Sample records for patient risk stratification

  1. Risk stratification of ICU patients using arterial blood pressure waveforms

    E-print Network

    Sridharan, Mathura J

    2013-01-01

    Identifying patients at high risk for adverse events is very important to the practice of clinical medicine. Non-invasive ECG-based methods of risk stratification such as T wave Alterans, Morphological Variability, and ...

  2. Risk Stratification of Patients With Syncope

    Microsoft Academic Search

    Thomas P Martin; Barbara H Hanusa; Wishwa N Kapoor

    1997-01-01

    See related editorial p 540.Study objective: To develop and validate a risk classification system for patients presenting to emergency departments with syncope. Methods: Two prospective studies were carried out at a large urban teaching hospital ED. One cohort of 252 patients with syncope who reported to the ED was used to develop the risk classification system; a second cohort of

  3. Risk Stratification of Patients Presenting with Transient Loss of Consciousness.

    PubMed

    Puppala, Venkata Krishna; Akkaya, Mehmet; Dickinson, Oana; Benditt, David G

    2015-08-01

    Important goals in the initial evaluation of patients with transient loss of consciousness include determining whether the episode was syncope and choosing the venue for subsequent care. Patients who have high short-term risk of adverse outcomes need prompt hospitalization for diagnosis and/or treatment, whereas others may be safely referred for outpatient evaluation. This article summarizes the most important available risk assessment studies and points out key differences among the existing recommendations. Current risk stratification methods cannot replace critical assessment by an experienced physician, but they do provide much needed guidance and offer direction for future risk stratification consensus development. PMID:26115825

  4. Patient Risk Stratification for Hospital-Associated C. diff as a Time-Series Classification Task

    E-print Network

    Horvitz, Eric

    Patient Risk Stratification for Hospital-Associated C. diff as a Time-Series Classification Task. In doing so, patient risk stratification becomes a time-series classification task. The task differs from-out set of sev- eral hundred patients. Our two-stage approach to risk stratification outperforms

  5. QT variability improves risk stratification in patients with dilated cardiomyopathy.

    PubMed

    Fischer, C; Seeck, A; Schroeder, R; Goernig, M; Schirdewan, A; Figulla, H R; Baumert, M; Voss, A

    2015-04-01

    Recently it could be demonstrated that systolic and diastolic blood pressure variability (BPV) as well as segmented Poincare plot analysis (SPPA) contribute to risk stratification in patients suffering from dilated cardiomyopathy (DCM). The aim of this study was to improve the risk stratification applying a multivariate technique including QT variability (QTV). We enrolled and significantly separated 56 low risk and 13 high risk DCM patients by nearly all applied BPV and QTV methods, but not with traditional heart rate variability analysis. The optimum set of two indices calculating the multivariate discriminate analysis (DA) included one BPV index calculated by symbolic dynamics method (DBP(Shannon)) and one index calculated from QTV (QTV(log)) achieving an area under the receiver operating characteristics curve (AUC) of 92%, sensitivity of 92.3% and specificity of 89.3%. Performing only electrocardiogram analysis, the optimum multivariate approach including indices from segmented Poincaré plot analysis and QTV still achieved a remarkable AUC of 88.3%. Increasing the number of indices for multivariate DA up to three, we achieved an AUC of 95.7%, sensitivity of 100% and specificity of 85.7% including one clinical, one BPV and one QTV index. Summarizing, we identified DCM patients with an increased risk of sudden cardiac death applying QTV analysis in a multivariate approach. PMID:25799313

  6. Noninvasive risk stratification for sudden death in asymptomatic patients with Wolff-Parkinson-White syndrome.

    PubMed

    Novella, John; DeBiasi, Ralph M; Coplan, Neil L; Suri, Ranji; Keller, Seth

    2014-01-01

    Sudden cardiac death (SCD) as the first clinical manifestation of Wolff-Parkinson-White (WPW) syndrome is a well-documented, although rare occurrence. The incidence of SCD in patients with WPW ranges from 0% to 0.39% annually. Controversy exists regarding risk stratification for patients with preexcitation on surface electrocardiogram (ECG), particularly in those who are asymptomatic. This article focuses on the role of risk stratification using exercise and pharmacologic testing in patients with WPW pattern on ECG. PMID:25662922

  7. Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure

    Microsoft Academic Search

    Jörg Koglin; Sinan Pehlivanli; Martin Schwaiblmair; Michael Vogeser; Peter Cremer; Wolfgang vonScheidt

    2001-01-01

    ObjectivesUsing a prospective study design, we assessed the value of brain natriuretic peptide (BNP) to identify patients with heart failure who have an increased risk of deterioration of their functional status. Furthermore, we examined the relationship between BNP and various clinical characteristics incorporated into an established survival model used for risk stratification.

  8. Sudden cardiac death risk stratification.

    PubMed

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J

    2015-06-01

    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized. PMID:26044247

  9. Pancreatic Cancer Risk Stratification based on Patient Family History Anand Krishnan 1

    E-print Network

    Zhou, Yaoqi

    Pancreatic Cancer Risk Stratification based on Patient Family History Anand Krishnan 1 , C. Max, IN USA. Background: Pancreatic cancer is the fourth leading cause of cancer-related deaths in the US, resulting in a 5-year survival rate of less than 6%. Screening the general population for pancreatic cancer

  10. Risk stratification of hospitalized patients on the wards.

    PubMed

    Churpek, Matthew M; Yuen, Trevor C; Edelson, Dana P

    2013-06-01

    Patients who suffer adverse events on the wards, such as cardiac arrest and death, often have vital sign abnormalities hours before the event. Early warning scores have been developed with the aim of identifying clinical deterioration early and have been recommended by the National Institute for Health and Clinical Excellence. In this review, we discuss recently developed and validated risk scores for use on the general inpatient wards. In addition, we compare newly developed systems with more established risk scores such as the Modified Early Warning Score and the criteria used in the Medical Early Response Intervention and Therapy (MERIT) trial in our database of > 59,000 ward admissions. In general we found the single-parameter systems, such as the MERIT criteria, to have the lowest predictive accuracy for adverse events, whereas the aggregate weighted scoring systems had the highest. The Cardiac Arrest Risk Triage (CART) score was best for predicting cardiac arrest, ICU transfer, and a composite outcome (area under the receiver operating characteristic curve [AUC], 0.83, 0.77, and 0.78, respectively), whereas the Standardized Early Warning Score, VitalPAC Early Warning Score, and CART score were similar for predicting mortality (AUC, 0.88). Selection of a risk score for a hospital or health-care system should be guided by available variables, calculation method, and system resources. Once implemented, ensuring high levels of adherence and tying them to specific levels of interventions, such as activation of a rapid response team, are necessary to allow for the greatest potential to improve patient outcomes. PMID:23732586

  11. The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients

    PubMed Central

    Khalill, Ramjane; Han, Lei; Jing, Chang; Quan, He

    2009-01-01

    OBJECTIVE: To review the methods available for the risk stratification of non-ST elevation (NSTE) acute coronary syndrome (ACS) patients and to evaluate the use of risk scores for their initial risk assessment. DATA SOURCES: The data of the present review were identified by searching PUBMED and other databases (1996 to 2008) using the key terms “risk stratification”, “risk scores”, “NSTEMI”, “UA” and “acute coronary syndrome”. STUDY SELECTION: Mainly original articles, guidelines and critical reviews written by major pioneer researchers in this field were selected. RESULT: After evaluation of several risk predictors and risk scores, it was found that estimating risk based on clinical characteristics is challenging and imprecise. Risk predictors, whether used alone or in simple binary combination, lacked sufficient precision because they have high specificity but low sensitivity. Risk scores are more accurate at stratifying NSTE ACS patients into low-, intermediate- or high-risk groups. The Global Registry of Acute Cardiac Events risk score was found to have superior predictive accuracy compared with other risk scores in ACS population. Treatments based according to specific clinical and risk grouping show that certain benefits may be predominantly or exclusively restricted to higher risk patients. CONCLUSION: Based on the trials in the literature, the Global Registry of Acute Cardiac Events risk score is more advantageous and easier to use than other risk scores. It can categorize a patient’s risk of death and/or ischemic events, which can help tailor therapy to match the intensity of the patient’s NSTE ACS. PMID:19675816

  12. Selecting Patients With Atrial Fibrillation for Anticoagulation Stroke Risk Stratification in Patients Taking Aspirin

    Microsoft Academic Search

    Brian F. Gage; Carl van Walraven; Lesly Pearce; Robert G. Hart; Peter J. Koudstaal; B. S. P. Boode; Palle Petersen

    2009-01-01

    Background—The rate of stroke in atrial fibrillation (AF) depends on the presence of comorbid conditions and the use of antithrombotic therapy. Although adjusted-dose warfarin is superior to aspirin for reducing stroke in AF, the absolute risk reduction of warfarin depends on the stroke rate with aspirin. This prospective cohort study tested the predictive accuracy of 5 stroke risk stratification schemes.

  13. [Updated criteria for diagnosis and risk stratification in patients with multiple myeloma].

    PubMed

    Djurdjevi?, Predrag; Andjelkovi?, Nebojša; Bila, Jelena

    2011-12-01

    Search and disclosure of most adequate diagnostic criteria and prognostic indicators of disease represents one of the most difficult tasks in the understanding of any disease, which creates the way toward a more successful treatment and longer survival. The recent advances in research techniques that have helped refine the diagnostic work up and prognosis of myeloma include serum-free light chains, especially in oligosecretory myeloma, magnetic resonance and positron emission tomography in the diagnosis of bone diseases, cytogenetics and fluorescent in situ hibridization (FISH) technique to determine prognosis. The International Staging System and Durie/Salmon PLUS system are the current standards for staging myeloma. Newer risk stratification protocols are based on international staging system and chromosomal changes detected by conventional cytogenetics and FISH. These improved predictive risk stratification models have enabled the determination of prognosis in patients with myeloma which has a considerable influence on the choice of therapeutic algorism. Novel therapies enable a significant increase in achieving complete remission in a significant number of patients which also results in the definition of more precise criteria regarding the response to therapy. A firm and complete remission with a very good partial remission represent new categories defined by the international uniform criteria of response to therapy. This paper provides the current criteria for diagnosis, staging, risk stratification and response assessment of myeloma. PMID:22352190

  14. Clinical Usefulness of Novel Serum and Imaging Biomarkers in Risk Stratification of Patients with Stable Angina

    PubMed Central

    Ikonomidis, Ignatios; Tsantes, Argirios

    2014-01-01

    Inflammatory mediators appear to be the most intriguing yet confusing subject, regarding the management of patients with acute coronary syndromes (ACS). The current inflammatory concept of atherosclerotic coronary artery disease (CAD) led many investigators to concentrate on systemic markers of inflammation, as well as imaging techniques, which may be helpful in risk stratification and prognosis assessment for cardiovascular events. In this review, we try to depict many of the recently studied markers regarding stable angina (SA), their clinical usefulness, and possible future applications in the field. PMID:25045198

  15. Primary myelofibrosis: risk stratification by IPSS identifies patients with poor clinical outcome

    PubMed Central

    Benites, Bruno Deltreggia; Lima, Carolina Silva Costa; Lorand-Metze, Irene; Delamain, Marcia Torresan; Oliveira, Gislaine Borba; de Almeida, Daiane; de Souza, Carmino Antonio; Vassallo, Jose; Pagnano, Katia Borgia Barbosa

    2013-01-01

    OBJECTIVES: To evaluate whether risk scores used to classify patients with primary myelofibrosis and JAK-2 V617F mutation status can predict clinical outcome. METHODS: A review of clinical and laboratory data from 74 patients with primary myelofibrosis diagnosed between 1992 and 2011. The IPSS and Lille scores were calculated for risk stratification and correlated with overall survival. RESULTS: A V617F JAK2 mutation was detected in 32 cases (47%), with no significant correlation with overall survival. The patients were classified according to the scores: Lille - low, 53 (73.%); intermediate, 13 (18%); and high, 5 (7%); and IPSS – low, 15 (26%); intermediate-1, 23 (32%); intermediate-2, 19 (26%); and high, 15 (31%). Those patients presenting a higher risk according to the IPSS (high and intermediate-2) had a significantly shorter overall survival relative to the low risk groups (intermediate-1 and low) (p?=?0.02). CONCLUSIONS: These results emphasize the importance of the IPSS prognostic score for risk assessment in predicting the clinical outcome of primary myelofibrosis patients. PMID:23644853

  16. A Three-Gene Expression Signature Model for Risk Stratification of Patients with Neuroblastoma

    PubMed Central

    Garcia, Idoia; Mayol, Gemma; Ríos, José; Domenech, Gema; Cheung, Nai-Kong V.; Oberthuer, André; Fischer, Matthias; Maris, John M.; Brodeur, Garrett M.; Hero, Barbara; Rodríguez, Eva; Suñol, Mariona; Galvan, Patricia; de Torres, Carmen; Mora, Jaume; Lavarino, Cinzia

    2014-01-01

    Purpose Neuroblastoma is an embryonal tumor with contrasting clinical courses. Despite elaborate stratification strategies, precise clinical risk assessment still remains a challenge. The purpose of this study was to develop a PCR-based predictor model to improve clinical risk assessment of patients with neuroblastoma. Experimental Design The model was developed using real-time PCR gene expression data from 96 samples and tested on separate expression data sets obtained from real-time PCR and microarray studies comprising 362 patients. Results On the basis of our prior study of differentially expressed genes in favorable and unfavorable neuroblastoma subgroups, we identified three genes, CHD5, PAFAH1B1, and NME1, strongly associated with patient outcome. The expression pattern of these genes was used to develop a PCR-based single-score predictor model. The model discriminated patients into two groups with significantly different clinical outcome [set 1: 5-year overall survival (OS): 0.93 ± 0.03 vs. 0.53 ± 0.06, 5-year event-free survival (EFS): 0.85 ± 0.04 vs. 0.042 ± 0.06, both P < 0.001; set 2 OS: 0.97 ± 0.02 vs. 0.61 ± 0.1, P = 0.005, EFS: 0.91 ± 0.8 vs. 0.56 ± 0.1, P = 0.005; and set 3 OS: 0.99 ± 0.01 vs. 0.56 ± 0.06, EFS: 0.96 ± 0.02 vs. 0.43 ± 0.05, both P < 0.001]. Multivariate analysis showed that the model was an independent marker for survival (P < 0.001, for all). In comparison with accepted risk stratification systems, the model robustly classified patients in the total cohort and in different clinically relevant risk subgroups. Conclusion We propose for the first time in neuroblastoma, a technically simple PCR-based predictor model that could help refine current risk stratification systems. PMID:22328561

  17. Orthostatic Blood Pressure Test for Risk Stratification in Patients with Hypertrophic Cardiomyopathy

    PubMed Central

    Münch, Julia; Aydin, Ali; Suling, Anna; Voigt, Christian; Blankenberg, Stefan; Patten, Monica

    2015-01-01

    Background Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in young adults, mainly ascribed to ventricular tachycardia (VT). Assuming that VT is the major cause of (pre-) syncope in HCM patients, its occurrence is essential for SCD risk stratification and primarily preventive ICD-implantation. However, evidence of VT during syncope is often missing. As the differentiation of potential lethal causes for syncope such as VT from more harmless reasons is crucial, HCM patients were screened for orthostatic dysregulation by using a simple orthostatic blood pressure test. Methods Over 15 months (IQR [9;20]) 100 HCM patients (55.8±16.2 yrs, 61% male) were evaluated for (pre-)syncope and VT (24h-ECGs, device-memories) within the last five years. Eighty patients underwent an orthostatic blood pressure test. Logistic regression models were used for statistical analysis. Results In older patients (>40 yrs) a positive orthostatic test result increased the chance of (pre-) syncope by a factor of 63 (95%-CI [8.8; 447.9], p<0.001; 93% sensitivity, 95%-CI [76; 99]; 74% specificity, 95%-CI [58; 86]). No correlation with VT was shown. A prolonged QTc interval also increased the chance of (pre-) syncope by a factor of 6.6 (95%-CI [2.0; 21.7]; p=0.002). Conclusions The orthostatic blood pressure test is highly valuable for evaluation of syncope and presyncope especially in older HCM patients, suggesting that orthostatic syncope might be more relevant than previously assumed. Considering the high complication rates due to ICD therapies, this test may provide useful information for the evaluation of syncope in individual risk stratification and may help to prevent unnecessary device implantations, especially in older HCM patients. PMID:26107635

  18. Growth-differentiation factor-15 for early risk stratification in patients with acute chest pain

    PubMed Central

    Eggers, Kai M.; Kempf, Tibor; Allhoff, Tim; Lindahl, Bertil; Wallentin, Lars; Wollert, Kai C.

    2008-01-01

    Aims Growth-differentiation factor-15 (GDF-15) has emerged as a biomarker of increased mortality and recurrent myocardial infarction (MI) in patients diagnosed with non-ST-elevation acute coronary syndrome. We explored the usefulness of GDF-15 for early risk stratification in 479 unselected patients with acute chest pain. Methods and results Sixty-nine per cent of the patients presented with GDF-15 levels above the previously defined upper reference limit (1200 ng/L). The risks of the composite endpoint of death or (recurrent) MI after 6 months were 1.3, 5.1, and 12.6% in patients with normal (<1200 ng/L), moderately elevated (1200–1800 ng/L), or markedly elevated (>1800 ng/L) levels of GDF-15 on admission, respectively (P < 0.001). By multivariable analysis that included clinical characteristics, ECG findings, peak cardiac troponin I levels within 2 h (cTnI0–2 h), N-terminal pro-B-type natriuretic peptide, C-reactive protein, and cystatin C, GDF-15 remained an independent predictor of the composite endpoint. The ability of the ECG combined with peak cTnI0–2 h to predict the composite endpoint was markedly improved by addition of GDF-15 (c-statistic, 0.74 vs. 0.83; P < 0.001). Conclusion GDF-15 improves risk stratification in unselected patients with acute chest pain and provides prognostic information beyond clinical characteristics, the ECG, and cTnI. PMID:18664460

  19. Expression of two parental imprinted miRNAs improves the risk stratification of neuroblastoma patients

    PubMed Central

    Gattolliat, Charles-Henry; Le Teuff, Gwénaël; Combaret, Valérie; Mussard, Eugénie; Valteau-Couanet, Dominique; Busson, Pierre; Bénard, Jean; Douc-Rasy, Sétha

    2014-01-01

    Age at diagnosis, stage, and MYCN amplification are the cornerstones of the risk-stratification score of neuroblastoma that enables defining patients at low- and high risk. Refinement of this stratification is needed to optimize standard treatment and to plan future clinical trials. We investigated whether two parental imprinted miRNAs (miR-487b and miR-516a-5p) may lead to a risk score with a better discrimination. Expression levels of maternal miR-487b and paternal miR-516a-5p were determined using quantitative RT-PCR both for 231 neuroblastoma tumors (derivation set) and 101 independent neuroblastoma tumors (validation set). Survival outcomes were overall survival (OS) and disease-free survival (DFS). Multivariable Cox models were developed from derivation set and their performance evaluated using Akaike's information criterion (AIC) (goodness-of-fit) and time-dependent area under curves (discrimination). The selected model was validated using internal and external validation. The prognostic model including current prognostic factors plus miR-487b, miR-516a-5p, and interaction between two miRNAs was selected. Performance of this model was better in terms of both predictive ability (smallest AIC) and discrimination power (AUC close to 0.70). This model identifies three risk groups: high (3), intermediate (2), and low (1). Hazard ratios (HR) across risk groups were HR2/1 = 6.3 (2.7–14.6), HR3/1 = 14.8 (7.2–30.2) for OS and HR2/1 = 2.8 (1.5–5.4), HR3/1 = 7.2 (3.9–13.4) for DFS. The rank between these three risk groups was maintained and validated when performing internal and external validation. Expression of maternal miR-487b and paternal miR-516a-5p improves the risk stratification. This better discrimination at diagnosis is of clinical utility both for current and future treatments of neuroblastoma patients. PMID:24931722

  20. Risk stratification of prostate cancer patients based on EPS-urine zinc content

    PubMed Central

    Medarova, Zdravka; Ghosh, Subrata K; Vangel, Mark; Drake, Richard; Moore, Anna

    2014-01-01

    The early detection of prostate cancer is a life-saving event in patients harboring potentially aggressive disease. With the development of malignancy there is a dramatic reduction in the zinc content of prostate tissue associated with the inability of cancer cells to accumulate the ion. In the current study, we utilized endogenous zinc as a diagnostic biomarker for prostate cancer. We employed a novel fluorescent sensor for mobile zinc (ZPP1) to measure the concentration of zinc in thirty-nine patient samples of expressed prostatic secretion (EPS) in urine. We estimated the probability of classifying a subject as benign, low-risk, or high-risk as functions of the diagnostic test results using a non-informative prior Bayesian approach. Permutation tests and other non-parametric tests were also used. We demonstrated a significant trend in zinc score with disease and with disease risk (P = 0.03), and lack of a significant correlation between zinc score and PSA. We also showed that the proposed diagnostic is potentially superior to PSA for detecting high-risk disease. Considering that risk stratification represents an important unmet need, our method should advance the field of prostate cancer diagnostics and treatment planning. PMID:25057441

  1. Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

    PubMed Central

    Kim, Eun Kyoung; Chattranukulchai, Pairoj

    2015-01-01

    In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation. PMID:26175568

  2. Towards actionable risk stratification: a bilinear approach.

    PubMed

    Wang, Xiang; Wang, Fei; Hu, Jianying; Sorrentino, Robert

    2015-02-01

    Risk stratification is instrumental to modern clinical decision support systems. Comprehensive risk stratification should be able to provide the clinicians with not only the accurate assessment of a patient's risk but also the clinical context to be acted upon. However, existing risk stratification techniques mainly focus on predicting the risk score for individual patients; at the cohort level, they offer little insight beyond a flat score-based segmentation. This essentially reduces a patient to a score and thus removes him/her from his/her clinical context. To address this limitation, in this paper we propose a bilinear model for risk stratification that simultaneously captures the three key aspects of risk stratification: (1) it predicts the risk of each individual patient; (2) it stratifies the patient cohort based on not only the risk score but also the clinical characteristics; and (3) it embeds all patients into clinical contexts with clear interpretation. We apply our model to a cohort of 4977 patients, 1127 among which were diagnosed with Congestive Heart Failure (CHF). We demonstrate that our model cannot only accurately predict the onset risk of CHF but also provide rich and actionable clinical insights into the patient cohort. PMID:25445924

  3. Genetic screening of patients with hypertrophic cardiomyopathy--a new diagnostic strategy for risk stratification?

    PubMed

    Hudecova, K; Simkova, I; Gardlik, R; Bernadic, M

    2009-01-01

    Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disease of the heart muscle and its main characteristic is unexplained hypertrophy of the left and/or the right ventricle. HCM is the most common genetically determined cardiovascular disease and is prevalent in approximately in 1 of 500 of the population. The most serious complication of HCM is sudden cardiac death (SCD) which can be the first manifestation of the disease. However, there are other forms of benign prognosis which do not jeopardize patient's health or life. The clinical symptoms of HCM are partly dependent on mutations in affected sarcomere genes. Different mutations in the same gene can present as malign with a high risk of SCD, while other mutations can be benign. The clinical symptomatology can also be influenced by other factors such as the presence of polymorphisms in other genes. Nowadays the aim of intensive clinical research is to access the contribution of molecular genetic methods in HCM diagnostics as well as in risk stratification of SCD. It is expected that genetic analyses will have an important consequence in the screening the relatives of HCM patients and also in the prenatal diagnostics and genetic counseling (Tab. 2, Fig. 1, Ref. 45). Full Text (Free, PDF) www.bmj.sk. PMID:19408839

  4. Individual patient risk stratification of high-risk neuroblastomas using a two-gene score suited for clinical use.

    PubMed

    von Stedingk, Kristoffer; De Preter, Katleen; Vandesompele, Jo; Noguera, Rosa; Øra, Ingrid; Koster, Jan; Versteeg, Rogier; Påhlman, Sven; Lindgren, David; Axelson, Håkan

    2015-08-15

    Several gene expression-based prognostic signatures have been described in neuroblastoma, but none have successfully been applied in the clinic. Here we have developed a clinically applicable prognostic gene signature, both with regards to number of genes and analysis platform. Importantly, it does not require comparison between patients and is applicable amongst high-risk patients. The signature is based on a two-gene score (R-score) with prognostic power in high-stage tumours (stage 4 and/or MYCN-amplified diagnosed after 18 months of age). QPCR-based and array-based analyses of matched cDNAs confirmed cross platform (array-qPCR) transferability. We also defined a fixed cut-off value identifying prognostically differing subsets of high-risk patients on an individual patient basis. This gene expression signature independently contributes to the current neuroblastoma classification system, and if prospectively validated could provide further stratification of high-risk patients, and potential upfront identification of a group of patients that are in need of new/additional treatment regimens. PMID:25652004

  5. Post-Myocardial Infarction Risk Stratification

    PubMed Central

    Meldrum, Donald A.N.

    1987-01-01

    Increased morbidity and mortality after a myocardial infarct are related to residual myocardial ischemia, ventricular dysrhythmias, and left ventricular dysfunction. Clinical assessment of the survivor of an acute myocardial infarct, together with non-invasive assessment involving a combination of symptom-limited low-level treadmill stress testing, ambulatory electrocardiography and radionuclide studies of selected patients, allows stratification of patients into low-risk, intermediate-risk and high-risk sub-groups. This process results in the tailoring of further investigation and treatment to the individual patient and avoids unnecessary interventions and therapies in the low-risk population. PMID:21263908

  6. Risk stratification in extramammary Paget disease.

    PubMed

    Cohen, J M; Granter, S R; Werchniak, A E

    2015-07-01

    Extramammary Paget disease (EMPD) is an uncommon intraepithelial adenocarcinoma that involves body sites with apocrine glands such as the genital, perineal and perianal regions. Risk stratification and treatment planning for EMPD can be challenging. This review presents important prognostic information in EMPD to assist physicians with risk stratification of patients with EMPD. The best-understood prognostic factors are depth of invasion and involvement of extracutaneous sites. Tumours that invade into the reticular dermis or have a depth of > 1 mm are associated with poorer prognosis. Additionally, tumours spreading outside the skin into lymph nodes or other tissues are higher risk. There is an emerging understanding of the importance of tumour genetics in risk stratification, and we review the data on Ki-67, cyclin D1, Mucin 5AC and E-cadherin. There is less evidence supporting the importance of lesion site and patient age in risk stratification. This succinct review will be helpful in clinical practice and in EMPD research. PMID:26011765

  7. Operative risk stratification in the older adult.

    PubMed

    Scandrett, Karen G; Zuckerbraun, Brian S; Peitzman, Andrew B

    2015-02-01

    As the population ages, the health care system must to adapt to the needs of the older population. Hospitalization risks are particularly significant in the frail geriatric patients, with costly and morbid consequences. Appropriate preoperative assessment can identify sources of increased risk and enable the surgical team to manage this risk, through "prehabilitation," intraoperative modification, and postoperative care. Geriatric preoperative assessment expands usual risk stratification and careful medication review to include screening for functional disability, cognitive impairment, nutritional deficiency, and frailty. The information gathered can also equip the surgeon to develop a patient-centered and realistic treatment plan. PMID:25459549

  8. Risk Stratification by the \\

    Microsoft Academic Search

    Heinz Rupp; Daniela Wagner; Thomas Rupp; Lisa-Maria Schulte; Bernhard Maisch

    The identification of risks associated with sudden cardiac death requires further investigations. The question was addressed whether parameters can be established which not only de- scribe an increased risk for an enhanced electrical instability of the heart but also of inflammatory events underlying plaque rupture. Emphasis is placed on dose-dependent effects of the long-chain omega-(?-)3 fatty acids eicosapentaenoic acid (EPA)

  9. Risk stratification by regadenoson stress magnetic resonance imaging in patients with known or suspected coronary artery disease.

    PubMed

    Abbasi, Siddique A; Heydari, Bobak; Shah, Ravi V; Murthy, Venkatesh L; Zhang, Ying Yi; Blankstein, Ron; Steigner, Michael; Jerosch-Herold, Michael; Kwong, Raymond Y

    2014-10-15

    The aim of this study was to investigate the association between major adverse cardiovascular events (MACEs) and inducible ischemia on regadenoson cardiac magnetic resonance (CMR) myocardial perfusion imaging (MPI) performed at 3.0 T. Regadenoson stress CMR MPI is increasingly used to assess patients with suspected ischemia; however, its value in patient prognostication and risk reclassification is only emerging. A total of 346 patients with suspected ischemia who were referred for regadenoson CMR were studied. The prognostic association of presence of inducible ischemia by CMR with MACEs was determined. In addition, we assessed the extent of net reclassification improvement by CMR beyond a clinical risk model. There were 52 MACEs during a median follow-up period of 1.9 years. Patients with inducible ischemia were fourfold more likely to experience MACEs (hazard ratio, 4.14, 95% confidence interval 2.37 to 7.24, p <0.0001). In the best overall model, presence of inducible ischemia conferred a 2.6-fold increased hazard for MACEs adjusted to known clinical risk markers (adjusted hazard ratio 2.59, 95% confidence interval 1.30 to 5.18, p = 0.0069). Patients with no inducible ischemia experienced a low rate of cardiac death and myocardial infarction (0.6% per patient-year), whereas those with inducible ischemia had an annual event rate of 3.2%. Net reclassification improvement across risk categories (low <5%, intermediate 5% to 10%, and high >10%) by CMR was 0.29 (95% confidence interval 0.15 to 0.44), and continuous net reclassification improvement was 0.58. In conclusion, in patients with clinical suspicion of myocardial ischemia, regadenoson stress CMR MPI provides robust risk stratification. CMR MPI negative for ischemia was associated with a very low annual rate of hard cardiac events. In addition, CMR MPI provides effective risk reclassification in a substantial proportion of patients. PMID:25173444

  10. Cardiac risk stratification and protection.

    PubMed

    Halub, Meghan E; Sidwell, Richard A

    2015-04-01

    The goal of preoperative cardiac evaluation is to screen for undiagnosed cardiac disease or to find evidence of known conditions that are poorly controlled to allow management that reduces the risk of perioperative cardiac complications. A careful history and physical examination combined with the procedure-specific risk is the cornerstone of this assessment. This article reviews a brief history of prior cardiac risk stratification indexes, explores current practice guidelines by the American College of Cardiology and the American Heart Association Task Force, reviews current methods for preoperative evaluation, discusses revascularization options, and evaluates perioperative medication recommendations. PMID:25814103

  11. Are Coronary Angiograms of Value in the Risk Stratification of Patients Undergoing Coronary Artery Bypass Surgery?

    PubMed Central

    Lawrence, David R; Somaskanthan, Rajael; Barnard, Matthew J; Curtis, Miles; Keogh, Bruce E

    2009-01-01

    INTRODUCTION There are currently more than 20 risk-scoring systems that attempt to predict peri-operative mortality following coronary artery bypass surgery (CABG). All these scoring systems use objective criteria to assess operative risk. Angiographic data are currently not included in any of these systems. This pilot study assessed the value of coronary angiography in predicting peri-operative mortality following CABG. PATIENTS AND METHODS Fourteen patients who died following first-time isolated CABG surgery were identified. These were matched with 14 patients of similar age, sex, left ventricle function and European System for Cardiac Operative Risk Evaluation (EuroSCORE). A panel of 25 clinicians were given details of the patients' age, sex, diabetic status, family history, smoking history, hypertensive status, lipid status, pre-operative symptoms, left ventricle ejection fraction and weight and shown the coronary angiograms of the patient. They were asked to predict the outcome following CABG for each patient. RESULTS Receiver operator characteristic curves were constructed and the area under the curves calculated and analysed using a commercially available statistical package (PRISM). The area under the curve for the group was 0.6820 for the group. Consultant clinicians achieved an area of 0.6789 versus their trainees 0.6844 (P = NS). The cardiologists achieved an area of 0.7063 versus the cardiothoracic surgeons 0.6491 (P = NS). CONCLUSIONS Despite the EuroSCORE predicting equal risk for the two groups of patients, it would appear that clinicians are able to identify individual higher risk patients by assessing pre-operatively the quality of the patient' coronary vasculature. Although the clinicians were able to predict individual patient mortality better than the EuroSCORE, the area under the curve indicates that it is not a robust method and clinicians, with all the clinical information to hand, are only moderately good at predicting the outcome following coronary artery bypass surgery. PMID:19344558

  12. Risk stratification and dental management of the patient with thyroid dysfunction.

    PubMed

    Huber, Michaell A; Terézhalmy, Géza T

    2008-02-01

    The thyroid gland produces hormones critical to the maintenance of the cellular metabolic rate. The actions of these hormones are far-reaching, affecting thermoregulation and calorigenesis; the metabolism of carbohydrates, fats, and proteins; and oxygen utilization. Thyroid hormones also appear to act synergistically with epinephrine and enhance tissue sensitivity to catecholamines. Signs and symptoms of hypothyroidism include listlessness, fatigue, cold intolerance, dry skin, hair loss, constipation, weight gain, muscle soreness, and slow heart rate. Signs and symptoms of hyperthyroidism include irritability, heat intolerance, tremors, increased sweating, frequent bowel movements, and quickened heart rate. The effect of inadequately treated or undiagnosed hyperthyroidism on the heart carries perioperative risks. To provide competent dental care to patients with thyroid dysfunction, clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care. PMID:18560652

  13. Risk stratification in arrhythmogenic right ventricular cardiomyopathy.

    PubMed

    Silvano, M; Corrado, D; Köbe, J; Mönnig, G; Basso, C; Thiene, G; Eckardt, L

    2013-12-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by myocyte death and fibrofatty replacement mostly in the right ventricle. It is a leading cause of sudden cardiac death (SCD) in individuals under the age of 35 years. The main goal in the treatment of the disease is the prevention of SCD. An implantable cardioverter-defibrillator (ICD) is the only proven life-saving therapeutic option able to improve survival in ARVC patients. This therapy is not free from side effects and it accounts for a relatively high rate of morbidity because of the occurrence of inappropriate ICD interventions and of complications, both at implantation and during the follow-up. In recent years, the approach to ICD implantation has been changing on the basis of new emerging data on risk stratification. The usefulness of ICD implantation for secondary prevention has been definitively proven; the most challenging question is how to treat patients with no history of previous cardiac arrest or hemodynamically unstable ventricular tachycardia (VT). The value of ECG abnormalities, syncope, VT, and right/left ventricular involvement as predictors of SCD has been assessed in different studies with the purpose of better defining risk stratification in ARVC. Nevertheless, in spite of the growing amount of data, primary prevention in ARVC patients remains mostly an individual decision. PMID:24113835

  14. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease

    Microsoft Academic Search

    Satyendra Giri; Leslee J. Shaw; Dakshina R. Murthy

    2002-01-01

    Background—Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable. Methods and Results—Patients with symptoms of coronary artery disease who were undergoing stress myocardial perfusion imaging (MPI) from 5 centers were prospectively followed (2.51.5 years) for the subsequent occurrence of cardiac death, myocardial infarction (MI), and revascularization. Stress MPI results

  15. Surgical site infection risk factors and risk stratification.

    PubMed

    Florschutz, Anthony V; Fagan, Ryan P; Matar, Wadih Y; Sawyer, Robert G; Berrios-Torres, Sandra I

    2015-04-01

    Preoperative identification of the risk factors for surgical site infection and patient risk stratification are essential for deciding whether surgery is appropriate, educating patients on their individual risk of complications, and managing postoperative expectations. Early identification of these factors is also necessary to help guide both patient medical optimization and perioperative care planning. Several resources are currently available to track and analyze healthcare-associated infections, including the Centers for Disease Control and Prevention's National Healthcare Safety Network. In addition, the Centers for Disease Control and Prevention and the American Academy of Orthopaedic Surgeons are exploring collaborative opportunities for the codevelopment of a hip and/or knee arthroplasty national quality measure for periprosthetic joint infection. PMID:25808971

  16. Managing patients undergoing non-cardiac surgery: need to shift emphasis from risk stratification to risk modification

    Microsoft Academic Search

    G Karthikeyan; B Bhargava

    2006-01-01

    Many patients undergo non-invasive testing for the detection of coronary artery disease before non-cardiac surgery. This is despite the low predictive value of positive tests in this population and the lack of any evidence of benefit of coronary revascularisation before non-cardiac surgical procedures. Further, this strategy often triggers a clinical cascade exposing the patient to progressively riskier testing and intervention

  17. Sudden cardiac arrest in a young patient with hypertrophic cardiomyopathy and zero canonical risk factors: the inherent limitations of risk stratification in hypertrophic cardiomyopathy.

    PubMed

    Kohorst, John J; Bos, J Martijn; Hagler, Donald J; Ackerman, Michael J

    2014-01-01

    Hypertrophic cardiomyopathy is the most common heritable cardiovascular disease and a common cause of sudden cardiac death (SCD) in young adolescents and athletes. Clinical risk stratification for SCD is predicated on the presence of established risk factors; however, this assessment is far from perfect. Herein, we present a 16-year-old male who was resuscitated successfully from his sentinel event of out-of-hospital cardiac arrest. Prior to this event, he was asymptomatic and lacked all traditional SCD-predisposing risk factors for hypertrophic cardiomyopathy. PMID:23648018

  18. Risk stratification for cesarean delivery using a regional database

    Microsoft Academic Search

    Carl A. Sirio; Jayne Jones; Geoff Webster; Dennis English

    2000-01-01

    Objective: To distinguish between patients at high and low risk for undergoing cesarean delivery using a regional database.Methods: As part of a large metropolitan regional evaluation of variation and quality of care regarding childbirth, we developed a risk stratification tool using ICD-9-CM codes accounting for the likelihood of undergoing cesarean delivery from 26,358 consecutive deliveries between July 1997 and June

  19. Cardiovascular risk stratification obtained by Framingham risk score and C-reactive protein measurement

    Microsoft Academic Search

    Robert L. Bard; Nicholas Clarke; Melvyn Rubenfire; Kim Eagle; Robert D. Brook

    2005-01-01

    High sensitivity C-reactive protein (hsCRP) evaluation adds prognostic information beyond that available from Framingham risk scores (FRS) and is a useful tool to further risk stratify patients at intermediate risk. However, the clinical utility of hsCRP in routine practice remains unclear. We investigated how hsCRP evaluation may change the cardiovascular risk stratification of 100 patients deemed intermediate risk by FRS.

  20. Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging

    PubMed Central

    Thomas, Deepak; Al-Mallah, Mouaz; Govindarajulu, Usha; Forman, Daniel E.; Mora, Samia; Di Carli, Marcelo F.; Dorbala, Sharmila

    2013-01-01

    Aims To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI). Methods and results We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8–3.3]. In multivariable models adjusting for age, sex, ejection fraction, medications, heart rate recovery, Duke treadmill score (DTS), and rest-PP, each 10 mmHg lower reserve-PP was associated with a 20.6% increase in risk-adjusted mortality (adjusted HR 0.83, 95% CI 0.76–0.91). Models incorporating reserve-PP significantly reclassified risk compared with models without these parameters (net reclassification index 14.3%, P = 0.0007; integrated discrimination index 0.69, P = 0.01). Conclusion In patients without a history of CAD and a normal MPI, an abnormal reserve-PP identified and reclassified those at higher risk of death independent of known risk factors and DTS. PMID:23539339

  1. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study

    Microsoft Academic Search

    Jonas Bjerring Olesen; Gregory Y H Lip; Morten Lock Hansen; Peter Riis Hansen; Janne Schurmann Tolstrup; Jesper Lindhardsen; Christian Selmer; Ole Ahlehoff; Anne-Marie Schjerning Olsen; Gunnar Hilmar Gislason; Christian Torp-Pedersen

    2011-01-01

    Objectives To evaluate the individual risk factors composing the CHADS2 (Congestive heart failure, Hypertension, Age?75 years, Diabetes, previous Stroke) score and the CHA2DS2-VASc (CHA2DS2-Vascular disease, Age 65-74 years, Sex category) score and to calculate the capability of the schemes to predict thromboembolism.Design Registry based cohort study.Setting Nationwide data on patients admitted to hospital with atrial fibrillation.Population All patients with atrial

  2. Distant Metastasis Risk Stratification for Patients Undergoing Curative Resection Followed by Adjuvant Chemoradiation for Extrahepatic Bile Duct Cancer

    SciTech Connect

    Kim, Kyubo [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chie, Eui Kyu, E-mail: ekchie93@snu.ac.kr [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jang, Jin-Young; Kim, Sun Whe [Department of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of)] [Department of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, Sae-Won; Oh, Do-Youn; Im, Seock-Ah; Kim, Tae-You; Bang, Yung-Jue [Department of Internal Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of)] [Department of Internal Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ha, Sung W. [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of) [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University (Korea, Republic of)

    2012-09-01

    Purpose: To analyze the prognostic factors predicting distant metastasis in patients undergoing adjuvant chemoradiation for extrahepatic bile duct (EHBD) cancer. Methods and Materials: Between January 1995 and August 2006, 166 patients with EHBD cancer underwent resection with curative intent, followed by adjuvant chemoradiation. There were 120 males and 46 females, and median age was 61 years (range, 34-86). Postoperative radiotherapy was delivered to tumor bed and regional lymph nodes (median dose, 40 Gy; range, 34-56 Gy). A total of 157 patients also received fluoropyrimidine chemotherapy as a radiosensitizer, and fluoropyrimidine-based maintenance chemotherapy was administered to 127 patients. Median follow-up duration was 29 months. Results: The treatment failed for 97 patients, and the major pattern of failure was distant metastasis (76 patients, 78.4%). The 5-year distant metastasis-free survival rate was 49.4%. The most common site of distant failure was the liver (n = 36). On multivariate analysis, hilar tumor, tumor size {>=}2 cm, involved lymph node, and poorly differentiated tumor were associated with inferior distant metastasis-free survival (p = 0.0348, 0.0754, 0.0009, and 0.0078, respectively), whereas T stage was not (p = 0.8081). When patients were divided into four groups based on these risk factors, the 5-year distant metastasis-free survival rates for patients with 0, 1, 2, and 3 risk factors were 86.4%, 59.9%, 32.5%, and 0%, respectively (p < 0.0001). Conclusion: Despite maintenance chemotherapy, distant metastasis was the major pattern of failure in patients undergoing adjuvant chemoradiation for EHBD cancer after resection with curative intent. Intensified chemotherapy is warranted to improve the treatment outcome, especially in those with multiple risk factors.

  3. BET 2: negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus.

    PubMed

    Ferguson, Craig; Horner, Daniel

    2015-06-01

    A shortcut review was carried out to establish whether a negative B natriuretic peptide could identify patients with confirmed pulmonary embolus at low risk for a complicated clinical course and therefore potentially suitable for outpatient therapy. Two systematic review/meta-analyses were found directly relevant to the three-part question. A further six prospective cohort studies of high quality postdating the systematic review were also found, relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that in normotensive patients with confirmed pulmonary embolism, a negative B natriuretic peptide or NTProBNP confers a low clinical risk of complications. When used in addition to a clinical risk scoring system such as the simplified pulmonary severity index, the risk becomes negligible (<1%). Such patients could be considered for outpatient therapy direct from the emergency department. PMID:25991776

  4. Quantitative Risk Stratification of Oral Leukoplakia with Exfoliative Cytology

    PubMed Central

    Liu, Xiaoyong; Liu, Xudong; Khawar, Waqaar; Zhang, Xinyan; Wang, Fan; Chen, Xiaoxin; Sun, Zheng

    2015-01-01

    Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma (OSCC). Test outcome is reported as “negative”, “atypical” (defined as abnormal epithelial changes of uncertain diagnostic significance), and “positive” (defined as definitive cellular evidence of epithelial dysplasia or carcinoma). The major challenge is how to properly manage the “atypical” patients in order to diagnose OSCC early and prevent OSCC. In this study, we collected exfoliative cytology data, histopathology data, and clinical data of normal subjects (n=102), oral leukoplakia (OLK) patients (n=82), and OSCC patients (n=93), and developed a data analysis procedure for quantitative risk stratification of OLK patients. This procedure involving a step called expert-guided data transformation and reconstruction (EdTAR) which allows automatic data processing and reconstruction and reveals informative signals for subsequent risk stratification. Modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Among the several models tested using resampling methods for parameter pruning and performance evaluation, Support Vector Machine (SVM) was found to be optimal with a high sensitivity (median>0.98) and specificity (median>0.99). With the SVM model, we constructed an oral cancer risk index (OCRI) which may potentially guide clinical follow-up of OLK patients. One OLK patient with an initial OCRI of 0.88 developed OSCC after 40 months of follow-up. In conclusion, we have developed a statistical method for qualitative risk stratification of OLK patients. This method may potentially improve cost-effectiveness of clinical follow-up of OLK patients, and help design clinical chemoprevention trial for high-risk populations. PMID:25978541

  5. Thyroid Incidentalomas: Epidemiology, Risk Stratification with Ultrasound and Workup

    PubMed Central

    Russ, Gilles; Leboulleux, Sophie; Leenhardt, Laurence; Hegedüs, Laszlo

    2014-01-01

    A thyroid incidentaloma is an unexpected, asymptomatic thyroid tumor fortuitously discovered during the investigation of an unrelated condition. The prevalence rate is 67% with ultrasonography (US) imaging, 15% with computed tomography (CT) or magnetic resonance imaging (MRI) of the neck, and 1-2% with fluorodeoxyglucose (FDG) positron emission tomography. In the absence of a history of external beam radiation or familial medullary thyroid cancer, the risk of malignancy ranges between 5 and 13% when discovered with US, CT or MRI, but is much higher if based on focal FDG uptake (30%). All patients with a thyroid incidentaloma, independent of the mode of detection, should undergo a dedicated neck US with risk stratification: US imaging allows a quantitative risk stratification of malignancy in thyroid nodules, named ‘reporting system’ or ‘TIRADs' (thyroid imaging reporting and data system). The reported sensitivity ranges from 87 to 95% for the detection of carcinomas and the negative predictive value from 88 to 99.8%. We suggest that the indications for fine-needle aspiration be based mainly on size and US risk stratification. However, the diagnosis and workup of thyroid incidentalomas leads to superfluous surgery for benign conditions, and excess diagnosis and treatment of papillary microcarcinomas, the vast majority of which would cause no harm. Recognizing this must form the basis of any decision as to supplementary investigations and whether to offer therapy, in a close dialogue between patient and physician. The current use of minimally invasive nonsurgical ablation options, as alternatives to surgery, is highlighted. PMID:25538897

  6. The use of adenosine and adenosine triphosphate testing in the diagnosis, risk stratification and management of patients with syncope: current evidence and future perspectives.

    PubMed

    Fragakis, Nikolaos; Antoniadis, Antonios P; Saviano, Massimo; Vassilikos, Vassilios; Pappone, Carlo

    2015-03-15

    Syncope is a significant source of cardiovascular-related morbidity yet the etiology is frequently obscure and the identification of patients at highest risk is challenging. Adenosine (AD) and adenosine triphosphate (ATP) administrations have been suggested as potentially useful non-invasive tools in the diagnostic workup of patients with neurally-mediated or bradycardia-related syncope. It has been postulated that both compounds by modulating the autonomic innervation in the heart and exerting negative chronotropic and dromotropic effects in the conduction system, may unmask the mechanism of syncope. However, the clinical implications derived from the efficacy of both tests in the investigation of syncope remain unclear mainly due to inconclusive and occasionally contradictory results of published studies. This review article summarizes recent and past information in the use of ATP and AD in the investigation of syncope with emphasis on clinical trials. We present the current level of evidence for the use of these agents in clinical practice, identify areas where further research is warranted and highlight the future perspectives of these agents as complements to an accurate risk-stratification of patients with syncope. PMID:25725201

  7. Cardiac PET perfusion: prognosis, risk stratification, and clinical management.

    PubMed

    Dorbala, Sharmila; Di Carli, Marcelo F

    2014-09-01

    Myocardial perfusion imaging (MPI) with PET has expanded significantly over the past decade. With the wider availability of PET scanners and the routine use of quantitative blood flow imaging, the clinical use of PET MPI is expected to increase further. PET MPI is a powerful tool to identify risk, to quantify risk, and to guide therapy in patients with known or suspected coronary artery disease. A large body of evidence supports the prognostic value of PET MPI and ejection fraction in intermediate- to high-risk subjects, in women, in obese individuals, and in post-coronary artery bypass grafting individuals. A normal perfusion study indicates low risk (<1% annualized rate of cardiac events of cardiac death and non-fatal myocardial infarction), while an abnormal study indicates high risk. With accurate risk stratification, high-quality images, and quantitation, PET MPI may transform the management of patients with known or suspected coronary artery disease. PMID:25234079

  8. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease*y

    Microsoft Academic Search

    Daniel S. Berman; Rory Hachamovitch; Leslee J. Shaw; John D. Friedman; Sean W. Hayes; Louise E. J. Thomson; David S. Fieno; Guido Germano; Nathan D. Wong; Xingping Kang; Alan Rozanski

    This review deals with noninvasive imaging for risk stratification and with a conceptual approach to the selection of noninvasive tests in patients with suspected or known chronic coronary ar- tery disease (CAD). Already widely acknowledged with SPECT, there is an increasing body of literature data demonstrating thatCTcoronarycalciumassessmentisalsoofprognosticvalue. The amount of coronary atherosclerosis, as can be extrapolated from CT coronary calcium

  9. Volumetric Left Ventricular Ejection Fraction is Superior to 2-Dimensional Echocardiography for Risk Stratification of Patients for Primary Prevention Implantable Cardioverter-Defibrillator Implantation

    PubMed Central

    Rayatzadeh, Hussein; Patel, Shalin J.; Hauser, Thomas H.; Ngo, Long L.; Shaw, Jaime L.; Tan, Alex; Buxton, Alfred E.; Zimetbaum, Peter; Josephson, Mark E.; Appelbaum, Evan; Manning, Warren J.; Nezafat, Reza

    2013-01-01

    Current guidelines recommend an implantable cardioverter-defibrillator (ICD) according to the left ventricular ejection fraction (LVEF). However, they do not mandate volumetric LVEF assessment. We sought to determine whether volumetric LVEF measurement using cardiovascular magnetic resonance imaging (CMR-LVEF) is superior to conventional LVEF measurement using 2-dimensional transthoracic echocardiography (Echo-LVEF) for risk stratifying patients referred for primary prevention ICD. Patients who underwent primary prevention ICD implantation at our institution and had undergone preimplantation CMR-LVEF from November 2001 to February 2011 were identified. Volumetric CMR-LVEF was determined from cine short-axis data sets. CMR-LVEF and Echo-LVEF were extracted from the clinical reports. The end point was appropriate ICD discharge (shock and/or antitachycardia pacing). Of 48 patients, appropriate ICD discharge occurred in 9 (19%) within 29 – 25 months (range 1 to 99, median 20). All patients met the Echo-LVEF criteria for ICD implantation; however 25% (95% confidence interval 13% to 37%) did not meet the CMR-LVEF criteria. None (0%) of these latter patients had received an appropriate ICD discharge. Using CMR-LVEF ?30% as a threshold for ICD eligibility, 19 patients (40%) with a qualifying Echo-LVEF would not have been referred for ICD, and none (0%) received an ICD discharge. For primary prevention ICD implantation, volumetric CMR-LVEF might be superior to clinical Echo-LVEF for risk stratification and can identify a large minority of subjects in whom ICD implantation can be safely avoided. In conclusion, if confirmed by larger prospective series, volumetric methods such as CMR should be considered a superior “gatekeeper” for the identification of patients likely to benefit from primary prevention ICD implantation. PMID:23375599

  10. Post infarction risk stratification using the 3-D angle between QRS complex and T-wave vectors

    Microsoft Academic Search

    Marek Malik; Katerina Hnatkova; Velislav N. Batchvarov

    2004-01-01

    Present experience with prospective identification of patients who might benefit from prophylactic antiarrhythmic intervention is restricted to risk stratification using left ventricular ejection fraction (LVEF). The precision of LVEF-based identification of high risk patients is neither highly sensitive nor highly specific. This study investigated risk stratification of 466 survivors of acute myocardial infarction (86 women, mean age 57.5 years) for

  11. Example 1: social stratification Example 2: methadone patients

    E-print Network

    Hennig, Christian

    Example 1: social stratification Example 2: methadone patients Example 3: Gaussian mixtures and BIC: social stratification Example 2: methadone patients Example 3: Gaussian mixtures and BIC Conclusion Example 1: social stratification Hennig & Liao (2013) looked for evidence for social strata in 2007 US

  12. Autonomic Dysfunction and Risk Stratification Assessed from Heart Rate Pattern

    PubMed Central

    Günther, A; Witte, O.W; Hoyer, D

    2010-01-01

    The modulation of the autonomic nervous system (ANS) under physiological and pathophysiological conditions is in focus of recent research. Many patients with cardio- and cerebrovascular diseases display features of sympathovagal dysregulation. Measuring specific ANS parameters could improve risk stratification. Thus, the early diagnosis of ANS dysfunction in these patients poses a great challenge with high prognostic relevance. The most relevant methods and measures of Heart Rate Variability (HRV) analysis and HRV monitoring will be described in detail in this chapter. The grown importance of these easily obtainable heart rate patterns in stratifying the risk of patients with myocardial infarction and heart failure as well as ischemic stroke will be demonstrated based on recent clinical studies. In order to perspectively improve clinical management of these patients further large scale clinical investigations on the role of ANS dysfunction will be useful. PMID:21258571

  13. QRS fragmentation in patients with arrhythmogenic right ventricular cardiomyopathy and complete right bundle branch block: a risk stratification

    PubMed Central

    2012-01-01

    Background: Patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and complete right bundle branch block (RBBB) very often have recurrent ventricular tachycardia and develop biventricular heart failure in the follow up, requiring heart transplantation and/or diuretics. In other patients with ARVC/D excluding RBBB, QRS fragmentation in the S wave of right precordial leads identifies patients with recurrent ventricular tachycardia, primary ventricular fibrillation, and recurrent implantable cardioverter defibrillator discharges; QRS fragmentation ?3 leads characterized patients who died from sudden cardiac death. Method: In a cohort of 374 patients with ARVC/D (208 males; mean±SD age 46.5±14.8 years), there were 22 patients with complete RBBB: 17 patients with ARVD/C developed complete RBBB and had biventricular heart failure in a follow up of 4–6 years. In five patients with ARVC/D, complete RBBB was initially evident. In all patients with ARVC/D and RBBB, QRS fragmentation ?3 of all 12 ECG leads and QRS fragmentation in the S wave of right precordial leads were analysed. Results: QRS fragmentation ?3 of all 12 ECG leads and in the S wave of right precordial leads were present in 16/17 patients who developed RBBB and none of the five patients with initial RBBB. In one patient with initial RBBB, QRS fragmentation ?3 leads was present (r=17.45; p<0.0001). Conclusion: Patients with recurrent ventricular tachycardia who develop biventricular heart failure requiring heart transplantation and/or diuretics are characterized by QRS fragmentation in the S wave of right precordial leads and ?3 of all 12 ECG leads. These results are statistically significant. Patients with initial RBBB have an overall benign prognosis. PMID:24062912

  14. Natural history of Brugada Syndrome. Insights for risk stratification and management

    Microsoft Academic Search

    Silvia G. Priori; Carlo Napolitano; Maurizio Gasparini

    2002-01-01

    Background—Treatment of patients with Brugada syndrome is complicated by the incomplete information on the natural history of the disease related to the small number of cases reported. Furthermore, the value of programmed electrical stimulation (PES) for risk stratification is highly debated. The objective of this study was to search for novel parameters to identify patients at risk of sudden death.

  15. La valutazione funzionale dopo rivascolarizzazione miocardica Risk stratification after myocardial revascularisation

    Microsoft Academic Search

    Salvatore Pirelli; Bianca Maria Fadin

    Risk stratification after coronary revascular- ization. S. Pirelli, B.M. Fadin. Coronary angioplasty could be applied to broad groups of coronary patients with high rates of success and low rates of complication. Although multiple clinical, angiographic and procedural factors have beeen associated with an in- creased incidence of restenosis, the ability to predict the risk of restenosis in individual patients remains

  16. Risk stratification for survival and leukemic transformation in essential thrombocythemia: a single institutional study of 605 patients

    Microsoft Academic Search

    N Gangat; A P Wolanskyj; R F McClure; C-Y Li; S Schwager; W Wu; A Tefferi; A Tefferi

    2007-01-01

    Unlike the case with thrombosis, prognostic models for survival and leukemic transformation (LT) in essential thrombocythemia (ET) are not available. Among 605 patients with ET seen at our institution and followed for a median of 84 months, 155 died and LT was documented in 20 patients (3.3%). In a multivariable analysis, hemoglobin level below normal (females<120 g\\/l; males<135 g\\/l) was

  17. The unresolved issues with risk stratification and management of patients with coronary artery disease undergoing major vascular surgery

    Microsoft Academic Search

    Marie-Claude Parent; Stéphane Rinfret

    2008-01-01

    Purpose: The purpose of this article, with a specific focus on patients undergoing vascular surgery, is to review controversial issues\\u000a related to mechanisms of perioperative myocardial infarction (MI), coronary artery disease detection, and strategies to reduce\\u000a perioperative complications. We propose explanations for the many conflicting results that have recently emerged in the literature.\\u000a \\u000a \\u000a Source documents: We searched MEDLINE and reviewed

  18. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

    PubMed Central

    2014-01-01

    Background To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk. Methods 7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator). Results In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83). Conclusion Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation. PMID:24628849

  19. The need for improved risk stratification in chronic critical limb ischemia.

    PubMed

    Chung, Jayer; Modrall, J Gregory; Valentine, R James

    2014-12-01

    Vascular surgeons are well acquainted with chronic critical limb ischemia (CLI), the most severe manifestation of peripheral arterial disease, with patients presenting with ischemic rest pain or ulcerations, or both. Epidemiologic data predict a burgeoning epidemic of CLI within the United States, commensurate with the increasing incidence and prevalence of atherosclerotic risk factors, especially age and diabetes. Untreated, the risk of major amputation (above the ankle) or death, or both, ranges between 20% and 40% at 1 year. Current open and endovascular therapies have imperfect results, diverse treatment options, and recommendations that are often conflicting and confuse physicians, industry, and patients alike. The best treatment options are ideally evaluated by prospective, randomized controlled trials. However, these have proven impractical in CLI because the rapid evolution of devices and techniques has outstripped the ability to measure outcomes and compare treatment options. Alternatively, risk-stratifying models have been proposed to allow physicians, patients, and industry to objectively evaluate new therapeutics and devices as they evolve. These models are developed from prospective cohorts to identify and quantify variables that can subsequently predict outcome in individual patients. The risk stratification models can also compare CLI outcomes between physicians and institutions, supporting quality assessments, and compensation decisions within Accountable Care Organizations under the Affordable Health Care Act (ACA). Widespread adoption of risk-stratification schemes has yet to occur, despite the critical need for such a tool in CLI, because present models lack optimal predictive ability and generalizability. The passage of the ACA amplifies the importance of developing an improved risk-stratification tool to ensure equitable quality assessments and compensation. This review presents current risk-stratification models for CLI with a summary of the respective strengths and limitations of each. Future research is needed to simplify and improve the accuracy and generalizability of risk stratification in CLI. PMID:25214365

  20. Hepatitis B virus reactivation during immunosuppressive therapy: Appropriate risk stratification.

    PubMed

    Seto, Wai-Kay

    2015-04-28

    Our understanding of hepatitis B virus (HBV) reactivation during immunosuppresive therapy has increased remarkably during recent years. HBV reactivation in hepatitis B surface antigen (HBsAg)-positive individuals has been well-described in certain immunosuppressive regimens, including therapies containing corticosteroids, anthracyclines, rituximab, antibody to tumor necrosis factor (anti-TNF) and hematopoietic stem cell transplantation (HSCT). HBV reactivation could also occur in HBsAg-negative, antibody to hepatitis B core antigen (anti-HBc) positive individuals during therapies containing rituximab, anti-TNF or HSCT.For HBsAg-positive patients, prophylactic antiviral therapy is proven to the effective in preventing HBV reactivation. Recent evidence also demonstrated entecavir to be more effective than lamivudine in this aspect. For HBsAg-negative, anti-HBc positive individuals, the risk of reactivations differs with the type of immunosuppression. For rituximab, a prospective study demonstrated the 2-year cumulative risk of reactivation to be 41.5%, but prospective data is still lacking for other immunosupressive regimes. The optimal management in preventing HBV reactivation would involve appropriate risk stratification for different immunosuppressive regimes in both HBsAg-positive and HBsAg-negative, anti-HBc positive individuals. PMID:25937860

  1. First review on psoriasis severity risk stratification: An engineering perspective.

    PubMed

    Shrivastava, Vimal K; Londhe, Narendra D; Sonawane, Rajendra S; Suri, Jasjit S

    2015-08-01

    Computer-aided diagnosis (CAD) systems have been used for characterization of several dermatologic diseases in the last few years. Psoriasis is a potentially life-threatening skin disease which affects 125 million people worldwide. The paper presents the first state-of-the-art review of technology solicitation in psoriasis along with its current practices, challenges and assessment techniques. The paper also conducts in-depth examination of the existing literature for all clinical parameters of Psoriasis Area and Severity Index (PASI) i.e., area, erythema, scaliness and thickness. We suggest a role of risk assessment using a decision support system for stratification of psoriasis in large populations. A balanced insight has been presented in all the components of the design, namely: feature extraction, feature selection, disease stratification and overall CAD performance evaluation. We conclude that CAD systems are promising for risk stratification and assessment of psoriasis. PMID:26005793

  2. Risk stratification and surveillance in Barrett oesophagus

    PubMed Central

    Gorospe, Emmanuel C.; Wang, Kenneth K.

    2015-01-01

    Advances are being made in understanding the pathogenesis, treatment outcomes and surveillance of Barrett oesophagus. Central obesity and age at onset of gastro-oesophageal reflux are being recognized as risk factors that have implications for screening. The persistent finding of nondysplastic Barrett oesophagus during surveillance is associated with low risk of malignant progression, whereas dysplastic Barrett oesophagus requires continued surveillance. PMID:24322896

  3. Does risk stratification decrease the risk of natalizumab-associated PML? Where is the evidence?

    PubMed

    Cutter, Gary R; Stüve, Olaf

    2014-09-01

    The use of natalizumab has likely been limited by its association with progressive multifocal leukoencephalopathy (PML), an infection caused by the human polyomavirus John Cunningham (JC). Three factors were recently identified that contribute to the overall risk of natalizumab-associated PML: (1) Positive serostatus for anti-JCV antibodies, (2) prior use of immunosuppressants, and (3) duration of natalizumab therapy. This risk stratification algorithm has not led to a reduction in the incidence of PML in natalizumab-treated patients with multiple sclerosis between April 2010 and February 2014. This observation may appear perplexing, as treatment duration and JCV serostatus are modifiable risk factors. Potential reasons for the lack of success of companion diagnostics that determine the overall risk of natalizumab-associated PML are discussed. PMID:24812045

  4. Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society.

    PubMed

    Kwon, Young-Min; Lombardi, Adolph V; Jacobs, Joshua J; Fehring, Thomas K; Lewis, Courtland G; Cabanela, Miguel E

    2014-01-01

    There should be a low threshold to perform a systematic evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment prior to significant adverse biological reactions. A painful MoM hip arthroplasty has various intrinsic and extrinsic causes, and a systematic treatment approach based on the currently available data is presented to optimize management of MoM patients. The risk stratification algorithm presented will continue to develop as further evidence becomes available providing additional insights. While specialized tests such as metal ion analysis are useful modalities for assessing MoM hip arthroplasty, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Future research focusing on validation of the current diagnostic tools for detecting adverse local tissue reactions as well as optimization of MoM bearings and modular connections to further diminish wear and corrosion is warranted. PMID:24382732

  5. Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society.

    PubMed

    Kwon, Young-Min; Fehring, Thomas K; Lombardi, Adolph V; Barnes, C Lowry; Cabanela, Miguel E; Jacobs, Joshua J

    2014-11-01

    Although 'dual taper' modular stems with interchangeable modular necks have the potential to optimize hip biomechanical parameters, there is increasing concern regarding the occurrence of adverse local tissue reactions from mechanically assisted crevice corrosion at the neck-stem taper junction. A systematic treatment approach (risk stratification algorithm) based on the currently available data is recommended to optimize patient management. While specialized tests such as metal ion analysis and MARS MRI are useful modalities in evaluating for adverse tissue reactions, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. There should be a low threshold to perform a systematic evaluation of patients with dual taper stem total hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment. PMID:25189673

  6. Stratification of the risk of sudden death in nonischemic heart failure.

    PubMed

    Pimentel, Maurício; Zimerman, Leandro Ioschpe; Rohde, Luis Eduardo

    2014-10-01

    Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD) is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure. PMID:25352509

  7. Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure

    Microsoft Academic Search

    Junnichi Ishii; Masanori Nomura; Yuu Nakamura; Hiroyuki Naruse; Yoshihisa Mori; Takashi Ishikawa; Toshikazu Ando; Hiroshi Kurokawa; Takeshi Kondo; Youichi Nagamura; Kouji Ezaki; Hitoshi Hishida

    2002-01-01

    We prospectively evaluated whether the combination of admission measurements of a marker for myocardial cell injury and a marker for left ventricular overload would effectively risk stratify patients with acutely decompensated heart failure. We measured serum concentrations of cardiac troponin T (cTnT) using a second-generation assay, as well as serum cardiac troponin I (cTnI) and plasma atrial and brain natriuretic

  8. Early risk stratification in pediatric type 1 diabetes.

    PubMed

    Broe, Rebecca

    2015-03-01

    In the late 1980s all Danish children with type 1 diabetes were invited for a nationwide evaluation of glycemic control. Approximately 75% (n = 720) participated and have later been referred to as The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). The results were surprisingly poor glycemic control among these young patients which lead to a great emphasis on glycemic control in the Danish Pediatric Departments. In 1995 the participants were invited for yet another evaluation but this time with main focus on early signs of microvascular complications - 339 participated. The mean HbA1c had remained at high levels (9.6%) and 60% of the participants had some level of Diabetic Retinopathy (DR). However, as the patients with DR mostly had the very milder forms it was believed that stricter glycemic control would reverse or at least stop progression of the disease in accordance with results from the large intervention study DCCT. This was investigated further at follow-up in 2011. The first study in the present thesis aimed to describe the 16-year incidence, progression and regression of DR in 185 participants from the DCPD1987 cohort. The 16-year incidence of proliferative retinopathy (PDR), 2-step progression and regression of DR was 31.0, 64.4, and 0.0%, respectively. As expected, the participants with PDR at follow-up had significantly higher HbA1c-values at both baseline and follow-up than those without PDR. However; a significantly larger decrease in HbA1c was also observed in the group with PDR over the study period, which in accordance with DCCT should have prevented the development of PDR to some extent. A surprisingly high incidence of proliferative retinopathy amongst young patients with type 1 diabetes in Denmark was found despite improvements in HbA1c over time. The improvement in HbA1c was either too small or happened too late. This study highlights that sight-threatening diabetic retinopathy remain a major concern in type 1 diabetes and the importance of early glycemic control. Identifying high-risk patients at a very early stage is not only desired for prevention of diabetic retinopathy - neuropathy and nephropathy similarly remain frequent in type 1 diabetes. Early risk stratification will allow for timely implementation of effective interventions and for individualized screening and diabetes care. The second and third studies of this thesis provide the longest prospective studies to date on both retinal vessel calibers and retinal fractal dimensions and their predictive value on diabetic microvascular complications. Semi-automated computer software has been developed to measure smaller changes in the retinal vessels on retinal photographs. Two of the first parameters to be reliably estimated by these programs were retinal vessel calibers and retinal vascular fractal dimensions (a quantitative measure on vascular complexity). There is very limited knowledge on their predictive value on diabetic complications thus far. In the second and third study, a consistent relation between narrower retinal arteriolar calibers, wider retinal venular calibers, lower fractal dimensions and the 16-year incidences of diabetic neuropathy, nephropathy and proliferative retinopathy was found. This has never been shown before. The results on vessel analyzes provides indications of a common pathogenic pathway for diabetic microvascular complications and therefore a possibility of universal risk estimation for development of neuropathy, nephropathy and retinopathy in type 1 diabetes. PMID:25703648

  9. Risk stratification in heart surgery: comparison of six score systemsq

    Microsoft Academic Search

    Hans J. Geissler; Philipp Holzl; Sascha Marohl; Uwe Mehlhorn; Michael Sudkamp; E. Rainer de Vivie

    2000-01-01

    Objective: Risk scores have become an important tool in patient assessment, as age, severity of heart disease, and comorbidity in patients undergoing heart surgery have considerably increased. Various risk scores have been developed to predict mortality after heart surgery. However, there are significant differences between scores with regard to score design and the initial patient population on which score development

  10. Patient stratification and genomics: flares, fizzlers and foxes

    E-print Network

    Smith, Kenneth GC

    2012-11-28

    will describe the use of whole genome transcriptome analysis of purified CD8 T cells to define two sub-groups within patients with a number of inflammatory diseases (including SLE, AAV, Crohn’s disease and ulcerative colitis). These otherwise “invisible” groups... , Parkes M, Smith KGC: Gene expression profiling of CD8+ T cells predicts prognosis in patients with Crohn disease and ulcerative colitis. J Clin Invest 2011, 121:4170-4179. doi:10.1186/1479-5876-10-S3-I5 Cite this article as: Smith: Patient stratification...

  11. Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

    PubMed Central

    Abu-Assi, Emad; Raposeiras-Roubín, Sergio; García-Acuña, José María; González-Juanatey, José Ramón

    2014-01-01

    Major bleeding is currently one of the most common non-cardiac complications observed in the treatment of patients with acute coronary syndrome (ACS). Hemorrhagic complications occur with a frequency of 1% to 10% during treatment for ACS. In fact, bleeding events are the most common extrinsic complication associated with ACS therapy. The identification of clinical characteristics and particularities of the antithrombin therapy associated with an increased risk of hemorrhagic complications would make it possible to adopt prevention strategies, especially among those exposed to greater risk. The international societies of cardiology renewed emphasis on bleeding risk stratification in order to decide strategy and therapy for patients with ACS. With this review, we performed an update about the ACS bleeding risk scores most frequently used in daily clinical practice. PMID:25429326

  12. Noninvasive Risk Stratification of Sudden Death: T-Wave Alternans

    Microsoft Academic Search

    Roberto Pedretti; Simona Braga; Raffaella Vaninetti; Antonio Laporta; Sergio Masnaghetti; Rossella Raimondo; Mario Salerno; Francesco Santoro

    year in the USA and remains a health problem of epidemic proportions. Most SCDs are caused by fatal ventricular arrhythmias, i.e., ventricular tachycardia (VT) and ventricular fibrillation (VF), in patients with and without known structural heart diseases [1, 2]. Identifying patients at risk for these arrhythmias remains a major challenge since < 2% of patients who have sudden cardiac arrest

  13. Molecular microscope strategy to improve risk stratification in early antibody-mediated kidney allograft rejection.

    PubMed

    Loupy, Alexandre; Lefaucheur, Carmen; Vernerey, Dewi; Chang, Jessica; Hidalgo, Luis G; Beuscart, Thibaut; Verine, Jerome; Aubert, Olivier; Dubleumortier, Sébastien; Duong van Huyen, Jean-Paul; Jouven, Xavier; Glotz, Denis; Legendre, Christophe; Halloran, Philip F

    2014-10-01

    Antibody-mediated rejection (ABMR) is the leading cause of kidney allograft loss. We investigated whether the addition of gene expression measurements to conventional methods could serve as a molecular microscope to identify kidneys with ABMR that are at high risk for failure. We studied 939 consecutive kidney recipients at Necker Hospital (2004-2010; principal cohort) and 321 kidney recipients at Saint Louis Hospital (2006-2010; validation cohort) and assessed patients with ABMR in the first 1 year post-transplant. In addition to conventional features, we assessed microarray-based gene expression in transplant biopsy specimens using relevant molecular measurements: the ABMR Molecular Score and endothelial donor-specific antibody-selective transcript set. The main outcomes were kidney transplant loss and progression to chronic transplant injury. We identified 74 patients with ABMR in the principal cohort and 54 patients with ABMR in the validation cohort. Conventional features independently associated with failure were donor age and humoral histologic score (g+ptc+v+cg+C4d). Adjusting for conventional features, ABMR Molecular Score (hazard ratio [HR], 2.22; 95% confidence interval [95% CI], 1.37 to 3.58; P=0.001) and endothelial donor-specific antibody-selective transcripts (HR, 3.02; 95% CI, 1.00 to 9.16; P<0.05) independently associated with an increased risk of graft loss. The results were replicated in the independent validation group. Adding a gene expression assessment to a traditional risk model improved the stratification of patients at risk for graft failure (continuous net reclassification improvement, 1.01; 95% CI, 0.57 to 1.46; P<0.001; integrated discrimination improvement, 0.16; P<0.001). Compared with conventional assessment, the addition of gene expression measurement in kidney transplants with ABMR improves stratification of patients at high risk for graft loss. PMID:24700874

  14. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation

    Microsoft Academic Search

    Tomas Jernberg; Mats Stridsberg; Per Venge; Bertil Lindahl

    2002-01-01

    ObjectivesThe study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation.

  15. Risk stratification in the era of novel therapies.

    PubMed

    San-Miguel, Jesus; Mateos, M Victoria; Gutierrez, Norma C

    2009-01-01

    Multiple myeloma (MM) is an heterogeneous disease and this concept, together with the recent discovery of new drugs with novel mechanisms of action, will lead to the design of individualized treatments. The term "high-risk MM" includes those patients with at least one of the following features: deletion of 17p or t(4;14) or t(14;16), detected by fluorescence in situ hybridization analysis; deletion of 13q detected by conventional cytogenetics; or hypodiploidy or complex karyotype. In addition, patients with high proliferative activity of plasma cells (> or = 3%) measured by the PC labeling index or S-phase by flow cytometry as well as those with a poor response to induction therapy are also high risk. The definition of high-risk MM has been based on patients treated with conventional drugs with or without autologous transplant. However, current data suggest that novel agents can overcome the initial adverse prognosis of deletion 13q and t(4;14) but probably not that of 17p deletion, at least when using immunomodulatory drugs. Nevertheless, the number of patients analyzed is rather limited and, more important, time to progression is only available in a small number of studies. On the basis of these data, it is probably premature to mandate specific therapies on the basis of cytogenetic abnormalities. Moreover, it is possible that the more intensive therapies selected for high-risk patients may be of even greater benefit to standard-risk cases. Accordingly, at present, although we discourage treatment of high-risk patients with conventional schedules, we recommend to include them in large cooperative trials based on novel agents and performing a comprehensive genetic analysis up-front, so that the patients benefiting most from each treatment can subsequently be identified. PMID:20010164

  16. Improving clinical risk-stratification tools : instance-transfer for selecting relevant training data

    E-print Network

    Gong, Jen J. (Jen Jian)

    2014-01-01

    One of the primary problems in constructing risk-stratification models for medical applications is that the data are often noisy, incomplete, and suffer from high class-imbalance. This problem becomes more severe when the ...

  17. Ventilatory inefficiency in major depressive disorder: A potential adjunct for cardiac risk stratification in depressive disorders?

    Microsoft Academic Search

    Lars Donath; Christian Puta; Silke Boettger; Hans Josef Mueller; Oliver Faude; Tim Meyer; Karl-Jürgen Bär; Holger H. W. Gabriel

    2010-01-01

    BackgroundCardiopulmonary exercise testing (CPET) provides insights into ventilatory, cardiac and metabolic dysfunction in heart and lung diseases and might play a role in cardiac risk stratification in major depressive disorder (MDD).

  18. Diffuse large B-cell lymphoma: risk stratification and management of relapsed disease.

    PubMed

    Sweetenham, John W

    2005-01-01

    The clinical factors described by the International Prognostic Index (IPI) provide a model for risk stratification in diffuse large B-cell lymphomas (DLBCLs). However, there is variability in outcome within IPI risk groups, indicating the biological and clinical heterogeneity of these diseases. Studies of gene expression profiling (GEP) in DLBCL are uncovering biological heterogeneity with prognostic significance. Various gene expression signatures with predictive value independent of the IPI are now recognized. Immunophenotypic features of DLBCL have also been shown to have prognostic value. The use of fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning may provide additional predictive information when used at diagnosis or soon after initiation of treatment. Future prognostic models in DLBCL are likely to incorporate functional imaging, immunophenotype and GEPs as well as clinical data in risk stratification and choice of treatment. Treatment of relapsed DLBCL remains a major problem. High-dose therapy (HDT) and stem cell transplantation (SCT) has been shown to produce superior overall survival (OS) compared with conventional dose salvage therapy in patients with relapsed, chemosensitive DLBCL. However, only 20% to 30% of patients are cured by this approach, and the effectiveness of HDT and SCT in patients treated with rituximab-based combinations as first-line therapy is unknown. Although new transplant techniques including non-myeloablative allogeneic SCT are being investigated, their role is unclear. New treatment strategies are needed for these patients. The use of molecular techniques such as GEP is identifying many potential new therapeutic targets in DLBCL including histone deacetylase, HLA-DR, bcl-2, bcl-6, mTOR and TRAIL. PMID:16304389

  19. Risk stratification-based surveillance of bacterial contamination in metropolitan ambulances.

    PubMed

    Noh, Hyun; Shin, Sang Do; Kim, Nam Joong; Ro, Young Sun; Oh, Hyang Soon; Joo, Se Ik; Kim, Jung In; Ong, Marcus Eng Hock

    2011-01-01

    We aimed to know the risk-stratification-based prevalence of bacterial contamination of ambulance vehicle surfaces, equipment, and materials. This study was performed in a metropolitan area with fire-based single-tiered Basic Life Support ambulances. Total 13 out of 117 ambulances (11.1%) were sampled and 33 sites per each ambulance were sampled using a soft rayon swab and aseptic containers. These samples were then plated onto a screening media of blood agar and MacConkey agar. Specific identification with antibiotic susceptibility was performed. We categorized sampling sites into risk stratification-based groups (Critical, Semi-critical, and Non-critical equipment) related to the likelihood of direct contact with patients' mucosa. Total 214 of 429 samples showed positive results (49.9%) for any bacteria. Four of these were pathogenic (0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these were environmental flora (49.0%). However, the prevalence (positive/number of sample) of bacterial contamination in critical, semi-critical airway, semi-critical breathing apparatus group was as high as 15.4% (4/26), 30.7% (16/52), and 46.2% (48/104), respectively. Despite current formal guidelines, critical and semi-critical equipments were contaminated with pathogens and normal flora. This study suggests the need for strict infection control and prevention for ambulance services. PMID:21218040

  20. Diabetes and atrial fibrillation: stratification and prevention of stroke risks

    PubMed Central

    2014-01-01

    Background Although evidence is not very clear, diabetes is assumed to be an independent risk factor for atrial fibrillation (AF). One reason for the lack of evidence could be that AF often is not detected due to its paroxysmal or asymptomatic character. A better understanding of the relationship between both diseases and improved detection of AF is necessary since the combination of both diseases dramatically increase the risk of strokes if not treated properly. Methods Available literature about diabetes as an independent risk factor for AF has been evaluated, and limitations of studies are discussed. Results Results from different trials and registers are contradictory concerning diabetes as an independent risk factor for AF. Reasons for these differences can be found in different study designs and neglecting patients with unknown AF. Conclusions Due to the increasing burden of disease of diabetes and AF as common risk factors for stroke, a systematic screening for AF in diabetes patients could provide a better understanding of their correlation and personalized prevention strategies. PMID:25302085

  1. Emergency department management of syncope: need for standardization and improved risk stratification.

    PubMed

    Thiruganasambandamoorthy, Venkatesh; Taljaard, Monica; Stiell, Ian G; Sivilotti, Marco L A; Murray, Heather; Vaidyanathan, Aparna; Rowe, Brian H; Calder, Lisa A; Lang, Eddy; McRae, Andrew; Sheldon, Robert; Wells, George A

    2015-08-01

    Variations in emergency department (ED) syncope management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians' risk perception and disposition decision making. We conducted a prospective study of adults with syncope in six EDs in four cities over 32 months. We collected patient characteristics, ED management, disposition, physicians' prediction probabilities at index presentation and followed patients for 30 days for serious outcomes: death, myocardial infarction (MI), arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 patients: mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 patients (91.9 %) and 345 patients (10.3 %) suffered serious outcomes: 120 (3.6 %) after ED disposition including 48 patients outside the hospital. After accounting for differences in patient case mix, the rates of ED investigations and disposition were significantly different (p < 0.0001) across the four study cities; as were the rates of 30-day serious outcomes (p < 0.0001) and serious outcomes after ED disposition (p = 0.0227). There was poor agreement between physician risk perception and both observed event rates and referral patterns (p < 0.0001). Only 76.7 % (95 % CI 68.1-83.6) of patients with serious outcomes were appropriately referred. There are large and unexplained differences in ED syncope management. Moreover, there is poor agreement between physician risk perception, disposition decision making, and serious outcomes after ED disposition. A valid risk-stratification tool might help standardize ED management and improve disposition decision making. PMID:25918108

  2. IMWG consensus on risk stratification in multiple myeloma.

    PubMed

    Chng, W J; Dispenzieri, A; Chim, C-S; Fonseca, R; Goldschmidt, H; Lentzsch, S; Munshi, N; Palumbo, A; Miguel, J S; Sonneveld, P; Cavo, M; Usmani, S; Durie, B G M; Avet-Loiseau, H

    2014-02-01

    Multiple myeloma is characterized by underlying clinical and biological heterogeneity, which translates to variable response to treatment and outcome. With the recent increase in treatment armamentarium and the projected further increase in approved therapeutic agents in the coming years, the issue of having some mechanism to dissect this heterogeneity and rationally apply treatment is coming to the fore. A number of robustly validated prognostic markers have been identified and the use of these markers in stratifying patients into different risk groups has been proposed. In this consensus statement, the International Myeloma Working Group propose well-defined and easily applicable risk categories based on current available information and suggests the use of this set of prognostic factors as gold standards in all clinical trials and form the basis of subsequent development of more complex prognostic system or better prognostic factors. At the same time, these risk categories serve as a framework to rationalize the use of therapies. PMID:23974982

  3. Risk stratification for progression of IgA nephropathy using a decision tree induction algorithm

    PubMed Central

    Goto, Masashi; Kawamura, Takashi; Wakai, Kenji; Ando, Masahiko; Endoh, Masayuki; Tomino, Yasuhiko

    2009-01-01

    Background. Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and many patients are at risk of at least slow progression. However, prediction of the renal outcome in individual patients remains difficult. Methods. To develop a practical and user-friendly scheme for risk stratification of IgAN patients, data were extracted from a prospective cohort study conducted in 97 clinical units in Japan from 1995. Specifically, we examined deterioration in renal function, defined as doubling of serum creatinine, within 10 years of follow-up in 790 adult IgAN patients without substantial renal dysfunction at baseline using a decision tree induction algorithm. Results. Recursive partitioning indicated that the best single predictor of renal deterioration was severe proteinuria on urine dipstick testing, followed by hypoalbuminaemia and the presence of mild haematuria for patients with and without severe proteinuria, respectively. Serum total protein levels, diastolic blood pressure and histological grade were placed in the third tier of the decision tree model. With these six variables, patients can be readily stratified into seven risk groups whose incidence of renal deterioration within 10-year follow-up ranges from 1.0% to 51.4%. Logistic regression also identified severe proteinuria, hypoalbuminaemia and mild haematuria as significant predictors of deterioration. Areas under the receiver-operating characteristic curve for the prediction were comparable between the decision tree model and the logistic regression model [0.830 (95% confidence interval, 0.777–0.883) versus 0.808 (95% confidence interval, 0.754–0.861)]. Conclusion. Risk of substantial renal deterioration in IgAN patients can be validly estimated using six predictors obtained from clinical routine. PMID:19017674

  4. The RAG Model: A New Paradigm for Genetic Risk Stratification in Multiple Myeloma.

    PubMed

    Prideaux, Steven M; Conway O'Brien, Emma; Chevassut, Timothy J

    2014-01-01

    Molecular studies have shown that multiple myeloma is a highly genetically heterogonous disease which may manifest itself as any number of diverse subtypes each with variable clinicopathological features and outcomes. Given this genetic heterogeneity, a universal approach to treatment of myeloma is unlikely to be successful for all patients and instead we should strive for the goal of personalised therapy using rationally informed targeted strategies. Current DNA sequencing technologies allow for whole genome and exome analysis of patient myeloma samples that yield vast amounts of genetic data and provide a mutational overview of the disease. However, the clinical utility of this information currently lags far behind the sequencing technology which is increasingly being incorporated into clinical practice. This paper attempts to address this shortcoming by proposing a novel genetically based "traffic-light" risk stratification system for myeloma, termed the RAG (Red, Amber, Green) model, which represents a simplified concept of how complex genetic data may be compressed into an aggregate risk score. The model aims to incorporate all known clinically important trisomies, translocations, and mutations in myeloma and utilise these to produce a score between 1.0 and 3.0 that can be incorporated into diagnostic, prognostic, and treatment algorithms for the patient. PMID:25295194

  5. The RAG Model: A New Paradigm for Genetic Risk Stratification in Multiple Myeloma

    PubMed Central

    Prideaux, Steven M.; Conway O'Brien, Emma; Chevassut, Timothy J.

    2014-01-01

    Molecular studies have shown that multiple myeloma is a highly genetically heterogonous disease which may manifest itself as any number of diverse subtypes each with variable clinicopathological features and outcomes. Given this genetic heterogeneity, a universal approach to treatment of myeloma is unlikely to be successful for all patients and instead we should strive for the goal of personalised therapy using rationally informed targeted strategies. Current DNA sequencing technologies allow for whole genome and exome analysis of patient myeloma samples that yield vast amounts of genetic data and provide a mutational overview of the disease. However, the clinical utility of this information currently lags far behind the sequencing technology which is increasingly being incorporated into clinical practice. This paper attempts to address this shortcoming by proposing a novel genetically based “traffic-light” risk stratification system for myeloma, termed the RAG (Red, Amber, Green) model, which represents a simplified concept of how complex genetic data may be compressed into an aggregate risk score. The model aims to incorporate all known clinically important trisomies, translocations, and mutations in myeloma and utilise these to produce a score between 1.0 and 3.0 that can be incorporated into diagnostic, prognostic, and treatment algorithms for the patient. PMID:25295194

  6. Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions

    PubMed Central

    Avital, Itzhak; Langan, Russell C.; Summers, Thomas A.; Steele, Scott R.; Waldman, Scott A.; Backman, Vadim; Yee, Judy; Nissan, Aviram; Young, Patrick; Womeldorph, Craig; Mancusco, Paul; Mueller, Renee; Noto, Khristian; Grundfest, Warren; Bilchik, Anton J.; Protic, Mladjan; Daumer, Martin; Eberhardt, John; Man, Yan Gao; Brücher, Björn LDM; Stojadinovic, Alexander

    2013-01-01

    Colorectal cancer (CRC) is the third most common cause of cancer-related death in the United States (U.S.), with estimates of 143,460 new cases and 51,690 deaths for the year 2012. Numerous organizations have published guidelines for CRC screening; however, these numerical estimates of incidence and disease-specific mortality have remained stable from years prior. Technological, genetic profiling, molecular and surgical advances in our modern era should allow us to improve risk stratification of patients with CRC and identify those who may benefit from preventive measures, early aggressive treatment, alternative treatment strategies, and/or frequent surveillance for the early detection of disease recurrence. To better negotiate future economic constraints and enhance patient outcomes, ultimately, we propose to apply the principals of personalized and precise cancer care to risk-stratify patients for CRC screening (Precision Risk Stratification-Based Screening, PRSBS). We believe that genetic, molecular, ethnic and socioeconomic disparities impact oncological outcomes in general, those related to CRC, in particular. This document highlights evidence-based screening recommendations and risk stratification methods in response to our CRC working group private-public consensus meeting held in March 2012. Our aim was to address how we could improve CRC risk stratification-based screening, and to provide a vision for the future to achieving superior survival rates for patients diagnosed with CRC. PMID:23459409

  7. Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions.

    PubMed

    Avital, Itzhak; Langan, Russell C; Summers, Thomas A; Steele, Scott R; Waldman, Scott A; Backman, Vadim; Yee, Judy; Nissan, Aviram; Young, Patrick; Womeldorph, Craig; Mancusco, Paul; Mueller, Renee; Noto, Khristian; Grundfest, Warren; Bilchik, Anton J; Protic, Mladjan; Daumer, Martin; Eberhardt, John; Man, Yan Gao; Brücher, Björn Ldm; Stojadinovic, Alexander

    2013-01-01

    Colorectal cancer (CRC) is the third most common cause of cancer-related death in the United States (U.S.), with estimates of 143,460 new cases and 51,690 deaths for the year 2012. Numerous organizations have published guidelines for CRC screening; however, these numerical estimates of incidence and disease-specific mortality have remained stable from years prior. Technological, genetic profiling, molecular and surgical advances in our modern era should allow us to improve risk stratification of patients with CRC and identify those who may benefit from preventive measures, early aggressive treatment, alternative treatment strategies, and/or frequent surveillance for the early detection of disease recurrence. To better negotiate future economic constraints and enhance patient outcomes, ultimately, we propose to apply the principals of personalized and precise cancer care to risk-stratify patients for CRC screening (Precision Risk Stratification-Based Screening, PRSBS). We believe that genetic, molecular, ethnic and socioeconomic disparities impact oncological outcomes in general, those related to CRC, in particular. This document highlights evidence-based screening recommendations and risk stratification methods in response to our CRC working group private-public consensus meeting held in March 2012. Our aim was to address how we could improve CRC risk stratification-based screening, and to provide a vision for the future to achieving superior survival rates for patients diagnosed with CRC. PMID:23459409

  8. Prognosis and risk stratification of young adults with Brugada syndrome.

    PubMed

    Hiraoka, Masayasu; Takagi, Masahiko; Yokoyama, Yasuhiro; Sekiguchi, Yukio; Aihara, Naohiko; Aonuma, Kazutaka

    2013-01-01

    Prognosis and risk factors for patients age 35years or younger with Brugada syndrome (BrS) were prospectively explored in a sub-analysis of the Japan Idiopathic Ventricular Fibrillation Study (J-IVFS) registry. During the period from February 2002 to January 2011, 69 cases (mean age 30±6years, male=66) of the young (at or less than 35years old) BrS were enrolled in J-IVFS and the clinical course was followed for more than 1year. They were divided into 3 groups: documented ventricular fibrillation (VF) or aborted sudden cardiac death (SCD) (VF group, 12 cases), syncope without documentation of VF (Syncope group, 17 cases) and asymptomatic group (Asympt. group, 40 cases). During a mean follow-up period of 43±27months, cardiac events (VF and/or SCD) developed in 8 cases, with 5 of 12 cases in the VF (41.7%), 2 of 17 cases in the Syncope (11.8%) and 1 of 40 cases in the Asympt. group (2.5%). The VF group had a worse prognosis for cardiac events than the Syncope and Asympt. group. Multivariate analysis revealed symptoms as a risk factor for predicting cardiac events. PMID:23702150

  9. Risk stratification of non-contrast CT beyond the coronary calcium scan

    PubMed Central

    Madaj, Paul; Budoff, Matthew J.

    2014-01-01

    Coronary artery calcification (CAC) is a well-known marker for coronary artery disease and has important prognostic implications. CAC is able to provide clinicians with a reliable source of information related to cardiovascular atherosclerosis, which carries incremental information beyond Framingham risk. However, non-contrast scans of the heart provide additional information beyond the Agatston score. These studies are also able to measure various sources of fat, including intrathoracic (eg, pericardial or epicardial) and hepatic, both of which are thought to be metabolically active and linked to increased incidence of subclinical atherosclerosis as well as increased prevalence of type 2 diabetes. Testing for CAC is also useful in identifying extracoronary sources of calcification. Specifically, aortic valve calcification, mitral annular calcification, and thoracic aortic calcium (TAC) provide additional risk stratification information for cardiovascular events. Finally, scanning for CAC is able to evaluate myocardial scaring due to myocardial infarcts, which may also add incremental prognostic information. To ensure the benefits outweigh the risks of a scanning for CAC for an appropriately selected asymptomatic patient, the full utility of the scan should be realized. This review describes the current state of the art interpretation of non-contrast cardiac CT, which clinically should go well beyond coronary artery Agatston scoring alone. PMID:22981856

  10. Buccal Spectral Markers for Lung Cancer Risk Stratification

    PubMed Central

    Radosevich, Andrew J.; Mutyal, Nikhil N.; Rogers, Jeremy D.; Gould, Bradley; Hensing, Thomas A.; Ray, Daniel

    2014-01-01

    Lung cancer remains the leading cause of cancer deaths in the US with >150,000 deaths per year. In order to more effectively reduce lung cancer mortality, more sophisticated screening paradigms are needed. Previously, our group demonstrated the use of low-coherence enhanced backscattering (LEBS) spectroscopy to detect and quantify the micro/nano-architectural correlates of colorectal and pancreatic field carcinogenesis. In the lung, the buccal (cheek) mucosa has been suggested as an excellent surrogate site in the “field of injury”. We, therefore, wanted to assess whether LEBS could similarly sense the presence of lung. To this end, we applied a fiber-optic LEBS probe to a dataset of 27 smokers without diagnosed lung cancer (controls) and 46 with lung cancer (cases), which was divided into a training and a blinded validation set (32 and 41 subjects, respectively). LEBS readings of the buccal mucosa were taken from the oral cavity applying gentle contact. The diagnostic LEBS marker was notably altered in patients harboring lung cancer compared to smoking controls. The prediction rule developed on training set data provided excellent diagnostics with 94% sensitivity, 80% specificity, and 95% accuracy. Applying the same threshold to the blinded validation set yielded 79% sensitivity and 83% specificity. These results were not confounded by patient demographics or impacted by cancer type or location. Moreover, the prediction rule was robust across all stages of cancer including stage I. We envision the use of LEBS as the first part of a two-step paradigm shift in lung cancer screening in which patients with high LEBS risk markers are funnelled into more invasive screening for confirmation. PMID:25299667

  11. Electrocardiographic methods for diagnosis and risk stratification in the Brugada syndrome

    PubMed Central

    Naseef, Abdulrahman; Behr, Elijah R.; Batchvarov, Velislav N.

    2014-01-01

    The Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. The diagnosis of the BrS is mainly based on the presence of a spontaneous or Na + channel blocker induced characteristic, electrocardiographic (ECG) pattern (type 1 or coved Brugada ECG pattern) typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal (i.c.) spaces. This pattern needs to be distinguished from similar ECG changes due to other causes (Brugada ECG phenocopies). This review focuses mainly on the ECG-based methods for diagnosis and arrhythmia risk assessment in the BrS. Presently, the main unresolved clinical problem is the identification of those patients at high risk of SCD who need implantable cardioverter-defibrillator (ICD), which is the only therapy with proven efficacy. Current guidelines recommend ICD implantation only in patients with spontaneous type 1 ECG pattern, and either history of aborted cardiac arrest or documented sustained VT (class I), or syncope of arrhythmic origin (class IIa) because they are at high risk of recurrent arrhythmic events (up to 10% or more annually for those with aborted cardiac arrest). The majority of BrS patients are asymptomatic when diagnosed and considered to have low risk (around 0.5% annually) and therefore not indicated for ICD. The majority of SCD victims in the BrS, however, had no symptoms prior to the fatal event and therefore were not protected with an ICD. While some ECG markers such as QRS fragmentation, infero-lateral early repolarisation, and abnormal late potentials on signal-averaged ECG are known to be linked to increased arrhythmic risk, they are not sufficiently sensitive or specific. Potential novel ECG-based strategies for risk stratification are discussed based on computerised methods for depolarisation and repolarisation analysis, a composite approach targeting several major components of ventricular arrhythmogenesis, and the collection of large digital ECG databases in genotyped BrS patients and their relatives. PMID:25870503

  12. Electrocardiographic methods for diagnosis and risk stratification in the Brugada syndrome.

    PubMed

    Naseef, Abdulrahman; Behr, Elijah R; Batchvarov, Velislav N

    2015-04-01

    The Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts. The diagnosis of the BrS is mainly based on the presence of a spontaneous or Na + channel blocker induced characteristic, electrocardiographic (ECG) pattern (type 1 or coved Brugada ECG pattern) typically seen in leads V1 and V2 recorded from the 4th to 2nd intercostal (i.c.) spaces. This pattern needs to be distinguished from similar ECG changes due to other causes (Brugada ECG phenocopies). This review focuses mainly on the ECG-based methods for diagnosis and arrhythmia risk assessment in the BrS. Presently, the main unresolved clinical problem is the identification of those patients at high risk of SCD who need implantable cardioverter-defibrillator (ICD), which is the only therapy with proven efficacy. Current guidelines recommend ICD implantation only in patients with spontaneous type 1 ECG pattern, and either history of aborted cardiac arrest or documented sustained VT (class I), or syncope of arrhythmic origin (class IIa) because they are at high risk of recurrent arrhythmic events (up to 10% or more annually for those with aborted cardiac arrest). The majority of BrS patients are asymptomatic when diagnosed and considered to have low risk (around 0.5% annually) and therefore not indicated for ICD. The majority of SCD victims in the BrS, however, had no symptoms prior to the fatal event and therefore were not protected with an ICD. While some ECG markers such as QRS fragmentation, infero-lateral early repolarisation, and abnormal late potentials on signal-averaged ECG are known to be linked to increased arrhythmic risk, they are not sufficiently sensitive or specific. Potential novel ECG-based strategies for risk stratification are discussed based on computerised methods for depolarisation and repolarisation analysis, a composite approach targeting several major components of ventricular arrhythmogenesis, and the collection of large digital ECG databases in genotyped BrS patients and their relatives. PMID:25870503

  13. Fetal and neonatal alloimmune thrombocytopenia: a management algorithm based on risk stratification.

    PubMed

    Pacheco, Luis D; Berkowitz, Richard L; Moise, Kenneth J; Bussel, James B; McFarland, Janice G; Saade, George R

    2011-11-01

    Fetal and neonatal alloimmune thrombocytopenia constitutes the most common cause of severe thrombocytopenia in fetuses and neonates and of intracranial hemorrhage among term newborns. The cornerstone of therapy involves the use of steroids and intravenous immunoglobulins. Despite the risk of potentially devastating consequences to the fetus, fetal blood sampling has typically been used to document response to therapy. We propose a therapeutic algorithm based on risk stratification with individualized treatment optimization without the use of fetal blood sampling. PMID:22015886

  14. Risk stratification of Ramadan fasting in person with diabetes.

    PubMed

    AlArouj, Monira

    2015-05-01

    The world population comprises of 23% Muslims. Ramadan is the holy month of the Islamic year during which all healthy Muslims observe fasts. Although children and sick people are exempted from fasting but many of this group, want to observe fasts despite the medical advice against it. This includes a subset of people with diabetes which carries a considerable risk. Hypoglycaemia and hyperglycaemia are among the main hazards. Majority of Muslims with diabetes can fast safely during Ramadan; However some are placed at a greater risk. Pre-Ramadan risk assessment, structured education and selection of appropriate medication has shown to minimize the risks associated with fasting among people with diabetes. PMID:26013777

  15. Plasma IL-8 is not an effective risk stratification tool for adults with vasopressor-dependent septic shock

    PubMed Central

    Calfee, Carolyn S.; Thompson, B. Taylor; Parsons, Polly E.; Ware, Lorraine B.; Matthay, Michael A.; Wong, Hector R.

    2012-01-01

    Objective Plasma interleukin-8 (IL-8) levels of < 220 pg/ml have an excellent negative predictive value (94–95%) for death at 28 days in children with septic shock and thus may be useful for risk stratification in clinical trial enrollment in this population. Whether plasma IL-8 would have similar utility in adults with septic shock is unknown. Design, Setting, and Patients Analysis of plasma IL-8 levels in 192 adults with vasopressor-dependent septic shock enrolled in clinical trials of acute lung injury conducted by the Acute Respiratory Distress Syndrome Network Measurements and Main Results Plasma IL-8 levels ? 220 pg/ml were significantly associated with death at 28 days in this cohort (odds ratio 2.92, 95% CI 1.42–5.99; p=0.001). However, in contrast to the findings in pediatric septic shock, a plasma IL-8 cutoff below 220 pg/ml had a negative predictive value for death of only 74% (95% CI 66–81%) in adults with septic shock. Receiver-operating characteristic analysis found an area under the curve of 0.59 for plasma IL-8, indicating that plasma IL-8 is a poor predictor of mortality in this group. In adults under age 40, a plasma IL-8 cutoff < 220 pg/ml had a negative predictive value of 92%. Conclusions In contrast to similar pediatric patients, plasma IL-8 levels are not an effective risk stratification tool in older adults with septic shock. Future studies of biomarkers for risk stratification in critically ill subjects will need to be replicated in multiple different populations before being applied in screening for clinical trials. PMID:20386309

  16. Risk stratification for LDL cholesterol using induction technique.

    PubMed

    Ho, Seung Hee; Park, Hyun Young; Jang, Yang Soo; Jee, Sun Ha

    2007-01-01

    We identified the combined patterns of LDL cholesterol risk factors including biometric, environmental and genetic factors using induction technique. In this hospital based cardiovascular genome study of Korean men and women, we found that CART (classification and regression tree) was a better method to predict LDL cholesterol compared to the regression method. The CART had a better prediction ability than the multiple regression for male and female, respectively. We also identified combined patterns of LDL cholesterol risk factors and segment specific information for LDL cholesterol management using induction rules. The CART method provided more detailed results according to each segmentation and subgroup. In addition, we demonstrated how the CART algorithm could be used in risk assessment and target segmentation of LDL cholesterol management. PMID:17911781

  17. 1 Importance Sampling and Stratification for Value-at-Risk

    Microsoft Academic Search

    Paul Glasserman; Philip Heidelberger; Perwez Shahabuddin

    1999-01-01

    This paper proposes and evaluates variance reduction techniques for efficient esti- mation of portfolio loss probabilities using Monte Carlo simulation. Precise estima- tion of loss probabilities is essential to calculating value-at-risk, which is simply a percentile of the loss distribution. The methods we develop build on delta-gamma approximations to changes in portfolio value. The simplest way to use such approxi-

  18. Social stratification, risk factor prevalence and cancer screening attendance.

    PubMed

    Eisinger, François; Viguier, Jérôme; Touboul, Chantal; Coscas, Yvan; Pivot, Xavier; Blay, Jean-Yves; Lhomel, Christine; Morère, Jean-François

    2015-06-01

    This analysis aimed to assess the extent to which exposure to cancer risk factors and attendance of screening programmes are influenced by social characteristics. The validated Evaluation of deprivation and health inequalities in public health centres (EPICES) index was used to measure social deprivation. A sample of the general population (N=1603) was assessed to search for potential correlations between screening attendance, risk factors and any components of the EPICES score. In 2011, 33% of the population studied was classified as 'vulnerable'. Sex had no significant impact on this rating (32% men, 35% women), whereas occupational status did. Vulnerable individuals were more likely already to have cancer (10 vs. 7%; nonsignificant difference; odds ratio 1.43 [0.98-2.10]). The mean BMI was 26.0?kg/m (SD 4.9) for the vulnerable population versus 24.8?kg/m (SD 3.9) in the nonvulnerable population (P<0.01). The prevalence of current smoking was higher in the vulnerable group (38 vs. 23%, odds ratio 2.03 [1.61-2.56]). In contrast, no statistically significant difference was observed between attendance rates for nationwide organized cancer screening programmes (breast and colorectal; target age group 50-74 years) by the vulnerable and nonvulnerable groups. Social indicators of vulnerable populations are associated with increased rates of risk factors for cancer, but not with screening attendance. Our data support the previously reported marked impact of organized programmes that reduce or even remove inequalities in access to cancer screening. However, although the organized programmes have indeed enabled population-wide, nonselective access to screening, primary prevention as it stands today remains inadequate in the underserved population and further improvements are warranted. PMID:26016792

  19. Cardiovascular risk stratification with plasma B-type natriuretic peptide levels in a community-based hypertensive cohort.

    PubMed

    Sato, Kenyu; Segawa, Toshie; Tanaka, Fumitaka; Takahashi, Tomohiro; Tanno, Kozo; Ohsawa, Masaki; Onoda, Toshiyuki; Itai, Kazuyoshi; Sakata, Kiyomi; Omama, Shinichi; Ogasawara, Kunihiro; Ishibashi, Yasuhiro; Makita, Shinji; Okayama, Akira; Nakamura, Motoyuki

    2014-02-15

    Few reports have examined the utility of plasma B-type natriuretic peptide (BNP) testing for cardiovascular (CV) risk stratification in real-world hypertensive subjects. Subjects of the study were community-based hypertensive patients (n = 5,865). The CV event rate within each BNP quartile was estimated, and a Cox regression model was used to determine the relative hazard ratio (HR) among the quartiles. Furthermore, to determine the usefulness of BNP as a biomarker in combination with the Framingham risk score (FRS), the predictive abilities in terms of area under the curve of receiver operating characteristic analysis, net reclassification improvement, and integrated discrimination improvement indices were determined. The mean follow-up duration was 5.6 years. The highest quartile showed a significantly higher rate of CV events compared with the lower quartiles (p <0.001). After adjustment for established CV risk factors, the HR for CV events increased significantly according to the quartile (p value for trend <0.03), and the HR for the highest quartile was significantly elevated compared with the lowest quartile (HR 1.59, 95% confidence interval 1.16 to 2.19). The predictive abilities of BNP in terms of sensitivity and specificity for CV events were comparable with those of FRS. When BNP was added to an FRS-only model, the predictive abilities in terms of area under receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement were significantly increased (all; p <0.001). Elevated BNP levels are thus a useful biomarker for CV risk stratification in unselected real-world hypertensive subjects. Adding BNP to an established CV risk score improves the predictive ability in this cohort. PMID:24388621

  20. Incremental Prognostic Value of Myocardial Perfusion Single Photon Emission Computed Tomography for the Prediction of Cardiac Death Differential Stratification for Risk of Cardiac Death and Myocardial Infarction

    Microsoft Academic Search

    Rory Hachamovitch; Daniel S. Berman; Leslee J. Shaw; Hosen Kiat; Ishac Cohen; J. Arthur Cabico; John Friedman; George A. Diamond

    Background—The incremental prognostic value of stress single photon emission computed tomography (SPECT) for the prediction of cardiac death as an individual end point and the implications for risk stratification are undefined. Methods and Results—We identified 5183 consecutive patients who underwent stress\\/rest SPECT and were followed up for the occurrence of cardiac death or myocardial infarction. Over a mean follow up

  1. Tree-structured Risk Stratification of In-hospital Mortality Following Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Report From the New York State Percutaneous Coronary Intervention Database

    PubMed Central

    Negassa, Abdissa; Monrad, E. Scott; Bang, Ji Yon; Srinivas, V.S.

    2008-01-01

    BACKGROUND: Previous risk scores have shown excellent performance. However, the need for real-time risk score computation makes their implementation in an emergent situation challenging. A more simplified approach can provide practitioners with a practical bedside risk stratification tool. METHODS: We developed an easy-to-use tree-structured risk stratification model for patients undergoing early Percutaneous Coronary Intervention (PCI) for Acute Myocardial Infraction (AMI). The model was developed on the New York State PCI database for 1999-2000 (consisting of 5385 procedures) and was validated using the subsequent 2001-2002 database (consisting of 7414 procedures). RESULTS: Tree-structured modeling identified three key presenting features: cardiogenic shock, congestive heart failure and age. In the validation dataset, this risk stratification model identified patient groups with in-hospital mortality ranging from 0.5% to 20.6%, more than a twenty-fold increased risk. The performance of this model was similar to the Mayo Clinic Risk Score with a discriminative capacity of 82% (95% CI: 79%, 84%) versus 80% (95% CI: 77%, 82%), respectively. CONCLUSION: Patients undergoing PCI for AMI can be readily stratified into risk categories using the tree-structured model. This provides practicing cardiologists with an internally validated and easy-to-use scheme for in-hospital mortality risk stratification. PMID:17643583

  2. Usefulness of semiquantitative analysis of dipyridamole-thallium-201 redistribution for improving risk stratification before vascular surgery

    SciTech Connect

    Levinson, J.R.; Boucher, C.A.; Coley, C.M.; Guiney, T.E.; Strauss, H.W.; Eagle, K.A. (Harvard Univ. School of Medicine, Boston, MA (USA))

    1990-08-15

    Preoperative dipyridamole-thallium-201 scanning is sensitive in identifying patients prone to ischemic cardiac complications after vascular surgery, but most patients with redistribution do not have an event after surgery. Therefore, its positive predictive value is limited. To determine which patients with thallium redistribution are at highest risk, dipyridamole-thallium-201 images were interpreted semiquantitatively. Sixty-two consecutive patients with redistribution on preoperative dipyridamole-thallium-201 planar imaging studies were identified. Each thallium scan was then analyzed independently by 2 observers for the number of myocardial segments out of 15, the number of thallium views out of 3 and the number of coronary artery territories with redistribution. Seventeen patients (27%) had postoperative ischemic events, including unstable angina pectoris, ischemic pulmonary edema, myocardial infarction and cardiac death. Thallium predictors of ischemic operative complications included thallium redistribution greater than or equal to 4 myocardial segments (p = 0.03), greater than or equal to 2 of the 3 planar views (p = 0.005) and greater than or equal to 2 coronary territories (p = 0.007). No patient with redistribution in only 1 view had an ischemic event (0 of 15). Thus, determining the extent of redistribution by dipyridamole-thallium-201 scanning improves risk stratification before vascular surgery. Patients with greater numbers of myocardial segments and greater numbers of coronary territories showing thallium-201 redistribution are at higher risk for ischemic cardiac complications. In contrast, when the extent of thallium redistribution is limited, there is a lower risk despite the presence of redistribution.

  3. A new gender-specific model for skin autofluorescence risk stratification

    PubMed Central

    Ahmad, Muhammad S.; Damanhouri, Zoheir A.; Kimhofer, Torben; Mosli, Hala H.; Holmes, Elaine

    2015-01-01

    Advanced glycation endproducts (AGEs) are believed to play a significant role in the pathophysiology of a variety of diseases including diabetes and cardiovascular diseases. Non-invasive skin autofluorescence (SAF) measurement serves as a proxy for tissue accumulation of AGEs. We assessed reference SAF and skin reflectance (SR) values in a Saudi population (n?=?1,999) and evaluated the existing risk stratification scale. The mean SAF of the study cohort was 2.06 (SD = 0.57) arbitrary units (AU), which is considerably higher than the values reported for other populations. We show a previously unreported and significant difference in SAF values between men and women, with median (range) values of 1.77?AU (0.79–4.84?AU) and 2.20?AU (0.75–4.59?AU) respectively (p-value?«?0.01). Age, presence of diabetes and BMI were the most influential variables in determining SAF values in men, whilst in female participants, SR was also highly correlated with SAF. Diabetes, hypertension and obesity all showed strong association with SAF, particularly when gender differences were taken into account. We propose an adjusted, gender-specific disease risk stratification scheme for Middle Eastern populations. SAF is a potentially valuable clinical screening tool for cardiovascular risk assessment but risk scores should take gender and ethnicity into consideration for accurate diagnosis. PMID:25974028

  4. A new gender-specific model for skin autofluorescence risk stratification.

    PubMed

    Ahmad, Muhammad S; Damanhouri, Zoheir A; Kimhofer, Torben; Mosli, Hala H; Holmes, Elaine

    2015-01-01

    Advanced glycation endproducts (AGEs) are believed to play a significant role in the pathophysiology of a variety of diseases including diabetes and cardiovascular diseases. Non-invasive skin autofluorescence (SAF) measurement serves as a proxy for tissue accumulation of AGEs. We assessed reference SAF and skin reflectance (SR) values in a Saudi population (n?=?1,999) and evaluated the existing risk stratification scale. The mean SAF of the study cohort was 2.06 (SD = 0.57) arbitrary units (AU), which is considerably higher than the values reported for other populations. We show a previously unreported and significant difference in SAF values between men and women, with median (range) values of 1.77?AU (0.79-4.84?AU) and 2.20?AU (0.75-4.59?AU) respectively (p-value?«?0.01). Age, presence of diabetes and BMI were the most influential variables in determining SAF values in men, whilst in female participants, SR was also highly correlated with SAF. Diabetes, hypertension and obesity all showed strong association with SAF, particularly when gender differences were taken into account. We propose an adjusted, gender-specific disease risk stratification scheme for Middle Eastern populations. SAF is a potentially valuable clinical screening tool for cardiovascular risk assessment but risk scores should take gender and ethnicity into consideration for accurate diagnosis. PMID:25974028

  5. The use of molecular-based risk stratification and pharmacogenomics for outcome prediction and personalized therapeutic management of multiple myeloma

    PubMed Central

    Johnson, Sarah K.; Heuck, Christoph J.; Albino, Anthony P.; Qu, Pingping; Zhang, Qing; Barlogie, Bart

    2015-01-01

    Despite improvement in therapeutic efficacy, multiple myeloma (MM) remains incurable with a median survival of approximately 10 years. Gene-expression profiling (GEP) can be used to elucidate the molecular basis for resistance to chemotherapy through global assessment of molecular alterations that exist at diagnosis, after therapeutic treatment and that evolve during tumor progression. Unique GEP signatures associated with recurrent chromosomal translocations and ploidy changes have defined molecular classes with differing clinical features and outcomes. When compared to other stratification systems the GEP70 test remained a significant predictor of outcome, reduced the number of patients classified with a poor prognosis, and identified patients at increased risk of relapse despite their standard clinico-pathologic and genetic findings. GEP studies of serial samples showed that risk increases over time, with relapsed disease showing GEP shifts toward a signature of poor outcomes. GEP signatures of myeloma cells after therapy were prognostic for event-free and overall survival and thus may be used to identify novel strategies for overcoming drug resistance. This brief review will focus on the use of GEP of MM to define high-risk myeloma, and elucidate underlying mechanisms that are beginning to change clinical decision-making and inform drug design. PMID:22002477

  6. SIOP-PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low- and middle-income settings.

    PubMed

    Parikh, Nehal S; Howard, Scott C; Chantada, Guillermo; Israels, Trijn; Khattab, Mohammed; Alcasabas, Patricia; Lam, Catherine G; Faulkner, Lawrence; Park, Julie R; London, Wendy B; Matthay, Katherine K

    2015-08-01

    Neuroblastoma is the most common extracranial solid tumor in childhood in high-income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low- and middle- income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse. Pediatr Blood Cancer 2015;62:1305-1316. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc. PMID:25810263

  7. Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification.

    PubMed

    Strati, Paolo; Shanafelt, Tait D

    2015-07-23

    Monoclonal B lymphocytosis (MBL) is defined as the presence of a clonal B-cell population in the peripheral blood with fewer than 5 × 10(9)/L B-cells and no other signs of a lymphoproliferative disorder. The majority of cases of MBL have the immunophenotype of chronic lymphocytic leukemia (CLL). MBL can be categorized as either low count or high count based on whether the B-cell count is above or below 0.5 × 10(9)/L. Low-count MBL can be detected in ?5% of adults over the age of 40 years when assessed using standard-sensitivity flow cytometry assays. A number of biological and genetic characteristics distinguish low-count from high-count MBL. Whereas low-count MBL rarely progresses to CLL, high-count MBL progresses to CLL requiring therapy at a rate of 1% to 2% per year. High-count MBL is distinguished from Rai 0 CLL based on whether the B-cell count is above or below 5 × 10(9)/L. Although individuals with both high-count MBL and CLL Rai stage 0 are at increased risk of infections and second cancers, the risk of progression requiring treatment and the potential to shorten life expectancy are greater for CLL. This review highlights challenging questions regarding the classification, risk stratification, management, and supportive care of patients with MBL and CLL. PMID:26065657

  8. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    PubMed Central

    2010-01-01

    Background Response to preoperative radiochemotherapy (RCT) in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR) is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3), treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0) total mesorectal excision (TME) in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS) and overall survival (OS). Results Residual tumor transgression into the mesorectal compartment (ypT3) did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively). Nodal involvement after preoperative RCT (ypN1/2) turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively). Persistent tumor infiltration of the mesorectum (ypT3) and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p < 0.001). Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0) resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters. PMID:20388220

  9. Arrhythmogenic right ventricular cardiomyopathy: an update on pathophysiology, genetics, diagnosis, and risk stratification.

    PubMed

    Paul, M; Wichter, T; Fabritz, L; Waltenberger, J; Schulze-Bahr, E; Kirchhof, P

    2012-09-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy accounting for life-threatening ventricular tachyarrhythmias and sudden death in young individuals and athletes. Over the past years, mutations in desmosomal genes have been identified as disease-causative. However, genetic heterogeneity and variable phenotypic expression alongside with diverse disease progression still render the evaluation of its prognostic implication difficult. ARVC was initially entered into the canon of cardiomyopathies of the World Health Organization in 1995, and international efforts have resulted in the 2010 modified diagnostic criteria for ARVC. Despite all additional insights into pathophysiology, clinical management, and modern risk stratification, under-/misdiagnosing of ARVC remains a problem and hampers reliable statements on the incidence, prevalence, and natural course of the disease.This review provides a comprehensive overview of the current literature on the pathogenesis, diagnosis, treatment, and prognosis of ARVC and sheds some light on potential new developments in these areas. PMID:23011601

  10. Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction

    Microsoft Academic Search

    E. Magnus Ohman; Paul W Armstrong; Harvey D White; Christopher B Granger; Robert G Wilcox; W. Douglas Weaver; W. Brian Gibler; Amanda L Stebbins; Cresha Cianciolo; Robert M Califf; Eric J Topol

    1999-01-01

    Troponin T has been used successfully to risk stratify patients with acute coronary syndromes, but the utility of this approach using a rapid bedside assay in patients undergoing thrombolysis for ST-segment elevation acute myocardial infarction has not been assessed in a large population. We assessed whether a point-of-care, qualitative troponin T test at enrollment could independently risk-stratify patients randomized to

  11. Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification

    Microsoft Academic Search

    Harriette G. C. Van Spall; Clare Atzema; Michael J. Schull; Gary E. Newton; Susanna Mak; Alice Chong; Jack V. Tu; Thérèse A. Stukel; Douglas S. Lee

    2011-01-01

    ObjectivesGeneric triage risk assessments are widely used in the emergency department (ED), but have not been validated for prediction of short-term risk among patients with acute heart failure (HF). Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS) for prediction of early death among HF patients.MethodsWe included patients presenting with HF to an ED in Ontario from Apr

  12. Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study

    PubMed Central

    2013-01-01

    Background In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction. A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery. We aimed to assess the impact of a CPET-based risk-stratification strategy upon perioperative mortality, length of stay and non-operative costs for elective (open and endovascular) infra-renal AAA patients. Methods A retrospective cohort study was undertaken. Pre-operative CPET-based selection for elective surgical intervention was introduced in 2007. An anonymized cohort of 230 consecutive infra-renal AAA patients (2007 to 2011) was studied. A historical control group of 128 consecutive infra-renal AAA patients (2003 to 2007) was identified for comparison. Comparative analysis of demographic and outcome data for CPET-pass (AT ? 11 ml/kg/min), CPET-fail (AT < 11 ml/kg/min) and CPET-submaximal (no AT generated) subgroups with control subjects was performed. Primary outcomes included 30-day mortality, survival and length of stay (LOS); secondary outcomes were non-operative inpatient costs. Results Of 230 subjects, 188 underwent CPET: CPET-pass n = 131, CPET-fail n = 35 and CPET-submaximal n = 22. When compared to the controls, CPET-pass patients exhibited reduced median total LOS (10 vs 13 days for open surgery, n = 74, P < 0.01 and 4 vs 6 days for EVAR, n = 29, P < 0.05), intensive therapy unit requirement (3 vs 4 days for open repair only, P < 0.001), non-operative costs (£5,387 vs £9,634 for open repair, P < 0.001) and perioperative mortality (2.7% vs 12.6% (odds ratio: 0.19) for open repair only, P < 0.05). CPET-stratified (open/endovascular) patients exhibited a mid-term survival benefit (P < 0.05). Conclusion In this retrospective cohort study, a pre-operative AT > 11 ml/kg/min was associated with reduced perioperative mortality (open cases only), LOS, survival and inpatient costs (open and endovascular repair) for elective infra-renal AAA surgery. PMID:24472159

  13. Impact of Primary Gleason Grade on Risk Stratification for Gleason Score 7 Prostate Cancers

    SciTech Connect

    Koontz, Bridget F., E-mail: bridget.koontz@duke.edu [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Tsivian, Matvey [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Mouraviev, Vladimir [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Sun, Leon [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Vujaskovic, Zeljko [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Moul, Judd [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Lee, W. Robert [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States)

    2012-01-01

    Purpose: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. Methods: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D'Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. Results: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). Conclusions: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

  14. Therapeutic risk management of the suicidal patient: safety planning.

    PubMed

    Matarazzo, Bridget B; Homaifar, Beeta Y; Wortzel, Hal S

    2014-05-01

    This column is the fourth in a series describing a model for therapeutic risk management of the suicidal patient. Previous columns presented an overview of the therapeutic risk management model, provided recommendations for how to augment risk assessment using structured assessments, and discussed the importance of risk stratification in terms of both severity and temporality. This final column in the series discusses the safety planning intervention as a critical component of therapeutic risk management of suicide risk. We first present concerns related to the relatively common practice of using no-suicide contracts to manage risk. We then present the safety planning intervention as an alternative approach and provide recommendations for how to use this innovative strategy to therapeutically mitigate risk in the suicidal patient. PMID:24847995

  15. Predictive risk stratification model: a progressive cluster-randomised trial in chronic conditions management (PRISMATIC) research protocol

    PubMed Central

    2013-01-01

    Background An ageing population increases demand on health and social care. New approaches are needed to shift care from hospital to community and general practice. A predictive risk stratification tool (Prism) has been developed for general practice that estimates risk of an emergency hospital admission in the following year. We present a protocol for the evaluation of Prism. Methods/Design We will undertake a mixed methods progressive cluster-randomised trial. Practices begin as controls, delivering usual care without Prism. Practices will receive Prism and training randomly, and thereafter be able to use Prism with clinical and technical support. We will compare costs, processes of care, satisfaction and patient outcomes at baseline, 6 and 18 months, using routine data and postal questionnaires. We will assess technical performance by comparing predicted against actual emergency admissions. Focus groups and interviews will be undertaken to understand how Prism is perceived and adopted by practitioners and policy makers. We will model data using generalised linear models and survival analysis techniques to determine whether any differences exist between intervention and control groups. We will take account of covariates and explanatory factors. In the economic evaluation we will carry out a cost-effectiveness analysis to examine incremental cost per emergency admission to hospital avoided and will examine costs versus changes in primary and secondary outcomes in a cost-consequence analysis. We will also examine changes in quality of life of patients across the risk spectrum. We will record and transcribe focus groups and interviews and analyse them thematically. We have received full ethical and R&D approvals for the study and Information Governance Review Panel (IGRP) permission for the use of routine data. We will comply with the CONSORT guidelines and will disseminate the findings at national and international conferences and in peer-reviewed journals. Discussion The proposed study will provide information on costs and effects of Prism; how it is used in practice, barriers and facilitators to its implementation; and its perceived value in supporting the management of patients with and at risk of developing chronic conditions. Trial registration Controlled Clinical Trials ISRCTN no. ISRCTN55538212. PMID:24330749

  16. Arrhythmia Phenotype during Fetal Life Suggests LQTS Genotype: Risk Stratification of Perinatal Long QT Syndrome

    PubMed Central

    Cuneo, Bettina F.; Etheridge, Susan P.; Horigome, Hitoshi; Sallee, Denver; Moon-Grady, Anita; Weng, Hsin-Yi; Ackerman, Michael J.; Benson, D. Woodrow

    2014-01-01

    Background Fetal arrhythmias characteristic of long QT syndrome (LQTS) include torsades de pointes (TdP) and/or 2° atrioventricular block (AVB), but sinus bradycardia, defined as fetal heart rate <3% for gestational age, is most common. We hypothesized that prenatal rhythm phenotype might predict LQTS genotype and facilitate improved risk stratification and management. Method and Results Records of subjects exhibiting LQTS fetal arrhythmias were reviewed. Fetal echocardiograms, neonatal ECG, and genetic testing were evaluated. We studied 43 subjects exhibiting fetal LQTS arrhythmias: TdP ± 2° AVB (Group 1, n=7), isolated 2° AVB (Group 2, n=4) and sinus bradycardia (Group 3, n=32). Mutations in known LQTS genes were found in 95% of subjects tested. SCN5A mutations occurred in 71% of Group 1 while 91% of subjects with KCNQ1 mutations were in Group 3. Small numbers of subjects with KCNH2 mutations (n=4) were scattered in all 3 groups. Age at presentation did not differ among groups, and most subjects (n=42) were live born with gestational ages of 37.5±2.8 wks (mean±SD). However, those with TdP were typically delivered earlier. Prenatal treatment in Group 1 terminated (n=2) or improved (n=4) TdP. The neonatal QTc (mean±SE) of Group 1 (664.7±24.9) was longer than neonatal QTc in both Group 2 (491.2±27.6, p=0.004) and Group 3 (483.1±13.7, p<0.001). Despite medical and pacemaker therapy, postnatal cardiac arrest (n=4) or sudden death (n=1) was common among subjects with fetal/neonatal TdP. Conclusions Rhythm phenotypes of fetal LQTS have genotype-suggestive features which, along with QTc duration, may risk stratify perinatal management. PMID:23995044

  17. A New Bayesian Network-Based Risk Stratification Model for Prediction of Short-Term and Long-Term LVAD Mortality.

    PubMed

    Loghmanpour, Natasha A; Kanwar, Manreet K; Druzdzel, Marek J; Benza, Raymond L; Murali, Srinivas; Antaki, James F

    2015-01-01

    Existing risk assessment tools for patient selection for left ventricular assist devices (LVADs) such as the Destination Therapy Risk Score and HeartMate II Risk Score (HMRS) have limited predictive ability. This study aims to overcome the limitations of traditional statistical methods by performing the first application of Bayesian analysis to the comprehensive Interagency Registry for Mechanically Assisted Circulatory Support dataset and comparing it to HMRS. We retrospectively analyzed 8,050 continuous flow LVAD patients and 226 preimplant variables. We then derived Bayesian models for mortality at each of five time end-points postimplant (30 days, 90 days, 6 month, 1 year, and 2 years), achieving accuracies of 95%, 90%, 90%, 83%, and 78%, Kappa values of 0.43, 0.37, 0.37, 0.45, and 0.43, and area under the receiver operator characteristic (ROC) of 91%, 82%, 82%, 80%, and 81%, respectively. This was in comparison to the HMRS with an ROC of 57% and 60% at 90 days and 1 year, respectively. Preimplant interventions, such as dialysis, ECMO, and ventilators were major contributing risk markers. Bayesian models have the ability to reliably represent the complex causal relations of multiple variables on clinical outcomes. Their potential to develop a reliable risk stratification tool for use in clinical decision making on LVAD patients encourages further investigation. PMID:25710772

  18. Risk stratification of sudden cardiac death and malignant ventricular arrhythmias in right ventricular dysplasia cardiomyopathy

    Microsoft Academic Search

    Stefan Peters; Heidi Peters; Ludwig Thierfelder

    Arrhythmogenic right ventricular dysplasia-cardiomyopathy is in most cases a benign cause of ventricular arrhythmias in young patients. The major reason of mortality is sudden arrhythmic death with an annual rate of 2-3% as the first manifestation of the disease in most cases. Little is known about risk factors of sudden arrhythmic death so far. The purpose of the retrospective study

  19. Risk stratification of sudden cardiac death and malignant ventricular arrhythmias in right ventricular dysplasia-cardiomyopathy

    Microsoft Academic Search

    Stefan Peters; Heidi Peters; Ludwig Thierfelder

    1999-01-01

    Arrhythmogenic right ventricular dysplasia-cardiomyopathy is in most cases a benign cause of ventricular arrhythmias in young patients. The major reason of mortality is sudden arrhythmic death with an annual rate of 2–3% as the first manifestation of the disease in most cases. Little is known about risk factors of sudden arrhythmic death so far. The purpose of the retrospective study

  20. A genomic approach to colon cancer risk stratification yields biologic insights into therapeutic opportunities

    PubMed Central

    Garman, Katherine S.; Acharya, Chaitanya R.; Edelman, Elena; Grade, Marian; Gaedcke, Jochen; Sud, Shivani; Barry, William; Diehl, Anna Mae; Provenzale, Dawn; Ginsburg, Geoffrey S.; Ghadimi, B. Michael; Ried, Thomas; Nevins, Joseph R.; Mukherjee, Sayan; Hsu, David; Potti, Anil

    2008-01-01

    Gene expression profiles provide an opportunity to dissect the heterogeneity of solid tumors, including colon cancer, to improve prognosis and predict response to therapies. Bayesian binary regression methods were used to generate a signature of disease recurrence in patients with resected early stage colon cancer validated in an independent cohort. A 50-gene signature was developed that effectively distinguished early stage colon cancer patients with a low or high risk of disease recurrence. RT-PCR analysis of the 50-gene signature validated 9 of the top 10 differentially expressed genes. When applied to two independent validation cohorts of 55 and 73 patients, the 50-gene model accurately predicted recurrence. Standard Kaplan–Meier survival analysis confirmed the prognostic accuracy (P < 0.01, log rank), as did multivariate Cox proportional hazard models. We tested potential targeted therapeutic options for patients at high risk for disease recurrence and found a clinically important relationship between sensitivity to celecoxib, LY-294002 (PI3kinase inhibitor), retinol, and sulindac in colon cancer cell lines expressing the poor prognostic phenotype (P < 0.01, t test), which performed better than standard chemotherapy (5-FU and oxaliplatin). We present a genomic strategy in early stage colon cancer to identify patients at highest risk of recurrence. An ability to move beyond current staging by refining the estimation of prognosis in early stage colon cancer also has implications for individualized therapy. PMID:19050079

  1. Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome

    PubMed Central

    Villar, Jesús; Blanco, Jesús; del Campo, Rafael; Andaluz-Ojeda, David; Díaz-Domínguez, Francisco J; Muriel, Arturo; Córcoles, Virgilio; Suárez-Sipmann, Fernando; Tarancón, Concepción; González-Higueras, Elena; López, Julia; Blanch, Lluis; Pérez-Méndez, Lina; Fernández, Rosa Lidia; Kacmarek, Robert M

    2015-01-01

    Objectives A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiO2 would not provide accurate assessment of lung injury severity. Design A prospective, multicentre, observational study. Setting A network of teaching hospitals. Participants 478 patients with eligible criteria for moderate (100patients were reclassified as severe, moderate, mild (200300). Primary and secondary outcomes Group severity and hospital mortality. Results At ARDS onset, 173 patients had a PaO2/FiO2?100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). Conclusions Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. Trial registration numbers NCT00435110 and NCT00736892. PMID:25818272

  2. Breast Cancer Patient Stratification using a Molecular Regularized Consensus Clustering Method

    PubMed Central

    Wang, Chao; Machiraju, Raghu; Huang, Kun

    2014-01-01

    Breast cancers are highly heterogeneous with different subtypes that lead to different clinical outcomes including prognosis, response to treatment and chances of recurrence and metastasis. An important task in personalized medicine is to determine the subtype for a breast cancer patient in order to provide the most effective treatment. In order to achieve this goal, integrative genomics approach has been developed recently with multiple modalities of large datasets ranging from genotypes to multiple levels of phenotypes. A major challenge in integrative genomics is how to effectively integrate multiple modalities of data to stratify the breast cancer patients. Consensus clustering algorithms have often been adopted for this purpose. However, existing consensus clustering algorithms are not suitable for the situation of integrating clustering results obtained from a mixture of numerical data and categorical data. In this work, we present a mathematical formulation for integrative clustering of multiple-source data including both numerical and categorical data to resolve the above issue. Specifically, we formulate the problem as a novel consensus clustering method called Molecular Regularized Consensus Patient Stratification (MRCPS) based on an optimization process with regularization. Unlike the traditional consensus clustering methods, MRCPS can automatically and spontaneously cluster both numerical and categorical data with any option of similarity metrics. We apply this new method by applying it on the TCGA breast cancer datasets and evaluate using both statistical criteria and clinical relevance on predicting prognosis. The result demonstrates the superiority of this method in terms of effectiveness of aggregation and differentiating patient outcomes. Our method, while motivated by the breast cancer research, is nevertheless universal for integrative genomics studies. PMID:24657666

  3. Risk-adapted stratification and treatment of childhood acute lymphoblastic leukaemia.

    PubMed

    Schrappe, Martin

    2008-01-01

    Systematic enrollment of children and adolescents with acute lymphoblastic leukaemia (ALL) into clinical trials has allowed the establishment of prognostic parameters derived from initial diagnostic findings. More important, these trials have significantly contributed to the reduction of disease recurrence as much as to the reduction of acute and late side effects. Some problems that are related to the specificity of the parameters used for risk assessment were not overcome: high tumour load by white blood cell count (WBC), age and (rare) cytogenetic subtypes (e.g. t9;22) may characterise a significant proportion of children and adolescents with high-risk ALL. Most patients who will eventually relapse do not present with characteristic features at initial diagnosis. It appears feasible through careful response assessment to identify these patients at risk of relapse, who present initially without specific features. Earlier trials of the ALL-BFM (Berlin/Frankfurt/Münster) study group and others have demonstrated that inadequate leukaemic blast reduction in the peripheral blood or bone marrow after the first few days of therapy is highly predictive of treatment failure. Using clone-specific polymerase chain reaction-based detection of minimal residual disease (MRD) as done in trial AIEOP-BFM ALL 2000 allowed a close surveillance of specific treatment elements when applied in MRD positive patients. This may facilitate innovative chemotherapy approaches and a more rational use of allogeneic haematopoetic stem cell transplantation. In addition, genetic signatures of treatment response or failure have been identified. PMID:19017727

  4. 5. Stratification to control prognostic 5.1. Stratification and randomization

    E-print Network

    Chen, Zehua

    5. Stratification to control prognostic variables §5.1. Stratification and randomization schemes, these factors must be controlled. Stratification is a common method to use. In stratification design, patients that the treat- ments at each level of each prognostic factor are as balanced as possible. Stratification

  5. Stroke Prevention in the High-risk Atrial Fibrillation Patient: Medical Management

    Microsoft Academic Search

    Michael Broukhim; Jonathan L. Halperin

    2011-01-01

    Medical management of patients with atrial fibrillation (AF) at high risk for stroke is limited by problems of imperfect tools\\u000a for assessment of thromboembolism and bleeding risks. Improved instruments, such as the CHA2DS2VASc and HAS-BLED risk stratification scores, have been incorporated into European practice guidelines. Until recently, the\\u000a most effective therapy for stroke prevention has been anticoagulation with a vitamin

  6. Noninvasive cardiac risk stratification of diabetic and nondiabetic uremic renal allograft candidates using dipyridamole-thallium-201 imaging and radionuclide ventriculography

    SciTech Connect

    Brown, K.A.; Rimmer, J.; Haisch, C. (Univ. of Vermont College of Medicine, Burlington (USA))

    1989-11-01

    The ability of noninvasive risk stratification using dipyridamole-thallium-201 (Tl-201) imaging and radionuclide ventriculography to predict perioperative and long-term cardiac events (myocardial infarction or cardiac death) was evaluated in 36 uremic diabetic and 29 nondiabetic candidates for renal allograft surgery. Of the 35 patients who underwent renal allograft surgery 8 +/- 7 months after the study, none had transient Tl-201 defects (although 13 had depressed left ventricular ejection fraction) and none developed perioperative cardiac events. During a mean follow-up of 23 +/- 11 months, 6 (9%) patients developed cardiac events. Logistic regression analysis was used to compare the predictive value of clinical data (including age, sex, diabetes, chest pain history, allograft recipient) and radionuclide data. Presence of transient Tl-201 defect and left ventricular ejection fraction were the only significant predictors of future cardiac events (p less than 0.01). No other patient variables, including diabetes or receiving a renal allograft, had either univariate or multivariate predictive value. All 3 patients with transient Tl-201 defects had cardiac events compared with only 3 of 62 (5%) patients without transient Tl-201 defect (p less than 0.0001). Mean left ventricular ejection fraction was lower in patients with cardiac events (44 +/- 13%) compared with patients without cardiac events (57 +/- 9%, p less than 0.005). Overall, 5 of 6 patients with cardiac events had either transient Tl-201 defects or depressed left ventricular ejection fraction. Dipyridamole-Tl-201 imaging and radionuclide ventriculography may be helpful in identifying uremic candidates for renal allograft surgery who are at low risk for perioperative and long-term cardiac events.

  7. Application of noninvasive and invasive tests for risk assessment in patients with ventricular arrhythmias.

    PubMed

    Windhagen-Mahnert, B; Kadish, A H

    2000-05-01

    Sudden cardiac death remains a major public health problem in western society. Because most patients who experience cardiac arrest are not successfully resuscitated, primary prevention of sudden death remains an important challenge. A number of noninvasive risk stratification techniques have been suggested as providing useful information in patients with underlying structural heart defects. Unfortunately, the positive predictive value of most of these techniques has been limited. Left ventricular ejection fraction, the presence of nonsustained ventricular tachycardia on Holter monitoring, and inducible sustained ventricular tachycardia at electrophysiologic testing in patients with coronary artery disease remain the best established prognostic test. However, with the exception of two ICD studies using the combination of these markers, prospective studies have not yet completely validated the use of these and other prognostic markers. Further understanding of the pathophysiology of ventricular fibrillation and other risk stratification techniques will be necessary before a clear algorithm can be developed for application to patients at risk for sudden death. PMID:10849872

  8. Coronary CT and the Coronary Calcium Score, the Future of ED Risk Stratification?

    PubMed Central

    Fernandez-Friera, Leticia; Garcia-Alvarez, Ana; Guzman, Gabriela; Garcia, Mario J

    2012-01-01

    Accurate and efficient evaluation of acute chest pain remains clinically challenging because traditional diagnostic modalities have many limitations. Recent improvement in non-invasive imaging technologies could potentially improve both diagnostic efficiency and clinical outcomes of patients with acute chest pain while reducing unnecessary hospitalizations. However, there is still controversy regarding much of the evidence for these technologies. This article reviews the role of coronary artery calcium score and the coronary computed tomography in the assessment of individual coronary risk and their usefulness in the emergency department in facilitating appropriate disposition decisions. The evidence base and clinical applications for both techniques are also described, together with cost- effectiveness and radiation exposure considerations. PMID:22708911

  9. Imaging of cardiovascular risk in patients with Turner's syndrome.

    PubMed

    Marin, A; Weir-McCall, J R; Webb, D J; van Beek, E J R; Mirsadraee, S

    2015-08-01

    Turner's syndrome is a disorder defined by an absent or structurally abnormal second X chromosome and affects around 1 in 2000 newborn females. The standardised mortality ratio in Turner's syndrome is around three-times higher than in the general female population, mainly as a result of cardiovascular disorders. Most striking is the early age at which Turner's syndrome patients develop the life-threatening complications of cardiovascular disorders compared to the general population. The cardiovascular risk stratification in Turner's syndrome is challenging and imaging is not systematically used. The aim of this article is to review cardiovascular risks in this group of patients and discuss a systematic imaging approach for early identification of cardiovascular disorders in these patients. PMID:25917542

  10. How can neuroimaging facilitate the diagnosis and stratification of patients with psychosis?

    PubMed

    Kempton, Matthew J; McGuire, Philip

    2015-05-01

    Early diagnosis and treatment of patients with psychosis are associated with improved outcome in terms of future functioning, symptoms and treatment response. Identifying neuroimaging biomarkers for illness onset and treatment response would lead to immediate clinical benefits. In this review we discuss if neuroimaging may be utilised to diagnose patients with psychosis, predict those who will develop the illness in those at high risk, and stratify patients. State-of-the-art developments in the field are critically examined including multicentre studies, longitudinal designs, multimodal imaging and machine learning as well as some of the challenges in utilising future neuroimaging biomarkers in clinical trials. As many of these developments are already being applied in neuroimaging studies of Alzheimer?s disease, we discuss what lessons have been learned from this field and how they may be applied to research in psychosis. PMID:25092428

  11. Meta-Analysis on Risk Stratification of Asymptomatic Individuals With the Brugada Phenotype.

    PubMed

    Letsas, Konstantinos P; Liu, Tong; Shao, Qingmiao; Korantzopoulos, Panagiotis; Giannopoulos, Georgios; Vlachos, Konstantinos; Georgopoulos, Stamatis; Trikas, Athanasios; Efremidis, Michael; Deftereos, Spyridon; Sideris, Antonios

    2015-07-01

    The prognosis of asymptomatic subjects remains the most controversial issue in Brugada syndrome (BS). A meta-analysis on the prognostic role of spontaneous type 1 electrocardiographic (ECG) pattern and programmed ventricular stimulation (PVS) in asymptomatic subjects with Brugada electrocardiogram was performed. Current databases were searched until March 2014. Fourteen prospective observational studies were included in the present meta-analysis, accumulating data on 3,536 asymptomatic subjects (2,820 men) with BS phenotype. The mean follow-up period varied from 20 and 77 months. Data regarding 1,398 asymptomatic subjects with spontaneous type 1 ECG pattern of BS were retrieved from 6 studies. During follow-up, arrhythmic events (sustained ventricular tachycardia/fibrillation, appropriate device therapies, or arrhythmic death) occurred in 42 patients (3%). The meta-analysis of these studies demonstrated that asymptomatic subjects with spontaneous type 1 ECG pattern of BS exhibit an increased risk of future arrhythmic events (odds ratio = 3.56, 95% confidence interval 1.70 to 7.47, Z = 3.37, p = 0.0008); 1,104 asymptomatic subjects with BS ECG pattern from 12 studies underwent PVS and were available for analysis. During follow-up, arrhythmic events occurred in 36 subjects (3.3%). Inducible ventricular arrhythmias at PVS were predictive of future arrhythmic events (odds ratio = 3.51, 95% confidence interval 1.60 to 7.67, Z = 3.14, p = 0.002). In conclusion, this meta-analysis showed that asymptomatic subjects with either spontaneous diagnostic ECG pattern or inducible ventricular arrhythmias at PVS are at increased risk. PMID:25933735

  12. Is There a High-Risk Subtype of Depression in Patients with Coronary Heart Disease?

    PubMed Central

    Carney, Robert M.; Freedland, Kenneth E.

    2012-01-01

    Depression is a risk factor for cardiac morbidity and mortality in patients with coronary heart disease, especially in those with a recent history of acute coronary syndrome. To improve risk stratification and treatment planning, it would be useful to identify the characteristics or subtypes of depression that are associated with the highest risk of cardiac events. This paper reviews the evidence concerning several putative depression subtypes and symptom patterns that may be associated with a high risk of morbidity and mortality in cardiac patients, including single-episode major depressive disorder, depression that emerges after a cardiac event, somatic symptoms of depression, and treatment-resistant depression. PMID:22076689

  13. Objective Estimates Improve Risk Stratification for Primary Graft Dysfunction after Lung Transplantation.

    PubMed

    Shah, R J; Diamond, J M; Cantu, E; Flesch, J; Lee, J C; Lederer, D J; Lama, V N; Orens, J; Weinacker, A; Wilkes, D S; Roe, D; Bhorade, S; Wille, K M; Ware, L B; Palmer, S M; Crespo, M; Demissie, E; Sonnet, J; Shah, A; Kawut, S M; Bellamy, S L; Localio, A R; Christie, J D

    2015-08-01

    Primary graft dysfunction (PGD) is a major cause of early mortality after lung transplant. We aimed to define objective estimates of PGD risk based on readily available clinical variables, using a prospective study of 11 centers in the Lung Transplant Outcomes Group (LTOG). Derivation included 1255 subjects from 2002 to 2010; with separate validation in 382 subjects accrued from 2011 to 2012. We used logistic regression to identify predictors of grade 3 PGD at 48/72?h, and decision curve methods to assess impact on clinical decisions. 211/1255 subjects in the derivation and 56/382 subjects in the validation developed PGD. We developed three prediction models, where low-risk recipients had a normal BMI (18.5-25?kg/m(2) ), chronic obstructive pulmonary disease/cystic fibrosis, and absent or mild pulmonary hypertension (mPAP<40?mmHg). All others were considered higher-risk. Low-risk recipients had a predicted PGD risk of 4-7%, and high-risk a predicted PGD risk of 15-18%. Adding a donor-smoking lung to a higher-risk recipient significantly increased PGD risk, although risk did not change in low-risk recipients. Validation demonstrated that probability estimates were generally accurate and that models worked best at baseline PGD incidences between 5% and 25%. We conclude that valid estimates of PGD risk can be produced using readily available clinical variables. PMID:25877792

  14. Development and validation of a clinical score for prognosis stratification in patients requiring antiretroviral therapy in sub-Saharan Africa: a prospective open cohort study

    PubMed Central

    Gerardo, Rivero; Dayana, Pérez

    2011-01-01

    Background Mortality rates among patients initiating antiretroviral therapy (ART) in sub-Saharan Africa continue high. Also HIV treatment services from the region are affronting the challenges of been attending more patients than never. In this scenario, there are no integrated scoring systems capable of an adequate risk identification/ prognostic stratification among patients requiring ART; in order of optimize actual programmes outcomes. Several independent risk factors at baseline are associated with a poor prognosis after ART initiation. These include: male sex, low body mass index, anemia, low CD4 count and stage-4 WHO disease. The aim of this research was evaluate prospectively a new scoring system composed by these factors. Methods An open cohort study was conducted in 1769 patients from May 2008 to December 2010 at two HIV clinics of Zimbabwe. A new clinical model (MASIB score) was applied at ART initiation and patients were followed for 4 months. After that, validation characteristics of the score were examined. Results Patients selected in this cohort exhibited similar baseline characteristics that the patients selected in previous cohorts from the region. Overall performance for mortality prediction of MASIB score was accurate, as reflected by the Brier score test result 0.084 (95%CI: 0.080–0.088). Calibration was adequate taking in consideration a p>0.05 in the Hosmer Lemeshow test and discrimination was also good (Area Under Curve: 0.915, 95%CI: 0,901– 0,928). Conclusion The new model developed exhibited adequate validation characteristics supporting the clinical use. Further evaluations of this model in others scenarios from the sub-Saharan region are needed. PMID:22187587

  15. Risk stratification at the time of diagnosis for children with hypertrophic cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry Study Group

    PubMed Central

    Lipshultz, Steven E; Orav, E John; Wilkinson, James D; Towbin, Jeffrey A; Messere, Jane E; Lowe, April M; Sleeper, Lynn A; Cox, Gerald F; Hsu, Daphne T; Canter, Charles E; Hunter, Juanita A; Colan, Steven D

    2014-01-01

    Summary Background Treatment of children with hypertrophic cardiomyopathy might be improved if the risk of death or heart transplantation could be predicted by risk factors present at the time of diagnosis. Methods The Pediatric Cardiomyopathy Registry collected longitudinal data on 1085 children with hypertrophic cardiomyopathy from 1990 to 2006. The primary outcome was death or heart transplantation. Our goal is to understand how patient factors measured at the time of diagnosis will predict the subsequent risk of death or heart transplantation. The Kaplan-Meier method was used to calculate time-to-event rates from the time of diagnosis to the earlier of heart transplantation or death for children in each subgroup. Cox proportional-hazards regression was used to identify both univariable and multivariable predictors of death or heart transplantation within each aetiologic subgroup. Findings The poorest outcomes (death or transplant) were observed among children with inborn errors of metabolism, for whom the estimated rate of death or heart transplantation was 57% (95% CI: 45%, 69%) at 2 years. Children with mixed functional phenotypes also did poorly, with rates of death or heart transplantation of 45% (95% CI: 33%, 57%) at 2 years for children with mixed hypertrophic and dilated cardiomyopathy, and 38% (95% CI: 24%, 52%) at 2 years for children with mixed hypertrophic and restrictive cardiomyopathy. Excellent outcomes were observed among the 407 children who received a diagnosis of idiopathic hypertrophic cardiomyopathy at 1 year of age or older, with rates of death or heart transplantation of 3% (95% CI: 1%, 5·0%) at 2 years. The risk factors for poor outcomes varied according to hypertrophic cardiomyopathy subgroup, but they generally included age, weight, congestive heart failure, lower left ventricular (LV) fractional shortening, or higher LV end-diastolic posterior wall thickness or end-diastolic ventricular septal thickness at the time of cardiomyopathy diagnosis. For all hypertrophic cardiomyopathy subgroups, the risk of death or heart transplantation is significantly increased when two or more risk factors are present and also as the number of risk factors increases. Interpretation Among children with hypertrophic cardiomyopathy, the risk of death or heart transplantation is greater for those who present as infants or with inborn errors of metabolism or with mixed hypertrophic and dilated or restrictive cardiomyopathy. Risk stratification by subgroup of cardiomyopathy, by characteristics such as lower weight, congestive heart failure, or abnormal echocardiographic findings, and by the presence of multiple risk factors allows for more informed clinical decision-making and prognosis at the time of diagnosis. PMID:24011547

  16. Should preclinical vascular abnormalities be measured in asymptomatic adults to improve cardiovascular risk stratification?

    Microsoft Academic Search

    J. de Graaf; S. Holewijn; A. F. H. Stalenhoef; A. D. Sniderman

    2011-01-01

    PURPOSE OF REVIEW: Guideline groups have issued contradictory decisions as to the value of noninvasive tests in asymptomatic adults at intermediate cardiovascular risk. Reclassification has only recently been accepted as a critical criterion to determine the utility of a diagnostic test. The present review examines potential limitations in reclassification and evaluates the utility of carotid ultrasound, pulse wave velocity and

  17. Association of BMI and Cardiovascular Risk Stratification in the Elderly African-American Females

    PubMed Central

    Javed, Fahad; Aziz, Emad F.; Sabharwal, Manpreet S.; Nadkarni, Girish N.; Khan, Shahzeb A.; Cordova, Juan P.; Benjo, Alexandre M.; Gallagher, Dympna; Herzog, Eyal; Messerli, Franz H.; Pi-Sunyer, F. Xavier

    2012-01-01

    We aimed to estimate the association of BMI and risk of systemic hypertension in African-American females aged 65 years and older. In this retrospective, cross-sectional study, medical charts were randomly reviewed after obtaining institutional review board approval and data collection was conducted for height, weight, BMI, age, ethnicity, gender, and hypertension. A multivariable logistic regression analysis was performed. The mean BMI was significantly higher in hypertensive subjects than normotensives (30.3 vs. 29 kg/m2; P = 0.003). A higher proportion of hypertensive subjects had a BMI >23 kg/m2 as compared to normotensives (88.9% vs. 83.5%; P = 0.023). When the log odds of having a history of hypertension was plotted against BMI as a continuous variable, we found that the odds showed an increasing trend with increasing BMI and a steep increase after a BMI of 23 kg/m2. When BMI was analyzed as a categorical variable, a BMI of 23–30 kg/m2 was found to have an odds ratio of 1.43 (95% confidence interval 1.01–2.13; P = 0.05) and a BMI of >30 kg/m2 had an odds ratio of 1.76 (95% confidence interval 1.17–2.65; P = 0.007) when compared to a BMI of <23 kg/m2. This association remained significant in both univariate and multivariate analysis. We conclude that BMI is an independent predictor of hypertension in elderly African-American females. Our results indicate that the risk of hypertension increased significantly at BMI of >23 kg/m2 in this ethnic group. Weight reduction to a greater extent than previously indicated could play an integral role in prevention and control of high blood pressure in this particular population. PMID:21183933

  18. SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines

    PubMed Central

    Bernetich, Matthew; Oliai, Caspian; Lanciano, Rachelle; Hanlon, Alexandra; Lamond, John; Arrigo, Stephen; Yang, Jun; Good, Michael; Feng, Jing; Brown, Royce; Garber, Bruce; Mooreville, Michael; Brady, Luther W.

    2014-01-01

    Purpose: To report an update of our previous experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer, risk stratified by the updated National Comprehensive Cancer Network (NCCN) version 2.2014, reporting efficacy and toxicity in a community hospital setting. Methods: From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using CyberKnife. NCCN guidelines Version 2.2014 risk groups analyzed included very low (20%), low (23%), intermediate (35%), and high (22%) risk. To further explore group heterogeneity and to comply with new guidelines, we separated our prior intermediate risk group into favorable intermediate and unfavorable intermediate groups depending on how many intermediate risk factors were present (one vs.?>?one). The unfavorable intermediate group was further analyzed in combination with the high risk group as per NCCN guidelines Version 2.2014. Various dose levels were used over the years of treatment, and have been categorized into low dose (35?Gy, n?=?5 or 36.25?Gy, n?=?107) and high dose (37.5?Gy, n?=?30). All treatments were delivered in five fractions. Toxicity was assessed using radiation therapy oncology group criteria. Results: Five-year actuarial freedom from biochemical failure (FFBF) was 100, 91.7, 95.2, 90.0, and 86.7% for very low, low, intermediate and high risk patients, respectively. A significant difference in 5?year FFBF was noted for patients with Gleason score (GS) ?8 vs. 7 vs. 5/6 (p?=?0.03) and low vs. high dose (p?=?0.05). T-stage, pretreatment PSA, age, risk stratification group, and use of ADT did not affect 5-year FFBF. Multivariate analysis revealed GS and dose to be the most predictive factors for 5-year FFBF. Conclusion: Our experience with SBRT for the primary treatment of localized prostate cancer demonstrates favorable efficacy and toxicity comparable to the results reported for IMRT in literature. GS remains the single most important pretreatment predictor of outcome. PMID:25426447

  19. [Update in arrhythmogenic right ventricular cardiomyopathy: genetic, clinical presentation and risk stratification].

    PubMed

    Tomé Esteban, María T; García-Pinilla, José M; McKenna, William J

    2004-08-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC), or dysplasia, is a genetic heart muscle disease whose diagnosis is often a challenge for the clinician. It is one of the commonest causes of sudden cardiac death in the young. The classic description of the disease describes the end stage of a process where the myocardium, mainly of the right ventricle, has been substituted by fibrofatty tissue. Thus the early stages of the disease with subtle symptomatology are often missed. Unfortunately the risk of a fatal outcome is no less severe. The genetic basis is under investigations. Disease causing mutations in important cell adhesion genes (plakoglobin, desmoplakin) provide the basis for improved diagnosis and understanding of the pathogenesis. Animal models support the pathogenic theory that alterations on the integrity of the adhesion junction is followed by a cellular death and progressive fibrofatty replacement, the substrate for ventricular arrhythmias. Due the growing complexity and numerous phenotypic variations reported, sometimes in the same family, international registries have been created. The present review aims to summarise the current concepts on ARVC emphasising the genetic studies, the diagnosis, new diagnostic techniques and prognosis. PMID:15282065

  20. A Novel Risk Stratification to Predict Local-Regional Failures in Urothelial Carcinoma of the Bladder After Radical Cystectomy

    SciTech Connect

    Baumann, Brian C. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Guzzo, Thomas J. [Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); He Jiwei [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Keefe, Stephen M. [Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Tucker, Kai; Bekelman, Justin E. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Hwang, Wei-Ting [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Vaughn, David J. [Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Malkowicz, S. Bruce [Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)] [Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Christodouleas, John P., E-mail: christojo@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: Local-regional failures (LF) following radical cystectomy (RC) plus pelvic lymph node dissection (PLND) with or without chemotherapy for invasive urothelial bladder carcinoma are more common than previously reported. Adjuvant radiation therapy (RT) could reduce LF but currently has no defined role because of previously reported morbidity. Modern techniques with improved normal tissue sparing have rekindled interest in RT. We assessed the risk of LF and determined those factors that predict recurrence to facilitate patient selection for future adjuvant RT trials. Methods and Materials: From 1990-2008, 442 patients with urothelial bladder carcinoma at University of Pennsylvania were prospectively followed after RC plus PLND with or without chemotherapy with routine pelvic computed tomography (CT) or magnetic resonance imaging (MRI). One hundred thirty (29%) patients received chemotherapy. LF was any pelvic failure detected before or within 3 months of distant failure. Competing risk analyses identified factors predicting increased LF risk. Results: On univariate analysis, pathologic stage {>=}pT3, <10 nodes removed, positive margins, positive nodes, hydronephrosis, lymphovascular invasion, and mixed histology significantly predicted LF; node density was marginally predictive, but use of chemotherapy, number of positive nodes, type of surgical diversion, age, gender, race, smoking history, and body mass index were not. On multivariate analysis, only stage {>=}pT3 and <10 nodes removed were significant independent LF predictors with hazard ratios of 3.17 and 2.37, respectively (P<.01). Analysis identified 3 patient subgroups with significantly different LF risks: low-risk ({<=}pT2), intermediate-risk ({>=}pT3 and {>=}10 nodes removed), and high-risk ({>=}pT3 and <10 nodes) with 5-year LF rates of 8%, 23%, and 42%, respectively (P<.01). Conclusions: This series using routine CT and MRI surveillance to detect LF confirms that such failures are relatively common in cases of locally advanced disease and provides a rubric based on pathological stage and number of nodes removed that stratifies patients into 3 groups with significantly different LF risks to simplify patient selection for future adjuvant radiation therapy trials.

  1. Usefulness of quantitative versus qualitative ST-segment depression for risk stratification of non-ST elevation acute coronary syndromes in contemporary clinical practice.

    PubMed

    Yan, Raymond T; Yan, Andrew T; Granger, Christopher B; Lopez-Sendon, Jose; Brieger, David; Kennelly, Brian; Budaj, Andrzej; Steg, Ph Gabriel; Georgescu, Alina A; Hassan, Quamrul; Goodman, Shaun G

    2008-04-01

    This aim of this study was to assess the clinical utility of quantitative ST-segment depression (STD) for refining the risk stratification of non-ST elevation acute coronary syndromes in the prospective, multinational Global Registry of Acute Coronary Events (GRACE). Quantitative measurements of STD on admission electrocardiograms were evaluated independently by a core laboratory, and their predictive value for in-hospital and cumulative 6-month mortality was examined. Although more severe STD is a marker of increased short- and long-term mortality, it is also associated with higher risk clinical features and biomarkers. Thus, after adjustment for these clinically important predictors, quantitative STD does not provide incremental prognostic value beyond simple dichotomous evaluation for the presence of STD. Furthermore, adopting quantitative instead of the prognostically proven qualitative evaluation of STD does not improve risk discrimination afforded by the validated GRACE risk models. In conclusion, the findings do not support the quantification of STD in routine clinical practice beyond simple evaluation for the presence of STD as an integral part of comprehensive risk stratification using the GRACE risk score. PMID:18359308

  2. IMPROVING THE STRATIFICATION OF MEDICAL INSTITUTIONS FOR STRATIFIED SAMPLING IN THE PATIENT SURVEY

    Microsoft Academic Search

    Takashi Sozu; Chikuma Hamad; Isao Yoshimura

    2005-01-01

    The Patient Survey is a designated statistical survey conducted every three years with the objective of obtaining basic data on the current status of patients in medical institutions in Japan. Since stratified sampling is used in this survey, suitable con- struction of strata is essential for achieving low error rates in the estimation of the number of patients having various

  3. Biology, Risk Stratification, and Therapy of Pediatric Acute Leukemias: An Update

    PubMed Central

    Pui, Ching-Hon; Carroll, William L.; Meshinchi, Soheil; Arceci, Robert J.

    2011-01-01

    Purpose We review recent advances in the biologic understanding and treatment of childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), identify therapeutically challenging subgroups, and suggest future directions of research. Methods A review of English literature on childhood acute leukemias from the past 5 years was performed. Results Contemporary treatments have resulted in 5-year event-free survival rates of approximately 80% for childhood ALL and almost 60% for pediatric AML. The advent of high-resolution genome-wide analyses has provided new insights into leukemogenesis and identified many novel subtypes of leukemia. Virtually all ALL and the vast majority of AML cases can be classified according to specific genetic abnormalities. Cooperative mutations involved in cell differentiation, cell cycle regulation, tumor suppression, drug responsiveness, and apoptosis have also been identified in many cases. The development of new formulations of existing drugs, molecularly targeted therapy, and immunotherapies promises to further advance the cure rates and improve quality of life of patients. Conclusion The application of new high-throughput sequencing techniques to define the complete DNA sequence of leukemia and host normal cells and the development of new agents targeted to leukemogenic pathways promise to further improve outcome in the coming decade. PMID:21220611

  4. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    SciTech Connect

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-04-24

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning.

  5. Effective risk stratification using exercise myocardial perfusion SPECT in women: Gender-related differences in prognostic nuclear testing

    Microsoft Academic Search

    Rory Hachamovitch; Daniel S. Berman; Hosen Kiat; C. Noel Bairey Merz; Ishac Cohen; J. Arthur Cabico; John Friedman; Guido Germano; Kenneth F. Van Train; George A. Diamond

    1996-01-01

    Objectives. This study was designed to evaluate the incremental prognostic value over clinical and exercise variables of rest thallium-201\\/exercise technetium-99m sestamibi single-photon emission computed tomography (SPECT) in women compared with men and to determine whether this test can be used to effectively risk stratify patients of both genders.Background. To minimize the previously described gender-related bias in the evaluation of coronary

  6. A Novel Method in the Stratification of Post-Myocardial-Infarction Patients Based on Pathophysiology

    PubMed Central

    Yang, Fan; Sun, Yujun; Li, Zheng; Jiang, Meng; Fan, Yiting; Pu, Jun; Shen, Xuedong

    2015-01-01

    Objectives We proposed that the severity of ST-segment elevation myocardial infarction (STEMI) could be classified based on pathophysiological changes. Methods First-STEMI patients were classified within hospitalization. Grade 0: no detectable myocardial necrosis; Grade 1: myocardial necrosis without functional and morphological abnormalities; Grade 2: myocardial necrosis with reduced LVEF; Grade 3: reduced LVEF on the basis of cardiac remodeling; Grade 4: mitral regurgitation additional to the Grade-3 criteria. Results Of 180 patients, 1.7, 43.9, 26.1, 23.9 and 4.4% patients were classified as Grade 0 to 4, respectively. The classification is an independent predicator of 90-day MACEs (any death, resuscitated cardiac arrest, acute heart failure and stroke): the rate was 0, 5.1, 8.5, 48.8 and 75% from Grade 0 to 4 (p<0.001), respectively. The Grade-2 patients were more likely to have recovered left ventricular ejection fraction than the Grade-3/4 patients did after 90 days (48.9% vs. 19.1%, p<0.001). Avoiding complicated quantification, the classification served as a good reflection of infarction size as measured by cardiac magnetic resonance imaging (0±0, 15.68±8.48, 23.68±9.32, 36.12±11.35 and 40.66±14.33% of the left ventricular mass by Grade 0 to 4, P<0.001), and with a comparable prognostic value (AUC 0.819 vs. 0.813 for infarction size, p = 0.876 by C-statistics) for MACEs. Conclusions The new classification represents an easy and objective method to scale the cardiac detriments for STEMI patients. PMID:26090807

  7. Development and Validation of a Clinical Trial Patient Stratification Assay That Interrogates 27 Mutation Sites in MAPK Pathway Genes

    PubMed Central

    Weiner, Russell; Marton, Matthew J.

    2013-01-01

    Somatic mutations identified on genes related to the cancer-developing signaling pathways have drawn attention in the field of personalized medicine in recent years. Treatments developed to target a specific signaling pathway may not be effective when tumor activating mutations occur downstream of the target and bypass the targeted mechanism. For instance, mutations detected in KRAS/BRAF/NRAS genes can lead to EGFR-independent intracellular signaling pathway activation. Most patients with these mutations do not respond well to anti-EGFR treatment. In an effort to detect various mutations in FFPE tissue samples among multiple solid tumor types for patient stratification many mutation assays were evaluated. Since there were more than 30 specific mutations among three targeted RAS/RAF oncogenes that could activate MAPK pathway genes, a custom designed Single Nucleotide Primer Extension (SNPE) multiplexing mutation assay was developed and analytically validated as a clinical trial assay. Throughout the process of developing and validating the assay we overcame many technical challenges which include: the designing of PCR primers for FFPE tumor tissue samples versus normal blood samples, designing of probes for detecting consecutive nucleotide double mutations, the kinetics and thermodynamics aspects of probes competition among themselves and against target PCR templates, as well as validating an assay when positive control tumor tissue or cell lines with specific mutations are not available. We used Next Generation sequencing to resolve discordant calls between the SNPE mutation assay and Sanger sequencing. We also applied a triplicate rule to reduce potential false positives and false negatives, and proposed special considerations including pre-define a cut-off percentage for detecting very low mutant copies in the wild-type DNA background. PMID:23991070

  8. A multidisciplinary approach to therapeutic risk management of the suicidal patient

    PubMed Central

    Grant, Cynthia L; Lusk, Jaimie L

    2015-01-01

    As health care trends toward a system of care approach, providers from various disciplines strive to collaborate to provide optimal care for their patients. While a multidisciplinary approach to suicide risk assessment and management has been identified as important for reducing suicidality, standardized clinical guidelines for such an approach do not yet exist. In this article, the authors propose the adoption of the therapeutic risk management of the suicidal patient (TRMSP) to improve suicide risk assessment and management within multidisciplinary systems of care. The TRMSP, which has been fully articulated in previous articles, involves augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. Augmenting clinical risk assessments with reliable and valid structured instruments serves several functions, including ensuring important aspects of suicide are addressed, establishing a baseline for suicidal thoughts and behaviors, facilitating interprofessional communication, and mitigating risk. Similarly, a two-dimensional risk stratification qualifying suicide risk in terms of both severity and temporality can enhance communication across providers and settings and improve understanding of acute crises in the context of chronic risk. Finally, safety planning interventions allow providers and patients to collaboratively create a personally meaningful plan for managing a suicidal crisis that can be continually modified across time with multiple providers in different care settings. In a busy care environment, the TRMSP can provide concrete guidance on conducting clinically and medicolegally sound suicide risk assessment and management. This collaborative and comprehensive process would potentially improve care of patients with suicidality, optimize clinical resources, decrease unnecessary and costly admissions, and mitigate medicolegal risk. The TRMSP may serve as a foundation for building a standardized, collaborative, stepped-care approach that patients, individual providers, and the health care system can all benefit from. PMID:26150725

  9. Human CMV-specific T-cell responses in kidney transplantation; toward changing current risk-stratification paradigm.

    PubMed

    Lúcia, Marc; Crespo, Elena; Cruzado, Josep M; Grinyó, Josep M; Bestard, Oriol

    2014-07-01

    Despite the great efficacy of current antiviral preventive strategies, hCMV infection is still a major complication after renal transplantation, significantly challenging patient and graft survival. This issue seems to be explained because of the rather poor immunologic monitoring of the antiviral immune response. An important body of evidence has shown that monitoring the hCMV-specific T-cell response, at different time points of the transplant setting, seems to add crucial information for predicting the risk of viral infection, thus potentially helping individualization of therapeutic decision-making in clinical transplantation. While several immune-cellular assays have shown its capability for accurately monitoring hCMV-specific T-cell responses, only few such as the IFN-? ELISPOT and the ELISA based technology assays might be reliable for its application in the clinic. Nonetheless, an important effort has to be made among the transplant community to standardize and validate such immune assays. Noteworthy, large-scale prospective randomized trials are highly warranted to ultimately introduce them in current clinical practice as a part of the highly desired personalized medicine. PMID:24629072

  10. Performance of stroke risk scores in older people with atrial fibrillation not taking warfarin: comparative cohort study from BAFTA trial

    Microsoft Academic Search

    F D R Hobbs; A K Roalfe; G Y H Lip; K Fletcher; D A Fitzmaurice; J Mant

    2011-01-01

    Objective To compare the predictive power of the main existing and recently proposed schemes for stratification of risk of stroke in older patients with atrial fibrillation.Design Comparative cohort study of eight risk stratification scores. Setting Trial of thromboprophylaxis in stroke, the Birmingham Atrial Fibrillation in the Aged (BAFTA) trial.Participants 665 patients aged 75 or over with atrial fibrillation based in

  11. Radon: Counseling patients about risk

    SciTech Connect

    Birrer, R.B. (Catholic Medical Center of Brooklyn and Queens, Jamaica, NY (USA))

    1990-09-01

    Exposure to radon and its decay products has increased as the United States has changed from an outdoor society to a largely indoor society. Radon, which is found primarily in the soil, enters houses and buildings through cracks, holes and pipes in foundation walls and floors. Although radon is suspected of being a significant cause of lung cancer, comparisons with other risk factors cannot yet be made. Radon levels in the home can be measured with commercially available kits. Guidelines for reducing the amount of radon in a home are provided by the U.S. Environmental Protection Agency.18 references.

  12. First-line natalizumab in multiple sclerosis: rationale, patient selection, benefits and risks

    PubMed Central

    Racke, Michael Karl; Imitola, Jamie; Boster, Aaron Lee

    2014-01-01

    Natalizumab (NTZ) is a highly effective disease modifying therapy for the treatment of relapsing forms of multiple sclerosis (MS). Despite evidence to support its use as first-line therapy, risk of NTZ-associated progressive multifocal leukoencephalopathy (PML) has largely contributed to it being relegated to a second-line position. Recent preliminary data may allow for a more accurate analysis of JC virus (JCV) risk stratification of a given patient’s PML risk. Herein we propose an algorithm to help guide clinicians through this decision-making process. We recommend that NTZ be considered for first-line use in JCV antibody negative MS patients, JCV ‘low positive’ MS patients without prior exposure to immunosuppression and for a limited period (12–24 months) in JCV ‘high positive’ MS patients with an aggressive disease course . We caution against first-line use in JCV antibody ‘high positive’ patients beyond 12–24 months and any JCV antibody positive patient with a history of prior immunosuppression. PMID:24587891

  13. Role of Coronary Artery Calcium Score and Coronary CT Angiography in the Diagnosis and Risk Stratification of Individuals with Suspected Coronary Artery Disease

    Microsoft Academic Search

    Sean R. Wilson; Fay Y. Lin; James K. Min

    Coronary heart disease is the leading cause of death worldwide, and has traditionally been assessed through a patient’s cardiovascular\\u000a risk profile that is comprised of a combination of genetic, social, physiologic, and environmental factors. A growing discordance\\u000a is being recognized in the ability of current risk estimation tools to predict outcomes versus that of actual measured outcomes.\\u000a Exciting new improvements

  14. Prediction of Clinical Outcome Using Gene Expression Profiling and Artificial Neural Networks for Patients with Neuroblastoma

    Microsoft Academic Search

    Jun S. Wei; Braden T. Greer; Frank Westermann; Seth M. Steinberg; Chang-Gue Son; Qing-Rong Chen; Craig C. Whiteford; Sven Bilke; Alexei L. Krasnoselsky; Nicola Cenacchi; Daniel Catchpoole; Frank Berthold; Manfred Schwab; Javed Khan

    2004-01-01

    Currently, patients with neuroblastoma are classified into risk groups (e.g., according to the Children's Oncology Group risk-stratification) to guide physicians in the choice of the most appropriate therapy. Despite this careful stratification, the survival rate for patients with high-risk neuroblastoma remains <30%, and it is not possible to predict which of these high-risk patients will survive or succumb to the

  15. An alternative approach to selecting patients for high-risk screening with breast MRI.

    PubMed

    Hollingsworth, Alan B; Stough, Rebecca G

    2014-01-01

    Current guidelines for adding breast MRI to annual screening mammography are based entirely upon stratification of risk, with a heavy focus on lifetime calculations. This approach is fraught with difficulty due to the reliance on mathematical models that vary widely in their calculations, the inherent age discrimination of using lifetime risks rather than short-term incidence, and the failure to incorporate mammographic density, the latter being an independent risk as well as the greatest predictor of mammographic failure. By utilizing a system of patient selection similar to what was used in the American College of Radiology Imaging Network (ACRIN) 6666 trial for multi-modality imaging, 33 women without a prior diagnosis of breast cancer were found to harbor mammographically occult carcinoma through MRI screening. These 33 patients represent a 2% yield, closely approximating the yields seen in prospective MRI screening trials of women at very high risk of breast cancer. Using the "~20-25%" minimum established by the American Cancer Society and later the National Comprehensive Cancer Network, the Gail model would have prompted the use of MRI in only 9 of 33 (27.3%) patients, the Claus model 1 of 33 (3%), and the Tyrer-Cuzick model 12 of 33 (36.4%). Using all three models and opting for the highest calculated risk, then including BRCA-positivity, still would have identified only 16 of 33 (48.5%) patients with occult breast cancer discovered by MRI. Only one patient was BRCA-positive, and none had lobular carcinoma in situ, while 6 of 33 patients (18.2%) had atypical ductal hyperplasia (ADH). Measures are proposed to refine patient selection for MRI screening through the use of short-term or categorical risks, mammographic density, while maintaining cost-effectiveness through longer MRI screening intervals. PMID:24387050

  16. Temporal trends in the use of invasive cardiac procedures for non-ST segment elevation acute coronary syndromes according to initial risk stratification

    PubMed Central

    Jedrzkiewicz, Sean; Goodman, Shaun G; Yan, Raymond T; Welsh, Robert C; Kornder, Jan; DeYoung, J Paul; Wong, Graham C; Rose, Barry; Grondin, François R; Gallo, Richard; Huang, Wei; Gore, Joel M; Yan, Andrew T

    2009-01-01

    BACKGROUND: Current guidelines support an early invasive strategy in the management of high-risk non-ST elevation acute coronary syndromes (NSTE-ACS). Although studies in the 1990s suggested that high-risk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada. OBJECTIVE: To examine the in-hospital use of coronary angiography and revascularization in relation to risk among less selected patients with NSTE-ACS. METHODS: Data from the prospective, multicentre Global Registry of Acute Coronary Events (main GRACE and expanded GRACE2) were used. Between June 1999 and September 2007, 7131 patients from across Canada with a final diagnosis of NSTE-ACS were included the study. The study population was stratified into low-, intermediate- and high-risk groups, based on their calculated GRACE risk score (a validated predictor of in-hospital mortality) and according to time of enrollment. RESULTS: While rates of in-hospital death and reinfarction were significantly (P<0.001) greater in higher-risk patients, the in-hospital use of cardiac catheterization in low- (64.7%), intermediate- (60.3%) and high-risk (42.3%) patients showed an inverse relationship (P<0.001). This trend persisted despite the increase in the overall rates of cardiac catheterization over time (47.9% in 1999 to 2003 versus 51.6% in 2004 to 2005 versus 63.8% in 2006 to 2007; P<0.001). After adjusting for confounders, intermediate-risk (adjusted OR 0.80 [95% CI 0.70 to 0.92], P=0.002) and high-risk (adjusted OR 0.38 [95% CI 0.29 to 0.48], P<0.001) patients remained less likely to undergo in-hospital cardiac catheterization. CONCLUSION: Despite the temporal increase in the use of invasive cardiac procedures, they remain paradoxically targeted toward low-risk patients with NSTE-ACS in contemporary practice. This treatment-risk paradox needs to be further addressed to maximize the benefits of invasive therapies in Canada. PMID:19898699

  17. Classification and risk stratification of invasive breast carcinomas using a real-time quantitative RT-PCR assay

    Microsoft Academic Search

    Laurent Perreard; Cheng Fan; John F Quackenbush; Michael Mullins; Nicholas P Gauthier; Edward Nelson; Mary Mone; Heidi Hansen; Saundra S Buys; Karen Rasmussen; Alejandra Ruiz Orrico; Donna Dreher; Rhonda Walters; Joel Parker; Zhiyuan Hu; Xiaping He; Juan P Palazzo; Olufunmilayo I Olopade; Aniko Szabo; Charles M Perou; Philip S Bernard

    2006-01-01

    INTRODUCTION: Predicting the clinical course of breast cancer is often difficult because it is a diverse disease comprised of many biological subtypes. Gene expression profiling by microarray analysis has identified breast cancer signatures that are important for prognosis and treatment. In the current article, we use microarray analysis and a real-time quantitative reverse-transcription (qRT)-PCR assay to risk-stratify breast cancers based

  18. Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement.

    PubMed

    La Mura, Vincenzo; Nicolini, Antonio; Tosetti, Giulia; Primignani, Massimo

    2015-04-01

    Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice. PMID:25866605

  19. Cardiac risk telemonitoring

    Microsoft Academic Search

    H. Hutten; M. Hribernigg; G. Rauchegger

    2001-01-01

    Utilization of advanced information, telecommunication and implant technology for cardiac risk stratification and management is one of the greatest challenges for modern health care provision. Sudden cardiac death is the major contributor to overall cardiovascular mortality with approximately 60% of all coronary heart disease fatalities occurring annually. Although some high-risk patient groups have been identified with reasonable sensitivity and specificity

  20. Erythroid-predominant myelodysplastic syndromes: enumeration of blasts from nonerythroid rather than total marrow cells provides superior risk stratification.

    PubMed

    Wang, Sa A; Tang, Guilin; Fadare, Oluwole; Hao, Suyang; Raza, Azra; Woda, Bruce A; Hasserjian, Robert P

    2008-11-01

    In the FAB (French-American-British) and WHO (World Heath Organization) classifications, the blasts in erythroleukemia (M6a) are enumerated from the marrow nonerythroid rather than the total-nucleated cells. However, the method for blast calculation in erythroid-predominant myelodysplastic syndrome (erythroblasts>or=50%) is not specified either in the FAB or WHO classifications. We retrieved the files of 74 erythroid-predominant myelodysplastic syndrome patients (17% of all myelodysplastic syndrome) and 192 myelodysplastic syndrome controls (erythroblasts<50%). In erythroid-predominant myelodysplastic syndrome, by enumerating blasts from marrow nonerythroid cells rather than from total nucleated cells, 41 of 74 (55%) cases would be upgraded, either by disease subcategory or International Prognostic Scoring System. Importantly, the patients with <5% blasts demonstrated a superior survival to patients with >or=5% blasts (P=0.002); this distinction was lost when blasts were calculated from total-nucleated cells. Of cases with >or=5% blasts, cytogenetics rather than blast count correlated with survival. We conclude that in erythroid-predominant myelodysplastic syndrome, blast calculation as a proportion of marrow nonerythroid rather than total nucleated cells can better stratify patients into prognostically relevant groups. PMID:18839018

  1. Cancer risk in patients with diabetes mellitus

    Microsoft Academic Search

    Hans-Olov Adami; Joseph McLaughlin; Anders Ekbom; Christian Berne; Debra Silverman; David Hacker; Ingemar Persson

    1991-01-01

    Cancer incidence was ascertained in a population-based cohort of 51,008 patients in Uppsala, Sweden, who were given a discharge diagnosis of diabetes mellitus during 1965–83. Complete follow-up through 1984 with exclusion of the first year of observation showed that the observed number of cancers in females (1,294) was eight percent higher than expected (relative risk [RR]=1.1, 95 percent confidence interval

  2. Management of patients with risk factors

    PubMed Central

    Waldfahrer, Frank

    2013-01-01

    This review addresses concomitant diseases and risk factors in patients treated for diseases of the ears, nose and throat in outpatient and hospital services. Besides heart disease, lung disease, liver disease and kidney disease, this article also covers disorders of coagulation (including therapy with new oral anticoagulants) and electrolyte imbalance. Special attention is paid to the prophylaxis, diagnosis and treatment of perioperative delirium. It is also intended to help optimise the preparation for surgical procedures and pharmacotherapy during the hospital stay. PMID:24403970

  3. Expression of Y-box-binding protein YB-1 allows stratification into long- and short-term survivors of head and neck cancer patients

    PubMed Central

    Kolk, A; Jubitz, N; Mengele, K; Mantwill, K; Bissinger, O; Schmitt, M; Kremer, M; Holm, P S

    2011-01-01

    Background: Histology-based classifications and clinical parameters of head and neck squamous cell carcinoma (HNSCC) are limited in their clinical capacity to provide information on prognosis and treatment choice of HNSCC. The primary aim of this study was to analyse Y-box-binding protein-1 (YB-1) protein expression in different grading groups of HNSCC patients, and to correlate these findings with the disease-specific survival (DSS). Methods: We investigated the expression and cellular localisation of the oncogenic transcription/translation factor YB-1 by immunohistochemistry on tissue micro arrays in a total of 365 HNSCC specimens and correlated expression data with clinico-pathological parameters including DSS. Results: Compared with control tissue from healthy individuals, a significantly (P<0.01) increased YB-1 protein expression was observed in high-grade HNSCC patients. By univariate survival data analysis, HNSCC patients with elevated YB-1 protein expression had a significantly (P<0.01) decreased DSS. By multivariate Cox regression analysis, high YB-1 expression and nuclear localisation retained its significance as a statistically independent (P<0.002) prognostic marker for DSS. Within grade 2 group of HNSCC patients, a subgroup defined by high nuclear and cytoplasmic YB-1 levels (co-expression pattern) in the cells of the tumour invasion front had a significantly poorer 5-year DSS rate of only 38% compared with overall 55% for grade 2 patients. Vice versa, the DSS rate was markedly increased to 74% for grade 2 cancer patients with low YB-1 protein expression at the same localisation. Conclusion: Our findings point to the fact that YB-1 expression in combination with histological classification in a double stratification strategy is superior to classical grading in the prediction of tumour progression in HNSCC. PMID:22095225

  4. Allocation Constraints in Stratification

    Microsoft Academic Search

    Marcin Kozak; Pawel Jankowski

    2008-01-01

    When a finite population is to be stratified, one of constraints in stratification is that sample sizes from strata may not be greater than the corresponding stratum sizes and may not be smaller than two. There are several ways of treating this allocation constraint, each providing an alternative approach to stratification. In this article, it is shown that a choice

  5. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

    PubMed Central

    Korosoglou, Grigorios; Giusca, Sorin; Gitsioudis, Gitsios; Erbel, Christian; Katus, Hugo A.

    2014-01-01

    Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein. PMID:25147526

  6. Isolation for high-risk patients

    PubMed Central

    Emond, Ronald T. D.

    1976-01-01

    Standard isolation accommodation provides adequate protection against the infectious diseases prevalent in the U.K. but higher standards are necessary for more dangerous infections imported from overseas. These may be provided reasonably cheaply by modifying existing wards but staff are still exposed to risk. By physically separating the patient from the attendants, the Trexler plastic isolator affords a greater degree of protection and is of particular value when dealing with a dangerous infection against which there is no form of immunization. ImagesFig. 3 PMID:981101

  7. [Clinical stratification of cardiogenic shock].

    PubMed

    Martínez Sánchez, Carlos Rodolfo; Martínez-Reding, Jesús Octavio; Lupi Herrera, Eulo

    2006-01-01

    Cardiogenic shock (CHC) associated to acute myocardial infarct has high mortality and their manifestations are heterogenous. In our institution historical mortality, was 98%, but with different methods of reperfusion, its reduced to 53%. In other hand, with opportune clinical stratification is useful to improve the treatment strategy. This stratification on basis in clinical signs: age, infarction location, cardiac frequency and systemic arterial pressure, and hemodynamical valuation with the use of right catheterism with quantification miocardial work parameters like "Cardiac power" that is the product of flow and arterial pressure and that is of utility to know the "Miocardial reserve". In our experience after reperfusion procedure patients with CHC and cardiac power less than 1.0 had highly mortality. PMID:17017114

  8. Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

    Microsoft Academic Search

    Alan S. Go; Margaret C. Fang; Natalia Udaltsova; Yuchiao Chang

    Background—Atrial fibrillation (AF) substantially increases the risk of ischemic stroke, but this risk varies among individual patients with AF. Existing risk stratification schemes have limited predictive ability. Chronic kidney disease is a major cardiovascular risk factor, but whether it independently increases the risk for ischemic stroke in persons with AF is unknown. Methods and Results—We examined how chronic kidney disease

  9. Stratification of the phase clouds and statistical effects of the non-Markovity in chaotic time series of human gait for healthy people and Parkinson patients

    NASA Astrophysics Data System (ADS)

    Yulmetyev, Renat; Demin, Sergey; Emelyanova, Natalya; Gafarov, Fail; Hänggi, Peter

    2003-03-01

    In this work we develop a new method of diagnosing the nervous system diseases and a new approach in studying human gait dynamics with the help of the theory of discrete non-Markov random processes (Phys. Rev. E 62 (5) (2000) 6178, Phys. Rev. E 64 (2001) 066132, Phys. Rev. E 65 (2002) 046107, Physica A 303 (2002) 427). The stratification of the phase clouds and the statistical non-Markov effects in the time series of the dynamics of human gait are considered. We carried out the comparative analysis of the data of four age groups of healthy people: children (from 3 to 10 year olds), teenagers (from 11 to 14 year olds), young people (from 21 up to 29 year olds), elderly persons (from 71 to 77 year olds) and Parkinson patients. The full data set are analyzed with the help of the phase portraits of the four dynamic variables, the power spectra of the initial time correlation function and the memory functions of junior orders, the three first points in the spectra of the statistical non-Markov parameter. The received results allow to define the predisposition of the probationers to deflections in the central nervous system caused by Parkinson's disease. We have found out distinct differences between the five submitted groups. On this basis we offer a new method of diagnostics and forecasting Parkinson's disease.

  10. The risks of minor head injury in the warfarinised patient.

    PubMed Central

    Volans, A P

    1998-01-01

    The risk factors affecting intracranial haemorrhage in warfarinised patients are described and an attempt made to calculate the risk of haemorrhage in warfarinised patients with minor head injuries. Using the data from studies of patients with spontaneous haemorrhage while taking warfarin, guidelines for treatment and given and the likely outcome predicted. PMID:9639176

  11. Progression in Acute Stroke Value of the Initial NIH Stroke Scale Score on Patient Stratification in Future Trials

    Microsoft Academic Search

    Thomas J. DeGraba; John M. Hallenbeck; Karen D. Pettigrew; Andrew J. Dutka; Brian J. Kelly

    Background and Purpose—The objective was to determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to initial stroke severity. Methods—The National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 127 consecutive ischemic stroke patients (129 strokes) admitted to the neuroscience intensive care unit. Incidence of

  12. Simple Stratification of Survival Using Bone Scan and Serum C-Reactive Protein in Prostate Cancer Patients with Metastases

    Microsoft Academic Search

    Jun Nakashima; Eiji Kikuchi; Akira Miyajima; Ken Nakagawa; Mototsugu Oya; Takashi Ohigashi; Masaru Murai

    2008-01-01

    Background: IL-6 has been reported to be a significant prognostic factor for prostate cancer and induces synthesis of C-reactive protein (CRP) by hepatocytes. The present study was undertaken to evaluate the clinical value of serum CRP in prostate cancer patients with metastases. Methods: The prognostic significance of serum CRP as well as tumor histology, extent of disease (EOD) on bone

  13. Cancer Stratification by Molecular Imaging

    PubMed Central

    Weber, Justus; Haberkorn, Uwe; Mier, Walter

    2015-01-01

    The lack of specificity of traditional cytotoxic drugs has triggered the development of anticancer agents that selectively address specific molecular targets. An intrinsic property of these specialized drugs is their limited applicability for specific patient subgroups. Consequently, the generation of information about tumor characteristics is the key to exploit the potential of these drugs. Currently, cancer stratification relies on three approaches: Gene expression analysis and cancer proteomics, immunohistochemistry and molecular imaging. In order to enable the precise localization of functionally expressed targets, molecular imaging combines highly selective biomarkers and intense signal sources. Thus, cancer stratification and localization are performed simultaneously. Many cancer types are characterized by altered receptor expression, such as somatostatin receptors, folate receptors or Her2 (human epidermal growth factor receptor 2). Similar correlations are also known for a multitude of transporters, such as glucose transporters, amino acid transporters or hNIS (human sodium iodide symporter), as well as cell specific proteins, such as the prostate specific membrane antigen, integrins, and CD20. This review provides a comprehensive description of the methods, targets and agents used in molecular imaging, to outline their application for cancer stratification. Emphasis is placed on radiotracers which are used to identify altered expression patterns of cancer associated markers. PMID:25749472

  14. Cancer stratification by molecular imaging.

    PubMed

    Weber, Justus; Haberkorn, Uwe; Mier, Walter

    2015-01-01

    The lack of specificity of traditional cytotoxic drugs has triggered the development of anticancer agents that selectively address specific molecular targets. An intrinsic property of these specialized drugs is their limited applicability for specific patient subgroups. Consequently, the generation of information about tumor characteristics is the key to exploit the potential of these drugs. Currently, cancer stratification relies on three approaches: Gene expression analysis and cancer proteomics, immunohistochemistry and molecular imaging. In order to enable the precise localization of functionally expressed targets, molecular imaging combines highly selective biomarkers and intense signal sources. Thus, cancer stratification and localization are performed simultaneously. Many cancer types are characterized by altered receptor expression, such as somatostatin receptors, folate receptors or Her2 (human epidermal growth factor receptor 2). Similar correlations are also known for a multitude of transporters, such as glucose transporters, amino acid transporters or hNIS (human sodium iodide symporter), as well as cell specific proteins, such as the prostate specific membrane antigen, integrins, and CD20. This review provides a comprehensive description of the methods, targets and agents used in molecular imaging, to outline their application for cancer stratification. Emphasis is placed on radiotracers which are used to identify altered expression patterns of cancer associated markers. PMID:25749472

  15. Income Stratification and Income Inequality

    Microsoft Academic Search

    Shlomo Yitzhaki; Robert I. Lerman

    1991-01-01

    This paper develops a new index of stratification that highlights the distinction between inequality and stratification. The stratification index captures the extent to which population subgroups occupy disctinct strata within an overall distribution. The indices are group specific and control for group size. A weighted sum of group stratification indices is the third term that, together with between-group inequality and

  16. Risk of malignancy in patients with celiac disease

    Microsoft Academic Search

    Peter H. R Green; Aaron T Fleischauer; Govind Bhagat; Rishi Goyal; Bana Jabri; Alfred I Neugut

    2003-01-01

    PurposeStudies from Europe have demonstrated an increased risk of malignancy, especially non-Hodgkin’s lymphoma, in patients with celiac disease. However, there are no data on the risk for similar patients in the United States. Our aim was to estimate the risk of malignancy in a cohort of patients with celiac disease compared with the general U.S. population and to determine if

  17. Dissecting DNA repair in adult high grade gliomas for patient stratification in the post-genomic era

    PubMed Central

    Perry, Christina; Agarwal, Devika; Abdel-Fatah, Tarek M.A.; Lourdusamy, Anbarasu; Grundy, Richard; Auer, Dorothee T.; Walker, David; Lakhani, Ravi; Scott, Ian S.; Chan, Stephen; Ball, Graham; Madhusudan, Srinivasan

    2014-01-01

    Deregulation of multiple DNA repair pathways may contribute to aggressive biology and therapy resistance in gliomas. We evaluated transcript levels of 157 genes involved in DNA repair in an adult glioblastoma Test set (n=191) and validated in ‘The Cancer Genome Atlas’ (TCGA) cohort (n=508). A DNA repair prognostic index model was generated. Artificial neural network analysis (ANN) was conducted to investigate global gene interactions. Protein expression by immunohistochemistry was conducted in 61 tumours. A fourteen DNA repair gene expression panel was associated with poor survival in Test and TCGA cohorts. A Cox multivariate model revealed APE1, NBN, PMS2, MGMT and PTEN as independently associated with poor prognosis. A DNA repair prognostic index incorporating APE1, NBN, PMS2, MGMT and PTEN stratified patients in to three prognostic sub-groups with worsening survival. APE1, NBN, PMS2, MGMT and PTEN also have predictive significance in patients who received chemotherapy and/or radiotherapy. ANN analysis of APE1, NBN, PMS2, MGMT and PTEN revealed interactions with genes involved in transcription, hypoxia and metabolic regulation. At the protein level, low APE1 and low PTEN remain associated with poor prognosis. In conclusion, multiple DNA repair pathways operate to influence biology and clinical outcomes in adult high grade gliomas. PMID:25026297

  18. Risk assessment and prophylaxis for VTE in cancer patients.

    PubMed

    Khorana, Alok A

    2011-07-01

    The frequency of venous thromboembolism (VTE) is rising in patients with cancer. VTE contributes to mortality and morbidity, but the risk for VTE can vary widely between individual patients. Clinical risk factors for VTE in cancer include primary site of cancer, use of systemic therapy, surgery, and hospitalization. Biomarkers predictive of VTE include platelet and leukocyte counts, hemoglobin, D-dimer, and tissue factor. A recently validated risk model incorporates 5 easily available variables and can be used clinically to identify patients at increased risk of VTE. In high-risk settings, including surgery and hospitalization, thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparins has been shown to be safe and effective. Recent studies have also suggested a potential benefit for thromboprophylaxis in the ambulatory setting, although criteria for selecting patients for prophylaxis are not currently well defined. This article focuses on recent and ongoing studies of risk assessment and prophylaxis in patients with cancer. PMID:21715725

  19. Risk of thromboembolic events in patients with atrial flutter

    Microsoft Academic Search

    Karlheinz Seidl; Bernd Hauer; Nicola G Schwick; Dietmar Zellner; Ralf Zahn; Jochen Senges

    1998-01-01

    Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter.

  20. Comorbidities and cardiovascular risk factors in patients with psoriasis*

    PubMed Central

    Baeta, Isabela Guimarães Ribeiro; Bittencourt, Flávia Vasques; Gontijo, Bernardo; Goulart, Eugênio Marcos Andrade

    2014-01-01

    BACKGROUND Psoriasis is a chronic inflammatory disease and its pathogenesis involves an interaction between genetic, environmental, and immunological factors. Recent studies have suggested that the chronic inflammatory nature of psoriasis may predispose to an association with other inflammatory diseases, especially cardiovascular diseases and metabolic disorders. OBJECTIVES To describe the demographic, clinical, epidemiological, and laboratory characteristics of a sample of psoriasis patients; to assess the prevalence of cardiovascular comorbidities in this group of patients; and to identify the cardiovascular risk profile using the Framingham risk score. METHODS We conducted a cross-sectional study involving the assessment of 190 patients. Participants underwent history and physical examination. They also completed a specific questionnaire about epidemiological data, past medical history, and comorbidities. The cardiovascular risk profile was calculated using the Framingham risk score. RESULTS Patients' mean age was 51.5 ± 14 years, and the predominant clinical presentation was plaque psoriasis (78.4%). We found an increased prevalence of systemic hypertension, type 2 diabetes, metabolic syndrome, and obesity. Increased waist circumference was also found in addition to a considerable prevalence of depression, smoking, and regular alcohol intake. Patients' cardiovascular risk was high according to the Framingham risk score, and 47.2% of patients had moderate or high risk of fatal and non-fatal coronary events in 10 years. CONCLUSIONS Patients had high prevalence of cardiovascular comorbidities, and high cardiovascular risk according to the Framingham risk score. Further epidemiological studies are needed in Brazil for validation of our results. PMID:25184912

  1. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients

    Microsoft Academic Search

    Kamyar Kalantar-Zadeh; Gladys Block; Michael H. Humphreys; Joel D. Kopple

    2003-01-01

    Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Conventional risk factors of cardiovascular disease and mortality in the general population such as body mass, serum cholesterol, and blood pressure are also found to relate to outcome in maintenance dialysis patients, but often in an opposite direction. Obesity, hypercholesterolemia, and hypertension appear to be protective features that are associated

  2. Coronary risk factors in patients underwent coronary artery bypass grafting.

    PubMed

    Safaei, Nasser; Alikhah, Hossein; Abadan, Younes

    2011-01-01

    Coronary Artery Disease (CAD) risk increases with increasing number of risk factors. This study was aimed to assess different coronary risk factors among Coronary Artery Bypass Grafting (CABG) surgery patients. A total of 700 patients younger than 45 or older than 65 years and underwent CABG in Tabriz Shahid Madani Heart Center since 2003 to 2007 were enrolled. We examined the probable differences of CAD risk factors between male and female groups and age groups. We also assessed the change of risk factors presentation in last 5 years. There was not significant difference between risk factor numbers in <45 and >65 years groups, but smoking and dyslipidemia was more prevalent in patients < 45 than > 65 years old. Hypertension and diabetes mellitus was more prevalent in patients > 65 old than < 45 years old; also differences were found between males and females patients, so that dyslipidemia, diabetes and hypertension were more prevalent in women than men. Some risk factors were recognized as acting more on one gender than the other. Also, the majority of patients have one or more risk factors, but different age and gender groups may have different risk factors that suggest the need for exact programming for appropriate prophylactic and therapeutic interventions in all groups. PMID:21913494

  3. Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score

    PubMed Central

    Cavalcanti, Paulo Ernando Ferraz; Sá, Michel Pompeu Barros de Oliveira; dos Santos, Cecília Andrade; Esmeraldo, Isaac Melo; Chaves, Mariana Leal; Lins, Ricardo Felipe de Albuquerque; Lima, Ricardo de Carvalho

    2015-01-01

    Objective To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality. Methods Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed. Results 360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766. Conclusion The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality.

  4. A Clinical Prediction Model to Estimate Risk for Thirty Day Adverse Events in Emergency Department Patients with Symptomatic Atrial Fibrillation

    PubMed Central

    Barrett, Tyler W.; Martin, Amy R.; Storrow, Alan B.; Jenkins, Cathy A; Harrell, Frank E.; Russ, Stephan; Roden, Dan M.; Darbar, Dawood

    2010-01-01

    Study Objective Atrial fibrillation (AF) affects over 2 million people in the United States and accounts for nearly 1% of emergency department (ED) visits. Physicians have little information to guide risk stratification of patients with symptomatic AF and admit more than 65%. Our aim was to assess whether data available in the ED management of symptomatic AF can estimate a patient's risk of experiencing a 30-day adverse event. Methods We systematically reviewed the electronic medical records of all ED patients presenting with symptomatic AF between August 2005 and July 2008. Predefined adverse outcomes included 30-day ED return visit, unscheduled hospitalization, cardiovascular complication or death. We performed multivariable logistic regression to identify predictors of 30-day adverse events. The model was validated using 300 bootstrap replications. Results During the 3-year study period, 914 patients accounted for 1228 ED visits. Eighty patients were excluded for non-AF related complaints and 2 patients had no follow-up recorded. Of 832 eligible patients, 216 (25.9%) experienced at least one of the 30-day adverse events. Increasing age (odds ratio [OR] and [95% CI]: 1.20 per decade [1.06, 1.36]), complaint of dyspnea (OR: 1.57 [1.12, 2.20]), smokers (OR: 2.35 [1.47, 3.76]), inadequate ventricular rate control (OR: 1.58 [1.13, 2.21]), and patients taking beta-blockers (OR: 1.44 [1.02, 2.04]) were independently associated with higher risk for adverse events. C-index was 0.67. Conclusion In ED patients with symptomatic AF, increased age, inadequate ED ventricular rate control, dyspnea, smoking, and beta-blocker treatment were associated with an increased risk of a 30-day adverse event. PMID:20728962

  5. The Matrix Metalloproteinase-7 Polymorphism Rs10895304 Is Associated With Increased Recurrence Risk in Patients With Clinically Localized Prostate Cancer

    SciTech Connect

    Jaboin, Jerry J. [Department of Radiation Oncology, Vanderbilt University, Nashville, TN (United States); Hwang, Misun; Lopater, Zachary [School of Medicine, Vanderbilt University, Nashville, TN (United States); Chen Heidi [Department of Biostatistics, Vanderbilt University, Nashville, TN (United States); Ray, Geoffrey L. [Department of Radiation Oncology, Howard University College of Medicine, Washington DC (United States); Perez, Carmen [School of Medicine, Vanderbilt University, Nashville, TN (United States); Cai Qiuyin [Department of Medicine and Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN (United States); Wills, Marcia L. [Department of Pathology, Vanderbilt University, Nashville, TN (United States); Lu Bo, E-mail: bo.lu@vanderbilt.ed [Department of Radiation Oncology, Vanderbilt University, Nashville, TN (United States)

    2011-04-01

    Purpose: To evaluate whether selected high-risk matrix metalloproteinase-7 single nucleotide polymorphisms influence clinicopathologic outcomes in patients with early-stage prostate cancer. Methods and Materials: Two hundred twelve prostate cancer patients treated with radical prostatectomy were evaluated with a median follow-up of 9.8 years. Genotyping was performed using hybridization with custom-designed allele-specific probes. Three single nucleotide polymorphisms within the matrix metalloproteinase-7 gene were assessed with respect to age at diagnosis, margin status, extracapsular extension, lymph node involvement, recurrence-free survival, and overall survival in paraffin-embedded prostate tissue specimens from patients with early-stage prostate cancer who underwent radical prostatectomy. Results: Rs10895304 was the sole significant polymorphism. The A/G genotype of rs10895304 had a statistically significant association with recurrence-free survival in postprostatectomy patients (p = 0.0061, log-rank test). The frequency of the risk-reducing genotype (A/A) was 74%, whereas that of the risk-enhancing genotypes (A/G and G/G) were 20% and 6%, respectively. Multivariable Cox regression analyses detected a significant association between rs10895304 and recurrences after adjustment for known prognostic factors. The G allele of this polymorphism was associated with increased risk of prostate cancer recurrence (adjusted hazards ratio, 3.375; 95% confidence interval 1.567-7.269; p < 0.001). The other assayed polymorphisms were not significant, and no correlations were made to other clinical variables. Conclusions: The A/G genotype of rs10895304 is predictive of decreased recurrence-free survival in patients with clinically localized prostate cancer. Our data suggest that for this subset of patients, prostatectomy alone may not be adequate for local control. This is a novel and relevant marker that should be evaluated for improved risk stratification of patients who may be candidates for adjuvant radiation therapy to improve local control.

  6. Referenceless stratification of parenchymal lung abnormalities.

    PubMed

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A; Bartholmai, Brian J; Robb, Richard A

    2011-01-01

    This paper introduces computational tools that could enable personalized, predictive, preemptive, and participatory (P4) Pulmonary medicine. We demonstrate approaches to (a) stratify lungs from different subjects based on the spatial distribution of parenchymal abnormality and (b) visualize the stratification through glyphs that convey both the grouping efficacy and an iconic overview of an individual's lung wellness. Affinity propagation based on regional parenchymal abnormalities is used in the referenceless stratification. Abnormalities are computed using supervised classification based on Earth Mover's distance. Twenty natural clusters were detected from 372 CT lung scans. The computed clusters correlated with clinical consensus of 9 disease types. The quality of inter- and intra-cluster stratification as assessed by ANOSIM R was 0.887 +/- 0.18 (pval < 0.0005). The proposed tools could serve as biomarkers to objectively diagnose pathology, track progression and assess pharmacologic response within and across patients. PMID:22003703

  7. Outcomes and Temporal Trends among High Risk Patients after Lung Transplantation in the US

    PubMed Central

    George, Timothy J.; Beaty, Claude A.; Kilic, Arman; Shah, Pali D.; Merlo, Christian A.; Shah, Ashish S.

    2014-01-01

    Introduction: Although several studies have evaluated risk factors for mortality after lung transplantation (LTx), few studies have focused on the highest risk recipients. We undertook this study to evaluate the impact of high lung allocation scores (LAS), ventilator support, and extracorporeal membrane oxygenation (ECMO) support on outcomes after LTx. Methods: We retrospectively reviewed all LTx recipients in the United Network for Organ Sharing database. Primary stratification was by recipient acuity at the time of LTx. The three strata consisted of: (1) recipients in the highest LAS quartile (LAS?48.4); (2) those requiring ventilator support; and (3) those requiring ECMO support. The primary outcome was 1-year mortality. Subgroup analysis focused on temporal trends. Results: From 05/2005-06/2011, 9,267 adult patients underwent LTx. Prior to LTx, 1,874 (20.2%) were in the highest LAS quartile, 526 (5.7%) required ventilator support, and 122 (1.3%) required ECMO support. On unadjusted analysis, ventilator and ECMO support were both associated with decreased 1-year survival compared to those in the highest LAS quartile (High LAS: 81.0% vs. Vent: 67.7% vs. ECMO: 57.6%, p<0.001 for each comparison). These differences persisted on adjusted analysis (Ventilator support, HR: 1.99, p<0.001; ECMO support, HR: 3.03, p<0.001). Increasing annual center volume was associated with decreased mortality. In patients bridged to LTx with ECMO support, 1-year survival improved over time (Coefficient: 8.03%/year, p=0.06). Conclusions: High acuity LTx recipients, particularly those bridged with ventilator or ECMO support, have increased short-term mortality after LTx. However, since the introduction of the LAS, high-risk patients have demonstrated improving outcomes, particularly at high volume centers. PMID:22885156

  8. Perceptions of high-risk patients and their providers on the patient-centered medical home.

    PubMed

    Kangovi, Shreya; Kellom, Katherine; Sha, Christopher; Johnson, Sarah; Chanton, Casey; Carter, Tamala; Long, Judith A; Grande, David

    2015-01-01

    To explore perceptions of high-risk patients and their practice staff on the patient-centered medical home, we conducted a multisite qualitative study with chronically ill, low-income patients and their primary care practice staff (N = 51). There were 3 key findings. Both patients and staff described a trade-off: timely care from an unfamiliar provider versus delayed access to their personal physician. Staff were enthusiastic about enhancing access through strategies such as online communication, yet high-risk patients viewed these as access barriers. Practices lacked capacity to manage high-risk patients and therefore frequently referred them to the emergency room. PMID:25748262

  9. STRATIFICATION OF MATRIX PENCILS IN

    E-print Network

    Johansson, Stefan

    STRATIFICATION OF MATRIX PENCILS IN SYSTEMS AND CONTROL: THEORY AND ALGORITHMS Stefan Johansson x UNIVERSITY SWEDEN #12;#12;Stratification of Matrix Pencils in Systems and Control: Theory and Algorithms and notation, Paper I gives an introduction to stratification for orbits and bundles of matrices, matrix

  10. REGULARITY OF THE BRUNOVSKYKRONECKER STRATIFICATION

    E-print Network

    Politècnica de Catalunya, Universitat

    REGULARITY OF THE BRUNOVSKY­KRONECKER STRATIFICATION J. FERRER ­ M.I. GARC'iA ­ F. PUERTA \\Lambda. We show that it is a constructible stratification, and that it is Whitney regular when the second, transversality, stratification, bifurcation. AMS subject classifications. 15A21, 93B10, 93B35. 1. Introduction

  11. 5, 187211, 2008 Stratification in

    E-print Network

    Paris-Sud XI, Université de

    OSD 5, 187­211, 2008 Stratification in estuarine models S. Blaise and E. Deleersnijder Title Page for the journal Ocean Science A new parameterisation of salinity advection to prevent stratification from running­211, 2008 Stratification in estuarine models S. Blaise and E. Deleersnijder Title Page Abstract Introduction

  12. Risk prediction and risk reduction in patients with manifest arterial disease

    Microsoft Academic Search

    B. M. B. Goessens

    2006-01-01

    Risicovoorspelling en risicoverlaging bij patienten met manifest vaatlijden Engelstalig abstract The number of patients with clinical manifest arterial disease is increasing because of the aging of the population. Patients with manifest arterial disease have an increased risk of a new vascular event in the same or different arterial bed. Medical treatment of vascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and

  13. Management of Newly Diagnosed Symptomatic Multiple Myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines

    PubMed Central

    Kumar, Shaji K.; Mikhael, Joseph R.; Buadi, Francis K.; Dingli, David; Dispenzieri, Angela; Fonseca, Rafael; Gertz, Morie A.; Greipp, Philip R.; Hayman, Suzanne R.; Kyle, Robert A.; Lacy, Martha Q.; Lust, John A.; Reeder, Craig B.; Roy, Vivek; Russell, Stephen J.; Short, Kristen E. Detweiler; Stewart, A. Keith; Witzig, Thomas E.; Zeldenrust, Steven R.; Dalton, Robert J.; Rajkumar, S. Vincent; Bergsagel, P. Leif

    2009-01-01

    Multiple myeloma is a malignant plasma cell neoplasm that affects more than 20,000 people each year and is the second most common hematologic malignancy. It is part of a spectrum of monoclonal plasma cell disorders, many of which do not require active therapy. During the past decade, considerable progress has been made in our understanding of the disease process and factors that influence outcome, along with development of new drugs that are highly effective in controlling the disease and prolonging survival without compromising quality of life. Identification of well-defined and reproducible prognostic factors and introduction of new therapies with unique modes of action and impact on disease outcome have for the first time opened up the opportunity to develop risk-adapted strategies for managing this disease. Although these risk-adapted strategies have not been prospectively validated, enough evidence can be gathered from existing randomized trials, subgroup analyses, and retrospective studies to develop a working framework. This set of recommendations represents such an effort—the development of a set of consensus guidelines by a group of experts to manage patients with newly diagnosed disease based on an interpretation of the best available evidence. PMID:19955246

  14. How can we identify the high-risk patient?

    PubMed Central

    Sankar, Ashwin; Beattie, W. Scott; Wijeysundera, Duminda N.

    2015-01-01

    Purpose of review Accurate and early identification of high-risk surgical patients allows for targeted use of perioperative monitoring and interventions that may improve their outcomes. This review summarizes current evidence on how information from the preoperative, operative, and immediate postoperative periods can help identify such individuals. Recent findings Simple risk indices, such as the Revised Cardiac Risk Index or American Society of Anesthesiologists Physical Status scale, and online calculators allow risk to be estimated with moderate accuracy using readily available preoperative clinical information. Both specific specialized tests (i.e., cardiopulmonary exercise testing and cardiac stress testing) and promising novel biomarkers (i.e., troponins and natriuretic peptides) can help refine these risk estimates before surgery. Estimates of perioperative risk can be further informed by information acquired during the operative and immediate postoperative periods, such as risk indices (i.e., surgical Apgar score), individual risk factors (i.e., intraoperative hypotension), or postoperative biomarkers (i.e., troponins and natriuretic peptides). Summary Preoperative clinical risk indices and risk calculators estimate surgical risk with moderate accuracy. Although novel biomarkers, specialized preoperative testing, and immediate postoperative risk indices show promise as methods to refine these risk estimates, more research is needed on how best to integrate risk information from these different sources. PMID:26083327

  15. Treating Patients with High-Risk Smoldering Myeloma

    Cancer.gov

    In this phase III clinical trial, patients with smoldering myeloma classified as high risk for progression will be randomly assigned to undergo standard observation or six 4-week courses of treatment with the drug lenalidomide.

  16. Prevalence and risk factors for osteopenia in dialysis patients

    Microsoft Academic Search

    Mark S. Stein; David K. Packham; Peter R. Ebeling; John D. Wark; Gavin J. Becker

    1996-01-01

    Dialysis patients are at risk for low bone mineral density (BMD) consequent of hyperparathyroidism, 1,25-dihydroxyvitamin D deficiency, previous immunosuppression, chronic acidosis, secondary amenorrhea, and chronic heparin and aluminum exposure. We wanted to determine the prevalence and distribution of osteopenia and the influence of risk factors for osteopenia in dialysis patients. Dual energy x-ray absorptiometry was used to record BMD at

  17. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients

    Microsoft Academic Search

    JOSEF ZIMMERMANN; SILKE HERRLINGER; ANTJE PRUY; THOMAS METZGER; CHRISTOPH WANNER

    1999-01-01

    Inflammation enhances cardiovascular risk and mortality in hemodialysis patients.BackgroundAtherosclerosis, a major problem in patients on chronic hemodialysis, has been characterized as an inflammatory disease. C-reactive protein (CRP), the prototypical acute phase protein in humans, is a predictor of cardiovascular mortality in the general population. We hypothesize that several of the classic, as well as nontraditional, cardiovascular risk factors may respond

  18. Two faller risk functions for geriatric assessment unit patients

    Microsoft Academic Search

    Jacqueline McClaran roDirector; Francoise Forette; Jean-Louis Golmard; Marie-Pierre Hérvy; Patrice Bouchacourt

    1991-01-01

    This study was done in order to construct a simple clinical failer predictor model, which quantifies risk for the individual\\u000a elderly patient. Fifty patients sequentially admitted to a geriatric assessment unit were assessed systematically at admission\\u000a for six potential failer risk factors: age, gait, speed, gait quality, gender, symptoms of urinary urgency, and symptoms of\\u000a dizziness. Falls were systematically recorded

  19. Nephrogenic systemic fibrosis and management of high-risk patients.

    PubMed

    Altun, Ersan; Semelka, Richard C; Cakit, Ceylan

    2009-07-01

    The purpose of this work is to provide current information on the rapidly evolving subject of nephrogenic systemic fibrosis (NSF), to establish the radiologic approach to the management of high-risk patients for NSF, and to assess the probabilistic risk of NSF compared to contrast induced nephropathy (CIN), as encountered with iodinated contrast media used in computed tomographic (CT) imaging. NSF is a disease process of considerable concern following gadolinium-containing contrast agents (GCCA) exposure in patients with diminished renal function. To minimize the possibility of NSF development in high-risk patients, GGCAs should not be used when they are not necessary, or the GCCAs, that have not at present been associated with NSF development, should be used at the lowest possible diagnostic dose, when they are necessary. Contrast-induced nephropathy is also a great risk in this patient population following the adminstration of iodinated contrast media (CM). In patients with diminished renal function who are not on regular dialysis, the risk of CIN following the administration of iodinated CM is higher than the risk of NSF following the administration of the most stable GCCAs. Risk benefit analysis should be performed prior to the administration of all CM, and the best combination of safety and diagnostic accuracy should be sought. Concern of NSF or CIN should not prevent the use of contrast agents in magnetic resonance imaging or computed tomography when they are deemed essential. PMID:19375360

  20. Adaptive Patient Education Framework Featuring Personalized Cardiovascular Risk Management

    E-print Network

    Abidi, Syed Sibte Raza

    Adaptive Patient Education Framework Featuring Personalized Cardiovascular Risk Management Interventions Selena Davis and Syed Sibte Raza Abidi Health Informatics Laboratory, Faculty of Computer Science of cardiovascular risk. We present a web-based adaptive hypermedia system to create and deliver the personalized

  1. Management in high-risk patients.

    PubMed

    Burns, Patrick; Highlander, Pete; Shinabarger, Andrew B

    2014-10-01

    Injuries to the foot and ankle are often missed or underestimated in patients with polytrauma and are a source of long-term limitations. Injures below the knee are among the highest causes for unemployment, longer sick leave, more pain, more follow-up appointments, and decreased overall outcome. As mortalities decrease for patients with polytrauma a greater emphasis on timely diagnosis and treatment of foot and ankle injuries is indicated. Geriatric patients represent nearly one-quarter of trauma admissions in the United States. This article discusses perioperative management and complications associated with foot and ankle injuries in polytrauma, and in diabetic and geriatric patients. PMID:25281513

  2. Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

    SciTech Connect

    Lee, Ching-Chih [Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (China); Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Su, Yu-Chieh [Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Ho, Hsu-Chueh [Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Hung, Shih-Kai; Lee, Moon-Sing [Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); School of Medicine, Tzu Chi University, Hualien, Taiwan (China); Chiou, Wen-Yen [Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Tumor Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China); Chou, Pesus [Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (China); Huang, Yung-Sung, E-mail: enttcd@hotmail.com [Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan (China)

    2011-12-01

    Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35-54 had a 1.66 times (95% CI, 1.16-2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55-64 years (hazard ratio = 0.87; 95% CI, 0.56-1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

  3. Precision medicine to improve use of bleeding avoidance strategies and reduce bleeding in patients undergoing percutaneous coronary intervention: prospective cohort study before and after implementation of personalized bleeding risks

    PubMed Central

    Decker, Carole; Gialde, Elizabeth; Jones, Philip G; McNulty, Edward J; Bach, Richard; Chhatriwalla, Adnan K

    2015-01-01

    Objective To examine whether prospective bleeding risk estimates for patients undergoing percutaneous coronary intervention could improve the use of bleeding avoidance strategies and reduce bleeding. Design Prospective cohort study comparing the use of bleeding avoidance strategies and bleeding rates before and after implementation of prospective risk stratification for peri-procedural bleeding. Setting Nine hospitals in the United States. Participants All patients undergoing percutaneous coronary intervention for indications other than primary reperfusion for ST elevation myocardial infarction. Main outcome measures Use of bleeding avoidance strategies, including bivalirudin, radial approach, and vascular closure devices, and peri-procedural bleeding rates, stratified by bleeding risk. Observed changes were adjusted for changes observed in a pool of 1135 hospitals without access to pre-procedural risk stratification. Hospital level and physician level variability in use of bleeding avoidance strategies was examined. Results In a comparison of 7408 pre-intervention procedures with 3529 post-intervention procedures, use of bleeding avoidance strategies within intervention sites increased with pre-procedural risk stratification (odds ratio 1.81, 95% confidence interval 1.44 to 2.27), particularly among higher risk patients (2.03, 1.58 to 2.61; 1.41, 1.09 to 1.83 in low risk patients, after adjustment for control sites; P for interaction=0.05). Bleeding rates within intervention sites were significantly lower after implementation of risk stratification (1.0% v 1.7%; odds ratio 0.56, 0.40 to 0.78; 0.62, 0.44 to 0.87, after adjustment); the reduction in bleeding was greatest in high risk patients. Marked variability in use of bleeding avoidance strategies was observed across sites and physicians, both before and after implementation. Conclusions Prospective provision of individualized bleeding risk estimates was associated with increased use of bleeding avoidance strategies and lower bleeding rates. Marked variability between providers highlights an important opportunity to improve the consistency, safety, and quality of care. Study registration Clinicaltrials.gov NCT01383382. PMID:25805158

  4. Gun Safety Management with Patients at Risk for Suicide

    ERIC Educational Resources Information Center

    Simon, Robert I.

    2007-01-01

    Guns in the home are associated with a five-fold increase in suicide. All patients at risk for suicide must be asked if guns are available at home or easily accessible elsewhere, or if they have intent to buy or purchase a gun. Gun safety management requires a collaborative team approach including the clinician, patient, and designated person…

  5. Epidemiology and risk factors of pneumonia in critically ill patients

    Microsoft Academic Search

    P. Mosconi; M. Langer; M. Cigada; M. Mandelli

    1991-01-01

    Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre “pneumonia studies” in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay = 48 hours and no rapidly irreversible illness at admission were included.

  6. Risk of Disease in Siblings of Patients with Hereditary Hemochromatosis

    Microsoft Academic Search

    Richard L. Nelson; Victoria Persky; Faith Davis; Eugene Becker

    2001-01-01

    Background: Parents of hereditary hemochromatosis (HH) homozygote patients, who are predominantly HH heterozygotes, have been found to have an increased risk of colonic neoplasia, diabetes, stroke death, stomach cancer and leukemia. The health histories of siblings of HH patients are reported. Methods: Individuals homozygous for HH were mailed questionnaires concerning the health histories of their siblings. Spouses of the HH

  7. Adrenal Insufficiency in High-Risk Surgical ICU Patients

    Microsoft Academic Search

    Emanuel P. Rivers; Mario Gaspari; George Abi Saad; Mark Mlynarek; John Fath; H. Matilda Horst; Jacobo Wortsman

    2001-01-01

    Study objectives: To examine the incidence and response to treatment of adrenal insufficiency (AI) in high-risk postoperative patients. Design: Prospective observational case series. Setting: Large urban tertiary-care surgical ICU (SICU). Participants: Adults > 55 years of age who required vasopressor therapy after adequate volume resuscitation in the immediate postoperative period. Interventions: Each patient underwent a cosyntropin (ACTH) stimulation test; at

  8. Intra-hospital transport of critically ill patients: minimising risk

    Microsoft Academic Search

    Peter J. Shirley; Julian F. Bion

    2004-01-01

    Sir, “Is your journey really necessary?” asked a railway poster during the privations of the Second World War. A similar question should be asked of clinicians committing sick patients to a transfer between, or within, hospitals, with the additional question, “Is this transfer really safe?” There are many potential risks associated with transporting the critically ill patient, including their greater

  9. Epidemiology of cardiovascular risk in patients with chronic kidney disease

    Microsoft Academic Search

    Francesco Locatelli; Pietro Pozzoni; Francesca Tentori; Lucia Del Vecchio

    2003-01-01

    Background. Chronic kidney disease (CKD) patients are highly prone to cardiovascular disease for a number of reasons. At the time of starting renal replacement treatment, their cardiovascular condition is already severely compromised, suggesting that cardiovascular risk factors begin to operate very early in the progression of CKD. Moreover, those patients reaching end-stage renal disease without cardiovascular abnormalities have a high

  10. Risk Factors for Hip Fracture in Hemodialysis Patients

    Microsoft Academic Search

    Hiroshi Kaji; Mizune Suzuki; Shozo Yano; Toshitsugu Sugimoto; Kazuo Chihara; Saburo Hattori; Kenichi Sekita

    2002-01-01

    Background: The incidence and mortality of hip fractures were several times greater in the patients with hemodialysis (HD) than in the general population. Although patients with end-stage renal disease develop renal osteodystrophy, few published data examined the risk factor of hip fractures in the dialysis population. Methods: The present study was performed to compare various indices and bone mineral density

  11. Neural network diagnostic system for dengue patients risk classification.

    PubMed

    Faisal, Tarig; Taib, Mohd Nasir; Ibrahim, Fatimah

    2012-04-01

    With the dramatic increase of the worldwide threat of dengue disease, it has been very crucial to correctly diagnose the dengue patients in order to decrease the disease severity. However, it has been a great challenge for the physicians to identify the level of risk in dengue patients due to overlapping of the medical classification criteria. Therefore, this study aims to construct a noninvasive diagnostic system to assist the physicians for classifying the risk in dengue patients. Systematic producers have been followed to develop the system. Firstly, the assessment of the significant predictors associated with the level of risk in dengue patients was carried out utilizing the statistical analyses technique. Secondly, Multilayer perceptron neural network models trained via Levenberg-Marquardt and Scaled Conjugate Gradient algorithms was employed for constructing the diagnostic system. Finally, precise tuning for the models' parameters was conducted in order to achieve the optimal performance. As a result, 9 noninvasive predictors were found to be significantly associated with the level of risk in dengue patients. By employing those predictors, 75% prediction accuracy has been achieved for classifying the risk in dengue patients using Scaled Conjugate Gradient algorithm while 70.7% prediction accuracy were achieved by using Levenberg-Marquardt algorithm. PMID:20703665

  12. Competing risks analysis in mortality estimation for breast cancer patients from independent risk groups

    E-print Network

    on breast cancer and other cause mortality. To estimate mortality probabilities from breast cancer and other, 9], our study predicts breast cancer mortality and mortality from other causes as a functionCompeting risks analysis in mortality estimation for breast cancer patients from independent risk

  13. Model-Based Stratification Stephanie Zimmer

    E-print Network

    Carriquiry, Alicia

    Model-Based Stratification Stephanie Zimmer Survey Working Group March 7, 2014 Zimmer (SWG) Model-Based Stratification March 7, 2014 1 / 13 #12;Introduction Stratification Stratification is used to create homogenous and population size of stratum h, respectively Model-based stratification takes into account the discrepancy

  14. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  15. Cumulative life course impairment: identifying patients at risk.

    PubMed

    Augustin, Matthias

    2013-01-01

    Cumulative life course impairment (CLCI) is a multidimensional construct, which reflects the overall increasing burden posed on patients by chronic (dermatological) disease. As such, CLCI can, to date, neither be directly measured nor can the patients' risk for CLCI be assessed by univocally defined screening scales. Presently, patients at risk for CLCI need to be identified by clinical, personal and psychosocial indicators and predictors of CLCI which need to be individually applied. Among those factors, the following are to be considered: (1) clinical disease severity; (2) chronic course of disease; (3) early onset of psoriasis; (4) perception of stigmatization; (5) lack of social support; (6) negative impact on profession; (7) 'negative' mood/personality trait; (8) coping strategy; (9) quality of life; (10) behaviors putting the patient at risk, and (11) comorbidities. Each of these factors requires accurate assessment either by clinical considerations or by specific tools. In particular, apart from other any single objectifiable risk factors, personality and social support of the patient can markedly affect the extent of CLCI and thus modulate the risks. PMID:23796811

  16. Using the STarT Back Tool: Does timing of stratification matter?

    PubMed

    Newell, D; Field, J; Pollard, D

    2015-08-01

    It is likely that individuals with nonspecific LBP (nsLBP) constitute a heterogenic group and targeting treatment appropriately to those most likely to respond is of major relevance. The STarT Back Tool (SBT) has been developed to stratify patients into risk groups to aid management choices. However, there is controversy over its generalisability and uncertainty as to the timing of use. This study investigated whether SBT categorisation early in a course of treatment would prove more prognostic than categorising patients at baseline. Seven hundred and forty nine patients over the age of 16 were recruited at 11 chiropractic clinics within the UK. The SBT was used to categorise these patients at presentation and 2 days following initial treatment with patient characteristics and condition specific markers also collected at baseline. The primary outcome was the Patient Global Impression of Change (PGIC) collected at 14, 30 and 90 days following the initial visit. In this population undergoing chiropractic care, patients had similar outcomes irrespective of their STarT back risk ranking. Multivariate prognostic models included only the post initial visit SBT as an independent predictor of favourable outcome for the medium risk group but only at 30 days. Follow up improvement was dominated by previous improvement in 30 and 90-day models. Over one third of patients swapped SBT risk groups in the 2 day period between initial stratification and post initial visit although there was little difference in eventual improvement at follow-up. Understanding the impact of timing of SBT stratification is indicated. PMID:25175750

  17. Self-criticism of physicians, patient participation and risk competence.

    PubMed

    Wolffsohn, Michael

    2015-01-01

    Self-criticism of physicians and patient participation are the pillars of modern medical ethics and medical programmes. Patients expect risk minimisation from physicians, mostly without realising how much they could actively do themselves in this respect. But what about the willingness of German people to take risks, how high is it really at present? Direct empirical data are not available, but results from general empirical research show that people's willingness to take risks is probably rather low. Post-heroic societies of welfare states are less likely to take risks than supposedly heroic ones. Therefore, the question whether it is responsible for medical experts to transfer even more responsibility to non-medical laypeople becomes increasingly important in a social context. PMID:26195919

  18. Self-criticism of physicians, patient participation and risk competence

    PubMed Central

    Wolffsohn, Michael

    2015-01-01

    Self-criticism of physicians and patient participation are the pillars of modern medical ethics and medical programmes. Patients expect risk minimisation from physicians, mostly without realising how much they could actively do themselves in this respect. But what about the willingness of German people to take risks, how high is it really at present? Direct empirical data are not available, but results from general empirical research show that people’s willingness to take risks is probably rather low. Post-heroic societies of welfare states are less likely to take risks than supposedly heroic ones. Therefore, the question whether it is responsible for medical experts to transfer even more responsibility to non-medical laypeople becomes increasingly important in a social context. PMID:26195919

  19. Risk factors for infection in the trauma patient.

    PubMed Central

    Morgan, A. S.

    1992-01-01

    The most common cause of late death following trauma is sepsis. The traumatized patient has a significant increased risk of infection. Transfusion, hypotension, and prolonged ventilatory support are predictive of septic complications. In addition, the trauma patient has a higher predisposition to pneumonia than nontrauma patients (18% versus 3% incidence of pneumonia, P < .001). Additional risk factors include the degree of nutrition status and the type of medications used during surgery. Immunologic depression may be an additional risk factor. There is mounting evidence that trauma can result in host defense abnormalities. To prevent the significant mortality caused by sepsis, close surveillance must be maintained, nutritional status must be optimal, and liberal use of antibiotics should be discouraged. Their use should be guided by appropriate cultures and sensitivities. PMID:1296993

  20. Risk assessment and psychosocial interventions for suicidal patients

    PubMed Central

    Chesin, Megan; Stanley, Barbara

    2013-01-01

    Objectives Suicide is a leading cause of death in the US. Although factors elevating long-term risk for suicide are known and include bipolar disorder, signs of imminent suicide risk are difficult to study and not well-specified. Acute risk determinations must be made to determine the appropriate level of care to safeguard patients. To increase safety among at-risk patients in the short term and to decrease risk over time, psychosocial interventions to prevent suicide have been developed and tested in acute care and outpatient settings. Methods A narrative review of studies of imminent risk factors for suicide, suicide risk decision making, and psychosocial suicide prevention interventions was conducted. Results While some long-term risk factors of suicide have been established, accurate identification of individuals at imminent risk for suicide is difficult. Therefore, prevention efforts targeting individuals at high suicide behavior risk discharging from acute care settings tend to be generic and focus on psychoeducation and supportive follow-up contact. Data regarding the effectiveness of brief interventions (i.e., those not requiring more than one individualized treatment session) is mixed, showing better outcomes in the shorter term and when incidence of suicidal behavior or ideation is the outcome. With respect to longer term suicide prevention interventions (i.e., those with a minimum of 10 sessions), Dialectical Behavior Therapy has the largest evidence base. Conclusions To improve suicide prevention efforts, more rigorous study of imminent risk factors and psychosocial interventions is needed. Adaptations specific to individuals with bipolar disorder are possible and needed. PMID:23782460

  1. Hyperhomocysteinaemia and Risk of Thrombosis in Systemic Lupus Erythematosus Patients

    Microsoft Academic Search

    T. M. K. Refai; I. H. Al-Salem; D. Nkansa-Dwamena; M. H. Al-Salem

    2002-01-01

    :   Hyperhomocysteinaemia is strongly associated with increased relative risk of occlusive vascular disease, mainly of the carotid\\u000a and coronary arteries. The aim of our study was to assess whether raised plasma homocysteine is a risk factor for thrombotic\\u000a events in patients with systemic lupus erythematosus (SLE), a condition known to be associated with premature atherothrombotic\\u000a complications. The study included 34

  2. Eulerian Stratification of Polyhedra Beifang Chen

    E-print Network

    Yan, Min

    Eulerian Stratification of Polyhedra Beifang Chen and Min Yan Department of Mathematics Hong Kong.1 Preliminaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2 Eulerian Stratification Stratifications 21 4.1 Construction of Eulerian Pieces . . . . . . . . . . . . . . . . . . . . . 21 4

  3. Recurrence Risk of Supraventricular Tachycardia in Pediatric Patients

    Microsoft Academic Search

    Thomas W. Riggs; Julie A. Byrd; Elliott Weinhouse

    1999-01-01

    We analyzed risk of recurrence of supraventricular tachycardia (SVT) in 70 pediatric patients using both Kaplan-Meier survival analysis and logistic regression of likelihood of recurrence, each with covariates: (1) age at onset of SVT; (2) presence of Wolff-Parkinson-White syndrome (WPW), and (3) gender. Among 38 patients who had onset of SVT <1 year, only 11 had a recurrence, while among

  4. Risk of Sleep Apnea in Hospitalized Older Patients

    PubMed Central

    Shear, Talia C.; Balachandran, Jay S.; Mokhlesi, Babak; Spampinato, Lisa M.; Knutson, Kristen L.; Meltzer, David O.; Arora, Vineet M.

    2014-01-01

    Background/Objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. Design: Prospective cohort study. Setting: General medicine ward in academic medical center Participants: 424 hospitalized adult patients ? 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). Main Measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and efficiency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). Key Results: Two of every 5 inpatients ? 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ? 5 h and mean sleep efficiency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ? 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These findings remained significant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ? 5.5% less sleep efficiency per night (-5.50 [-9.96, -1.05], p = 0.015). In multivariate analysis, patients at high risk for OSA also had lower self-reported sleep quality on KSQI (-0.101 [-0.164, -0.037], p = 0.002). Conclusion: Two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality. Commentary: A commentary on this article appears in this issue on page 1067. Citation: Shear TC, Balachandran JS, Mokhlesi B, Spampinato LM, Knutson KL, Meltzer DO, Arora VM. Risk of sleep apnea in hospitalized older patients. J Clin Sleep Med 2014;10(10):1061-1066. PMID:25317085

  5. Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients

    PubMed Central

    Kang, Dong-Yoon; Park, Soyoung; Rhee, Chul-Woo; Kim, Ye-Jee; Choi, Nam-Kyong; Lee, Joongyub

    2012-01-01

    Objectives To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the casecrossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. Results One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. Conclusions Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education. PMID:22880153

  6. Propellant thermal stratification

    NASA Technical Reports Server (NTRS)

    Winstead, T. W.

    1971-01-01

    The term thermal stratification is used to express nonuniform heat distribution within the bulk propellant. The nonuniform distribution of heat results in significant temperature variations in booster propulsion propellants and causes an undesirable increase in the self-pressurization rate of cryogen storage systems. A semiempirical prediction method has been developed for high gravity environments and is adequate for design purposes; model accuracy is somewhat limited to similarity in tank geometries, and additional work is needed to extend the correlation range. Several low gravity environment models that cover a broad range of predicted results have been developed. There are no applicable data by which any of these models may be selected in preference over the others.

  7. Antidepressants Reduce the Risk of Suicide among Elderly Depressed Patients

    Microsoft Academic Search

    Yoram Barak; Ahikam Olmer; Dov Aizenberg

    2006-01-01

    Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial. We aimed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder (MDD). This was a

  8. Impulsivity, Aggression and Suicide Risk among Male Schizophrenia Patients

    Microsoft Academic Search

    Iulian Iancu; Ehud Bodner; Suzana Roitman; Anna Piccone Sapir; Amir Poreh; Moshe Kotler

    2010-01-01

    Introduction: Impulsivity has been shown to be a major variable in the etiology of suicide and aggression, but has not been researched as much in the schizophrenic population, which is characterized by serious suicide and aggression risks. Methods: 68 male schizophrenia patients responded to a battery of measures including the Positive and Negative Syndrome Scale (PANSS), the impulsivity control scale

  9. Competing risks analysis in mortality estimation for breast cancer patients from independent risk groups.

    PubMed

    Zhang, Shengfan; Ivy, Julie S; Wilson, James R; Diehl, Kathleen M; Yankaskas, Bonnie C

    2014-09-01

    This study quantifies breast cancer mortality in the presence of competing risks for complex patients. Breast cancer behaves differently in different patient populations, which can have significant implications for patient survival; hence these differences must be considered when making screening and treatment decisions. Mortality estimation for breast cancer patients has been a significant research question. Accurate estimation is critical for clinical decision making, including recommendations. In this study, a competing risks framework is built to analyze the effect of patient risk factors and cancer characteristics on breast cancer and other cause mortality. To estimate mortality probabilities from breast cancer and other causes as a function of not only the patient's age or race but also biomarkers for estrogen and progesterone receptor status, a nonparametric cumulative incidence function is formulated using data from the community-based Carolina Mammography Registry. Based on the log(-log) transformation, confidence intervals are constructed for mortality estimates over time. To compare mortality probabilities in two independent risk groups at a given time, a method with improved power is formulated using the log(-log) transformation. PMID:24242701

  10. Quantitative Stratification of Diffuse Parenchymal Lung Diseases

    PubMed Central

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A.; Maldonado, Fabien; Peikert, Tobias; Moua, Teng; Ryu, Jay H.; Bartholmai, Brian J.; Robb, Richard A.

    2014-01-01

    Diffuse parenchymal lung diseases (DPLDs) are characterized by widespread pathological changes within the pulmonary tissue that impair the elasticity and gas exchange properties of the lungs. Clinical-radiological diagnosis of these diseases remains challenging and their clinical course is characterized by variable disease progression. These challenges have hindered the introduction of robust objective biomarkers for patient-specific prediction based on specific phenotypes in clinical practice for patients with DPLD. Therefore, strategies facilitating individualized clinical management, staging and identification of specific phenotypes linked to clinical disease outcomes or therapeutic responses are urgently needed. A classification schema consistently reflecting the radiological, clinical (lung function and clinical outcomes) and pathological features of a disease represents a critical need in modern pulmonary medicine. Herein, we report a quantitative stratification paradigm to identify subsets of DPLD patients with characteristic radiologic patterns in an unsupervised manner and demonstrate significant correlation of these self-organized disease groups with clinically accepted surrogate endpoints. The proposed consistent and reproducible technique could potentially transform diagnostic staging, clinical management and prognostication of DPLD patients as well as facilitate patient selection for clinical trials beyond the ability of current radiological tools. In addition, the sequential quantitative stratification of the type and extent of parenchymal process may allow standardized and objective monitoring of disease, early assessment of treatment response and mortality prediction for DPLD patients. PMID:24676019

  11. Quantitative stratification of diffuse parenchymal lung diseases.

    PubMed

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A; Maldonado, Fabien; Peikert, Tobias; Moua, Teng; Ryu, Jay H; Bartholmai, Brian J; Robb, Richard A

    2014-01-01

    Diffuse parenchymal lung diseases (DPLDs) are characterized by widespread pathological changes within the pulmonary tissue that impair the elasticity and gas exchange properties of the lungs. Clinical-radiological diagnosis of these diseases remains challenging and their clinical course is characterized by variable disease progression. These challenges have hindered the introduction of robust objective biomarkers for patient-specific prediction based on specific phenotypes in clinical practice for patients with DPLD. Therefore, strategies facilitating individualized clinical management, staging and identification of specific phenotypes linked to clinical disease outcomes or therapeutic responses are urgently needed. A classification schema consistently reflecting the radiological, clinical (lung function and clinical outcomes) and pathological features of a disease represents a critical need in modern pulmonary medicine. Herein, we report a quantitative stratification paradigm to identify subsets of DPLD patients with characteristic radiologic patterns in an unsupervised manner and demonstrate significant correlation of these self-organized disease groups with clinically accepted surrogate endpoints. The proposed consistent and reproducible technique could potentially transform diagnostic staging, clinical management and prognostication of DPLD patients as well as facilitate patient selection for clinical trials beyond the ability of current radiological tools. In addition, the sequential quantitative stratification of the type and extent of parenchymal process may allow standardized and objective monitoring of disease, early assessment of treatment response and mortality prediction for DPLD patients. PMID:24676019

  12. A Risk Score for Predicting 1-Year Mortality in Patients ?75 Years of Age Presenting With Non-ST-Elevation Acute Coronary Syndrome.

    PubMed

    Angeli, Fabio; Cavallini, Claudio; Verdecchia, Paolo; Morici, Nuccia; Del Pinto, Maurizio; Petronio, Anna Sonia; Antonicelli, Roberto; Murena, Ernesto; Bossi, Irene; De Servi, Stefano; Savonitto, Stefano

    2015-07-15

    Approximately 1/3 of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) are ?75 years of age. Risk stratification in these patients is generally difficult because supporting evidence is scarce. The investigators developed and validated a simple risk prediction score for 1-year mortality in patients ?75 years of age presenting with NSTE ACS. The derivation cohort was the Italian Elderly ACS trial, which included 313 patients with NSTE ACS aged ?75 years. A logistic regression model was developed to predict 1-year mortality. The validation cohort was a registry cohort of 332 patients with NSTE ACS meeting the same inclusion criteria as for the Italian Elderly ACS trial but excluded from the trial for any reason. The risk score included 5 statistically significant covariates: previous vascular event, hemoglobin level, estimated glomerular filtration rate, ischemic electrocardiographic changes, and elevated troponin level. The model allowed a maximum score of 6. The score demonstrated a good discriminating power (C statistic = 0.739) and calibration, even among subgroups defined by gender and age. When validated in the registry cohort, the scoring system confirmed a strong association with the risk for all-cause death. Moreover, a score ?3 (the highest baseline risk group) identified a subset of patients with NSTE ACS most likely to benefit from an invasive approach. In conclusion, the risk for 1-year mortality in patients ?75 years of age with NSTE ACS is substantial and can be predicted through a score that can be easily derived at the bedside at hospital presentation. The score may help in guiding treatment strategy. PMID:25978978

  13. LDL particle size and number compared with LDL cholesterol and risk categorization in end-stage renal disease patients

    PubMed Central

    Bowden, Rodney G.; Wilson, Ronald L.; Beaujean, A. Alexander

    2015-01-01

    Background Few studies have been conducted that make comparisons between traditional measures of cholesterol and cholesterol subfractions, and only one study has compared low-density lipoprotein cholesterol (LDL-C) particle number, LDL-C particle size and LDL-C among end-stage renal disease (ESRD) patients. The purpose of this study was to examine the relationships between cholesterol measures and differences in risk stratification when using ATP-III guidelines compared with cholesterol particle number and size in ESRD patients. Methods ESRD patients (n=1,092) from clinics associated with the Central Texas Nephrology Associates were recruited to participate in this study. Results LDL particle size categorized more patients at-risk when compared with LDL-C, non-HDL-C and triglycerides. Pearson correlation coefficients revealed a strong significant correlation between LDL-C and LDL particle number (r2=0.908, p=0.0001) and a significant correlation between LDL particle number and LDL particle size (r2=?0.290, p=0.0001). A significant but weak correlation existed between LDL-C and LDL particle size (r2=0.107, p=0.0001). A significant correlation existed between LDL particle number and triglycerides (r2=0.335, p=0.0001) and a significant inverse relationship between LDL particle size and triglycerides (r2=?0.500, p=0.0001). Conclusions Our study seems to suggest that using LDL particle size may help to identify those who would not be considered at-risk using LDL-C, non-HDL-C or triglycerides alone, and can be used as a further screening measure that may be more predictive of coronary heart disease outcomes. PMID:21360474

  14. Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide

    Microsoft Academic Search

    Marc S. Sabatine; David A. Morrow; James A. de Lemos

    2002-01-01

    Background—In patients with acute coronary syndromes (ACS), troponin I (TnI), C-reactive protein (CRP), and B-type natriuretic peptide (BNP) each predict adverse cardiac events. Little is known, however, about the utility of these biomarkers in combination. Methods and Results—Baseline measurements of TnI, CRP, and BNP were performed in 450 patients in OPUS-TIMI 16. Elevations in TnI, CRP, and BNP each were

  15. Bedside multimarker testing for risk-stratification in chest pain units: the chest pain evaluation by creatine Kinase-MB, myoglobin, and Troponin-I (CHECKMATE) study

    Microsoft Academic Search

    L. Kristin Newby; Alan B. Storrow; W. Brian Gibler

    2001-01-01

    Background—Earlier, rapid evaluation in chest pain units may make patient care more efficient. A multimarker strategy (MMS) testing for several markers of myocardial necrosis with different time-to-positivity profiles also may offer clinical advantages. Methods and Results—We prospectively compared bedside quantitative multimarker testing versus local laboratory results (LL) in 1005 patients in 6 chest pain units. Myoglobin, creatine kinase-MB, and troponin

  16. Constraint Stratification in Deductive Databases Kenneth A. Ross \\Lambda

    E-print Network

    Ross, Kenneth A.

    Constraint Stratification in Deductive Databases Kenneth A. Ross \\Lambda Columbia University kar­founded model. This condition, called constraint stratification, is significantly more general than previous syntactic conditions such as stratification and local stratification. Modular stratification has been

  17. Metabolomic profiling of schizophrenia patients at risk for metabolic syndrome.

    PubMed

    Paredes, R Madelaine; Quinones, Marlon; Marballi, Ketan; Gao, Xiaoli; Valdez, Celina; Ahuja, Seema S; Velligan, Dawn; Walss-Bass, Consuelo

    2014-08-01

    Second-generation antipsychotics (SGAs) are commonly used to treat schizophrenia. However, SGAs cause metabolic disturbances that can manifest as metabolic syndrome (MetS) in a subset of patients. The causes for these metabolic disturbances remain unclear. We performed a comprehensive metabolomic profiling of 60 schizophrenia patients undergoing treatment with SGAs that puts them at high (clozapine, olanzapine), medium (quetiapine, risperidone), or low (ziprasidone, aripiprazole) risk for developing MetS, compared to a cohort of 20 healthy controls. Multiplex immunoassays were used to measure 13 metabolic hormones and adipokines in plasma. Mass spectrometry was used to determine levels of lipids and polar metabolites in 29 patients and 10 controls. We found that levels of insulin and tumor necrosis factor alpha (TNF-?) were significantly higher (p < 0.005) in patients at medium and high risk for MetS, compared to controls. These molecules are known to be increased in individuals with high body fat content and obesity. On the other hand, adiponectin, a molecule responsible for control of food intake and body weight, was significantly decreased in patients at medium and high risk for MetS (p < 0.005). Further, levels of dyacylglycerides (DG), tryacylglycerides (TG) and cholestenone were increased, whereas ?-Ketoglutarate and malate, important mediators of the tricarboxylic acid (TCA) cycle, were significantly decreased in patients compared to controls. Our studies suggest that high- and medium-risk SGAs are associated with disruption of energy metabolism pathways. These findings may shed light on the molecular underpinnings of antipsychotic-induced MetS and aid in design of novel therapeutic approaches to reduce the side effects associated with these drugs. PMID:24565079

  18. The Prevalence of Risk Factors of Coronary Artery Disease in the Patients who Underwent Coronary Artery Bypass Graft, Shiraz, Iran: Suggesting a Model

    PubMed Central

    Ostovan, Mohammad Ali; Darvish, Negar; Askarian, Mehrdad

    2014-01-01

    Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented. Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery. Materials and Methods: In this cross-sectional (descriptive – analytical) study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0). Besides, P < 0.05 was considered as statistically significant. Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001), diabetes (P = 0.028), hypercholesterolemia (P = 0.020), and cigarette smoking (P = 0.001). In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level. Conclusions: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality. PMID:25614855

  19. [Management of vascular risk factors in patients older than 80].

    PubMed

    Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

    2014-08-01

    The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors. PMID:24908624

  20. Risk of Bladder Cancer Among Diabetic Patients Treated With Pioglitazone

    PubMed Central

    Lewis, James D.; Ferrara, Assiamira; Peng, Tiffany; Hedderson, Monique; Bilker, Warren B.; Quesenberry, Charles P.; Vaughn, David J.; Nessel, Lisa; Selby, Joseph; Strom, Brian L.

    2011-01-01

    OBJECTIVE Some preclinical in vivo studies and limited human data suggest a possible increased risk of bladder cancer with pioglitazone therapy. This is an interim report of an ongoing cohort study examining the association between pioglitazone therapy and the risk of bladder cancer in patients with diabetes. RESEARCH DESIGN AND METHODS This study includes 193,099 patients in the Kaiser Permanente Northern California diabetes registry who were ?40 years of age between 1997 and 2002. Those with prior bladder cancer were excluded. Ever use of each diabetes medication (defined as two or more prescriptions within 6 months) was treated as a time-dependent variable. Cox regression–generated hazard ratios (HRs) compared pioglitazone use with nonpioglitazone use adjusted for age, sex, race/ethnicity, diabetes medications, A1C, heart failure, household income, renal function, other bladder conditions, and smoking. RESULTS The group treated with pioglitazone comprised 30,173 patients. There were 90 cases of bladder cancer among pioglitazone users and 791 cases of bladder cancer among nonpioglitazone users. Overall, ever use of pioglitazone was not associated with risk of bladder cancer (HR 1.2 [95% CI 0.9–1.5]), with similar results in men and women (test for interaction P = 0.8). However, in the a priori category of >24 months of therapy, there was an increased risk (1.4 [1.03–2.0]). Ninety-five percent of cancers diagnosed among pioglitazone users were detected at early stage. CONCLUSIONS In this cohort of patients with diabetes, short-term use of pioglitazone was not associated with an increased incidence of bladder cancer, but use for more than 2 years was weakly associated with increased risk. PMID:21447663

  1. Clinical Symptoms and Risk Factors in Cerebral Microangiopathy Patients

    PubMed Central

    Okroglic, Sandra; Widmann, Catherine N.; Urbach, Horst; Scheltens, Philip; Heneka, Michael T.

    2013-01-01

    Objective Although the clinical manifestation and risk factors of cerebral microangiopathy (CM) remain unclear, the number of diagnoses is increasing. Hence, patterns of association among lesion topography and severity, clinical symptoms and demographic and disease risk factors were investigated retrospectively in a cohort of CM patients. Methods Patients treated at the Department of Neurology, University of Bonn for CM (n?=?223; 98m, 125f; aged 77.32±9.09) from 2005 to 2010 were retrospectively enrolled. Clinical symptoms, blood chemistry, potential risk factors, demographic data and ratings of vascular pathology in the brain based on the Wahlund scale were analyzed using Pearson's chi square test and one-way ANOVA. Results Progressive cognitive decline (38.1%), gait apraxia (27.8%), stroke-related symptoms and seizures (24.2%), TIA-symptoms (22%) and vertigo (17%) were frequent symptoms within the study population. Frontal lobe WMLs/lacunar infarcts led to more frequent presentation of progressive cognitive decline, seizures, gait apraxia, stroke-related symptoms, TIA, vertigo and incontinence. Parietooccipital WMLs/lacunar infarcts were related to higher frequencies of TIA, seizures and incontinence. Basal ganglia WMLs/lacunar infarcts were seen in patients with more complaints of gait apraxia, vertigo and incontinence. Age (p?=?.012), arterial hypertension (p<.000), obesity (p<.000) and cerebral macroangiopathy (p?=?.018) were positively related to cerebral lesion load. For increased glucose level, homocysteine, CRP and D-Dimers there was no association. Conclusion This underlines the association of CM with neurological symptoms upon admission in a topographical manner. Seizures and vertigo are symptoms of CM which may have been missed in previous studies. In addition to confirming known risk factors such as aging and arterial hypertension, obesity appears to increase the risk as well. Since the incidence of CM is increasing, future studies should focus on the importance of prevention of vascular risk factors on its pathogenesis. PMID:23393549

  2. Circulating matrix metalloproteinase-3 and metalloproteinase-9 and tissue Doppler measures of diastolic dysfunction to risk stratify patients with systolic heart failure.

    PubMed

    Buralli, Simona; Dini, Frank Lloyd; Ballo, Piercarlo; Conti, Umberto; Fontanive, Paolo; Duranti, Emiliano; Metelli, Maria Rita; Marzilli, Mario; Taddei, Stefano

    2010-03-15

    Abnormal matrix metalloproteinase (MMP) activity and diastolic dysfunction may affect left ventricular (LV) remodeling and prognosis, but it is not known whether the combined evaluation of MMP-3 and MMP-9 and variables of diastolic dysfunction are useful for the risk stratification of patients with systolic heart failure (HF). Therefore, this study was designed to assess the value of combining circulating levels of MMPs and tissue Doppler measures of LV diastolic dysfunction to risk-stratify patients with systolic HF. Consecutive patients with systolic HF due to either ischemic or nonischemic cardiomyopathy (n = 134) and LV ejection fractions <45% were submitted to complete echocardiographic and Doppler examinations. The ratio of mitral E peak velocity and averaged e' velocity (E/e') was calculated. Plasma levels of MMP-3 and MMP-9 were measured at the time of index echocardiography. All-cause mortality was defined as the end point. The mean LV ejection fraction was 28 +/- 9%. There was a total of 32 deaths during follow-up (24 +/- 14 months). Several clinical, biochemical, Doppler, and echocardiographic parameters were associated with the outcome on univariate Cox regression analysis. After statistical adjustment for the potentially confounding factors by multivariate analysis, E/e' (hazard ratio 1.11, p = 0.0028), ejection fraction (hazard ratio 0.92, p = 0.017), and MMP-9 (hazard ratio 1.01, p = 0.027) remained significant independent predictors of the end point. Kaplan-Meier curves showed that survival was worse in patients with E/e' ratios >/=13 and MMP-9 levels >89.9 ng/mL (p <0.0001). In conclusion, the assessment of circulating MMP levels and tissue Doppler measures of LV diastolic dysfunction may improve the prognostic stratification of patients with systolic HF. PMID:20211331

  3. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients

    PubMed Central

    Couto-Mallón, D; Rodríguez-Garrido, J; García-Guimaraes, M; Gargallo-Fernández, P; Piñón-Esteban, P; Aldama-López, G; Salgado-Fernández, J; Calviño-Santos, R; Vázquez-González, N; Castro-Beiras, A

    2013-01-01

    Aims: To compare the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION risk models in the ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: We studied all consecutive patients with STEMI who underwent PPCI at our institution between 2006 and 2010 (n=1391). The CRUSADE, ACUITY-HORIZONS, and ACTION risk scores were calculated based on the patients’ clinical characteristics. The occurrence of in-hospital major bleeding (defined as the composite of intracranial or intraocular bleeding, access site haemorrhage requiring intervention, reduction in haemoglobin ?4 g/dl without or ?3g/dl with overt bleeding source, reoperation for bleeding, or blood transfusion) reached 9.8%. Calibration and discrimination of the three risk models were evaluated by the Hosmer?Lemeshow test and the C-statistic, respectively. We compared the predictive accuracy of the risk scores by the DeLong non-parametric test. Results: Calibration of the three risk scores was adequate, given the non-significant results of Hosmer?Lemeshow test for the three risk models. Discrimination of CRUSADE, ACUITY-HORIZONS, and ACTION models was good (C-statistic 0.77, 0.70, and 0.78, respectively). The CRUSADE and ACTION risk scores had a greater predictive accuracy than the ACUITY-HORIZONS risk model (z=3.89, p-value=0.0001 and z=3.51, p-value=0.0004, respectively). There was no significant difference between the CRUSADE and ACTION models (z=0.63, p=0.531). Conclusions: The CRUSADE, ACUITY-HORIZONS, and ACTION scores are useful tools for the risk stratification of bleeding in STEMI treated by PPCI. Our findings favour the CRUSADE and ACTION risk models over the ACUITY-HORIZONS risk score. PMID:24062930

  4. Population Stratification in Epidemiologic Studies of Common Genetic Variants and Cancer: Quantification of Bias

    Microsoft Academic Search

    Sholom Wacholder; Nathaniel Rothman; Neil Caporaso

    2000-01-01

    Background: Some critics argue that bias from population stratification (the mixture of individuals from heterogeneous genetic backgrounds) undermines the credibility of epide- miologic studies designed to estimate the association between a genotype and the risk of disease. We investigated the de- gree of bias likely from population stratification in U.S. stud- ies of cancer among non-Hispanic Caucasians of European origin.

  5. Lectures on Real Stratification Theory David TROTMAN

    E-print Network

    Trotman, Davis

    Lectures on Real Stratification Theory David TROTMAN LATP-UMR 6632 University of Provence Marseille, France Preliminary version : 12 October 2005. 1. Stratifications. What is a stratification ? The idea papers [W2, W3] which appeared in 1965, concerning stratifications of real and complex analytic varieties

  6. Stratification and Gender Robert M Blackburn

    E-print Network

    de Gispert, Adrià

    Stratification and Gender Robert M Blackburn University of Cambridge Jennifer Jarman National of advantage/disadvantage of men compared to women in the stratification structure. The structural inequalities of social stratification are usually understood by sociologists as being represented in a stratification

  7. A Syntactic Stratification Condition Using Constraints

    E-print Network

    Ross, Kenneth A.

    A Syntactic Stratification Condition Using Constraints Kenneth A. Ross Department of Computer Science Columbia University New York, NY 10027 kar@cs.columbia.edu Abstract Stratification conditions. Previous stratification conditions suffer from one of two problems. Some (such as modular stratification

  8. Identification of Patients at Risk for Hereditary Colorectal Cancer

    PubMed Central

    Mishra, Nitin; Hall, Jason

    2012-01-01

    Diagnosis of hereditary colorectal cancer syndromes requires clinical suspicion and knowledge of such syndromes. Lynch syndrome is the most common cause of hereditary colorectal cancer. Other less common causes include familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), juvenile polyposis syndrome, and others. There have been a growing number of clinical and molecular tools used to screen and test at risk individuals. Screening tools include diagnostic clinical criteria, family history, genetic prediction models, and tumor testing. Patients who are high risk based on screening should be referred for genetic testing. PMID:23730221

  9. Identifying patients at risk of type 2 diabetes.

    PubMed

    Savill, Peter

    2012-01-01

    At present there are nearly 3 million people with diabetes in the UK. It is predicted that this number will almost double by 2025. Nine out of ten of these individuals will have type 2 diabetes. It is estimated that one in seven adults have impaired glucose regulation and up to 12% of these will develop type 2 diabetes each year. The impact of obesity on the development of type 2 diabetes cannot be overemphasised, with a 1 kg/m2 increase in BMI raising the risk of impaired fasting glycaemia by 9.5% and of developing new-onset type 2 diabetes by 8.4%. A 1 cm increase in waist circumference increases the risks by 3.2% and 3.5% respectively. NICE advises using a validated risk assessment tool to identify patients at risk of diabetes. Risk factors used by such tools include: age; ethnicity; weight; first-degree relative with type 2 diabetes; low birthweight and sedentary lifestyle. Certain comorbidities increase the risk of type 2 diabetes, these include: cardiovascular and cerebrovascular disease; polycystic ovary syndrome; a history of gestational diabetes; and mental health problems. The initial screening blood test could be a fasting plasma glucose, HbA1c, or an oral glucose tolerance test, according to WHO criteria. NICE recommends that high-risk patients should be offered a programme encouraging them to undertake a minimum of 150 minutes of moderate intensity physical activity a week, gradually lose weight to reach and maintain a BMI within the healthy range, increase consumption of whole grains, vegetables, and other foods that are high in dietary fibre, reduce the total amount of fat in their diet and eat less saturated fat. PMID:22988703

  10. Arthroprosthetic cobaltism: identification of the at-risk patient.

    PubMed

    Tower, Stephen

    2010-09-01

    MoM hip bearings are being scrutinized due to high early failure rates and concerns that the results of the revision surgeries will be poor. However, orthopedic surgeons and the general medical community are unaware that patients with MoM bearings are also at risk for cobaltism. Medical providers need to know that hip arthroplasty implantees that present with symptom complexes that include tinnitus, deafness, vertigo, visual changes, rashes, hypothyroidism, tremor, dyspnea on exertion, mood disorders, dementia, heart failure, and peripheral neuropathy may be presenting arthroprosthetic cobaltism. These patients need to be asked if they have had a hip replacement and if so what type. For those patients implanted with a MoM bearing or those with a history of hip revision for a failed ceramic bearing obtaining a [Co] is indicated. MoM implantees with renal failure are a particularly high risk for cobaltism. A [Co] can be measured by many reference laboratories from royal blue top trace elements tube of venous blood. Venipuncture with a standard needle is adequate as long as a red stoppered tube is drawn first. The radiographic appearance of a MoM bearing is readily apparent to an orthopedic surgeon. The patient's operative report will usually specify the bearing type. Given that the publicity of the recent ASR bearing recall medical providers will be contacted by worried patients concerned about their hip implants. Most patients with hip replacements will not know the brand or material of their bearings. Providing patients with copies of their hip implant inventory might avoid worry by the majority of patients with hip arthroplasties that are not at risk. Patients with a cobalt levels of greater than 7 mcg/l bear observation of neurologic and cardiac function. Those patients with levels greater than 20 should be advised to have revision of their hip arthroplasty to a bearing that eliminates cobalt. Most patients implanted with MoM bearing have cobalt levels greater than those allowed in industry and cobalt exposed workers may have an increased incidence of subclinical cognitive and cardiac impairments. This association merits further study. Table 1 is a summation of the previously referenced data of this paper that might assist the clinician in interpreting a [Co]. PMID:21066926

  11. Validation of the revised international prognostic scoring system (IPSS-R) in patients with lower-risk myelodysplastic syndromes: a report from the prospective European LeukaemiaNet MDS (EUMDS) registry.

    PubMed

    de Swart, Louise; Smith, Alex; Johnston, Thomas W; Haase, Detlef; Droste, Jackie; Fenaux, Pierre; Symeonidis, Argiris; Sanz, Guillermo; Hellström-Lindberg, Eva; Cermák, Jaroslav; Germing, Ulrich; Stauder, Reinhard; Georgescu, Otilia; MacKenzie, Marius; Malcovati, Luca; Holm, Mette S; Almeida, Antonio M; M?dry, Krzysztof; Slama, Borhane; Guerci-Bresler, Agnes; Sanhes, Laurence; Beyne-Rauzy, Odile; Luño, Elisa; Bowen, David; de Witte, Theo

    2015-08-01

    Baseline characteristics, disease-management and outcome of 1000 lower-risk myelodysplastic syndrome (MDS) patients within the European LeukaemiaNet MDS (EUMDS) Registry are described in conjunction with the validation of the revised International Prognostic Scoring System (IPSS-R). The EUMDS registry confirmed established prognostic factors, such as age, gender and World Health Organization 2001 classification. Low quality of life (EQ-5D visual analogue scale score) was significantly associated with reduced survival. A high co-morbidity index predicted poor outcome in univariate analyses. The IPSS-R identified a large group of 247 patients with Low (43%) and Very low (23%) risk score within the IPSS intermediate-1 patients. The IPSS-R also identified 32 High or Very high risk patients within the IPSS intermediate-1 patients. IPSS-R was superior to the IPSS for predicting both disease progression and survival. Seventy percent of patients received MDS-specific treatment or supportive care, including red blood cell transfusions (51%), haematopoietic growth factors (58%) and iron chelation therapy (8%), within 2 years of diagnosis; while 30% of the patients only required active monitoring. The IPSS-R proved its utility as a more refined risk stratification tool for the identification of patients with a very good or poor prognosis and in this lower-risk MDS population. PMID:25907546

  12. BCG vaccination in SCID patients: complications, risks and vaccination policies

    PubMed Central

    Marciano, Beatriz E; Huang, Chiung-Yu; Joshi, Gyan; Rezaei, Nima; Carvalho, Beatriz Costa; Allwood, Zoe; Ikinciogullari, Aydan; Reda, Shereen M; Gennery, Andrew; Thon, Vojtech; Espinosa-Rosales, Francisco; Al-Herz, Waleed; Porras, Oscar; Shcherbina, Anna; Szaflarska, Anna; Kiliç, ?ebnem; Franco, Jose L; Raccio, Andrea C Gómez; Roxo-Jr, Persio; Esteves, Isabel; Galal, Nermeen; Grumach, Anete Sevciovic; Al-Tamemi, Salem; Yildiran, Alisan; Orellana, Julio C; Yamada, Masafumi; Morio, Tomohiro; Liberatore, Diana; Ohtsuka, Yoshitoshi; Lau, Yu-Lung; Nishikomori, Ryuta; Torres-Lozano, Carlos; Mazzucchelli, Juliana TL; Vilela, Maria MS; Tavares, Fabiola S; Cunha, Luciana; Pinto, Jorge A; Espinosa-Padilla, Sara E; Hernandez-Nieto, Leticia; Elfeky, Reem A; Ariga, Tadashi; Toshio, Heike; Dogu, Figen; Cipe, Funda; Formankova, Renata; Nuñez-Nuñez, M Enriqueta; Bezrodnik, Liliana; Marques, Jose Gonçalo; Pereira, María I; Listello, Viviana; Slatter, Mary A; Nademi, Zohreh; Kowalczyk, Danuta; Fleisher, Thomas A.; Davies, Graham; Neven, Bénédicte; Rosenzweig, Sergio D

    2014-01-01

    Background SCID is a syndrome characterized by profound T cell deficiency. BCG vaccine is contraindicated in SCID patients. Because most countries encourage BCG vaccination at birth, a high percent of SCID patients are vaccinated before their immune defect is detected. Objectives To describe the complications and risks associated with BCG vaccination in SCID patients. Methods An extensive standardized questionnaire evaluating complications, therapeutics, and outcome regarding BCG in patients diagnosed with SCID was widely distributed. Summary statistics and association analysis was performed. Results Data on 349 BCG vaccinated SCID patients from 28 centers in 17 countries was analyzed. Fifty-one percent of the patients developed BCG complications, 34% disseminated and 17% localized (a 33,000 and 400 fold increase, respectively, over the general population). Patients receiving early vaccination (? 1 month) showed an increased prevalence of complications (p=0.006) and death due to BCG complications (p<0.0001). The odds of experiencing complications among patients with T cells ? 250/uL at diagnosis was 2.1 times higher (95% CI, 1.4-3.4; p = 0.001) than among those with T cells > 250/uL. BCG complications were reported in 2/78 patients who received anti-mycobacterial therapy while asymptomatic and no deaths due to BCG complications occurred in this group. In contrast 46 BCG-associated deaths were reported among 160 patients treated with anti-mycobacterial therapy for a symptomatic BCG infection (p<0.0001). Conclusions BCG vaccine has a very high rate of complications in SCID patients, which increase morbidity and mortality rates. Until safer and more efficient anti-tuberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications. PMID:24679470

  13. Risk of cancer among rheumatoid arthritis patients in California

    Microsoft Academic Search

    Arti Parikh-Patel; Richard H. White; Mark Allen; Rosemary Cress

    2009-01-01

    Objective  The objective of this retrospective cohort study was to evaluate cancer risk among rheumatoid arthritis (RA) patients in California.\\u000a \\u000a \\u000a \\u000a Methods  The study cohort derived from statewide patient discharge records was followed via linkage with cancer registry data over\\u000a the period 1991–2002. Age and sex adjusted standardized incidence ratios (SIRs) and 95% confidence intervals were calculated\\u000a to compare observed to expected numbers

  14. Tim-3 is highly expressed in T cells in acute myeloid leukemia and associated with clinicopathological prognostic stratification

    PubMed Central

    Li, Caixia; Chen, Xiaochen; Yu, Xiao; Zhu, Yibei; Ma, Chao; Xia, Rui; Ma, Jinfeng; Gu, Caihong; Ye, Lu; Wu, Depei

    2014-01-01

    T cells immunoglobulin mucin 3 (Tim-3) is an important inhibitory stimulatory molecule, which has been reported to play a vital role in the tumor immune escape and be correlated with clinicopathological prognostic stratification in solid tumor. However, the related research is rare of Tim-3 in non-solid tumor, such as acute myeloid leukemia (AML). In this study, we investigated the expression characteristics of Tim-3 on the peripheral blood T cells of newly diagnosed AML patients and its clinical significance. Peripheral blood was obtained from 36 patients with newly diagnosed AML before intervention, with peripheral blood from 20 cases of healthy volunteers collected as normal control. Expression levels of Tim-3 on the peripheral blood T cells were assayed with flow cytometry. We found that Tim-3 expression on the peripheral blood CD4+ T cells and CD8+ T cells in newly diagnosed AML patients were significantly increased compared with that of normal control. CD4+ T cells/CD8+ T cell ratio (CD4/CD8) of peripheral blood in AML patients was significantly correlated with NCCN high risk group. The higher expression level of Tim-3 on CD4+ T cells in the peripheral blood of AML patients had significant correlation with FLT3-ITD mutation, the higher expression level of Tim-3 on CD8+ T cells in AML patients was significantly correlated with NCCN high risk group. To conclude, our results support the concept that Tim-3 is highly expressed on the peripheral blood T cells of AML patients, and Tim-3 expression significantly correlates with clinicopathological prognostic stratification in AMLTim-3, T cell, acute myeloid leukemia, tumor immune escape, clinicopathological prognostic stratification PMID:25400771

  15. Optimizing glycoprotein IIb\\/IIIa receptor antagonist use for the non-ST–segment elevation acute coronary syndromes: risk stratification and therapeutic intervention

    Microsoft Academic Search

    James L Januzzi; Christopher P Cannon; Pierre Theroux; William E Boden

    2003-01-01

    Despite extensive data supporting their use for non-ST–segment elevation acute coronary syndromes, glycoprotein (GP) IIb\\/IIIa antagonists are underutilized. This is likely the consequence of confusion as to which patients should receive these agents, as well as to the most appropriate timing and venue for their initiation. We will review the advances in the understanding of GP IIb\\/IIIa antagonist therapy, emphasizing

  16. Patient-generated secure messages and eVisits on a patient portal: are patients at risk?

    PubMed Central

    North, Frederick; Crane, Sarah J; Stroebel, Robert J; Cha, Stephen S; Edell, Eric S; Tulledge-Scheitel, Sidna M

    2013-01-01

    Background Patient portals are becoming increasingly common, but the safety of patient messages and eVisits has not been well studied. Unlike patient-to-nurse telephonic communication, patient messages and eVisits involve an asynchronous process that could be hazardous if patients were using it for time-sensitive symptoms such as chest pain or dyspnea. Methods We retrospectively analyzed 7322 messages (6430 secure messages and 892 eVisits). To assess the overall risk associated with the messages, we looked for deaths within 30?days of the message and hospitalizations and emergency department (ED) visits within 7?days following the message. We also examined message content for symptoms of chest pain, breathing concerns, and other symptoms associated with high risk. Results Two deaths occurred within 30?days of a patient-generated message, but were not related to the message. There were six hospitalizations related to a previous secure message (0.09% of secure messages), and two hospitalizations related to a previous eVisit (0.22% of eVisits). High-risk symptoms were present in 3.5% of messages but a subject line search to identify these high-risk messages had a sensitivity of only 15% and a positive predictive value of 29%. Conclusions Patients use portal messages 3.5% of the time for potentially high-risk symptoms of chest pain, breathing concerns, abdominal pain, palpitations, lightheadedness, and vomiting. Death, hospitalization, or an ED visit was an infrequent outcome following a secure message or eVisit. Screening the message subject line for high-risk symptoms was not successful in identifying high-risk message content. PMID:23703826

  17. [Benefits and risks of electroconvulsive therapy (ECG) in elderly patients with cardiovascular risk factors].

    PubMed

    Agelink, M W; Dammers, S; Malessa, R; Leonhardt, M; Zitzelsberger, A; Ullrich, H; Zeit, T

    1998-01-01

    Between January 1995 and June 1996, 24 inpatients at our hospital (mean age 55.6 years) were treated with electroconvulsive therapy (ECT). Clinical improvement was observed in 80% of the patients, including those without risk factors (NRG, n = 16), as well as those with concomitant cardiovascular diseases (RG, n = 8). During a mean period of observation of 224 days after the end of ECT 7 patients (35%) relapsed. The rate of relapse was higher in RG than in NRG patients (57.1 vs 23.1%). In all cases ECT was well tolerated; 285 applications of ECT did not result in mortality or persistent morbidity. However, RG patients may be at increased risk for the development of minor cardiovascular complications, which were noted in three RG patients (37.5%), but only in one patient (6.2%) in the NRG (Fisher's test, P = 0.09). Taken together, our results demonstrate that ECT is a safe treatment regimen for depression even in medically ill patients of old age. PMID:9522336

  18. Scoring System May Predict Patient's Risk of Death in Next Year

    MedlinePLUS

    Scoring System May Predict Patient's Risk of Death in Next Year For now, researchers see this as a tool ... 8, 2015 (HealthDay News) -- A fairly simple scoring system appears to accurately estimate patients' risk of dying ...

  19. Surgical errors and risks - the head and neck cancer patient.

    PubMed

    Harréus, Ulrich

    2013-01-01

    Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery. PMID:24403972

  20. Innovative tools for assessing risks for severe adverse events in areas of overlapping Loa loa and other filarial distributions: the application of micro-stratification mapping

    PubMed Central

    2014-01-01

    Background The wide distribution of Loa loa infection (loiasis) throughout the Democratic Republic of Congo (DRC) is a major obstacle to the plans to eliminate onchocerciasis and lymphatic filariasis (LF) because the standard drug regime is dependent on ivermectin, which cannot be used in co-endemic areas due to the risk of severe adverse events (SAEs). A better understanding of the micro-epidemiology, overlapping low and high risk areas, and how they relate to SAEs is critical to ensure safe and effective treatment. Findings Based on published data from the Bas Congo Province in DRC, this study used geographical information systems (GIS) to re-map and analyse onchocerciasis and loiasis prevalence (<20%, 20 to 40%, >40%) at 144 sites in relation to health district areas reporting SAEs. The new maps highlighted the contrasting patterns of the high prevalence sites, and significant geographical overlap between low onchocerciasis and high loiasis sites. Statistical analyses found that sites with medium to high loiasis prevalence were 10 to 16 times more likely to be in a SAE area than those with low prevalence of loiasis. Sites where both onchocerciasis and loiasis prevalence was >20% were also associated with SAE areas. Conclusions Collaborative efforts between the national onchocerciasis and LF programmes are critical as plans to scale interventions are moving forward and thus, alternative strategies needed in loiasis co-endemic areas which may include the new L. loa test and treat strategy using the Cellscope, or interventions such as integrated vector management, or anti Wolbachia therapy using doxycycline. PMID:24992829

  1. Risk Management for Gastrointestinal Endoscopy in Elderly Patients: Questionnaire for Patients Undergoing Gastrointestinal Endoscopy

    PubMed Central

    Umegaki, Eiji; Abe, Shinya; Tokioka, Satoshi; Takeuchi, Nozomi; Takeuchi, Toshihisa; Yoda, Yukiko; Murano, Mitsuyuki; Higuchi, Kazuhide

    2010-01-01

    More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication. PMID:20104268

  2. Geriatric nutritional risk index: a mortality predictor in hemodialysis patients.

    PubMed

    Edalat-Nejad, Mahnaz; Zameni, Fatemeh; Qlich-Khani, Mahdi; Salehi, Fatemeh

    2015-03-01

    Recently, the Geriatric Nutritional Risk Index (GNRI) has been introduced as a valuable tool to assess the nutritional status of hemodialysis (HD) patients. To determine the predictive value of the GNRI score for death in HD, we studied 145 chronic HD patients (%53 men, mean age 60 ± 16 years). The GNRI score was estimated by an equation involving serum albumin and individual's weight and height. According to the highest positive likelihood and risk ratios, the cut-off value of the GNRI for mortality was set at 100. The survival of patients on HD was examined with the Cox proportional hazards model. Mortality was monitored prospectively over an 18-month period, during which 35 patients died. The GNRI (mean 102.6 ± 5.5) was significantly positively correlated with lean body mass, hematocrit, serum lipids and presence of metabolic syndrome. Multivariate Cox proportional hazards analysis demonstrated that the GNRI <100, serum ferritin ? 500 ? g/L and age 65 years or older were significant predictors for mortality (hazard ratio 3.691, 95% CI 1.751-7.779, P = 0.001; hazard ratio 3.105, 95% CI 1.536-6.277, P = 0.002; and hazard ratio 2.806, 95% CI 1.297-6.073, P = 0.009, respectively), after adjustment to gender and vintage time. It can be concluded that, in addition to old age, malnutrition (low GNRI) and inflammation (high ferritin) are identified as significant independent risk factors that predict all-cause mortality in HD patients. PMID:25758879

  3. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis†

    PubMed Central

    Shaw, Richard E.; Johnson, Christopher K.; Ferrari, Giovanni; Zapolanski, Alex; Brizzio, Mariano; Rioux, Nancy; Edara, Srinivasa; Sperling, Jason; Grau, Juan B.

    2013-01-01

    OBJECTIVES Prior studies have found that cardiac surgery patients receiving blood transfusions are at risk for increased mortality and morbidity following surgery. It is not clear whether this increased risk occurs across all haematocrit (HCT) levels. The goal of this study was to compare operative mortality in propensity-matched cardiac surgery patients based on stratification of the preoperative HCT levels. METHODS Between 1 August 2004 and 30 June 2011, 3516 patients had cardiac surgery. One thousand nine hundred and twenty-two (54.5%) required blood transfusion during or after surgery. A propensity score for transfusion was developed based on 22 baseline variables. One thousand seven hundred and fourteen patients were matched: 857 in the transfusion group (TG) and 857 in the non-transfused control group (CG). Univariate analyses demonstrated that, after propensity matching, the groups did not differ on any baseline factors included in the propensity model. Operative mortality was defined as death within 30 days of surgery. Preoperative HCT was stratified into four groups: <36, 36–39, 40–42 and ?43. RESULTS For HCT <36%, 30-day mortality was higher in the TG than that in the CG (3.0 vs 0.0%). For HCT 36–39, operative mortality was similar between TG (1.1%, N = 180) and CG (0.8%, N = 361; P = 0.748). For HCT 40–42, operative mortality was significantly higher in the TG compared with that in the CG (1.9 vs 0%, N = 108 and 218, respectively; P = 0.044). For HCT of ?43, there was a trend towards higher operative mortality in the TG vs the CG (2.0 vs 0%, N = 102 and 152, respectively; P = 0.083). Other surgical complications followed the same pattern with higher rates found in the transfused group at higher presurgery HCT levels. HCT at discharge for the eight groups were similar, with an average of 29.1 ± 1.1% (P = 0.117). CONCLUSIONS Our study indicates that a broad application of blood products shows no discernible benefits. Furthermore, patients who receive blood at all HCT levels may be placed at an increased risk of operative mortality and/or other surgical complications. Paradoxically, even though patients with low HCTs theoretically should benefit the most, transfusion was still associated with a higher complication and mortality rate in these patients. Our results indicate that blood transfusion should be used judiciously in cardiac surgery patients. PMID:23537850

  4. Cardiovascular risk levels in general practice patients with type 2 diabetes in rural and urban areas

    Microsoft Academic Search

    Qing Wan; Mark F. Harris; Gawaine Powell-Davies; Upali W. Jayasinghe; Jeff Flack; Andrew Georgiou; Joan R. Burns; Danielle L. Penn

    2007-01-01

    Objective: To investigate the change of cardiovascular risk factor from 2000 to 2002 in general practice patients with type 2 diabetes in urban and rural areas, and the association between cardiovascular risk (both single risk factors and coronary heart disease absolute risk (CHDAR)) and rurality in three years. Methods: In total, 6305 patients were extracted from 16 Divisions (250 practices).

  5. Patient selection for cardiac transplant in 2012.

    PubMed

    Kinkhabwala, Mona Parikh; Mancini, Donna

    2013-02-01

    Heart transplantation is the treatment of choice for many patients with advanced heart failure who remain symptomatic despite optimal medical therapy. Although heart transplantation results have improved over the past 10 years, careful patient selection and risk stratification of patients with advanced heart failure is paramount given limited allograft resources. Moreover, as alternative therapies to heart transplant, such as mechanical circulatory support, continue to improve in terms of patient outcomes, the selection strategy for those patients who would benefit from device support as destination therapy or bridge-to-transplant versus those patients who should proceed directly to transplant will continue to evolve. This review focuses on the optimal timing for heart transplant, risk stratification models for patient selection, as well as examining factors that continue to provoke controversy during the candidate selection process and factors that have changed from absolute to relative contraindications as the authors experience with cardiac transplantation continues to increase. PMID:23405839

  6. Cancer incidence risks to patients due to hysterosalpingography

    PubMed Central

    Gyekye, Prince K.; Emi-Reynolds, Geoffrey; Boadu, Mary; Darko, Emmanuel O.; Yeboah, Johnson; Inkoom, Stephen; Mensah, Cynthia K.

    2012-01-01

    Cancer incidence estimates and dosimetry of 120 patients undergoing hysterosalpingography (HSG) without screening at five rural hospitals and with screening using image intensifier-TV at an urban hospital have been studied. Free in air kerma measurements were taken for patient dosimetry. Using PCXMC version 1.5, organ and effective doses to patients were estimated. Incidence of cancer of the ovary, colon, bladder and uterus due to radiation exposure were estimated using biological effects of ionising radiation committee VII excess relative risk models. The effective dose to patients was estimated to be 0.20 ± 0.03 mSv and 0.06 ± 0.01 mSv for procedures with and without screening, respectively. The average number of exposures for both procedures, 2.5, and screening time of 48.1 s were recorded. Screening time contributed majority of the patient doses due to HSG; therefore, it should be optimised as much as possible. Of all the cancers considered, the incidence of cancer of the bladder for patients undergoing HSG procedures is more probable. PMID:22557802

  7. Risk Factors for Ileus in Patients with Schizophrenia

    PubMed Central

    Nielsen, Jimmi; Meyer, Jonathan M.

    2012-01-01

    Constipation is a known side effect of psychotropics that possess high affinity for muscarinic cholinergic receptors. In severe cases, constipation progresses to ileus and bowel ischemia, with multiple fatalities related to sepsis and perforation described in the literature, primarily among patients with schizophrenia. A historical prospective database study was performed using registry data from psychiatric and somatic hospitals, combined with the prescription database to examine associations between medications and ileus. Only cases with an ICD-10 diagnosis of schizophrenia (F20) and a concurrent diagnosis of ileus in the years 1996–2007 were included in the study. A total of 26?720 patients with schizophrenia were identified with 123 cases of ileus noted in the study period. Increasing age (OR: 1.03 CI: 1.01–1.04) and female sex (OR: 1.60 CI: 1.10–2.31) were associated with an increased risk of ileus. Treatment with clozapine (OR: 1.99 CI: 1.21–3.29), high-potency first-generation antipsychotics (OR: 1.81 CI: 1.01–3.23), tricyclic antidepressants (OR: 2.29 CI: 1.29–4.09), anticholinergics (OR: 1.48 CI: 1.00–2.19), and opioids (OR: 2.14 CI: 1.36–3.36) were associated with an increased risk of ileus. The onset of ileus occurred on average more than 3 years after the first prescription of the offending drug. Aripiprazole and amisulpride were not associated with ileus. Nine of the ileus cases (7.3%) had a fatal course. Treatment with clozapine (OR: 6.73 CI: 1.55–29.17) or anticholinergics (OR: 5.88 CI: 1.47–23.58) were associated with increased risk of fatal ileus. Patients receiving psychotropics associated with significant anticholinergic properties should undergo proper monitoring and interventions in order to minimize the burden of constipation and the risk of ileus. PMID:21112965

  8. New Cardiovascular Risk Factors and Their Use for an Accurate Cardiovascular Risk Assessment in Hypertensive Patients

    PubMed Central

    TAUTU, Oana-Florentina; DARABONT, Roxana; ONCIUL, Sebastian; DEACONU, Alexandru; COMANESCU, Ioana; ANDREI, Radu Dan; DRAGOESCU, Bogdan; CINTEZA, Mircea; DOROBANTU, Maria

    2014-01-01

    Objectives: To analyze the predictive value of new cardiovascular (CV) risk factors for CV risk assessment in the adult Romanian hypertensive (HT) population. Methods: Hypertensive adults aged between 40-65 years of age, identified in national representative SEPHAR II survey were evaluated by anthropometric, BP and arterial stiffness measurements: aortic pulse wave velocity (PWVao), aortic augmentation index (AIXao), revers time (RT) and central systolic blood pressure (SBPao), 12 lead ECGs and laboratory workup. Values above the 4th quartile of mean SBP' standard deviation (s.d.) defined increased BP variability. Log(TG/HDL-cholesterol) defined atherogenic index of plasma (AIP). Serum uric acid levels above 5.70 mg/dl for women and 7.0 mg/dl for males defined hyperuricemia (HUA). CV risk was assessed based on SCORE chart for high CV risk countries. Binary logistic regression using a stepwise likelihood ratio method (adjustments for major confounders and colliniarity analysis) was used in order to validate predictors of high and very high CV risk class. Results: The mean SBP value of the study group was 148.46±19.61 mmHg. Over forty percent of hypertensives had a high and very high CV risk. Predictors of high/very high CV risk category validated by regression analysis were: increased visit-to-visit BP variability (OR: 2.49; 95%CI: 1.67-3.73), PWVao (OR: 1.12; 95%CI: 1.02-1.22), RT (OR: 0.95; 95% CI: 0.93-0.98), SBPao (OR: 1.01; 95%CI: 1.01-1.03) and AIP (OR: 7.08; 95%CI: 3.91-12.82). Conclusion: The results of our study suggests that the new CV risk factors such as increased BP variability, arterial stiffness indices and AIP are useful tools for a more accurate identification of hypertensives patients at high and very high CV risk. PMID:25705267

  9. Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project

    PubMed Central

    Frank, Bernd; Ariza, Liana; Lamparter, Heidrun; Grossmann, Vera; Prochaska, Jürgen H; Ullmann, Alexander; Kindler, Florentina; Weisser, Gerhard; Walter, Ulrich; Lackner, Karl J; Espinola-Klein, Christine; Münzel, Thomas; Konstantinides, Stavros V; Wild, Philipp S

    2015-01-01

    Introduction Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. Methods and analysis The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5?years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60?months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three ‘all-comer’ studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. Ethics and dissemination The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. Trial registration number NCT02156401. PMID:26133379

  10. Eulerian Stratification of Polyhedra Beifang Chen* and Min Yany

    E-print Network

    Yan, Min

    Eulerian Stratification of Polyhedra Beifang Chen . . . . . . . . . . . . . . . . . . . . . . . . . . . .* * . . . 3 1.2 Eulerian Stratification . . . . . . . . . . . . . . . . . . . . . . .* * . . . 5 Characterization of Eulerian Stratifications 21 4.1 Construction of Eulerian Pieces

  11. Transcranial Doppler Monitoring During Carotid Endarterectomy Helps to Identify Patients at Risk of Postoperative Hyperperfusion

    Microsoft Academic Search

    JE Dalman; ICM Beenakkers; FL Moll; JA Leusink; RGA Ackerstaff

    1999-01-01

    Objectives: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion, and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH). Design: a case cohort study of 688 patients undergoing carotid endarterectomy (CEA) with intraoperative TCD monitoring. Methods: sixty-two patients (9%) fulfilled the TCD criteria for hyperperfusion, i.e. >100% increase of

  12. Use of Implantable Cardioverter Defibrillators in Heart Failure Patients and Risk of Mortality: A Meta-Analysis

    PubMed Central

    Zhang, Yucong; Li, Kang

    2015-01-01

    Background The purpose of this study was to evaluate the effect of implantable cardioverter defibrillators (ICD) in heart failure (HF) patients compared to pharmacologic/conventional management. Material/Methods We searched PubMed, Embase, and Springer Link Library databases up to February 10th, 2014. Pooled risk ratio (RR) and 95% confidence interval (CI) for the mortality of the patients with HF were collected and calculated in a fixed-effects model or a random-effects model, as appropriate. Summary effect estimates were also stratified by sex and follow-up time. Egger’s regression asymmetry tests were utilized for publication bias detection. Results A total of 7 separate studies including 15 520 patients (10 801 ICD cases and 4719 controls) with HF were considered in the meta-analysis. The overall estimates showed that ICD could statistically significantly reduce the mortality of male (RR=0.73, 95% CI: 0.66–0.80) and female (RR=0.75, 95% CI: 0.63–0.90) patients. In addition, the further stratification subgroup analysis indicated that ICD presented a significant reduction (male: RR=0.72, 95% CI: 0.64–0.81; female: RR=0.69, 95% CI: 0.56–0.85) of mortality after 2–3 years of ICD therapy. The RR (95% CI) effects of mortality after 4–5 years of ICD therapy for males and females were 0.76 (0.51–1.14) and 0.96 (0.68–1.37), respectively. Conclusions This meta-analysis suggests that ICD could reduce HF patient mortality despite the sex difference. PMID:26093516

  13. Use of Implantable Cardioverter Defibrillators in Heart Failure Patients and Risk of Mortality: A Meta-Analysis.

    PubMed

    Zhang, Yucong; Li, Kang

    2015-01-01

    BACKGROUND The purpose of this study was to evaluate the effect of implantable cardioverter defibrillators (ICD) in heart failure (HF) patients compared to pharmacologic/conventional management. MATERIAL AND METHODS We searched PubMed, Embase, and Springer Link Library databases up to February 10th, 2014. Pooled risk ratio (RR) and 95% confidence interval (CI) for the mortality of the patients with HF were collected and calculated in a fixed-effects model or a random-effects model, as appropriate. Summary effect estimates were also stratified by sex and follow-up time. Egger's regression asymmetry tests were utilized for publication bias detection. RESULTS A total of 7 separate studies including 15 520 patients (10 801 ICD cases and 4719 controls) with HF were considered in the meta-analysis. The overall estimates showed that ICD could statistically significantly reduce the mortality of male (RR=0.73, 95% CI: 0.66-0.80) and female (RR=0.75, 95% CI: 0.63-0.90) patients. In addition, the further stratification subgroup analysis indicated that ICD presented a significant reduction (male: RR=0.72, 95% CI: 0.64-0.81; female: RR=0.69, 95% CI: 0.56-0.85) of mortality after 2-3 years of ICD therapy. The RR (95% CI) effects of mortality after 4-5 years of ICD therapy for males and females were 0.76 (0.51-1.14) and 0.96 (0.68-1.37), respectively. CONCLUSIONS This meta-analysis suggests that ICD could reduce HF patient mortality despite the sex difference. PMID:26093516

  14. Treatment with octreotide in patients with well-differentiated neuroendocrine tumors of the ileum: prognostic stratification with Ga-68-DOTA-TATE positron emission tomography.

    PubMed

    Koch, Walter; Auernhammer, Christoph J; Geisler, Julia; Spitzweg, Christine; Cyran, Clemens C; Ilhan, Harun; Bartenstein, Peter; Haug, Alexander R

    2014-01-01

    We investigated the use of Ga-68-DOTA-Tyr3-octreotate (Ga-68-DOTA-TATE) positron emission tomography (PET) and standardized uptake values (SUVs) to predict the effectiveness of treatment with the somatostatin analogue octreotide acetate (Sandostatin LAR) in patients with neuroendocrine tumors (NETs). Thirty patients with well-differentiated NETs of the ileum (grades G1 and G2) were studied with Ga-68-DOTA-TATE. The average SUV of a 50% isocontour volume of interest covering the lesion with maximum uptake (SUV mean) and the maximum SUV (SUV max) were determined. Patients were followed up, and the time to progression was recorded. Twenty-one patients showed progressive disease at the end of the study; nine patients had stable disease. The median progression-free survival (PFS) was 51.0 weeks (95% confidence interval [CI] 26.4-75.6). A cutoff for the SUV max of 29.4 and for the SUV mean of 20.3 could separate between patients with a long PFS (69.0 weeks; 95% CI 9.8-128.2) and a short PFS (26.0 weeks; 95% CI 8.7-43.3) response to octreotide acetate therapy. Patients with high radiotracer uptake had significantly higher PFS with a 2.9-fold higher chance for stable disease after 45 weeks; however, the prognostic performance of SUV max on an individual basis was poor, with a sensitivity of 75% and a specificity of 64%. SUV max and SUV mean of NET tumor lesions in Ga-68-DOTA-TATE PET are important prognostic indices for predicting the response to therapy with octreotide acetate. PMID:24824963

  15. Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery

    PubMed Central

    Osinaike, Babatunde Babasola

    2015-01-01

    Background: Hemodynamic monitoring (HM) and optimization of cardiac output and parameters of dynamic fluid responsiveness is said to improve perioperative outcome in high-risk surgical patients (HRSP). There is insufficient data to determine the burden of care and HM practices in HRSP in Nigeria. Hence, the need to assess and document the current hemodynamic management practices of anesthetists in Nigeria regarding patients undergoing high-risk surgery. Methods: An electronic mail (E-mail) based survey was conducted among 180 consultant members of the Nigeria Society of Anaesthetists. The survey contained 24 questions that range from practice location, experience in the perioperative management of high-risk patients, expectations of care, to what is available to the anesthetists to provide such care. The survey was on for 3 months. Results: A total of 157 E-mail messages were delivered, and 73 responses were received, giving a response rate of 46.5%. The survey showed that 67 (91.8%) of respondents provide or directly supervise anesthesia for HRSP, 50 (84%) of them do this 1–5 times a week. Noninvasive blood pressure (83.6%) was routinely monitored while the central venous pressure (CVP 35.6%), invasive blood pressure (28.8%), and cardiac output (1.4%) monitored less often. Urine output, arterial blood pressure, pulse rate, and clinical experience were considered best indicators of volume expansion. Most respondents were of the opinion that oxygen delivery to tissues is of major importance during the management of HRSP. Conclusion: Nigerian consultant anesthetists employ mostly noninvasive blood pressure, CVP, and invasive blood pressure for HM in HRSP. Though a good knowledge of hemodynamic goals was demonstrated, most rated their practice as inadequate.

  16. A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile

    PubMed Central

    Benner, J S; Erhardt, L; Flammer, M; Moller, R A; Rajicic, N; Changela, K; Yunis, C; Cherry, S B; Gaciong, Z; Johnson, E S; Sturkenboom, M C J M; García-Puig, J; Girerd, X

    2008-01-01

    Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care. Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster-randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients' risk and provided usual care only. The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care. Results Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04). Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice. PMID:18691228

  17. [Increased risk of suicide in patients with agitated depression].

    PubMed

    Kenchadze, V G; Chkoniia, E D; Sikharulidze, G G

    2009-12-01

    In our study we aimed to verify the clinical features of agitated depression, which intensify suicidal trends leading to completed suicide. From 477 patients with agitated depression we selected 126, who presented high risk of suicide and studded them by using Mood Anxiety Inventory. On the bases of the structural-dynamic analyses we determine seven clinical variations of agitated-depression with prominent affective, cognitive, psychomotor, somato-algetic and behavioral symptoms. The most dangerous types with regards of suicidal behavior appeared to be senestopathic and algetic types and agitated depression with depersonalization and derealization. PMID:20090153

  18. Planning Patient-Centered Health Homes for Medicaid Psychiatric Patients at Greatest Risk for Intensive Service Use.

    PubMed

    West, Joyce C; Rae, Donald S; Mojtabai, Ramin; Duffy, Farifteh F; Kuramoto, Janet; Moscicki, Eve; Narrow, William E

    2015-07-01

    This study identified characteristics of Medicaid psychiatric patients at risk of hospitalizations and emergency department (ED) visits to identify their service delivery needs. A total of 4,866 psychiatrists were randomly selected from the AMA Physician Masterfile; 62 % responded, 32 % met eligibility criteria and reported on 1,625 Medicaid patients. Patients with schizophrenia, substance use disorders, suicidal and violent ideation/behavior, and psychotic, substance use, or manic symptoms were at high risk for intensive service use, along with homeless and incarcerated patients. Patients with schizophrenia or psychotic symptoms represented 37 % of patients, but used 73 % of all hospital days and 61 % of all ED visits. Patients with substance use problems comprised 21 % of patients, but used nearly half of all ED visits. Our findings highlight opportunities to enhance treatments and interventions, and inform the development of patient-centered health homes to address the needs of patients at high risk for intensive service use. PMID:25666205

  19. Methods to evaluate the nutrition risk in hospitalized patients

    PubMed Central

    Erkan, Tülay

    2014-01-01

    The rate of malnutrition is substantially high both in the population and in chronic patients hospitalized because of different reasons. The rate of patients with no marked malnutrition at the time of hospitalization who develop malnutrition during hospitalization is also substantially high. Therefore, there are currently different screening methods with different targets to prevent malnutrition and its overlook. These methods should be simple and reliable and should not be time-consuming in order to be used in daily practice. Seven nutrition risk screening methods used in children have been established until the present time. However, no consensus has been made on any method as in adults. It should be accepted that interrogation of nutrition is a part of normal examination to increase awareness on this issue and to draw attention to this issue.

  20. Perioperative Glucose Control and Infection Risk in Older Surgical Patients.

    PubMed

    Lee, Pearl; Min, Lillian; Mody, Lona

    2014-03-01

    The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations. PMID:25431751

  1. Fungal endocarditis: patients at risk and their treatment

    PubMed Central

    Seelig, M. S.; Goldberg, P.; Kozinn, P. J.; Berger, A. R.

    1979-01-01

    Fungal endocarditis is not rare. It usually develops in patients with abnormal or surgically traumatized hearts, to whose blood fungi have gained access, perhaps during temporary (often iatrogenic) impairment of host defences. Although the blood is cleared rapidly, the fungus can establish itself in the endocardium, where it grows slowly. Thus, clinical and laboratory procedures (including blood and urine cultures) that have permitted early diagnosis and treatment of bacterial endocarditis, are not reliable in early fungal endocarditis. Greater reliance must be placed on serological monitoring of patients who have had transient fungaemia and are at risk of endocarditis. The clinician must consider factors that enhance fungal proliferation and invasion and be cognizant of its dangers - even in the absence of clear signs of infection. Prophylactic measures should be employed to protect the patient at risk, including topical, oral and systemic use of appropriate antifungal agents. Early therapy, the extent and duration of which can be determined by (1) obtaining the MIC of transitory blood or urine isolates - which should not be ignored - and (2) monitoring serology, might eliminate early invaders of the endocardium. Sixty-four reported cures of fungal endocarditis caused by Candida, the most common fungal pathogen, are tabulated, 29 were of classic fungal endocarditis requiring surgery, 3 of whom were seen later by others as fatal recurrences. Those treated early (shortly after candidaemia was diagnosed - mostly in patients on treatment for bacterial endocarditis or after cardiac surgery) survived without need for surgical removal of vegetations or valve replacement. Despite strong suggestive evidence that the first 35 patients tabulated had fungal endocarditis, histological proof exists for only a few who had surgery. Cures of endocarditis caused by other fungi are noted. Improved surgical and medical therapy has improved the prognosis even of patients with the far-advanced disease. However, development of classic fungal endocarditis has been reported one or more years after cardiac surgery and late recurrences after intensive therapy of fungal endocarditis, that had led to clinical recovery of 2 years or more, have been reported. Serological monitoring of vulnerable patients might alert the physician to recurrence early enough for efficacy of drug therapy, averting fatal outcome or the need for further surgery. PMID:392478

  2. Risk Factors for Mortality in Patients with Serratia marcescens Bacteremia

    PubMed Central

    Kim, Sun Bean; Jeon, Yong Duk; Kim, Jung Ho; Kim, Jae Kyoung; Ann, Hea Won; Choi, Heun; Kim, Min Hyung; Song, Je Eun; Ahn, Jin Young; Jeong, Su Jin; Han, Sang Hoon; Choi, Jun Yong; Song, Young Goo; Kim, June Myung

    2015-01-01

    Purpose Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. Materials and Methods We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. Results The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. Conclusion Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia. PMID:25683980

  3. [Safe patient care: safety culture and risk management in otorhinolaryngology].

    PubMed

    St Pierre, M

    2013-04-01

    Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum. PMID:23625714

  4. Safe patient care - safety culture and risk management in otorhinolaryngology.

    PubMed

    St Pierre, Michael

    2013-01-01

    Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their curriculum. PMID:24403977

  5. Risk Factors for Asymptomatic Ventricular Dysfunction in Rheumatoid Arthritis Patients

    PubMed Central

    Garza-García, Carlos; Rocío, Sánchez-Santillán; Orea-Tejeda, Arturo; Castillo-Martínez, Lilia; Eduardo, Canseco; López-Campos, José Luis; Keirns-Davis, Candace

    2013-01-01

    Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included (n = 105). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls (n = 41). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction (P < 0.0001). Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter (P = 0.01), aortic diameter (P = 0.01), ventricular septum (P = 0.01), left ventricular posterior wall (P = 0.013), and right ventricular (P = 0.01) and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients. PMID:24368945

  6. Surface Quasigeostrophic Solutions and Baroclinic Modes with Exponential Stratification

    E-print Network

    LaCasce, Joseph H.

    Surface Quasigeostrophic Solutions and Baroclinic Modes with Exponential Stratification J. H (SQG) solutions with exponential stratification and compares the results to those obtained with constant stratification. The SQG solutions with exponential stratification decay more rapidly

  7. Modular Stratification and Magic Sets for Datalog Programs with Negation

    E-print Network

    Ross, Kenneth A.

    Modular Stratification and Magic Sets for Datalog Programs with Negation Kenneth A. Ross \\Lambda A class of ``modularly stratified'' logic programs is defined. Modular stratification generalizes stratification and local stratification, while allowing programs that are not expressible as stratified programs

  8. Risk-based antifungal prophylaxis in hematologic malignancy and stem cell transplantation

    Microsoft Academic Search

    Joshua Wolf; Monica A. Slavin

    2009-01-01

    Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy,\\u000a prolonged neutropenia, or after hematopoietic stem cell transplant. Antifungal prophylaxis prevents IFI in high-risk hematology\\u000a patients. This article discusses recent developments in antifungal prophylaxis, focusing on those expected to affect patient\\u000a management. Significant advances have occurred in understanding risk stratification and assessment of

  9. The Origin of Stratification and States 26-485 Chapter 26. THE ORIGIN OF STRATIFICATION AND

    E-print Network

    Richerson, Peter J.

    The Origin of Stratification and States 26-485 Chapter 26. THE ORIGIN OF STRATIFICATION AND STATES, and government always seems to allow some to be #12;The Origin of Stratification and States 26-486 better off class. This is the problem we want to understand: How could stratification and the state arise

  10. Towards Stratification Learning through Homology Inference

    E-print Network

    West, Mike

    Towards Stratification Learning through Homology Inference Paul Bendich , Bei Wang , and Sayan Mukherjee August 13, 2010 Abstract A topological approach to stratification learning is developed for point to the same strata. First we define a multi-scale notion of a stratified space, giving stratifications over

  11. TRANSLATED POISSON MIXTURE MODEL FOR STRATIFICATION LEARNING

    E-print Network

    TRANSLATED POISSON MIXTURE MODEL FOR STRATIFICATION LEARNING By Gloria Haro Gregory Randal for Stratification Learning Gloria Haro Dept. Teoria del Senyal i Comunicacions Universitat Polit`ecnica de Catalunya stratifications, that is, mixture of manifolds repre- senting different characteristics and complexities

  12. Superperverse intersection cohomology: stratification (in)dependence

    E-print Network

    Friedman, Greg

    Superperverse intersection cohomology: stratification (in)dependence Greg Friedman Yale University superperversities, in which case intersection cohomology may depend on the choice of the stratification by which it is defined. Topological invariance also does not hold if one allows stratifications with codimension one

  13. Perception of stroke and knowledge of potential risk factors among Omani patients at increased risk for stroke

    PubMed Central

    Al Shafaee, Mohammed A; Ganguly, Shyam S; Al Asmi, Abdullah R

    2006-01-01

    Background Previous studies have demonstrated poor knowledge of stroke among patients with established risk factors. This study aims to assess the baseline knowledge, among patients with increased risk for stroke in Oman, of warning symptoms of stroke, impending risk factors, treatment, and sources of information. Methods In April 2005, trained family practice residents at Sultan Qaboos University Hospital Clinics (cardiology, neurology, diabetic, and lipid clinics), using a standardised, structured, pre-tested questionnaire, conducted a survey of 400 Omani patients. These patients all demonstrated potential risk factors for stroke. Results Only 35% of the subjects stated that the brain is the organ affected by a stroke, 68% correctly identified at least one symptom/sign of a stroke, and 43% correctly identified at least one stroke risk factor. The majority (62%) did not believe they were at increased risk for stroke, and 98% had not been advised by their attending physician that their clinical conditions were risk factors for stroke. In the multivariable logistic regression analysis, lower age and higher levels of education were associated with better knowledge regarding the organ involved in stroke, stroke symptoms, and risk factors. Conclusion Because their knowledge about stroke risk factors was poor, the subjects in this study were largely unaware of their increased risk for stroke. Intensive health education is needed to improve awareness of stroke, especially among the most vulnerable groups. PMID:17054787

  14. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements.

    PubMed

    Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard; Havelin, Leif; Hallan, Geir; Overgaard, Søren; Pedersen, Alma B; Kärrholm, Johan; Garellick, Göran; Pulkkinen, Pekka; Eskelinen, Antti; Mäkelä, Keijo; Engesæter, Lars B; Fevang, Bjørg-Tilde

    2015-08-01

    Background and purpose - Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year period, and compared it with that in THR patients with osteoarthritis (OA). Patients and methods - We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery. Results - RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision for infection. After 2001, this risk increased more for RA patients than for OA patients. During the first 3 months and from 8 years postoperatively, the risk of revision for infection was higher in RA patients with THRs fixated with antibiotic-loaded cement than in corresponding OA patients. Interpretation - We found a slightly higher overall risk of revision for infection in RA patients than in OA patients, but this difference was only present after 2001. In THRs with antibiotic-loaded cement, the risk of very early and late infections leading to revision was higher in RA patients than in OA patients. PMID:25782042

  15. Risk of radiocontrast nephropathy in patients with and without diabetes mellitus

    Microsoft Academic Search

    Lawrence S Weisberg; Peter B Kurnik; Brenda R C Kurnik

    1994-01-01

    Risk of radiocontrast nephropathy in patients with and without diabetes mellitus. The present study was designed to test whether altered renovascular reactivity is associated with the increased risk of radiocontrast nephropathy (RCN) in diabetics. We studied 50 patients (24 diabetics, 26 nondiabetics) with chronic renal insufficiency undergoing cardiac catheterization. Patients were randomized to receive either saline, or one of three

  16. Breast Cancer Patients with High Density Mammograms Do Not Have Increased Risk of Death

    MedlinePLUS

    ... mail For Immediate Release: Thursday, September 6, 2012 Breast cancer patients with high density mammograms do not have ... is a marker of increased risk of developing breast cancer, does not seem to increase the risk of ...

  17. Peripheral endothelial dysfunction in patients suffering from acute schizophrenia: A potential marker for cardiovascular morbidity?

    Microsoft Academic Search

    Anna-Karoline Israel; Andrea Seeck; Michael Karl Boettger; Tobias Rachow; Sandy Berger; Andreas Voss; Karl-Jürgen Bär

    2011-01-01

    Patients suffering from schizophrenia have an increased standardized ratio for cardiovascular mortality compared to the general population. Endothelial function was identified as a prominent parameter for cardiac risk stratification in patients with heart disease. Here, we aimed to analyze the reactivity of the microcirculation applying the post-occlusive reactive hyperemia (PORH) test and spectral analysis of skin vasomotion as markers of

  18. Relationship between nutritional risk and exercise capacity in severe chronic obstructive pulmonary disease in male patients

    PubMed Central

    Shan, Xizheng; Liu, Jinming; Luo, Yanrong; Xu, Xiaowen; Han, Zhiqing; Li, Hailing

    2015-01-01

    Objective The nutritional status of chronic obstructive pulmonary disease (COPD) patients is associated with their exercise capacity. In the present study, we have explored the relationship between nutritional risk and exercise capacity in severe male COPD patients. Methods A total of 58 severe COPD male patients were enrolled in this study. The patients were assigned to no nutritional risk group (n=33) and nutritional risk group (n=25) according to the Nutritional Risk Screening (NRS, 2002) criteria. Blood gas analysis, conventional pulmonary function testing, and cardiopulmonary exercise testing were performed on all the patients. Results Results showed that the weight and BMI of the patients in the nutritional risk group were significantly lower than in the no nutritional risk group (P<0.05). The pulmonary diffusing capacity for carbon monoxide of the no nutritional risk group was significantly higher than that of the nutritional risk group (P<0.05). Besides, the peak VO2 (peak oxygen uptake), peak O2 pulse (peak oxygen pulse), and peak load of the nutritional risk group were significantly lower than those of the no nutritional risk group (P<0.05) and there were significantly negative correlations between the NRS score and peak VO2, peak O2 pulse, or peak load (r<0, P<0.05). Conclusion The association between exercise capacity and nutritional risk based on NRS 2002 in severe COPD male patients is supported by these results of this study. PMID:26150712

  19. Unbiased stratification of left ventricles.

    PubMed

    Srinivasan, Rajagopalan; Shriram, K S; Suryanarayanan, Srikanth

    2008-01-01

    Image based quantitative stratification of the Left Ventricles (LV) across a population helps in unraveling the structure-function symbiosis of the heart. An unbiased, reference less grouping scheme that automatically determines the number of clusters and a physioanatomically relevant strategy that aligns the intra cluster LV shapes would enable the robust construction of pathology stratified cardiac atlas. This paper achieves this hitherto elusive stratification and alignment by adapting the conventional strategies routinely followed by clinicians. The individual LV shape models (N=127) are independently oriented to an "attitudinally consistent orientation" that captures the physioanatomic variations of the LV morphology. Affinity propagation technique based on the automatically identified inter-LV_landmark distances is used to group the LV shapes. The proposed algorithm is computationally efficient and, if the inter cluster variations are linked to pathology, could provide a clinically relevant cardiac atlas. PMID:18979790

  20. [Triage risk screening tool (TRST) in screening elderly patients requiring the intervention of a mobile geriatric team: results of a pilot study].

    PubMed

    Duc, Sophie; Fernandez, Catherine; Moheb, Bahman; Dang, Van Mô; Bloch, Frederic; Floccia, Marie; Videau, Marie-Neige; Tournier Louvel, Sandrine; Ducastaing, Laure; Couturier, Pascal; Salles, Nathalie

    2015-03-01

    Improving care and health course for hospitalized elderly patients is one of the tasks set out in the "Rapport du parcours de santé des PAERPA" (elderly people with or at risk of functional decline). Identification of the needs of a mobile geriatric team (MGT) intervention for the patients remain difficult in emergency department and in medical surgical units. A screening tool is needed and should be simple and fast to use. Its implementation implies that it is efficient and previously validated. The aim of our study was to evaluate the validity and predictive performances of the Triage risk stratification tool (TRST) for identify patients aged over 75 years, requiring the intervention of the MGT. This is a prospective, national, multicenter study including consecutive patients aged 75 years and older, hospitalized in emergency services and medical-surgical units in September and October 2013. The TRST was considered positive when the score was greater than 2 of 5 points. A supplementary question with binary answer (yes/no) was asked to MGT, in order to define if MGT intervention was useful. This issue has served as a "gold standard" for assessing the validity and predictive test performance. In emergency departments, the TRST was performed in 427 patients, 347 were positive. Results showed high sensitivity (79%), and poor specificity (19%) of the test in emergency units, showing that TRST did not permit to identify patients requiring MGT intervention. In contrast, the TRST seems more performant in medical-surgical (n=63 patients) units with good predictive performances (positive predictive value 90% and negative predictive value 87%). The specificity of TRST in emergency services is insufficient to generalize its use. However, performances of the TRST in other units are encouraging to propose a validation as part of a national research project. PMID:25786424

  1. Fears, Feelings, and Facts: Interactively Communicating Benefits and Risks of Medical Radiation With Patients

    PubMed Central

    Dauer, Lawrence T.; Thornton, Raymond H.; Hay, Jennifer L.; Balter, Rochelle; Williamson, Matthew J.; St. Germain, Jean

    2013-01-01

    OBJECTIVE As public awareness of medical radiation exposure increases, there has been heightened awareness among patients and physicians of the importance of holistic benefit-and-risk discussions in shared medical decision making. CONCLUSION We examine the rationale for informed consent and risk communication, draw on the literature on the psychology of radiation risk communication to increase understanding, examine methods commonly used to communicate radiation risk, and suggest strategies for improving communication about medical radiation benefits and risk. PMID:21427321

  2. Patients, their doctors, nonsteroidal anti-inflammatory drugs and the perception of risk

    PubMed Central

    Goldkind, Lawrence; Simon, Lee S

    2006-01-01

    This article is about risk. Risk is probably the most misunderstood component in determining therapeutic intervention; however, it is probably the most relevant issue to consider in the context of expected benefit. The rarity of quantitative risk–benefit assessment and the lack of comparative risk–benefit when alternative therapies exist for a given condition leads to inadequate decisions. Without some quantitation of the risks associated with specific therapies, doctors and patients cannot make optimal risk–benefit calculations. Patients may abandon effective therapies for which benefits may still outweigh risks, or opt for therapies with less well-publicized potential adverse events of even greater frequency or severity. When only small incremental benefits accrue to patients from the use of a given therapy, on the other hand, even very rare serious events may play a role in decision-making by patients, by their health care providers and by regulatory authorities. PMID:16542490

  3. Patient-specific radiation dose and cancer risk estimation in pediatric chest CT: a study in 30 patients

    NASA Astrophysics Data System (ADS)

    Li, Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P.

    2010-04-01

    Radiation-dose awareness and optimization in CT can greatly benefit from a dosereporting system that provides radiation dose and cancer risk estimates specific to each patient and each CT examination. Recently, we reported a method for estimating patientspecific dose from pediatric chest CT. The purpose of this study is to extend that effort to patient-specific risk estimation and to a population of pediatric CT patients. Our study included thirty pediatric CT patients (16 males and 14 females; 0-16 years old), for whom full-body computer models were recently created based on the patients' clinical CT data. Using a validated Monte Carlo program, organ dose received by the thirty patients from a chest scan protocol (LightSpeed VCT, 120 kVp, 1.375 pitch, 40-mm collimation, pediatric body scan field-of-view) was simulated and used to estimate patient-specific effective dose. Risks of cancer incidence were calculated for radiosensitive organs using gender-, age-, and tissue-specific risk coefficients and were used to derive patientspecific effective risk. The thirty patients had normalized effective dose of 3.7-10.4 mSv/100 mAs and normalized effective risk of 0.5-5.8 cases/1000 exposed persons/100 mAs. Normalized lung dose and risk of lung cancer correlated strongly with average chest diameter (correlation coefficient: r = -0.98 to -0.99). Normalized effective risk also correlated strongly with average chest diameter (r = -0.97 to -0.98). These strong correlations can be used to estimate patient-specific dose and risk prior to or after an imaging study to potentially guide healthcare providers in justifying CT examinations and to guide individualized protocol design and optimization.

  4. Mammostrat® as a tool to stratify breast cancer patients at risk of recurrence during endocrine therapy

    Microsoft Academic Search

    Jeremy Thomas; Douglas T Ross; Robert S Seitz; Brian Z Ring; Rodney A Beck; Hans Christian Pedersen; Alison Munro; Ian H Kunkler; Fiona M Campbell; Wilma Jack; Gillian R Kerr; Laura Johnstone; David A Cameron; Udi Chetty

    2010-01-01

    INTRODUCTION: Patients with early-stage breast cancer, treated with endocrine therapy, have approximately 90% 5-year disease-free survival. However, for patients at higher risk of relapse despite endocrine therapy, additional adjuvant therapy, such as chemotherapy, may be indicated. The challenge is to prospectively identify such patients. The Mammostrat® test uses five immunohistochemical markers to stratify patients on tamoxifen therapy into risk groups

  5. Are urban safety-net hospitals losing low-risk Medicaid maternity patients?

    PubMed Central

    Gaskin, D J; Hadley, J; Freeman, V G

    2001-01-01

    OBJECTIVE: To examine data on Medicaid and self-pay/charity maternity cases to address four questions: (1) Did safety-net hospitals' share of Medicaid patients decline while their shares of self-pay/charity-care patients increased from 1991 to 1994? (2) Did Medicaid patients' propensity to use safety-net hospitals decline during 1991-94? (3) Did self-pay/charity patients' propensity to use safety-net hospitals increase during 1991-94? (4) Did the change in Medicaid patients' use of safety-net hospitals differ for low- and high-risk patients? STUDY DESIGN: We use hospital discharge data to estimate logistic regression models of hospital choice for low-risk and high-risk Medicaid and self-pay/charity maternity patients for 25 metropolitan statistical areas (MSAs) in five states for the years 1991 and 1994. We define low-risk patients as discharges without comorbidities and high-risk patients as discharges with comorbidities that may substantially increase hospital costs, length of stay, or morbidity. The five states are California, Florida, Massachusetts, New Jersey, and New York. The MSAs in the analysis are those with at least one safety-net hospital and a population of 500,000 or more. This study also uses data from the 1990 Census and AHA Annual Survey of Hospitals. The regression analysis estimates the change between 1991 and 1994 in the relative odds of a Medicaid or self-pay/charity patient using a safety-net hospital. We explore whether this change in the relative odds is related to the risk status of the patient. PRINCIPAL FINDINGS: The findings suggest that competition for Medicaid patients increased from 1991 to 1994. Over time, safety-net hospitals lost low-risk maternity Medicaid patients while services to high-risk maternity Medicaid patients and self-pay/charity maternity patients remained concentrated in safety-net hospitals. IMPLICATIONS FOR POLICY: Safety-net hospitals use Medicaid patient revenues and public subsidies that are based on Medicaid patient volumes to subsidize care for uninsured and underinsured patients. If safety-net hospitals continue to lose their low-risk Medicaid patients, their ability to finance care for the medically indigent will be impaired. Increased hospital competition may improve access to hospital care for low-risk Medicaid patients, but policymakers should be cognizant of the potential reduction in access to hospital care for uninsured and underinsured patients. Public policymakers should ensure that safety-net hospitals have sufficient financial resources to care for these patients by subsidizing their care directly. PMID:11324742

  6. Predicting patients with high risk of becoming high-cost healthcare users in Ontario (Canada).

    PubMed

    Chechulin, Yuriy; Nazerian, Amir; Rais, Saad; Malikov, Kamil

    2014-02-01

    Literature and original analysis of healthcare costs have shown that a small proportion of patients consume the majority of healthcare resources. A proactive approach is to target interventions towards those patients who are at risk of becoming high-cost users (HCUs). This approach requires identifying high-risk patients accurately before substantial avoidable costs have been incurred and health status has deteriorated further. We developed a predictive model to identify patients at risk of becoming HCUs in Ontario. HCUs were defined as the top 5% of patients incurring the highest costs. Information was collected on various demographic and utilization characteristics. The modelling technique used was logistic regression. If the top 5% of patients at risk of becoming HCUs are followed, the sensitivity is 42.2% and specificity is 97%. Alternatives for implementation of the model include collaboration between different levels of healthcare services for personalized healthcare interventions and interventions addressing needs of patient cohorts with high-cost conditions. PMID:24726075

  7. Value of Acute Rest Sestamibi Perfusion Imaging for Evaluation of Patients Admitted to the Emergency Department With Chest Pain

    Microsoft Academic Search

    Michael C Kontos; Robert L Jesse; Kristin L Schmidt; Joseph P Ornato; James L Tatum

    1997-01-01

    Objectives. This study sought to determine the ability of early perfusion imaging using technetium-99m sestamibi to predict adverse cardiac outcomes in patients who present to the emergency department with possible cardiac ischemia and nondiagnostic electrocardiograms (ECGs).Background. Evaluation of patients presenting to the emergency department with possible acute coronary syndromes and nondiagnostic ECGs is problematic. Accurate risk stratification is necessary to

  8. Risk and natural history of colonic neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis

    Microsoft Academic Search

    TA Brentnall; RC Haggitt; PS Rabinovitch; MB Kimmey; MP Bronner; DS Levine; KV Kowdley; AC Stevens; DA Crispin; M Emond; CE Rubin

    1996-01-01

    BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) has been suggested as a risk factor for the development of colorectal cancer in ulcerative colitis (UC); however, previous studies of this association have been limited by small numbers of patients with PSC or have been performed retrospectively. This study prospectively evaluates the risk and natural history of colonic tumorigenesis in patients with

  9. Predicting Future High-Cost Patients: A Real-World Risk Modeling Application

    E-print Network

    Liu, Huan

    specific challenges in this real-life health care application to build predictive risk models) predictive risk models using real-life data from the Arizona Health Care Cost Containment System (AHCCCSPredicting Future High-Cost Patients: A Real-World Risk Modeling Application Sai T. Moturu

  10. Low expression of T-cell transcription factor BCL11b predicts inferior survival in adult standard risk T-cell acute lymphoblastic leukemia patients

    PubMed Central

    2014-01-01

    Background Risk stratification, detection of minimal residual disease (MRD), and implementation of novel therapeutic agents have improved outcome in acute lymphoblastic leukemia (ALL), but survival of adult patients with T-cell acute lymphoblastic leukemia (T-ALL) remains unsatisfactory. Thus, novel molecular insights and therapeutic approaches are urgently needed. Methods We studied the impact of B-cell CLL/lymphoma 11b (BCL11b), a key regulator in normal T-cell development, in T-ALL patients enrolled into the German Multicenter Acute Lymphoblastic Leukemia Study Group trials (GMALL; n?=?169). The mutational status (exon 4) of BCL11b was analyzed by Sanger sequencing and mRNA expression levels were determined by quantitative real-time PCR. In addition gene expression profiles generated on the Human Genome U133 Plus 2.0 Array (affymetrix) were used to investigate BCL11b low and high expressing T-ALL patients. Results We demonstrate that BCL11b is aberrantly expressed in T-ALL and gene expression profiles reveal an association of low BCL11b expression with up-regulation of immature markers. T-ALL patients characterized by low BCL11b expression exhibit an adverse prognosis [5-year overall survival (OS): low 35% (n?=?40) vs. high 53% (n?=?129), P?=?0.02]. Within the standard risk group of thymic T-ALL (n?=?102), low BCL11b expression identified patients with an unexpected poor outcome compared to those with high expression (5-year OS: 20%, n?=?18 versus 62%, n?=?84, P?patient cohort show that low BCL11b expression was associated with poor prognosis; particularly in the standard risk group of thymic T-ALL. These findings can be utilized for improved risk prediction in a significant proportion of adult T-ALL patients, which carry a high risk of standard therapy failure despite a favorable immunophenotype. PMID:25023966

  11. Pre-Exercise Participation Cardiovascular Screening in a Heterogeneous Cohort of Adult Cancer Patients

    PubMed Central

    Kenjale, Aarti A.; Hornsby, Whitney E.; Crowgey, Theresa; Thomas, Samantha; Herndon, James E.; Khouri, Michel G.; Lane, Amy R.; Bishop, Caroline E.; Eves, Neil D.; Peppercorn, Jeffrey; Douglas, Pamela S.

    2014-01-01

    Background. The purpose of this study was to investigate the extent of pre-exercise participation (“preparticipation”) health screening in a heterogeneous cohort of adult cancer patients. Methods. Patients (n = 413) with histologically confirmed solid or hematologic malignancy were categorized into preparticipation health screening risk stratification based on American College Sports Medicine (ACSM) recommendations. Risk of an exercise-related event was evaluated during a symptom-limited cardiopulmonary exercise test (CPET) with 12-lead electrocardiography (ECG). Results. Participant risk was categorized as low risk (n = 59, 14%), moderate risk (n = 217, 53%), and high risk (n = 137, 33%). Mean peak oxygen consumption was 21.7 ± 6.7 mL/kg?1 per minute?1 or 19.5 ± 21.7% below age- and sex-predicted sedentary values. No major serious adverse events or fatal events were observed during CPET procedures. A total of 31 positive ECG tests were observed, for an event rate of 8%. ACSM risk stratification did not predict the risk of a positive test. Age, statin use, antiplatelet therapy use, cardiovascular disease, prior treatment with anthracycline or radiation therapy, and being sedentary were predictors of a positive test (all p < .10). Conclusion. The patient risk-stratification profile strongly suggests that the use of formalized preparticipation health screening is required in all oncology scenarios; however, risk of an exercise-induced event is low, suggesting that the use of exercise testing is not required for pre-exercise clearance in the majority of patients. PMID:25061091

  12. Secure e-Health: managing risks to patient health data.

    PubMed

    Kluge, Eike-Henner W

    2007-01-01

    e-Health, as an inter-jurisdictional enterprise, presents risks to patient health data that involve not only technology and professional protocols but also laws, regulations and professional security cultures. The USA Patriot Act is one example of how national laws can shape these concerns. Secure e-Health therefore requires not only national standardization of professional education and protocols but also global interoperability of regulations and laws. Some progress in this regard has been made in the European context; however, even here developments are incomplete, and nothing similar has been accomplished on a global scale. Professional health information organizations must take the lead in developing appropriate high-level principles for professional certification and security protocols and in harmonizing these on a global basis, so that they can provide a firm and consistent foundation for international treaties. Such developments should occur in concert with other health professions, so that coordinated requirements are integrated into revisions of the relevant codes of ethics. This presentation identifies and addresses some of the ethical and legal issues and proposes a series of recommendations. PMID:17084665

  13. Logistic or additive EuroSCORE for high-risk patients?

    Microsoft Academic Search

    Philippe Michel; Francois Roques; Samer A. M Nashef

    2003-01-01

    Objectives: To assess whether the use of the full logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) is superior to the standard additive EuroSCORE in predicting mortality in high-risk cardiac surgical patients. Methods: Both the simple additive EuroSCORE and the full logistic EuroSCORE were applied to 14,799 cardiac surgical patients from across Europe, of whom there were 4293 high-risk

  14. Screening high-risk patients and assisting in diagnosing anxiety in primary care: the Patient Health Questionnaire evaluated

    PubMed Central

    2013-01-01

    Background Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders. Methods A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ. Results Using only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio?=?23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio?=?13.9; 95% confidence interval 3.8 to 50.6). Conclusions The PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident. PMID:23865984

  15. Prevalence and risk factors for significant liver fibrosis among HIV-monoinfected patients

    Microsoft Academic Search

    Michelle DallaPiazza; Valerianna K. Amorosa; Russell Localio; Jay R. Kostman; Vincent Lo Re III

    2010-01-01

    BACKGROUND: HIV-monoinfected patients may be at risk for significant liver fibrosis, but its prevalence and determinants in these patients are unknown. Since HIV-monoinfected patients do not routinely undergo liver biopsy, we evaluated the prevalence and risk factors of significant hepatic fibrosis in this group using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI). METHODS: We conducted a cross-sectional study among HIV-infected

  16. Influence of Risk Factors on Coronary Flow Reserve in Patients with 1Vessel Coronary Artery Disease

    Microsoft Academic Search

    Maria Lucia Eufrasia Vicario; Lorenzo Cirillo; Giovanni Storto; Teresa Pellegrino; Nicola Ragone; Luca Fontanella; Mario Petretta; Domenico Bonaduce; Alberto Cuocolo

    Coronary artery disease (CAD) risk factors influence the hyper- emic response in patients without coronary artery stenosis. The aim of this study was to evaluate the influence of risk factors on coronary flow reserve (CFR) estimated by 99mTc-sestamibi car- diac imaging in patients with 1-vessel CAD. Methods: Forty- eight patients with 1-vessel CAD were enrolled in the study. Systemic hypertension,

  17. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

    Microsoft Academic Search

    D. Phil; Koon K. Teo; Janice Pogue; Leanne Dyal; Ingrid Copland; Helmut Schumacher; Boehringer Ingelheim; Gilles Dagenais; Peter Sleight; Craig Anderson

    2010-01-01

    Background In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-converting-enzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs) in such patients is unknown. We compared the ACE inhibitor ramipril, the ARB telmisartan, and the combination of the two drugs in patients with vascular disease or high-risk diabetes. Methods

  18. Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction

    PubMed Central

    Canto, John G.; Kiefe, Catarina I.; Rogers, William J.; Peterson, Eric D.; Frederick, Paul D.; French, William J.; Gibson, C. Michael; Pollack, Charles V.; Ornato, Joseph P.; Zalenski, Robert J.; Penney, Jan; Tiefenbrunn, Alan J.; Greenland, Philip

    2013-01-01

    Context Few studies have examined the association between the number of coronary heart disease risk factors and outcomes of acute myocardial infarction in community practice. Objective To determine the association between the number of coronary heart disease risk factors in patients with first myocardial infarction and hospital mortality. Design Observational study from the National Registry of Myocardial Infarction, 1994-2006. Patients We examined the presence and absence of 5 major traditional coronary heart disease risk factors (hypertension, smoking, dyslipidemia, diabetes, and family history of coronary heart disease) and hospital mortality among 542 008 patients with first myocardial infarction and without prior cardiovascular disease. Main Outcome Measure All-cause in-hospital mortality. Results A majority (85.6%) of patients who presented with initial myocardial infarction had at least 1 of the 5 coronary heart disease risk factors, and 14.4% had none of the 5 risk factors. Age varied inversely with the number of coronary heart disease risk factors, from a mean age of 71.5 years with 0 risk factors to 56.7 years with 5 risk factors (P for trend <.001). The total number of in-hospital deaths for all causes was 50 788. Unadjusted in-hospital mortality rates were 14.9%, 10.9%, 7.9%, 5.3%, 4.2%, and 3.6% for patients with 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjusting for age and other clinical factors, there was an inverse association between the number of coronary heart disease risk factors and hospital mortality adjusted odds ratio (1.54; 95% CI, 1.23-1.94) among individuals with 0 vs 5 risk factors. This association was consistent among several age strata and important patient subgroups. Conclusion Among patients with incident acute myocardial infarction without prior cardiovascular disease, in-hospital mortality was inversely related to the number of coronary heart disease risk factors. PMID:22089719

  19. Seasonal variations in urinary risk factors among patients with nephrolithiasis

    NASA Technical Reports Server (NTRS)

    Hill, K.; Poindexter, J.; Pak, C. Y.

    1991-01-01

    Twenty-four hour urine specimens from 5,677 stone-forming patients throughout the United States were analyzed for seasonal variations in urinary risk factors for nephrolithiasis. Determinations were performed for urine volume, pH, calcium, oxalate, phosphorus, sodium, magnesium, citrate, sulfate, uric acid, and the relative supersaturation (RS) of calcium oxalate, brushite, monosodium urate, and uric acid. Criteria for significant seasonal variation included a significant difference in monthly means of risk factors, seasonal grouping of the data by the Student-Newman-Keuls multiple range test, consistent year-to-year trends and a physiologically significant range. Minimum urine volume of 1.54 +/- 0.70 SD L/day occurred in October while a maximum urine volume of 1.76 +/- 0.78 SD L/day was observed during February. Minimum urine pH of 5.94 +/- 0.64 SD was observed during July and August while a maximum pH of 6.18 +/- 0.61 SD was observed during February. Daily urinary excretion of sodium was lowest during August, 158 +/- 74 SD mEq/day and highest during February 177 +/- 70 SD mEq/day. The RS of brushite and uric acid were found to display significant pH-dependent seasonal variation with a maximum RS of uric acid 2.26 +/- 1.98 SD in June and a low of 1.48 +/- 1.30 SD in February. Maximum RS of brushite 2.75 +/- 2.58 was observed during February. Minimum RS of brushite 1.93 +/- 1.70 SD was observed in June. Phosphorus excretion displayed seasonal variation about a spring-fall axis with a maximum value 1042 +/- 373 SD mg/day in April and a minimum value of 895 +/- 289 SD mg/day. Urine volume, sodium, and pH were significantly lower during the summer (June, July, August) than in the winter (December, January, February). The RS of uric acid was higher, but that of brushite and monosodium urate was lower in the summer than in the winter. The seasonal changes observed in urine volume, pH, sodium, and the RS of brushite and uric acid are consistent with summertime sweating and increased physical activity. Seasonal variations in phosphorus excretion are probably dietary in origin. The summertime was characterized by an increased propensity for the crystallization of uric acid but not of calcium oxalate or calcium phosphate.

  20. Risk-Based Ultrasound Screening for Thyroid Cancer in Obese Patients is Cost-Effective

    PubMed Central

    Cham, Stephanie; Zanocco, Kyle; Sturgeon, Cord; Yeh, Michael W.

    2014-01-01

    Background: A higher body mass index (BMI) is associated with more advanced stages of thyroid cancer. Screening obese patients for thyroid cancer has been proposed but has yet to be examined for cost-effectiveness. The objective of this study was to assess the cost-effectiveness of ultrasound (US) screening of obese patients for thyroid cancer. Methods: A decision-tree model compared cost savings for the following: (i) base case scenario of an obese patient with thyroid nodule found by palpation, (ii) universal US screening of all obese patients, and (iii) risk-based US screening in obese patients. Risk-based screening consisted of patients who had at least one of four major identified risk factors for thyroid cancer (family history of thyroid cancer, radiation exposure, Hashimoto's thyroiditis, and/or elevated thyrotropin). Patients with nodules underwent established treatment and management guidelines. The model accounted for recurrence, complications, and long-term treatment/follow-up for five years. Outcome probabilities were identified from a literature review. Costs were estimated using a third-party payer perspective. Sensitivity analyses were performed to examine the impact of risk factor prevalence and US cost on the model. Results: The resulted costs per patient were $210.73 in the base case scenario, $434.10 in the universal US screening arm, and $166.72 in the risk-based screening arm. Risk-based screening remained cost-effective until more than 14% of obese patients had risk factors and with a wide variation of US costs ($0–$1113). Conclusion: Risk-based US screening in selected obese patients with risk factors for thyroid cancer is cost-effective. Recommendations for screening this subgroup will result in cost savings and a likely decreased morbidity and mortality in this subpopulation with more aggressive disease. PMID:24512476

  1. [Is autonomic neuropathy a risk factor of death in dialysed patients?].

    PubMed

    Jedras, Miros?aw; Zakrzewska-Pniewska, Beata; Gellert, Ryszard; Debowska, Ma?gorzata; Wojtaszek, Ewa; Muszy?ski, Jerzy; Bataa, Och

    2002-01-01

    The aim of the study was to determine, whether autonomic neuropathy is a risk factor of death in dialysed patients. Results of autonomic tests (R-R interval variation and sympathetic skin response) which were performed 3 years ago in 51 patients were analysed. 22 of these patients died. A greater incidence of dysautonomia was found in patients who died. However, due to the small number of examined patients, it cannot be concluded, that dysautonomia is a risk factor of death in uremia. PMID:12632917

  2. Resolving the stratification discrepancy of turbulent natural convection in differentially

    E-print Network

    Paris-Sud XI, Université de

    Resolving the stratification discrepancy of turbulent natural convection in differentially heated;Abstract: The problem of the long established thermal stratification discrepancy be- tween numerical dynamics. However both configurations keep resulting in a core thermal stratification value equal to 1

  3. IS THE LUNA STRATIFICATION INTRINSIC? J. KUTTLER AND Z. REICHSTEIN

    E-print Network

    Reichstein, Zinovy

    IS THE LUNA STRATIFICATION INTRINSIC? J. KUTTLER AND Z of characteristic zero. The categorical quotient V //G carr* *ies a natural stratification, due to D. Luna. This paper addresses the follow* *ing questions: (i) Is the Luna stratification of X

  4. Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

    Microsoft Academic Search

    Joanna L. Starrels; William C. Becker; Mark G. Weiner; Xuan Li; Moonseong Heo; Barbara J. Turner

    Background\\/Objective  Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those\\u000a at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher\\u000a risk patients.\\u000a \\u000a \\u000a \\u000a \\u000a Design  Retrospective cohort using electronic medical records.\\u000a \\u000a \\u000a \\u000a Participants  Patients on long-term opioids (?3 monthly prescriptions in 6 months) treated for CNCP in eight primary care practices.\\u000a \\u000a \\u000a \\u000a Methods  We

  5. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction

    Microsoft Academic Search

    Amin Al-Ahmad; William M Rand; Guruprasad Manjunath; Marvin A Konstam; Deeb N Salem; Andrew S Levey; Mark J Sarnak

    2001-01-01

    OBJECTIVESWe sought to evaluate the relationship between the level of kidney function, level of hematocrit and their interaction on all-cause mortality in patients with left ventricular (LV) dysfunction.BACKGROUNDAnemia and reduced kidney function occur frequently in patients with heart failure. The level of hematocrit and its relationship with renal function have not been evaluated as risk factors for mortality in patients

  6. Effect of Orthosis Material Hardness on Walking Pressure in High-Risk Diabetes Patients

    Microsoft Academic Search

    James A. Birke; James G. Foto; Larry A. Pfiefer

    1999-01-01

    This study evaluated the effect of levels of hardness of a commonly used orthosis material in reducing plantar pressure in patients at high-risk for foot ulcers. The mean peak pressure was measured, by using the Pedar System, on 19 patients with diabetes mellitus and a history of plantar foot ulceration. Patients walked in standard extra-depth shoes with no orthoses, standard

  7. Are There Gender-Specific Risk Factors for Suicidal Activity among Patients with Schizophrenia and Depression?

    ERIC Educational Resources Information Center

    Kaplan, Kalman J.; Harrow, Martin; Faull, Robert N.

    2012-01-01

    Are there gender-specific risk factors for suicidal activity among patients with schizophrenia and depression? A total of 74 schizophrenia patients (51 men, 23 women) and 77 unipolar nonpsychotic depressed patients (26 men, 51 women) from the Chicago Follow-up Study were studied prospectively at 2 years posthospitalization and again at 7.5 years.…

  8. Reduction of specific circulating lymphocyte populations with metabolic risk factors in patients at risk to develop type 2 diabetes.

    PubMed

    Cucak, Helena; Vistisen, Dorte; Witte, Daniel; Philipsen, Annelotte; Rosendahl, Alexander

    2014-01-01

    Low-grade inflammation, characterized by increased pro-inflammatory cytokine levels, is present in patients with obesity-linked insulin resistance, hyperglycemia and hyperlipidemia and considered to play a leading role to progression into type 2 diabetes (T2D). In adipose tissue in obese patients and in pancreatic islets in T2D patients cellular inflammation is present. However, the systemic leukocyte compartment and the circulating endothelial/precursor compartment in patients at risk to develop T2D has so far not been analyzed in detail. To address this, peripheral blood cells from a cohort of 20 subjects at risk to develop diabetes with normal to impaired glucose tolerance were analyzed by flow cytometry using a wide range of cellular markers and correlated to known metabolic risk factors for T2D i.e. fasting plasma glucose (FPG), 2 h plasma glucose (2 h PG), HbA1c, body mass index (BMI), homeostasis model assessment of ?-cell function (HOMA-B), homeostasis model assessment of insulin sensitivity (HOMA-IS) and fasting insulin (FI). The four highest ranked cell markers for each risk factor were identified by random forest analysis. In the cohort, a significant negative correlation between the number of TLR4(+) CD4 T cells and increased FPG was demonstrated. Similarly, with increased BMI the frequency of TLR4(+) B cells was significantly decreased, as was the frequency of IL-21R(+) CD4 T cells. Unlinked to metabolic risk factors, the frequency of regulatory T cells was reduced and TLR4(+) CD4 T cells were increased with age. Taken together, in this small cohort of subjects at risk to develop T2D, a modulation of the circulating immune cell pool was demonstrated to correlate with risk factors like FPG and BMI. This may provide novel insights into the inflammatory mechanisms involved in the progression to diabetes in subjects at risk. PMID:25254631

  9. The Impact of C Reactive Protein on Global Cardiovascular Risk on Patients with Coronary Artery Disease

    PubMed Central

    Cozlea, D.L.; Farcas, D.M.; Nagy, A.; Keresztesi, A.A.; Tifrea, Ramona; Cozlea, L.; Cara?ca, E.

    2013-01-01

    Introduction. Cardiovascular disease (CVD) is the major cause of premature death worldwide. Hundreds of risk factors have been associated with cardiovascular disease. Recent extensive evidence supports inflammation as a key pathogenetic mechanism in the development and progression of atherosclerosis and in triggering clinical atherothrombotic CVD events. C-reactive protein (CRP) is one possible marker of vascular inflammation and plays a direct role in promoting vascular inflammation, vessel damage and clinical CVD events. Material and method. The purpose of this study was to evaluate the correlation between CRP level and the global cardiovascular risk. We evaluated 100 patients with cardiovascular risk factors, using the systematic coronary risk evalution (SCORE) charts for high risk regions of Europe and we determined the CRP level, using the nephelometric method. Results. By their SCORE chart, 44% of the patients are in the moderate risk category, and almost 40% in the high risk category, the rest of them (16%) are in the low and very high risk category. A statistically significant p value (p<0.05) was observed between patients with CRP<10mg/L, who had a lower sistolic blood pressure than patients with CRP?10mg/L, Conclusion. The CRP level over 10mg/L is correlated with an over 4% risk of developing a fatal CVD in 10 years. The acute phase reactant, CRP, a simple downstream marker of inflammation, has now emerged as a major cardiovascular risk factor. PMID:24778862

  10. The impact of C reactive protein on global cardiovascular risk on patients with coronary artery disease.

    PubMed

    Cozlea, D L; Farcas, D M; Nagy, A; Keresztesi, A A; Tifrea, Ramona; Cozlea, L; Cara?ca, E

    2013-10-01

    Introduction. Cardiovascular disease (CVD) is the major cause of premature death worldwide. Hundreds of risk factors have been associated with cardiovascular disease. Recent extensive evidence supports inflammation as a key pathogenetic mechanism in the development and progression of atherosclerosis and in triggering clinical atherothrombotic CVD events. C-reactive protein (CRP) is one possible marker of vascular inflammation and plays a direct role in promoting vascular inflammation, vessel damage and clinical CVD events. Material and method. The purpose of this study was to evaluate the correlation between CRP level and the global cardiovascular risk. We evaluated 100 patients with cardiovascular risk factors, using the systematic coronary risk evalution (SCORE) charts for high risk regions of Europe and we determined the CRP level, using the nephelometric method. Results. By their SCORE chart, 44% of the patients are in the moderate risk category, and almost 40% in the high risk category, the rest of them (16%) are in the low and very high risk category. A statistically significant p value (p<0.05) was observed between patients with CRP<10mg/L, who had a lower sistolic blood pressure than patients with CRP?10mg/L, Conclusion. The CRP level over 10mg/L is correlated with an over 4% risk of developing a fatal CVD in 10 years. The acute phase reactant, CRP, a simple downstream marker of inflammation, has now emerged as a major cardiovascular risk factor. PMID:24778862

  11. Who and how to screen for cancer in at-risk inflammatory bowel disease patients.

    PubMed

    Parian, Alyssa; Lazarev, Mark

    2015-06-01

    Inflammatory bowel diseases (IBDs) include both Crohn's disease and ulcerative colitis and both diseases are marked by inflammation within the gastrointestinal tract. Due to long-standing inflammation, IBD patients are at increased risk of colorectal cancer, especially patients with chronic inflammation, pancolitis, co-diagnosis of primary sclerosing cholangitis and a longer duration of disease. Small bowel inflammation places Crohn's patients at an increased risk of small bowel cancer. A higher risk of skin cancers, lymphomas and cervical abnormalities is also seen in IBD patients; this is likely related to both disease factors and the presence of immunosuppressive medication. This article reviews which patients are at an increased risk of IBD-associated or IBD treatment-associated cancers, when to begin screening and which screening methods are recommended. PMID:25592672

  12. Primary prevention for patients with intermediate framingham Risk Scores

    Microsoft Academic Search

    Jason B. Thompson; Juan J. Rivera; Roger S. Blumenthal; Peter Danyi

    2006-01-01

    Coronary heart disease (CHD) is the leading cause of mortality in the industrialized world. Proper identication of individuals\\u000a at risk for CHD is challenging. The Framingham Risk Score, the most widely accepted tool for quantifying 10-year risk, fails\\u000a to identify a great proportion of future CHD. Because of the health and economic consequences of CHD, there is a need to

  13. Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey.

    PubMed

    Bergmann, Jean-Francois; Cohen, Alexander T; Tapson, Victor F; Goldhaber, Samuel Z; Kakkar, Ajay K; Deslandes, Bruno; Huang, Wei; Anderson, Frederick A

    2010-04-01

    Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients. PMID:20135072

  14. Development of gene expression-based risk score in cytogenetically normal acute myeloid leukemia patients

    PubMed Central

    Bou Samra, Elias; Klein, Bernard; Commes, Thérèse; Moreaux, Jérôme

    2012-01-01

    Patients with normal karyotype represent the single largest cytogenetic group of acute myeloid leukemia (AML), with highly heterogeneous clinical and molecular characteristics. In this study, we sought to determine new prognostic biomarkers in cytogenetically normal (CN)-AML patients. A gene expression (GE)-based risk score was built, summing up the prognostic value of 22 genes whose expression is associated with a bad prognosis in a training cohort of 163 patients. GE-based risk score allowed identifying a high-risk group of patients (53.4%) in two independent cohorts of CN-AML patients. GE-based risk score and EVI1 gene expression remained independent prognostic factors using multivariate Cox analyses. Combining GE-based risk score with EVI1 gene expression allowed the identification of three clinically different groups of patients in two independent cohorts of CN-AML patients. Thus, GE-based risk score is powerful to predict clinical outcome for CN-AML patients and may provide potential therapeutic advances. PMID:22910040

  15. Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient.

    PubMed

    Rab, Tanveer; Kern, Karl B; Tamis-Holland, Jacqueline E; Henry, Timothy D; McDaniel, Michael; Dickert, Neal W; Cigarroa, Joaquin E; Keadey, Matthew; Ramee, Stephen

    2015-07-01

    Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory. PMID:26139060

  16. Principal-Component Analysis for Assessment of Population Stratification

    E-print Network

    de Bakker, Paul

    ARTICLE Principal-Component Analysis for Assessment of Population Stratification in Mitochondrial of confounding due to mitochondrial population stratification (PS). We sought to identify a reliable method

  17. Risk Factors of Coronary Artery Disease in Secondary Prevention—Results from the AtheroGene—Study

    PubMed Central

    Schnabel, Renate B.; Zeller, Tanja; Lackner, Karl-J.; Rupprecht, Hans-J.; Blankenberg, Stefan; Westermann, Dirk

    2015-01-01

    Background Risk factors are important in cardiovascular (CV) medicine for risk stratification of patients. We aimed to compare the traditional risk factors to clinical variables for the prediction of secondary cardiovascular events. Methods and Results For this study, 3229 patients with known coronary artery disease (CAD) were included. We calculated whether the traditional risk factors, diabetes mellitus, increased LDL/HDL ratio, arterial hypertension and smoking alone and in combination with the clinical variables, ejection fraction, creatinine clearance, multi-vessel disease and CRP concentration predict the outcome cardiovascular death or non-fatal myocardial infarction (N = 432) during the mean follow-up time of 4.2 ± 2.0 years. In this cohort diabetes mellitus was the risk factor with the strongest influence regarding occurrence of secondary events (hazard ratio; HR:1.70, confidence interval; CI 95%: 1.36-2.11; P<0.0001), followed by LDL/HDL ratio and smoking. However, risk stratification is further improved by using additional clinical variables like ejection fraction (HR:3.30 CI 95%:2.51-4.33; P>0.0001) or calculated creatinine clearence (Cockroft-Gault formula) (HR:2.26 CI 95%:1.78-2.89; P<0.0001). Further ameliorating risk stratification from the clinical variables were CRP and multi-vessel disease. The most precise risk prediction was achieved when all clinical variables were added to the CV risk factors. Conclusion Diabetes mellitus has the strongest influence to predict secondary cardiovascular events in patients with known CAD. Risk stratification can further be improved by adding CV risk factors and clinical variables together. Control of risk factors is of paramount importance in patients with known CAD, while clinical variables can further enhance prediction of events. PMID:26154343

  18. Stable density stratification solar pond

    NASA Technical Reports Server (NTRS)

    Lansing, F. L. (inventor)

    1985-01-01

    A stable density-stratification solar pond for use in the collection and storage of solar thermal energy including a container having a first section characterized by an internal wall of a substantially cylindrical configuration and a second section having an internal wall of a substantially truncated conical configuration surmounting the first section in coaxial alignment therewith, the second section of said container being characterized by a base of a diameter substantially equal to the diameter of the first section and a truncated apex defining a solar energy acceptance opening is discussed. A body of immiscible liquids is disposed within the container and comprises a lower portion substantially filling the first section of the container and an upper portion substantially filling the second section of the container, said lower portion being an aqueous based liquid of a darker color than the upper portion and of a greater density. A protective cover plate is removably provided for covering the acceptance opening.

  19. Fracture Risk and Adjuvant Therapies in Young Breast Cancer Patients: A Population-Based Study

    PubMed Central

    Chang, Chun-Hung; Chen, Shaw-Ji; Liu, Chieh-Yu

    2015-01-01

    Background Breast cancer survivors have an increased risk of bone fracture. But the risk among young patients with adjuvant therapies remains unknown. This population-based study is aimed to assess the incidence and risk of fracture among young (age of 20 to 39 years) breast cancer patients who received adjuvant therapies. Methods From January 2001 to December 2007, 5,146 newly diagnosed breast cancer patients were enrolled from the National Health Insurance Research Database (NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidence of newly onset fracture. Kaplan Meier and Cox regression analyses were used to evaluate the risk of fracture in young breast cancer patients who received adjuvant treatments. Results Of the total 5,146 young (age of 20 to 39 years) breast cancer patients, the Cox multivariate proportional hazards analysis showed that AIs, radiotherapy, and monoclonal antibodies were significantly associated with a high risk of fracture. Moreover, patients who received AIs for more than 180 days had a high hazard ratio (HR) of 1.77 (95% CI = 0.68–4.57), and patients who received more than four radiotherapy visits had a high HR of 2.54 (95% CI = 1.07–6.06). Under the site-specific analysis, young breast cancer patients who received AIs had the highest risk of hip fracture (HR = 8.520, 95% CI = 1.711–42.432, p < 0.04), whereas patients who received radiotherapy had the highest risk of vertebral fracture (HR = 5.512, 95% CI = 1.847–16.451, p < 0.01). Conclusion Young breast cancer patients who are receiving AIs, radiotherapy or monoclonal antibody need to be more careful for preventing fracture events. Breast cancer treatment plans are suggested to incorporate fracture prevention interventions. PMID:26107848

  20. Automatic Auditory Processing Deficits in Schizophrenia and Clinical High-Risk Patients: Forecasting Psychosis Risk with Mismatch Negativity

    PubMed Central

    Perez, Veronica B.; Woods, Scott W.; Roach, Brian J.; Ford, Judith M.; McGlashan, Thomas H.; Srihari, Vinod H.; Mathalon, Daniel H.

    2013-01-01

    Introduction Only about one third of patients at high risk for psychosis based on current clinical criteria convert to a psychotic disorder within a 2.5-year follow-up period. Targeting clinical high-risk (CHR) individuals for preventive interventions could expose many to unnecessary treatments, underscoring the need to enhance predictive accuracy with non-clinical measures. Candidate measures include event-related potential (ERP) components with established sensitivity to schizophrenia. Here we examined the mismatch negativity (MMN) component of the ERP elicited automatically by auditory deviance in CHR and early illness schizophrenia (ESZ) patients. We also examined whether MMN predicted subsequent conversion to psychosis in CHR patients. Method MMN to auditory deviants (duration, frequency, and duration+frequency “double deviant”) were assessed in 44 healthy controls (HC), 19 ESZ, and 38 CHR patients. Within CHR patients, 15 converters to psychosis were compared to 16 non-converters with at least 12 months of clinical follow-up. Hierarchical Cox regression examined the ability of MMN to predict time to psychosis onset in CHR patients. Results Irrespective of deviant type, MMN was significantly reduced in ESZ and CHR patients relative to HC, and in CHR converters relative to non-converters. MMN did not significantly differentiate ESZ and CHR patients. The duration+frequency double deviant MMN, but not the single deviant MMNs, significantly predicted the time to psychosis onset in CHR patients. Conclusions Neurophysiological mechanisms underlying automatic processing of auditory deviance, as reflected by the duration+frequency double deviant MMN, are compromised prior to psychosis onset, and can enhance the prediction of psychosis risk among CHR patients. PMID:24050720

  1. Comparison of Methods for Renal Risk Prediction in Patients with Type 2 Diabetes (ZODIAC-36)

    PubMed Central

    Riphagen, Ineke J.; Kleefstra, Nanne; Drion, Iefke; Alkhalaf, Alaa; van Diepen, Merel; Cao, Qi; Groenier, Klaas H.; Landman, Gijs W. D.; Navis, Gerjan; Bilo, Henk J. G.; Bakker, Stephan J. L.

    2015-01-01

    Background Patients with diabetes are at high risk of death prior to reaching end-stage renal disease, but most models predicting the risk of kidney disease do not take this competing risk into account. We aimed to compare the performance of Cox regression and competing risk models for prediction of early- and late-stage renal complications in type 2 diabetes. Methods Patients with type 2 diabetes participating in the observational ZODIAC study were included. Prediction models for (micro)albuminuria and 50% increase in serum creatinine (SCr) were developed using Cox regression and competing risk analyses. Model performance was assessed by discrimination and calibration. Results During a total follow-up period of 10 years, 183 out of 640 patients (28.6%) with normoalbuminuria developed (micro)albuminuria, and 22 patients (3.4%) died without developing (micro)albuminuria (i.e. experienced the competing event). Seventy-nine out of 1,143 patients (6.9%) reached the renal end point of 50% increase in SCr, while 219 (19.2%) died without developing the renal end point. Performance of the Cox and competing risk models predicting (micro)albuminuria was similar and differences in predicted risks were small. However, the Cox model increasingly overestimated the risk of increase in SCr in presence of a substantial number of competing events, while the performance of the competing risk model was quite good. Conclusions In this study, we demonstrated that, in case of substantial numbers of competing events, it is important to account for the competing risk of death in renal risk prediction in patients with type 2 diabetes. PMID:25775414

  2. Characterization of diabetes risk factors in patients prescribed chronic statin therapy

    PubMed Central

    King, William M.; Saseen, Joseph J.

    2014-01-01

    Objective: Determine the incidence of major diabetes risk factors over time in patients prescribed chronic statin therapy. Methods: Retrospective observational chart review of adult patients without diabetes in primary care who initiated statin therapy between 2005 and 2010. Presence of diabetes risk factors were determined 1 year prior to statin initiation and continued up to a maximum of 7 years. Diabetes risk factors included impaired fasting glucose, body mass index (BMI) ?30 kg/m2, hemoglobin A1c >6% and metabolic syndrome. Descriptive statistics were used to describe the incidence of diabetes risk factors over time. Results: A total of 98 patients met study criteria; mean age was 57 ± 13 years, 43% were men and 71% self-identified as Caucasian/white. Mean baseline values were A1c of 5.97%, fasting glucose of 104 mg/dl and BMI of 28 kg/m2. There were zero diabetes risk factors over time in 54% ± 7% of patients. The incidence over time of 1 risk factor was 25 ± 9%, 2 risk factors was 17 ± 5% and 3 risk factors was 3 ± 2%. A total of 12 patients were diagnosed with type 2 diabetes during the course of the study period. Conclusion: The incidence of diabetes risk factors did not change over time in an ambulatory adult population prescribed chronic statin therapy. Larger population studies assessing the incidence of and change in diabetes risk factors in patients on chronic statin therapy may help assess the association between statin therapy and presence of such risk factors. PMID:25177478

  3. Factors Influencing the Clinical Stratification of Suitability to Drive after Stroke: A Qualitative Study.

    PubMed

    Stapleton, Tadhg; Connolly, Deirdre; O'Neill, Desmond

    2015-07-01

    While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum. PMID:26020451

  4. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    PubMed Central

    Afrasiabirad, Abbas; Safaie, Naser; Montazergaem, Hosein

    2015-01-01

    Background There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with the conventional methods. Methods In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001). Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications. PMID:25650152

  5. Is Adjuvant Chemoradiotherapy Overtreatment in Cervical Cancer Patients With Intermediate Risk Factors?

    SciTech Connect

    Ryu, Sang-Young, E-mail: ryu@kcch.re.k [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Park, Sang-Il [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Nam, Byung-Ho [Center for Clinical Trials, National Cancer Center, Kyongi (Korea, Republic of); Cho, Chul-Koo [Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Kim, Kidong; Kim, Beob-Jong; Kim, Moon-Hong; Choi, Seok-Cheol; Lee, Eui-Don; Lee, Kyoung-Hee [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2011-03-01

    Purpose: To determine whether adjuvant chemoradiotherapy (CRT) improves the outcome of cervical cancer patients with intermediate risk factors. Methods and Materials: Between January 2000 and June 2006, the medical records of 735 patients who had undergone radical surgery for Stage IB-IIA cervical cancer were reviewed retrospectively. Of the 735 patients, 172 with two or more intermediate risk factors (i.e., lymphovascular space involvement, deep stromal invasion, and tumor size {>=}2 cm) were grouped as follows according to the adjuvant treatment received: 34 patients, no further treatment; 49 patients, RT; and 89 patients, CRT. The significance of the clinical parameters and recurrence-free survival of each group were analyzed. Results: Of the 172 patients with any of the intermediate risk factors, 137 (79.6%) had two or more intermediate risk factors. Of the 172 patients, 12 developed recurrences (6.4%)->(7.0%), with 6 in the pelvis and 6 in distant sites. All 12 recurrences occurred in those who had two or more intermediate risk factors (sensitivity, 100%); however, only six recurrences were detected in patients who met the Gynecologic Oncology Group criteria for the intermediate-risk group (sensitivity, 50%; Z test, p < .05). A statistically significant difference was found in the 3-year recurrence-free survival rate among the no further treatment, RT, and CRT groups (67.5%, 90.5%, and 97.5%, respectively; p < .05). The incidence of Grade 3-4 hematologic and gastrointestinal toxicities was not significantly different statistically between the RT and CRT groups (6.1% and 13.4%, respectively; p > .05). Conclusion: Postoperative adjuvant CRT can improve the outcome of cervical cancer patients with intermediate risk factors, with low increase in toxicity.

  6. When neurologist and patient disagree on reasonable risk: new challenges in prescribing for patients with multiple sclerosis

    PubMed Central

    Kachuck, Norman J

    2011-01-01

    New more powerful therapies for the treatment of multiple sclerosis may also confer a potential for unprecedented life-endangering side effects. How does a physician respond to a patient’s request for a treatment the benefit of which cannot be clearly established as worth its risk? The current challenge with prescription of natalizumab (Tysabri®, Biogen Idec) is used to illustrate how this conflict creates an opportunity to re-examine our goals as physicians and the nature of the physician–patient relationship. Understanding the physician’s role in that partnership, and the ethical and psychological issues impacting on how reasonable risk is determined, can improve the neurologist’s capacity to explicate such quandaries. Redefining what is required to mediate disagreement between doctors and patients about reasonable risk is at the heart of why many of us became physicians. However, such nuanced interpersonal dynamics of patient care can be neglected due to the time and resource pressures of our practices. These demands have increased the seductiveness of the efficiencies promoted by the trend toward the pseudo-objectification of evidence-based care, which has arguably monopolized the healing conversation often to the detriment of the shared narrative. We examine and attempt to reframe the fiduciary and biopsychosocial contretemps of the doctor and patient disagreeing on risk, emphasizing its humanistic, relational dimensions. PMID:21573081

  7. Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients

    PubMed Central

    Faramarzi, Elnaz; Mohammad-Zadeh, Mohammad; Nasirimotlagh, Behnam

    2013-01-01

    Objective To validate malnutrition screening tool of nutrition risk index (NRI) against patient-generated subjective global assessment (PG-SGA) as a gold standard tool in colorectal cancer patients before radiotherapy. Methods Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA (gold standard method) and NRI. Serum albumin levels of patients were determined by colorimetric method. A contingency table was used to determine the sensitivity, specificity, and predictive value of the NRI in screening patients at risk of malnutrition, in comparison with the PG-SGA in patients before radiotherapy. Results The findings of PG-SGA and NRI showed that 52% and 45% of patients in our study were moderately or severely malnourished respectively. The NRI had a sensitivity of 66% and a specificity of 60% against PG-SGA. The positive predictive value was 64% and the negative predicative value was 62%. The agreement between NRI and PG-SGA was statistically insignificant (kappa =0.267; P>0.05). Conclusions The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer. Moreover, NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer. It seems that the combination of anthropometric, laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients. PMID:24255578

  8. Risk factors for pericardial effusion in adult patients receiving allogeneic haematopoietic stem cell transplantation.

    PubMed

    Liu, Yao-Chung; Chien, Sheng-Hsuan; Fan, Nai-Wen; Hu, Ming-Hung; Gau, Jyh-Pyng; Liu, Chia-Jen; Yu, Yuan-Bin; Liu, Chun-Yu; Hsiao, Liang-Tsai; Liu, Jin-Hwang; Chiou, Tzeon-Jye; Tzeng, Cheng-Hwai

    2015-06-01

    Pericardial effusion (PE) is a rare but potentially life-threatening complication for allogeneic haematopoietic stem cell transplantation (HSCT) recipients. The risk factors, aetiology, incidence and therapy are largely unclear. To investigate this issue, we reviewed 391 adult patients undergoing allogeneic HSCT between January 2003 and December 2013. Twelve out of 391 patients (3·1%) developed PE of moderate to large amounts, including 9 out of 12 patients (75%) identified as late-onset PE. Two out of the nine patients with late-onset PE experienced recurrent effusion. The median age at HSCT was 44·5 years (range: 22-63 years) among the 12 patients with PE and 47 years in the late-onset patients. Multivariate analysis revealed that multiple transplant procedures was a significant risk factor for PE (P = 0·036) and a trend as risk factor in patients aged>50 years (P = 0·066). For late-onset PE, pre-transplant age>50 years (P = 0·032) and extensive chronic graft-versus-host disease (cGVHD) (P = 0·006) remained statistically significant on multivariate analysis. Currently, there are no published data exploring the risk factors for post-transplant PE in adult patients of allogeneic HSCT. Our study determined the risk factors and incidence for the post-transplant PE, especially in the late-onset group. PMID:25818840

  9. Identification of Patients at Risk for Ischaemic Cerebral Complications After Carotid Endarterectomy with TCD Monitoring

    Microsoft Academic Search

    J. Horn; A. R. Naylor; D. M. Laman; B. R. Chambers; J. L. Stork; T. V. Schroeder; M.-Y. Nielsen; V. G. Dunne; R. G. A. Ackerstaff

    2005-01-01

    ObjectivesTranscranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated.

  10. Does Statin Therapy Decrease the Risk for Bleeding in Patients Who Are Receiving Warfarin?

    Microsoft Academic Search

    James D. Douketis; Magda Melo; Chaim M. Bell; Muhammad M. Mamdani

    2007-01-01

    PurposeRecent observations in patients with atrial fibrillation who are receiving warfarin suggest that concomitant treatment with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) decreases the risk for bleeding.

  11. Treatment and follow-up of low-risk patients with thyroid cancer

    Microsoft Academic Search

    Isabelle Borget; Camila Nascimento; Maryse Brassard; Sophie Leboulleux; Martin Schlumberger

    2011-01-01

    The postoperative administration of radioiodine can be avoided in low-risk patients with undetectable TSH-stimulated serum thyroglobulin and no lymph-node metastases detected at surgery. Sensitive methods for serum thyroglobulin determination can be used to avoid TSH stimulation 9–12 months after surgery in low-risk patients who have an undetectable serum thyroglobulin on levothyroxine treatment; the role of these sensitive assays in the

  12. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    PubMed Central

    Shpata, Vjollca; Ohri, Ilir; Nurka, Tatjana; Prendushi, Xhensila

    2015-01-01

    Purpose Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18–64 years), and to examine the negative consequences associated with risk of malnutrition in older adults. Materials and methods A prospective cohort study in the ICU of the University Hospital Center of Tirana, Albania, was conducted. Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay, the duration of being on the ventilator, the total complications, the infectious complications, and the mortality. Results In this study, 963 patients participated, of whom 459 patients (47.7%) were aged ?65 years. The prevalence of malnutrition risk at the time of ICU admission of the patients aged ?65 years old was 71.24%. Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients, for 1) infections (odds ratio [OR] =4.37; 95% confidence interval [CI]: 2.61–7.31); 2) complications (OR =6.73; 95% CI: 4.26–10.62); 3) mortality (OR =2.68; 95% CI: 1.72–4.18); and 4) ICU length of stay >14 days (OR =5.18, 95% CI: 2.43–11.06). Conclusion Malnutrition risk is highly prevalent among elderly ICU patients, especially among severely ill patients with malignancy admitted to the emergency ward. ICU elderly patients at malnutrition risk will have higher complication and infection rates, longer duration of ICU stay, and increased mortality. Efforts should be made to implement a variety of nutritional care strategies, to change the nutritional practices not only at ward level, but nationally, according to the best clinical practice and recent guidelines. PMID:25733824

  13. Rates of violence in patients classified as high risk by structured risk assessment instruments

    PubMed Central

    Singh, Jay P.; Fazel, Seena; Gueorguieva, Ralitza; Buchanan, Alec

    2014-01-01

    Background Rates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies. Aims To analyse the variation in rates of violence in individuals identified as high risk by SRAIs. Method A systematic search of databases (1995-2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity. Results Information was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study. Conclusions After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety. PMID:24590974

  14. Differences in Risk Factors for Suicidality between African American and White Patients Vulnerable to Suicide

    ERIC Educational Resources Information Center

    Vanderwerker, Lauren C.; Chen, Joyce H; Charpentier, Peter; Paulk, Mary Elizabeth; Michalski, Marion; Prigerson, Holly G.

    2007-01-01

    Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty.…

  15. Post-operative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients

    PubMed Central

    Pannucci, Christopher J.; Dreszer, George; Wachtman, Christine Fisher; Bailey, Steven H.; Portschy, Pamela R.; Hamill, Jennifer B.; Hume, Keith M.; Hoxworth, Ronald E.; Rubin, J. Peter; Kalliainen, Loree K.; Pusic, Andrea L.; Wilkins, Edwin G.

    2015-01-01

    Background Venous thromboembolism (VTE) is a major patient safety issue. The PSF-sponsored Venous Thromboembolism Prevention Study (VTEPS) examined whether post-operative enoxaparin prevents symptomatic VTE in plastic surgery patients. Methods VTEPS eligibility criteria included age ?18, general anesthesia, and post-operative hospital admission. In 2009, four sites uniformly adopted a clinical protocol. Patients with Caprini score ?3 received post-operative enoxaparin prophylaxis starting 6–8 hours after surgery and continuing for the duration of their inpatient stay. VTEPS historic control patients had an operation between 2006 and 2008 but received no chemoprophylaxis for 60 days after surgery. The primary study outcome was symptomatic 60-day VTE. Stratified analyses were performed. Multivariable logistic regression controlled for baseline risk and other identified confounders. Results 3334 patients (1876 controls and 1458 enoxaparin patients) were included. Notable risk reduction was present in patients with Caprini >8 (8.54% vs. 4.07%, p=0.182) and Caprini 7–8 (2.55% vs. 1.15%, p=0.230) who received post-operative enoxaparin. Logistic regression was limited to highest risk patients (Caprini ?7) and demonstrated that length of stay (LOS) ?4 days (adjusted odds ratio (OR) 4.63, p=0.007) and Caprini score >8 (OR 2.71, p=0.027) were independent predictors of VTE. When controlling for LOS and Caprini score, receipt of post-operative enoxaparin was protective against VTE (OR 0.39, p=0.042). Conclusions In high-risk plastic surgery patients, post-operative enoxaparin prophylaxis is protective against 60-day VTE when controlling for baseline risk and LOS. Hospitalization ?4 days is an independent risk factor for VTE. Clinical Question Risk Level of Evidence III (retrospective cohort study) PMID:22030491

  16. Health Risk Behaviors in Family Caregivers During Patients’ Stay in Intensive Care Units: A Pilot Analysis

    PubMed Central

    Choi, JiYeon; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara; Sherwood, Paula R.

    2014-01-01

    Background Studies of family caregivers of the critically ill have mainly focused on the psychological impact of the patients’ stay in the intensive care unit and related stress. Despite known associations between stress and physical health, limited attention has been paid to the need to promote and maintain physical health in these caregivers. Objective To explore how family caregivers’ health risk behaviors are associated with patients’ preexisting care needs and the caregivers’ depressive symptoms and burden. Methods During the intensive-care-unit stay of critically ill patients (who required mechanical ventilation for ?4 days), 50 family caregivers were surveyed to determine the caregivers’ depressive symptoms, burden, and health risk behaviors. Data were also collected on patients’ care needs before admission to the intensive care unit. Results One or more health risk behaviors were reported by 94% of family caregivers. More than 90% of caregivers reported depressive symptoms above the score indicating risk for clinical depression. A high level of burden was reported by 36% of caregivers. More health risk behaviors were associated with higher scores of depressive symptoms and burden (P<.001 for both). Caregivers’ responses did not differ according to patients’ preexisting care needs. Conclusion Health risk behaviors of family caregivers are associated with greater perceptions of burden and/or depressive symptoms but not with patients’ care needs before admission to the intensive care unit. PMID:23283087

  17. Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis

    PubMed Central

    Eckert, Laurent; Wang, Yanxin; Wang, Hongwei; Cohen, Alexander

    2013-01-01

    Introduction. The occurrence of malignant disease increases the risk for venous thromboembolism (VTE). Here we evaluate the risk for VTE in a large unselected cohort of patients with cancer receiving chemotherapy. Methods. The United States IMPACT health care claims database was retrospectively analyzed to identify patients with a range of solid tumors who started chemotherapy from January 2005 through December 2008. International Classification of Diseases, 9th revision, Clinical Modification Codes were used to identify cancer location, presence of VTE 3.5 months and 12 months after starting chemotherapy, and incidence of major bleeding complications. Health care costs were assessed one year before initiation of chemotherapy and one year after initiation of chemotherapy. Results. The overall incidence of VTE 3.5 months after starting chemotherapy was 7.3% (range 4.6%–11.6% across cancer locations) rising to 13.5% at 12 months (range 9.8%–21.3%). The highest VTE risk was identified in patients with pancreatic, stomach, and lung cancer. Patients in whom VTE developed had a higher risk for major bleeding at 3.5 months and at 12 months (11.0% and 19.8% vs. 3.8% and 9.6%, respectively). Health care costs were significantly higher in patients in whom VTE developed. Conclusion. Those undergoing chemotherapy as outpatients are at increased risk for VTE and for major bleeding complications. Thromboprophylaxis may be considered for such patients after carefully assessing the risks and benefits of treatment. PMID:24212499

  18. Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke1

    PubMed Central

    Oliveira, Ana Railka de Souza; Costa, Alice Gabrielle de Sousa; Morais, Huana Carolina Cândido; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; de Araujo, Thelma Leite

    2015-01-01

    Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration. PMID:26039291

  19. Risk of Cancer in Patients with Iron Deficiency Anemia: A Nationwide Population-Based Study

    PubMed Central

    Hu, Yu-Wen; Hu, Li-Yu; Yeh, Chiu-Mei; Teng, Chung-Jen; Kuan, Ai-Seon; Chen, San-Chi; Chen, Tzeng-Ji; Liu, Chia-Jen

    2015-01-01

    Objective This study evaluated the risk of cancer among patients with iron deficiency anemia (IDA) by using a nationwide population-based data set. Method Patients newly diagnosed with IDA and without antecedent cancer between 2000 and 2010 were recruited from the Taiwan National Health Insurance Research Database. The standardized incidence ratios (SIRs) of cancer types among patients with IDA were calculated. Results Patients with IDA exhibited an increased overall cancer risk (SIR: 2.15). Subgroup analysis showed that patients of both sexes and in all age groups had an increased SIR. After we excluded patients diagnosed with cancer within the first and first 5 years of IDA diagnosis, the SIRs remained significantly elevated at 1.43 and 1.30, respectively. In addition, the risks of pancreatic (SIR: 2.31), kidney (SIR: 2.23), liver (SIR: 1.94), and bladder cancers (SIR: 1.74) remained significantly increased after exclusion of patients diagnosed with cancer within 5 years after IDA diagnosis. Conclusion The overall cancer risk was significantly elevated among patients with IDA. After we excluded patients diagnosed with IDA and cancer within 1 and 5 years, the SIRs remained significantly elevated compared with those of the general population. The increased risk of cancer was not confined to gastrointestinal cancer when the SIRs of pancreatic, kidney, liver, and bladder cancers significantly increased after exclusion of patients diagnosed with IDA and cancer within the first 5 years. This finding may be caused by immune activities altered by IDA. Further study is necessary to determine the association between IDA and cancer risk. PMID:25781632

  20. [Risk factors for coronary heart disease in 1002 patients with hyperlipidemia].

    PubMed

    K?osiewicz-Latoszek, L; Pachocka, L; Górska, K; Grzybowska, B; Ostasz, B; Paluszkiewicz, J; Szonert, J; Targosz, U; Stolarska, I; Nowicka, G

    1997-05-01

    The aim of this study was to estimate the coexistence of risk factors for coronary heart disease (CHD) in hyperlipidemic patients. Studies were performed in 1002 (601 women, 401 men) subjects who referred to our outpatient clinic among 12 months. Hypercholesterolemia was the predominant lipid disorder found in 66% of patients, mixed hyperlipidemia in 31.8%, and hypertriglyceridemia only in 2.2%. Overweight and obesity remain a major health burden among our patients: BMI > or = 25 was observed in 66%. Hypertension was recognized in 37.5% of subjects, and diabetes mellitus in 11.2%, 17% were long-term smokers. Familial aggregation of hyperlipidemia was observed in 15.7% of subjects, and more than 44% had a positive family history of cardiovascular disease. Low HDL cholesterol levels (< 35 mg/dl) were seen frequently in men (24.7%) and rare in women (7%). Lp(a) excess (> or = 30 mg/dl) was observed in 12% of patients. Myocardial infarction (MI) had already 11.7% subjects (7% women, 18.7% men). In these patients CHD risk factors were observed more frequently. The higher apo B and Lp(a) levels and lower HDL cholesterol levels were recognized in the patients who suffered from MI. More than 83% of our hyperlipidemic patients had coexistence CHD risk factors. The multiple coexisting risk factors cause the high risk for CHD and they require intensive correction. PMID:9411422

  1. Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

    PubMed Central

    Kahl, Christoph; Storer, Barry E.; Sandmaier, Brenda M.; Mielcarek, Marco; Maris, Michael B.; Blume, Karl G.; Niederwieser, Dietger; Chauncey, Thomas R.; Forman, Stephen J.; Agura, Edward; Leis, Jose F.; Bruno, Benedetto; Langston, Amelia; Pulsipher, Michael A.; McSweeney, Peter A.; Wade, James C.; Epner, Elliot; Bo Petersen, Finn; Bethge, Wolfgang A.; Maloney, David G.

    2007-01-01

    Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for hematologic malignancies depends on graft-versus-tumor effects for eradication of cancer. Here, we estimated relapse risks according to disease characteristics. Between 1997 and 2006, 834 consecutive patients (median age, 55 years; range, 5-74 years) received related (n = 498) or unrelated (n = 336) HCT after 2 Gy total body irradiation alone (n = 171) or combined with fludarabine (90 mg/m2; n = 663). Relapse rates per patient year (PY) at risk, corrected for follow-up and competing nonrelapse mortality, were calculated for 29 different diseases and stages. The overall relapse rate per PY was 0.36. Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in remission (CR), low-grade or mantle cell non-Hodgkin lymphoma (NHL) (CR + partial remission [PR]), and high-grade NHL-CR had the lowest rates (0.00-0.24; low risk). In contrast, patients with advanced myeloid and lymphoid malignancies had rates of more than 0.52 (high risk). Patients with lymphoproliferative diseases not in CR (except Hodgkin lymphoma and high-grade NHL) and myeloid malignancies in CR had rates of 0.26-0.37 (standard risk). In conclusion, patients with low-grade lymphoproliferative disorders experienced the lowest relapse rates, whereas patients with advanced myeloid and lymphoid malignancies had high relapse rates after nonmyeloablative HCT. The latter might benefit from cytoreductive treatment before HCT. PMID:17595333

  2. Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning.

    PubMed

    Kahl, Christoph; Storer, Barry E; Sandmaier, Brenda M; Mielcarek, Marco; Maris, Michael B; Blume, Karl G; Niederwieser, Dietger; Chauncey, Thomas R; Forman, Stephen J; Agura, Edward; Leis, Jose F; Bruno, Benedetto; Langston, Amelia; Pulsipher, Michael A; McSweeney, Peter A; Wade, James C; Epner, Elliot; Bo Petersen, Finn; Bethge, Wolfgang A; Maloney, David G; Storb, Rainer

    2007-10-01

    Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for hematologic malignancies depends on graft-versus-tumor effects for eradication of cancer. Here, we estimated relapse risks according to disease characteristics. Between 1997 and 2006, 834 consecutive patients (median age, 55 years; range, 5-74 years) received related (n = 498) or unrelated (n = 336) HCT after 2 Gy total body irradiation alone (n = 171) or combined with fludarabine (90 mg/m(2); n = 663). Relapse rates per patient year (PY) at risk, corrected for follow-up and competing nonrelapse mortality, were calculated for 29 different diseases and stages. The overall relapse rate per PY was 0.36. Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in remission (CR), low-grade or mantle cell non-Hodgkin lymphoma (NHL) (CR + partial remission [PR]), and high-grade NHL-CR had the lowest rates (0.00-0.24; low risk). In contrast, patients with advanced myeloid and lymphoid malignancies had rates of more than 0.52 (high risk). Patients with lymphoproliferative diseases not in CR (except Hodgkin lymphoma and high-grade NHL) and myeloid malignancies in CR had rates of 0.26-0.37 (standard risk). In conclusion, patients with low-grade lymphoproliferative disorders experienced the lowest relapse rates, whereas patients with advanced myeloid and lymphoid malignancies had high relapse rates after nonmyeloablative HCT. The latter might benefit from cytoreductive treatment before HCT. PMID:17595333

  3. Risk factors for depression in patients with epilepsy

    Microsoft Academic Search

    Ewa Naganska; Urszula Fiszer

    2006-01-01

    Purpose. Symptoms of depression are present in 40 to 60 percent of patients with epilepsy. Prior research indicated significant cor- relation between the incidence and frequency of focal seizures and clinical depression, especially in patients with temporal lobe epilepsy. Anticonvulsive drugs and psychosocial factors contribute to the occurrence of depression as well. The aim of the study was to determine

  4. Invasive breast cancer: stratification of histological grade by gene-based assays: a still relevant example from an older data set

    PubMed Central

    Dalton, Leslie

    2014-01-01

    Aims A Netherlands Kanker Institute data set provided the results of gene-based assays (GBAs) and histological grades of 295 patients with invasive breast cancer. Grade is the first prognostic assay available after a cancer diagnosis. Given this time-line of actual practise, the aim was to study how gene-based assays further stratify histologic grade. Methods and results Emphasis was placed on evaluation of a simple decision tree and on study of the recurrence score (RS). The decision tree determined three risk stratifications. Tumours that were both intermediate grade (IG) and low-RS were grouped with low grade, and tumours that were IG and high-RS were coupled with high grade. IG and intermediate-RS tumours comprised the third category. Survival analysis was performed with respect to the three stratifications. Cramer's V statistic was used for concordance analysis. The mixed grade-RS classifier showed significant survival stratification (P < 0.00001). The mixed classifier was concordant with the 70-gene assay (Cramer's V = 0.57). Recurrence score alone had a 0.59 Cramer's V with the gene assay. Because two-thirds of tumours were of either low or high grade, concordance was maintained despite the majority of classifications having been determined by grade alone. Conclusion There is no compelling reason to test low- and high-grade tumours further by GBAs. PMID:24673556

  5. IS THE LUNA STRATIFICATION INTRINSIC? J. KUTTLER AND Z. REICHSTEIN

    E-print Network

    Reichstein, Zinovy

    IS THE LUNA STRATIFICATION INTRINSIC? J. KUTTLER AND Z. REICHSTEIN Abstract. Let G GL stratification, due to D. Luna. This paper addresses the following questions: (i) Is the Luna stratification of X? In general, the Luna stratification is not intrinsic. Nevertheless, we give positive answers to questions (i

  6. CYCLICITY OF LUSZTIG'S STRATIFICATION OF GRASSMANNIANS AND POISSON GEOMETRY

    E-print Network

    Yakimov, Milen

    CYCLICITY OF LUSZTIG'S STRATIFICATION OF GRASSMANNIANS AND POISSON GEOMETRY MILEN YAKIMOV Abstract-geometric stratification of G/P and conjectured that in- tersecting this stratification with (G/P)0 is producing a cell and the Lusztig stratification of a flag variety were studied in recent years from many different combinatorial

  7. CYCLICITY OF LUSZTIG'S STRATIFICATION OF GRASSMANNIANS AND POISSON GEOMETRY

    E-print Network

    Yakimov, Milen

    CYCLICITY OF LUSZTIG'S STRATIFICATION OF GRASSMANNIANS AND POISSON GEOMETRY MILEN YAKIMOV Abstract­geometric stratification of G/P and conjectured that in­ tersecting this stratification with (G/P ) #0 is producing a cell and the Lusztig stratification of a flag variety were studied in recent years from many di#erent combinatorial

  8. Adjuvant chemotherapy for elderly patients (>=70 years) with early high-risk breast cancer: a retrospective analysis of 260 patients

    Microsoft Academic Search

    A. Brunello; U. Basso; C. Pogliani; A. Jirillo; C. Ghiotto; H. Koussis; F. Lumachi; M. Iacobone

    2005-01-01

    of patients; grading was G3 in 27.3%, hormonal status was negative (HR- ) in 16.9% and lymph nodes were involved (N + ) in 36.1%. Of 188 patients presenting one or more risk factors (pT2 - 3, G3, N + , HR - ), 48.4% were not proposed for adjuvant chemotherapy (compared with 7.2% in the control group), 39.8% of

  9. Curriculum Placement and Educational Stratification in France.

    ERIC Educational Resources Information Center

    Hout, Michael; Garnier, Maurice A.

    1979-01-01

    Maintains that curriculum differentiation in France is the keystone of educational, and, consequently, social stratification. Factors which influence curriculum differentiation include father's occupation, academic performance, parents' expectations, and teachers' expectations. (DB)

  10. Stratification, superfluidity and magnetar QPOs

    E-print Network

    A. Passamonti; S. K. Lander

    2012-10-10

    The violent giant flares of magnetars excite QPOs which persist for hundreds of seconds, as seen in the X-ray tail following the initial burst. Recent studies, based on single-fluid barotropic magnetar models, have suggested that the lower-frequency QPOs correspond to magneto-elastic oscillations of the star. The higher frequencies, however, in particular the strong 625 Hz peak, have proved harder to explain, except as high mode multipoles. In this work we study the time evolutions of non-axisymmetric oscillations of two-fluid Newtonian magnetars with no crust. We consider models with superfluid neutrons and normal protons, and poloidal and toroidal background field configurations. We show that multi-fluid physics (composition-gradient stratification, entrainment) tends to increase Alfven mode frequencies significantly from their values in a single-fluid barotropic model. The higher-frequency magnetar QPOs may then be naturally interpreted as Alfven oscillations of the multi-fluid stellar core. The lower-frequency QPOs are less easily explained within our purely fluid core model, but we discuss the possibility that these are crustal modes.

  11. Stratification, superfluidity and magnetar QPOs

    E-print Network

    Passamonti, A

    2012-01-01

    The violent giant flares of magnetars excite QPOs which persist for hundreds of seconds, as seen in the X-ray tail following the initial burst. Recent studies, based on single-fluid barotropic magnetar models, have suggested that the lower-frequency QPOs correspond to magneto-elastic oscillations of the star. The higher frequencies, however, in particular the strong 625 Hz peak, have proved harder to explain, except as high mode multipoles. In this work we study the time evolutions of non-axisymmetric oscillations of two-fluid Newtonian magnetars with no crust. We consider models with superfluid neutrons and normal protons, and poloidal and toroidal background field configurations. We show that multi-fluid physics (composition-gradient stratification, entrainment) tends to increase Alfven mode frequencies significantly from their values in a single-fluid barotropic model. The higher-frequency magnetar QPOs may then be naturally interpreted as Alfven oscillations of the multi-fluid stellar core. The lower-freq...

  12. Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model 1 This study was carried out with the help of the Catalan Study Group on Open Heart Surgery. This study group was composed of the following surgeons as representatives of participating centers: A. Aris, E. Castells, L. Camera, J. Caralps, C. Fontanillas, F. Morillo, J. Mulet, M. Murtra, J.L. Pomar, R. Rovira, O. Sole. Research assistant to the group was M. Cardona. 1

    Microsoft Academic Search

    J. M. V Pons; A Granados; J. A Espinas; J. M Borras; I Martin; V Moreno

    1997-01-01

    Objective: To develop a risk stratification model to assess open heart surgery mortality in Catalonia (Spain) in order to use risk-adjusted hospital mortality rates as an approach to analyze quality of care. Methods: Data were prospectively collected through a specific data-sheet during 612 months in consecutive adult patients subjected to open heart surgery. The dependent variable was surgical mortality, and

  13. FRACTURE RISK IN PATIENTS WITH MUSCULAR DYSTROPHY AND SPINAL MUSCULAR ATROPHY

    Microsoft Academic Search

    Peter Vestergaard; Henning Glerup; Birgit F. Steffensen; Lars Rejnmark; Jes Rahbek; Leif Mosekilde

    2001-01-01

    We aimed at studying fracture risk in patients with Duchenne' s muscular dystrophy (DMD), Becker' s muscular dystrophy (BEMD), and spinal muscular atrophy type II and III (SMA II and III). A self-administered questionnaire was mailed to 293 patients with DMD, BEMD, SMA II or SMA III of which 229 returned the questionnaire. Each respondent was compared with an age-

  14. Contemporary identification of patients at high risk of early prostate cancer recurrence after radical retropubic prostatectomy

    Microsoft Academic Search

    William W Roberts; Erik J Bergstralh; Michael L Blute; Jeffrey M Slezak; Michael Carducci; Misop Han; Jonathan I Epstein; Mario A Eisenberger; Patrick C Walsh; Alan W Partin

    2001-01-01

    Objectives. To develop a model that will identify a contemporary cohort of patients at high risk of early prostate cancer recurrence (greater than 50% at 36 months) after radical retropubic prostatectomy for clinically localized disease. Data from this model will provide important information for patient selection and the design of prospective randomized trials of adjuvant therapies.Methods. Proportional hazards regression analysis

  15. Catheter Lock Solutions to Prevent Bloodstream Infections in High-Risk Hemodialysis Patients

    Microsoft Academic Search

    Theodore Feely; Angela Copley; Anthony J. Bleyer

    2007-01-01

    Background: Antimicrobial catheter lock solutions (CLS) have been shown to prevent bacteremia in chronic hemodialysis (HD) patients with new HD catheters. However, there is little information regarding the usage of these solutions in patients who have a history of recurrent bacteremia and are at very high risk of infection. The purpose of this investigation was to identify the efficacy of

  16. Recurrence after Ischemic Stroke in Chinese Patients: Impact of Uncontrolled Modifiable Risk Factors

    Microsoft Academic Search

    Gelin Xu; Xinfeng Liu; Wentao Wu; Renliang Zhang; Qin Yin

    2007-01-01

    Background: Data concerning stroke occurrence and recurrence in China are extremely rare. This study was designed to analyze determinants of stroke recurrence in a cohort of Chinese patients. Methods: Subjects were patients with ischemic stroke registered in the Nanjing Stroke Registry Program. Modifiable risk factors for stroke were identified and stratified into 3 levels: without, controlled and uncontrolled. Cox proportional

  17. Prophylactic Greenfield filter placement in selected high-risk trauma patients

    Microsoft Academic Search

    Saeid Khansarinia; James W. Dennis; Henry C. Veldenz; J. Laurence Butcher; Lillian Hartland

    1995-01-01

    Purpose: Pulmonary embolus (PE) remains a major factor in morbidity and death in severely injured patients, especially those in specific high-risk groups. PEs have been documented to occur despite routine deep venous thrombosis prophylaxis. The purpose of this study was to evaluate the safety and efficacy of prophylactic Greenfield filter (PGF) placement in patients who have multiple trauma with known

  18. [The risk and its communication to patients for decision-making in healthcare].

    PubMed

    Almendro-Padilla, C; García-Vicente, S; Vázquez-Costa, M; Blanes-Pérez, M C

    2013-10-01

    Informing the patients before starting diagnostic and therapeutic procedures is advisable in order to establish a trusting and caring relationship. In this article, we analyze factors that determine the risk perception by the patients, as well as elements which facilitate a good information process by health professionals. PMID:23791830

  19. Frequency of and risk factors for poor cognitive performance in hemodialysis patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing. In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwe...

  20. Early Noninvasive Ventilation Averts Extubation Failure in Patients at Risk A Randomized Trial

    Microsoft Academic Search

    Miquel Ferrer; Mauricio Valencia; Josep Maria Nicolas; Oscar Bernadich; Joan Ramon Badia; Antoni Torres

    Rationale: Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality. Objectives: To assess the efficacy of noninvasive ventilation in avert- ing respiratory failure after extubation in patients at increased risk. Methods: A prospective randomized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontane- ous breathing trial after recovery from the acute episode

  1. Aggression and Risk of Future Violence in Forensic Psychiatric Patients with and without Dyslexia

    ERIC Educational Resources Information Center

    Selenius, Heidi; Hellstrom, Ake; Belfrage, Henrik

    2011-01-01

    Dyslexia does not cause criminal behaviour, but it may worsen aggressive behaviour tendencies. In this study, aggressive behaviour and risk of future violence were compared between forensic psychiatric patients with and without dyslexia. Dyslexia was assessed using the Swedish phonological processing battery "The Pigeon". The patients filled in…

  2. Preventing Therapist-Patient Sexual Intimacy: Therapy for a Therapist at Risk

    Microsoft Academic Search

    Kenneth S. Pope

    1987-01-01

    Survey research, as well as rates of complaints to licensing boards, ethics committees, and the civil courts, indicates that therapist-patient sexual intimacy is a major problem for the profession. Furthermore, research suggests that an overwhelming majority of psychologists experience sexual attraction to their patients, are uncomfortable with that attraction, and may be at risk for acting it out. It is

  3. Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients

    Microsoft Academic Search

    Kunitoshi Iseki; Fujihiko Miyasato; Kiyoyuki Tokuyama; Keizo Nishime; Hajime Uehara; Yoshiki Shiohira; Hiroshi Sunagawa; Kunio Yoshihara; Shinichiro Yoshi; Shigeki Toma; Teruo Kowatari; Toru Wake; Takashi Oura; Koshiro Fukiyama

    1997-01-01

    Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. In a previous report, we showed that nutritional status and especially serum albumin had great predictive value for death in chronic hemodialysis patients, whereas blood pressure did not. In the present study, we analyzed the causes of death in consideration of the relationship between

  4. HIV Risk Among Patients Attending Sexually Transmitted Disease Clinics in China

    Microsoft Academic Search

    Kyung-Hee Choi; Zheng Xiwen; Qu Shuquan; Kevin Yiee; Jeffrey Mandel

    2000-01-01

    HIV and other sexually transmitted diseases (STDs) are spreading rapidly in China. However, little is known about HIV risk among STD patients. In October–November 1997, we recruited a consecutive sample of 1,371 STD clinic patients from 16 different provinces and municipalities across the country and examined their sexual practices and condom use. We found that the median age for sexual

  5. Continuity of care and risk of hospital readmission among dual diagnosis patients

    Microsoft Academic Search

    Fabian Termorshuizen; Bas E. A. van der Hoorn; Peter Blanken; Albert M. van Hemert; Hans W. Hoek; Vincent M. Hendriks

    2012-01-01

    The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility

  6. Continuity of care and risk of hospital readmission among dual diagnosis patients

    Microsoft Academic Search

    Fabian Termorshuizen; Bas E. A. van der Hoorn; Peter Blanken; Albert M. van Hemert; Hans W. Hoek; Vincent M. Hendriks

    2011-01-01

    The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility

  7. Risk communication and shared decision making in the care of patients with osteoporosis.

    PubMed

    Lewiecki, E Michael

    2010-01-01

    Health maintenance and disease management require vigilance in assessing risk, communicating risk, and balancing the expected benefits of therapeutic interventions with potential harms. The evaluation of skeletal health includes identification of clinical risk factors for fracture, bone density testing in appropriate patients, and the use of validated algorithms for estimating the probability of fracture. To reduce the burden of osteoporotic fractures, patients at risk for fracture must be identified and treated with effective agents that are taken regularly, correctly, and for a sufficient length of time to achieve the desired benefit. These goals may be enhanced by shared decision making, a process by which the clinician and the patient share all applicable information and negotiate a plan of treatment that is acceptable to both. As an educator and a partner in making treatment decisions, the clinician must be familiar with the medical evidence and able to discuss complex medical information in a manner that is understood by the patient, with appropriate consideration of the patient's expectations, beliefs, and concerns. After treatment is started, risk communication, patient education, and shared decision making should be continued in an effort to maintain good compliance and persistence with therapy. Further study is needed to identify and validate optimal risk communication tools for the care of patients with osteoporosis. Challenges to shared decision making include competition from other health care priorities for limited patient encounter time during office visits, poor reimbursement, insufficient knowledge of the medical evidence, inadequate communication skills, and cognitive/affective disorders limiting patient participation in making treatment decisions. PMID:20663701

  8. Radiation risks associated with serial imaging in colorectal cancer patients: Should we worry?

    PubMed Central

    Oh, Jeong Suk; Koea, Jonathan B

    2014-01-01

    To provide an overview of the radiation related cancer risk associated with multiple computed tomographic scans required for follow up in colorectal cancer patients. A literature search of the PubMed and Cochrane Library databases was carried out and limited to the last 10 years from December 2012. Inclusion criteria were studies where computed tomographic scans or radiation from other medical imaging modalities were used and the risks associated with ionizing radiation reported. Thirty-six studies were included for appraisal with no randomized controlled trials. Thirty-four of the thirty-six studies showed a positive association between medical imaging radiation and increased risk of cancer. The radiation dose absorbed and cancer risk was greater in children and young adults than in older patients. Most studies included in the review used a linear, no-threshold model to calculate cancer risks and this may not be applicable at low radiation doses. Many studies are retrospective and ensuring complete follow up on thousands of patients is difficult. There was a minor increased risk of cancer from ionizing radiation in medical imaging studies. The radiation risks of low dose exposure (< 50 milli-Sieverts) are uncertain. A clinically justified scan in the context of colorectal cancer is likely to provide more benefits than harm but current guidelines for patient follow up will need to be revised to accommodate a more aggressive approach to treating metastatic disease. PMID:24415862

  9. Ramipril: a review of its use in preventing cardiovascular outcomes in high-risk patients.

    PubMed

    Anderson, Vanessa R; Perry, Caroline M; Robinson, Dean M

    2006-01-01

    Ramipril is an oral, non-sulfhydryl ACE inhibitor thought to act in the renin-angiotensin-aldosterone system to decrease vasopressor activity, aldosterone secretion, and bradykinin degradation. Ramipril is generally well tolerated and effective in the treatment of patients aged > or =55 years at high risk for the development of cardiovascular (CV) events, in whom the risk of myocardial infarction (MI), stroke, and CV death can be significantly reduced. The risk of these CV outcomes may also be reduced with ramipril therapy in various subgroups; these include patients with diabetes mellitus, peripheral arterial disease (PAD) or renal insufficiency, and women. Thus, ramipril, in addition to lifestyle interventions, should be considered an important therapy in the prevention of CV outcomes in high-risk patients. PMID:17192135

  10. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12.

    PubMed

    Vincent, Jean-Louis; Pelosi, Paolo; Pearse, Rupert; Payen, Didier; Perel, Azriel; Hoeft, Andreas; Romagnoli, Stefano; Ranieri, V Marco; Ichai, Carole; Forget, Patrice; Rocca, Giorgio Della; Rhodes, Andrew

    2015-01-01

    A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality. Reducing these risks is important for the individual patient but also for health-care planners and managers. Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications. Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes. In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients. PMID:25953531

  11. Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

    PubMed Central

    Triantafyllopoulos, Georgios; Memtsoudis, Stavros; Poultsides, Lazaros A.

    2015-01-01

    Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that can be taken to reduce their effect and consequently the overall risk for infection.

  12. Molecular Reclassification of Crohn’s Disease: A Cautionary Note on Population Stratification

    PubMed Central

    Maus, Bärbel; Jung, Camille; Mahachie John, Jestinah M.; Hugot, Jean-Pierre; Génin, Emmanuelle; Van Steen, Kristel

    2013-01-01

    Complex human diseases commonly differ in their phenotypic characteristics, e.g., Crohn’s disease (CD) patients are heterogeneous with regard to disease location and disease extent. The genetic susceptibility to Crohn’s disease is widely acknowledged and has been demonstrated by identification of over 100 CD associated genetic loci. However, relating CD subphenotypes to disease susceptible loci has proven to be a difficult task. In this paper we discuss the use of cluster analysis on genetic markers to identify genetic-based subgroups while taking into account possible confounding by population stratification. We show that it is highly relevant to consider the confounding nature of population stratification in order to avoid that detected clusters are strongly related to population groups instead of disease-specific groups. Therefore, we explain the use of principal components to correct for population stratification while clustering affected individuals into genetic-based subgroups. The principal components are obtained using 30 ancestry informative markers (AIM), and the first two PCs are determined to discriminate between continental origins of the affected individuals. Genotypes on 51 CD associated single nucleotide polymorphisms (SNPs) are used to perform latent class analysis, hierarchical and Partitioning Around Medoids (PAM) cluster analysis within a sample of affected individuals with and without the use of principal components to adjust for population stratification. It is seen that without correction for population stratification clusters seem to be influenced by population stratification while with correction clusters are unrelated to continental origin of individuals. PMID:24147066

  13. Risk for delirium tremens in patients with alcohol withdrawal syndrome

    Microsoft Academic Search

    David A. Fiellin; Patrick G. OConnor; Eric S. Holmboe; Ralph I. Horwitz

    2002-01-01

    To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case?control study at the detoxification units of two hospitals. Cases met DSM?IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to

  14. Risk for Delirium Tremens in Patients with Alcohol Withdrawal Syndrome

    Microsoft Academic Search

    David A. Fiellin; Patrick G. O'Connor; Eric S. Holmboe; Ralph I. Horwitz

    2002-01-01

    To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case-control study at the detoxification units of two hospitals. Cases met DSM-IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to

  15. Increased Risk of Coeliac Disease in Patients with Congenital Hypothyroidism

    Microsoft Academic Search

    Stefano Stagi; Cristina Manoni; Cecilia Cecchi; Francesco Chiarelli; Maurizio de Martino

    2011-01-01

    Background: In patients with congenital hypothyroidism (CH), the presence of coeliac disease (CD) has been sporadically described. Methods: Seventy-nine consecutive children (58 females and 21 males; age range 3.1–12.1 years) with permanent CH were studied. For all patients, a family history of autoimmune diseases as far as second-degree relatives was collected, and total serum IgA, antigliadin, anti-endomysium and anti-transglutaminase antibodies

  16. Laboratory for Patients at Risk of Multiple Primary Malignancies

    Microsoft Academic Search

    Marcello Caggiano; Angela Mariano; Massimiliano Zuccaro; Sergio Spiezia; Marco Clemente; Vincenzo Macchia

    Biomarkers are a useful laboratory diagnostic approach for the non-invasive early detection of disease and recurrent disease.\\u000a An ideal tumor marker is a protein or protein fragment that can be easily detected in the patient’s blood or urine, but is\\u000a not detectable in healthy people. The first of such biomarkers to be used in laboratory testing was carcinoembryonic antigen\\u000a (CEA),

  17. Risks associated with obese patient handling in emergency prehospital care.

    PubMed

    Réminiac, François; Jouan, Youenn; Cazals, Xavier; Bodin, Jean-François; Dequin, Pierre-François; Guillon, Antoine

    2014-01-01

    The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries. In this report, we illustrate the fatal consequences of initial problems in patient handling due to a small ambulance crew size in an obese patient who suffered an out-of-hospital cardiac arrest. Following successful resuscitation, this patient presented humeral fractures that may have promoted a disorder of hemostasis. The patient eventually died. This case highlights the requirement for specific instructions for paramedics to manage obese patients in these emergency conditions. This case also highlights the need to take into account body mass index when deciding on appropriate pre-hospital care, especially regarding the number of ambulance crewmembers. PMID:24830962

  18. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers

    Microsoft Academic Search

    M.-C. Roghmann; A. Siddiqui; K. Plaisance; H. Standiford

    2001-01-01

    A cohort study of patients with chronic ulcers was performed to estimate the risk of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in a population colonized with MRSA. During a five-year period (January 1990–May 1995), 911 patients with chronic ulcers (CU), as determined by ICD9-CM code search, were admitted to an acute care hospital. Sixty percent (545\\/911) of these patients with CU

  19. Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes

    PubMed Central

    Kotagal, Meera; Symons, Rebecca G.; Hirsch, Irl B.; Umpierrez, Guillermo E.; Dellinger, E. Patchen; Farrokhi, Ellen T.; Flum, David R.

    2014-01-01

    Objective To study the association between diabetes status, perioperative hyperglycemia, and adverse events in a statewide surgical cohort. Background Perioperative hyperglycemia may increase the risk of adverse events more significantly in patients without diabetes (NDM) than in those with diabetes (DM). Methods Using data from the Surgical Care and Outcomes Assessment Program, a cohort study (2010–2012) evaluated diabetes status, perioperative hyperglycemia, and composite adverse events in abdominal, vascular, and spine surgery at 53 hospitals in Washington State. Results Among 40,836 patients (mean age, 54 years; 53.6% women), 19% had diabetes; 47% underwent a perioperative blood glucose (BG) test, and of those, 18% had BG ?180 mg/dL. DM patients had a higher rate of adverse events (12% vs 9%, P < 0.001) than NDM patients. After adjustment, among NDM patients, those with hyperglycemia had an increased risk of adverse events compared with those with normal BG. Among NDM patients, there was a dose-response relationship between the level of BG and composite adverse events [odds ratio (OR), 1.3 for BG 125–180 (95% confidence interval (CI), 1.1–1.5); OR, 1.6 for BG ?180 (95% CI, 1.3–2.1)]. Conversely, hyperglycemic DM patients did not have an increased risk of adverse events, including those with a BG 180 or more (OR, 0.8; 95% CI, 0.6–1.0). NDM patients were less likely to receive insulin at each BG level. Conclusions For NDM patients, but not DM patients, the risk of adverse events was linked to hyperglycemia. Underlying this paradoxical effect may be the underuse of insulin, but also that hyperglycemia indicates higher levels of stress in NDM patients than in DM patients. PMID:25133932

  20. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography

    Microsoft Academic Search

    Meir Gare; Yosef S Haviv; Arie Ben-Yehuda; Dvorah Rubinger; Tali Bdolah-Abram; Shmuel Fuchs; Ora Gat; Mordecai M Popovtzer; Mervyn S Gotsman; Morris Mosseri

    1999-01-01

    OBJECTIVESThe purpose of the study was to examine the potential renal protective effect of low-dose dopamine in high-risk patients undergoing coronary angiography.BACKGROUNDContrast nephropathy is prevalent in patients with chronic renal failure (CRF) and\\/or diabetes mellitus (DM). Decreased renal blood flow due to vasoconstriction was suggested as a contributory mechanism. Low-dose dopamine has a dilatory effect on the renal vasculature.METHODSSixty-six patients

  1. Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists

    Microsoft Academic Search

    Jeffrey R. Curtis; Nivedita M. Patkar; Aiyuan Xie; Carolyn K. Martin; Jeroan J. Allison; Michael S. Saag; Deborah Shatin; Kenneth G. Saag

    2007-01-01

    OBJECTIVE: To evaluate the risk of serious bacterial infections associated with tumor necrosis factor alpha (TNFalpha) antagonists among rheumatoid arthritis (RA) patients.\\u000aMETHODS: A retrospective cohort study of US RA patients enrolled in a large health care organization identified patients who received either TNFalpha antagonists or methotrexate (MTX). Administrative data were used to identify hospitalizations with possible bacterial infections; corresponding

  2. Levetiracetam seizure prophylaxis in craniotomy patients at high risk for postoperative seizures

    PubMed Central

    Gokhale, Sankalp; Khan, Shariq Ali; Agrawal, Abhishek; Friedman, Allan H.; McDonagh, David L.

    2013-01-01

    Background: The risk of developing immediate postoperative seizures in patients undergoing supratentorial brain tumor surgery without anti-epileptic drug (AED) prophylaxis is 15-20%. Patients who present with pre-operative seizures and patients with supratentorial meningioma or supratentorial low grade gliomas are at significantly higher risk. There is little data on the efficacy of levetiracetam as a prophylactic AED in the immediate postoperative period (within 7 days of surgery) in these patients. Methods: We conducted a retrospective chart review of 165 adult patients classified as higher risk for postoperative seizures who underwent brain tumor resection at Duke University Hospital between time May 2010 and December 2011. All patients had received levetiracetam monotherapy in doses of 1000-3000 mg/day in the immediate postoperative period. Results: We identified 165 patients with following tumor locations: Frontal 83 (50.3%), Temporal 37 (22.4%), Parietal 30 (18.2%), Occipital 2 (1.2%) and 13 (7.8%) with single lesions involving more than one lobe. Histology revealed: Glioma 98 (59.4%), Meningioma 57 (34.5%) and Brain Metastases 6 (3.6%). Preoperatively, 88/165 (53.3%) patients had presented with seizures. 12/165 patients (7.3%) developed clinical seizures (generalized 10, partial 2) in the immediate post-operative period. Other than somnolence in 7 patients (4.2%), no major side-effects were noted. Conclusions: The incidence of seizures was significantly lower in patients treated with levetiracetam (7.3%) when compared with the expected (15-20%) rate without AED prophylaxis based on the previous literature. Levetiracetam appears effective and safe for seizure prevention in patients undergoing brain tumor resection and who are at significantly higher risk of developing post-operative seizures. These findings warrant confirmation in a prospective randomized trial. PMID:24550999

  3. EVALUATION OF CARDIAC RISK BY OXIDATIVE STRESS AND INFLAMMATORY MARKERS IN DIABETIC PATIENTS

    Microsoft Academic Search

    Dilshad Ahmed Khan; Shazia Qayyum

    Objectives: To evaluate the diabetic patients for cardiac risk by measuring oxidative stress and inflammatory markers in relation with glycaemic control. Methodology: A total of 140 subjects were included in this case-control study, comprising of 70 diabetic patients with coronary heart disease (CHD) and an equal number, age and sex matched controls. The patients were non-alcoholic and had age >40years,

  4. Using routine inpatient data to identify patients at risk of hospital readmission

    Microsoft Academic Search

    Stuart Howell; Michael Coory; Jennifer Martin; Stephen Duckett

    2009-01-01

    BACKGROUND: A relatively small percentage of patients with chronic medical conditions account for a much larger percentage of inpatient costs. There is some evidence that case-management can improve health and quality-of-life and reduce the number of times these patients are readmitted. To assess whether a statistical algorithm, based on routine inpatient data, can be used to identify patients at risk

  5. Informing patients about risks and benefits of radiology examinations: a review article.

    PubMed

    Cardinal, Jeremy S; Gunderman, Richard B; Tarver, Robert D

    2011-06-01

    Communicating the risks, benefits, and alternatives to a planned medical intervention is integral to high-quality patient care. When effective, such communication promotes patient autonomy, alleviates unfounded patient apprehension, and mitigates medicolegal liability. The topic of medical radiation adds to the usual challenges of effective medical communication some special challenges of its own. Among these is a lack of understanding by the general population and health professionals of the benefits and risks of medical radiation, which is compounded by unfamiliar terminology and units of measure. This is further complicated by the fact that many patients have poor comprehension of risk data in general. In this article, the authors present a case, review the ethical basis and legal history of informed consent, and explore the current initiatives, available resources, and further opportunities related to this challenging topic. PMID:21636054

  6. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery

    PubMed Central

    Pannucci, Christopher J.; Shanks, Amy; Moote, Marc J.; Bahl, Vinita; Cederna, Paul S.; Naughton, Norah N.; Wakefield, Thomas W.; Henke, Peter K.; Campbell, Darrell A.; Kheterpal, Sachin

    2015-01-01

    Objective To identify independent predictors of 30-day VTE events requiring treatment after outpatient surgery. Summary Background Data An increasing proportion of surgical procedures are performed in the outpatient setting. The incidence of venous thromboembolism (VTE) requiring treatment after outpatient surgery is unknown. Methods Prospective observational cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005–2009. Adult patients who had outpatient surgery or surgery with subsequent 23-hour observation were included. The main outcome measure was 30-day VTE requiring treatment. Patients were randomly assigned to derivation (N=173,501) or validation (N=85,730) cohorts. Logistic regression examined independent risk factors for 30-day VTE. A weighted risk index was created and applied to the validation cohort. Stratified analyses examined 30-day VTE by risk level. Results 30-day incidence of VTE for the overall cohort was 0.15%. Independent risk factors included current pregnancy (adjusted odds ratio (OR) 7.80, p=0.044), active cancer (OR 3.66, p=0.005), age 41–59 (OR 1.72, p=0.008), age ?60 (OR 2.48, p<0.001), body mass index ?40 (OR 1.81, p=0.015), operative time ?120 minutes (OR 1.69, p=0.027), arthroscopic surgery (OR 5.16, p<0.001), sapheno-femoral junction surgery (OR 13.20, p<0.001), and venous surgery not involving the great saphenous vein (OR 15.61, p<0.001). The weighted risk index identified a 20-fold variation in 30-day VTE between low (0.06%) and highest risk (1.18%) patients. Conclusions 30-day VTE risk after outpatient surgery can be quantified using a weighted risk index. The risk index identifies a high-risk subgroup of patients with 30-day VTE rates of 1.18%. PMID:22584630

  7. Value of FDG PET/CT in Patient Management and Outcome of Skeletal and Soft Tissue Sarcomas.

    PubMed

    Sheikhbahaei, Sara; Marcus, Charles; Hafezi-Nejad, Nima; Taghipour, Mehdi; Subramaniam, Rathan M

    2015-07-01

    Fluorodeoxyglucose (FDG)-PET/computed tomography (CT) has been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. FDG-PET/CT metabolic parameters are reliable predictors of survival in sarcomas and could be implemented in risk stratification models along with other prognostic factors in these patients. PMID:26099673

  8. Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline

    Microsoft Academic Search

    James L. Rosenzweig; Ele Ferrannini; Scott M. Grundy; Steven M. Haffner; Robert J. Heine; Edward S. Horton; Ryuzo Kawamori

    2010-01-01

    Objective: The objective was to develop clinical practice guidelines for the primary prevention of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in patients at metabolic risk. Conclusions: Healthcare providers should incorporate into their practice concrete measures to reduce the risk of developing CVD and T2DM. These include the regular screening and identifi- cation of patients at metabolic risk

  9. Role of Endothelial Function and Inflammation in Patients with Cardiovascular Risk Factors, with and without a History of Myocardial Infarction

    Microsoft Academic Search

    Miran Šebeštjen; Pavel Poredoš; Irena Keber

    2007-01-01

    Background: Endothelial dysfunction and inflammation, in particular their lack of improvement after risk reduction, might better reflect advanced atherosclerosis than just the presence of risk factors. The aim of this study was to compare endothelial function and inflammatory parameters in high-risk patients who had no history of myocardial infarction and in patients in a stable phase after myocardial infarction. Methods:

  10. Chemoembolization Decreases Drop-Off Risk of Hepatocellular Carcinoma Patients on the Liver Transplant List

    SciTech Connect

    Frangakis, Constantine [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health (United States); Geschwind, Jean-Francois; Kim, Daniel [Johns Hopkins University, Department of Vascular and Interventional Radiology (United States); Chen, Yong [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health (United States); Koteish, Ayman [Johns Hopkins University, Department of Transplant Hepatology (United States); Hong, Kelvin; Liapi, Eleni; Georgiades, Christos S., E-mail: g_christos@hotmail.com [Johns Hopkins University, Department of Vascular and Interventional Radiology (United States)

    2011-12-15

    Introduction: The drop-off risk for patients awaiting liver transplantation for hepatocellular carcinoma (HCC) is 22%. Transplant liver availability is expected to worsen, resulting in longer waiting times and increased drop-off rates. Our aim was to determine whether chemoembolization can decrease this risk. Patients and Methods: Eighty-seven consecutive HCC patients listed for liver transplant (Milan criteria) underwent statistical comparability adjustments using the propensity score (Wilcoxon, Fisher's, and chi-square tests). Forty-three nonchemoembolization patients and 22 chemoembolization patients were comparable for Child-Pugh and Model for End-Stage Liver Disease scores, tumor size and number, alpha fetoprotein (AFP) levels, and cause of cirrhosis. We calculated the risk of dropping off the transplant list by assigning a transplant time to those who dropped off (equal probability with patients who were on the list longer than the patient in question). The significance level was obtained by calculating the simulation distribution of the difference compared with the permutations of chemoembolization versus nonchemoembolization assignment of the patients. Kaplan-Meier estimators (log-rank test) were used to determine survival rates. Results: Median follow-up was 187 {+-} 110 weeks (range 38 to 435, date of diagnosis). The chemoembolization group had an 80% drop-off risk decrease (15% nonchemoembolization versus 3% chemoembolization, p = 0.04). Although survival was better for the chemoembolization group, it did not reach statistical significance. Two-year survival for the nonchemoembolization and chemoembolization group was 57.3% {+-} 7.1% and 76.0% {+-} 7.9%, respectively (p = 0.078). Conclusions: Chemoembolization appears to result in a significant decrease in the risk of dropping off liver transplant list for patients with HCC and results in a tendency toward longer survival.

  11. The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease

    PubMed Central

    Diouf, Momar; Temmar, Mohamed; Renard, Cédric; Choukroun, Gabriel; Massy, Ziad A.

    2015-01-01

    Background Although a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages. Methods We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement. Results Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%. Conclusion The addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population. PMID:26181592

  12. A within-patient analysis for time-varying risk factors of CKD progression.

    PubMed

    Li, Liang; Chang, Alexander; Rostand, Stephen G; Hebert, Lee; Appel, Lawrence J; Astor, Brad C; Lipkowitz, Michael S; Wright, Jackson T; Kendrick, Cynthia; Wang, Xuelei; Greene, Tom H

    2014-03-01

    Recent data suggest that nonlinear GFR trajectories are common among patients with CKD, but the modifiable risk factors underlying these changes in CKD progression rate are unknown. Analyses relating baseline risk factors to subsequent GFR decline are suboptimal because these relationships often attenuate as follow-up time increases and these analyses do not account for temporal changes in risk factors. We identified 74 participants in the African American Study of Kidney Disease and Hypertension who had both a period of rapid GFR decline and an extended period of stability during a follow-up period of ?12 years. We performed a within-patient comparison of time-varying risk factors measured during the periods of GFR decline and stability and identified several risk factors associated with faster GFR decline: more hospitalization episodes and hospitalization days per year; higher BP, serum phosphorus, and urine protein-to-creatinine ratio; lower serum albumin and urine sodium-to-potassium ratio; slower rate of decline of serum urea nitrogen, serum creatinine, serum uric acid, and serum phosphorus; and faster rate of decline of serum hematocrit and serum bicarbonate. By allowing each patient to serve as his or her own control, this novel, within-patient analytic approach holds considerable promise as a means to identify time-varying risk factors associated with stabilization of GFR or acceleration of GFR decline. PMID:24231660

  13. SU-E-T-208: Incidence Cancer Risk From the Radiation Treatment for Acoustic Neuroma Patient

    SciTech Connect

    Kim, D [Kyung Hee University International Med. Serv., Seoul (Korea, Republic of); Chung, W [Kyung Hee University Hospital at Gangdong, Seoul, Seoul (Korea, Republic of); Shin, D [Kyung Hee University Hospital, Seoul, Seoul (Korea, Republic of); Yoon, M [Korea University, Seoul (Korea, Republic of)

    2014-06-01

    Purpose: The present study aimed to compare the incidence risk of a secondary cancer from therapeutic doses in patients receiving intensitymodulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiosurgery (SRS). Methods: Four acoustic neuroma patients were treated with IMRT, VMAT, or SRS. Their incidnece excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were estimated using the corresponding therapeutic doses measured at various organs by radio-photoluminescence glass dosimeters (RPLGD) placed inside a humanoid phantom. Results: When a prescription dose was delivered in the planning target volume of the 4 patients, the average organ equivalent doses (OED) at the thyroid, lung, normal liver, colon, bladder, prostate (or ovary), and rectum were measured. The OED decreased as the distance from the primary beam increased. The thyroid received the highest OED compared to other organs. A LAR were estimated that more than 0.03% of AN patients would get radiation-induced cancer. Conclusion: The tyroid was highest radiation-induced cancer risk after radiation treatment for AN. We found that LAR can be increased by the transmitted dose from the primary beam. No modality-specific difference in radiation-induced cancer risk was observed in our study.

  14. Drug-induced hepatitis and the risk factors for liver injury in pulmonary tuberculosis patients

    PubMed Central

    Gaude, Gajanan S.; Chaudhury, Alisha; Hattiholi, Jyothi

    2015-01-01

    Introduction: Short-course chemotherapy containing rifampicin and isoniazid in combination has proved to be highly effective in the treatment of tuberculosis, but one of its adverse effects is hepatotoxicity. Various risk factors have been found to be associated with drug-induced liver injury (DILI) in general population. The study aimed to determine the prevalence of drug-induced hepatitis and the risk factors associated with the DILI among the patients of pulmonary tuberculosis in Indian patients. Setting and Design: Prospective nested case control study. Materials and Methods: Out of the cohort of 3900 tuberculosis patients who were initiated on anti-tubercular therapy, 150 patients who developed drug-induced liver injury due to short-course chemotherapy under RNTCP were included in the analysis. Thirty cases were being followed up in our hospital and other 120 were referred to us for the management of drug-induced hepatitis from the primary health centers. The diagnostic criteria's for DILI were made according to the American Thoracic Society criteria. Analyses of various risk factors were done for the development of DILI. Results: The prevalence of DILI in the present study was 3.8%. It was observed that DILI patients were older and their serum albumin levels were lower, and they had multiple co-morbid conditions. Regular alcohol intake, more extensive disease associated with radiological and female gender were observed to be independent risk factors for the development of DILI. Conclusions: Of the various risk factors analyzed, advanced age, hypoalbuminemia, regular alcohol intake and advanced nature of the disease were independent risk factors for the development of DILI. The risk of development of hepatitis is increased in the presence of one or more of these risk factors. PMID:25949974

  15. Incidence and impact of risk factors in critically ill trauma patients.

    PubMed

    Bochicchio, Grant V; Joshi, Manjari; Bochicchio, Kelly; Shih, Diane; Meyer, W; Scalea, Thomas M

    2006-01-01

    There is a paucity of data describing the incidence of pre-existing diseases or risk factors and their effects in trauma patients. We conducted a prospective study to determine the incidence of such factors in critically ill trauma patients and to evaluate their impact on outcome. The study, performed over a 2-year period, examined the hospital course of all trauma patients admitted to the ICU. Multiple risk factors were evaluated and analyzed via multivariate regression analysis. Outcome was evaluated by infection rate, hospital length of stay, ventilator days, and mortality matched for age and Injury Severity Score (ISS). A total of 1172 patients (73% blunt injury) were enrolled over the study period. Of these, 873 (74.5%) were male. The mean age was 42.5 years with an ISS of 19.8. Tobacco use (24%) was the most common risk factor identified, followed by hypertension (HTN, 17%), coronary artery disease (9%), chronic obstructive pulmonary disease (COPD)/reactive airway disease (4%), non-insulin-dependent diabetes (NIDDM) (4%), insulin-dependent diabetes (IDDM) (3.2%), cancer (3%), liver disease (2%), and HIV/AIDS (1.4%). Of these risk factors, IDDM was found to be an independent risk factor for infection (0.004) and ventilator days (0.047), increasing age was found to be an independent risk factor for hospital length of stay (0.023) and mortality (<0.001), and HTN was found to be an independent risk factor for increased ventilator days (0.04). In addition, COPD/reactive airway disease was found to be an independent predictor of ventilator days, infection, and ICU days (P < 0.05). Thus, increased age, IDDM, COPD, and HTN are most predictive of outcome in critically ill trauma patients. With our aging population it is becoming increasingly important to identify pre-existing risk factors on admission in order to minimize their effects on outcome. PMID:16369714

  16. Extraction and Analysis of Risk Elements for Korean Homecare Patients with Senile Dementia.

    PubMed

    Choi, Mi-Hyun; Kim, Hyung-Sik; Kim, BoSeong; Lee, Jung-Chul; Park, Sung-Jun; Jeong, Ul-Ho; Baek, Ji-Hye; Kim, Hyun-Jun; Lim, Dae-Woon; Chung, Soon-Cheol

    2014-07-22

    The purpose of this study is to provide information for the protection of Korean homecare patients with senile dementia by investigating accident cases using a survey. With the survey of accident cases, the caregivers of 55 Korean homecare patients with senile dementia (75.9?±?7.0 years) were administered the short form of the Samsung Dementia Questionnaire (S-SDQ) and an activities of daily living (ADL) test. Twelve risk elements were extracted. The order of frequency of occurrence from highest to lowest was "egress," "fall," "violence," "collision," "gas accident," "slip," "faucet misuse," "overeating," "drop," "discharge," "weird eating," and "self-injury." The percentage of risk elements resulting in physical harm was 40.1% across all risk elements. The risk elements resulting in the most physical harm were "fall," "collision," "slip," and "drop," respectively. Regarding the location of occurrence of risk elements, risk elements resulting in physical harm showed no significant differences between indoors and outdoors. Some risk elements, such as "egress," "fall," and "gas accident" happened concurrently with more than four other elements, while "collision," "drop," and "violence" happened together with more than two other elements. "Slip" happened significantly more often in the low ADL score group, while "gas accident" happened significantly more often in the high ADL score group. This study provides basic information about monitoring factors to protect senior homecare patients with senile dementia. PMID:25047103

  17. Determining Risk Factors of Bleeding in Patients on Warfarin Treatment

    PubMed Central

    Uygungül, Evren; Ayrik, Cuneyt; Narci, Huseyin; Erdo?an, Semra; Toker, ?brahim; Demir, Filiz; Karaaslan, Ulas

    2014-01-01

    Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57?mg/dL versus 0.94 ± 0.38?mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin. PMID:25431593

  18. A Web Application for Managing Data of Cardiovascular Risk Patients

    Microsoft Academic Search

    Stefano Bonacina; Marco Masseroli

    2006-01-01

    In the last years the development of home based e-health applications, which use information, telecommunication and videoconferencing technologies, is increased because of their characteristics that allow reducing hospitalization costs and managing and monitoring patient health in real time. However, the development of a home based e-health monitoring system requires the contribution of different expertise, from medicine to engineering, and technologies,

  19. Benefit\\/Risk Assessment: Perspective of a Patient Advocate

    Microsoft Academic Search

    Angela J. Bowen

    1993-01-01

    Present regulation and public policy mandate the safety and efficacy of pharmaceuticals. Patients and advocacy groups evaluate benefits in a more relative and subjective manner. These value systems may not coincide with regulatory and market judgments. Strict liability biases drug development toward the establishment of safety, sometimes to the detriment of efficacy. Special avenues may be required to maintain access

  20. Ultrasound imaging for risk assessment in atherosclerosis.

    PubMed

    Steinl, David C; Kaufmann, Beat A

    2015-01-01

    Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned clinical consequences. Therefore, there is a clinical need for imaging methods to detect the early stages of atherosclerosis and to better risk stratify patients. In this review, we will discuss how ultrasound imaging can contribute to the detection and risk stratification of atherosclerosis by (a) detecting advanced and early plaques; (b) evaluating the biomechanical consequences of atherosclerosis in the vessel wall; PMID:25938969

  1. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    PubMed Central

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (?65 years, n = 95) were compared with those of PD patients aged ?49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ?49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  2. Risk Factors of HCV Seroconversion in Hemodialysis Patients in Tabriz, Iran

    PubMed Central

    Somi, Mohammad Hossein; Etemadi, Jalal; Ghojazadeh, Morteza; Farhang, Sara; Faramarzi, Mehrasa; Foroutan, Sanaz; Soleimanpour, Maryam

    2014-01-01

    Background: Hepatitis C virus (HCV) infection is a significant health concern in patients with end-stage renal disease under dialysis. Epidemiological studies have reported a prevalence rate of 5.5-55.9% for this condition in Iran. Objectives: We evaluated the risk factors for HCV infection and seroconversion in hemodialysis patients. Patients and Methods: A retrospective analysis was performed on 455 hemodialysis patients from each of the five dialysis units in Tabriz, northwest Iran. Possible risk factors for HCV infection and seroconversion were evaluated. Results: A total of 37 patients were HCV positive (8.1% of the study population) and seroconversion occurred in 18 of them during the dialysis treatment (3.95% of the study population). History of renal transplantation (44.4%, P < 0.0001), surgical intervention (except for renal transplantation and AV fistula placement) (94.4%, P = 0.03), and mean duration of dialysis (106.06 ± 55.519, P < 0.0001) had strong statistically significant associations with the seroconversion. Conclusions: The current study indicates increased risk for HCV infection in patients under dialysis and its relation with the mean duration of hemodialysis, history of renal transplantation and surgical intervention. Considering the immune deficiency in these patients, intense education to both patients and medical staff will be beneficial. PMID:24976839

  3. Patient safety in the operating room: an intervention study on latent risk factors

    PubMed Central

    2012-01-01

    Background Patient safety is one of the greatest challenges in healthcare. In the operating room errors are frequent and often consequential. This article describes an approach to a successful implementation of a patient safety program in the operating room, focussing on latent risk factors that influence patient safety. We performed an intervention to improve these latent risk factors (LRFs) and increase awareness of patient safety issues amongst OR staff. Methods Latent risk factors were studied using a validated questionnaire applied to the OR staff before and after an intervention. A pre-test/post-test control group design with repeated measures was used to evaluate the effects of the interventions. The staff from one operating room of an university hospital acted as the intervention group. Controls consisted of the staff of the operating room in another university hospital. The outcomes were the changes in LRF scores, perceived incident rate, and changes in incident reports between pre- and post-intervention. Results Based on pre-test scores and participants’ key concerns about organizational factors affecting patient safety in their department the intervention focused on the following LRFs: Material Resources, Training and Staffing Recourses. After the intervention, the intervention operating room - compared to the control operating room - reported significantly fewer problems on Material Resources and Staffing Resources and a significantly lower score on perceived incident rate. The contribution of technical factors to incident causation decreased significantly in the intervention group after the intervention. Conclusion The change of state of latent risk factors can be measured using a patient safety questionnaire aimed at these factors. The change of the relevant risk factors (Material and Staffing resources) concurred with a decrease in perceived and reported incident rates in the relevant categories. We conclude that interventions aimed at unfavourable latent risk factors detected by a questionnaire focussed at these factors may contribute to the improvement of patient safety in the OR. PMID:22726757

  4. Pulmonary Hypertension and Risk of Death in Cardiomyopathy Patients With Myocarditis Are at Higher Risk

    Microsoft Academic Search

    Thomas P. Cappola; G. Michael Felker; W. H. Linda Kao; Joshua M. Hare; Kenneth L. Baughman; Edward K. Kasper

    Background—Pulmonary hypertension is a clinically useful predictor of death in patients with heart failure. Whether pulmonary hypertension has the same prognostic value among specific underlying causes of cardiomyopathy is unknown. Using a diverse cohort of cardiomyopathy patients, we tested the hypotheses that (1) elevated mean pulmonary arterial pressure is the most important hemodynamic predictor of death and (2) the prognostic

  5. High Risk of Hepatitis B Reactivation among Patients with Acute Myeloid Leukemia

    PubMed Central

    Chen, Chien-Yuan; Huang, Sheng-Yi; Cheng, Aristine; Chou, Wen-Chien; Yao, Ming; Tang, Jih-Luh; Tsay, Woei; Sheng, Wang-Huei; Tien, Hwei-Fang

    2015-01-01

    Background Hepatitis B virus (HBV) infections are common and associated with significant morbidity and mortality in cancer patients. However, the incidence and risk factors of HBV reactivation in patients with acute myeloid leukemia (AML) are rarely investigated. Methods AML patients followed-up at the National Taiwan University Hospital between 2006 and 2012 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed. Results Four hundred and ninety patients comprising 265 men and 225 women were studied. The median age was 52 years (range, 18 - 94). Chronic HBV carriage was documented at the time of leukemia diagnosis in 57 (11.6%) patients. Forty-six (80.7%) of the 57 HBV carriers received prophylaxis with anti-HBV agents. Sixteen HBV carriers (28.1%) developed hepatitis B reactivation during or after chemotherapy, including 7 patients who had discontinued antiviral therapy. The incidence of hepatitis B reactivation among AML patients with HBV carriage was 9.5 per 100 person-years. Prophylaxis with anti-HBV agents significantly decreased the risk of hepatitis B reactivation among HBV carriers (13% vs. 61%, p<0.001). Four (2.8%) of 142 patients with initial positive anti-HBsAb and anti-HBcAb experienced hepatitis B reactivation and lost their protective anti-HBsAb. Multivariate analysis revealed that diabetes mellitus (p=0.008, odds ratio (OR) = 2.841, 95% confident interval (CI): 0.985-8.193) and carriage of HBsAg (p<0.001, OR=36.878, 95% CI: 11.770-115.547) were independent risk factors for hepatitis B reactivation in AML patients. Conclusions Hepatitis B reactivation is not uncommon in the HBsAg positive AML patients. Prophylaxis with anti-HBV agent significantly decreased the risk of hepatitis B reactivation. PMID:25973905

  6. Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

    PubMed Central

    Marchaim, Dror; Johnson, Paul C.; Awali, Reda A.; Doshi, Hardik; Chalana, Indu; Davis, Naomi; Zhao, Jing J.; Pogue, Jason M.; Parmar, Sapna; Kaye, Keith S.

    2014-01-01

    Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ?3 (odds ratio [OR], 2.34; P = 0.001), a direct admission from another health care facility (OR, 4.63; P < 0.0001), a prior hospitalization (OR, 3.11; P < 0.0001), the presence of an indwelling central venous line (OR, 2.75; P = 0.011), the receipt of total parenteral nutrition (OR, 21.2; P < 0.0001), the prior receipt of ?-lactams (OR, 3.58; P < 0.0001), the prior receipt of carbapenems (OR, 3.18; P = 0.006), and the prior receipt of chemotherapy (OR, 15.42; P < 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40; P < 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices. PMID:24890594

  7. Impact of atherosclerosis risk factors on the clinical presentation of arterial occlusive disease in Arabic patients

    PubMed Central

    Elsharawy, Mohamed A; Alkhadra, Akram H; Ibrahim, Mohammed Fakhary A; Selim, Fathi; Hassan, Khairy; Elsaid, Aymen S; Bahnassy, Ahmed

    2008-01-01

    BACKGROUND: Although the risk factors for atherosclerosis have been identified, their impact on the presentation of arterial occlusive disease has not been studied among Arabs. OBJECTIVE: To determine the correlation between atherosclerotic risk factors and the extent and presentation of atherosclerotic disease in different arterial systems. METHODS: The present case-control study was performed on a consecutive series of Arabic patients over one year. There were two groups – an atherosclerotic group, which included patients with peripheral arterial disease, extracranial cerebrovascular disease or coronary artery disease (CAD), and the control group, which included patients admitted to one of the general surgical units who were free from atherosclerotic disease. All patients underwent evaluation of risk factors (diabetes mellitus [DM], smoking, dyslipidemia and hypertension) for atherosclerosis and systemic assessment of the vascular tree. RESULTS: Two hundred fifteen patients in the atherosclerotic group and 191 patients in the control group were included in the study. There were positive correlations between the prevalence of DM, smoking, dyslipidemia and the severity of presentation of peripheral arterial disease, and the extent of CAD. The correlation between the incidence of DM and the severity of presentation of CAD was also significant. The correlation was also positive between the incidence of ex-smoking and hypertension, and the severity of presentation of extracranial cerebrovascular disease. CONCLUSION: Different risk factors may interact in different ways in the clinical presentation of atherosclerotic disease in different arterial systems. PMID:22477450

  8. Absolute lymphocyte count and risk of short-term infection in patients with immune thrombocytopenia.

    PubMed

    Hu, Ming-Hung; Yu, Yuan-Bin; Huang, Yu-Chung; Gau, Jyh-Pyng; Hsiao, Liang-Tsai; Liu, Jin-Hwang; Chen, Ming-Huang; Chiou, Tzeon-Jye; Chen, Po-Min; Tzeng, Cheng-Hwai; Liu, Chun-Yu

    2014-06-01

    Patients with immune thrombocytopenia (ITP) may be at increased risk of infection because of the steroids and other immunosuppressive agents used in its treatment. This study aimed to identify events that are associated with infection within 6 months of diagnosis and the impact that infection has on survival. We retrospectively evaluated 239 patients (107 men, 132 women; median age 61 years) diagnosed between January 1997 and August 2011. Every patient received steroid treatment according to the platelet count and the extent of bleeding. Logistic regression analysis was used to identify risk factors associated with the development of infection within 6 months of ITP being diagnosed. Sixty-two patients (25.9 %) developed an infection within 6 months of diagnosis. Multivariate analysis revealed that a lower absolute lymphocyte count (ALC) at diagnosis (<1?×?10(9)/l) was an independent risk factor for infection (P?=?0.039; 95 % confidence interval, 1.033-3.599; odds ratio, 1.928). The time to infection event is significant shorter in those of low ALC, compared with those of higher ALC (P?=?0.032). Furthermore, the 1-year mortality rate after ITP diagnosis was significantly higher in those patients who developed an infection (P?=?0.001). ITP patients with a low absolute lymphocyte count at diagnosis have an increased risk of infection, and those who develop infections have lower 1-year survival. PMID:24441917

  9. Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates

    PubMed Central

    2015-01-01

    Introduction The aim of this study was to establish the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in oncologic patients and to determine risk predictors with respect to this condition. Material and methods This retrospective review included 197 oncologic patients treated from January 2005 to December 2010 with administration of bisphosphonates (BPs) as part of management. Sex, age, type of cancer diagnosed, period of substantial disease, oral surgery, type of bisphosphonate, number of doses, and cases of BRONJ diagnosis were recorded. The cumulative incidence and incidence rate of BRONJ were calculated. The factors that influenced BRONJ were assessed with multivariate logistic regression and with estimations of 95% confidence intervals and odd ratios. Values of p ? 0.05 were considered significant. Results The BRONJ appeared in 9.64% of patients. The BRONJ incidence rate was 1 in 28 patients per year of BP treatment. Logistic regression showed that the odds of osteonecrosis increased 1.0172-fold with each given dose of BP. The BRONJ risk with zoledronate was 5-fold higher than that with pamidronate or ibandronate. The risk of BRONJ increased by 40-fold after dental surgery. Conclusions Period of BP administration and type of BP used are important risk predictors for the development of BRONJ in oncologic patients treated with intravenous administration of these drugs. Patient-related factors are dental or periodontal events connected with need for oral surgery. PMID:25995747

  10. Risk Factors for Hepatitis C Infection Among Sexually Transmitted Disease-Infected, Inner City Obstetric Patients

    PubMed Central

    Choy, Youyin; Apuzzio, Joseph; Skurnick, Joan; Zollicoffer, Carl; McGovern, Peter G.

    2003-01-01

    Objective: To test the hypothesis that our inner city obstetric patients who have been infected with sexually transmitted diseases (STDs) will have a higher prevalence of hepatitis C virus infection than the general population and to identify specific risk factors and high-risk groups. Methods: All patients in our prenatal clinic (July 1997–April 1999) who tested positive for one or more STDs were asked to return for hepatitis C antibody testing. Medical charts of all patients who returned for hepatitis C testing were reviewed. Results: A total of 106 patients with STDs were tested for hepatitis C. Positive screening tests for anti-hepatitis C antibody were found in 6.6% (7/106) of the patients (95% CI = 2.7–13.1%). This frequency is significantly higher than the hepatitis C prevalence (1.8%) in the general United States population (p = 0.006). Multiple logistic regression analysis confirmed only older age (p = 0.016) and positive HIV status (p = 0.023) to be significant predictors of hepatitis C infection. Conclusions: Inner city STD-infected obstetric patients are at high risk for hepatitis C infection compared with the general population. Increasing age and HIV-positive status are risk factors which are significantly associated with hepatitis C infection. PMID:15108864

  11. Estrogen replacement therapy (ERT) in high-risk cancer patients.

    PubMed Central

    Hutchinson-Williams, K. A.; Gutmann, J. N.

    1991-01-01

    Menopausal estrogens are now being prescribed not only for symptom relief, but also to prevent the long-term sequelae of estrogen deficiency, namely osteoporosis and atherosclerotic disease. The well-established association between endometrial cancer and estrogen replacement therapy (ERT) has become less of a clinical concern due to the recognition of the protective effect of progestogens in this setting. A small literature has emerged suggesting that extending ERT to the woman with a history of endometrial carcinoma imposes no increased risk of recurrence and may improve survival. Candidates for ERT should be women with a better prognostic profile with reference to their cancer. The relationship between ERT and breast cancer remains a topic of intense debate and investigation. Overall, the current literature finds no significant increase in risk among healthy women without a family history of breast cancer. There are no guidelines with reference to the woman with a history of breast cancer and the use of ERT. The most prudent approach with this population is to consider alternative treatments until more is known. PMID:1810102

  12. Risk of Developing Second Cancer From Neutron Dose in Proton Therapy as Function of Field Characteristics, Organ, and Patient Age

    SciTech Connect

    Zacharatou Jarlskog, Christina [Department of Radiation Oncology, Copenhagen University Hospital, Copenhagen (Denmark); Paganetti, Harald [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)], E-mail: hpaganetti@partners.org

    2008-09-01

    Purpose: To estimate the risk of a second malignancy after treatment of a primary brain cancer using passive scattered proton beam therapy. The focus was on the cancer risk caused by neutrons outside the treatment volume and the dependency on the patient's age. Methods and Materials: Organ-specific neutron-equivalent doses previously calculated for eight different proton therapy brain fields were considered. Organ-specific models were applied to assess the risk of developing solid cancers and leukemia. Results: The main contributors (>80%) to the neutron-induced risk are neutrons generated in the treatment head. Treatment volume can influence the risk by up to a factor of {approx}2. Young patients are subject to significantly greater risks than are adult patients because of the geometric differences and age dependency of the risk models. Breast cancer should be the main concern for females. For males, the risks of lung cancer, leukemia, and thyroid cancer were significant for pediatric patients. In contrast, leukemia was the leading risk for an adult. Most lifetime risks were <1% (70-Gy treatment). The only exceptions were breast, thyroid, and lung cancer for females. For female thyroid cancer, the treatment risk can exceed the baseline risk. Conclusion: The risk of developing a second malignancy from neutrons from proton beam therapy of a brain lesion is small (i.e., presumably outweighed by the therapeutic benefit) but not negligible (i.e., potentially greater than the baseline risk). The patient's age at treatment plays a major role.

  13. [Cooking as a therapy for dangerous mental health patients: controlled risk-taking].

    PubMed

    Geay, Janique; Schmitt, Stéphane; Bouchard, Jean-Pierre

    2015-01-01

    Among the range of therapeutic mediators used with dangerous mental health patients in the unit for dangerous patients in Cadillac, cooking holds an important place. Led by caregivers, this activity has undeniable positive effects for the psychotic and non-psychotic patients taking part. These effects concern notably their capacities for conception, creation, organisation, execution, sensation, collaboration and socialisation. For some patients, it is also the opportunity to take the drama out of handling utensils which they previously used as weapons. As the risk factors are controlled before and during the activity, no dangerous acting out has ever occurred. PMID:26143218

  14. Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months

    PubMed Central

    Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

    2014-01-01

    Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period. PMID:25258628

  15. Microalbuminuria indicates long-term vascular risk in patients after acute stroke undergoing in-patient rehabilitation

    PubMed Central

    2012-01-01

    Background Patients in neurologic in-patient rehabilitation are at risk of cardio- and cerebrovascular events. Microalbuminuria (MAU) is frequent and an important risk predictor but has not been validated in in-patient rehabilitation. We therefore aimed to examine MAU as an indicator of risk and predictor of vascular events in a prospective study. Methods The INSIGHT (INvestigation of patients with ischemic Stroke In neuroloGic reHabiliTation) registry is the first to provide large scale data on 1,167 patients with acute stroke (< 3 months) that survived the initial phase of high risk and were undergoing neurologic in-patient rehabilitation. MAU was determined by dipstick-testing and correlated to baseline clinical variables (stroke-origin, functional impairment, co-morbidity, ankle-brachial-index, intima-media-thickeness) as well as vascular events after one year of follow-up. Comparisons were made with the ?2 or Mann–Whitney-U Test. Relative risks (RR) with 95% confidence intervals (CI) were estimated using log-binominal models. To evaluate the association between MAU and new vascular events as well as mortality, we calculated hazard ratios (HR) using Cox proportional hazard regression. Results A substantial proportion of patients was MAU positive at baseline (33.1%). Upon univariate analysis these patients were about 4 years older (69 vs. 65 years; p?Patients with MAU had a similar NIH stroke scale score (median 3 vs. 3; p?=?0.379) but had lower values on the Barthel Index (median 75 vs. 90; p?patients recovering from ischemic stroke. This biomarker may also be used in patients during neurologic in-patient rehabilitation, opening a window of opportunity for early intervention in this patient group at increased risk for recurrent events. PMID:23007013

  16. Bathymetry, stratification, and internal seiche structure

    NASA Astrophysics Data System (ADS)

    Fricker, P. D.; Nepf, H. M.

    2000-06-01

    Internal seiches play a significant role in a broad range of physical, chemical, and biological processes in lakes. A detailed assessment of the impact of seiching requires an understanding of seiche structure, which is determined by bathymetry and stratification. In this study, internal seiche solutions are evaluated for arbitrary bathymetry and continuous stratification using a two-dimensional numerical model. Formulated in terms of a stream function, the model produces a finite set of linear internal wave eigenmodes and allows the computation of the complete velocity field (over a grid) associated with each seiche mode. Several idealized configurations of continuous stratification and variable bathymetry are used to explore the effect of nonuniform systems on internal wave structure. In particular, we focus on bed velocity distribution and the resulting potential impact on scalar fluxes, sediment transport, and internal wave damping. Model results are also compared to thermistor chain data collected in the Upper Mystic Lake (UML, Winchester, Massachusetts). Using an idealized description of the UML bathymetry and density profiles which emulate the seasonal variation of stratification in the lake, the evolution of bed velocities during the autumnal breakdown in stratification is assessed, providing insight into the fate of the contaminants entering the lake.

  17. Magnesium Modifies the Cardiovascular Mortality Risk Associated with Hyperphosphatemia in Patients Undergoing Hemodialysis: A Cohort Study

    PubMed Central

    Sakaguchi, Yusuke; Fujii, Naohiko; Shoji, Tatsuya; Hayashi, Terumasa; Rakugi, Hiromi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu; Isaka, Yoshitaka

    2014-01-01

    Background In vitro studies have shown inhibitory effects of magnesium (Mg) on phosphate-induced calcification of vascular smooth muscle cells, raising the possibility that maintaining a high Mg level may be useful for reducing cardiovascular risks of patients with hyperphosphatemia. We examined how serum Mg levels affect the association between serum phosphate levels and the risk of cardiovascular mortality in patients undergoing hemodialysis. Methods A nationwide register-based cohort study was conducted using database of the Renal Data Registry of the Japanese Society for Dialysis Therapy in 2009. We identified 142,069 patients receiving in-center hemodialysis whose baseline serum Mg and phosphate levels were available. Study outcomes were one-year cardiovascular and all-cause mortality. Serum Mg levels were categorized into three groups (lower, <2.7 mg/dL; intermediate, ?2.7, <3.1 mg/dL; and higher, ?3.1 mg/dL). Results During follow-up, 11,401 deaths occurred, out of which 4,751 (41.7%) were ascribed to cardiovascular disease. In multivariable analyses, an increase in serum phosphate levels elevated the risk of cardiovascular mortality in the lower- and intermediate-Mg groups, whereas no significant risk increment was observed in the higher-Mg group. Moreover, among patients with serum phosphate levels of ?6.0 mg/dL, the cardiovascular mortality risk significantly decreased with increasing serum Mg levels (adjusted odds ratios [95% confidence intervals] of the lower-, intermediate-, and higher-Mg groups were 1.00 (reference), 0.81 [0.66–0.99], and 0.74 [0.56–0.97], respectively.). An interaction between Mg and phosphate on the risk of cardiovascular mortality was statistically significant (P?=?0.03). Conclusion Serum Mg levels significantly modified the mortality risk associated with hyperphosphatemia in patients undergoing hemodialysis. PMID:25545498

  18. Serum parathyroid hormone and risk of adverse outcomes in patients with stable coronary heart disease

    Microsoft Academic Search

    Norma Christine Grandi; Lutz Philipp Breitling; Harry Hahmann; Bernd Wüsten; Winfried März; Dietrich Rothenbacher; Hermann Brenner

    2011-01-01

    Background and objectiveRecent longitudinal studies have suggested an association of high serum parathyroid hormone levels (PTH) with elevated cardiovascular risk in the general population. This study presents analyses of the prognostic value of baseline PTH for subsequent cardiovascular events and all-cause mortality in a high-risk population with stable coronary heart disease.MethodsBased on measurements of PTH levels in 1133 patients recruited

  19. Addressing Risk Assessment for Patient Safety in Hospitals through Information Extraction in Medical Reports

    NASA Astrophysics Data System (ADS)

    Proux, Denys; Segond, Frédérique; Gerbier, Solweig; Metzger, Marie Hélène

    Hospital Acquired Infections (HAI) is a real burden for doctors and risk surveillance experts. The impact on patients' health and related healthcare cost is very significant and a major concern even for rich countries. Furthermore required data to evaluate the threat is generally not available to experts and that prevents from fast reaction. However, recent advances in Computational Intelligence Techniques such as Information Extraction, Risk Patterns Detection in documents and Decision Support Systems allow now to address this problem.

  20. Hiv risk behavior in male and female russian sexually transmitted disease clinic patients

    Microsoft Academic Search

    Eric G. Benotsch; Steven D. Pinkerton; Roman V. Dyatlov; Wayne DiFranceisco; Tatyana S. Smirnova; Valentina Y. Dudko; Andrei Kozlov

    2006-01-01

    Russia is experiencing one of the fastest growing HIV epidemics in the world. Russian sexually transmitted disease (STD) clinic\\u000a patients are at elevated risk for infection with HIV and other STDs due to unsafe sexual behaviors. Future risk reduction\\u000a intervention efforts for this group must be grounded in a solid understanding of the factors associated with risky behaviors.\\u000a We collected

  1. Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain

    PubMed Central

    Amsterdam, Ezra A.; Kirk, J. Douglas; Bluemke, David A.; Diercks, Deborah; Farkouh, Michael E.; Garvey, J. Lee; Kontos, Michael C.; McCord, James; Miller, Todd D.; Morise, Anthony; Newby, L. Kristin; Ruberg, Frederick L.; Scordo, Kristine Anne; Thompson, Paul D.

    2011-01-01

    The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians' diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain. PMID:20660809

  2. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors

    PubMed Central

    2013-01-01

    Background Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH2O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH2O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence. PMID:23587445

  3. Concurrent Androgen Deprivation Therapy During Salvage Prostate Radiotherapy Improves Treatment Outcomes in High-Risk Patients

    SciTech Connect

    Soto, Daniel E., E-mail: dsoto2@partners.org [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Passarelli, Michael N.; Daignault, Stephanie [Cancer Center Biostatistics Core, University of Michigan, Ann Arbor, MI (United States); Sandler, Howard M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

    2012-03-01

    Purpose: To determine whether concurrent androgen deprivation therapy (ADT) during salvage radiotherapy (RT) improves prostate cancer treatment outcomes. Methods and Materials: A total of 630 postprostatectomy patients were retrospectively identified who were treated with three-dimensional conformal RT. Of these, 441 were found to be treated for salvage indications. Biochemical failure was defined as prostate-specific antigen (PSA) of 0.2 ng/mL or greater above nadir with another PSA increase or the initiation of salvage ADT. Progression-free survival (PFS) was defined as the absence of biochemical failure, continued PSA rise despite salvage therapy, initiation of systemic therapy, clinical progression, or distant failure. Multivariate-adjusted Cox proportional hazards modeling was performed to determine which factors predict PFS. Results: Low-, intermediate-, and high-risk patients made up 10%, 24%, and 66% of patients, respectively. The mean RT dose was 68 Gy. Twenty-four percent of patients received concurrent ADT (cADT). Regional pelvic nodes were treated in 16% of patients. With a median follow-up of 3 years, the 3-year PFS was 4.0 years for cADT vs. 3.4 years for cADT patients (p = 0.22). Multivariate analysis showed that concurrent ADT (p = 0.05), Gleason score (p < 0.001), and pre-RT PSA (p = 0.03) were independent predictors of PFS. When patients were stratified by risk group, the benefits of cADT (hazard ratio, 0.65; p = 0.046) were significant only for high-risk patients. Conclusions: This retrospective study showed a PFS benefit of concurrent ADT during salvage prostate RT. This benefit was observed only in high-risk patients.

  4. Colonoscopy Reduces Risk of Death from Colorectal Cancer in High-Risk Patients

    Cancer.gov

    Long-term results from the National Polyp Study confirm that removing precancerous adenomas not only reduces the risk of colorectal cancer but also reduces the number of deaths from the disease by more than half. The findings appeared February 23, 2012, in the New England Journal of Medicine.

  5. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations.

    PubMed

    Gupta, A K; Daigle, D; Foley, K A

    2015-06-01

    Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection. PMID:25413984

  6. Total and High Molecular Weight Adiponectin Levels and Prediction of Cardiovascular Risk in Diabetic Patients

    PubMed Central

    Horáková, Dagmar; Azeem, Kate?ina; Benešová, Radka; Pastucha, Dalibor; Horák, Vladimír; Dumbrovská, Lenka; Martínek, Arnošt; Novotný, Dalibor; Hobzová, Milada; Galuszková, Dana; Janout, Vladimír; Don?vská, Sandra; Vrbková, Jana; Kollárová, Helena

    2015-01-01

    The study aimed at assessing the potential use of lower total and HMW adiponectin levels for predicting cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). Concentrations of total adiponectin or high molecular weight (HMW) adiponectin decrease in association with the development of metabolic dysfunction such as obesity, insulin resistance, or T2DM. Increased adiponectin levels are associated with a lower risk for coronary heart disease. A total of 551 individuals were assessed. The first group comprised metabolically healthy participants (143 females, and 126 males) and the second group were T2DM patients (164 females, and 118 males). Both total adiponectin and HMW adiponectin in diabetic patients were significantly lower when compared with the group of metabolically healthy individuals. There was a weak monotonic correlation between HMW adiponectin levels and triglycerides levels. Binary logistic regression analysis, gender adjusted, showed a higher cardiovascular risk in diabetic persons when both total adiponectin (OR = 1.700) and HMW adiponectin (OR = 2.785) levels were decreased. A decrease in total adiponectin levels as well as a decrease in its HMW adiponectin is associated with a higher cardiovascular risk in individuals with T2DM. This association suggests that adiponectin levels may be potentially used as an epidemiological marker for cardiovascular risk in diabetic patients.

  7. Increase in stroke risk in patients with head and neck cancer: a retrospective cohort study

    PubMed Central

    Chu, C-N; Chen, S-W; Bai, L-Y; Mou, C-H; Hsu, C Y; Sung, F-C

    2011-01-01

    Background: This study investigated the stroke risk in patients with head and neck cancers (HNCs) using population-based data. Methods: From claims collected in the Taiwan National Health Insurance database, we identified 13?390 HNC patients with diagnosis made in 2000–2002. A reference cohort of 53?517 non-cancer individuals matched for age, gender, and stroke risk factors was used for assessing stroke risk in follow-up to 2008. Results: The overall stroke incidence was 1.44-fold higher in the HNC than in the reference cohort (11.4 vs 7.9 per 1000 person-years). Adjusted hazard ratios (HRs) were 1.54 (95% confidence interval (CI): 1.40–1.68) for ischaemic stroke and 1.36 (95% CI: 1.09–1.69) for haemorrhagic stroke. The cancer-to-reference stroke incidence rate ratio was age dependent and the highest in the age group younger than 40 years (5.45, 95% CI: 3.78–7.87) and decreased with aging. Comparing different therapeutic modalities, HNC patients receiving both radiotherapy (RT) and chemotherapy (CT) had the highest stroke risk (HR: 1.46, 95% CI: 1.22–1.74), followed in sequence by those who had CT alone, RT alone, and without therapy. Conclusion: Patients with HNC are at increased risk of developing stroke, especially in the young age group and in those who received both RT and CT. PMID:21915128

  8. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin.

    PubMed

    Quinn, Gene R; Singer, Daniel E; Chang, Yuchiao; Go, Alan S; Borowsky, Leila H; Udaltsova, Natalia; Fang, Margaret C

    2014-08-15

    Selective serotonin reuptake inhibitor (SSRI) medications have been linked to increased bleeding risk; however, the actual association among warfarin, SSRI exposure, and bleeding risk has not been well-established. We studied the AnTicoagulation and Risk factors In Atrial fibrillation cohort of 13,559 adults with atrial fibrillation, restricted to the 9,186 patients contributing follow-up time while taking warfarin. Exposure to SSRIs and tricyclic antidepressants (TCAs) was assessed from pharmacy database dispensing data. The main outcome was hospitalization for major hemorrhage. Results were adjusted for bleeding risk and time in international normalized ratio range >3. We identified 461 major hemorrhages during 32,888 person-years of follow-up, 45 events during SSRI use, 12 during TCA-only use, and 404 without either medication. Hemorrhage rates were higher during periods of SSRI exposure compared with periods on no antidepressants (2.32 per 100 person-years vs 1.35 per 100 person-years, p <0.001) and did not differ between TCA exposure and no antidepressants (1.30 per 100 person-years on TCAs, p = 0.94). After adjustment for underlying bleeding risk and time in international normalized ratio range >3, SSRI exposure was associated with an increased rate of hemorrhage compared with no antidepressants (adjusted relative risk 1.41, 95% confidence interval 1.04 to 1.92, p = 0.03), whereas TCA exposure was not (adjusted relative risk 0.82, 95% confidence interval 0.46 to 1.46, p = 0.50). In conclusion, SSRI exposure was associated with higher major hemorrhage risk in patients taking warfarin, and this risk should be considered when selecting antidepressant treatments in those patients. PMID:25001151

  9. Dyslipidemia and cardiovascular disease risk profiles of patients attending an HIV treatment clinic in Harare, Zimbabwe

    PubMed Central

    Zhou, Danai Tavonga; Kodogo, Vitaris; Chokuona, Kudzai Fortunate Vongai; Gomo, Exnevia; Oektedalen, Olav; Stray-Pedersen, Babill

    2015-01-01

    The chronic inflammation induced by human immunodeficiency virus (HIV) contributes to increased risk of coronary heart disease (CHD) in HIV-infected individuals. HIV-infected patients generally benefit from being treated with antiretroviral drugs, but some antiretroviral agents have side effects, such as dyslipidemia and hyperglycemia. There is general consensus that antiretroviral drugs induce a long-term risk of CHD, although the levels of that risk are somewhat controversial. The intention of this cross-sectional study was to describe the lipid profile and the long-term risk of CHD among HIV-positive outpatients at an HIV treatment clinic in Harare, Zimbabwe. Two hundred and fifteen patients were investigated (females n=165, mean age 39.8 years; males n=50; mean age 42.0 years). Thirty of the individuals were antiretroviral-naïve and 185 had been on antiretroviral therapy (ART) for a mean 3.9±3.4 years. All participants had average lipid and glucose values within normal ranges, but there was a small difference between the ART and ART-for total cholesterol (TC) and high-density lipoprotein (HDL). Those on a combination of D4T or ZDV/NVP/3TC and PI-based ART were on average oldest and had the highest TC levels. Framingham risk showed 1.4% prevalence of high CHD risk within the next ten years. After univariate analysis age, sex, TC/HDL ratio, HDL, economic earnings and systolic BP were associated with medium to high risk of CHD. After multivariate regression analysis and adjusting for age or sex only age, sex and economic earnings were associated with medium to high risk of CHD. There is small risk of developing CHD, during the next decade in HIV infected patients at an HIV treatment clinic in Harare. PMID:25999764

  10. High dependency care: impact of lack of facilities for high-risk surgical patients

    Microsoft Academic Search

    J. P. R. Loughrey; G. Fitzpatrick; J. Connolly; M. Donnelly

    2002-01-01

    Background  The difference between the level of care available on general ward areas and intensive care units (ICUs) has resulted in the\\u000a development of high dependency units (HDUs).\\u000a \\u000a \\u000a \\u000a Aims  This study examined the current perioperative management techniques and clinical care settings of high-risk surgical patients\\u000a in a hospital without a HDU.\\u000a \\u000a \\u000a \\u000a Methods  A prospective audit of high-risk surgical patients was performed over an

  11. Maternal serum alpha-fetoprotein (MSAFP) patient-specific risk reporting: its use and misuse.

    PubMed

    Macri, J N; Kasturi, R V; Krantz, D A; Cook, E J; Larsen, J W

    1990-03-01

    Fundamental to maternal serum alpha-fetoprotein screening is the clinical utility of the laboratory report. It follows that the scientific form of expression in that report is vital. Professional societies concur that patient-specific risk reporting is the preferred form. However, some intermediate steps being taken to calculate patient-specific risks are invalid because of the erroneous assumption that multiples of the median (MoMs) represent an interlaboratory common currency. The numerous methods by which MoMs may be calculated belie the foregoing assumption. PMID:1689955

  12. Risk factors of intra-abdominal bacterial infection after liver transplantation in patients with hepatocellular carcinoma

    PubMed Central

    Nie, Kai; Ran, Rongzheng; Yi, Bin; Luo, Xiangji; Yu, Yong

    2014-01-01

    Objective To explore the risk factors of intra-abdominal bacterial infection (IAI) after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods A series of 82 HCC patients who received LT surgeries in our department between March 2004 and April 2010 was recruited in this study. Then we collected and analyzed the clinical data retrospectively. Statistical analysis system (SPSS) software was adopted to perform statistical analysis. Chi-square test, t-test and Wilcoxon rank sum test were used to analyze the clinical data and compute the significance of the incidences of early-stage IAI after LT for HCC patients. Binary logistic regression was performed to screen out the risk factors, and multiple logistic regression analyses were performed to compute the independent risk factors. Results A series of 13 patients (13/82, 15.9%) had postoperative IAI. The independent risk factors of postoperative intra-abdominal bacterial infections after LT for HCC patients were preoperative anemia [Hemoglobin (HGB) <90 g/L] and postoperative abdominal hemorrhage (72 hours >400 mL), with the odds ratios at 8.121 (95% CI, 1.417 to 46.550, P=0.019) and 5.911 (95% CI, 1.112 to 31.432, P=0.037). Conclusions Postoperative IAI after LT in patients with HCC was a common complication. Preoperative moderate to severe anemia, as well as postoperative intra-abdominal hemorrhage more than 400 mL within the first 72 hours might independently indicate high risk of IAI for these patients. PMID:25035658

  13. Treatment recommendations to prevent myocardial ischemia and infarction in patients undergoing vascular surgery

    Microsoft Academic Search

    Willem-Jan Flu; Sanne E. Hoeks; Jan-Peter van Kuijk; Jeroen J. Bax; Don Poldermans

    2009-01-01

    Opinion statement  During major vascular surgery (MVS), patients are at high risk for developing unrecognized myocardial infarction (MI) and\\u000a myocardial ischemia. In reducing postoperative morbidity and mortality, preoperative cardiac risk stratification and adequate\\u000a medical therapy play a pivotal role. Based on literature and current opinions, medical treatment should comprise at least\\u000a a combination of ?-blockers, aspirin, and statins. ?-Blockers exert their

  14. A quality improvement plan to reduce 30-day readmissions of heart failure patients.

    PubMed

    Simpson, Monica

    2014-01-01

    An evidence-based quality initiative to decrease heart failure 30-day readmissions was implemented at a hospital in Florida. Heart failure education and postdischarge telephone contact were provided to patients determined to be at high risk of readmission using risk stratification tools. The rate during the project decreased 13% as compared to the same time period in the previous year and 8.5% from the 2012 year to date rate. PMID:24378289

  15. Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

    PubMed Central

    Valeriani, Maurizio; Carnevale, Alessia; Bonome, Paolo; Montalto, Adelaide; Nicosia, Luca; Osti, Mattia F.; De Sanctis, Vitaliana; Minniti, Giuseppe; Maurizi Enrici, Riccardo

    2014-01-01

    Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT) in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT). Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60?Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 11.9% and 40.7%, respectively. Grade 1?GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ?2 late toxicities were recorded. Acute grade 2-3?GU toxicity resulted significantly lower (P = 0.04) in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2?GU toxicity was significantly higher (P < 0.001) for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT. PMID:24864248

  16. Risk of dementia in elderly patients with the use of proton pump inhibitors.

    PubMed

    Haenisch, Britta; von Holt, Klaus; Wiese, Birgitt; Prokein, Jana; Lange, Carolin; Ernst, Annette; Brettschneider, Christian; König, Hans-Helmut; Werle, Jochen; Weyerer, Siegfried; Luppa, Melanie; Riedel-Heller, Steffi G; Fuchs, Angela; Pentzek, Michael; Weeg, Dagmar; Bickel, Horst; Broich, Karl; Jessen, Frank; Maier, Wolfgang; Scherer, Martin

    2015-08-01

    Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ?75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer's disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer's disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95 % confidence interval (CI) 1.04-1.83] and Alzheimer's disease (HR 1.44, 95 % CI 1.01-2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention. PMID:25341874

  17. Clinical Analysis of Etiology, Risk Factors and Outcome in Patients with Acute Kidney Injury

    PubMed Central

    Hamzic-Mehmedbasic, Aida; Rebic, Damir; Balavac, Merima; Muslimovic, Alma; Dzemidzic, Jasminka

    2015-01-01

    Introduction: Acute kidney injury is characterized by a rapid loss of renal excretory function with the increase of nitrogen compounds in the blood and with different outcome. Objective: Since descriptions of the risk factors and sequelae of acute kidney injury (AKI) remain relatively limited, the objective of this study was to determine etiology and clinical characteristics of AKI, as well as risk factors for adverse outcome of renal function and death in AKI patients. Methods: We retrospectively studied a cohort of 84 adult AKI patients admitted to Nephrology Clinic in University Clinical Centre Sarajevo during period 2012-2014. Demographic, laboratory and clinical parameters were retrieved. The in-hospital and 6 months mortality were recorded. Renal function outcome was defined 3 months following discharge. Results: Majority of patients were older (median age 73.5 years) with great severity of AKI (Stage III in 78.5% of cases) and high burden of comorbidities (mean Charlson comorbidity index, CCI score 6.4±3.05). The most common causes of AKI were acute interstitial nephritis (16.7%), heart failure (15.5%), gastroenterocolitis (13.1%), and sepsis (12%). Renal function recovery was recorded in 48.8% of patients, with prevalence of 10.7% of intrahospital mortality and 37.3% of 6 months mortality. Risk factors for poor outcome of renal function and mortality in AKI patients were increasing age and higher CCI score, while protective factor was higher diuresis. Sepsis proved to be risk factor for death. PMID:26005378

  18. The 16-year course of shame and its risk factors in patients with borderline personality disorder.

    PubMed

    Karan, Esen; Niesten, Isabella J M; Frankenburg, Frances R; Fitzmaurice, Garrett M; Zanarini, Mary C

    2014-08-01

    The current study had two aims. The first was to examine the course of shame over 16?years of prospective follow-up among borderline patients and axis II comparison subjects. The second was to determine risk factors associated with feelings of shame among borderline patients. A total of 290 borderline inpatients and 72 axis II comparison subjects were assessed using a series of semi-structured interviews and self-report measures at baseline, and 87% of surviving patients were reassessed at eight waves of follow-up. Borderline patients reported significantly higher levels (2.6 times) of shame (assessed with one item) across 16?years of follow-up than axis II comparison subjects. However, the severity of shame decreased (78% relative decline) significantly over time for both groups. Regarding risk factors, four lifetime adversity risk factors were found to be significantly associated with feelings of shame. Two of these factors (severity of childhood sexual abuse and severity of childhood neglect) remained significant in multivariate analyses. Taken together, the results of this study suggest that borderline patients struggle with intense but decreasing feelings of shame. They also suggest that childhood adversities are significant risk factors for this dysphoric affective state. PMID:24599878

  19. Frequency-induced stratification in viscoelastic microfluidics.

    PubMed

    Poiré, E Corvera; Hernández-Machado, A

    2010-10-01

    We present a mechanism in the field of microfluidics by which the stratification of a viscoelastic fluid can be induced in a channel on the microscale by applying a dynamic pressure gradient at frequencies within the range of sound. Stratification is obtained with identical layers, parallel to the channel walls, whose number can be tailored. These layers are separated by 2D zero-velocity planes. This would allow different tracer particles with small diffusion coefficients to be confined in different fluid layers within the same microchannel. We obtain analytical results that allow us to make theoretical predictions regarding the possible experimental realization of stratification in a microchannel using a biofluid. We find a relation among the diffusion coefficient, fluid properties, and microchannel thickness that establishes a condition for the confinement of tracer particles to a layer. This mechanism has potential use in micrototal analysis systems and MEMS-containing viscoelastic fluids. PMID:20822118

  20. Double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin.

    PubMed

    Viterbo, Stefano; Boffano, Paolo; Guglielmi, Valeria; Fasolis, Massimo; Palumbo, Carlo; Berrone, Sid

    2012-11-01

    Retrobulbar hemorrhage is a vision-threatening emergency that may occur spontaneously or following facial trauma, orbital surgery, endoscopic sinus surgery, and retrobulbar injections. It may determine visual loss because of central retinal artery occlusion, optic neuropathy from direct compression, or compression of the circulation from mechanical tamponade. In addition to a deterioration in visual acuity with total blindness in the most severe cases, several symptoms and signs can be found, such as a sudden onset of severe pain, proptosis, and ophthalmoplegia.The knowledge of past medical history and underlying medical conditions is crucial in patients with retrobulbar hemorrhages. In fact, patients with blood dyscrasias have to be considered high-risk patients due to their increased propensity for uncontrolled bleeding.The aim of this article was to present and discuss the management of a case of double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin. PMID:23147322

  1. Assessment of risk factors related to suicide attempts in patients with bipolar disorder.

    PubMed

    Song, Joo Yun; Yu, Han Young; Kim, Se Hyun; Hwang, Samuel S-H; Cho, Hyun-Sang; Kim, Yong Sik; Ha, Kyooseob; Ahn, Yong Min

    2012-11-01

    We compared the characteristics of patients with bipolar disorder with and without a history of suicide attempts to identify the risk factors of suicide in this disorder. Among 212 patients with bipolar disorder, 44 (21.2%) patients had histories of suicide attempts. Suicide attempters were younger and more likely to be diagnosed with bipolar II. The variables that differentiated those who did from those who did not attempt suicide included age at first contact, lifetime history of antidepressant use, major depressive episode, mixed episode, auditory hallucinations, rapid cycling, the number of previous mood episodes, age of first depressive episode, and age of first psychotic symptoms. Strong predictors of suicide attempts were younger age at onset, lifetime history of auditory hallucinations, and history of antidepressant use. Antecedent depressive episodes and psychotic symptoms predicted the first suicide attempt in patients with bipolar disorder. This study could help clinicians to understand the major risk factors of suicidal behavior in bipolar disorder. PMID:23124183

  2. Implantable cardioverter defibrillators in diabetics: efficacy and safety in patients at risk of sudden cardiac death.

    PubMed

    Shahreyar, Muhammad; Mupiddi, Vijayadershan; Choudhuri, Indrajit; Sra, Jasbir; Tajik, Abdul Jamil; Jahangir, Arshad

    2015-08-01

    Diabetes mellitus is a major risk factor for arrhythmogenesis and is associated with a two-fold increase in all-cause mortality and a four-fold increase in cardiovascular mortality including sudden cardiac death when compared with nondiabetics. Implantable cardioverter defibrillators (ICD) have been shown to effectively reduce arrhythmic death and all-cause mortality in patients with severe myocardial dysfunction. With a high competing risk of nonarrhythmic cardiac and noncardiac death, survival benefit of ICD in patients with diabetes mellitus could be reduced, but the subanalysis of diabetic patients in randomized clinical trials provides reassurance regarding a similar beneficial survival effect of ICD and cardiac resynchronization therapy in diabetics, as observed in the overall population with advanced heart disease. In this article, the authors highlight some of the clinical issues related to diabetes, summarize the data on the efficacy of ICD in diabetics when compared with nondiabetics and discuss concerns related to ICD implantation in patients with diabetes. PMID:26098816

  3. Minimal intervention dentistry and older patients. Part 1: Risk assessment and caries prevention.

    PubMed

    Allen, Edith; da Mata, Cristiane; McKenna, Gerald; Burke, Francis

    2014-06-01

    Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5 1/2 million more people aged 65 and older in the next 20 years. This projected pattern of population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the 'medical model' whereby disease is controlled by the 'oral physician'. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment. Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention. PMID:25073221

  4. The value of personalised risk information: a qualitative study of the perceptions of patients with prostate cancer

    PubMed Central

    Han, Paul K J; Hootsmans, Norbert; Neilson, Michael; Roy, Bethany; Kungel, Terence; Gutheil, Caitlin; Diefenbach, Michael; Hansen, Moritz

    2013-01-01

    Objective To explore the experiences of patients with prostate cancer with risk information and their perceptions of the value of personalised risk information in treatment decisions. Design A qualitative study was conducted using focus groups. Semistructured interviews explored participants’ experiences with using risk information, and their perceptions of the potential value of personalised risk information produced by clinical prediction models. Participants English-speaking patients, ages 54–82, diagnosed with prostate cancer within the past 3?years, residing in rural and non-rural geographic locations in Maine (USA), and attending prostate cancer patient support groups. Setting 6 focus groups were conducted with 27 patients; separate groups were held for patients with low-risk, medium-risk and high-risk disease defined by National Comprehensive Cancer Network guidelines. Results Several participants reported receiving risk information that was imprecise rather than precise, qualitative rather than quantitative, indirect rather than direct and focused on biomarker values rather than clinical outcomes. Some participants felt that personalised risk information could be useful in helping them make better informed decisions, but expressed scepticism about its value. Many participants favoured decision-making strategies that were heuristic-based and intuitive rather than risk-based and deliberative, and perceived other forms of evidence—emotions, recommendations of trusted physicians, personal narratives—as more reliable and valuable in treatment decisions. Conclusions Patients with prostate cancer appear to have little experience using personalised risk information, may favour heuristic-based over risk-based decision-making strategies and may perceive personalised risk information as less valuable than other types of evidence. These decision-making approaches and perceptions represent potential barriers to the clinical use of personalised risk information. Overcoming these barriers will require providing patients with greater exposure to risk information, education about the nature and value of personalised risk information and training in deliberative decision-making strategies. More research is needed to confirm these findings and address these needs. PMID:24038007

  5. Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

    Microsoft Academic Search

    Martin Schlumberger; Gertrud Berg; Ohad Cohen; Leonidas Duntas; Francois Jamar; Barbara Jarzab; Eduard Limbert; Peter Lind; Furio Pacini; Christoph Reiners; Franco Sanchez Franco; S. Toft; Wilmar M Wiersinga

    2004-01-01

    Objective: Because differentiated (follicular and papillary) thyroid cancer (DTC) may recur years after initial treatment, the follow-up of patients with DTC is long term. However, this population has chan- ged, with more individuals being discovered at an earlier stage of the disease, so that previous follow-up protocols based mostly on data from high-risk patients no longer apply. We sought to

  6. Psychological distress following first recurrence of disease in patients with breast cancer: prevalence and risk factors

    Microsoft Academic Search

    Hitoshi Okamura; Toru Watanabe; Masaru Narabayashi; Noriyuki Katsumata; Masashi Ando; Isamu Adachi; Tatsuo Akechi; Yosuke Uchitomi

    2000-01-01

    Objectives: To investigate the prevalence of, and risk factors for psychological distress following first recurrences of breast cancer.\\u000a \\u000a \\u000a \\u000a Patients and methods: The sample was drawn consecutively from the inpatient and outpatient populations of the National Cancer Center Hospital in\\u000a Japan during an 18-month period from July 1996 to December 1997. Of the 56 eligible patients, 55 women aged 30–73 year

  7. Cardiovascular Disease and Risk Factors among Psoriasis Patients in Two US Healthcare Databases, 2001–2002

    Microsoft Academic Search

    A. B. Kimball; Y. Wu; C. Guzzo; N. Yeilding; C. Paramore; K. Fraeman; M. Bala

    2008-01-01

    Background: Cardiovascular diseases or risk factors (CVDR) seem to be more common in psoriasis patients than in the general population. Objective: We assessed the relationship of psoriasis with CVDR by analysis of healthcare claims data using a cross-sectional, prevalence-based study design. Patients and Methods: The IMS Health and MarketScan® claims databases were used to identify adults with psoriasis diagnostic codes.

  8. High prevalence of risk factors for cardiovascular disease in parents of IDDM patients with albuminuria

    Microsoft Academic Search

    S. De Cosmo; S. Bacci; G. P. Piras; M. Cignarelli; G. Placentino; M. Margaglione; D. Colaizzo; G. Di Minno; R. Giorgino; A. Liuzzi; G. C. Viberti

    1997-01-01

    Summary   Life expectancy is shorter in the subset of insulin-dependent diabetic (IDDM) patients who are susceptible to kidney disease.\\u000a Familial factors may be important. In this study the prevalence of cardiovascular disease mortality and morbidity and of risk\\u000a factors for cardiovascular disease was compared in the parents of 31 IDDM patients with elevated albumin excretion rate (AER\\u000a > 45 ?g\\/min;

  9. Risk factors of hyperammonemia in patients with epilepsy under valproic acid therapy.

    PubMed

    Tseng, Yu-Lung; Huang, Chi-Ren; Lin, Chih-Hsiang; Lu, Yan-Ting; Lu, Cheng-Hsien; Chen, Nai-Ching; Chang, Chiung-Chih; Chang, Wen-Neng; Chuang, Yao-Chung

    2014-09-01

    Hyperammonemia has been reported to be associated with patients who receive valproic acid (VPA) therapy. This study aimed to determine the risk factors for hyperammonemia in patients with epilepsy treated with VPA. One hundred and fifty-eight adult patients with epilepsy aged older than 17 years who received VPA therapy were enrolled into this study. Blood samples were taken during the interictal state and analyzed for the blood level of ammonia. Statistical analysis was conducted between different groups of patients. The results showed that the frequency of hyperammonemia associated with VPA therapy was 27.8% (ammonia level >93?µg/dL), and 5.1% of the patients had severe hyperammonemia (ammonia level >150?µg/dL). The blood ammonia level was significantly correlated with the dosage of VPA and the plasma concentration of VPA. An increase of 1?mg in the dosage of VPA increased the risk of hyperammonemia by 0.1%. In addition, combination treatment with liver enzyme inducing antiepileptic drugs (AEDs) and antipsychotic drugs increased the risk of hyperammonemia. In conclusion, the use of VPA in adult patients with epilepsy was associated with a dose-dependent increase in blood concentrations of ammonia. Combination treatment with liver enzyme-inducing AEDs and antipsychotic drugs increased the risk of VPA-induced hyperammonemia. Most of the patients with VPA-induced hyperammonemia were asymptomatic; however, if patients taking VPA present with symptoms such as nausea, fatigue, somnolence, ataxia, and consciousness disturbance, the blood ammonia level should be measured. PMID:25192484

  10. Increased Acquired Cholesteatoma Risk in Patients with Osteoporosis: A Retrospective Cohort Study

    PubMed Central

    Wang, Tang-Chuan; Lin, Che-Chen; Lin, Chia-Der; Chung, Hsiung-Kwang; Wang, Ching-Yuang; Tsai, Ming-Hsui; Kao, Chia-Hung

    2015-01-01

    Objective Clinically, we found the increased incidence of acquired colesteatoma in the patients with osteoporosis. In this study, we used a retrospective cohort to examine this association and to investigate the possible mechanism. Methods We conducted a population-based retrospective cohort study by using the National Health Insurance Research Database (NHIRD). We identified an osteoporosis cohort comprising 37 124 patients newly diagnosed with osteoporosis aged 20 years or older. Patients in the comparison cohort had no history of osteoporosis and were frequency matched with the patients in the osteoporosis cohort according to sex, age, and index year. Results The acquired cholesteatoma incidence rates for the osteoporosis and comparison cohorts were 1.12 and 0.83 per 1000 person-years, respectively. After we adjusted for confounding factors, the osteoporosis cohort exhibited a 1.32-fold increased acquired cholesteatoma risk relative to the comparison cohort (hazard ratio [HR] = 1.32, 95% confidence interval [CI] = 1.11–1.57). In addition, patients with no history of otitis media (HR = 1.33, 95% CI = 1.11–1.59), cancer (HR = 1.34, 95% CI = 1.12–1.60), or COPD (HR = 1.26, 95% CI = 1.05–1.52) in the osteoporosis cohort exhibited an increased risk of subsequent acquired cholesteatoma relative to those in the comparison cohort. Conclusions Our cohort study indicated that patients with osteoporosis had a 1.31-fold increased acquired cholesteatoma risk relative to the comparison cohort. This risk was further increased in patients with comorbid otitis media. Hence, we recommend that otolaryngologists evaluate the condition of the middle ear of patients with osteoporosis. PMID:26171780

  11. Time-varying pattern of recurrence risk for Chinese breast cancer patients

    Microsoft Academic Search

    Wenjin Yin; Genhong Di; Liheng Zhou; Jinsong Lu; Guangyu Liu; Jiong Wu; Kunwei Shen; Qixia Han; Zhenzhou Shen; Zhimin Shao

    2009-01-01

    Purpose To analyze the rule of recurrence risk for breast cancer patients after surgery in order to get characteristics for Chinese\\u000a breast cancer. Methods We performed a retrospective study of 2,213 female unilateral breast cancer patients undergoing surgery in Cancer hospital\\u000a of Fudan University, Shanghai, China. Survival curves were performed with Kaplan–Meier method and annual recurrence hazard\\u000a was estimated by

  12. Risk Factors and Dose-Effect Relationship for Mandibular Osteoradionecrosis in Oral and Oropharyngeal Cancer Patients

    SciTech Connect

    Lee, Ik Jae; Koom, Woong Sub [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Chang Geol, E-mail: cglee1023@yuhs.a [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Bae; Yoo, Sei Whan; Keum, Ki Chang; Kim, Gwi Eon [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Eun Chang [Department of Otolaryngology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Cha, In Ho [Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul (Korea, Republic of)

    2009-11-15

    Purpose: To analyze risk factors and the dose-effect relationship for osteoradionecrosis (ORN) of the mandible after radiotherapy of oral and oropharyngeal cancers. Materials and Methods: One-hundred ninety-eight patients with oral (45%) and oropharyngeal cancer (55%) who had received external radiotherapy between 1990 and 2000 were retrospectively reviewed. All patients had a dental evaluation before radiotherapy. The median radiation dose was 60 Gy (range, 16-75 Gy), and the median biologically effective dose for late effects (BED{sub late}) in bone was 114 Gy{sub 2} (range, 30-167 Gy{sub 2}). Results: The frequency of ORN was 13 patients (6.6%). Among patients with mandibular surgery, eight had ORN at the surgical site. Among patients without mandibular surgery, five patients had ORN on the molar area of the mandible. The median time to ORN was 22 months (range, 1-69 months). Univariate analysis revealed that mandibular surgery and Co-60 were significant risk factors for ORN (p = 0.01 and 0.04, respectively). In multivariate analysis, mandibular surgery was the most important factor (p = 0.001). High radiation doses over BED 102.6 Gy{sub 2} (conventional dose of 54 Gy at 1.8 Gy/fraction) were also a significant factor for ORN (p = 0.008) and showed a positive dose-effect relationship in logistic regression (p = 0.04) for patients who had undergone mandibular surgery. Conclusions: Mandibular surgery was the most significant risk factor for ORN of mandible in oral and oropharyngeal cancers patients. A BED of 102.6 Gy{sub 2} or higher to the mandible also significantly increases the risk of ORN.

  13. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS

    Microsoft Academic Search

    Trinh B Pifer; Keith P Mccullough; Friedrich K Port; David A Goodkin; Bradley J Maroni; Philip J Held; Eric W Young

    2002-01-01

    Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS.BackgroundNutritional status is strongly associated with outcomes among hemodialysis patients. We analyzed the independent predictive value of several readily measured nutritional indicators, including a modified subjective global assessment (mSGA), body mass index (BMI), serum albumin, serum creatinine, normalized protein catabolic rate (nPCR), serum bicarbonate, lymphocyte count, and neutrophil count, using

  14. Analysis of Risk Factors for Progression in Patients with Pathologically Confined Prostate Cancers After Radical Retropubic Prostatectomy

    Microsoft Academic Search

    Seth E. Lerner; Michael L. Blute; Erik J. Bergstralh; David G. Bostwick; Jeffery T. Eickholt; Horst Zincke

    1996-01-01

    PurposeUp to 26 percent of patients with pathologically organ confined prostate cancer will experience clinical progression after radical prostatectomy. We attempted to identify patients at greatest risk for future clinical failure despite a favorable pathological outcome.

  15. Nitroglycerin Use in Myocardial Infarction Patients: Risks and Benefits

    PubMed Central

    Ferreira, Julio C.B.; Mochly-Rosen, Daria

    2012-01-01

    Acute myocardial infarction and its sequelae are leading causes of morbidity and mortality worldwide. Nitroglycerin remains a first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin achieves its benefit by giving rise to nitric oxide, which causes vasodilation and increases blood flow to the myocardium. However, continuous delivery of nitroglycerin results in tolerance, limiting the use of this drug. Nitroglycerin tolerance is due, at least in part, to inactivation of aldehyde dehydrogenase 2 (ALDH2), an enzyme that converts nitroglycerin to the vasodilator, nitric oxide. We have recently found that, in addition to nitroglycerin’s effect on the vasculature, sustained treatment with nitroglycerin negatively affects cardiomyocyte viability following ischemia, thus resulting in increased infarct size in a myocardial infarction model in animals. Co-administration of Alda-1, an activator of ALDH2, with nitroglycerin improves metabolism of reactive aldehyde adducts and prevents the nitroglycerin-induced increase in cardiac dysfunction following myocardial infarction. In this review, we describe the molecular mechanisms associated with the benefits and risks of nitroglycerin administration in myocardial infarction. (167 of 200). PMID:22040938

  16. Identifying patients at risk of sudden arrhythmic death.

    PubMed

    Merghani, Ahmed; Sharma, Sanjay

    2012-10-01

    Most GPs will encounter at least one case of sudden arrhythmic death syndrome (SADS) during their career. They may have to evaluate a young person at risk of SADS or offer support and screening to family members. SADS is the term used to describe an unexpected death in individuals with no prior history of cardiac disease and where no underlying pathology is identified despite a comprehensive post-mortem evaluation and toxicology screen. in England alone, SADS is responsible for 544 deaths per year, with a mean age of 32 years and a male predominance. Among the 100,000 cases of sudden cardiac death in the UK per year, SADS makes up around 4%, but this proportion is significantly higher in younger cohorts (13% of sudden cardiac deaths in those aged less than 35). Most cases of SADS are the result of inherited cardiac ion channel abnormalities of the heart which predispose to fatal arrhythmias. These include Brugada syndrome, long QT syndrome, short QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Most individuals remain asymptomaticand are diagnosed incidentally on routine ECG testing or family screening. Syncope or cardiac arrest may be the first manifestation, All first-degree relatives of SADS victims should be referred for comprehensive evaluation in an expert setting. In studies of families of SADS victims evaluation of blood relatives identified a hereditary arrhythmogenic syndrome in almost 50% of families, thereby providing a likely cause of ath and preventing further tragedies. PMID:23214271

  17. STATIN USE AND LOWER-EXTREMITY AMPUTATION RISK IN NON-ELDERLY DIABETIC PATIENTS

    PubMed Central

    Sohn, Min-Woong; Meadows, Judith L.; Oh, Elissa H.; Budiman-Mak, Elly; Lee, Todd A.; Stone, Neil J.; Pearce, William B.

    2013-01-01

    Objective To examine the association between use of statin and non-statin cholesterol-lowering medications and risk of nontraumatic major lower-extremity amputations (LEA) and treatment failure (LEA or death). Design of Study A retrospective cohort of patients with Type I and Type 2 diabetes mellitus (diabetes) was followed for five years between 2004 and 2008. The follow-up exposure duration was divided into 90-day periods. Use of cholesterol-lowering agents, diabetic medications, hemoglobin A1c, body mass index, and systolic and diastolic blood pressures were observed in each period. Demographic factors were observed at baseline. Major risk factors of LEA including peripheral neuropathy, PAD, and foot ulcers were observed at baseline and were updated for each period. LEA and deaths were assessed in each period and their hazard ratios were estimated. Setting US Department of Veterans Affairs Healthcare system (VA) Subjects Cholesterol drug-naïve patients with Type I or II diabetes who were treated in the VA in 2003 and were <65 years old at the end of follow-up. Results Of 83,593 patients in the study cohort, 217 (0.3%) patients experienced a major LEA and 11,716 (14.0%) patients experienced an LEA or death (treatment failure) after a mean follow-up of 4.6 years. Compared to patients who did not use cholesterol-lowering agents, statin users were 35% - 43% less likely to experience an LEA (HR = 0.65; 95% CI, 0.42–0.99) and a treatment failure (HR = 0.57; 95% CI, 0.54–0.60). Users of other cholesterol-lowering medications were not significantly different in LEA risk (HR = 0.95; 95% CI, 0.35–2.60) but had a 41% lower risk of treatment failure (HR = 0.59; 95% CI, 0.51–0.68). Conclusions This is the first study to report a significant association between statin use and diminished amputation risk among patients with diabetes. In this non-randomized cohort, beneficial effects of statin therapy were similar to that seen in large-scale clinical trial experience. For LEA risk, those given non-statins did not have a statistically significant benefit and its effect on LEA risk was much smaller compared to statins.. Unanswered questions to be explored in future studies include a comparison of statins of moderate versus high potency in those with high risk of coronary heart disease and an exploration of whether the effects seen in this study are simply effects of cholesterol-lowering or possibly pleiotropic effects. PMID:23932803

  18. Risk Assessment-Based Individualized Treatment (RABIT): a comprehensive approach to dental patient recall.

    PubMed

    Teich, Sorin T

    2013-04-01

    Patient recall should be a tool to support prevention, allow early intervention, and ensure long-term dental health. Although the concept of patient-customized recall intervals has increased in popularity, recommendations vary significantly. Concepts of risk assessment-derived recalls are described in the literature separately for caries, periodontal disease, and edentulism, but no published guidelines exist for creating patient-centered recall systems that integrate all risks. Further, no recommendations exist regarding oral cancer risk assessment and recall intervals. The evidence shows that recall intervals of less than twelve months do not impact stage and tumor size at diagnosis although increasing this interval may significantly affect the outcome. The typical approach to recall scheduling is that the interval before the next oral health review should be chosen when no further treatment is indicated or on completion of a specific treatment journey. This article advocates a modified approach that supports individualized risk-based recall schedules not only after active therapy is completed but also during the course of treatment. The design of individualized recall schedules would address a patient's risk for caries and periodontal disease and the need to perform periodic oral cancer screenings. Evidence is also presented regarding the timing of recalls for edentulous patients. This article describes design principles for a Risk Assessment-Based Individualized Treatment (RABIT) system, presents an example of an electronic health record (EHR) recall module implemented at one dental school, and identifies barriers to implementation. As EHRs become more prevalent in dental practice, it is expected that the software industry and the profession will collaborate to include RABIT-like concepts in software management packages. PMID:23576590

  19. Risk factors for development of chronic periodontitis in Bulgarian patients (pilot research)

    PubMed Central

    Stoykova, Maria; Musurlieva, Nina; Boyadzhiev, Doychin

    2014-01-01

    The aim of this work was to assess the risks and analyse the risk factors for development of chronic periodontitis in Bulgarian patients. The quality of life was investigated in a cohort of 228 patients with chronic periodontitis. Within the frame of this study, pilot research (a case-control study) was conducted among 80 patients (20 cases and 60 control patients without periodontitis) to evaluate the risk for development of chronic periodontitis. The minimum sample size of patients was determined based on power analysis for sample-size calculation. The mean age of participants in the control group was 31.33 ± 9.38 years and in the case group, 33.00 ± 11.52. Data were accumulated by clinical and sociological methods. Descriptive statistics and multi-factor logistic regression analysis (Backward Conditional procedure) were used. One-factor dispersion analysis showed that, of the 12 studied risk factors, the following variables were significant: stress, diabetes, presence of calculus, overlapping and misaligned teeth (P < 0.05). Multiple logistic regressions were applied to evaluate the association between the variables. Three predictors were selected in the final logistic regression equation: diabetes (B = 4.195; P = 0.001), crooked and overlapping teeth (B = 3.022; P = 0.010) and stress (B = 2.882; P = 0.014). The logistic risk assessment model for development of periodontitis has a predictive value of 93.80% (?2 = 63.91; P = 0.000). Our results confirmed some proven risk factors for periodontal disease. In the studied population, diabetes was the single, most important predictor for development of periodontitis. PMID:26019602

  20. Atypical Antipsychotics and Metabolic Syndrome in Patients with Schizophrenia: Risk Factors, Monitoring, and Healthcare Implications

    PubMed Central

    Riordan, Henry J.; Antonini, Paola; Murphy, Michael F.

    2011-01-01

    Background Metabolic syndrome is a leading cause of morbidity and mortality in patients with schizophrenia, with a prevalence rate double that of nonpsychiatric populations. Given the amount of evidence suggesting a link between atypical antipsychotic medications and metabolic syndrome, several agencies have recommended regular clinical monitoring of weight, symptoms of hyperglycemia, and glucose in chronically medicated patients with schizophrenia. Objectives To summarize the current literature on atypical antipsychotic-induced metabolic syndrome in patients with schizophrenia, outline some of the molecular mechanisms behind this syndrome, identify demographic and disease-related risk factors, and describe cost-effective methods for surveillance. Discussion The differential prevalence of metabolic syndrome associated with various atypical antipsychotic medications has been evidenced across numerous studies, with higher effects seen for certain antipsychotic medications on weight gain, waist circumference, fasting triglyceride level, and glucose levels. Given the association of these symptoms, all atypical antipsychotic medications currently include a warning about the risk of hyperglycemia and diabetes, as well as suggestions for regular monitoring. Despite this, very little data are available to support adherence to these monitoring recommendations. Lack of awareness and resources, diffusion of responsibility, policy implementation, and organizational structure have all been implicated. Conclusion The treatment of schizophrenia involves a balance in terms of risks and benefits. Failing to treat because of risk for complications from metabolic syndrome may place the patient at a higher risk for more serious health outcomes. Supporting programs aimed at increasing monitoring of simple laboratory and clinical measures associated with metabolic syndrome may decrease important risk factors, improve patients' quality of life, and reduce healthcare costs. PMID:25126357

  1. Fracture risk in patients with muscular dystrophy and spinal muscular atrophy.

    PubMed

    Vestergaard, P; Glerup, H; Steffensen, B F; Rejnmark, L; Rahbek, J; Moseklide, L

    2001-07-01

    We aimed at studying fracture risk in patients with Duchenne's muscular dystrophy (DMD), Becker's muscular dystrophy (BEMD), and spinal muscular atrophy type II and III (SMA II and III). A self-administered questionnaire was mailed to 293 patients with DMD, BEMD, SMA II or SMA III of which 229 returned the questionnaire. Each respondent was compared with an age- and gender-matched control subject. The mean age was 23.9 +/- 15.9 years for the patients and 23.3 +/- 16.5 years for the controls. There were significantly more fractures among patients than controls after the diagnosis was made (RR = 1.9), but not before. The patients had more fractures of the femurs, lower legs, and upper arms than the controls. Low energy fractures were more frequent in patients than controls (9% vs 0%). Many fractures in the femurs (40%), lower legs (35%), and feet and toes (44%) led to a permanent loss of function. Loss of ambulation was the major risk factor for fractures. In conclusion, fracture risk is increased in neuromuscular disease. PMID:11506212

  2. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor

    PubMed Central

    Romero-Velez, Gustavo; Lisker-Cervantes, Andrés; Villeda-Sandoval, Christian I; Sotomayor de Zavaleta, Mariano; Olvera-Posada, Daniel; Sierra-Madero, Juan Gerardo; Arreguin-Camacho, Lucrecia O; Castillejos-Molina, Ricardo A

    2014-01-01

    Objective To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. Design Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. Methods A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. Results One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). Conclusions ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24–30. PMID:25356298

  3. Risk of Stroke in Patients with Rheumatism: A Nationwide Longitudinal Population-based Study

    PubMed Central

    Liou, Tsan-Hon; Huang, Shih-Wei; Lin, Jia-Wei; Chang, Yu-Sheng; Wu, Chin-Wen; Lin, Hui-Wen

    2014-01-01

    The aim of this study was to investigate rheumatoid arthritis (RA), and systemic lupus erythematous (SLE) as risk factors for stroke. The study was analyzed by Using the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005), this cohort study investigated patients with a recorded diagnosis of RA (N = 6114), and SLE (N = 621) between January 1, 2004, and December 31, 2007, with age-matched controls (1:4) (for RA, N = 24456; SLE, N = 2484). We used Cox proportional-hazard regressions to evaluate the hazard ratios (HRs) after adjusting confounding factors. Our study found 383 of 6114 RA patients, experienced stroke during the 20267 person-year follow-up period. The adjusted HR of stroke for RA patients was 1.24 (95% CI, 1.11 to 1.39), and for SLE patients was 1.88 (95% CI, 1.08 to 3.27). When steroid was added as additional confounding factor, the adjusted HR of ischemic stroke for RA patients was 1.32 (95% CI, 1.15 to 1.50), and for SLE patients was 1.31 (95% CI, 0.51 to 3.34). In conclusion, the rheumatic diseases of RA, and SLE are all risk factors for stroke. After controlled the effect of steroid prescription, RA is risk factor for ischemic stroke. PMID:24898360

  4. Prevalence of and risk factors for endogenous endophthalmitis in patients with pyogenic liver abscesses

    PubMed Central

    Park, In Hyung; Jun, Chung Hwan; Wi, Jin Woo; Park, Seon Young; Lee, Wan Sik; Jung, Sook In; Park, Chang Hwan; Joo, Young Eun; Kim, Hyun Soo; Rew, Jong Sun

    2015-01-01

    Background/Aims Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. Methods Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non-LAEE. Results The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. Conclusions PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.

  5. Identification of Bacteriology and Risk Factor Analysis of Asymptomatic Bacterial Colonization in Pacemaker Replacement Patients

    PubMed Central

    Chu, Xian-Ming; Yu, Hua; Sun, Xue-Xia; An, Yi; Li, Bing; Li, Xue-Bin

    2015-01-01

    Background Recent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures. Objective The present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization. Methods From June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed. Results The total bacterial positive rate was 37.3% (44 cases), and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6%) patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate wa