical therapy, is presently unclear. Methods: Thirty-two pediatric centers across the United States and Canada were surveyed regarding current treatment practices for CML in order to explore treatment practices in 2008. The survey targeted primary pediatric oncologists and bone marrow transplant physicians regarding their treatment approach for CML in terms of upfront therapy, utility of allo-HCT, use of TKI (including their role in the post-HCT setting) and how response to therapy was monitored. Results: Twenty-three of the thirty-two centers completed the survey to provide a completion rate of 72% (Table 1). Sixty-three percent of survey responders recommended allo-HCT, when a matched sibling donor was available, for patients with CML in first chronic phase. Regarding the use of TKI in the post-HCT setting, 9 of 27 (33%) physicians reported using imatinib as maintenance therapy post-HCT as a means to prevent relapse. All physicians reported using PCR techniques for bcr-abl of either bone marrow, peripheral blood or both to monitor treatment response with frequencies ranging from monthly to every six months. Conclusion: Treatment of pediatric CML appears variable and center dependent. This survey identified a trend toward less allo-HCT for CML in 2008 compared to years past. Despite the trend toward less HCT, the pediatric treatment consensus in 2008 for CML remains MSD allo-HCT when available. Use of imatinib was recognized by all survey responders as standard of care in upfront therapy, but the use of imatinib or other TKI in the post-HCT setting as maintenance therapy remains in question. Prospective pediatric clinical trials will be necessary to determine the optimal strategy for CML in children. Table 1. Pediatric Centers British Columbia’s Children’s Hospital Children’s Hospital of Pittsburgh Children’s Memorial Medical Center–Northwestern Cincinnati Children’s Hospital Medical Center City of Hope Columbia Presbyterian College of Phys & Surgeons Doernbecher Children’s Hospital-OHSU Duke University Medical Center Mayo Clinic Medical College of Wisconsin Nationwide Children’s Hospital Schneider Children’s Hospital St. Jude Children’s Research Hospital Stollery Children’s Hospital–Edmonton Texas Children’s Cancer Center at Baylor College of Medicine The Children’s Hospital of Philadelphia The University of Chicago Comer Children’s Hospital University of California at San Diego/Rady Children’s Hospital San Diego UCSF School of Medicine University of Florida University of Michigan–C.S. Mott Children’s Hospital University of Minnesota Children’s Hospital, Fairview Washington University–St. Louis
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Penney, Christine, and Effie Henry. "Improving Performance Management for Delivering Appropriate Care for Patients No Longer Needing Acute Hospital Care." Journal of Health Services Research & Policy 13, no. 1_suppl (January 2008): 30–34. http://dx.doi.org/10.1258/jhsrp.2007.007025.
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Objective The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. Method A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). Results A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted. Conclusions This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.
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Nilasena, David S., Timothy F. Kresowik, Anton F. Piskac, Rebecca A. Hemann, Marian A. Brenton, June M. Wilwert, Marc E. Hendel, and Lynnette E. Nevins. "National Rates of Warfarin Use in Medicare Patients with Atrial Fibrillation: Results from the National Stroke Project." Stroke 32, suppl_1 (January 2001): 328. http://dx.doi.org/10.1161/str.32.suppl_1.328-a.
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66 Background: The National Stroke Project is a HCFA initiative to improve stroke related hospital care for Medicare beneficiaries. As part of the evaluation of these efforts, HCFA is measuring performance on a set of quality indicators at the state and national levels. We report the baseline results for a key quality indicator for this project: warfarin at discharge for patients with atrial fibrillation (AF). Methods: Project data were abstracted from a national sample of Medicare inpatient charts with a principal or secondary diagnosis of AF (ICD-9-CM 427.31) and discharged between 4/98 and 3/99. All U.S. states, the District of Columbia, and Puerto Rico were sampled using a systematic random approach. Eligible patients were required to have physician confirmation of AF during the hospitalization and at discharge, or intermittent AF. The main outcome measure was a prescription or physician documented plan for warfarin at discharge. Results: Of 38,925 cases reviewed, 12,303 met the inclusion criteria. Many of the cases (38.3%) were excluded due to a history or current finding of hemorrhage. Nationwide, 6,633 (unadjusted rate, 53.9%) patients were prescribed warfarin at discharge or had a plan to start warfarin after discharge. The state-specific rates ranged from 30.7% to 65.3%. Univariate analyses showed that warfarin was prescribed less frequently (p<0.002) for adults 85 years of age and older (rate=39.9%, OR=0.47, 95% CI=0.43–0.51) and women (rate=52.0%, OR=0.83, 95% CI=0.78–0.90). African-Americans (rate=47.2%, OR=0.76 95% CI=0.63–0.90) and Asians (n=108, rate=37.0%, OR=0.50, 95% CI=0.34–0.74) were also found to have lower warfarin therapy rates. Conclusions: The results from this large national sample confirm the findings from other reports that there is substantial under-utilization of warfarin therapy for stroke prevention among Medicare patients with AF. This is particularly true for demographic subgroups at high risk for stroke. Quality improvement efforts are currently underway through HCFA’s National Stroke Project (AF topic) to increase warfarin use in appropriate AF patients.
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De Oliveira, Ricardo Santos. "Prof. James Tait Goodrich 1946 - 2020+." Archives of Pediatric Neurosurgery 2, no. 2(May-August) (June 18, 2020): e472020. http://dx.doi.org/10.46900/apn.v2i2(may-august).47.
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James Tait Goodrich was born on April 16, 1946 in Portland, Oregon, United States, the son of Richard Goodrich and Gail (Josselyn) Goodrich. Dr. Goodrich served as a Marine officer during the Vietnam War, during which time he decided his next step would be to pursue a medical career. Not only was he an elite surgeon, but over the years he was also a generous mentor and teacher who shared his craft with many young surgeons who wanted to follow in his footsteps. During the Tet Offensive, he spotted a Vietnamese surgeon in a medical tent opening up a soldier’s head. “Cool,” he thought. “I want to do that” (1). Upon return to the USA, Jim married Judy Loudin on December 27, 1970, the love of his life who gave him the confidence and support to pursue his dreams. Dr. Goodrich completed his undergraduate work at the University of California, Irvine and his graduate studies at the School of Arts and Sciences of Columbia University (1972), receiving his Masters and Doctor of Philosophy degrees in 1978 and 1980, respectively. He received his Medical Degree from Columbia University College of Physicians and Surgeons. After an internship at Columbia- Presbyterian Medical Center (1980-1981), he completed his residency training at the Presbyterian Hospital in New York City and the New York Neurological Institute (1981-1986). He also holds the rank of Professor Contralto of Neurological Surgery at the University of Palermo in Palermo, Italy. He was Director of the Division of Pediatric Neurosurgery at the Children’s Hospital of Montefiore Health System and he served as a Professor of Clinical Neurological Surgery, Pediatrics, Plastic and Reconstructive Surgery at the Albert Einstein College of Medicine since 1998 (2). Dr. James T. Goodrich dedicated his life to saving children with complex neurological conditions. He had a particular interest in the treatment of craniofacial abnormalities. He was a pioneer in this field and developed a multi-stage approach for separating craniopagus twins who have their brain and skull conjoined. In 2016, he famously led a team of 40 doctors in a 27-hour procedure to separate the McDonald twins. Throughout his distinguished career, he became known as the world’s leading expert on this lifesaving procedure. He has been consulted on hundreds of cases, and he routinely traveled the world sharing his vast knowledge and expertise with colleagues (3,4). In Brazil, Dr. Goodrich played a very important role in leading the processes to successfully separate craniopagus sets in Ribeirao Preto (2017-2018), and in Brasilia (2019). A classical multistage surgery was performed to separate the Ribeirao Preto conjoined twins, and Dr. Goodrich participated on all the neurosurgical procedures as a great mentor. In the final operation, on October 28, 2019, some members of Montefiore Hospital medical staff (Dr. Oren Tepper, plastic surgeon, Dr. Carlene Broderick, pediatric anesthesiologist and Kamilah A. Dowling, nurse) also worked alongside Jim and the Brazilian team. An extraordinary and humble man, his words after the first surgical step, during an interview for a TV channel, were that in “this particular surgery we were able to do more than we expected because the anatomy was very good and the team had exceptional skills that made the difference”. Dr. Goodrich was a chief supporter of the Latin American Pediatric Neurosurgery Course (LACPN), having participated in all editions since 2004. In these events, he did not hesitate to share his knowledge during the hands-on sessions and, likewise, his wonderful conferences. Prof. Goodrich was officially honored by the Brazilian Society for Pediatric Neurosurgery during the “XII Brazilian Congress of Pediatric Neurosurgery”, in Florianopolis, Brazil. Dr. Goodrich was a gentle and truly caring man. He did not crave the limelight and was beloved by his colleagues and staff. He has authored numerous book chapters and articles on Pediatric Neurosurgery and is known worldwide as a prominent lecturer in this field. Outside his work, he was also known for his passion for historical artifacts, travelling, wine, and surfing. Dr. Goodrich was an incredible human being. In March 30th, 2020, he passed away after complications due to Covid-19 (5). In that day the world has become a little less bright without Jim. Our sympathy and prayers go to his wife Judy, his three sisters, and all those who were close to him
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Rajapakshe, Rasika, Christabelle Bitgood, Steven McAvoy, Cynthia Araujo, Paula Gordon, and Andy Coldman. "Estimation of additional MRI resources needed in British Columbia for screening high-risk women for breast cancer." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 51. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.51.
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51 Background: Screening women at high risk with MRI has been shown to detect breast cancer at an early stage. Therefore, MRI screening has been recommended in the UK and USA for women who are at a high risk of developing breast cancer. However, there is no information available in the province of British Columbia (BC) about the number of women who have a high risk of developing breast cancer. Therefore, we carried out a study to estimate the breast cancer risk distribution in three sample populations in BC using Tyrer-Cuzick (TC) risk prediction model so that additional resource requirement for MRI breast screening can be calculated. Methods: A survey questionnaire was designed based on the TC model, which includes family history, hormonal factors, and benign breast disease. Additional questions also include factors that are used in other models (Gail, Claus, and BCRAPRO) as well as factors that may be included in the future. Women were recruited by staff and volunteers at three screening mammography clinics: Kelowna, Victoria General Hospital, and BC Women’s Health Centre in Vancouver. The survey was available to women to complete on the web, by phone, or on paper. An online database was constructed to store and query the data. The 10-year risk of developing breast cancer for each woman was calculated using the Tyrer-Cuzick IBIS Risk Evaluator software and the risk distribution of the survey population was analyzed. Results: Data from 3,200 women recruited from three sites, gives a risk distribution showing 2.6% are at high risk of developing breast cancer, 31.2% are at moderate risk, and 66.2% are at low risk. Based on NICE guidelines (UK), high risk is defined as having a 10-year risk of greater than 8%, moderate risk as 3-8%, and low risk as less than 3%. Extrapolating this to the approximately 500,000 women who are eligible to attend for screening mammography in BC, 13,000 women are considered at high risk. Conclusions: Our results indicate that 2.6% of women ages 40-79 attending screening mammography in BC may have a very high risk of developing breast cancer based on personal and family history. Based on a 14-hour work day, three additional MRI scanners would be required to implement MRI screening for these high-risk women in BC.
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Douglas, James W., Moon H. Kim, and Bruce E. Batten. "Electric field mediated transfer of enzymes into human oocytes**Presented in part at the 45th Annual Meeting of The American Fertility Society, San Francisco, California, November 13 to 16, 1989. ††Supported by a research grant from The Ohio State University Hospitals, Columbus, Ohio." Fertility and Sterility 53, no. 6 (June 1990): 1044–48. http://dx.doi.org/10.1016/s0015-0282(16)53582-1.
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Gabbe, Belinda J., Joanna F. Dipnall, John W. Lynch, Frederick P. Rivara, Ronan A. Lyons, Shanthi Ameratunga, Mariana Brussoni, et al. "Validating injury burden estimates using population birth cohorts and longitudinal cohort studies of injury outcomes: the VIBES-Junior study protocol." BMJ Open 8, no. 8 (August 2018): e024755. http://dx.doi.org/10.1136/bmjopen-2018-024755.
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IntroductionTraumatic injury is a leading contributor to the global disease burden in children and adolescents, but methods used to estimate burden do not account for differences in patterns of injury and recovery between children and adults. A lack of empirical data on postinjury disability in children has limited capacity to derive valid disability weights and describe the long-term individual and societal impacts of injury in the early part of life. The aim of this study is to establish valid estimates of the burden of non-fatal injury in children and adolescents.Methods and analysisFive longitudinal studies of paediatric injury survivors <18 years at the time of injury (Australia, Canada, UK and USA) and two whole-of-population linked administrative data paediatric studies (Australia and Wales) will be analysed over a 3-year period commencing 2018. Meta-analysis of deidentified patient-level data (n≈2,600) from five injury-specific longitudinal studies (Victorian State Trauma Registry; Victorian Orthopaedic Trauma Outcomes Registry; UK Burden of Injury; British Columbia Children’s Hospital Longitudinal Injury Outcomes; Children’s Health After Injury) and >1 million children from two whole-of-population cohorts (South Australian Early Childhood Data Project and Wales Electronic Cohort for Children). Systematic analysis of pooled injury-specific cohort data using a variety of statistical techniques, and parallel analysis of whole-of-population cohorts, will be used to develop estimated disability weights for years lost due to disability, establish appropriate injury classifications and explore factors influencing recovery.Ethics and disseminationThe project was approved by the Monash University Human Research Ethics Committee project number 12 311. Results of this study will be submitted for publication in internationally peer-reviewed journals. The findings from this project have the capacity to improve the validity of paediatric injury burden measurements in future local and global burden of disease studies.
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Hirsh, A. L., D. J. Lee, G. Hruby, M. C. Benson, and J. M. McKiernan. "Does the day or season of operation predict biochemical recurrence after radical prostatectomy?" Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16162-e16162. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16162.
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e16162 Background: Outcomes in hospital based medicine are associated with the experience and availability of the medical staff, as mortality and morbidity rates increase each summer with new medical graduates. Hospital staff members are thought to be more fatigued and less available towards the end of the week and on weekends. However it is not known if there is a difference of outcomes based on the season or day of the week. We sought to identify if different seasons or surgical days of the week can predict poor outcomes and biochemical recurrence (BCR) in radical prostatectomy (RP). Methods: A retrospective analysis of the Columbia Urologic Oncology database was performed. 1865 consecutive men underwent RP from 1991 to 2008 by three surgeons. Data was collected in an institutional review board approved registry, with median follow up of 36 months. BCR was defined as two consecutive PSA levels > 0.2 ng/ml. Stratified cox regression methods were used to model the relationship between surgeon, preoperative variables, season, day of the week, and BCR. Winter was defined as December through February, spring as March through May, summer as June through August, and fall as September through November. Results: The mean age of the men undergoing RP was 61.2 years (37–79), with a mean preoperative PSA of 8.12. 424 men (22.7%) had positive surgical margins, and the mean estimated blood loss (EBL) was 1119cc. Patient age (p=0.68), preoperative PSA (p=0.32), EBL (p=0.51), and positive surgical margin rate (p=0.78) were not significantly different between each day. Men undergoing RP did not have different rates of BCR according to the day of the operation (p=0.58) or season (p=0.997). The particular season and day of the operation were not significantly associated with BCR, and were not independent predictors of BCR in a multivariable model after adjusting for preoperative PSA, Gleason sum, tumor stage, and surgeon. Conclusions: Patient surgical outcomes and BCR rates after RP are not associated with the particular season or day of the week of the procedure. These findings suggest that men undergoing RP do not need to be concerned about the particular season or day when scheduling the procedure. No significant financial relationships to disclose.
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Lacativa, Paulo Gustavo Sampaio, Felipe Malzac Franco, José Raimundo Pimentel, Pedro José de Mattos Patrício Filho, Manoel Domingos da Cruz Gonçalves, and Maria Lucia Fleiuss Farias. "Prevalence of radiological findings among cases of severe secondary hyperparathyroidism." Sao Paulo Medical Journal 127, no. 2 (May 2009): 71–77. http://dx.doi.org/10.1590/s1516-31802009000200004.
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CONTEXT AND OBJECTIVE: Patients with end stage renal disease (ESRD) and secondary hyperparathyroidism (HPT2) are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING: This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF), in Rio de Janeiro, Brazil. METHODS: Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS: The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each). "Rugger jersey spine" sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%), abdominal aorta and lower limb arteries (35% each). Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each). CONCLUSION: The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.
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Anagnostou, Valsamo, Gunnar Hartvigsen, George Hripcsak, Chunhua Weng, and Taxiarchis Botsis. "Developing a multivariable prognostic model for pancreatic endocrine tumors using the clinical data warehouse resources of a single institution." Applied Clinical Informatics 01, no. 01 (2010): 38–49. http://dx.doi.org/10.4338/aci-2009-12-ra-0026.
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Summary Objective: Current staging systems are not accurate for classifying pancreatic endocrine tumors (PETs) by risk. Here, we developed a prognostic model for PETs and compared it to the WHO classification system. Methods: We identified 98 patients diagnosed with PET at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a risk score was calculated; the prognostic strength of our model was assessed with the concordance index. Results: Our cohort had median age of 60 years and consisted of 61.2% women; median follow-up time was 10.4 months (range: 0.1-99.6) with a 5-year survival of 61.5%. The majority of PETs were non-functional and no difference was observed between functional and non-functional tumors with respect to WHO stage, age, pathologic characteristics or survival. Distant metastases, aspartate aminotransferase-AST and surgical resection (HR=3.39, 95% CI: 1.38-8.35, p=0.008, HR=3.73, 95% CI: 1.20-11.57, p=0.023 and HR=0.20, 95% CI: 0.08-0.51, p<0.001 respectively) were the strongest predictors in the univariate analysis. Age, perineural and/or lymphovascular invasion, distant metastases and AST were the independent prognostic factors in the final multivariable model; a risk score was calculated and classified patients into low (n=40), intermediate (n=48) and high risk (n=10) groups. The concordance index of our model was 0.93 compared to 0.72 for the WHO system. Conclusion: Our prognostic model was highly accurate in stratifying patients by risk; novel approaches as such could thus be incorporated into clinical decisions.
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Gumenyuk, B. M., and V. V. Popov. "The blood preservation in surgical treatment of the mitral disease of the heart." Klinicheskaia khirurgiia 85, no. 9 (September 30, 2018): 27–30. http://dx.doi.org/10.26779/2522-1396.2018.09.27.
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Objective. Investigation of modern possibilities of the bloodless technique of surgical treatment of the mitral valve failure (МVF) in environment of artificial blood circulation (ABC).
Маterials and methods. There were examined 727 patients, suffering MVF. All the patients were divided into two groups: the main and a comparative one. The main group have consisted of 637 patients, in whom various variants of the blood preservation without its transfusion were applied, without application of a cell-saver, hemoconcentrating columns and the blood ultrafiltration; and a comparative one group have consisted of 90 patients, to whom the blood preparations were transfused. The procedure depicted have provided the anesthesia and the perfusion measures during operation of the mitral valve change, including аs well the peculiarities of the intraoperative infusion therapy management in the ABC conditions.
Results. In the main group of patients the rate of postoperative infectious complications have constituted 1.2%, while in a comparative one - 9.9%. Median duration of stay on the artificial pulmonary ventilation have constituted (6.7 ± 2.3) and (12.3 ± 8.4) hours accordingly. The average duration of stay in reanimation department was (58.4 ± 12.4) and (116.3 ± 45.2) hours, accordingly (р < 0.05). The intraoperative blood loss volume in the main group was significantly lesser, than in a comparative one: (261.2 ± 33.8) and (533.1 ± 131.6) ml, accordingly (р < 0.05).
On all stages of the operation and in postoperative period the level of hemoglobin have persisted in a compensation period range, what constitutes a safe level of the blood oxygen capacity.
Conclusion. Introduction of intraoperative variants of the autologous blood reservation without application of the donor’s blood, сеll-saver and hemoconcentration columns is not accompanied with lowering of the oxygen delivery and consumption, as well as development of lactate-acidosis.
The improved procedure of anesthesiological support consisted of the infusion-transfusion therapy conduction with stimulation of diuresis, the water balance control, applying combination of an acute normovolemic hemodilution with ABC, and lowering of hemodilution due to retrograde filling of oxygenator by autologous blood. As well there were applied various methods of the autologous blood exfusion and its components combinations, change of tactics in the infusion hemostatic therapy; a central venous pressure control and support of median arterial pressure.
Introduction of the procedure depicted have guaranteed a good clinical effect without complications of transfusion on a hospital stage of the patients’ management.
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Rocktäschel, Tina, Katharina Renner-Martin, Christiane Cuny, Walter Brehm, Uwe Truyen, and Stephanie Speck. "Surgical hand preparation in an equine hospital: Comparison of general practice with a standardised protocol and characterisation of the methicillin-resistant Staphylococcus aureus recovered." PLOS ONE 15, no. 12 (December 22, 2020): e0242961. http://dx.doi.org/10.1371/journal.pone.0242961.
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Presurgical hand asepsis is part of the daily routine in veterinary medicine. Nevertheless, basic knowledge seems to be low, even among specialised veterinary surgeons. The major objectives of our study were to assess current habits for presurgical hand preparation (phase 1) among personnel in a veterinary hospital and their effectiveness in reducing bacteria from hands in comparison to a standardised protocol (phase 2). Assessment of individual habits focused on time for hand washing and disinfection, the amount of disinfectant used, and the usage of brushes. The standardised protocol defined hand washing for 1 min with liquid neutral soap without brushing and disinfection for 3 min. All participants (2 surgeons, 8 clinic members, 32 students) used Sterillium®. Total bacterial counts were determined before and after hand washing, after disinfection, and after surgery. Hands were immersed in 100 ml sterile sampling fluid for 1 min and samples were inoculated onto Columbia sheep blood agar using the spread-plate method. Bacterial colonies were manually counted. Glove perforation test was carried out at the end of the surgical procedure. Differences in the reduction of relative bacterial numbers between current habits and the standardised protocol were investigated using Mann-Whitney-Test. The relative increase in bacterial numbers as a function of operation time (≤60 min, >60 min) and glove perforation as well as the interaction of both was investigated by using ANOVA. Forty-six and 41 preparations were carried out during phase 1 and phase 2, respectively. Individual habits differed distinctly with regard to time (up to 8 min) and amount of disinfectant (up to 48 ml) used both between participants and between various applications of a respective participant. Comparison of current habits and the standardised protocol revealed that the duration of hand washing had no significant effect on reducing bacteria. Contrary, the reduction in bacterial numbers after disinfection by the standardised protocol was significantly higher (p<0.001) compared to routine every-day practice. With regard to disinfection efficacy, the standardised protocol completely eliminated individual effects. The mean reduction in phase 1 was 90.72% (LR = 3.23; right hand) and 89.97% (LR = 3.28; left hand) compared to 98.85% (LR = 3.29; right hand) and 98.92% (LR = 3.47; left hand) in phase 2. Eight participants (19%) carried MRSA (spa type t011, CC398) which is well established as a nosocomial pathogen in veterinary clinics. The isolates could further be assigned to a subpopulation which is particularly associated with equine clinics (mainly t011, ST398, gentamicin-resistant). Glove perforation occurred in 54% (surgeons) and 17% (assistants) of gloves, respectively, with a higher number in long-term invasive procedures. Overall, bacterial numbers on hands mainly increased over time, especially when glove perforation occurred. This was most distinct for glove perforations on the left hand and with longer operating times. Our results demonstrate that standardised protocols highly improve the efficacy of hand asepsis measures. Hence, guiding standardised protocols should be prerequisite to ensure state-of-the-art techniques which is essential for a successful infection control intervention.
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Trivedi, Meghna S., VanAnh L. Vo, Tarsha Jones, Thomas Silverman, Wendy Chung, Rita Kukafka, and Katherine D. Crew. "BRCA1/2 and multigene panel testing among metastatic breast, pancreas, prostate, and ovarian cancer patients." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e13160-e13160. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e13160.
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e13160 Background: Given the availability of targeted therapies such as PARP inhibitors, patients with metastatic breast, pancreas, prostate, and ovarian cancer are recommended to have germline genetic testing for hereditary cancer syndromes. Completion of genetic testing among this population is understudied. Methods: We performed a retrospective study of 548 patients with stage 4 breast, pancreas, prostate, and ovarian cancer at diagnosis from January 2013-December 2017 identified in the New York Presbyterian Hospital Tumor Registry at Columbia University Irving Medical Center. Data on socio-demographics, clinical factors, and genetic testing completion and results were collected from the medical record. We conducted descriptive statistics. Results: Our study population had a median age of 66 years (range, 23-97) at diagnosis; 61% female; 50% non-Hispanic white/22% Hispanic/15% non-Hispanic black/5% Asian/7% other; 33% private insurance/16% Medicaid/44% Medicare/7% unknown insurance. Primary cancer was 24% breast, 8% ovary, 61% pancreas, and 7% prostate. Only 38 patients were seen by a genetic counselor (7%) and only 50 (9%) had genetic testing performed. Among those who underwent germline testing, 92% had multigene panel testing (median number of genes tested 13.5, range 2-74). Pathogenic variants were detected in 6 patients (12%), of which 4 had a BRCA1/2 mutation, and 26% had a variant of uncertain significance (VUS). Conclusions: We found that only a small percentage of metastatic breast, pancreas, prostate, and ovarian cancer patients underwent genetic testing. Further research is necessary to identify the barriers to genetic testing uptake in metastatic cancer patients. BRCA1/2 and multigene panel testing has important implications in this patient population not only for treatment decisions, but also to increase cascade testing in unaffected family members who may be at risk for malignancy in the future.
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Seddon, Megan M., P. Brandon Bookstaver, Julie Ann Justo, Joseph Kohn, Hana Rac, Emily Haggard, Krutika N. Mediwala, Sangita Dash, and Majdi N. Al-Hasan. "Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides difficile Infection Following Enterobacteriaceae Bloodstream Infections." Clinical Infectious Diseases 69, no. 3 (October 12, 2018): 414–20. http://dx.doi.org/10.1093/cid/ciy863.
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Abstract Background There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. Methods Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. Results Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48–9.92]; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89–9.11]; P = .001) were independently associated with higher risk of CDI. Conclusions The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
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Sribnyak, Ihor, and Victor Schneider. "PERIODICAL «PROSVITNII LYSTOK» (“ENLIGHTENMENT LEAF”) AS SOURCE FOR RECONSTRUCTION OF HISTORY OF UKRAINIAN COMMUNITY DEVELOPMENT IN WETZLAR CAMP, GERMANY (1916)." Kyiv Historical Studies 11, no. 2 (2020): 50–59. http://dx.doi.org/10.28925/2524-0757.2020.2.7.
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The article attempts to reconstruct the course of cultural, educational and national-organisational work in the Wetzlar camp (Germany) in 1916 by frontal elaboration of the annual set of the camp journal «Prosvitnyi Lystok». It was established that his columns contained a huge amount of information about the life and everyday life of Ukrainian prisoners in Wetzlar, which allows a fairly complete reconstruction of the features of organizational and educational work in this camp. In almost every issue of the newspaper there was a column “From Camp Life”, which contained brief information about the activities of all camp groups and organizations, as well as elected bodies of the Ukrainian community. In addition, all donations received were also reported here (for the disabled and sick in the camp hospital, for Volyn schools, etc.). Acquaintance with the camp chronicle allows to determine the circle of donors, which were profitable organizations in the camp (cooperative union, theatre, “artisan workshop”). With its publications, the newspaper had a strong influence on the formation of the national and political worldview of prisoners, publishing materials on the course of socio-political processes in Ukraine and Russia. At the same time, «Prosvitnyi Lystok» effectively expanded the knowledge of prisoners in agronomy with its articles. At the same time, the magazine instilled in the prisoners the basic principles of civic life, emphasizing the injustice of the imperial order in Russia and the enslaved status of Ukraine as part of the empire. Thanks to this, the magazine gained the support of the majority of Ukrainian prisoners, serving them as almost the only “window” into the world of politics, public life and art. Besides, it successfully fulfilled the mission of an information link between the camp organization and the work teams, providing their members with news and socially significant information. The most important feature of the “Enlightenment Leaf” was the Ukrainian-centricity of all its materials, which helped the prisoners to learn the national-state ideals.
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Alzahrani, Musa F., Tarec Christoffer El-Galaly, Martin Hutchings, Jakob Werner Hansen, Peter de Nully Brown, Annika Loft, Hans E. Johnsen, et al. "Role of Bone Marrow Biopsy in the Staging of Diffuse Large B-Cell Lymphoma in the PET/CT Era." Blood 124, no. 21 (December 6, 2014): 2960. http://dx.doi.org/10.1182/blood.v124.21.2960.2960.
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Abstract Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma (NHL) and bone marrow involvement by lymphoma is seen in up to one third of cases, as assessed by iliac crest bone marrow biopsy (BMB) at the time of diagnosis. Traditionally, BMB has been the gold standard test to detect bone marrow infiltration by lymphoma. 18-Fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET/CT), has become standard in the initial staging of DLBCL. Prior studies have suggested that PET/CT staging may obviate the need for staging BMB in patients with Hodgkin lymphoma. However, because of limited evidence, this approach has not been adopted in patients with DLBCL. We investigated whether BMB adds useful information to PET/CT staging in patients with an initial diagnosis of DLBCL. Patients and Methods Patients with a new diagnosis of DLBCL who underwent both staging PET/CT and BMB were retrospectively identified across three institutions: British Columbia Cancer Agency (n=149, 2011-2013), Aalborg University Hospital (n=179, 2007-2013), and Copenhagen University Hospital (n=202, 2009-2012). We reviewed the reports of PET/CT scans and BMBs from each academic institution performed at the time of diagnosis prior to treatment of DLBCL. Ann Arbor stage was determined including PET/CT with and without the contribution of BMB, and the proportion of stage IV cases by each method was calculated. Results 530 patients were identified: median age 65 years (range 16-90), 294 (56%) male, 137 (26%) largest mass >10cm, 263 (50%) elevated LDH, 105 (20%) performance status >2, and 149 (28%) with more than one extranodal site. International Prognostic Index score was 0-1 in 159 (30%), 2 in 145 (27%), 3 in 119 (23%), and 4-5 in 107 (20%) patients. 520 (98%) received rituximab-containing chemotherapy, 130 (25%) radiotherapy, and 3 (<1%) consolidative autologous stem cell transplantation. A total of 181 (34%) patients had bone marrow involvement established by either PET/CT (n=146, 28%), BMB (n=87, 16%), or both (n=52, 10%). Focal skeletal lesions on PET/CT were unifocal (n=42), bifocal (n=15), multifocal/diffuse (n=89). 52 of the 146 patients (36%) with positive PET/CT had a positive BMB (39 DLBCL, 13 iNHL), while 35 of the 384 patients (9%) with negative PET/CT had a positive BMB (12 DLBCL, 23 iNHL). Table 1 shows the distribution of Ann Arbor staging as defined by PET/CT alone and with inclusion of BMB results. BMB upstaged 12/209 (6%) stage I/II patients to stage IV, including 3 patients with DLBCL and 9 patients with iNHL in the bone marrow. Focal skeletal lesions on PET/CT identified bone marrow involvement by lymphoma (DLBCL or iNHL) with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. In a subgroup analysis excluding the 36 patients with iNHL in the bone marrow, focal skeletal lesions on PET/CT identified bone marrow involvement by DLBCL with sensitivity 78%, specificity 79%, positive predictive value 29%, and negative predictive value 97%. Conclusions In patients with DLBCL, staging PET/CT does not identify all cases with bone marrow involvement. BMB upstaged 6% of patients with stage I/II who had a PET/CT negative for any skeletal involvement. However, the majority had indolent histologies in the bone marrow, and only 1% were upstaged due to involvement of the bone marrow with DLBCL. Although PET/CT has a high negative predictive value for ruling out bone marrow involvement by high grade lymphoma, BMB remains a necessary component in the evaluation of patients with a new diagnosis of DLBCL mainly because of its ability to detect iNHL that was missed by PET/CT which may have implications in the post-treatment surveillance setting. Table 1. Clinical staging by PET/CT alone and with inclusion of bone marrow biopsy results. Clinical Stage Staging Modality Patients upstaged to stage IV by bone marrow biopsy PET/CT alone PET/CT and bone marrow biopsy N (%) N (%) N I 121 (23) 114 (21) 7 (2 DLBCL, 5 iNHL) II 88 (17) 83 (16) 5 (1 DLBCL, 4 iNHL) III 92 (17) 77 (15) 15 (5 DLBCL, 10 iNHL) IV 229 (43) 256 (48) Not applicable Disclosures No relevant conflicts of interest to declare.
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Hicks, Lisa, Matthew Cheung, Jordana Boro, Hatoon Ezzat, and Heather Leitch. "HIV-Associated Diffuse Large B Cell Lymphoma: Determinants of Survival In the Era of Rituximab and HAART." Blood 116, no. 21 (November 19, 2010): 2835. http://dx.doi.org/10.1182/blood.v116.21.2835.2835.
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Abstract Abstract 2835 Background: Diffuse large B cell lymphoma (DLBCL) is associated with the human immunodeficiency virus (HIV). The optimal treatment for DLBCL in persons with HIV is uncertain. Anthracycline-based chemotherapy plus rituximab is frequently administered because this therapy has an established survival benefit in non-HIV DLBCL. However, there is controversy regarding the risks and benefits of rituximab in the setting of HIV, and practice remains varied. Due to concerns about tolerance and drug interactions, controversy also exists regarding whether highly active antiretroviral therapy (HAART) should be administered concurrent with chemotherapy. Methods: We completed a retrospective cohort study of all patients with HIV-DLBCL treated with curative-intent, at St. Paul's Hospital in British Columbia, Canada, and at St. Michael's and Sunnybrook Hospitals in Ontario, Canada. Univariate and multivariate analyses were completed to identify factors associated with improved overall survival (OS). Due to differences in provincial funding, we were able to compare patients treated with and without rituximab during the same time period. Results: Seventy-four patients were identified; 21 were treated between 1992 and 2000 (prior to the introduction of rituximab); 53 were treated between 2001 and 2009. Mean age was 45 years, 93% were male, 80% had stage 3–4 disease, 53% had an IPI (International Prognostic Index) > 2, 63% had a CD4 count < 200 and 18% had a CD4 count < 50. Median follow-up was 8.8 months (range 0.7 to 79.1). One-year OS was 53% and 32 of 35 deaths occurred in the first year. Seven deaths were due to infectious complications of chemotherapy, only one of these patients received rituximab, six had CD4 counts greater than 100, and four were receiving HAART. Because none of the patients prior to 2001 received rituximab, and because the pre-2001 cohort was very different from the post-2001 cohort with respect to CD4 counts, HAART usage and primary chemotherapy, comparative survival analyses were restricted to the post-2001 cohort (N=53). In univariate analyses, the only factor associated with improved OS in this cohort was concurrent administration of HAART (p=0.002). A Cox proportional hazards model incorporating use of rituximab, age, IPI > 2, CD4 count < 200, and concurrent HAART was constructed. As illustrated in table 1, IPI > 2, CD4 count < 200, and concurrent HAART were significantly and independently associated with overall survival. Conclusions: In this retrospective analysis, rituximab did not appear to be associated with a high toxic death rate in patients with HIV-DLBCL. However, rituximab was also not associated with significantly improved OS. Concurrent administration of HAART, higher CD4 count and lower IPI were independently associated with improved OS in patients with HIV-DLBCL. It is possible that this study was under-powered to detect a benefit of rituximab, however, we also hypothesize that previous studies reporting a benefit of rituximab in this population may have been biased by the use of historical controls. Disclosures: Leitch: Roche Canada: Honoraria.
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McGuinness, Julia Elizabeth, Vicky Ro, Simukayi Mutasa, Richard Ha, and Katherine D. Crew. "Use of a novel convolutional neural network-based mammographic evaluation to assess response to adjuvant endocrine therapy in women with early-stage breast cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 530. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.530.
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530 Background: The standard of care for early-stage hormone receptor (HR)-positive breast cancer (BC) is 5-10 years of adjuvant endocrine therapy (ET), which leads to a 50-60% relative risk reduction in BC recurrence. However, 10-40% of patients may relapse up to 20 years (y) after diagnosis, and there is a need for biomarkers of response to ET. We developed a novel, fully-automated convolutional neural network (CNN)-based mammographic evaluation that accurately predicts BC risk, which is being evaluated as a pharmacodynamic response biomarker to adjuvant ET. Methods: We conducted a retrospective cohort study among women with HR-positive stage I-III unilateral BC diagnosed at Columbia University Irving Medical Center from 2007-2017, who received adjuvant ET and had at least 2 mammograms of the contralateral breast (baseline and annual follow-up). Demographics, clinical characteristics, BC treatments, and relapse status were extracted from the electronic health record and New York-Presbyterian Hospital Tumor Registry. We performed CNN analysis of mammograms at baseline (start of ET) and annual follow-up. Our primary endpoint was change in CNN risk score, expressed as a continuous variable (range, 0-1). We used two-sample t-tests to assess for differences in mean CNN scores between patients who relapsed or remained in remission. We evaluated if CNN score at baseline and change from baseline were associated with relapse using logistic regression, with adjustment for known prognostic factors. Results: Among 870 evaluable women, mean age at diagnosis was 59.5y (standard deviation [SD], 12.4); 60.3% had stage I tumors, 72.6% underwent lumpectomy, and 45.8% received chemotherapy. With a median follow-up of 4.9y, there were 68 (7.9%) breast cancer relapses (36 distant, 26 local, 6 new primary). Median number of evaluable mammograms per patient was 5 (range, 2-13). Mean baseline CNN risk scores were significantly higher among women who relapsed compared to those in remission (0.258 vs 0.237, p = 0.022), which remained significant after adjustment for known prognostic factors. There was a significant difference in mean absolute change in CNN risk score from baseline to 1y follow-up between those who relapsed vs. remained in remission (0.001 vs. -0.022, p = 0.027), but this was no longer significant in multivariable analysis. Conclusions: We demonstrated that higher baseline CNN risk score was an independent predictor of BC relapse. A greater decrease in mean CNN risk scores at 1-year follow-up after initiating adjuvant ET was seen among BC patients who remained in remission compared to those who relapsed. Therefore, baseline CNN risk scores may identify patients at high-risk for breast cancer recurrence to target for more intensive adjuvant treatment. Early changes in CNN risk scores may be used to predict response to long-term ET in the adjuvant setting.
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Gainey, Christopher E., Heather A. Brown, and William C. Gerard. "Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina (USA)." Prehospital and Disaster Medicine 33, no. 4 (July 17, 2018): 432–35. http://dx.doi.org/10.1017/s1049023x18000572.
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AbstractAs health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes prehospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med. 2018;33(4):432–435
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Costa, A. V., A. Zhunus, B. Storey, M. S. Sait, S. Shah, F. Sanei, J. Mathew, and M. Heitor. "40 Improving Urinary Catheter Documentation and Care in Geriatric Wards." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.01.
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Abstract Introduction NICE guidelines state that urinary catheter insertion, changes and care should be documented. Duration of catheterization is directly linked to the risk of developing a catheter-associated UTI. Furthermore, Public Health England has announced a national aim to reduce the incidence of Gram-negative bacteraemia by 50% by March 2021, and targeting catheters is one of the first steps. Local problem These issues are relevant to the elderly population at Princess Royal University Hospital, where documentation surrounding catheters was found to be inadequate. Despite there being an Electronic Patient Record (EPR) order for catheter insertion and monitoring available, this was not being used. Our primary aim was for all patients to have this order. We also hoped to reduce the weekly rate of catheter days (catheter days per 100 bed days), and improve documentation in clinical notes. Methods We focused on two medical wards and sampled all patients admitted over a period of 4 months who had a catheter at the time of data collection. We identified catheterized patients and whether they had an EPR catheter order on a daily basis. Additional parameters such as indication, insertion date, inserter, and documentation standards were extracted from EPR on a weekly basis. Patients were kept “live” and contributing to catheter day calculations until they were no longer on the ward or if the catheter was removed. Interventions We implemented changes over 2 PDSA cycles. Interventions included the addition of catheter columns to boards and education sessions for doctors and nurses (cycle 1), as well as catheter posters, alert cards, and circulation of emails with guidance to doctors and nursing staff (cycle 2). Results A total of 87 patients were analysed during the project. There was an increase in EPR orders being used, with the 100% target being reached on the final data collection point, and with data showing a significant shift above baseline. Furthermore, there was a decrease in the weekly rate of catheter days, but changes were difficult to sustain. We also saw a general improvement in documentation standards. Conclusion By improving documentation and reducing unnecessary catheterization, we hope to have reduced the overall risk of infection whilst improving patient comfort and experience. Lessons may be transferrable to other trusts.
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Yang, Deok-Hwan, Jae Sook Ahn, Yeo-Kyeoung Kim, Je-Jung Lee, Young Jin Choi, Ho Jin Shin, Joo-Seop Chung, et al. "Comparing Standard IPI with Revised-IPI in Patients with Diffuse Large B-Cell Lymphoma: Which Has a More Differential Potential for Predicting the Outcomes after R-CHOP Chemotherapy." Blood 112, no. 11 (November 16, 2008): 2003. http://dx.doi.org/10.1182/blood.v112.11.2003.2003.
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Abstract The utility of International Prognostic index (IPI) in the era of immunochemotherapy could not be determined by the available randomized trials. Recently, the study of British Columbia group suggested that a revised IPI (R-IPI) which redistributed the IPI factors into 3 distinct prognostic groups provided a more clinically useful prediction of outcome for patients with diffuse large B-cell lymphoma (DLBCL). We investigated the clinical outcomes of R-CHOP chemotherapy in patients with DLBCL for determining which has a more differential potential of predicting the prognosis among R-IPI or standard IPI. Patients and Methods: We analyzed a total of 348 patients with newly diagnosed DLBCL from National University Hospitals of Southern Korea (NUHSK) between September 2002 and July 2008. R-CHOP conducted standard doses of chemotherapy and rituximab (375 mg/m2) administered a 21-day interval. The limited-stage patients were treated with 3rd or 4th chemotherapy followed by involved field radiation therapy (IFRT) and the advanced-stage patients were treated with six to eight cycles of chemotherapy. Results: The median age was 61 years (range, 18–85) with 51.6% of patients aged above 60. After a median follow-up of 25 months (range, 2-66.8), 280 patients (80.5%) were alive and 76 patients (21.8%) had relapsed or progressed. 16 patients (4.6%) underwent autologous stem cell transplantation (ASCT). The 4-year probability of overall survival (OS) and progression-free survival (PFS) were 73.7 ± 3.4 % and 69.1 ± 3.6 %, respectively (Fig. 1A). The distribution of patients and 4-year OS rates according to IPI factors were followings; 16.7% patients had zero risk factor with 95.4%, 33.9% patients had 1 factor with 90.0%, 19.3% patients had 2 factors with 69.9%, 19.0% patients had 3 factors with 55.7%, 10.3% patients had 4 factors with 28.4% and 0.9% patients had 5 factors without reached 4-year OS rates (Fig. 1B). Both standard IPI and revised IPI showed a significant potential as prognostic variable in OS and PFS. However, the standard IPI distinguished clinical outcomes between patients with 3 risk factors and patients with 4–5 risk factors. In addition, there was no survival difference between patients with zero risk factor and patients with 1 risk factor (Fig. 2). Conclusion: The standard IPI had more differentiation potency in predicting prognosis than R-IPI in patients with DLBCL treated with R-CHOP chemotherapy. Fig. 1 Overall outcomes (A) and outcomes according to the number of IPI factors (B) Fig. 1. Overall outcomes (A) and outcomes according to the number of IPI factors (B) Fig. 2 Comparison of OS and PFS according to the standard IPI and revised IPI Fig. 2. Comparison of OS and PFS according to the standard IPI and revised IPI
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Hong, Junshik, Sanghui Park, Jinny Park, Jeong Yeal Ahn, Kyung-Hee Kim, and Jae Hoon Lee. "Prognostic Value of Epstein-Barr Virus Infected Tumor Cell Size in Patients with Extranodal Natural Killer T-Cell Lymphoma, Nasal Type." Blood 118, no. 21 (November 18, 2011): 5191. http://dx.doi.org/10.1182/blood.v118.21.5191.5191.
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Abstract Abstract 5191 Backgrounds: Extranodal natural killer T-cell lymphoma, nasal type (nasal ENKTL) is a distinct clinicopathologic entity of lymphoid tumors with variable size and differentiation of tumor cells. Nasal ENKTL is related to infection of the tumor cells with Epstein-Barr virus (EBV) and virtually all cases contain monoclonal episomal EBV DNA and detectable EBV encoded small nuclear RNAs (EBERs). Several clinical factors were known for their relation to the prognosis, but histopathologic prognostic factors of nasal ENKTL have not yet been well established. We evaluated prognostic value of the size and density of EBER-positive tumor cells along with immunohistochemistry (IHC) expression of CD30 and CD56. Patients and Methods: Patients with newly diagnosed nasal ENKTL treated in a single institution (Gachon University Gil Hospital) were evaluated with respect to clinical characteristics, survival, and histopathologic characteristics. IHC were performed using anti-CD56 (DAKO), CD30 (DAKO). EBV RNA was detected by an ISH (in situ hybridization) technique. Paraffin sections were pretreated with xylene followed by treatment with proteinase K and hybridized with FITC-conjugated EBV oligonucleotides (Novocastra) complementary to the nRNA portion of the EBER-1 and EBER-2 genes. The numbers of EBER-positive tumor cells were counted and the nuclear length of tumor cells were measured using a computerized image analysis system (IMT i-Solution Inc., Vancouver, British Columbia, Canada) that included a DP70 Digital camera (Olympus, Tokyo, Japan) installed on an Olympus light microscope (Olympus BX51) and attached to a personal computer. Five independent microscopic fields (at x400 magnification), representing the densest tumor infiltration, were selected for each patient sample to ensure representativeness and homogeneity. Each independent microscopic field contained an approximately 80% tumor ratio. The results were expressed as the mean number of cells (± standard error) in 1 computerized x400 microscopic field (9941.38mm2/field). More than 50 tumor cells were selected for the measurement of nuclear length of tumor cells. The results were expressed as the mean diameter of cells (± standard error). The mean density and mean diameter were used for statistical analysis. Results: Twenty-two patients were analyzed. Median age were 48.5 (range 15–81) and 20 of them were male (91%). Seven (32%) patients were Ann Arbor stage I, and 6 (27%), 3 (14%), and 6 (27%) were stage II, III, IV, respectively. Sixteen patients (73%) received combined chemotherapy and radiotherapy whereas 5 patients (23%) received chemotherapy alone and 1 patient received only radiotherapy. Median of the mean EBER-positive tumor cell diameters of the patients were 7.32 mm (range 5.15–11.27). Median of the mean tumor cell counts of the patients were 71.7/field. Patients with larger mean tumor cell diameters (≥ 7.32 mm) had a poorer event-free survival (EFS), which was defined as survival free from failure or death from any cause, than those with smaller (<7.32 mm) mean cell diameters (table 1 and figure 1). Density of tumor cells (≥71.7 vs. < 71.7/field) and IHC to CD56 or CD30 (≥50% vs. < 50% of expression) had no impact on EFS, whereas previously known clinical factors - local tumor invasion, type of therapy, performance status, and splenomegaly - maintained power enough to predict EFS (table 1). Conclusion: Larger EBER-positive tumor cell size had an adverse impact on EFS in patients with nasal ENKTL. Further larger scale study to define the prognostic value of EBV infected tumor cell size is warranted. Disclosures: No relevant conflicts of interest to declare.
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Gerrie, Alina S., Maryse M. Power, Kerry J. Savage, John D. Shepherd, and Joseph M. Connors. "Chemoresistance Can Be Reliably Overcome with High-Dose Therapy and Autologous Stem Cell Transplantation (HDT/ASCT) for Relapsed and Refractory Hodgkin's Lymphoma." Blood 118, no. 21 (November 18, 2011): 2022. http://dx.doi.org/10.1182/blood.v118.21.2022.2022.
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Abstract Abstract 2022 Background: HDT/ASCT is the preferred treatment for relapsed and refractory HL patients (pts) with chemosensitive disease, with cure rates approximating 40–60%. The role for HDT/ASCT in chemoresistant HL is less well defined and many centers do not offer this treatment to such patients. Since 1985, HDT/ASCT has been recommended in British Columbia (BC) for all HL pts with progressive disease despite primary ABVD-type therapy, irrespective of response to salvage therapy. We sought to evaluate the long-term outcomes of HL pts whose disease was resistant to chemotherapy preceding HDT/ASCT. Methods: We reviewed all HL pts who underwent HDT/ASCT for primary progression (PP) or first relapse (1REL) after initial treatment with chemotherapy +/− radiation. Primary progression (PP) was defined as progression during or within 3 months of completion of initial therapy. Pts were considered to have: chemoresistant (R) disease = stable disease or progression on chemotherapy preceding HDT/ASCT; chemosensitive (S) disease = clinical and/or radiographic response to chemotherapy preceding HDT/ASCT; or untested (U) if no salvage chemotherapy was given. Clinical and laboratory data were obtained from the BC Cancer Agency Lymphoid Cancer Database, the Leukemia/BMT Program of BC Database and from hospital, clinic, and physician records. Results: 251 pts underwent HDT/ASCT for PP (n=90 36%) or 1REL (n=161 64%) between 1985–2011: male 53%; median age at diagnosis 28 y (range 16–59 y), at HDT/ASCT 31 y (range 31–62 y). Characteristics at diagnosis were: advanced stage(stage IIB, II bulky, III or IV) 94%; stage 3–4 60%; B symptoms 57%; bulk (≥10 cm) 42%; primary therapy: ABVD/ABVD-like, 95%; MOPP-like 5%; combined modality therapy 31%. Salvage therapy prior to HDT/ASCT included MVPP (28%); COP/COPP (22%); GDP (27%); no chemotherapy (13%); other (11%). RT was given with salvage therapy in 19%: alone, 27%; with chemotherapy, 73%. Conditioning regimen was with CBV/CBVP in the majority of cases (88%); BEAM (11%); other (1%). At a median follow-up for living pts of 8 y (range 0.2 – 25 y), 136 pts (54%) were alive free of HL; 89 pts (35%) have relapsed. For all pts, median overall (OS) and progression free survivals (PFS) were 21.7 y (95% CI 16.0–27.5) and 17.3 y (95% CI 9.8–24.8), respectively. 13 pts (5%) died of complications related to or within 1 month of HDT/ASCT, 6 (2%) from secondary malignancies, 7 (3%) from unrelated causes. 199 pts (56 PP, 143 1REL) had information available regarding response to salvage therapy. Of the 56 PP pts, 14 (25%) had chemoresistant disease (PP/R); 21 (38%) did not receive salvage therapy and thus were untested (PP/U); 21 (38%) had chemosensitive disease (PP/S). 10-y PFS for PP/R, PP/U, and PP/S groups were 27%, 24%, and 40%, respectively; 10-y OS were 53%, 27%, and 53%, respectively. Of the 143 1REL pts, 26 (18%) had chemoresistant disease (1REL/R); 12 (8%) did not receive salvage therapy (1REL/U); 105 (73%) had chemosensitive disease (1REL/S). 10-y PFS for 1REL/R, 1REL/U, and 1REL/S groups were 49%, 57%, and 58%, respectively; 10-y OS were 55%, 65%, 69%, respectively. OS and PFS for the chemoresistant groups (PP/R, PP/U, 1REL/R) and 1REL/U are shown in Figures 1A and 1B respectively. To evaluate impact of chemoresistance on outcomes, PP/R (pts resistant to both primary and salvage therapy, “double-resistant”) and PP/U pts (resistant to primary therapy, “single-resistant”) were grouped together (n=35) and compared to PP/S pts. There was a significant difference in OS (P =.05) but not PFS (P =.12). When pts with 1REL/R were compared to 1REL/S, there was no significant difference in OS (P =.25) or PFS (P =.26). Conclusion: In this large uniformly treated cohort of HL pts with long-term follow-up, chemoresistance preceding HDT/ASCT was identified as a poor prognostic factor, particularly for PP pts; however, this poor prognostic factor could be partially overcome by HDT/ASCT, resulting in cure in 25–50% of pts across all chemoresistant groups. Importantly, even pts who were double-resistant to both primary and salvage therapy were cured in 27% of cases. HDT/ASCT should therefore be considered in all transplant eligible pts, regardless of responsiveness to salvage chemotherapy. Disclosures: No relevant conflicts of interest to declare.
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Masias, Camila, Rawan Tarawneh, Haiwa Wu, Krista Carter, Shangbin Yang, Alcinda Flowers, Marie Scully, and Spero Cataland. "A Pilot Study on Biomarkers of Vascular Injury in Patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura." Blood 134, Supplement_1 (November 13, 2019): 2377. http://dx.doi.org/10.1182/blood-2019-130369.
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Background: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is defined by thrombocytopenia and microangiopathic hemolytic anemia without an alternative explanation, confirmed by severely deficient ADAMTS13 to <10%. It is caused by autoantibodies against the ADAMTS13 protease. Following recovery from an acute iTTP episode, the patient is at risk for relapses and multiple long-term complications including hypertension, depression, headaches and neurocognitive impairment. The etiology of these complications is not well understood. The aim of this study was to identify biomarkers of vascular injury that could help to diagnose or predict the development of these long term complications of iTTP. Four plasma biomarkers of vascular injury were selected with the assistance of a multidisciplinary team of neurologists, pathologists and psychologists, based on their relevance in other chronic diseases and inflammation. Syndecan-1 (CD-138), is a cell surface heparan sulfate proteoglycan that interacts with extracellular matrix molecules and growth factors to maintain epithelial cell morphology. It has been reported to be a negative regulator of various inflammatory processes, with Syndecan-1 knockout (Sdc-1−/−) mice showing enhanced disease severity and impaired recovery.Thrombomodulin (CD141), is an endothelial surface transmembrane glycoprotein. It is involved in the activation of protein C in the inactivation of thrombin. Its expression has been associated with aging and cardiovascular disease.Vascular adhesion protein-1 (VAP) is a member of the copper-containing amine oxidase/semicarbazide-sensitive amine oxidase (AOC/SSAO) enzyme family. It is continuously expressed as a transmembrane glycoprotein in the vascular wall during development and facilitates the accumulation of inflammatory cells into the inflamed environment. It has been shown to be released in cerebral ischemia.E-selectin (CD62E), is a selectin cell adhesion molecule, expressed only in endothelial cells activated by cytokines, and is known to be increased in acute coronary syndrome and atherosclerosis. Methods: Patients with a diagnosis of iTTP functioning normally in their activities of daily living were recruited from existing IRB approved patient cohorts at both the Ohio State University (n = 10) (Columbus) and the University College London Hospitals (n = 15) (London, UK). These patients were studied and reported previously (Cataland, Scully M et al. AJH 2011, 86; 87-89). with a validated measure of neurocognitive function (Cogstate). Patients were characterized by this testing as having normal or abnormal cognitive function. Syndecan-1, thrombomodulin, vascular adhesion protein-1, and E-selectin were studied in plasma samples obtained at the time of the previous neurocognitive testing. All four biomarker assays were performed with commercially available Elisa-based assays. Results: There was a total of 25 patients that underwent neurocognitive testing previously; 11 patients had normal neurocognitive testing and 14 patients were characterized as abnormal. The median age was 41 (range 18-62). One patient was Asian, six were black and 18 were white. Nine patients were male. The demographic information for each group is listed in Table 1. The biomarker results for each group are listed on Table 2 and a comparison is seen on Figure 1. We did see a trend to lower levels of Syndecan-1, and higher levels of thrombomodulin and VAP-1 in patients with abnormal cognitive testing. The two groups had similar levels of CD62E. all biomarker testing was repeated twice and given consistent data. Conclusions: There is a need in the field for a better understanding of the pathophysiology of the long-term complications described in patients with iTTP. This pilot study is the first to look at biomarkers of vascular injury and inflammation that can correlate with neurocognitive impairment and potentially vascular injury in patients with iTTP, not when patients are having an acute episode but during follow up. In addition, we have shown that these biomarkers can be reliably tested in frozen samples from patients with iTPP, and important step for feasibility of future studies. These data are an important first step to develop specific biomarkers that correlate with the development of long-term complications in iTTP patients. Disclosures Masias: Rigel Pharmaceuticals: Consultancy. Scully:Alexion: Consultancy; Novartis: Consultancy; Ablynx/Sanofi: Consultancy; Shire/Takeda: Consultancy; Shire: Research Funding. Cataland:Ablynx/Sanofi: Consultancy, Research Funding; Alexion: Consultancy, Research Funding.