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Sample records for risk stratify patients

  1. Using Computational Approaches to Improve Risk-Stratified Patient Management: Rationale and Methods

    PubMed Central

    Stone, Bryan L; Sakaguchi, Farrant; Sheng, Xiaoming; Murtaugh, Maureen A

    2015-01-01

    Background Chronic diseases affect 52% of Americans and consume 86% of health care costs. A small portion of patients consume most health care resources and costs. More intensive patient management strategies, such as case management, are usually more effective at improving health outcomes, but are also more expensive. To use limited resources efficiently, risk stratification is commonly used in managing patients with chronic diseases, such as asthma, chronic obstructive pulmonary disease, diabetes, and heart disease. Patients are stratified based on predicted risk with patients at higher risk given more intensive care. The current risk-stratified patient management approach has 3 limitations resulting in many patients not receiving the most appropriate care, unnecessarily increased costs, and suboptimal health outcomes. First, using predictive models for health outcomes and costs is currently the best method for forecasting individual patient’s risk. Yet, accuracy of predictive models remains poor causing many patients to be misstratified. If an existing model were used to identify candidate patients for case management, enrollment would miss more than half of those who would benefit most, but include others unlikely to benefit, wasting limited resources. Existing models have been developed under the assumption that patient characteristics primarily influence outcomes and costs, leaving physician characteristics out of the models. In reality, both characteristics have an impact. Second, existing models usually give neither an explanation why a particular patient is predicted to be at high risk nor suggestions on interventions tailored to the patient’s specific case. As a result, many high-risk patients miss some suitable interventions. Third, thresholds for risk strata are suboptimal and determined heuristically with no quality guarantee. Objective The purpose of this study is to improve risk-stratified patient management so that more patients will receive the

  2. Clark Level Risk Stratifies Patients with Mitogenic Thin Melanomas for Sentinel Lymph Node Biopsy

    PubMed Central

    Bartlett, Edmund K.; Gimotty, Phyllis A.; Sinnamon, Andrew J.; Wachtel, Heather; Roses, Robert E.; Schuchter, Lynn; Xu, Xiaowei; Elder, David E.; Ming, Michael; Elenitsas, Rosalie; Guerry, DuPont; Kelz, Rachel R.; Czerniecki, Brian J.; Fraker, Douglas L.; Karakousis, Giorgos C.

    2014-01-01

    Background The role for sentinel lymph node biopsy (SLNB) in patients with thin melanoma (≤1mm) remains controversial. We examined a large cohort of patients with thin melanoma to better define predictors of SLN positivity. Methods Between 1995-2011, 781 patients with thin primary melanoma and evaluable clinicopathologic data underwent SLNB at our institution. Predictors of SLN positivity were determined using univariate and multivariate regression analyses, and patients were risk-stratified using a classification and regression tree (CART) analysis. Results In the study cohort (n=781), 29 patients (3.7%) had nodal metastases. In the univariate analysis, mitotic rate (OR=8.11, p=0.005), Clark level (OR=4.04, p=0.003), and thickness (OR=3.33, p=0.011) were significantly associated with SLN positivity. In the multivariate analysis, MR (OR=7.01) and level IV-V (OR=3.45) remained significant predictors of SLN positivity. CART analysis initially stratified lesions by mitotic rate; non-mitogenic lesions (n=273) had a 0.7% SLN positivity rate versus 5.6% in mitogenic lesions (n=425). Mitogenic lesions were further stratified by Clark level; patients with level II-III had a 2.9% SLN positivity rate (n=205) versus 8.2% with level IV-V (n=220). With median follow up of 6.3 years, 5 SLN negative patients developed nodal recurrence and 4 SLN positive patients died of disease. Conclusion SLN positivity is low in patients with thin melanoma (3.7%) and exceedingly so in non-mitogenic lesions (0.7%). Appreciable rates of SLN positivity can be identified in patients with mitogenic lesions, particularly with concurrent level IV-V regardless of thickness. These factors may guide appropriate selection of patients with thin melanoma for SLNB. PMID:24121883

  3. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.

    PubMed

    Castro, Victor M; Roberson, Ashlee M; McCoy, Thomas H; Wiste, Anna; Cagan, Andrew; Smoller, Jordan W; Rosenbaum, Jerrold F; Ostacher, Michael; Perlis, Roy H

    2016-03-01

    Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk. PMID:26294109

  4. The Heartmate Risk Score Predicts Morbidity and Mortality in Unselected LVAD Recipients and Risk Stratifies INTERMACS Class 1 Patients

    PubMed Central

    Adamo, Luigi; Nassif, Michael; Tibrewala, Anjan; Novak, Eric; Vader, Justin; Silvestry, Scott C.; Itoh, Akinobu; Ewald, Gregory A.; Mann, Douglas L.; LaRue, Shane J.

    2016-01-01

    Objectives Evaluation of the Heartmate Risk Score and of its potential benefits in clinical practice. Background The Heartmate Risk Score (HMRS) has been shown to correlate with mortality in the cohort of patients enrolled in the Heartmate II trials but its validity in unselected, “real world” populations remains unclear. Methods We identified a cohort of 269 consecutive patients who received a Heartmate II left ventricular assist device at our institution between June 2005 and June 2013. 90-day and two year mortality rates as well as frequency of several morbid events were compared by retrospectively assigned HMRS category groups. The analysis was repeated within the subgroup of INTERMACS class 1 patients. Results Receiver Operating Curve (ROC) analysis showed that the HMRS correlated with 90-day mortality with an AUC of 0.70. Stratification in low, mid and high HMRS groups identified patients with increasing hazard of 90-day mortality, increasing long term mortality, increasing rate of GI bleeding events and increasing median number of days spent in the hospital in the first year post implant. Within INTERMACS class 1 patients, those in the highest HMRS group were found to have a relative risk of 90-day mortality 5.7 times higher than those in the lowest HMRS group (39.1% vs 6.9%, p=0.029). Conclusions HMRS is a valid clinical tool to stratify risk of morbidity and mortality after implant of Heartmate II devices in unselected patients and can be used to predict short term mortality risk in INTERMACS class 1 patients. PMID:25770410

  5. Validity of a PCI Bleeding Risk Score in patient subsets stratified for body mass index

    PubMed Central

    Dobies, David R; Barber, Kimberly R; Cohoon, Amanda L

    2015-01-01

    Objective An accurate tool with good discriminative for bleeding would be useful to clinicians for improved management of all their patients. Bleeding risk models have been published but not externally validated in independent clinical data set. We chose the National Cardiovascular Data Registry (NCDR) percutaneous coronary intervention (PCI) score to validate within a large, multisite community data set. The aim of the study was validation of this Bleeding Risk Score (BRS) tool among a subgroup of patients based on body mass index. Methods This is a large-scale retrospective analysis of a current registry utilising data from a 37-hospital health system. The central repository of patients with coronary heart disease undergoing PCI between 1 June 2009 and 30 June 2012 was utilised to validate the NCDR PCI BRS among 4693 patients. The primary end point was major bleeding. Validation analysis calculating the receiver operating characteristic curve was performed. Results There were 143 (3%) major bleeds. Mean BRS was 14.7 (range 3–42). Incidence of bleeding by risk category: low (0.5%), intermediate (1.7%) and high risk (7.6%). Tool accuracy was poor to fair (area-under-the curve (AUC) 0.78 heparin, 0.65 bivalirudin). Overall accuracy was 0.71 (CI 0.66 to 0.76). Accuracy did not improve when confined to just the intermediate risk group (AUC 0.58; CI 0.55 to 0.67). Tool accuracy was the lowest among the low BMI group (AUC 0.62) though they are at increased risk of bleeding following PCI. Conclusions Bleeding risk tools have low predictive value even among subgroups of patients at higher risk. Adjustment for anticoagulation use resulted in poor discrimination because bivalirudin differentially biases outcomes toward no bleeding. The current state of bleeding risk tools provide little support for diagnostic utility in regards to major bleeding and therefore have limited clinical applicability. PMID:25745565

  6. Stratified neutrophil-to-lymphocyte ratio accurately predict mortality risk in hepatocellular carcinoma patients following curative liver resection

    PubMed Central

    Huang, Gui-Qian; Zhu, Gui-Qi; Liu, Yan-Long; Wang, Li-Ren; Braddock, Martin; Zheng, Ming-Hua; Zhou, Meng-Tao

    2016-01-01

    Objectives Neutrophil lymphocyte ratio (NLR) has been shown to predict prognosis of cancers in several studies. This study was designed to evaluate the impact of stratified NLR in patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC). Methods A total of 1659 patients who underwent CLR for suspected HCC between 2007 and 2014 were reviewed. The preoperative NLR was categorized into quartiles based on the quantity of the study population and the distribution of NLR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses. Univariate and multivariate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease prognosis. Results Multivariable Cox proportional hazards models showed that the level of NLR (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P<0.001), portal vein thrombosis (HR = 4.329, 95%CI: 1.968-9.521, P<0.001), microvascular invasion (HR = 2.527, 95%CI: 1.726-3.700, P<0.001) and CTP score (HR = 1.675, 95%CI: 1.153-2.433, P = 0.007) were significant predictors of mortality. From the Kaplan-Meier analysis of overall survival (OS), each NLR quartile showed a progressively worse OS and apparent separation (log-rank P=0.008). The highest 5-year OS rate following CLR (60%) in HCC patients was observed in quartile 1. In contrast, the lowest 5-year OS rate (27%) was obtained in quartile 4. Conclusions Stratified NLR may predict significantly improved outcomes and strengthen the predictive power for patient responses to therapeutic intervention. PMID:26716411

  7. Corticosteroids and Pediatric Septic Shock Outcomes: A Risk Stratified Analysis

    PubMed Central

    Atkinson, Sarah J.; Cvijanovich, Natalie Z.; Thomas, Neal J.; Allen, Geoffrey L.; Anas, Nick; Bigham, Michael T.; Hall, Mark; Freishtat, Robert J.; Sen, Anita; Meyer, Keith; Checchia, Paul A.; Shanley, Thomas P.; Nowak, Jeffrey; Quasney, Michael; Weiss, Scott L.; Banschbach, Sharon; Beckman, Eileen; Howard, Kelli; Frank, Erin; Harmon, Kelli; Lahni, Patrick; Lindsell, Christopher J.; Wong, Hector R.

    2014-01-01

    Background The potential benefits of corticosteroids for septic shock may depend on initial mortality risk. Objective We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk. Methods We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days. Results Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3–4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1–2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM. Conclusions Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort. PMID:25386653

  8. A novel method to risk stratify patients undergoing exercise stress echocardiography using a set of combined criteria.

    PubMed

    Wong, Christopher B; Leung, Sue Ellen; Fukuyanagi, Sasa

    2015-03-01

    Background and Purposes A novel method using quantitative long-axis function and tissue Doppler in addition to wall motion analysis in exercise stress echocardiography was evaluated. We hypothesized that the novel criteria added additional accuracy in stress echocardiography. Methods Patients with chest pain and at low-to-intermediate risk for obstructive coronary artery disease (CAD) were retrospectively studied. They underwent stress echocardiography with attention to wall motion abnormalities, left ventricular long-axis function, and tissue Doppler measurement. Results The results showed that the combined novel criteria (i.e., classifying a case as positive if three out of the following four criteria were fulfilled: (1) abnormal segmental wall motion shortly after peak stress; (2) Ee wave after peak stress less than 10 cm/s and Ee/Aa ratio after peak stress less than 1; (3) Sm wave after peak stress less than 10.5 cm/s; (4) abnormal long-axis left ventricular function) offered a better accuracy for predicting obstructive CAD and future revascularization with a high sensitivity (100%) and high negative predictive value (100%) . Conclusion From a practical standpoint, the combined novel criteria may be useful in improving the diagnostic accuracy of stress echocardiography. PMID:25780326

  9. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score

    SciTech Connect

    Huang, Eugene H.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Sahin, Aysegul A.; Hortobagyi, Gabriel N.; Buchholz, Thomas A. . E-mail: tbuchhol@mdanderson.org

    2006-10-01

    Purpose: We previously developed a prognostic index that stratified patients treated with breast conservation therapy (BCT) after neoadjuvant chemotherapy into groups with different risks for local-regional recurrence (LRR). The purpose of this study was to compare the rates of LRR as a function of prognostic index score for patients treated with BCT or mastectomy plus radiation after neoadjuvant chemotherapy. Methods and Materials: We retrospectively analyzed 815 patients treated with neoadjuvant chemotherapy, surgery, and radiation. Patients were assigned an index score from 0 to 4 and given 1 point for the presence of each factor: clinical N2 to N3 disease, lymphovascular invasion, pathologic size >2 cm, and multifocal residual disease. Results: The 10-year LRR rates were very low and similar between the mastectomy and BCT groups for patients with an index score of 0 or 1. For patients with a score of 2, LRR trended lower for those treated with mastectomy vs. BCT (12% vs. 28%, p = 0.28). For patients with a score of 3 to 4, LRR was significantly lower for those treated with mastectomy vs. BCT (19% vs. 61%, p = 0.009). Conclusions: This analysis suggests that BCT can provide excellent local-regional treatment for the vast majority of patients after neoadjuvant chemotherapy. For the few patients with a score of 3 to 4, LRR was >60% after BCT and was <20% with mastectomy. If these findings are confirmed in larger randomized studies, the prognostic index may be useful in helping to select the type of surgical treatment for patients treated with neoadjuvant chemotherapy, surgery, and radiation.

  10. Age-Stratified Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma

    PubMed Central

    Li, Li; Andikyan, Vaagn; Običan, Sarah G.; Cioffi, Angela; Hao, Ke; Dudley, Joel T.; Ascher-Walsh, Charles; Kasarskis, Andrew; Maki, Robert G.

    2015-01-01

    Background. Estimates of unexpected uterine sarcoma following surgery for presumed benign leiomyoma that use age-stratification are lacking. Patients and Methods. A retrospective cohort of 2,075 patients that had undergone myomectomy was evaluated to determine the case incidence of unexpected uterine sarcoma. An aggregate risk estimate was generated using a meta-analysis of similar studies plus our data. Database-derived age distributions of the incidence rates of uterine sarcoma and uterine leiomyoma surgery were used to stratify risk by age. Results. Of 2,075 patients in our retrospective cohort, 6 were diagnosed with uterine sarcoma. Our meta-analysis revealed 8 studies from 1980 to 2014. Combined with our study, 18 cases of leiomyosarcoma are reported in 10,120 patients, for an aggregate risk of 1.78 per 1,000 (95% confidence interval [CI]: 1.1–2.8) or 1 in 562. Eight cases of other uterine sarcomas were reported in 6,889 patients, for an aggregate risk of 1.16 per 1,000 (95% CI: 0.5–4.9) or 1 in 861. The summation of these risks gives an overall risk of uterine sarcoma of 2.94 per 1,000 (95% CI: 1.8–4.1) or 1 in 340. After stratification by age, we predict the risk of uterine sarcoma to range from a peak of 10.1 cases per 1,000, or 1 in 98, for patients aged 75–79 years to <1 case per 500 for patients aged <30 years. Conclusion. The risk of unexpected uterine sarcoma varies significantly across age groups. Our age-stratified predictive model should be incorporated to more accurately counsel patients and to assist in providing guidelines for the surgical technique for leiomyoma. PMID:25765878

  11. Pan-European Chikungunya surveillance: designing risk stratified surveillance zones.

    PubMed

    Tilston, Natasha; Skelly, Chris; Weinstein, Phil

    2009-01-01

    The first documented transmission of Chikungunya within Europe took place in Italy during the summer of 2007. Chikungunya, a viral infection affecting millions of people across Africa and Asia, can be debilitating and no prophylactic treatment exists. Although imported cases are reported frequently across Europe, 2007 was the first confirmed European outbreak and available evidence suggests that Aedes albopictus was the vector responsible and the index case was a visitor from India. This paper proposed pan-European surveillance zones for Chikungunya, based on the climatic conditions necessary for vector activity and viral transmission. Pan-European surveillance provides the best hope for an early-warning of outbreaks, because national boundaries do not play a role in defining the risk of this new vector borne disease threat. A review of climates, where Chikungunya has been active, was used to inform the delineation of three pan-European surveillance zones. These vary in size each month across the June-September period of greatest risk. The zones stretch across southern Europe from Portugal to Turkey. Although the focus of this study was to define the geography of potential surveillance zones based on the climatic limits on the vector and virus, a preliminary examination of inward bound airline passengers was also undertaken. This indicated that France and Italy are likely to be at greater risk due to the number of visitors they receive from Chikungunya active regions, principally viraemic visitors from India. Therefore this study represents a first attempt at creating risk stratified surveillance zones, which we believe could be usefully refined with the use of higher resolution climate data and more complete air travel data. PMID:19878588

  12. Differences in Gene-Gene Interactions in Graves’ Disease Patients Stratified by Age of Onset

    PubMed Central

    Jurecka-Lubieniecka, Beata; Bednarczuk, Tomasz; Ploski, Rafal; Krajewska, Jolanta; Kula, Dorota; Kowalska, Malgorzata; Tukiendorf, Andrzej; Kolosza, Zofia; Jarzab, Barbara

    2016-01-01

    Background Graves’ disease (GD) is a complex disease in which genetic predisposition is modified by environmental factors. Each gene exerts limited effects on the development of autoimmune disease (OR = 1.2–1.5). An epidemiological study revealed that nearly 70% of the risk of developing inherited autoimmunological thyroid diseases (AITD) is the result of gene interactions. In the present study, we analyzed the effects of the interactions of multiple loci on the genetic predisposition to GD. The aim of our analyses was to identify pairs of genes that exhibit a multiplicative interaction effect. Material and Methods A total of 709 patients with GD were included in the study. The patients were stratified into more homogeneous groups depending on the age at time of GD onset: younger patients less than 30 years of age and older patients greater than 30 years of age. Association analyses were performed for genes that influence the development of GD: HLADRB1, PTPN22, CTLA4 and TSHR. The interactions among polymorphisms were analyzed using the multiple logistic regression and multifactor dimensionality reduction (MDR) methods. Results GD patients stratified by the age of onset differed in the allele frequencies of the HLADRB1*03 and 1858T polymorphisms of the PTPN22 gene (OR = 1.7, p = 0.003; OR = 1.49, p = 0.01, respectively). We evaluated the genetic interactions of four SNPs in a pairwise fashion with regard to disease risk. The coexistence of HLADRB1 with CTLA4 or HLADRB1 with PTPN22 exhibited interactions on more than additive levels (OR = 3.64, p = 0.002; OR = 4.20, p < 0.001, respectively). These results suggest that interactions between these pairs of genes contribute to the development of GD. MDR analysis confirmed these interactions. Conclusion In contrast to a single gene effect, we observed that interactions between the HLADRB1/PTPN22 and HLADRB1/CTLA4 genes more closely predicted the risk of GD onset in young patients. PMID:26943356

  13. Personalized Immunomonitoring Uncovers Molecular Networks that Stratify Lupus Patients.

    PubMed

    Banchereau, Romain; Hong, Seunghee; Cantarel, Brandi; Baldwin, Nicole; Baisch, Jeanine; Edens, Michelle; Cepika, Alma-Martina; Acs, Peter; Turner, Jacob; Anguiano, Esperanza; Vinod, Parvathi; Kahn, Shaheen; Obermoser, Gerlinde; Blankenship, Derek; Wakeland, Edward; Nassi, Lorien; Gotte, Alisa; Punaro, Marilynn; Liu, Yong-Jun; Banchereau, Jacques; Rossello-Urgell, Jose; Wright, Tracey; Pascual, Virginia

    2016-04-21

    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by loss of tolerance to nucleic acids and highly diverse clinical manifestations. To assess its molecular heterogeneity, we longitudinally profiled the blood transcriptome of 158 pediatric patients. Using mixed models accounting for repeated measurements, demographics, treatment, disease activity (DA), and nephritis class, we confirmed a prevalent IFN signature and identified a plasmablast signature as the most robust biomarker of DA. We detected gradual enrichment of neutrophil transcripts during progression to active nephritis and distinct signatures in response to treatment in different nephritis subclasses. Importantly, personalized immunomonitoring uncovered individual correlates of disease activity that enabled patient stratification into seven groups, supported by patient genotypes. Our study uncovers the molecular heterogeneity of SLE and provides an explanation for the failure of clinical trials. This approach may improve trial design and implementation of tailored therapies in genetically and clinically complex autoimmune diseases. PAPERCLIP. PMID:27040498

  14. Variation in Outcomes for Risk-Stratified Pediatric Cardiac Surgical Operations: An Analysis of the STS Congenital Heart Surgery Database

    PubMed Central

    Jacobs, Jeffrey Phillip; O'Brien, Sean M.; Pasquali, Sara K.; Jacobs, Marshall Lewis; Lacour-Gayet, François G.; Tchervenkov, Christo I.; Austin III, Erle H.; Pizarro, Christian; Pourmoghadam, Kamal K.; Scholl, Frank G.; Welke, Karl F.; Gaynor, J. William; Clarke, David R.; Mayer, John E.; Mavroudis, Constantine

    2013-01-01

    Background. We evaluated outcomes for groups of risk-stratified operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database to provide contemporary benchmarks and examine variation between centers. Methods. Patients undergoing surgery from 2005 to 2009 were included. Centers with more than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for groups of risk-stratified operations using the five Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality categories (STAT Mortality Categories). Power for analyzing between-center differences in outcome was determined for each STAT Mortality Category. Variation was evaluated using funnel plots and Bayesian hierarchical modeling. Results. In this analysis of risk-stratified operations, 58,506 index operations at 73 centers were included. Overall discharge mortality (interquartile range among programs with more than 10 cases) was as follows: STAT Category 1 = 0.55% (0% to 1.0%), STAT Category 2 = 1.7% (1.0% to 2.2%), STAT Category 3 = 2.6% (1.1% to 4.4%), STAT Category 4 = 8.0% (6.3% to 11.1%), and STAT Category 5 = 18.4% (13.9% to 27.9%). Funnel plots with 95% prediction limits revealed the number of centers characterized as outliers by STAT Mortality Categories was as follows: Category 1 = 3 (4.1%), Category 2 = 1 (1.4%), Category 3 = 7 (9.7%), Category 4 = 13 (17.8%), and Category 5 = 13 (18.6%). Between-center variation in PLOS was analyzed for all STAT Categories and was greatest for STAT Category 5 operations. Conclusions. This analysis documents contemporary benchmarks for risk-stratified pediatric cardiac surgical operations grouped by STAT Mortality Categories and the range of outcomes among centers. Variation was greatest for the more complex operations. These data may aid in the design and planning of quality assessment and quality improvement

  15. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications. PMID:27396802

  16. An Artificial Neural Network Stratifies the Risks of Reintervention and Mortality after Endovascular Aneurysm Repair; a Retrospective Observational study

    PubMed Central

    Karthikesalingam, Alan; Attallah, Omneya; Ma, Xianghong; Bahia, Sandeep Singh; Thompson, Luke; Vidal-Diez, Alberto; Choke, Edward C.; Bown, Matt J.; Sayers, Robert D.; Thompson, Matt M.; Holt, Peter J.

    2015-01-01

    Background Lifelong surveillance after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) is considered mandatory to detect potentially life-threatening endograft complications. A minority of patients require reintervention but cannot be predictively identified by existing methods. This study aimed to improve the prediction of endograft complications and mortality, through the application of machine-learning techniques. Methods Patients undergoing EVAR at 2 centres were studied from 2004-2010. Pre-operative aneurysm morphology was quantified and endograft complications were recorded up to 5 years following surgery. An artificial neural networks (ANN) approach was used to predict whether patients would be at low- or high-risk of endograft complications (aortic/limb) or mortality. Centre 1 data were used for training and centre 2 data for validation. ANN performance was assessed by Kaplan-Meier analysis to compare the incidence of aortic complications, limb complications, and mortality; in patients predicted to be low-risk, versus those predicted to be high-risk. Results 761 patients aged 75 +/- 7 years underwent EVAR. Mean follow-up was 36+/- 20 months. An ANN was created from morphological features including angulation/length/areas/diameters/volume/tortuosity of the aneurysm neck/sac/iliac segments. ANN models predicted endograft complications and mortality with excellent discrimination between a low-risk and high-risk group. In external validation, the 5-year rates of freedom from aortic complications, limb complications and mortality were 95.9% vs 67.9%; 99.3% vs 92.0%; and 87.9% vs 79.3% respectively (p<0.001) Conclusion This study presents ANN models that stratify the 5-year risk of endograft complications or mortality using routinely available pre-operative data. PMID:26176943

  17. Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children

    PubMed Central

    Combs, Daniel; Goodwin, James L.; Quan, Stuart F.; Morgan, Wayne J.; Parthasarathy, Sairam

    2015-01-01

    Purpose Obstructive sleep apnea (OSA) is prevalent in children and diagnostic polysomnography is costly and not readily available in all areas. We developed a pediatric modification of a commonly used adult clinical prediction tool for stratifying the risk of OSA and the need for polysomnography. Methods A total of 312 children (age 9–17 years) from phase 2 of the Tucson Children’s Assessment of Sleep Apnea cohort study, with complete anthropomorphic data, parent questionnaires, and home polysomnograms were included. An adolescent modification of STOP-Bang (teen STOP-Bang) was developed and included snoring, tired, observed apnea, blood pressure ≥ 95th percentile, BMI > 95th percentile, academic problems, neck circumference >95th percentile for age, and male gender. An apnea-hypopnea index ≥ 1.5 events/hour was considered diagnostic of OSA. Results Receiver Operator Characteristic (ROC) curves for parent-reported STOP-Bang scores were generated for teenage and pre-teen children. A STOP-Bang score of < 3 in teenagers was associated with a negative predictive value of 0.96. ROC curves were also generated based upon child-reported sexual maturity rating (SMR; n = 291). The ability of teen STOP-Bang to discriminate the presence or absence of OSA as measured by the AUC for children with SMR ≥ 4 (0.83; 95%CI 0.71–0.95) was better than children with SMR < 4 (0.63; 95%CI 0.46–0.81; p = 0.048). Conclusions In community dwelling adolescents, teen STOP-Bang may be useful in stratifying the risk of OSA. PMID:26581088

  18. Urine TMPRSS2:ERG fusion transcript stratifies prostate cancer risk in men with elevated serum PSA

    PubMed Central

    Tomlins, Scott A.; Aubin, Sheila M. J.; Siddiqui, Javed; Lonigro, Robert J.; Sefton-Miller, Laurie; Miick, Siobhan; Williamsen, Sarah; Hodge, Petrea; Meinke, Jessica; Blase, Amy; Penabella, Yvonne; Day, John R.; Varambally, Radhika; Han, Bo; Wood, David; Wang, Lei; Sanda, Martin G.; Rubin, Mark A.; Rhodes, Daniel R.; Hollenbeck, Brent; Sakamoto, Kyoko; Silberstein, Jonathan L.; Fradet, Yves; Amberson, James B.; Meyers, Stephanie; Palanisamy, Nallasivam; Rittenhouse, Harry; Wei, John T.; Groskopf, Jack; Chinnaiyan, Arul M.

    2011-01-01

    More than 1,000,000 men undergo prostate biopsy each year in the United States, most for “elevated” serum prostate specific antigen (PSA). Given the lack of specificity and unclear mortality benefit of PSA testing, methods to individualize management of elevated PSA are needed. Greater than 50% of PSA-screened prostate cancers harbor fusions between the transmembrane protease, serine 2 (TMPRSS2) and v-ets erythroblastosis virus E26 oncogene homolog (avian) (ERG) genes. Here, we report a clinical-grade, transcription-mediated amplification assay to risk stratify and detect prostate cancer noninvasively in urine. The TMPRSS2:ERG fusion transcript was quantitatively measured in prospectively collected whole urine from 1312 men at multiple centers. Urine TMPRSS2:ERG was associated with indicators of clinically significant cancer at biopsy and prostatectomy, including tumor size, high Gleason score at prostatectomy, and upgrading of Gleason grade at prostatectomy. TMPRSS2:ERG, in combination with urine prostate cancer antigen 3 (PCA3), improved the performance of the multivariate Prostate Cancer Prevention Trial risk calculator in predicting cancer on biopsy. In the biopsy cohorts, men in the highest and lowest of three TMPRSS2:ERG+PCA3 score groups had markedly different rates of cancer, clinically significant cancer by Epstein criteria, and high-grade cancer on biopsy. Our results demonstrate that urine TMPRSS2:ERG, in combination with urine PCA3, enhances the utility of serum PSA for predicting prostate cancer risk and clinically relevant cancer on biopsy. PMID:21813756

  19. Utility of Doppler Myocardial Imaging, Cardiac Biomarkers and Clonal Immunoglobulin Genes to Assess Left Ventricular Performance and Stratify Risk Following Peripheral Blood Stem Cell Transplantation in Patients with Systemic Light Chain Amyloidosis (AL)

    PubMed Central

    Bellavia, Diego; Abraham, Roshini S.; Pellikka, Patricia A.; Dispenzieri, Angela; Burnett, John C.; Al-Zahrani, Ghormallah B.; Green, Tammy D.; Manske, Michelle K.; Gertz, Morie A.; Miller, Fletcher A.; Abraham, Theodore P.

    2011-01-01

    Cardiac dysfunction is a well-recognized complication of light chain amyloidosis (AL). Autologous stem cell transplant (auto-SCT) has emerged as a successful treatment modality for AL patients. In this study, we examined the effect of clonal immunoglobulin light chain genes (VL), which encodes the immunoglobulin light chain protein that ultimately forms amyloid, on cardiac function, in the context of auto-SCT and its impact on overall survival. Longitudinal Doppler myocardial imaging parameters along with cardiac biomarkers were used to assess for cardiac function pre and post auto-SCT. VL gene analysis revealed that Vλ genes, in particular VλVI, were associated with worse cardiac function parameters than Vκ genes. Clonal VL genes appeared to have an impact on left ventricular (LV) function post-transplant and also influenced mortality, with specific VL gene families associated with lower survival. Another key predictor of mortality in this report was change in tricuspid regurgitant flow velocity following auto-SCT. Correlations were also observed between systolic strain rate, systolic strain and VL genes associated with amyloid formation. In summary, clonal VL gene usage influences global cardiac function in AL, with patients having VλVI and VλII-III-associated amyloid more severely affected than those having Vκ or VλI amyloid. Pulsed wave tissue Doppler imaging along with immunoglobulin gene analysis offers novel insights into prediction of mortality and cardiac dysfunction in AL after auto-SCT. PMID:21315556

  20. Risk stratified usage of antibiotic-loaded bone cement for primary total knee arthroplasty: short term infection outcomes with a standardized cement protocol.

    PubMed

    Qadir, Rabah; Sidhu, Sanbir; Ochsner, J Lockwood; Meyer, Mark S; Chimento, George F

    2014-08-01

    Efficacy of antibiotic cement (ALBC) in primary knee arthroplasty (pTKA) has been debated. The study's purpose was to examine efficacy of ALBC versus plain cement (PBC) in preventing infection in high-risk patients undergoing pTKA. 3292 consecutive pTKAs were divided into three cohorts: (1) patients receiving only PBC, (2) patients receiving only ALBC, and (3) only high-risk patients receiving ALBC. Cohorts' infections were compared. The 30-day infection rates for cohorts 1, 2, 3 were 0.29%, 0.20%, and 0.13% respectively. 6-month rates were 0.39%, 0.54% and 0.38%. 1-year rates were 0.78%, 0.61%, and 0.64%. Differences in infection rates at all time intervals were not statistically significant. The study supports that even judicious risk-stratified usage of ALBC may not confer added benefit in decreasing infection at one year. PMID:24703363

  1. The risk-stratified osteoporosis strategy evaluation study (ROSE): a randomized prospective population-based study. Design and baseline characteristics.

    PubMed

    Rubin, Katrine Hass; Holmberg, Teresa; Rothmann, Mette Juel; Høiberg, Mikkel; Barkmann, Reinhard; Gram, Jeppe; Hermann, Anne Pernille; Bech, Mickael; Rasmussen, Ole; Glüer, Claus C; Brixen, Kim

    2015-02-01

    The risk-stratified osteoporosis strategy evaluation study (ROSE) is a randomized prospective population-based study investigating the effectiveness of a two-step screening program for osteoporosis in women. This paper reports the study design and baseline characteristics of the study population. 35,000 women aged 65-80 years were selected at random from the population in the Region of Southern Denmark and-before inclusion-randomized to either a screening group or a control group. As first step, a self-administered questionnaire regarding risk factors for osteoporosis based on FRAX(®) was issued to both groups. As second step, subjects in the screening group with a 10-year probability of major osteoporotic fractures ≥15% were offered a DXA scan. Patients diagnosed with osteoporosis from the DXA scan were advised to see their GP and discuss pharmaceutical treatment according to Danish National guidelines. The primary outcome is incident clinical fractures as evaluated through annual follow-up using the Danish National Patient Registry. The secondary outcomes are cost-effectiveness, participation rate, and patient preferences. 20,904 (60%) women participated and included in the baseline analyses (10,411 in screening and 10,949 in control group). The mean age was 71 years. As expected by randomization, the screening and control groups had similar baseline characteristics. Screening for osteoporosis is at present not evidence based according to the WHO screening criteria. The ROSE study is expected to provide knowledge of the effectiveness of a screening strategy that may be implemented in health care systems to prevent fractures. PMID:25578146

  2. Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex

    PubMed Central

    Wei, Kai-Che; Lin, Hon-Yi; Hung, Shih-Kai; Huang, Yu-Tung; Lee, Moon-Sing; Wang, Wen-Hua; Wu, Chieh-Shan; Su, Yu-Chieh; Shen, Bing-Jie; Tsai, Shiang-Jiun; Tsai, Wei-Ta; Chen, Liang-Cheng; Li, Chung-Yi; Chiou, Wen-Yen

    2016-01-01

    Abstract A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention. A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval). After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282–1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 [all P < 0.05]). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women. These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated

  3. The risk of stillbirth and infant death by each additional week of expectant management stratified by maternal age

    PubMed Central

    Page, Jessica M.; Snowden, Jonathan M.; Cheng, Yvonne W.; Doss, Amy; Rosenstein, Melissa G.; Caughey, Aaron B.

    2016-01-01

    OBJECTIVE The objective of the study was to examine fetal/infant mortality by gestational age at term stratified by maternal age. STUDY DESIGN A retrospective cohort study was conducted using 2005 US national birth certificate data. For each week of term gestation, the risk of mortality associated with delivery was compared with composite mortality risk of expectant management. The expectant management measure included stillbirth and infant death. This expectant management risk was calculated to estimate the composite mortality risk with remaining pregnant an additional week by combining the risk of stillbirth during the additional week of pregnancy and infant death risk following delivery at the next week. Maternal age was stratified by 35 years or more compared with women younger than 35 years as well as subgroup analyses of younger than 20, 20–34, 35–39, or 40 years old or older. RESULTS The fetal/infant mortality risk of expectant management is greater than the risk of infant death at 39 weeks’ gestation in women 35 years old or older (15.2 vs 10.9 of 10,000, P < .05). In women younger than 35 years old, the risk of expectant management also exceeded that of infant death at 39 weeks (21.3 vs 18.8 of 10,000, P < .05). For women younger than 35 years old, the overall expectant management risk is influenced by higher infant death risk and does not rise significantly until 41 weeks compared with women 35 years old or older in which it increased at 40 weeks. CONCLUSION Risk varies by maternal age, and delivery at 39 weeks minimizes fetal/infant mortality for both groups, although the magnitude of the risk reduction is greater in older women. PMID:23707677

  4. A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study

    PubMed Central

    Kasch, Helge; Kongsted, Alice; Qerama, Erisela; Bach, Flemming W; Bendix, Tom; Jensen, Troels Staehelin

    2013-01-01

    Objectives An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. Design The design was an observational prospective study of risk factors embedded in a randomised controlled study. Setting Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. Participants During a 2-year inclusion period, acute consecutive whiplash-injured (age 18–70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I–III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. Results The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification. Analysis Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. Conclusions Application of the risk assessment score and use of the risk strata

  5. Prognostic Value of Baseline 18F-FDG PET/CT Functional Parameters in Patients with Advanced Lung Adenocarcinoma Stratified by EGFR Mutation Status

    PubMed Central

    Wang, Dalong; Zhang, Minghui; Gao, Xuan; Yu, Lijuan

    2016-01-01

    The study objective was to retrospectively analyze the metabolic variables derived from 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as predictors of progression-free survival (PFS) and overall survival (OS) in advanced lung adenocarcinoma stratified by epidermal growth factor receptor (EGFR) mutation status. A total of 176 patients (91, EGFR mutation; 85, wild-type EGFR) who underwent 18F-FDG PET/CT before treatment were enrolled. The main 18F-FDG PET/CT-derived variables: primary tumor maximum standardized uptake value (SUVmaxT), primary tumor total lesion glycolysis (TLGT), the maximum SUVmax of all selected lesions in whole body determined using the Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 criteria (SUVmaxWBR), and whole-body total TLG determined using the RECIST 1.1 criteria (TLGWBR) were measured. Survival analysis regarding TLGWBR, and other factors in advanced lung adenocarcinoma patients stratified using EGFR mutation status, were evaluated. The results indicated that high TLGWBR (≥259.85), EGFR wild-type, and high serum LDH were independent predictors of worse PFS and OS in all patients with advanced lung adenocarcinoma. Among patients with wild-type EGFR, only TLGWBR retained significance as an independent predictor of both PFS and OS. Among patients with the EGFR mutation, high serum LDH level was an independent predictor of worse PFS and OS, and high TLGWBR (≥259.85) was an independent predictor of worse PFS but not worse OS. In conclusion, TLGWBR is a promising parameter for prognostic stratification of patients with advanced lung adenocarcinoma and EGFR status; however, it cannot be used to further stratify the risk of worse OS for patients with the EGFR mutation. Further prospective studies are needed to validate our findings. PMID:27336755

  6. Recent research (N = 9,305) underscores the importance of using age-stratified actuarial tables in sex offender risk assessments.

    PubMed

    Wollert, Richard; Cramer, Elliot; Waggoner, Jacqueline; Skelton, Alex; Vess, James

    2010-12-01

    A useful understanding of the relationship between age, actuarial scores, and sexual recidivism can be obtained by comparing the entries in equivalent cells from "age-stratified" actuarial tables. This article reports the compilation of the first multisample age-stratified table of sexual recidivism rates, referred to as the "multisample age-stratified table of sexual recidivism rates (MATS-1)," from recent research on Static-99 and another actuarial known as the Automated Sexual Recidivism Scale. The MATS-1 validates the "age invariance effect" that the risk of sexual recidivism declines with advancing age and shows that age-restricted tables underestimate risk for younger offenders and overestimate risk for older offenders. Based on data from more than 9,000 sex offenders, our conclusion is that evaluators should report recidivism estimates from age-stratified tables when they are assessing sexual recidivism risk, particularly when evaluating the aging sex offender. PMID:21098823

  7. Healthy obese persons: How can they be identified and do metabolic profiles stratify risk?

    PubMed Central

    Denis, Gerald V.; Hamilton, James A.

    2014-01-01

    Purpose of the review New research supports the intuitive observation that many persons classified as obese are healthy, and should not treated and categorized medically as diseased. There is increasing agreement that major blood biomarkers are often not discriminatory, as for example, the return to normal blood glucose levels in bariatric patients who do not have long terms benefits. Although weight loss is appreciated to improve metabolic and inflammatory parameters, the cellular and immune factors that couple obesity to cardiometabolic risk are only partially understood. Recent findings Reduced body mass index upon successful bariatric surgery does not always result in reduced pericardial fat; certain patients gain ectopic fat, which should be considered an adverse response. There is emerging evidence that pericardial fat volume and brown fat stores may provide individualized patient assessments. Summary Some obese persons can be relieved of the additional stigma of classification in a major disease category and unnecessary medical interventions and costs can be reduced. Other patients should be monitored more closely for unexpected adverse outcomes. PMID:23974763

  8. Using Electronic Patient Records to Discover Disease Correlations and Stratify Patient Cohorts

    PubMed Central

    Schmock, Henriette; Dalgaard, Marlene; Andreatta, Massimo; Hansen, Thomas; Søeby, Karen; Bredkjær, Søren; Juul, Anders; Werge, Thomas; Jensen, Lars J.; Brunak, Søren

    2011-01-01

    Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently can be mapped to systems biology frameworks. PMID:21901084

  9. Risk stratifying asymptomatic aortic stenosis: role of the resting 12-lead ECG.

    PubMed

    Greve, Anders M

    2014-02-01

    Despite being routinely performed in the clinical follow-up of asymptomatic AS patients, little or no evidence describes the prognostic value of ECG findings in asymptomatic AS populations. This PhD thesis examined the correlates of resting 12-lead ECG variables with echocardiographic measures of AS severity and cardiovascular outcomes in the till date largest cohort (n=1,563) of asymptomatic patients with mild-to-moderate AS. Most importantly, this PhD thesis demonstrated that QRS-duration adds independent predictive value of sudden cardiac death and that the additional presence of ECG LVH/strain for fixed AS severity represents a lethal risk attribute. Finally, ECG abnormalities displayed low/moderate concordance with echocardiographic parameters. This argues that the ECG should be regarded as a separate tool for obtaining prognostically important information. Treatment was not randomized by ECG findings, future studies should therefore examine if and which ECG variables should elicit closer follow-up and/or earlier intervention to improve prognosis in asymptomatic AS populations. PMID:24495893

  10. Risk of Migraine in Patients With Asthma

    PubMed Central

    Peng, Yi-Hao; Chen, Kuan-Fei; Kao, Chia-Hung; Chen, Hsuan-Ju; Hsia, Te-Chun; Chen, Chia-Hung; Liao, Wei-Chih

    2016-01-01

    Abstract Asthma has been described as an “acephalic migraine” and “pulmonary migraine.” However, no study has investigated the temporal frequency of migraine development in patients with asthma, and the results of previous studies may be difficult to generalize. We investigated the effect of asthma on the subsequent development of migraine by using a population-based data set in Taiwan. We retrieved our study sample from the National Health Insurance Research Database. Specifically, 25,560 patients aged 12 years and older with newly diagnosed asthma were identified as the asthma group, and 102,238 sex and age-matched patients without asthma were identified as the nonasthma group. Cox proportional-hazards regression models were employed to measure the risk of migraine for the asthmatic group compared with that for the nonasthmatic group. The risk of migraine in the asthmatic group was 1.45-fold higher (95% confidence interval 1.33–1.59) than that in the nonasthmatic group after adjustment for sex, age, the Charlson comorbidity index, common medications prescribed for patients with asthma, and annual outpatient department visits. An additional stratified analysis revealed that the risk of migraine remained significantly higher in both sexes and all age groups older than 20 years. Asthma could be an independent predisposing risk factor for migraine development in adults. PMID:26945388

  11. IQ, handedness, and pedophilia in adult male patients stratified by referral source.

    PubMed

    Blanchard, Ray; Kolla, Nathan J; Cantor, James M; Klassen, Philip E; Dickey, Robert; Kuban, Michael E; Blak, Thomas

    2007-09-01

    This study investigated whether the previously observed association of pedophilia with lower IQs is an artifact of heterogeneity in referral source. The subjects were 832 adult male patients referred to a specialty clinic for evaluation of their sexual behavior. The patients' erotic preferences for prepubescent, pubescent, or adult partners were assessed with phallometric testing. Full scale IQ was estimated using six subtests from the WAIS-R. The results showed that the relations between pedophilia and lower IQ, lesser education, and increased rates of non-right-handedness were the same in homogeneous groups referred by lawyers or parole and probation officers as they were in a heterogeneous group referred by a miscellany of other sources. Those results, along with secondary analyses in the study, supported the conclusion that the relation between pedophilia and cognitive function is genuine and not artifactual. The findings were interpreted as evidence for the hypothesis that neurodevelopmental perturbations increase the risk of pedophilia in males. PMID:17634757

  12. The Impact of Implementation Fidelity on Mortality Under a CD4-Stratified Timing Strategy for Antiretroviral Therapy in Patients With Tuberculosis

    PubMed Central

    Patel, Monita R.; Westreich, Daniel; Yotebieng, Marcel; Nana, Mbonze; Eron, Joseph J.; Behets, Frieda; Van Rie, Annelies

    2015-01-01

    Among patients with tuberculosis and human immunodeficiency virus type 1, CD4-stratified initiation of antiretroviral therapy (ART) is recommended, with earlier ART in those with low CD4 counts. However, the impact of implementation fidelity to this recommendation is unknown. We examined a prospective cohort study of 395 adult patients diagnosed with tuberculosis and human immunodeficiency virus between August 2007 and November 2009 in Kinshasa, Democratic Republic of the Congo. ART was to be initiated after 1 month of tuberculosis treatment at a CD4 count of <100 cells/mm3 or World Health Organization stage 4 (other than extrapulmonary tuberculosis) and after 2 months of tuberculosis treatment at a CD4 count of 100–350 cells/mm3. We used the parametric g-formula to estimate the impact of implementation fidelity on 6-month mortality. Observed implementation fidelity was low (46%); 54% of patients either experienced delays in ART initiation or did not initiate ART, which could be avoided under perfect implementation fidelity. The observed mortality risk was 12.0% (95% confidence interval (CI): 8.2, 15.7); under complete (counterfactual) implementation fidelity, the mortality risk was 7.8% (95% CI: 2.4, 12.3), corresponding to a risk reduction of 4.2% (95% CI: 0.3, 8.1) and a preventable fraction of 35.1% (95% CI: 2.9, 67.9). Strategies to achieve high implementation fidelity to CD4-stratified ART timing are needed to maximize survival benefit. PMID:25787266

  13. Stratifying Type 2 Diabetes Cases by BMI Identifies Genetic Risk Variants in LAMA1 and Enrichment for Risk Variants in Lean Compared to Obese Cases

    PubMed Central

    Perry, John R. B.; Voight, Benjamin F.; Yengo, Loïc; Amin, Najaf; Dupuis, Josée; Ganser, Martha; Grallert, Harald; Navarro, Pau; Li, Man; Qi, Lu; Steinthorsdottir, Valgerdur; Scott, Robert A.; Almgren, Peter; Arking, Dan E.; Aulchenko, Yurii; Balkau, Beverley; Benediktsson, Rafn; Bergman, Richard N.; Boerwinkle, Eric; Bonnycastle, Lori; Burtt, Noël P.; Campbell, Harry; Charpentier, Guillaume; Collins, Francis S.; Gieger, Christian; Green, Todd; Hadjadj, Samy; Hattersley, Andrew T.; Herder, Christian; Hofman, Albert; Johnson, Andrew D.; Kottgen, Anna; Kraft, Peter; Labrune, Yann; Langenberg, Claudia; Manning, Alisa K.; Mohlke, Karen L.; Morris, Andrew P.; Oostra, Ben; Pankow, James; Petersen, Ann-Kristin; Pramstaller, Peter P.; Prokopenko, Inga; Rathmann, Wolfgang; Rayner, William; Roden, Michael; Rudan, Igor; Rybin, Denis; Scott, Laura J.; Sigurdsson, Gunnar; Sladek, Rob; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Tuomilehto, Jaakko; Uitterlinden, Andre G.; Vivequin, Sidonie; Weedon, Michael N.; Wright, Alan F.; Hu, Frank B.; Illig, Thomas; Kao, Linda; Meigs, James B.; Wilson, James F.; Stefansson, Kari; van Duijn, Cornelia; Altschuler, David; Morris, Andrew D.; Boehnke, Michael; McCarthy, Mark I.; Froguel, Philippe; Palmer, Colin N. A.; Wareham, Nicholas J.; Groop, Leif

    2012-01-01

    Common diseases such as type 2 diabetes are phenotypically heterogeneous. Obesity is a major risk factor for type 2 diabetes, but patients vary appreciably in body mass index. We hypothesized that the genetic predisposition to the disease may be different in lean (BMI<25 Kg/m2) compared to obese cases (BMI≥30 Kg/m2). We performed two case-control genome-wide studies using two accepted cut-offs for defining individuals as overweight or obese. We used 2,112 lean type 2 diabetes cases (BMI<25 kg/m2) or 4,123 obese cases (BMI≥30 kg/m2), and 54,412 un-stratified controls. Replication was performed in 2,881 lean cases or 8,702 obese cases, and 18,957 un-stratified controls. To assess the effects of known signals, we tested the individual and combined effects of SNPs representing 36 type 2 diabetes loci. After combining data from discovery and replication datasets, we identified two signals not previously reported in Europeans. A variant (rs8090011) in the LAMA1 gene was associated with type 2 diabetes in lean cases (P = 8.4×10−9, OR = 1.13 [95% CI 1.09–1.18]), and this association was stronger than that in obese cases (P = 0.04, OR = 1.03 [95% CI 1.00–1.06]). A variant in HMG20A—previously identified in South Asians but not Europeans—was associated with type 2 diabetes in obese cases (P = 1.3×10−8, OR = 1.11 [95% CI 1.07–1.15]), although this association was not significantly stronger than that in lean cases (P = 0.02, OR = 1.09 [95% CI 1.02–1.17]). For 36 known type 2 diabetes loci, 29 had a larger odds ratio in the lean compared to obese (binomial P = 0.0002). In the lean analysis, we observed a weighted per-risk allele OR = 1.13 [95% CI 1.10–1.17], P = 3.2×10−14. This was larger than the same model fitted in the obese analysis where the OR = 1.06 [95% CI 1.05–1.08], P = 2.2×10−16. This study provides evidence that stratification of type 2 diabetes cases by BMI may help identify

  14. Stratifying type 2 diabetes cases by BMI identifies genetic risk variants in LAMA1 and enrichment for risk variants in lean compared to obese cases.

    PubMed

    Perry, John R B; Voight, Benjamin F; Yengo, Loïc; Amin, Najaf; Dupuis, Josée; Ganser, Martha; Grallert, Harald; Navarro, Pau; Li, Man; Qi, Lu; Steinthorsdottir, Valgerdur; Scott, Robert A; Almgren, Peter; Arking, Dan E; Aulchenko, Yurii; Balkau, Beverley; Benediktsson, Rafn; Bergman, Richard N; Boerwinkle, Eric; Bonnycastle, Lori; Burtt, Noël P; Campbell, Harry; Charpentier, Guillaume; Collins, Francis S; Gieger, Christian; Green, Todd; Hadjadj, Samy; Hattersley, Andrew T; Herder, Christian; Hofman, Albert; Johnson, Andrew D; Kottgen, Anna; Kraft, Peter; Labrune, Yann; Langenberg, Claudia; Manning, Alisa K; Mohlke, Karen L; Morris, Andrew P; Oostra, Ben; Pankow, James; Petersen, Ann-Kristin; Pramstaller, Peter P; Prokopenko, Inga; Rathmann, Wolfgang; Rayner, William; Roden, Michael; Rudan, Igor; Rybin, Denis; Scott, Laura J; Sigurdsson, Gunnar; Sladek, Rob; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Tuomilehto, Jaakko; Uitterlinden, Andre G; Vivequin, Sidonie; Weedon, Michael N; Wright, Alan F; Hu, Frank B; Illig, Thomas; Kao, Linda; Meigs, James B; Wilson, James F; Stefansson, Kari; van Duijn, Cornelia; Altschuler, David; Morris, Andrew D; Boehnke, Michael; McCarthy, Mark I; Froguel, Philippe; Palmer, Colin N A; Wareham, Nicholas J; Groop, Leif; Frayling, Timothy M; Cauchi, Stéphane

    2012-05-01

    Common diseases such as type 2 diabetes are phenotypically heterogeneous. Obesity is a major risk factor for type 2 diabetes, but patients vary appreciably in body mass index. We hypothesized that the genetic predisposition to the disease may be different in lean (BMI<25 Kg/m²) compared to obese cases (BMI≥30 Kg/m²). We performed two case-control genome-wide studies using two accepted cut-offs for defining individuals as overweight or obese. We used 2,112 lean type 2 diabetes cases (BMI<25 kg/m²) or 4,123 obese cases (BMI≥30 kg/m²), and 54,412 un-stratified controls. Replication was performed in 2,881 lean cases or 8,702 obese cases, and 18,957 un-stratified controls. To assess the effects of known signals, we tested the individual and combined effects of SNPs representing 36 type 2 diabetes loci. After combining data from discovery and replication datasets, we identified two signals not previously reported in Europeans. A variant (rs8090011) in the LAMA1 gene was associated with type 2 diabetes in lean cases (P = 8.4×10⁻⁹, OR = 1.13 [95% CI 1.09-1.18]), and this association was stronger than that in obese cases (P = 0.04, OR = 1.03 [95% CI 1.00-1.06]). A variant in HMG20A--previously identified in South Asians but not Europeans--was associated with type 2 diabetes in obese cases (P = 1.3×10⁻⁸, OR = 1.11 [95% CI 1.07-1.15]), although this association was not significantly stronger than that in lean cases (P = 0.02, OR = 1.09 [95% CI 1.02-1.17]). For 36 known type 2 diabetes loci, 29 had a larger odds ratio in the lean compared to obese (binomial P = 0.0002). In the lean analysis, we observed a weighted per-risk allele OR = 1.13 [95% CI 1.10-1.17], P = 3.2×10⁻¹⁴. This was larger than the same model fitted in the obese analysis where the OR = 1.06 [95% CI 1.05-1.08], P = 2.2×10⁻¹⁶. This study provides evidence that stratification of type 2 diabetes cases by BMI may help identify

  15. T-wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

    PubMed Central

    Merchant, Faisal M.; Sayadi, Omid; Moazzami, Kasra; Puppala, Dheeraj; Armoundas, Antonis A.

    2013-01-01

    Microvolt level T-wave alternans (MTWA), a phenomenon of beat-to-beat variability in the repolarization phase of the ventricles, has been closely associated with an increased risk of ventricular tachyarrhythmic events (VTE) and sudden cardiac death (SCD) during medium- and long-term follow-up. Recent observations also suggest that heightened MTWA magnitude may be closely associated with short-term risk of impending VTE. At the sub-cellular and cellular level, perturbations in calcium transport processes likely play a primary role in the genesis of alternans, which then secondarily lead to alternans of action potential morphology and duration (APD). As such, MTWA may play a role not only in risk stratification but also more fundamentally in the pathogenesis of VTE. In this paper, we outline recent advances in understanding the pathogenesis of MTWA and also the utility of T-wave alternans testing for clinical risk stratification. We also highlight emerging clinical applications for MTWA. PMID:23881581

  16. Developing and evaluating polygenic risk prediction models for stratified disease prevention.

    PubMed

    Chatterjee, Nilanjan; Shi, Jianxin; García-Closas, Montserrat

    2016-07-01

    Knowledge of genetics and its implications for human health is rapidly evolving in accordance with recent events, such as discoveries of large numbers of disease susceptibility loci from genome-wide association studies, the US Supreme Court ruling of the non-patentability of human genes, and the development of a regulatory framework for commercial genetic tests. In anticipation of the increasing relevance of genetic testing for the assessment of disease risks, this Review provides a summary of the methodologies used for building, evaluating and applying risk prediction models that include information from genetic testing and environmental risk factors. Potential applications of models for primary and secondary disease prevention are illustrated through several case studies, and future challenges and opportunities are discussed. PMID:27140283

  17. The Predictive Effects of Early Pregnancy Lipid Profiles and Fasting Glucose on the Risk of Gestational Diabetes Mellitus Stratified by Body Mass Index

    PubMed Central

    Wang, Chen; Zhu, Weiwei; Wei, Yumei; Su, Rina; Feng, Hui; Lin, Li; Yang, Huixia

    2016-01-01

    This study aimed at evaluating the predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus (GDM) in patients stratified by prepregnancy body mass index (p-BMI) and to determine the optimal cut-off values of each indicator for different p-BMI ranges. A retrospective system cluster sampling survey was conducted in Beijing during 2013 and a total of 5,265 singleton pregnancies without prepregnancy diabetes were included. The information for each participant was collected individually using questionnaires and medical records. Logistic regression analysis and receiver operator characteristics analysis were used in the analysis. Outcomes showed that potential markers for the prediction of GDM include early pregnancy lipid profiles (cholesterol, triacylglycerols, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios [LDL-C/HDL-C], and triglyceride to high-density lipoprotein cholesterol ratios [TG/HDL-C]) and fasting glucose, of which fasting glucose level was the most accurate indicator. Furthermore, the predictive effects and cut-off values for these factors varied according to p-BMI. Thus, p-BMI should be a consideration for the risk assessment of pregnant patients for GDM development. PMID:26981541

  18. Classification of worldwide bovine tuberculosis risk factors in cattle: a stratified approach

    PubMed Central

    Humblet, Marie-France; Boschiroli, Maria Laura; Saegerman, Claude

    2009-01-01

    The worldwide status of bovine tuberculosis (bTB) as a zoonosis remains of great concern. This article reviews the main risk factors for bTB in cattle based on a three-level classification: animal, herd and region/country level. A distinction is also made, whenever possible, between situations in developed and developing countries as the difference of context might have consequences in terms of risk of bTB. Recommendations are suggested to animal health professionals and scientists directly involved in the control and prevention of bTB in cattle. The determination of Millenium Development Goals for bTB is proposed to improve the control/eradication of the disease worldwide. PMID:19497258

  19. Kernel Machine Testing for Risk Prediction with Stratified Case Cohort Studies

    PubMed Central

    Payne, Rebecca; Neykov, Matey; Jensen, Majken Karoline; Cai, Tianxi

    2015-01-01

    Summary Large assembled cohorts with banked biospecimens offer valuable opportunities to identify novel markers for risk prediction. When the outcome of interest is rare, an effective strategy to conserve limited biological resources while maintaining reasonable statistical power is the case cohort (CCH) sampling design, in which expensive markers are measured on a subset of cases and controls. However, the CCH design introduces significant analytical complexity due to outcome-dependent, finite-population sampling. Current methods for analyzing CCH studies focus primarily on the estimation of simple survival models with linear effects; testing and estimation procedures that can efficiently capture complex non-linear marker effects for CCH data remain elusive. In this paper, we propose inverse probability weighted (IPW) variance component type tests for identifying important marker sets through a Cox proportional hazards kernel machine (CoxKM) regression framework previously considered for full cohort studies (Cai et al., 2011). The optimal choice of kernel, while vitally important to attain high power, is typically unknown for a given dataset. Thus we also develop robust testing procedures that adaptively combine information from multiple kernels. The proposed IPW test statistics have complex null distributions that cannot easily be approximated explicitly. Furthermore, due to the correlation induced by CCH sampling, standard resampling methods such as the bootstrap fail to approximate the distribution correctly. We therefore propose a novel perturbation resampling scheme that can effectively recover the induced correlation structure. Results from extensive simulation studies suggest that the proposed IPW CoxKM testing procedures work well in finite samples. The proposed methods are further illustrated by application to a Danish CCH study of Apolipoprotein C-III markers on the risk of coronary heart disease. PMID:26692376

  20. Kernel machine testing for risk prediction with stratified case cohort studies.

    PubMed

    Payne, Rebecca; Neykov, Matey; Jensen, Majken Karoline; Cai, Tianxi

    2016-06-01

    Large assembled cohorts with banked biospecimens offer valuable opportunities to identify novel markers for risk prediction. When the outcome of interest is rare, an effective strategy to conserve limited biological resources while maintaining reasonable statistical power is the case cohort (CCH) sampling design, in which expensive markers are measured on a subset of cases and controls. However, the CCH design introduces significant analytical complexity due to outcome-dependent, finite-population sampling. Current methods for analyzing CCH studies focus primarily on the estimation of simple survival models with linear effects; testing and estimation procedures that can efficiently capture complex non-linear marker effects for CCH data remain elusive. In this article, we propose inverse probability weighted (IPW) variance component type tests for identifying important marker sets through a Cox proportional hazards kernel machine (CoxKM) regression framework previously considered for full cohort studies (Cai et al., 2011). The optimal choice of kernel, while vitally important to attain high power, is typically unknown for a given dataset. Thus, we also develop robust testing procedures that adaptively combine information from multiple kernels. The proposed IPW test statistics have complex null distributions that cannot easily be approximated explicitly. Furthermore, due to the correlation induced by CCH sampling, standard resampling methods such as the bootstrap fail to approximate the distribution correctly. We, therefore, propose a novel perturbation resampling scheme that can effectively recover the induced correlation structure. Results from extensive simulation studies suggest that the proposed IPW CoxKM testing procedures work well in finite samples. The proposed methods are further illustrated by application to a Danish CCH study of Apolipoprotein C-III markers on the risk of coronary heart disease. PMID:26692376

  1. Risk-stratified cardiovascular screening including angiographic and procedural outcomes of percutaneous coronary interventions in renal transplant candidates.

    PubMed

    König, Julian; Möckel, Martin; Mueller, Eda; Bocksch, Wolfgang; Baid-Agrawal, Seema; Babel, Nina; Schindler, Ralf; Reinke, Petra; Nickel, Peter

    2014-01-01

    Background. Benefits of cardiac screening in kidney transplant candidates (KTC) will be dependent on the availability of effective interventions. We retrospectively evaluated characteristics and outcome of percutaneous coronary interventions (PCI) in KTC selected for revascularization by a cardiac screening approach. Methods. In 267 patients evaluated 2003 to 2006, screening tests performed were reviewed and PCI characteristics correlated with major adverse cardiovascular events (MACE) during a follow-up of 55 months. Results. Stress tests in 154 patients showed ischemia in 28 patients (89% high risk). Of 58 patients with coronary angiography, 38 had significant stenoses and 18 cardiac interventions (6.7% of all). 29 coronary lesions in 17/18 patients were treated by PCI. Angiographic success rate was 93.1%, but procedural success rate was only 86.2%. Long lesions (P = 0.029) and diffuse disease (P = 0.043) were associated with MACE. In high risk patients, cardiac screening did not improve outcome as 21.7% of patients with versus 15.5% of patients without properly performed cardiac screening had MACE (P = 0.319). Conclusion. The moderate procedural success of PCI and poor outcome in long and diffuse coronary lesions underscore the need to define appropriate revascularization strategies in KTC, which will be a prerequisite for cardiac screening to improve outcome in these high-risk patients. PMID:25045528

  2. Risk Factors Associated with Very Low Birth Weight in a Large Urban Area, Stratified by Adequacy of Prenatal Care.

    PubMed

    Xaverius, Pamela; Alman, Cameron; Holtz, Lori; Yarber, Laura

    2016-03-01

    Objectives This study examined risk and protective factors associated with very low birth weight (VLBW) for babies born to women receiving adequate or inadequate prenatal care. Methods Birth records from St. Louis City and County from 2000 to 2009 were used (n = 152,590). Data was categorized across risk factors and stratified by adequacy of prenatal care (PNC). Multivariate logistic regression and population attributable risk (PAR) was used to explore risk factors for VLBW infants. Results Women receiving inadequate prenatal care had a higher prevalence of delivering a VLBW infant than those receiving adequate PNC (4.11 vs. 1.44 %, p < .0001). The distribution of risk factors differed between adequate and inadequate PNC regarding Black race (36.4 vs. 79.0 %, p < .0001), age under 20 (13.0 vs. 33.6 %, p < .0001), <13 years of education (35.9 vs. 77.9 %, p < .0001), Medicaid status (35.7 vs. 74.9, p < .0001), primiparity (41.6 vs. 31.4 %, p < .0001), smoking (9.7 vs. 24.5 %, p < .0001), and diabetes (4.0 vs. 2.4 %, p < .0001), respectively. Black race, advanced maternal age, primiparity and gestational hypertension were significant predictors of VLBW, regardless of adequate or inadequate PNC. Among women with inadequate PNC, Medicaid was protective against (aOR 0.671, 95 % CI 0.563-0.803; PAR -32.6 %) and smoking a risk factor for (aOR 1.23, 95 % CI 1.01, 1.49; PAR 40.1 %) VLBW. When prematurity was added to the adjusted models, the largest PAR shifts to education (44.3 %) among women with inadequate PNC. Conclusions Community actions around broader issues of racism and social determinants of health are needed to prevent VLBW in a large urban area. PMID:26537389

  3. Aligning the Economic Value of Companion Diagnostics and Stratified Medicines

    PubMed Central

    Blair, Edward D.; Stratton, Elyse K.; Kaufmann, Martina

    2012-01-01

    The twin forces of payors seeking fair pricing and the rising costs of developing new medicines has driven a closer relationship between pharmaceutical companies and diagnostics companies, because stratified medicines, guided by companion diagnostics, offer better commercial, as well as clinical, outcomes. Stratified medicines have created clinical success and provided rapid product approvals, particularly in oncology, and indeed have changed the dynamic between drug and diagnostic developers. The commercial payback for such partnerships offered by stratified medicines has been less well articulated, but this has shifted as the benefits in risk management, pricing and value creation for all stakeholders become clearer. In this larger healthcare setting, stratified medicine provides both physicians and patients with greater insight on the disease and provides rationale for providers to understand cost-effectiveness of treatment. This article considers how the economic value of stratified medicine relationships can be recognized and translated into better outcomes for all healthcare stakeholders. PMID:25562363

  4. Aligning the economic value of companion diagnostics and stratified medicines.

    PubMed

    Blair, Edward D; Stratton, Elyse K; Kaufmann, Martina

    2012-01-01

    The twin forces of payors seeking fair pricing and the rising costs of developing new medicines has driven a closer relationship between pharmaceutical companies and diagnostics companies, because stratified medicines, guided by companion diagnostics, offer better commercial, as well as clinical, outcomes. Stratified medicines have created clinical success and provided rapid product approvals, particularly in oncology, and indeed have changed the dynamic between drug and diagnostic developers. The commercial payback for such partnerships offered by stratified medicines has been less well articulated, but this has shifted as the benefits in risk management, pricing and value creation for all stakeholders become clearer. In this larger healthcare setting, stratified medicine provides both physicians and patients with greater insight on the disease and provides rationale for providers to understand cost-effectiveness of treatment. This article considers how the economic value of stratified medicine relationships can be recognized and translated into better outcomes for all healthcare stakeholders. PMID:25562363

  5. Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index.

    PubMed

    Wu, Eddie S; Cherian, Jeffrey J; Jauregui, Julio J; Robinson, Kristin; Harwin, Steven F; Mont, Michael A

    2016-05-01

    Obese patients undergoing total hip arthroplasty have been shown to have less functional recovery. This study prospectively compared temporal trends in patient-reported outcomes and activity levels between patients with a body mass index (BMI) of less than 30, 30 to 35, and 35 to 40 kg/m(2) after total hip arthroplasty. Patients were evaluated via the Harris Hip Score, Lower Extremity Activity Scale, and Short Form-12 physical and mental components. The results suggest that patients with BMIs of 35 to 40 kg/m(2) might have poorer functional outcomes preoperatively, with function returning more slowly or poor function being sustained and their not reaching other cohorts' levels. Surgeons must counsel these patients regarding functional expectations and the potential for slower functional returns. [Orthopedics. 2016; 39(3):e572-e577.]. PMID:27064775

  6. Obstacles to the ‘cleanliness of our race’: HIV, reproductive risk, stratified reproduction, and population quality in Hanoi, Vietnam

    PubMed Central

    Hong, Khuat Thu; Nhan, Vu Thi Thanh; Thao, Nguyen Thi Phuong; Hirsch, Jennifer S.

    2013-01-01

    This paper focuses on the interactions between medical professionals in Hanoi, Vietnam and their HIV-positive patients who desire children. Drawing on ethnographic research, we argue that despite ongoing state and civil society efforts to reduce discrimination against people living with HIV (PLHIV), doctors do stigmatize patients who choose to reproduce, even if the patients are found to have carefully considered all associated risks. While the effects of the Social Evils Campaign linger, the doctors’ prejudicial stance towards PLHIV’s reproductive desires and risks also reflects the messages communicated by the more recent governmental campaign on Population Quality. The result of this stigmatization is a stratification of reproduction among the Vietnamese citizenry whereby PLHIV are considered obstacles to ‘the cleanliness of the race’. PMID:25378810

  7. Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED.

    PubMed

    Frenkel, Oron; Riguzzi, Christine; Nagdev, Arun

    2014-06-01

    Stratifying risk of patients with acute coronary syndrome (ACS) in the emergency department (ED) remains a frequent challenge. When ST-elevation criteria are absent, current recommendations rely upon insensitive and time-intensive methods such as the electrocardiogram and cardiac enzyme testing. Here, we report on a series of cases, where emergency physicians used a simplified model for identifying regional wall motion abnormalities by point-of-care echocardiography in patients presenting with chest pain to the ED. With the use of a simplified model described herein, high-risk patients with ACS were identified rapidly in a cohort usually difficult to risk stratify. PMID:24745875

  8. Axl Expression Stratifies Patients with Poor Prognosis after Hepatectomy for Hepatocellular Carcinoma

    PubMed Central

    Xia, Yong; Li, Jun; Shi, Lehua; Zou, Qifei; Wan, Xuying; Jiao, Binghua; Wang, Hongyang; Wu, Mengchao; Zhang, Yongjie; Shen, Feng

    2016-01-01

    Background Axl is a receptor tyrosine kinase which plays an important role in multiple human malignancies. Design The Axl expression was examined in several hepatocellular carcinoma(HCC) cell lines, paired tumor and nontumorous samples. Then, we examined cell growth curve, cell apoptosis and cell migration in SMMC-7721 cells over-expressed with Axl or siRNA against Axl, respectively. Finally, the prognostic value of Axl was investigated in a prospective cohort of 246 consecutive HCC patients undergoing curative hepatoectomy. Results We found Axl was positive in 22% of examined tumor tissues and all four cell lines. Over-expressing Axl in SMMC-7721 cells accelerated cell growth, cell migration and inhibited cell apoptosis, while knock-down of Axl exerted opposite effect. Axl expression was closely associated with serum AFP, multiple tumors, absence of encapsulation, microvascular invasion, and advanced BCLC or TNM stage. Patients with positive Axl staining had a higher 5-year recurrence rate (92% vs. 71%, P<0.001) and a lower 5-year survival rate (9% vs. 48%, P<0.001) than those with negative staining. The multivariate analyses showed that Axl expression was an independent factor for both tumor recurrence (HR: 1.725; 95% CI: 1.219–2.441) and survival (1.847; 1.291–2.642). Conclusion Axl expression suggests more aggressive tumor invasiveness and predicts worse prognosis for HCC patients undergoing resection. PMID:27182739

  9. Risk groups in bladder cancer patients treated with radical cystectomy

    PubMed Central

    Mallen, Eva; Gil, Pedro; Gil, Maria Jesus

    2015-01-01

    Objective To stratify patients with bladder cancer into homogeneous risk groups according to statistically significant differences found in PFS (progression-free survival). To identify those patients at increased risk of progression and to provide oncological follow-up according to patient risk group. Materials and Methods A retrospective study of 563 patients treated with radical cystectomy (RC). In order to determine which factors might predict bladder tumour progression and death, uni- and multivariate analyses were performed. The risk groups were identified according to “inter-category” differences found in PFS and lack of differences, thus revealing intra-category homogeneity. Results Median follow up time was 37.8 months. Recurrence occurred in a total of 219 patients (38, 9%). In 63% of cases this was distant recurrence. Only two variables retained independent prognostic value in the multivariate analysis for PFS: pathological organ confinement and lymph node involvement. By combining these two variables, we created a new “risk group” variable. In this second model it was found that the new variable behaved as an independent predictor associated with PFS. Four risk groups were identified: very low, low, intermediate and high risk: • Very low risk: pT0 N0 • Low risk: pTa, pTis, pT1, pT2 and pN0 • Intermediate risk: pT3 and pN0 • High risk: pT4 N0 or pN1-3. Conclusions We retrospectively identified 4 risk groups with an independent prognostic value for progression-free survival following RC. Differences in recurrence patterns after RC between risk groups have led us to set different intervals in monitoring for cancer. PMID:25928508

  10. Risk of Nongenitourinary Cancers in Patients With Spinal Cord Injury

    PubMed Central

    Kao, Chia-Hong; Sun, Li-Min; Chen, Yueh-Sheng; Lin, Cheng-Li; Liang, Ji-An; Kao, Chia-Hung; Weng, Ming-Wei

    2016-01-01

    Abstract Little information is available regarding the risk of nongenitourinary (GU) cancers in patients with spinal cord injury (SCI). The authors conducted a nationwide population-based study to investigate whether a higher risk of non-GU cancer is seen among patients with SCI. Data retrieved from the National Health Insurance Research Database of Taiwan were used in this study. A total of 41,900 patients diagnosed with SCI between 2000 and 2011 were identified from the National Health Insurance Research Database and comprised the SCI cohort. Each of these patients was randomly frequency matched with 4 people from the general population (without SCI) according to age, sex, comorbidities, and index year. Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios and 95% confidence intervals and determine how SCI affected non-GU cancer risk. No significant difference in overall non-GU cancer risk was observed between the SCI and control groups. The patients with SCI exhibited a significantly higher risk of developing esophageal, liver, and hematologic malignancies compared with those without SCI. By contrast, the SCI cohort had a significantly lower risk of colorectal cancer compared with the non-SCI cohort (adjusted hazard ratio = 0.80, 95% confidence interval = 0.69–0.93). Additional stratified analyses by sex, age, and follow-up duration revealed various correlations between SCI and non-GU cancer risk. The patients with SCI exhibited higher risk of esophageal, liver, and hematologic malignancies but a lower risk of colorectal cancer compared with those without SCI. The diverse patterns of cancer risk among the patients with SCI may be related to the complications of chronic SCI. PMID:26765443

  11. Association between hospital case volume and mortality in non-elderly pneumonia patients stratified by severity: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background The characteristics and aetiology of pneumonia in the non-elderly population is distinct from that in the elderly population. While a few studies have reported an inverse association between hospital case volume and clinical outcome in elderly pneumonia patients, the evidence is lacking in a younger population. In addition, the relationship between volume and outcome may be different in severe pneumonia cases than in mild cases. In this context, we tested two hypotheses: 1) non-elderly pneumonia patients treated at hospitals with larger case volume have better clinical outcome compared with those treated at lower case volume hospitals; 2) the volume-outcome relationship differs by the severity of the pneumonia. Methods We conducted the study using the Japanese Diagnosis Procedure Combination database. Patients aged 18–64 years discharged from the participating hospitals between July to December 2010 were included. The hospitals were categorized into four groups (very-low, low, medium, high) based on volume quartiles. The association between hospital case volume and in-hospital mortality was evaluated using multivariate logistic regression with generalized estimating equations adjusting for pneumonia severity, patient demographics and comorbidity score, and hospital academic status. We further analyzed the relationship by modified A-DROP pneumonia severity score calculated using the four severity indices: dehydration, low oxygen saturation, orientation disturbance, and decreased systolic blood pressure. Results We identified 8,293 cases of pneumonia at 896 hospitals across Japan, with 273 in-hospital deaths (3.3%). In the overall population, no significant association between hospital volume and in-hospital mortality was observed. However, when stratified by pneumonia severity score, higher hospital volume was associated with lower in-hospital mortality at the intermediate severity level (modified A-DROP score = 2) (odds ratio (OR) of very low vs

  12. Opposite Associations between Individual KIAA0319 Polymorphisms and Developmental Dyslexia Risk across Populations: A Stratified Meta-Analysis by the Study Population.

    PubMed

    Shao, Shanshan; Niu, Yanfeng; Zhang, Xiaohui; Kong, Rui; Wang, Jia; Liu, Lingfei; Luo, Xiu; Zhang, Jiajia; Song, Ranran

    2016-01-01

    KIAA0319 at the DYX2 locus is one of the most extensively studied candidate genes for developmental dyslexia (DD) owing to its important role in neuronal migration. Previous research on associations between KIAA0319 genetic variations and DD has yielded inconsistent results. It is important to establish a more precise estimate of the DD risk associated with these genetic variations. We carried out a meta-analysis of association studies involving KIAA0319 polymorphisms and DD risk. The results of pooled analysis indicated that none of the six investigated markers in or near the KIAA0319 gene are associated with DD. However, a stratified analysis by the study population revealed opposite associations involving KIAA0319 rs4504469 in European and Asian subgroups. The stratified analysis also showed that the KIAA0319 rs9461045 minor allele (T allele) has a protective effect in Asians. This meta-analysis has allowed us to establish the effects of specific KIAA0319 polymorphisms on DD risk with greater precision, as they vary across populations; analyzing one single nucleotide polymorphism at a time could not fully explain the genetic association for DD. PMID:27464509

  13. Opposite Associations between Individual KIAA0319 Polymorphisms and Developmental Dyslexia Risk across Populations: A Stratified Meta-Analysis by the Study Population

    PubMed Central

    Shao, Shanshan; Niu, Yanfeng; Zhang, Xiaohui; Kong, Rui; Wang, Jia; Liu, Lingfei; Luo, Xiu; Zhang, Jiajia; Song, Ranran

    2016-01-01

    KIAA0319 at the DYX2 locus is one of the most extensively studied candidate genes for developmental dyslexia (DD) owing to its important role in neuronal migration. Previous research on associations between KIAA0319 genetic variations and DD has yielded inconsistent results. It is important to establish a more precise estimate of the DD risk associated with these genetic variations. We carried out a meta-analysis of association studies involving KIAA0319 polymorphisms and DD risk. The results of pooled analysis indicated that none of the six investigated markers in or near the KIAA0319 gene are associated with DD. However, a stratified analysis by the study population revealed opposite associations involving KIAA0319 rs4504469 in European and Asian subgroups. The stratified analysis also showed that the KIAA0319 rs9461045 minor allele (T allele) has a protective effect in Asians. This meta-analysis has allowed us to establish the effects of specific KIAA0319 polymorphisms on DD risk with greater precision, as they vary across populations; analyzing one single nucleotide polymorphism at a time could not fully explain the genetic association for DD. PMID:27464509

  14. [Patient safety and risk management].

    PubMed

    Schrappe, Matthias

    2005-08-15

    Patient safety is the latest issue in the present stage of the German health care system, characterized by costs and quality both resulting in value of care. Patient safety defined as "absence of adverse events" represents an important problem, because 10% of in-house patients experience an adverse event, which in nearly 50% of the cases is due to an error (preventable adverse event). Threats and near misses are errors without a consecutive adverse event, much more common and better to integrate in the concept of risk management, which is based on thorough analysis and prevention of errors in medicine. Chart reviews show adverse events in between 3% and 11% of hospital patients, studies with direct observation result in higher estimates (17.7%). Nosocomial infections occur in 3-5%, adverse drug events in 0.17-6.5%, and adverse medical device events in up to 8% of patients. Medication errors (ordering, dosing, distribution) are present in up to 50% of all drug applications. Adverse drug events are important reasons for hospital admissions (3.2-10.8% of all admitted patients), other consequences of adverse drug events are severe disability and death. Mortality of adverse drug events is estimated between 0.04% and 0.95% of all patients. The introduction of risk management in the German health care system is one option to prevent a malpractice crisis similar to the situation in the US health care system in the 1990s. Errors are not to be considered only individual but also organizational failures. Critical incident report systems (CIRS) can help to increase the knowledge about errors, near misses and adverse events, so that prevention of errors can take place. On the organizational level, it is an issue of leaderchip to convince the members of the organization that prevention of errors has a higher priority than punishing and blaming. The medical and other professions, on the other side, have to change their self-understanding from the zero mistake philosophy to

  15. 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

  16. Survival analysis of cervical cancer using stratified Cox regression

    NASA Astrophysics Data System (ADS)

    Purnami, S. W.; Inayati, K. D.; Sari, N. W. Wulan; Chosuvivatwong, V.; Sriplung, H.

    2016-04-01

    Cervical cancer is one of the mostly widely cancer cause of the women death in the world including Indonesia. Most cervical cancer patients come to the hospital already in an advanced stadium. As a result, the treatment of cervical cancer becomes more difficult and even can increase the death's risk. One of parameter that can be used to assess successfully of treatment is the probability of survival. This study raises the issue of cervical cancer survival patients at Dr. Soetomo Hospital using stratified Cox regression based on six factors such as age, stadium, treatment initiation, companion disease, complication, and anemia. Stratified Cox model is used because there is one independent variable that does not satisfy the proportional hazards assumption that is stadium. The results of the stratified Cox model show that the complication variable is significant factor which influent survival probability of cervical cancer patient. The obtained hazard ratio is 7.35. It means that cervical cancer patient who has complication is at risk of dying 7.35 times greater than patient who did not has complication. While the adjusted survival curves showed that stadium IV had the lowest probability of survival.

  17. Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease.

    PubMed

    Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica

    2016-01-01

    Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity. PMID:26730804

  18. Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study

    PubMed Central

    2014-01-01

    Background Epidemiological studies have shown adverse effects of short-term exposure to air pollution on respiratory disease outcomes; however, few studies examined this association on an hourly time scale. We evaluated the associations between hourly changes in air pollution and the risk of respiratory disease in the elderly, using the time of the emergency call as the disease onset for each case. Methods We used a time-stratified case-crossover design. Study participants were 6,925 residents of the city of Okayama, Japan, aged 65 or above who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of respiratory disease. We calculated city-representative hourly average concentrations of air pollutants from several monitoring stations. By using conditional logistic regression models, we estimated odds ratios per interquartile-range increase in each pollutant by exposure period prior to emergency call, adjusting for hourly ambient temperature, hourly relative humidity, and weekly numbers of reported influenza cases aged ≥60. Results Suspended particulate matter (SPM) exposure 24 to <72 hours prior to the onset and ozone exposure 48 to <96 hours prior to the onset were associated with the increased risk of respiratory disease. For example, following one interquartile-range increase, odds ratios were 1.05 (95% confidence interval: 1.01, 1.09) for SPM exposure 24 to <48 hours prior to the onset and 1.13 (95% confidence interval: 1.04, 1.23) for ozone exposure 72 to <96 hours prior to the onset. Sulfur dioxide (SO2) exposure 0 to <24 hours prior to onset was associated with the increased risk of pneumonia and influenza: odds ratio was 1.07 per one interquartile-range increase (95% confidence interval: 1.00, 1.14). Elevated risk for pneumonia and influenza of SO2 was observed at shorter lags (i.e., 8–18 hours) than the elevated risks for respiratory disease of SPM or ozone. Overall, the effect estimates for chronic obstructive

  19. Cardiovascular Risk in Patients with Psoriatic Arthritis

    PubMed Central

    Zhu, Tracy Y.; Li, Edmund K.; Tam, Lai-Shan

    2012-01-01

    Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. In addition to skin and joint involvement, there is increasing evidence suggesting that patients with PsA also have an increase in risk of clinical and subclinical cardiovascular diseases, mostly due to accelerating atherosclerosis. Both conventional and nonconventional cardiovascular risk factors contribute to the increased cardiovascular risk in PsA. Chronic inflammation plays a pivotal role in the pathogenesis of atherosclerosis in PsA, acting independently and/or synergistically with the conventional risk factors. In this paper, we discuss the current literature indicating that patients with PsA are at risk of cardiovascular diseases. PMID:22645614

  20. Total Joint Arthroplasty in Patients with Chronic Renal Disease: Is It Worth the Risk?

    PubMed

    Warth, Lucian C; Pugely, Andrew J; Martin, Christopher T; Gao, Yubo; Callaghan, John J

    2015-09-01

    26-27% of patients with end stage hip and knee arthritis requiring TJR have chronic renal disease. A multi-center, prospective clinical registry was queried for TJA's from 2006 to 2012, and 74,300 cases were analyzed. Renal impairment was quantified using estimated glomerular filtration rate (eGFR) to stratify each patient by stage of CRD (1-5). There was a significantly greater rate of overall complications in patients with moderate to severe CRD (6.1% vs. 7.6%, P<0.001). In those with CRD (Stage 3-5), mortality was twice as high (0.26% vs. 0.48%, P<0.001). Patients with Stage 4 and 5 CRD had a 213% increased risk of any complication (OR 2.13, 95% CI: 1.73-2.62). Surgeons may use these findings to discuss the risk-benefit ratio of elective TJR in patients with CRD. PMID:26122111

  1. microRNA fingerprinting of CLL patients with chromosome 17p deletion identify a miR-21 score that stratifies early survival

    PubMed Central

    Rossi, Simona; Shimizu, Masayoshi; Barbarotto, Elisa; Nicoloso, Milena S.; Dimitri, Federica; Sampath, Deepa; Fabbri, Muller; Lerner, Susan; Barron, Lynn L.; Rassenti, Laura Z.; Jiang, Li; Xiao, Lianchun; Hu, Jianhua; Secchiero, Paola; Zauli, Giorgio; Volinia, Stefano; Negrini, Massimo; Wierda, William; Kipps, Thomas J.; Plunkett, William; Coombes, Kevin R.; Abruzzo, Lynne V.

    2010-01-01

    Aberrant expression of microRNAs (miRNAs) has been associated with clinical outcome in patients with chronic lymphocytic leukemia (CLL). To identify a powerful and easily assessable miRNA bio-marker of prognosis and survival, we performed quantitative reverse-transcription polymerase chain reaction (qRT-PCR) profiling in 104 CLL patients with a well-defined chromosome 17p status, and we validated our findings with miRNA microarray data from an independent cohort of 80 patients. We found that miR-15a, miR-21, miR-34a, miR-155, and miR-181b were differentially expressed between CLLs with chromosome 17p deletion and CLLs with normal 17p and normal karyotype, and that miR-181b was down-regulated in therapy-refractory cases. miR-21 expression levels were significantly higher in patients with poor prognosis and predicted overall survival (OS), and miR-181b expression levels significantly predicted treatment-free survival. We developed a 21FK score (miR-21 qRT-PCR, fluorescence in situ hybridization, Karyotype) to stratify patients according to OS and found that patients with a low score had a significantly longer OS time. When we evaluated the relative power of the 21FK score with the most used prognostic factors, the score was the most significant in both CLL cohorts. We conclude that the 21FK score represents a useful tool for distinguishing between good-prognosis and poor-prognosis CLL patients. PMID:20393129

  2. Achieving cholesterol targets by individualizing starting doses of statin according to baseline low-density lipoprotein cholesterol and coronary artery disease risk category: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) study

    PubMed Central

    Ur, Ehud; Langer, Anatoly; Rabkin, Simon W; Calciu, Cristina-Dana; Leiter, Lawrence A

    2010-01-01

    BACKGROUND: Despite an increasing body of evidence on the benefit of lowering elevated levels of low-density lipoprotein cholesterol (LDL-C), there is still considerable concern that patients are not achieving target LDL-C levels. OBJECTIVE: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) trial tested whether an algorithm-based statin dosing approach would enable patients to achieve LDL-C and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio targets quickly. METHODS: Subjects requiring statin therapy, but with an LDL-C level of 5.7 mmol/L or lower, and triglycerides of 6.8 mmol/L or lower at screening participated in the 12-week study, which had two open-label, six-week phases: a treatment period during which patients received 10 mg, 20 mg, 40 mg or 80 mg of atorvastatin based on an algorithm incorporating baseline LDL-C value and cardiovascular risk; and patients who achieved both LDL-C and TC/HDL-C ratio targets at six weeks continued on the same atorvastatin dose. Patients who did not achieve both targets received dose uptitration using a single-step titration regimen. The primary efficacy outcome was the proportion of patients achieving target LDL-C levels after 12 weeks. RESULTS: Of 2016 subjects screened at 88 Canadian sites, 1258 were assigned to a study drug (1101 were statin-free and 157 were statin-treated at baseline). The proportion of subjects who achieved LDL-C targets after 12 weeks of treatment was 86% (95% CI 84% to 88%) for statin-free patients and 54% (95% CI 46% to 61%) for statin-treated patients. Overall, 1003 subjects (80%; 95% CI 78% to 82%) achieved both lipid targets. CONCLUSIONS: Algorithm-based statin dosing enables patients to achieve LDL-C and TC/HDL-C ratio targets quickly, with either no titration or a single titration. PMID:20151053

  3. A Prospective, Longitudinal Study of Patient Activity Levels Following Total Knee Arthroplasty Stratified by Demographic and Comorbid Factors.

    PubMed

    Issa, Kimona; Jauregui, Julio J; Given, Kristin; Harwin, Steven F; Mont, Michael A

    2015-08-01

    With the marked increase in the annual number of total knee arthroplasties (TKAs) in the United States, there has been an increased interest in evaluating patient-reported outcomes. The purpose of this study was to prospectively and longitudinally evaluate temporal trends in patient activity levels following TKA and to identify potential demographic and comorbid factors that may affect these outcomes. This prospective study evaluated 281 patients, including 108 men and 173 women, who had a mean age of 66 years (39-80 years) and underwent primary TKA. All patients were followed for a minimum of 2 years. Medical comorbidities were recorded preoperatively and activity scores were evaluated at each follow-up visit. The effects of different patient demographics and systemic comorbidities on activity outcomes were further analyzed using multivariate regression analysis. Compared with preoperative levels, the activity score was observed to initially significantly decrease at 6 weeks postoperatively to below preoperative levels (9.2 vs. 8.1 points). By 3 months, scores were above preoperative levels (10.3 points), but below peak levels. A significant peak in the activity score was observed at 2-year follow-up after which there were no significant differences in scores at 5 years (11.49 vs. 11.47 points). In evaluating patient demographics and comorbidities, significant negative impact of older age, tobacco use, history of cancer, cardiovascular disease, lymphatic disease, and renal disease can be seen on activity levels. Activity scores following TKA follow a temporal trend in which scores initially drop below preoperative levels after surgery, but recover and reach a peak at 2 years postoperatively. This peak was maintained at 5-year follow-up. Surgeons should counsel their patients that they will not perceive the full benefit of a TKA until 1 to 2 years after surgery, in addition, patients may actually perceive their progress to decrease initially. Also, their

  4. An Electronic Patient Risk Communication Board

    PubMed Central

    Ohashi, Kumiko; Caligtan, Christine A.; Benoit, Angela N.; Breydo, Eugene M.; Carroll, Diane L.; Keohane, Carol A.; Bates, David W.; Dykes, John S.; Dykes, Patricia C.

    2012-01-01

    Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient’s bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient’s key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB. PMID:24199109

  5. Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex: A Nationwide Population-Based Case-Control Study.

    PubMed

    Wei, Kai-Che; Lin, Hon-Yi; Hung, Shih-Kai; Huang, Yu-Tung; Lee, Moon-Sing; Wang, Wen-Hua; Wu, Chieh-Shan; Su, Yu-Chieh; Shen, Bing-Jie; Tsai, Shiang-Jiun; Tsai, Wei-Ta; Chen, Liang-Cheng; Li, Chung-Yi; Chiou, Wen-Yen

    2016-03-01

    A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention.A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval).After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282-1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 [all P < 0.05]). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women.These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated with an

  6. Dental care provided to sickle cell anemia patients stratified by age: A population-based study in Northeastern Brazil

    PubMed Central

    Costa, Cyrene Piazera Silva; Aires, Bárbara Tamires Cruz; Thomaz, Erika Bárbara Abreu Fonseca; Souza, Soraia de Fátima Carvalho

    2016-01-01

    Objective: To assess differences in the dental care provided to sickle cell anemia (SCA) patients depending on age. This retrospective study used secondary data from the dental records of the Center of Hematology and Hemotherapy in Maranhão (HEMOMAR). Materials and Methods: Data were obtained from 574 dental records of patients with SCA treated or under treatment in the Dental Department of HEMOMAR from 2000 to 2011. Data on the gender, age, duration of dental treatment, number of patients submitted to periodontal treatment (PT), number of filled teeth (FT), teeth extracted (EX), endodontically treated teeth (ET), and reason for the dental procedures were collected. The Kruskal–Wallis test together with Dunn's post hoc test, Chi-square test, and Spearman's correlation was used for statistical analysis. An alpha error of 5% was considered acceptable. Results: Significant differences were found for FT, EX (P < 0.05), ET and PT (P < 0.001) between the age groups. There were fewer FT in children compared to other age groups (P < 0.001). The most common reasons for restorations and endodontic treatment were dental caries (100%) and irreversible pulpitis (55.6%), respectively. The main reasons for teeth extractions were residual roots (21.3%), chronic apical periodontitis (19.7%), and crown destruction (19.3%). There were positive correlations between age and EX (r = 0.93; P = 0.025) and ET (r = 0.92; P = 0.028). Conclusions: FT, ET, EX, and PT procedures become more common in older patients. Tooth decay is the main reason for dental treatment in SCA patients. PMID:27403053

  7. CFD-based Thrombotic Risk Assessment in Kawasaki Disease Patients with Coronary Artery Aneurysms

    NASA Astrophysics Data System (ADS)

    Sengupta, Dibyendu; Kung, Ethan; Kahn, Andrew; Burns, Jane; Marsden, Alison

    2012-11-01

    Coronary aneurysms occur in 25% of untreated Kawasaki Disease (KD) patients and put patients at increased risk for myocardial infarction and sudden death. Clinical guidelines recommend using aneurysm diameter >8 mm as the arbitrary criterion for treating with anti-coagulation therapy. This study uses patient-specific modeling to non-invasively determine hemodynamic parameters and quantify thrombotic risk. Anatomic models were constructed from CT angiographic image data from 5 KD aneurysm patients and one normal control. CFD simulations were performed to obtain hemodynamic data including WSS and particle residence times (PRT). Thrombosis was clinically observed in 4/9 aneurysmal coronaries. Thrombosed vessels required twice as many cardiac cycles (mean 8.2 vs. 4.2) for particles to exit, and had lower mean WSS (1.3 compared to 2.8 dynes/cm2) compared to vessels with non-thrombosed aneurysms of similar max diameter. 1 KD patient in the cohort with acute thrombosis had diameter < 8 mm. Regions of low WSS and high PRT predicted by simulations correlated with regions of subsequent thrombus formation. Thrombotic risk stratification for KD aneurysms may be improved by incorporating both hemodynamic and geometric quantities. Current clinical guidelines to assess patient risk based only on aneurysm diameter may be misleading. Further prospective study is warranted to evaluate the utility of patient-specific modeling in risk stratifying KD patients with coronary aneurysms. NIH R21.

  8. Clinico-biological features of 5202 patients with acute lymphoblastic leukemia enrolled in the Italian AIEOP and GIMEMA protocols and stratified in age cohorts

    PubMed Central

    Chiaretti, Sabina; Vitale, Antonella; Cazzaniga, Gianni; Orlando, Sonia Maria; Silvestri, Daniela; Fazi, Paola; Valsecchi, Maria Grazia; Elia, Loredana; Testi, Anna Maria; Mancini, Francesca; Conter, Valentino; te Kronnie, Geertruy; Ferrara, Felicetto; Di Raimondo, Francesco; Tedeschi, Alessandra; Fioritoni, Giuseppe; Fabbiano, Francesco; Meloni, Giovanna; Specchia, Giorgina; Pizzolo, Giovanni; Mandelli, Franco; Guarini, Anna; Basso, Giuseppe; Biondi, Andrea; Foà, Robin

    2013-01-01

    The outcome of children and adults with acute lymphoblastic leukemia is markedly different. Since there is limited information on the distribution of clinico-biological variables in different age cohorts, we analyzed 5202 patients with acute lymphoblastic leukemia enrolled in the Italian multicenter AIEOP and GIMEMA protocols and stratified them in nine age cohorts. The highest prevalence of acute lymphoblastic leukemia was observed in children, although a second peak was recorded from the 4th decade onwards. Interestingly, the lowest incidence was found in females between 14–40 years. Immunophenotypic characterization showed a B-lineage in 85.8% of patients: a pro-B stage, associated with MLL/AF4 positivity, was more frequent in patients between 10–50 years. T-lineage leukemia (14.2%) was rare among small children and increased in patients aged 10–40 years. The prevalence of the BCR/ABL1 rearrangement increased progressively with age starting from the cohort of patients 10–14 years old and was present in 52.7% of cases in the 6th decade. Similarly, the MLL/AF4 rearrangement constantly increased up to the 5th decade, while the ETV6/RUNX1 rearrangement disappeared from the age of 30 onwards. This study shows that acute lymphoblastic leukemia in adolescents and young adults is characterized by a male prevalence, higher percentage of T-lineage cases, an increase of poor prognostic molecular markers with aging compared to cases in children, and conclusively quantified the progressive increase of BCR/ABL+ cases with age, which are potentially manageable by targeted therapies. PMID:23716539

  9. Radon: Counseling patients about risk

    SciTech Connect

    Birrer, R.B. )

    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.

  10. Radon: counseling patients about risk.

    PubMed

    Birrer, R B

    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. PMID:2203238

  11. Enhancing tumor apparent diffusion coefficient histogram skewness stratifies the postoperative survival in recurrent glioblastoma multiforme patients undergoing salvage surgery.

    PubMed

    Zolal, Amir; Juratli, Tareq A; Linn, Jennifer; Podlesek, Dino; Sitoci Ficici, Kerim Hakan; Kitzler, Hagen H; Schackert, Gabriele; Sobottka, Stephan B; Rieger, Bernhard; Krex, Dietmar

    2016-05-01

    Objective To determine the value of apparent diffusion coefficient (ADC) histogram parameters for the prediction of individual survival in patients undergoing surgery for recurrent glioblastoma (GBM) in a retrospective cohort study. Methods Thirty-one patients who underwent surgery for first recurrence of a known GBM between 2008 and 2012 were included. The following parameters were collected: age, sex, enhancing tumor size, mean ADC, median ADC, ADC skewness, ADC kurtosis and fifth percentile of the ADC histogram, initial progression free survival (PFS), extent of second resection and further adjuvant treatment. The association of these parameters with survival and PFS after second surgery was analyzed using log-rank test and Cox regression. Results Using log-rank test, ADC histogram skewness of the enhancing tumor was significantly associated with both survival (p = 0.001) and PFS after second surgery (p = 0.005). Further parameters associated with prolonged survival after second surgery were: gross total resection at second surgery (p = 0.026), tumor size (0.040) and third surgery (p = 0.003). In the multivariate Cox analysis, ADC histogram skewness was shown to be an independent prognostic factor for survival after second surgery. Conclusion ADC histogram skewness of the enhancing lesion, enhancing lesion size, third surgery, as well as gross total resection have been shown to be associated with survival following the second surgery. ADC histogram skewness was an independent prognostic factor for survival in the multivariate analysis. PMID:26830088

  12. Risk of sudden sensorineural hearing loss in stroke patients: A 5-year nationwide investigation of 44,460 patients.

    PubMed

    Kuo, Chin-Lung; Shiao, An-Suey; Wang, Shuu-Jiun; Chang, Wei-Pin; Lin, Yung-Yang

    2016-09-01

    Poststroke sudden sensorineural hearing loss (SSNHL) can hinder communication between patients and healthcare professionals, thereby restricting participation in rehabilitation programs and limiting improvements in physical performance. However, the relationship between stroke and SSNHL remains unclear. This study employed a nationwide population-based dataset to investigate the relationship between stroke and SSNHL.The Taiwan Longitudinal Health Insurance Database was used to compile data from 11,115 stroke patients and a comparison cohort of 33,345 matched nonstroke enrollees. Each patient was followed for 5 years to identify new-onset SSNHL. Stratified Cox proportional-hazard regression analysis was used to examine the association of stroke with subsequent SSNHL.Among the 44,460 patients, 66 patients (55,378 person-years) from the stroke cohort and 105 patients (166,586 person-years) from the comparison cohort were diagnosed with SSNHL. The incidence of SSNHL was approximately twice as high among stroke patients than among nonstroke patients (1.19 and 0.63/1000 person-years, respectively). Stroke patients had a 71% increased risk of SSNHL, compared with nonstroke patients (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.24-2.36). We also observed a remarkable increase in risk of SSNHL in stroke patients within 1-year of follow-up (adjusted HR 5.65, 95% CI 3.07-10.41) or under steroid therapy during hospitalization (adjusted HR 5.14, 95% CI 2.08-12.75).Patients with stroke had a higher risk of subsequent SSNHL compared with patients without stroke. In particular, stroke patients within 1-year follow-up and those undergoing steroid therapy during hospitalization should be treated with the utmost caution, considering that the risk of SSNHL increases by more than 5-fold. PMID:27603402

  13. Creation of a Prognostic Index for Spine Metastasis to Stratify Survival in Patients Treated With Spinal Stereotactic Radiosurgery: Secondary Analysis of Mature Prospective Trials

    SciTech Connect

    Tang, Chad; Hess, Kenneth; Bishop, Andrew J.; Pan, Hubert Y.; Christensen, Eva N.; Yang, James N.; Tannir, Nizar; Amini, Behrang; Tatsui, Claudio; Rhines, Laurence; Brown, Paul; Ghia, Amol

    2015-09-01

    Purpose: There exists uncertainty in the prognosis of patients following spinal metastasis treatment. We sought to create a scoring system that stratifies patients based on overall survival. Methods and Materials: Patients enrolled in 2 prospective trials investigating stereotactic spine radiation surgery (SSRS) for spinal metastasis with ≥3-year follow-up were analyzed. A multivariate Cox regression model was used to create a survival model. Pretreatment variables included were race, sex, age, performance status, tumor histology, extent of vertebrae involvement, previous therapy at the SSRS site, disease burden, and timing of diagnosis and metastasis. Four survival groups were generated based on the model-derived survival score. Results: Median follow-up in the 206 patients included in this analysis was 70 months (range: 37-133 months). Seven variables were selected: female sex (hazard ratio [HR] = 0.7, P=.02), Karnofsky performance score (HR = 0.8 per 10-point increase above 60, P=.007), previous surgery at the SSRS site (HR = 0.7, P=.02), previous radiation at the SSRS site (HR = 1.8, P=.001), the SSRS site as the only site of metastatic disease (HR = 0.5, P=.01), number of organ systems involved outside of bone (HR = 1.4 per involved system, P<.001), and >5 year interval from initial diagnosis to detection of spine metastasis (HR = 0.5, P<.001). The median survival among all patients was 25.5 months and was significantly different among survival groups (in group 1 [excellent prognosis], median survival was not reached; group 2 reached 32.4 months; group 3 reached 22.2 months; and group 4 [poor prognosis] reached 9.1 months; P<.001). Pretreatment symptom burden was significantly higher in the patient group with poor survival than in the group with excellent survival (all metrics, P<.05). Conclusions: We developed the prognostic index for spinal metastases (PRISM) model, a new model that identified patient subgroups with poor and excellent prognoses.

  14. Risk of Nongenitourinary Cancers in Patients With Spinal Cord Injury: A Population-based Cohort Study.

    PubMed

    Kao, Chia-Hong; Sun, Li-Min; Chen, Yueh-Sheng; Lin, Cheng-Li; Liang, Ji-An; Kao, Chia-Hung; Weng, Ming-Wei

    2016-01-01

    Little information is available regarding the risk of nongenitourinary (GU) cancers in patients with spinal cord injury (SCI). The authors conducted a nationwide population-based study to investigate whether a higher risk of non-GU cancer is seen among patients with SCI.Data retrieved from the National Health Insurance Research Database of Taiwan were used in this study. A total of 41,900 patients diagnosed with SCI between 2000 and 2011 were identified from the National Health Insurance Research Database and comprised the SCI cohort. Each of these patients was randomly frequency matched with 4 people from the general population (without SCI) according to age, sex, comorbidities, and index year. Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios and 95% confidence intervals and determine how SCI affected non-GU cancer risk.No significant difference in overall non-GU cancer risk was observed between the SCI and control groups. The patients with SCI exhibited a significantly higher risk of developing esophageal, liver, and hematologic malignancies compared with those without SCI. By contrast, the SCI cohort had a significantly lower risk of colorectal cancer compared with the non-SCI cohort (adjusted hazard ratio = 0.80, 95% confidence interval = 0.69-0.93). Additional stratified analyses by sex, age, and follow-up duration revealed various correlations between SCI and non-GU cancer risk.The patients with SCI exhibited higher risk of esophageal, liver, and hematologic malignancies but a lower risk of colorectal cancer compared with those without SCI. The diverse patterns of cancer risk among the patients with SCI may be related to the complications of chronic SCI. PMID:26765443

  15. 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

  16. The lower risk MDS patient at risk of rapid progression.

    PubMed

    Mittelman, Moshe; Oster, Howard S; Hoffman, Michael; Neumann, Drorit

    2010-12-01

    Most patients with myelodysplastic syndrome (MDS) are classified at diagnosis as having a low/INT-I or INT-II/high risk disease, based on the classical International Prognostic Scoring System (IPSS) criteria. The low/INT-I risk patients are usually managed mildly with supportive care, including red blood cell (RBC) transfusions, erythroid stimulating agents (ESAs), other cytokines (G-CSF, platelet stimulating agents), as well as thalidomide and lenalidomide. Some patients receive immunosuppressive therapy, and iron chelation is indicated in iron overloaded patients. Aggressive approach (hypomethylating agents, chemotherapy and stem cell transplantation) is usually not applied in such patients. Occasionally, we observe a "low risk" patient with rapid progression of disease and poor outcome. Can we identify demographic, clinical, laboratory, cellular-biological and/or molecular parameters that can predict "poor prognostic features" (PPF) in "low risk" MDS patients? Clinical and laboratory parameters have been reported to be associated with poor prognosis, in addition to the known "classical" IPSS criteria. These include older age, male gender, poor performance status, co-morbidities, degree of anemia, low absolute neutrophile count (ANC) and platelet counts, RBC transfusion requirements, high serum ferritin, high LDH, bone marrow (BM) fibrosis, increased number of BM CD34+ cells and multi-lineage dysplasia. Certain immunophenotypes (low CD11b, high HLA-Dr, CD34, CD13 and CD45), clonal granulocytes, multiple chromosomal abnormalities, chromosomal instability, short telomeres and high telomerase activity were also reported as PPF. Studies of apoptosis identified Bcl-2 expression and high caspase 3 as PPF, while the reports on survivin expression have been confusing. Recent exciting data suggest that methylation of p15 INK4b and of CTNNA1 (in 5q-), high level of methylation of other genes, absence of the TET2 mutation, down regulation of the lymphoid enhancer binding

  17. Hyperhomocysteinemia and cardiovascular risks in hemodialysis patients.

    PubMed

    Sagheb, Mohammad Mahdi; Ostovan, Mohammad Ali; Sohrabi, Zahra; Atabati, Elham; Raisjalai, Ghanbar Ali; Roozbeh, Jamshid

    2010-09-01

    The risk of premature and progressive occlusive vascular disease is high in chronic uremic patients, and it accounts for more than 40% of the mortality in dialysis patients. End stage renal failure (ESRF) patients exhibit elevated plasma homocystein levels, about four fold as much as those in the controls, and it is now considered as a causative factor for increased risk of cardiovascular death among these patients. The aim of this study was to evaluate the relationship of total plasma homocysteine level and echocardiographic abnormalities as a surrogate of cardiac disease outcome in hemodialysis patients. 123 adult patients on maintenance hemodialysis and having echocardiography done during January till November 2006 were enrolled in this cross-sectional study. Plasma homocysteine level was directly related to the presence of aortic regurgitation r= 0.27 P= 0.009. There were negative correlations between ejection fraction (EF), left ventricular systolic dimension (LV.S) (r= - 0.71, P= 0.0001), left ventricular diastolic dimension (LV.D) (r= -0.23 p= 0.01) and age (r= - 0.021 P= 0.02). In conclusion we did not find the paradoxical reverse epidemiology in our patients and plasma total homocysteine level was in direct correlation with cardiac risk factors such as left ventricular mass index and aortic regurgitation. PMID:20814121

  18. Evaluation of perioperative risk in elderly patients.

    PubMed

    Aubrun, F; Gazon, M; Schoeffler, M; Benyoub, K

    2012-05-01

    From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain. PMID:22269928

  19. Radiation risks for patients having X rays

    SciTech Connect

    Hale, J.; Thomas, J.W.

    1985-12-01

    In addition to radiation from naturally occurring radioactive materials and cosmic rays, individuals in developed countries receive radiation doses to bone marrow and gonads from the medical diagnostic use of X rays. A brief discussion of radiation epidemiology shows that deleterious effects are low even when doses are high. The concept of acceptable risk is introduced to help evaluate the small, but still existent, risks of radiation dose. Examples of bone marrow and gonadal doses for representative X-ray examinations are presented along with the current best estimates, per unit of X-ray dose, of the induction of leukemia or of genetic harm. The risk to the patient from an examination can then be compared with the normal risk of mortality from leukemia or of the occurrence of genetic defects. The risk increase is found to be very low. The risks to unborn children from radiographic examinations are also discussed. The benefit to the patient from information obtained from the examination must be balanced against the small risks.

  20. Individual and Combined Risk Factors for Incident Atrial Fibrillation and Incident Stroke: An Analysis of 3 Million At-Risk US Patients

    PubMed Central

    Chyou, Janice Y; Hunter, Tina D; Mollenkopf, Sarah A; Turakhia, Mintu P; Reynolds, Matthew R

    2015-01-01

    Background The incremental effects of risk factor combinations for atrial fibrillation (AF) and stroke are incompletely understood. We sought to quantify the risks of incident AF and stroke for combinations of established risk factors in a large US sample. Methods and Results Patients with no evidence of AF or stroke in 2007 were stratified by combinations of the following risk factors: heart failure, hypertension, diabetes, age 65 to 74, age ≥75, coronary artery disease, and chronic kidney disease. Patients with ≥2 of the first 5 or ≥3 of the first 7, classified as “high-risk,” and an age-matched sample of patients with fewer risk factors, classified as “low-risk,” were followed over 2008–2010 for incident AF and stroke. Annualized incidence rates and risks were quantified for each combination of factors by using Cox regression. Annualized incidence rates for AF, stroke, and both were 3.59%, 3.27%, and 0.62% in 1 851 653 high-risk patients and 1.32%, 1.48%, and 0.18% in 1 156 221 low-risk patients, respectively. Among patients with 1 risk factor, those with age ≥75 had the highest hazards of incident AF and stroke (HR 9.2, 6.9). Among patients with 2 risk factors, those with age ≥75 and heart failure had the highest annualized incidence rates of AF and stroke (10.2%, 5.9%). The combination of age ≥75 and hypertension was prevalent and had the highest incidences of AF and stroke. Conclusions Adults with combinations of known risk factors are at increased risk of incident AF and stroke, but combinations of risk factors are not always additive. PMID:26206736

  1. Risk of liver injury after α-glucosidase inhibitor therapy in advanced chronic kidney disease patients

    PubMed Central

    Kao, Chih-Chin; Wu, Pei-Chen; Wu, Che-Hsiung; Chen, Li-kwang; Chen, Hsi-Hsien; Wu, Mai-Szu; Wu, Vin-Cent

    2016-01-01

    Although α-glucosidase inhibitors (AGIs) are commonly used for controlling postprandial blood glucose, AGIs-induced liver injuries have been reported. However, the relationship between AGIs and liver injuries in advanced chronic kidney disease (CKD) patients remains unexplored. In this nationwide case-control study, we recruited 1765 advanced diabetic CKD patients, who received AGIs therapy from January 1, 2000 to December 31, 2010 as the study sample and 5295 matched controls. Recent and former AGIs users were defined as patients who received the AGIs prescription for 30–60 d and 30–210 d before the event of liver injury. The risk of AGIs-induced liver injury was examined using time-dependent Cox proportional hazards model. Liver injury occurred in 3.9% of patients in the study group and 3.3% of patients in the control group. AGIs use did not increase the risk of liver injury in advanced CKD patients (P = 0.19). The stratified analysis indicated no increased risk of liver injury in all AGIs-using subgroups (all P > 0.05). The available evidence supports extending the use of AGIs without increasing the risk of liver injury in patients with advanced CKD. Additional randomized controlled trials are warranted to confirm our results. PMID:26751038

  2. Cancer Risk in Patients With Empyema

    PubMed Central

    Teng, Chung-Jen; Hu, Yu-Wen; Yeh, Chiu-Mei; Chen, Tzeng-Ji; Liu, Chia-Jen

    2016-01-01

    Abstract This study aimed to evaluate cancer risk and possible risk factors in patients diagnosed with empyema. A total of 31,636 patients with newly diagnosed empyema between January 1, 1999 and December 31, 2010 were included in this study. Standardized incidence ratios (SIRs) were calculated to compare the cancer incidence in these empyema patients to that in the general population. Adjusted hazard ratios were also calculated to investigate whether characteristics increased cancer risk. During the 12-year study period, 2,654 cancers occurred in 31,636 patients with empyema, yielding an SIR of 2.67 (95% confidence interval [CI] 2.57–2.78). We excluded cancer that occurred within 1 year to avoid surveillance bias. The cancer risk remained significantly increased (SIR 1.50, 95% CI 1.41–1.58). Specifically, patients with empyema had higher SIR of cancers of the head and neck (1.50, 95% CI 1.41–1.58), esophagus (2.56, 95% CI 1.92–3.33), stomach (1.49, 95% CI 1.16–1.89), liver and biliary tract (2.18, 95% CI 1.93–2.45), and lung and mediastinum (1.62, 95% CI 1.39–1.86). Age ≥ 60, male sex, diabetes mellitus, and liver cirrhosis were independent risk factors for cancer development. Our study demonstrates an increased incidence of cancer development in patients with empyema, and patients’ age ≥ 60, men, and those with diabetes mellitus and liver cirrhosis showed a higher incidence of developing cancer compared to the general population. The association between such kind of infection and secondary malignancy may be elucidated by further study. PMID:26945399

  3. Cut the risks for cardiac cath patients.

    PubMed

    Beattie, S

    1999-01-01

    As the list of interventions performed with the aid of femoral catheterization grows, so does the number of patients at risk for developing post-procedure problems. Here's a primer on how to recognize and prevent complications like pseudoaneurysm, arteriovenous fistulas, and retroperitoneal hematoma. PMID:9987436

  4. Risk prediction for acute hypotensive patients by using gap constrained sequential contrast patterns.

    PubMed

    Ghosh, Shameek; Feng, Mengling; Nguyen, Hung; Li, Jinyan

    2014-01-01

    The development of acute hypotension in a critical care patient causes decreased tissue perfusion, which can lead to multiple organ failures. Existing systems that employ population level prognostic scores to stratify the risks of critical care patients based on hypotensive episodes are suboptimal in predicting impending critical conditions, or in directing an effective goal-oriented therapy. In this work, we propose a sequential pattern mining approach which target novel and informative sequential contrast patterns for the detection of hypotension episodes. Our results demonstrate the competitiveness of the approach, in terms of both prediction performance as well as knowledge interpretability. Hence, sequential patterns-based computational biomarkers can help comprehend unusual episodes in critical care patients ahead of time for early warning systems. Sequential patterns can thus aid in the development of a powerful critical care knowledge discovery framework for facilitating novel patient treatment plans. PMID:25954447

  5. The Risk of Chronic Pancreatitis in Patients with Psoriasis: A Population-Based Cohort Study

    PubMed Central

    Chiang, Yi-Ting; Huang, Weng-Foung; Tsai, Tsen-Fang

    2016-01-01

    Background Psoriasis is a chronic systemic inflammatory disorder, and studies have revealed its association with a variety of comorbidities. However, the risk of chronic pancreatitis (CP) in psoriasis has not been studied. This study aimed to investigate the risk of CP among patients with psoriasis. Methods Using the Taiwan National Health Insurance Research Database, this population-based cohort study enrolled 48430 patients with psoriasis and 193720 subjects without psoriasis. Stratified Cox proportional hazards models were used to compare the risks of CP between the patients with and without psoriasis. Results The incidence of CP was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls during a mean 6.6-year follow-up period. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude hazard ratio (HR) = 1.81; 95% confidence interval (CI) = 1.53–2.15), and the risk remained significantly higher after adjustments for gender, age group, medications, and comorbidities (adjusted HR (aHR) = 1.76; 95% CI = 1.47–2.10). All psoriasis patient subgroups other than those with arthritis, including those with mild and severe psoriasis and those without arthritis, had significantly increased aHRs for CP, and the risk increased with increasing psoriasis severity. Psoriasis patients taking nonsteroidal anti-inflammatory drugs (aHR = 0.33; 95% CI = 0.22–0.49) and methotrexate (aHR = 0.28; 95% CI = 0.12–0.64) had a lower risk of developing CP after adjustments. Conclusions Psoriasis is associated with a significantly increased risk of CP. The results of our study call for more research to provide additional insight into the relationship between psoriasis and CP. PMID:27467265

  6. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders

    PubMed Central

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-01-01

    Abstract Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant. We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17–1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34–7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  7. A disease risk index for patients undergoing allogeneic stem cell transplantation

    PubMed Central

    Gibson, Christopher J.; Cutler, Corey; Ho, Vincent T.; Koreth, John; Alyea, Edwin P.; Ritz, Jerome; Sorror, Mohamed L.; Lee, Stephanie J.; Deeg, H. Joachim; Storer, Barry E.; Appelbaum, Frederick R.; Antin, Joseph H.; Soiffer, Robert J.; Kim, Haesook T.

    2012-01-01

    The outcome of allogeneic HSCT varies considerably by the disease and remission status at the time of transplantation. Any retrospective or prospective HSCT study that enrolls patients across disease types must account for this heterogeneity; yet, current methods are neither standardized nor validated. We conducted a retrospective study of 1539 patients who underwent transplantation at Dana-Farber Cancer Institute/Brigham and Women's Hospital from 2000 to 2009. Using multivariable models for overall survival, we created a disease risk index. This tool uses readily available information about disease and disease status to categorize patients into 4 risk groups with significantly different overall survival and progression-free survival on the basis of primarily differences in the relapse risk. This scheme applies regardless of conditioning intensity, is independent of comorbidity index, and was validated in an independent cohort of 672 patients from the Fred Hutchinson Cancer Research Center. This simple and validated scheme could be used to risk-stratify patients in both retrospective and prospective HSCT studies, to calibrate HSCT outcomes across studies and centers, and to promote the design of HSCT clinical trials that enroll patients across diseases and disease states, increasing our ability to study nondisease-specific outcomes in HSCT. PMID:22709687

  8. Stratified Medicine and Reimbursement Issues

    PubMed Central

    Fugel, Hans-Joerg; Nuijten, Mark; Postma, Maarten

    2012-01-01

    Stratified Medicine (SM) has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R) authorities. However, the introduction of SM challenges current reimbursement schemes in many EU countries and the US as different P&R policies have been adopted for drugs and diagnostics. Also, there is a lack of a consistent process for value assessment of more complex diagnostics in these markets. New, innovative approaches and more flexible P&R systems are needed to reflect the added value of diagnostic tests and to stimulate investments in new technologies. Yet, the framework for access of diagnostic-based therapies still requires further development while setting the right incentives and appropriate align stakeholders interests when realizing long-term patient benefits. This article addresses the reimbursement challenges of SM approaches in several EU countries and the US outlining some options to overcome existing reimbursement barriers for stratified medicine. PMID:23087645

  9. Sensemaking of patient safety risks and hazards.

    PubMed

    Battles, James B; Dixon, Nancy M; Borotkanics, Robert J; Rabin-Fastmen, Barbara; Kaplan, Harold S

    2006-08-01

    In order for organizations to become learning organizations, they must make sense of their environment and learn from safety events. Sensemaking, as described by Weick (1995), literally means making sense of events. The ultimate goal of sensemaking is to build the understanding that can inform and direct actions to eliminate risk and hazards that are a threat to patient safety. True sensemaking in patient safety must use both retrospective and prospective approach to learning. Sensemaking is as an essential part of the design process leading to risk informed design. Sensemaking serves as a conceptual framework to bring together well established approaches to assessment of risk and hazards: (1) at the single event level using root cause analysis (RCA), (2) at the processes level using failure modes effects analysis (FMEA) and (3) at the system level using probabilistic risk assessment (PRA). The results of these separate or combined approaches are most effective when end users in conversation-based meetings add their expertise and knowledge to the data produced by the RCA, FMEA, and/or PRA in order to make sense of the risks and hazards. Without ownership engendered by such conversations, the possibility of effective action to eliminate or minimize them is greatly reduced. PMID:16898979

  10. Stably stratified building wakes

    SciTech Connect

    Kothari, K.M.; Peterka, J.A.; Meroney, R.N.

    1980-01-01

    The velocity and temperature wake behind an isolated building placed in a stably stratified turbulent boundary layer has been investigated utilizing wind tunnel tests and mathematical analysis. The mean velocity and mean temperature decrease but turbulence intensity and temperature fluctuation intensity increase as a result of the momentum wake. However, the vortex wake increases mean velocity and mean temperature, and decreases turbulence intensity and temperature fluctuation intensity along the centerline of the wake.

  11. [Cardiovascular risk in patients with psoriatic arthritis].

    PubMed

    Korotaeva, T V; Novikoya, D S; Loginova, E Yu

    2016-01-01

    Psoriatic arthritis (PsA) is a chronic.immune-mediated disease that is observed in 8-30% of psoriatic patients. It has been recently established that PsA and psoriasis are closely associated with the high prevalence of metabolic syndrome, hypertension; abdominal obesity, and a risk for cardiovascular diseases (CVD), including fatal myocardial infarction (Ml) and acute cerebrovascular accidents, which shortens lifespan in the patients compared to the general population. The authors state their belief that the synergic effect of traditional risk factors (RFs) for CYD and systemic inflammation underlie the development of atherosclerosis in PsA. It is pointed out that the risk of CYD may be reduced not only provided that the traditional RFs for CVD are monitored, but also systemic inflammation is validly suppressed. The cardioprotective abilities of methotrexate and tumor necrosis factor-a (TNF-a) inhibitors are considered; the data of investigations showing that the treatment of PsA patients with TNF-a inhibitors results in a reduction in carotid artery intima-media thickness are given. lt is noted that there is a need for the early monitoring of traditional RFs for CVD in patients with PsA and for the elaboration of interdisciplinary national guidelines. PMID:27458624

  12. Risk Factors and Outcomes for Carbapenem-Resistant Klebsiella pneumoniae Isolation, Stratified by Its Multilocus Sequence Typing: ST258 Versus Non-ST258.

    PubMed

    Dhar, Sorabh; Martin, Emily T; Lephart, Paul R; McRoberts, John P; Chopra, Teena; Burger, Timothy T; Tal-Jasper, Ruthy; Hayakawa, Kayoko; Ofer-Friedman, Hadas; Lazarovitch, Tsilia; Zaidenstein, Ronit; Perez, Federico; Bonomo, Robert A; Kaye, Keith S; Marchaim, Dror

    2016-01-01

    A "high risk" clone of carbapenem-resistant Klebsiella pneumoniae (CRKP) identified by multilocus sequence typing (MLST) as sequence type (ST) 258 has disseminated worldwide. As the molecular epidemiology of the CRE pandemic continues to evolve, the clinical impact of non-ST258 strains is less well defined. We conducted an epidemiological investigation of CRKP based on strains MLST. Among 68 CRKP patients, 61 were ST258 and 7 belonged to non-ST258. Klebsiella pneumoniae ST258 strains were significantly associated with bla KPC production and with resistance to an increased number of antimicrobials. Clinical outcomes were not different. Based on this analysis, one cannot rely solely on the presence of bla KPC in order to diagnose CRKP. PMID:26885543

  13. Assessing the risk for suicide in patients with cancer.

    PubMed

    Aiello-Laws, Lisa B

    2010-12-01

    The Joint Commission publishes its annual National Patient Safety Goals to guide accredited organizations in addressing high-risk, low-volume concerns related to patient safety. The 2010 list includes a goal to identify patients at risk for suicide, but do oncology nurses need to be concerned about the risk of suicide in patients with cancer? PMID:21112846

  14. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia. PMID:27004381

  15. 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

  16. Stress testing for risk stratification of patients with low to moderate probability of acute cardiac ischemia.

    PubMed

    Chandra, A; Rudraiah, L; Zalenski, R J

    2001-02-01

    In summary, this article focused on the use of stress testing to risk-stratify patients at the conclusion of their emergency evaluation for ACI. As discussed, those patients in the probably not ACI category require additional risk stratification prior to discharge. It should be kept in mind that patients in this category are heterogeneous, containing subgroups at both higher and lower risk of ACI and cardiac events. The patients with lower pretest probability for ACI may only need exercise testing in the ED. Patients with higher pretest probability should undergo myocardial perfusion or echocardiographic stress testing to maximize diagnostic and prognostic information. Prognostic information is the key to provocative testing in the ED. Prognostic information is the component that will help emergency physicians identify the patients who may be discharged home safely without having to worry about a 6% annual cardiac death rate and a 10% overall death rate over the next 30 months. Stress testing provides this key prognostic data, and it can be obtained in short-stay chest pain observation units in a safe, timely, and cost-effective fashion. PMID:11214405

  17. Risk of Cerebrovascular Events in Pneumoconiosis Patients

    PubMed Central

    Chuang, Chieh-Sen; Ho, Shang-Chang; Lin, Cheng-Li; Lin, Ming-Chia; Kao, Chia-Hung

    2016-01-01

    Abstract Pneumoconiosis is a parenchymal lung disease that develops through the inhalation of inorganic dust at work. Cerebrovascular and cardiovascular events are leading causes of mortality and adult disability worldwide. This retrospective cohort study investigated the association between pneumoconiosis, and cerebrovascular and cardiovascular events by using a nationwide population-based database in Taiwan. The data analyzed in this study was retrieved from the Taiwan National Health Insurance Research Database. We selected 6940 patients with pneumoconiosis from the database as our study cohort. Another 27,760 patients without pneumoconiosis were selected and matched with those with pneumoconiosis according to age and sex as the comparison cohort. We used univariate and multivariate Cox proportional-hazard regression analyses to determine the association between pneumoconiosis and the risk of cerebrovascular and cardiovascular events after adjusting for medical comorbidities. After adjustment for age, sex, and comorbidities, the patients with pneumoconiosis exhibited a significantly higher incidence of ischemic stroke (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05–1.24) than did those without pneumoconiosis. The incidence of hemorrhagic stroke was higher, but not significant, in the pneumoconiosis patients (HR 1.20, 95% CI 0.99–1.46). No statistically significant differences were observed between the pneumoconiosis and nonpneumoconiosis groups in acute coronary syndrome (HR 1.10, 95% CI 0.95–1.26). The findings of this study reveal an association between pneumoconiosis and a higher risk of cerebrovascular events after adjustment for comorbidities. Healthcare providers should control the related risk factors for primary prevention of stroke in pneumoconiosis patients. PMID:26945404

  18. Post-operative bleeding risk stratification in cardiac pulmonary bypass patients using artificial neural network.

    PubMed

    Huang, Richard S P; Nedelcu, Elena; Bai, Yu; Wahed, Amer; Klein, Kimberly; Tint, Hlaing; Gregoric, Igor; Patel, Manish; Kar, Biswajit; Loyalka, Pranav; Nathan, Sriram; Radovancevic, Rajko; Nguyen, Andy N D

    2015-01-01

    The prediction of bleeding risk in cardiopulmonary bypass (CPB) patients plays a vital role in their postoperative management. Therefore, an artificial neural network (ANN) to analyze intra-operative laboratory data to predict postoperative bleeding was set up. The JustNN software (Neural Planner Software, Cheshire, England) was used. This ANN was trained using 15 intra-operative laboratory parameters paired with one output category - risk of bleeding, defined as units of blood components transfused in 48 hours. The ANN was trained with the first 39 CPB cases. The set of input parameters for this ANN was also determined, and the ANN was validated with the next 13 cases. The set of input parameters include five components: pro-thrombin time, platelet count, thromboelastograph-reaction time, D-Dimer, and thromboelastograph-coagulation index. The validation results show 9 cases (69.2%) with exact match, 3 cases (23.1%) with one-grading difference, and 1 case (7.7%) with two-grading difference between actual blood usage versus predicted blood usage. To the best of our knowledge, ours is the first ANN developed for post-operative bleeding risk stratification of CPB patients. With promising results, we have started using this ANN to risk-stratify our CPB patients, and it has assisted us in predicting post-operative bleeding risk. PMID:25887872

  19. Risk of Tuberculosis Among Patients on Dialysis

    PubMed Central

    Shu, Chin-Chung; Hsu, Chia-Lin; Wei, Yu-Feng; Lee, Chih-Yuan; Liou, Hung-Hsiang; Wu, Vin-Cent; Yang, Feng-Jung; Lin, Hsien-Ho; Wang, Jann-Yuan; Chen, Jin-Shing; Yu, Chong-Jen; Lee, Li-Na

    2016-01-01

    Abstract Patients on long-term dialysis are at high risk for tuberculosis (TB). Although latent tuberculosis infection (LTBI) is good target for TB eradication, interferon-gamma release assay-defined LTBI has a high proportion of negative conversion and lacks active TB correlation among patients on dialysis. Patients on long-term dialysis were screened in multiple centers in Taiwan. QuantiFERON-TB Gold In-tube (QFT-GIT) was used to define LTBI and was performed thrice at 6-month intervals. The primary outcome was active TB diagnosed after LTBI screening. The incidence and predictive value of QFT-GIT were analyzed. The 940 dialysis patients enrolled had an average age of 59.3 years. The initial QFT-GIT results were positive in 193, including 49.6% with persistent positive results on second check. In an average follow-up period of 3 years, 7 patients had TB. Three (319.1 per 100,000 person-yrs) and 4 (141.8 per 100,000 person-yrs) of them were prevalent and incident TB cases, respectively. Persistent positive QFT-GIT for 2 and 3 times correlated with increased hazard ratio for TB (14.44 and 20.29, respectively) compared with a single positive result (hazard ratio 10.38). Among those with 3 positive QFT-GIT results, TB development rate was 4.5% and incidence rate was 1352.3 per 100,000 person-years. In contrast, none of the incident TB occurred in those with initial positive and then negative conversion of QFT-GIT. In an area of intermediate TB incidence, dialysis patients have high TB risk. LTBI status is a good predictor of TB development, especially for those with more than 1 positive result. After excluding prevalent TB cases, serial follow-up of LTBI may narrow the target population to reduce treatment costs. PMID:27258523

  20. Abnormal myocardial perfusion and risk of heart failure in patients with type 2 diabetes mellitus

    PubMed Central

    Utrera-Lagunas, Marcelo; Orea-Tejeda, Arturo; Castillo-Martínez, Lilia; Balderas-Muñoz, Karla; Keirns-Davis, Candace; Espinoza-Rosas, Sarahi; Sánchez-Ortíz, Néstor Alonso; Olvera-Mayorga, Gabriela

    2013-01-01

    BACKGROUND: Diabetes is a major risk factor for heart failure (HF), although the pathophysiological processes have not been clarified. OBJECTIVE: To determine the prevalence of HF and of abnormal myocardial perfusion in diabetic patients evaluated using technetium (99m) sestamibi single-photon emission computed tomography. METHODS: An observational cross-sectional study was conducted that included patients with type 2 diabetes mellitus who underwent echocardiography to diagnose HF and a pharmacological stress test with intravenous dipyridamole to examine cardiac scintigraphic perfusion abnormalities. Clinical and biochemical data were also collected. RESULTS: Of the 160 diabetic patients included, 92 (57.6%) were in HF and 68 (42.5%) were not. When patients were stratified according to the presence of abnormal myocardial perfusion, those with abnormal perfusion had a higher prevalence of HF (93%) than those with normal perfusion (44.4%) (P<0.0001). Patients with HF weighed more (P=0.03), used insulin less frequently (P=0.01), had lower total cholesterol (P=0.05) and high-density lipoprotein cholesterol concentrations (P=0.002), and a greater number of their myocardial segments showed abnormal perfusion (P≤0.001). More HF patients had a history of myocardial infarction (P<0.001) compared with those without HF. In a logistic regression analysis, the number of segments exhibiting abnormal myocardial perfusion was an independent risk factor for HF. CONCLUSIONS: The prevalence of HF in diabetic patients was high and HF predominantly occured in association with myocardial ischemia. PMID:24294048

  1. Patient mobility for cardiac problems: a risk-adjusted analysis in Italy

    PubMed Central

    2013-01-01

    Background The Italian National Health System was revised in the last 20 years, introducing new elements such as efficacy, efficiency and competitiveness. Devolution to regional authorities has created a quasi-market system where patients can choose the hospital in which to be treated. Patient mobility therefore becomes an indicator of perceived hospital quality and of financial flows between the regions of Italy. Previous studies analyzed patient mobility in general or by specific disease/diagnosis-related groups but there is a lack of research on the influence of severity of patient condition. The aim of the study was to describe patient mobility, crude and stratified by disease severity, in cardiac surgery units of three health areas (HAs) in Tuscany (Italy). Methods In this retrospective observational study, data was gathered from hospital discharge records obtained from the Tuscan Regional Health Agency, Italy. The three HAs (HA1, HA2, HA3) recorded 25,017 planned hospitalizations in cardiac surgery units in the period 2001–2007. Patients were stratified in four All Patient Refined Diagnosis Related Group (APR-DRG) severity levels. Gandy’s nomogram was used to describe how HAs met health care demand and their capacity to attract patients. Cuzick’s test was used to identify significant differences in time trends. Results Raw data showed that the HAs met their own local health care demand. Stratifying by APR-DRG severity, it emerged that capacity to meet local demand remained unchanged for zero-to-minor severity levels, but one HA was less able to meet demand for moderate severity levels or to attract patients from other HAs and Regions of Italy. In fact, HA3 showed a decrease in admissions of local residents. Conclusions The study highlights important differences between the three HAs that were only revealed by severity stratification: unlike HA3, HA1 and HA2 seemed able to deal with local demand, even after severity stratification. Planners and

  2. Concurrent Androgen Deprivation Therapy During Salvage Prostate Radiotherapy Improves Treatment Outcomes in High-Risk Patients

    SciTech Connect

    Soto, Daniel E.; Passarelli, Michael N.; Daignault, Stephanie; Sandler, Howard M.

    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.

  3. Invasive Stratified Mucin-producing Carcinoma and Stratified Mucin-producing Intraepithelial Lesion (SMILE): 15 Cases Presenting a Spectrum of Cervical Neoplasia With Description of a Distinctive Variant of Invasive Adenocarcinoma.

    PubMed

    Lastra, Ricardo R; Park, Kay J; Schoolmeester, J Kenneth

    2016-02-01

    Stratified mucin-producing intraepithelial lesion (SMILE) is a cervical intraepithelial lesion, distinct from conventional squamous or glandular counterparts, believed to arise from embryonic cells at the transformation zone by transdifferentiation during high-risk HPV-associated carcinogenesis. It is characterized by stratified, immature epithelial cells displaying varying quantities of intracytoplasmic mucin throughout the majority of the lesional epithelium. We identified a distinct form of invasive cervical carcinoma with morphologic features identical to those in SMILE, which we have termed "invasive stratified mucin-producing carcinoma." Fifteen cases from 15 patients (mean 36 y; range, 22 to 64 y) were retrieved from the pathology archives of multiple institutions with a diagnosis of either SMILE or invasive cervical carcinoma with a description or comment about the invasive tumor's resemblance to SMILE. Seven cases had solely intraepithelial disease with a component of SMILE (mean 29 y; range, 22 to 40 y). The 8 other cases had invasive stratified mucin-producing carcinoma (mean 44; range, 34 to 64 y) in which SMILE was identified in 7. All cases of invasive stratified mucin-producing carcinoma demonstrated stratified, immature nuclei with intracytoplasmic mucin, which morphologically varied between cases from "mucin-rich" to "mucin-poor" in a similar manner to SMILE. All cases had mitotic figures and apoptotic debris, and an intralesional neutrophilic infiltrate was seen in the majority of cases. In cases of invasive carcinoma, the depth of invasion ranged from <1 to 19 mm. Follow-up information was available in 8 cases and ranged from 1 to 36 months (mean 11 mo). Three cases of invasive stratified mucin-producing carcinoma had biopsy or resection-proven metastatic carcinoma on follow-up. These 15 cases of cervical stratified mucin-producing lesions show a combination of intraepithelial and invasive growth patterns. Given that SMILE is well rooted as a

  4. Risk of Venous Thromboembolism in Patients with Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Horsted, Freesia; West, Joe; Grainge, Matthew J.

    2012-01-01

    Background People with cancer are known to be at increased risk of venous thromboembolism (VTE), and this risk is believed to vary according to cancer type, stage of disease, and treatment modality. Our purpose was to summarise the existing literature to determine precisely and accurately the absolute risk of VTE in cancer patients, stratified by malignancy site and background risk of VTE. Methods and Findings We searched the Medline and Embase databases from 1 January 1966 to 14 July 2011 to identify cohort studies comprising people diagnosed with one of eight specified cancer types or where participants were judged to be representative of all people with cancer. For each included study, the number of patients who developed clinically apparent VTE, and the total person-years of follow-up were extracted. Incidence rates of VTE were pooled across studies using the generic inverse variance method. In total, data from 38 individual studies were included. Among average-risk patients, the overall risk of VTE was estimated to be 13 per 1,000 person-years (95% CI, 7 to 23), with the highest risk among patients with cancers of the pancreas, brain, and lung. Among patients judged to be at high risk (due to metastatic disease or receipt of high-risk treatments), the risk of VTE was 68 per 1,000 person-years (95% CI, 48 to 96), with the highest risk among patients with brain cancer (200 per 1,000 person-years; 95% CI, 162 to 247). Our results need to be considered in light of high levels of heterogeneity, which exist due to differences in study population, outcome definition, and average duration of follow-up between studies. Conclusions VTE occurs in greater than 1% of cancer patients each year, but this varies widely by cancer type and time since diagnosis. The absolute VTE risks obtained from this review can aid in clinical decision-making about which people with cancer should receive anticoagulant prophylaxis and at what times. Please see later in the article for the

  5. Incisional Reinforcement in High-Risk Patients

    PubMed Central

    Feldmann, Timothy F.; Young, Monica T.; Pigazzi, Alessio

    2014-01-01

    Hernia formation after surgical procedures continues to be an important cause of surgical morbidity. Incisional reinforcement at the time of the initial operation has been used in some patient populations to reduce the risk of subsequent hernia formation. In this article, reinforcement techniques in different surgical wounds are examined to identify situations in which hernia formation may be prevented. Mesh use for midline closure, pelvic floor reconstruction, and stoma site reinforcement is discussed. Additionally, the use of retention sutures, closure of the open abdomen, and reinforcement after component separation are examined using current literature. Although existing studies do not support the routine use of mesh reinforcement for all surgical incisions, certain patient populations appear to benefit from reinforcement with lower rates of subsequent hernia formation. The identification and characterization of these groups will guide the future use of mesh reinforcement in surgical incisions. PMID:25435823

  6. Stratified vapor generator

    DOEpatents

    Bharathan, Desikan; Hassani, Vahab

    2008-05-20

    A stratified vapor generator (110) comprises a first heating section (H.sub.1) and a second heating section (H.sub.2). The first and second heating sections (H.sub.1, H.sub.2) are arranged so that the inlet of the second heating section (H.sub.2) is operatively associated with the outlet of the first heating section (H.sub.1). A moisture separator (126) having a vapor outlet (164) and a liquid outlet (144) is operatively associated with the outlet (124) of the second heating section (H.sub.2). A cooling section (C.sub.1) is operatively associated with the liquid outlet (144) of the moisture separator (126) and includes an outlet that is operatively associated with the inlet of the second heating section (H.sub.2).

  7. Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.

    PubMed

    Nam, Denis; Nunley, Ryan M; Johnson, Staci R; Keeney, James A; Clohisy, John C; Barrack, Robert L

    2015-12-01

    This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE. PMID:26182980

  8. Falls risk assessment in older patients in hospital.

    PubMed

    Matarese, Maria; Ivziku, Dhurata

    2016-07-27

    Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. All hospitals in NHS organisations develop risk prevention policies that include falls risk assessment. Falls risk assessment involves the use of risk screening tools, aimed at identifying patients at increased risk of falls, and risk assessment tools, which identify a patient's risk factors for falls. Various risk screening tools have been used in clinical practice, but no single tool is able to identify all patients at risk of falls or to accurately exclude all those who are not at risk of falls. Guidelines recommend that patients aged 65 years and over who are admitted to hospital should be considered at high risk of falls and that a multifactorial falls risk assessment should be performed. Therefore, falls risk assessment tools should be used to identify the risk factors for each inpatient aged 65 years or over, in order to determine the most appropriate care plan for falls prevention and to maximise patient mobility and independence. PMID:27461329

  9. The Risk of Cancer in Patients With Obsessive-Compulsive Disorder

    PubMed Central

    Shen, Cheng-Che; Hu, Li-Yu; Hu, Yu-Wen; Chang, Wen-Han; Tang, Pei-Ling; Chen, Pan-Ming; Chen, Tzeng-Ji; Su, Tung-Ping

    2016-01-01

    Abstract Previous studies suggest a link between anxiety disorders and cancer. The aim of the study was to evaluate the risk of cancer among patients with obsessive-compulsive disorder (OCD) using a nationwide population-based dataset. We recruited newly diagnosed OCD patients without antecedent cancer from the Taiwan National Health Insurance Research Database between 2002 and 2011. The standardized incidence ratios (SIRs) were estimated for 22 specific cancer types among OCD patients and we determined the SIRs for subgroups according to age and sex group. In addition, because of a potential detection bias, a subgroup analysis stratified with the duration of the OCD diagnosis was carried out. Among the 52,656 OCD patients, who were followed up for 259,945 person-years (median follow-up = 4.9 years), there were 718 cases of cancer. Patients with OCD did not exhibit an increased overall cancer risk relative to the general population (SIR 1.05, 95% confidence interval [CI] 0.98–1.13). An increased SIR was observed among OCD patients only within the first year of OCD diagnosis (SIR 1.21, 95% CI 1.01–1.43). This study indicated that the overall cancer risk was not elevated among OCD patients. An increased SIR observed among OCD patients within the first year of OCD diagnosis may be caused by a surveillance bias, and because paraneoplastic manifestations presented with obsessive-compulsive behaviors. Prospective study is necessary to confirm these findings. PMID:26945419

  10. Dipeptidyl Peptidase-4 Inhibitor Use Is Not Associated With Acute Pancreatitis in High-Risk Type 2 Diabetic Patients

    PubMed Central

    Chang, Chia-Hsuin; Lin, Jou-Wei; Chen, Shu-Ting; Lai, Mei-Shu; Chuang, Lee-Ming; Chang, Yi-Cheng

    2016-01-01

    Abstract To analyze the association between use of DPP-4 inhibitors and acute pancreatitis in high-risk type 2 diabetic patients. A retrospective nationwide cohort study was conducted using the Taiwan National Health Insurance claim database. The risk associated with sitagliptin was compared to that with acarbose, a second-line antidiabetic drug prescribed for patients with similar diabetes severity and with a known neutral effect on pancreatitis. Between January 1, 2009 and December 31, 2010, a total of 8526 sitagliptin initiators and 8055 acarbose initiators who had hypertriglyceridemia or prior hospitalization history for acute pancreatitis were analyzed for the risk of hospitalization due to acute pancreatitis stratified for baseline propensity score. In the crude analysis, sitagliptin was associated with a decreased risk of acute pancreatitis (hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.62–0.88) compared to acarbose in diabetic patients with prior history of hospitalization for pancreatitis or hypertriglyceridemia. The association was abolished after stratification for propensity score quintiles (adjusted HR 0.95; 95% CI: 0.79–1.16). Similar results were found separately in both patients’ histories of prior hospitalization of acute pancreatitis (adjusted HR 0.97; 95% CI: 0.76–1.24) and those with hypertriglyceridemia (adjusted HR 0.86; 95% CI: 0.65–1.13). No significant association was found for different durations or accumulative doses of sitagliptin. In the stratified analysis, no significant effect modification was found in relation to patients’ characteristics. Use of sitagliptin was not associated with an increased risk of acute pancreatitis in high-risk diabetic patients with hypertriglyceridemia or with history of acute pancreatitis. PMID:26886601

  11. A hydrodynamics-based approach to evaluating the risk of waterborne pathogens entering drinking water intakes in a large, stratified lake.

    PubMed

    Hoyer, Andrea B; Schladow, S Geoffrey; Rueda, Francisco J

    2015-10-15

    Pathogen contamination of drinking water lakes and reservoirs is a severe threat to human health worldwide. A major source of pathogens in surface sources of drinking waters is from body-contact recreation in the water body. However, dispersion pathways of human waterborne pathogens from recreational beaches, where body-contact recreation is known to occur to drinking water intakes, and the associated risk of pathogens entering the drinking water supply remain largely undocumented. A high spatial resolution, three-dimensional hydrodynamic and particle tracking modeling approach has been developed to analyze the risk and mechanisms presented by pathogen dispersion. The pathogen model represents the processes of particle release, transport and survival. Here survival is a function of both water temperature and cumulative exposure to ultraviolet (UV) radiation. Pathogen transport is simulated using a novel and computationally efficient technique of tracking particle trajectories backwards, from a drinking water intake toward their source areas. The model has been applied to a large, alpine lake - Lake Tahoe, CA-NV (USA). The dispersion model results reveal that for this particular lake (1) the risk of human waterborne pathogens to enter drinking water intakes is low, but significant; (2) this risk is strongly related to the depth of the thermocline in relation to the depth of the intake; (3) the risk increases with the seasonal deepening of the surface mixed layer; and (4) the risk increases at night when the surface mixed layer deepens through convective mixing and inactivation by UV radiation is eliminated. While these risk factors will quantitatively vary in different lakes, these same mechanisms will govern the process of transport of pathogens. PMID:26162312

  12. Risk of type 1 diabetes progression in islet autoantibody-positive children can be further stratified using expression patterns of multiple genes implicated in peripheral blood lymphocyte activation and function.

    PubMed

    Jin, Yulan; Sharma, Ashok; Bai, Shan; Davis, Colleen; Liu, Haitao; Hopkins, Diane; Barriga, Kathy; Rewers, Marian; She, Jin-Xiong

    2014-07-01

    There is tremendous scientific and clinical value to further improving the predictive power of autoantibodies because autoantibody-positive (AbP) children have heterogeneous rates of progression to clinical diabetes. This study explored the potential of gene expression profiles as biomarkers for risk stratification among 104 AbP subjects from the Diabetes Autoimmunity Study in the Young (DAISY) using a discovery data set based on microarray and a validation data set based on real-time RT-PCR. The microarray data identified 454 candidate genes with expression levels associated with various type 1 diabetes (T1D) progression rates. RT-PCR analyses of the top-27 candidate genes confirmed 5 genes (BACH2, IGLL3, EIF3A, CDC20, and TXNDC5) associated with differential progression and implicated in lymphocyte activation and function. Multivariate analyses of these five genes in the discovery and validation data sets identified and confirmed four multigene models (BI, ICE, BICE, and BITE, with each letter representing a gene) that consistently stratify high- and low-risk subsets of AbP subjects with hazard ratios >6 (P < 0.01). The results suggest that these genes may be involved in T1D pathogenesis and potentially serve as excellent gene expression biomarkers to predict the risk of progression to clinical diabetes for AbP subjects. PMID:24595351

  13. Risk of Type 1 Diabetes Progression in Islet Autoantibody-Positive Children Can Be Further Stratified Using Expression Patterns of Multiple Genes Implicated in Peripheral Blood Lymphocyte Activation and Function

    PubMed Central

    Jin, Yulan; Sharma, Ashok; Bai, Shan; Davis, Colleen; Liu, Haitao; Hopkins, Diane; Barriga, Kathy

    2014-01-01

    There is tremendous scientific and clinical value to further improving the predictive power of autoantibodies because autoantibody-positive (AbP) children have heterogeneous rates of progression to clinical diabetes. This study explored the potential of gene expression profiles as biomarkers for risk stratification among 104 AbP subjects from the Diabetes Autoimmunity Study in the Young (DAISY) using a discovery data set based on microarray and a validation data set based on real-time RT-PCR. The microarray data identified 454 candidate genes with expression levels associated with various type 1 diabetes (T1D) progression rates. RT-PCR analyses of the top-27 candidate genes confirmed 5 genes (BACH2, IGLL3, EIF3A, CDC20, and TXNDC5) associated with differential progression and implicated in lymphocyte activation and function. Multivariate analyses of these five genes in the discovery and validation data sets identified and confirmed four multigene models (BI, ICE, BICE, and BITE, with each letter representing a gene) that consistently stratify high- and low-risk subsets of AbP subjects with hazard ratios >6 (P < 0.01). The results suggest that these genes may be involved in T1D pathogenesis and potentially serve as excellent gene expression biomarkers to predict the risk of progression to clinical diabetes for AbP subjects. PMID:24595351

  14. Does Age Matter Among Young Black Men Who Have Sex With Men? A Comparison of Risk Behaviors Stratified by Age Category.

    PubMed

    Chamberlain, Nicholas; Mena, Leandro; Geter, Angelica; Crosby, Richard A

    2016-06-01

    The purpose of this study is to assess whether different sexual risk behavior exists among young Black men who have sex with men (YBMSM) as a function of age. A total of 382 YBMSM completed a computer-assisted self-interview at a sexual health clinic. The frequency/prevalence of fifteen sexual risk behaviors was compared between three groups (ages 16-19, 20-25, and 26-29, respectively) in the 90 days prior to enrollment in the study. Regression models were used to control for the confounding influence of Human Immunodeficiency Virus (HIV) status. One hundred seven participants were HIV-infected at study enrollment. Of the 15 measures assessed, none significantly differed among the groups. These null findings did not change in multivariate analyses. Our findings suggest that there is no differential sexual risk based on age among YBMSM and that this group should be considered a homogenous population with regards to intervention strategies that aim to reduce the sexual risk behaviors of YBMSM. PMID:27244192

  15. Clinical decision aids for chest pain in the emergency department: identifying low-risk patients

    PubMed Central

    Alley, William; Mahler, Simon A

    2015-01-01

    Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS). However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography. This review describes several of the chest pain decision aids developed and studied through the recent past, starting with the thrombolysis in myocardial infarction (TIMI) risk score and Global Registry of Acute Coronary Events (GRACE) scores, which were developed as prognostic aids for patients already diagnosed with ACS, then subsequently validated in the undifferentiated chest pain population. Asia-Pacific Evaluation of Chest Pain Trial (ASPECT); Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins (ADAPT); North American Chest Pain Rule (NACPR); and History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score have been developed exclusively for use in the undifferentiated chest pain population as well, with improved performance compared to their predecessors. This review describes the relative merits and limitations of these decision aids so that providers can determine which tool fits the needs of their clinical practice setting. PMID:27147894

  16. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  17. Management of vascular risk factors in the hypertensive patient.

    PubMed

    Taylor, S H

    1990-10-01

    Understanding of the multiple risk factors for premature vascular degeneration is essential for the most effective management of the hypertensive patient. High blood pressure is the most important single predictor of coronary heart disease risk in general clinical practice in the UK. However, hypertension is only a marker of an apparent excess of other risk factors for coronary heart disease among hypertensive patients. The global management of the patient is further complicated for two reasons. First, many of the risk factors are complexly interrelated, either biologically or by lifestyle. Second, the attempted correction of one factor is fraught with the potential for aggravation of the others. The benefits to the coronary and vascular risk profile from lowering blood pressure may be offset, partially or completely, by the aggravation of other risk factors by the antihypertensive drug used. Optimum management of the hypertensive patient can only be achieved when all the risk factors for coronary heart disease in that individual are modified. PMID:2148191

  18. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Falls are a serious problem for hospitalized patients, reducing the duration and quality of life. It is estimated that over 84% of all adverse events in hospitalized patients are related to falls. Some fall risk assessment tools have been developed and tested in environments other than those for which they were developed with serious validity discrepancies. The aim of this review is to determine the accuracy of instruments for detecting fall risk and predicting falls in acute hospitalized patients. Methods Systematic review and meta-analysis. Main databases, related websites and grey literature were searched. Two blinded reviewers evaluated title and abstracts of the selected articles and, if they met inclusion criteria, methodological quality was assessed in a new blinded process. Meta-analyses of diagnostic ORs (DOR) and likelihood (LH) coefficients were performed with the random effects method. Forest plots were calculated for sensitivity and specificity, DOR and LH. Additionally, summary ROC (SROC) curves were calculated for every analysis. Results Fourteen studies were selected for the review. The meta-analysis was performed with the Morse (MFS), STRATIFY and Hendrich II Fall Risk Model scales. The STRATIFY tool provided greater diagnostic validity, with a DOR value of 7.64 (4.86 - 12.00). A meta-regression was performed to assess the effect of average patient age over 65 years and the performance or otherwise of risk reassessments during the patient’s stay. The reassessment showed a significant reduction in the DOR on the MFS (rDOR 0.75, 95% CI: 0.64 - 0.89, p = 0.017). Conclusions The STRATIFY scale was found to be the best tool for assessing the risk of falls by hospitalized acutely-ill adults. However, the behaviour of these instruments varies considerably depending on the population and the environment, and so their operation should be tested prior to implementation. Further studies are needed to investigate the effect of the

  19. Obesity and Risk of Biochemical Failure for Patients Receiving Salvage Radiotherapy After Prostatectomy

    SciTech Connect

    King, Christopher R. Spiotto, Michael T.; Kapp, Daniel S.

    2009-03-15

    Purpose: Obesity has been proposed as an independent risk factor for patients undergoing surgery or radiotherapy (RT) for prostate cancer. Using body mass index (BMI) as a measure of obesity, we tested its role as a risk factor for patients receiving salvage RT after prostatectomy. Methods and Materials: Rates of subsequent biochemical relapse were examined in 90 patients who underwent salvage RT between 1984 and 2004 for biochemical failure after radical prostatectomy. Median follow-up was 3.7 years. The BMI was tested as a continuous and categorical variable (stratified as <25, 25-<30, and {>=}30 kg/m{sup 2}). Univariate and multivariate proportional hazards regression analyses were performed for clinical, pathologic, and treatment factors associated with time to relapse after salvage RT. Results: There were 40 biochemical failures after salvage RT with a median time to failure of 1.2 years. The BMI was not associated with adverse clinical, pathologic, or treatment factors. On multivariate analysis, obesity was independently significant (hazard ratio [HR], 1.2; p = 0.01), along with RT dose (HR, 0.7; p = 0.003) and pre-RT prostate-specific antigen level (HR, 1.2; p = 0.0003). Conclusions: This study is weakly suggestive that obesity may be a risk factor for salvage RT patients. Whether this results from greater biologic aggressiveness or technical inadequacies cannot be answered by this study. Given the very high failure rate observed for severely obese patients, we propose that technical difficulties with RT are at play. This hypothesis is supported by the RT literature and could be prospectively investigated. Techniques that optimize targeting, especially in obese patients, perhaps seem warranted at this time.

  20. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders: A Population-Based Cohort Study.

    PubMed

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-03-01

    Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant.We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17-1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34-7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  1. Turbulent vortices in stratified fluids

    NASA Technical Reports Server (NTRS)

    Hecht, A. M.; Bilanin, A. J.; Hirsh, J. E.; Snedeker, R. S.

    1979-01-01

    In the present paper, calculations, made with the finite difference axisymmetric WAKE computer code, of the influence of turbulence and stratification on the behavior of vortex rings are compared with experimental data. Calculations, made with the two-dimensional version of the code, are used to study the behavior of vortex pairs in stably stratified atmospheres for a range of Froude numbers. Stratification is shown to have a profound effect on the radius of a vortex ring descending into a stably stratified fluid. The separation of the vortices of a vortex pair remains nearly constant or decreases monotonically with increasing penetration of a stably stratified fluid, depending on whether the stratification is discontinuous or linear. An analysis based on an energy balance is used to assess the maximum descent of a vortex pair in a stably stratified fluid.

  2. Risk Factors and Outcome of Contamination in Patients on Peritoneal Dialysis—A Single-Center Experience of 15 Years

    PubMed Central

    Yap, Desmond Y.H.; Chu, Wai Ling; Ng, Flora; Yip, Terence Pok Siu; Lui, Sing Leung; Lo, Wai Kei

    2012-01-01

    ♦ Objective: Contamination is an important risk factor for peritoneal dialysis (PD)-related peritonitis. The present study outlines the clinical characteristics and outcomes of PD patients experiencing touch contamination. ♦ Methods: We reviewed the case records of PD patients from 1995 to 2010. Patients who experienced contamination of their PD system were identified and stratified into “dry” and “wet” contamination groups. Risk factors, microbiology, and clinical outcomes were compared. ♦ Results: Of 548 episodes of touch contamination, 246 involved dry contamination, and 302, wet contamination. After contamination, 17 episodes of peritonitis (3.1%) developed; all episodes occurred in the wet contamination group (p < 0.001). The incidence of peritonitis after wet contamination was 5.63%. Prophylactic antibiotics significantly reduced the risk of peritonitis (1 of 182 episodes, p < 0.001). Half the patients experiencing peritonitis had either culture-negative or staphylococcal episodes, and most of those episodes responded to intraperitoneal antibiotics. In 2 patients, peritonitis was attributable to Pseudomonas, and in 3, to Acinetobacter. In these latter patients, outcomes were less favorable, with catheter removal being required in 4 of the 5 episodes. ♦ Conclusions: The overall rate of peritonitis was low after contamination. Wet contamination was associated with a much higher risk of peritonitis. Prophylactic antibiotics after wet contamination were effective in preventing peritonitis. PMID:22661672

  3. HDL Cholesterol and Cancer Risk Among Patients With Type 2 Diabetes

    PubMed Central

    Zhao, Wenhui; Guan, Jing; Horswell, Ronald; Li, Weiqin; Wang, Yujie; Wu, Xiaocheng

    2014-01-01

    OBJECTIVE To investigate the relationship between HDL cholesterol (HDL-C) and cancer risk among type 2 diabetic patients. RESEARCH DESIGN AND METHODS We performed a retrospective cohort study of 14,169 men and 23,176 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of various levels of HDL cholesterol (HDL-C) with cancer risk. RESULTS During a mean follow-up period of 6.4 years, 3,711 type 2 diabetic patients had a cancer diagnosis. A significant inverse association between HDL-C and the risk of cancer was found among men and women. The multivariable-adjusted hazard ratios (HRs) of cancer at various levels of HDL-C at baseline (<30, 30–39.9, 40–49.9, 50–59.9, 60–69.9, 70–79.9, and ≥80 mg/dL) were 1.00, 0.87, 0.95, 1.01, 0.61, 0.45, and 0.37, respectively, in men (Ptrend = 0.027) and 1.00, 0.98, 0.88, 0.85, 0.84, 0.86, and 0.84, respectively, in women (Ptrend = 0.025). When stratified by race, BMI, smoking status, or medication use, the inverse association was still present. With an updated mean of HDL-C used in the analysis, the inverse association of HDL-C with cancer risk did not change. The inverse association substantially attenuated after excluding patients who died of or were diagnosed with cancer during the first 2 years of follow-up. CONCLUSIONS The study suggests an inverse association of HDL-C with cancer risk among men and women with type 2 diabetes, whereas the effect of HDL-C was partially mediated by reverse causation. PMID:25216507

  4. [Risk factors for development of hypomagnesemia in the burned patient].

    PubMed

    Durán-Vega, Héctor César; Romero-Aviña, Francisco Javier; Gutiérrez-Salgado, Jorge Eduardo; Silva-Díaz, Teresita; Ramos-Durón, Luis Ernesto; Carrera-Gómez, Francisco Javier

    2004-01-01

    Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier. PMID:15633562

  5. The Safety of Thoracentesis in Patients with Uncorrected Bleeding Risk

    PubMed Central

    Argento, A. Christine; Murphy, Terrence E.; Araujo, Katy L. B.; Pisani, Margaret A.

    2013-01-01

    Background: Thoracentesis is commonly performed to evaluate pleural effusions. Many medications (warfarin, heparin, clopidogrel) or physiological factors (elevated International Normalized Ratio [INR], thrombocytopenia, uremia) increase the risk for bleeding. Frequently these medications are withheld or transfusions are performed to normalize physiological parameters before a procedure. The safety of performing thoracentesis without correction of these bleeding risks has not been prospectively evaluated. Methods: This prospective observational cohort study enrolled 312 patients who underwent thoracentesis. All patients were evaluated for the presence of risk factors for bleeding. Hematocrit levels were obtained pre- and postprocedure, and the occurrence of postprocedural hemothorax was evaluated. Measurements and Main Results: Thoracenteses were performed in 312 patients, 42% of whom had a risk for bleeding. Elevated INR, secondary to liver disease or warfarin, and renal disease were the two most common etiologies for bleeding risk, although many patients had multiple potential bleeding risks. There was no significant difference in pre- and postprocedural hematocrit levels in patients with a bleeding risk when compared with patients with no bleeding risk. No patient developed a hemothorax as a result of the thoracentesis. Conclusions: This single-center, observational study suggests that thoracentesis may be safely performed without prior correction of coagulopathy, thrombocytopenia, or medication-induced bleeding risk. This may reduce the morbidity associated with transfusions or withholding of medications. PMID:23952852

  6. Effect of carotid atherosclerosis screening on risk stratification during primary cardiovascular disease prevention.

    PubMed

    Bard, Robert L; Kalsi, Henna; Rubenfire, Melvyn; Wakefield, Thomas; Fex, Beverly; Rajagopalan, Sanjay; Brook, Robert D

    2004-04-15

    We investigated the effect that carotid plaque area (CPA) and intima media thickness (IMT) measurements have on risk stratification in 95 patients with intermediate Framingham scores (6% to 19%). The risk status of each patient was adjusted to be low, intermediate, or high based on the results of carotid ultrasound. After carotid testing, 44% (IMT) and 45% (CPA) of the intermediate-risk patients were stratified as low risk, and 22% (IMT) and 40% (CPA) were stratified as high risk. Using the threshold values derived from our laboratory, 28% (IMT) and 45% (CPA) of patients were stratified as low risk, and 35% (IMT) and 27% (CPA) were identified as high risk. These tests adjust the risk strata of >/=63% of patients deemed as having intermediate risk by Framingham scores. PMID:15081449

  7. A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma

    PubMed Central

    Nishijima, Daniel K.; Yang, Zhuo; Clark, John A.; Kuppermann, Nathan; Holmes, James F.; Melnikow, Joy

    2014-01-01

    Objectives Recently a clinical decision rule (CDR) to identify children at very low risk for intraabdominal injury needing acute intervention (IAI) following blunt torso trauma was developed. Potential benefits of a CDR include more appropriate abdominal computed tomography (CT) use and decreased hospital costs. The objective of this study was to compare the cost-effectiveness of implementing the CDR compared to usual care for the evaluation of children with blunt torso trauma. The hypothesis was that compared to usual care, implementation of the CDR would result in lower CT use and hospital costs. Methods A cost-effectiveness decision analytic model was constructed comparing the costs and outcomes of implementation of the CDR to usual care in the evaluation of children with blunt torso trauma. Probabilities from a multicenter cohort study of children with blunt torso trauma were derived; estimated costs were based on those at the study coordinating site. Outcome measures included missed IAI, number of abdominal CT scans, total costs, and incremental cost-effectiveness ratios. Sensitivity analyses varying imputed probabilities, costs, and scenarios were conducted. Results Using a hypothetical cohort of 1,000 children with blunt torso trauma, the base case model projected that the implementation of the CDR would result in 0.50 additional missed IAIs, a total cost savings of $54,527, and 104 fewer abdominal CT scans compared to usual care. The usual care strategy would cost $108,110 to prevent missing one additional IAI. Findings were robust under multiple sensitivity analyses. Conclusions Compared to usual care, implementation of the CDR in the evaluation of children with blunt torso trauma would reduce hospital costs and abdominal CT imaging, with a slight increase in the risk of missed intraabdominal IAI. PMID:24238315

  8. Prevalence and Risk Factors of Overweight and Obesity among Children Aged 6–59 Months in Cameroon: A Multistage, Stratified Cluster Sampling Nationwide Survey

    PubMed Central

    Tchoubi, Sébastien; Sobngwi-Tambekou, Joëlle; Noubiap, Jean Jacques N.; Asangbeh, Serra Lem; Nkoum, Benjamin Alexandre; Sobngwi, Eugene

    2015-01-01

    Background Childhood obesity is one of the most serious public health challenges of the 21st century. The prevalence of overweight and obesity among children (<5 years) in Cameroon, based on weight-for-height index, has doubled between 1991 and 2006. This study aimed to determine the prevalence and risk factors of overweight and obesity among children aged 6 months to 5 years in Cameroon in 2011. Methods Four thousand five hundred and eighteen children (2205 boys and 2313 girls) aged between 6 to 59 months were sampled in the 2011 Demographic Health Survey (DHS) database. Body Mass Index (BMI) z-scores based on WHO 2006 reference population was chosen to estimate overweight (BMI z-score > 2) and obesity (BMI for age > 3). Regression analyses were performed to investigate risk factors of overweight/obesity. Results The prevalence of overweight and obesity was 8% (1.7% for obesity alone). Boys were more affected by overweight than girls with a prevalence of 9.7% and 6.4% respectively. The highest prevalence of overweight was observed in the Grassfield area (including people living in West and North-West regions) (15.3%). Factors that were independently associated with overweight and obesity included: having overweight mother (adjusted odds ratio (aOR) = 1.51; 95% CI 1.15 to 1.97) and obese mother (aOR = 2.19; 95% CI = 155 to 3.07), compared to having normal weight mother; high birth weight (aOR = 1.69; 95% CI 1.24 to 2.28) compared to normal birth weight; male gender (aOR = 1.56; 95% CI 1.24 to 1.95); low birth rank (aOR = 1.35; 95% CI 1.06 to 1.72); being aged between 13–24 months (aOR = 1.81; 95% CI = 1.21 to 2.66) and 25–36 months (aOR = 2.79; 95% CI 1.93 to 4.13) compared to being aged 45 to 49 months; living in the grassfield area (aOR = 2.65; 95% CI = 1.87 to 3.79) compared to living in Forest area. Muslim appeared as a protective factor (aOR = 0.67; 95% CI 0.46 to 0.95).compared to Christian religion. Conclusion This study underlines a high prevalence of

  9. FREQUENCY OF ATTENDANCE AT RELIGIOUS SERVICES, CARDIOVASCULAR DISEASE, METABOLIC RISK FACTORS AND DIETARY INTAKE IN AMERICANS: AN AGE-STRATIFIED EXPLORATORY ANALYSIS

    PubMed Central

    OBISESAN, THOMAS; LIVINGSTON, IVOR; TRULEAR, HAROLD DEAN; GILLUM, FRANK

    2011-01-01

    Background Few data have been published on the association of attendance at religious services with cardiovascular morbidity and dietary and metabolic risk factors in representative samples of populations despite a known inverse association with mortality and smoking. Objective To test the null hypothesis that frequency of attendance at religious services is unrelated to prevalence or levels of cardiovascular disease, dietary and metabolic risk factors. Design Cross-sectional survey of a large national sample. Participants American men and women aged 20 years and over with complete data in the Third National Health and Nutrition Examination Survey (N = 14,192). Measurements Self-reported frequency of attendance at religious services, history of doctor-diagnosed diseases, food intake frequency, 24-hour dietary intake, health status, socio-demographic variables and measured serum lipids and body mass index. Results Weekly attenders were significantly less likely to report stroke, even after adjusting for multiple variables only in African American women OR = 0.35, 95% CI 0.19–0.66, p < 0.01. No association was seen for heart attack or diabetes. Fish intake at least weekly was more common in weekly attenders, significantly so only in African American women (odds ratio 1.24, 95% CI 1.01–1.58, p < 0.05) and in older Mexican American men (odds ratio 2.57, 95% CI 1.45–2.57, p < 0.01). In linear regression analyses, no significant independent associations were seen between attendance frequency and serum lipid levels or dietary intake of energy, or fat in g and % of kcal. Conclusion Hypotheses generated by these analyses are that in African American women stroke is less prevalent and weekly fish intake more prevalent among weekly attenders than others and that there are no significant independent associations of serum lipids, dietary intake, prevalent CHD, or diabetes with frequency of attendance of religious services. Independent testing of these hypotheses in other

  10. 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

  11. Risk factors for major amputation in hospitalised diabetic foot patients.

    PubMed

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung

    2016-03-01

    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels. PMID:26478562

  12. Risk Factors and Outcomes for Carbapenem-Resistant Klebsiella pneumoniae Isolation, Stratified by Its Multilocus Sequence Typing: ST258 Versus Non-ST258

    PubMed Central

    Dhar, Sorabh; Martin, Emily T.; Lephart, Paul R.; McRoberts, John P.; Chopra, Teena; Burger, Timothy T.; Tal-Jasper, Ruthy; Hayakawa, Kayoko; Ofer-Friedman, Hadas; Lazarovitch, Tsilia; Zaidenstein, Ronit; Perez, Federico; Bonomo, Robert A.; Kaye, Keith S.; Marchaim, Dror

    2016-01-01

    A “high risk” clone of carbapenem-resistant Klebsiella pneumoniae (CRKP) identified by multilocus sequence typing (MLST) as sequence type (ST) 258 has disseminated worldwide. As the molecular epidemiology of the CRE pandemic continues to evolve, the clinical impact of non-ST258 strains is less well defined. We conducted an epidemiological investigation of CRKP based on strains MLST. Among 68 CRKP patients, 61 were ST258 and 7 belonged to non-ST258. Klebsiella pneumoniae ST258 strains were significantly associated with blaKPC production and with resistance to an increased number of antimicrobials. Clinical outcomes were not different. Based on this analysis, one cannot rely solely on the presence of blaKPC in order to diagnose CRKP. PMID:26885543

  13. Renal Function and All-Cause Mortality Risk Among Cancer Patients

    PubMed Central

    Yang, Yan; Li, Hui-yan; Zhou, Qian; Peng, Zhen-wei; An, Xin; Li, Wei; Xiong, Li-ping; Yu, Xue-qing; Jiang, Wen-qi; Mao, Hai-ping

    2016-01-01

    Abstract Renal dysfunction predicts all-cause mortality in general population. However, the prevalence of renal insufficiency and its relationship with mortality in cancer patients are unclear. We retrospectively studied 9465 patients with newly diagnosed cancer from January 2010 to December 2010. Renal insufficiency was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation. The hazard ratio (HR) of all-cause mortality associated with baseline eGFR was assessed by Cox regression. Three thousand sixty-nine patients (32.4%) exhibited eGFR <90 mL/min/1.73 m2 and 3% had abnormal serum creatinine levels at the time of diagnosis. Over a median follow-up of 40.5 months, 2705 patients (28.6%) died. Compared with the reference group (eGFR ≥ 60 mL/min/1.73 m2), an elevated all-cause mortality was observed among patients with eGFR < 60 mL/min/1.73 m2 stratified by cancer stage in the entire cohort, the corresponding hazard ratios were 1.87 (95% CI, 1.41–2.47) and 1.28 (95% CI, 1.01–1.62) for stage I to III and stage IV, respectively. However, this relationship was not observed after multivariate adjustment. Subgroup analysis found that eGFR < 60 mL/min/1.73 m2 independently predicted death among patients with hematologic (adjusted HR 2.93, 95% CI [1.36–6.31]) and gynecological cancer (adjusted HR 2.82, 95% CI [1.19–6.70]), but not in those with other cancer. Five hundred fifty-seven patients (6%) had proteinuria. When controlled for potential confounding factors, proteinuria was a risk factor for all-cause mortality among patients in the entire cohort, regardless of cancer stage and eGFR values. When patients were categorized by specific cancer type, the risk of all-cause death was only significant in patients with digestive system cancer (adjusted HR, 1.85 [1.48–2.32]). The prevalence of renal dysfunction was common in patients with newly diagnosed cancer. Patients

  14. Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy.

    PubMed

    Seo, Yeon Seok; Kim, Mi Na; Kim, Seung Up; Kim, Sang Gyune; Um, Soon Ho; Han, Kwang-Hyub; Kim, Young Seok

    2016-03-01

    Liver stiffness (LS) assessed using transient elastography (TE) can assess the risk of developing hepatocellular carcinoma (HCC). We evaluated whether TE, when compared with histological data as a reference standard, can predict the risk of HCC development in chronic hepatitis B (CHB) patients starting antiviral therapy.Observational cohort database of 381 patients with CHB who underwent liver biopsy (LB) and TE were reviewed. All patients underwent surveillance for HCC development using ultrasonography and alpha-fetoprotein.During the median follow-up period of 48.1 (interquartile range 30.3-69.3) months, HCC developed in 34 (8.9%) patients. In patients with HCC development, age, proportion of diabetes mellitus, histological fibrosis stage, and LS value were significantly higher than those in patients without (all P <0.05). The cumulative incidence rates of HCC increased significantly in association with elevated LS value in 3 stratified groups (LS value <8, 8-13, and >13 kPa; log-rank test, P <0.001), and with higher histological fibrosis stage in 3 stratified groups (F0-2, F3, and F4; log-rank test, P <0.001). On multivariate analysis, along with age, LS value was an independent predictor of HCC development (hazard ratio 1.041, P <0.001), whereas histological staging was not (P >0.05).TE predicted HCC development independently in patients with CHB starting antiviral therapy. However, further investigation is needed to determine whether the current surveillance strategy can be optimized based on the LS value at the time of starting antiviral therapy. PMID:27015173

  15. Patient risk factors' influence on survival of posterior composites.

    PubMed

    van de Sande, F H; Opdam, N J; Rodolpho, P A Da Rosa; Correa, M B; Demarco, F F; Cenci, M S

    2013-07-01

    This practice-based retrospective study evaluated the survival of resin composite restorations in posterior teeth, focusing on the influence of potential patient risk factors. In total, 306 posterior composite restorations placed in 44 adult patients were investigated after 10 to 18 yrs. The history of each restoration was extracted from the dental records, and a clinical evaluation was performed with those still in situ. The patient risk status was assessed for caries and "occlusal-stress" (bruxism-related). Statistical analysis was performed by the Kaplan-Meier method and Cox-regression multivariate analysis. In total, 30% of the restorations failed, of which 82% were found in patients with 1 or 2 risk factors. Secondary caries was the main reason of failure within caries-risk patients, whereas fracture was the main reason in "occlusal-stress-risk" patients. The patient variables gender and age did not significantly affect survival, but risk did (p < .001). Tooth type (p < .001), arch (p = .013), and pulpal vitality (p = .003) significantly affected restoration survival. Within the limits of this retrospective evaluation, the survival of restorations is affected by patient risk factors, which should be included in survival analyses of restorations. PMID:23690354

  16. Effectiveness of Early Preventive Intervention with Semiannual Fluoride Varnish Application in Toddlers Living in High-Risk Areas: A Stratified Cluster-Randomized Controlled Trial.

    PubMed

    Anderson, Maria; Dahllöf, Göran; Twetman, Svante; Jansson, Leif; Bergenlid, Ann-Cathrine; Grindefjord, Margaret

    2016-01-01

    This study evaluated whether toddlers in an extended preventive program of semiannual fluoride varnish applications from 1 year of age had a lower incidence of caries than those undergoing a standard program. A cohort of 1-year-old children (n = 3,403) living in multicultural areas of low socioeconomic standing in Stockholm participated in a cluster-randomized controlled field trial with two parallel arms. The children attended 23 dental clinics. Using the ICDAS II criteria, the examiners recorded caries at baseline and after 1 and 2 years. The children in the reference group received a standardized oral health program once yearly between 1 and 3 years of age. The children in the test group received the same standard program supplemented with topical applications of fluoride varnish every 6 months. We compared the test group and the reference group for the prevalence and increment of caries. At baseline, 5% of the children had already developed caries (ICDAS II 1-6). We reexamined the children after 1 year (n = 2,675) and after 2 years (n = 2,536). Neither prevalence nor caries increment differed between the groups. At 3 years of age, 12% of the children had developed moderate and severe carious lesions (ICDAS II 3-6), with a mean increment of 0.5 (SD 2.4) in the test group and 0.6 (SD 2.2) in the reference group. In conclusion, semiannual professional applications of fluoride varnish, as a supplement to a standard oral health program, failed to reduce caries development in toddlers from high-risk communities. PMID:26795957

  17. Clinician-Patient Risk Discussion for Atherosclerotic Cardiovascular Disease Prevention

    PubMed Central

    Martin, Seth S.; Sperling, Laurence S.; Blaha, Michael J.; Wilson, Peter W.F.; Gluckman, Ty J.; Blumenthal, Roger S.; Stone, Neil J.

    2016-01-01

    Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation. PMID:25835448

  18. Venous thromboembolism in cancer patients: risk assessment, prevention and management.

    PubMed

    Tukaye, Deepali N; Brink, Heidi; Baliga, Ragavendra

    2016-03-01

    Thrombosis and thromboembolic events contribute to significant morbidity in cancer patients. Venous thrombosis embolism (which includes deep vein thrombosis and pulmonary embolism) accounts for a large percentage of thromboembolic events. Appropriate identification of cancer patients at high risk for venous thromboembolism and management of thromboembolic event is crucial in improving the quality of care for cancer patients. However, thromboembolism in cancer patients is a complex problem and the management has to be tailored to each individual. The focus of this review is to understand the complex pathology, physiology and risk factors that drive the process of venous thrombosis and embolism in cancer patients and the current guidelines in management. PMID:26919091

  19. Explaining the clinical manifestations of T wave alternans in patients at risk for sudden cardiac death

    PubMed Central

    Cutler, Michael J; Rosenbaum, David S.

    2009-01-01

    The mechanisms underlying sudden cardiac death (SCD) are complex and diverse. Therefore, correct application of any marker to risk stratify patients for appropriate therapy requires knowledge regarding how the marker is reflective of a particular electro-anatomical substrate for arrhythmias. Non-invasive measurement of beat-to-beat alternation of the electrocardiographic T-wave, referred to as T-wave alternans (TWA), is an important marker of risk for sudden cardiac death (SCD). Is this relationship a mere association or is TWA mechanistically linked to SCD? Recent experimental evidence strongly supports a mechanistic relationship between TWA and SCD. This review will consider the underlying mechanisms of TWA derived from experimental studies, as they relate to clinical observations of TWA in humans, addressing the following questions derived from common clinical observations: 1) Where does TWA on the surface ECG come from? 2) Why is controlled heart rate elevation required to elicit TWA? 3) Why is TWA associated with risk for SCD? 4) Why is TWA associated with a broad range of ventricular arrhythmias? and 5) How do commonly used medications affect TWA? PMID:19168395

  20. Increased Risk of Stroke in Patients With Fibromyalgia

    PubMed Central

    Tseng, Chun-Hung; Chen, Jiunn-Horng; Wang, Yu-Chiao; Lin, Ming-Chia; Kao, Chia-Hung

    2016-01-01

    Abstract Neuropsychiatric diseases might enhance stroke development, possibly through inflammation and atherosclerosis. Approximately 25% to 40% of patients with stroke, largely younger patients, are not associated with any conventional stroke risk factors. In this research, we explored whether fibromyalgia (FM), a neuropsychosomatic disorder, increases stroke risk. From a claims dataset with one million enrollees sourced of the Taiwan National Health Insurance database, we selected 47,279 patients with FM and randomly selected 189,112 age- and sex-matched controls within a 3-year period from January 1, 2000 to December 31, 2002. Stroke risk was assessed using Cox proportional hazards regression. Comorbidities associated with increased stroke risk, such as hypertension, diabetes, hyperlipidemia, coronary heart disease, irritable bowel syndrome, and interstitial cystitis, were more prevalent in patients with FM and high stroke risk than in the controls. The overall stroke risk was 1.25-fold (95% confidence interval [CI]: 1.21–1.30) higher in the FM group than in the non-FM group. Even without comorbidities, stroke risk was higher in patients with FM than in the controls (adjusted hazard ratio [aHR] = 1.44, 95% CI: 1.35–1.53, P < 0.001). The relative risk of stroke was 2.26-fold between FM and non-FM groups in younger patients (age <35 years, 95% CI: 1.86–2.75). This is the first investigation associating FM with an increased risk of stroke development. The outcomes imply that FM is a significant risk factor for stroke and that patients with FM, particularly younger patients, require close attention and rigorous measures for preventing stroke. PMID:26937918

  1. Identifying patients at high risk of breast cancer recurrence: strategies to improve patient outcomes

    PubMed Central

    Martei, Yehoda M; Matro, Jennifer M

    2015-01-01

    Identifying patients at high risk of breast cancer recurrence has important implications not only for enabling the ability to provide accurate information to patients but also the potential to improve patient outcomes. Patients at high recurrence risk can be offered appropriate treatment to improve the overall survival. However, the major challenge is identifying patients with early-stage breast cancer at lower risk who may be spared potentially toxic therapy. The successful integration of molecular assays into clinical practice may address the problem of overtreatment and improve overall patient outcomes. PMID:26504408

  2. Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

    PubMed Central

    Phillips, Siobhan M.; Glasgow, Russell E.; Bello, Ghalib; Ory, Marcia G.; Glenn, Beth A.; Sheinfeld-Gorin, Sherri N.; Sabo, Roy T.; Heurtin-Roberts, Suzanne; Johnson, Sallie Beth; Krist, Alex H.

    2014-01-01

    PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices. METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as “at risk” or “healthy” for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices. RESULTS On average, patients had 5.8 (SD = 2.12; range, 0–13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important. CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change. PMID:25384812

  3. [Risk assessment for pressure ulcer in critical patients].

    PubMed

    Gomes, Flávia Sampaio Latini; Bastos, Marisa Antonini Ribeiro; Matozinhos, Fernanda Penido; Temponi, Hanrieti Rotelli; Velásquez-Meléndez, Gustavo

    2011-04-01

    Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment. PMID:21655778

  4. [Assessment of cardiovascular risk in hypertensive patients: comparison among scores].

    PubMed

    Del Colle, Sara; Rabbia, Franco; Mulatero, Paolo; Veglio, Franco

    2004-09-01

    At present, a correct and thorough risk evaluation represents the best prognostic and therapeutic approach for hypertensive patients. Recent European and American guidelines recommend a global stratification of the cardiovascular risk of hypertensive patients, based on the evaluation of risk factors, organ damage, and the clinical conditions associated with hypertension. A similar approach uses numerical risk scores that transform the percentage risk, calculated from large populations, into absolute values. These scores have been calculated by different research groups and scientific organizations with the aim of better defining the real risk of a given population over time. Many of these risk scores have been conceived by American and European scientific groups on the basis of the epidemiology of different risk variables in the respective populations; in general, north American hypertensives are exposed to a higher cardiovascular risk compared to Europeans and some European countries have a higher risk than others. The present review underlines the pivotal role of a correct risk evaluation of hypertension as reported in the guidelines. We briefly analyze the principal studies on risk scores: we compare the advantages and disadvantages of the different scores, as well as the similarities and differences, in order to demonstrate not only their utility, but also the possible equivalence of the different parameters considered. PMID:15568607

  5. Risk of Second Primary Cancer among Prostate Cancer Patients in Korea: A Population-Based Cohort Study

    PubMed Central

    Joung, Jae Young; Lim, Jiwon; Oh, Chang-Mo; Jung, Kyu-Won; Cho, Hyunsoon; Kim, Sung Han; Seo, Ho Kyung; Park, Weon Seo; Chung, Jinsoo; Lee, Kang Hyun; Won, Young-Joo

    2015-01-01

    As patients with prostate cancer have a long life expectancy, there is increasing interest in predicting the risk of development of a second primary cancer (SPC), and we therefore designed this study to estimate the overall risk of developing SPCs among Korean prostate cancer patients. We used a population-based cohort from the Korean Central Cancer Registry composed of 55,378 men diagnosed with a first primary prostate cancer between 1993 and 2011. Standardized incidence ratios (SIRs) of SPCs were analyzed by age at diagnosis, latency period, period of diagnosis, and type of initial treatment. Survival analysis was stratified by development of SPC. Men with primary prostate cancer had an overall lower risk of developing an SPC [SIR = 0.75; 95% CI, 0.72−0.78], which was significant for SPCs of the esophagus, stomach, rectum, liver, gallbladder, bile duct, pancreas, larynx, lung, and bronchus. In contrast, there were significant increases in the risk of bladder and thyroid cancers, which tended to decrease after longer follow-up. Patients who received initial radiation therapy had an increased risk of subsequent rectal cancer, although this was still lower than that of the general male population. Other urinary tract cancers including those of the kidney, renal pelvis, and ureter tended to be associated with a higher risk of developing an SPC, but this difference did not reach statistical significance. The patients with prostate cancer and SPC had lower overall survival rates than those with one primary prostate cancer. Our findings suggest that men with prostate cancer have a 25% lower risk of developing an SPC in Korea, but a higher risk of developing subsequent bladder and thyroid cancers, which suggests the need for continued cancer surveillance among prostate cancer survivors. PMID:26469085

  6. 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.

  7. Skipping Meds Greatly Ups Heart Patients' Risk of Stroke

    MedlinePlus

    ... Skipping Meds Greatly Ups Heart Patients' Risk of Stroke: Study Fatal strokes seven times more likely if drugs to control ... are much more likely to die from a stroke if they don't take cholesterol-lowering statin ...

  8. Asian gastric cancer patients at a southern California comprehensive cancer center are diagnosed with less advanced disease and have superior stage-stratified survival.

    PubMed

    Theuer, C P

    2000-09-01

    The 5-year overall survival after curative gastrectomy for gastric cancer is markedly different in the West from that in the Far East. Japanese surgeons feel that extended lymphadenectomy contributes to this superior survival, although survival differences may reflect improved staging or less aggressive tumor biology. We analyzed consecutive cases of gastric adenocarcinoma diagnosed and treated at the University of California, Irvine Medical Center from 1989 through 1998 to determine whether patients of Asian descent diagnosed with gastric cancer in Southern California have improved outcome. Fifty-two cases (36%) occurred in patients of Asian descent (39% Vietnamese, 31% Chinese, 13% Korean, 6% Filipino, and 2% Japanese). Only one Asian patient was born in the United States. Non-Asian patients (67% white, 30% Latino, and 3% black) were younger (59 years vs 64 years; P < 0.05) and more likely to have tumors of the gastroesophageal junction (33% vs 4%; P < 0.001). Asian patients were less likely to have distant metastases (24% vs 39%; P = 0.08), were more likely to undergo formal gastrectomy (71% vs 45%; P < 0.01), and were more likely to undergo a curative resection (40% vs 18%; P < 0.01). The overall survival of Asian patients at 3 years was significantly higher than the overall survival of non-Asians (39.4% vs 19.6%, P < 0.05). Asians with regional (node-positive) disease had superior survival (40.2% vs 14.8%, P < 0.05), which can be largely attributed to greater rates of resectability. We conclude that the clinical behavior of gastric cancer in Asians in Southern California differs from that in non-Asians. The increased proportion of resectable disease and improved survival of patients of Asian descent likely reflects less aggressive tumor biology. PMID:10993608

  9. AKI in Low-Risk versus High-Risk Patients in Intensive Care

    PubMed Central

    Sileanu, Florentina E.; Murugan, Raghavan; Lucko, Nicole; Clermont, Gilles; Kane-Gill, Sandra L.; Handler, Steven M.

    2015-01-01

    Background and objectives AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU). Design, setting, participants, & measurements A large, academic medical center database, with records from July 2000 through October 2008, was used and the authors identified a low-risk cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. AKI was defined using Kidney Disease Improving Global Outcomes criteria. The primary end points were moderate to severe AKI (stages 2–3) and risk-adjusted hospital mortality. Results Of 40,152 critically ill patients, 44.9% received neither vasopressors nor mechanical ventilation on ICU day 1. Stages 2–3 AKI occurred less frequently in the low-risk patients versus high-risk patients within 24 hours (14.3% versus 29.1%) and within 1 week (25.7% versus 51.7%) of ICU admission. Patients developing AKI in both risk groups had higher risk of death before hospital discharge. However, the adjusted odds of hospital mortality were greater (odds ratio, 2.99; 95% confidence interval, 2.62 to 3.41) when AKI occurred in low-risk patients compared with those with respiratory or cardiovascular failures (odds ratio, 1.19; 95% confidence interval, 1.09 to 1.3); interaction P<0.001. Conclusions Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk

  10. Radioiodine remnant ablation in low-risk differentiated thyroid cancer patients who had R0 dissection is an over treatment

    PubMed Central

    Bal, Chandrasekhar; Ballal, Sanjana; Soundararajan, Ramya; Chopra, Saurav; Garg, Aayushi

    2015-01-01

    Low-risk (LR) differentiated thyroid cancer (DTC) patients should be ablated or not, albeit, with small dose of radioiodine is highly controversial. We hypothesized that those LR DTC patients who were surgically ablated need no radioiodine remnant ablation (RRA). This study aims to evaluate the long-term outcome in these two groups of patients. Retrospective cohort study conducted from January 1991 to December 2012. Based on extent of surgical resection and histopathology, LR DTC patients were classified as Gr-1: 169 patients, who were surgically ablated; Gr-2: 153 patients, who had significant remnant in thyroid bed. Basal parameters were comparable between two groups except pretherapy 24 h radioiodine uptake (0.16 ± 0.01% vs. 5.64 ± 0.46%; P < 0.001). No patient received RRA in Gr-1; Gr-2 patients were administered 30 mCi 131I. Total number of events (recurrence, persistent, and progression of disease), with median follow up of 10.3 years, was observed in 10/322 (3.1%) of LR DTC patients. Only one patient had disease recurrence from Gr-1, who became disease-free after radioiodine therapy. Similarly, one patient from 126, who was ablated with single dose of RRA, had recurrence from Gr-2. However, 8/27 (29.7%) patients from Gr-2 had persistent disease; even two of them subsequently developed disease progression, who failed first-dose of RRA. The event-free survival rates were 99.4% and 94.1% (P = 0.006) in Gr-1 and Gr-2, respectively. RRA is an overtreatment in surgically ablated LR DTC patients. Successfully ablated RRA patients also had similar long-term outcome, however, those who failed, should be re-stratified as intermediate-risk category, and managed aggressively. PMID:25755077

  11. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time

    PubMed Central

    Large, Matthew; Kaneson, Muthusamy; Myles, Nicholas; Myles, Hannah; Gunaratne, Pramudie; Ryan, Christopher

    2016-01-01

    Objective It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. Method We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. Results The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79–6.20). Between-study heterogeneity was very high (I2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. Conclusions The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to

  12. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    PubMed

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  13. Behavioral Risk Assessment of the Guarded Suicidal Patient

    ERIC Educational Resources Information Center

    Simon, Robert I.

    2008-01-01

    Psychiatrists and other mental health professionals are trained to assess patients by direct observation and examination. Short inpatient length of stay, brief outpatient visits, emergency room evaluations, and other time-limited clinical settings require rapid assessment of suicide risk. Recognition of behavioral suicide risk factors can assist…

  14. Presence of tumour high-endothelial venules is an independent positive prognostic factor and stratifies patients with advanced-stage oral squamous cell carcinoma.

    PubMed

    Wirsing, Anna M; Rikardsen, Oddveig G; Steigen, Sonja E; Uhlin-Hansen, Lars; Hadler-Olsen, Elin

    2016-02-01

    Staging of oral squamous cell carcinoma is based on the tumour-node-metastasis (TNM) system, which has been deemed insufficient for prognostic purposes. Hence, better prognostic tools are needed to reflect the biological diversity of these cancers. Previously, high numbers of specialized blood vessels called high-endothelial venules have been reported to be associated with prolonged survival in patients with breast cancer. In this study, we analysed the prognostic value and morphological characteristics of tumour-associated high-endothelial venules in oral cancer. The presence of tumour-associated high-endothelial venules was evaluated by immunohistochemistry in 75 patients with oral squamous cell carcinoma and analysed with correlation to clinicopathological parameters, patients' survival and vessel morphology. Ten of the samples were analysed at multiple levels to evaluate intratumoural heterogeneity. The presence of tumour-associated high-endothelial venules was found to be associated with lower disease-specific death in multivariate regression analyses (P = 0.002). High-endothelial venules were present in all (n = 53) T1-T2 tumours, but only in two thirds (n = 14) of the T3-T4 tumours. The morphology of high-endothelial venules was heterogeneous and correlated with lymphocyte density. High-endothelial venules were found to be distributed homogeneously within the tumours. We found the presence of tumour-associated high-endothelial venules to be an easy-to-use, robust, and independent positive prognostic factor for patients with oral cancer. Absence of these vessels in advanced-stage tumours might identify patients with more aggressive disease. Evaluating the presence of tumour-associated high-endothelial venules might help to tailor the treatment of oral cancer patients to their individual needs. PMID:26383526

  15. Role of risk stratification by SPECT, PET, and hybrid imaging in guiding management of stable patients with ischaemic heart disease: expert panel of the EANM cardiovascular committee and EACVI.

    PubMed

    Acampa, Wanda; Gaemperli, Oliver; Gimelli, Alessia; Knaapen, Paul; Schindler, Thomas H; Verberne, Hein J; Zellweger, Michael J

    2015-12-01

    Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field. PMID:25902767

  16. Modifiable Risk Factors in Patients With Low Back Pain.

    PubMed

    Shemory, Scott T; Pfefferle, Kiel J; Gradisar, Ian M

    2016-05-01

    Low back pain is one of the most common reasons for physician visits in the United States and is a chief complaint frequently seen by orthopedic surgeons. Patients with chronic low back pain can experience recurring debilitating pain and disability, decreasing their quality of life. A commercially available software platform, Explorys (Explorys, Inc, Cleveland, Ohio), was used to mine a pooled electronic health care database consisting of the medical records of more than 26 million patients. According to the available medical history data, 1.2 million patients had a diagnosis of low back pain (4.54%). The information was used to determine the incidence of low back pain in patients with a history of nicotine dependence, obesity (body mass index, >30 kg/m(2)), depressive disorders, and alcohol abuse. Relative risk was then calculated for the defined modifiable risk factors. Patients with nicotine dependence, obesity, depressive disorders, and alcohol abuse had a relative risk of 4.489, 6.007, 5.511, and 3.326 for low back pain, respectively, compared with patients without the defined risk factor. A statistically significant difference was found in the incidence of low back pain between all 4 groups with the risk factors evaluated and the general population (P<.05). By determining treatable patient risk factors for low back pain, physicians can monitor at-risk patients and focus on prevention and control of debilitating disease. These approaches can decrease the number of patients with isolated low back pain who are seen by orthopedic surgeons. [Orthopedics. 2016; 39(3):e413-e416.]. PMID:27064774

  17. Rosiglitazone Use and the Risk of Bladder Cancer in Patients With Type 2 Diabetes

    PubMed Central

    Han, Eugene; Jang, Suk-Yong; Kim, Gyuri; Lee, Yong-ho; Choe, Eun Yeong; Nam, Chung Mo; Kang, Eun Seok

    2016-01-01

    Abstract Patients with diabetes have a higher incidence of bladder cancer; however, the association between thiazolidinedione use and bladder cancer risk has been controversial. We aimed to investigate whether pioglitazone or rosiglitazone use is associated with bladder cancer risk in patients with type 2 diabetes mellitus. This nationwide nested case-control study used data set obtained from the Korean National Health Insurance Service National Sample Cohort 2002 to 2013. Among the 47,738 patients with incident diabetes, 85 cases of newly diagnosed bladder cancer and 850 controls (1:10 matched by age, sex, index year, and diabetes diagnosis year) were recruited. Type 2 diabetes mellitus and bladder cancer were diagnosed using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision code. More cases of bladder cancer were diagnosed in men (81.2%), and the stratified age peaked at 70 to 79 years old. Exclusive rosiglitazone use raised the incidence of bladder cancer (odds ratio [OR] = 3.07, 95% confidence interval [CI ] = 1.48–6.37). The risk of bladder cancer started to increase after less than 3 months use (OR = 3.30, 95% CI = 1.02–10.70) and peaked at 3 to 12 months of rosiglitazone use (OR = 4.48, 95% CI = 1.51–13.31). Patients were first exposed to exclusive rosiglitazone within 1 year (OR = 11.74, 95% CI = 2.46–56.12) and those who had consistently used it for 1 year (OR = 4.48 95% CI = 1.51–13.31), had higher risks of bladder cancer compared with nonthiazolidinedione users. Neither pioglitazone use nor exclusive pioglitazone use were associated with an increased incidence of bladder cancer. Rosiglitazone use is associated with an increased risk of incident bladder cancer independent of age and sex in patients with type 2 diabetes mellitus. The highest odds of bladder cancer in rosiglitazone users was seen in those with <1 year of exposure. PMID:26871835

  18. Rosiglitazone Use and the Risk of Bladder Cancer in Patients With Type 2 Diabetes.

    PubMed

    Han, Eugene; Jang, Suk-Yong; Kim, Gyuri; Lee, Yong-Ho; Choe, Eun Yeong; Nam, Chung Mo; Kang, Eun Seok

    2016-02-01

    Patients with diabetes have a higher incidence of bladder cancer; however, the association between thiazolidinedione use and bladder cancer risk has been controversial. We aimed to investigate whether pioglitazone or rosiglitazone use is associated with bladder cancer risk in patients with type 2 diabetes mellitus.This nationwide nested case-control study used data set obtained from the Korean National Health Insurance Service National Sample Cohort 2002 to 2013. Among the 47,738 patients with incident diabetes, 85 cases of newly diagnosed bladder cancer and 850 controls (1:10 matched by age, sex, index year, and diabetes diagnosis year) were recruited. Type 2 diabetes mellitus and bladder cancer were diagnosed using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision code.More cases of bladder cancer were diagnosed in men (81.2%), and the stratified age peaked at 70 to 79 years old. Exclusive rosiglitazone use raised the incidence of bladder cancer (odds ratio [OR] = 3.07, 95% confidence interval [CI ] = 1.48-6.37). The risk of bladder cancer started to increase after less than 3 months use (OR = 3.30, 95% CI = 1.02-10.70) and peaked at 3 to 12 months of rosiglitazone use (OR = 4.48, 95% CI = 1.51-13.31). Patients were first exposed to exclusive rosiglitazone within 1 year (OR = 11.74, 95% CI = 2.46-56.12) and those who had consistently used it for 1 year (OR = 4.48 95% CI = 1.51-13.31), had higher risks of bladder cancer compared with nonthiazolidinedione users. Neither pioglitazone use nor exclusive pioglitazone use were associated with an increased incidence of bladder cancer.Rosiglitazone use is associated with an increased risk of incident bladder cancer independent of age and sex in patients with type 2 diabetes mellitus. The highest odds of bladder cancer in rosiglitazone users was seen in those with <1 year of exposure. PMID:26871835

  19. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    PubMed Central

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-01-01

    Introduction National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the ‘high risk’ patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Methods Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien–Dindo classification. Results The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien–Dindo grade 2–3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4–5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Discussion Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. Conclusions In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the ‘high-risk’ patient. PMID:26468369

  20. Dipeptidyl Peptidase-4 Inhibitor Use Is Not Associated With Acute Pancreatitis in High-Risk Type 2 Diabetic Patients: A Nationwide Cohort Study.

    PubMed

    Chang, Chia-Hsuin; Lin, Jou-Wei; Chen, Shu-Ting; Lai, Mei-Shu; Chuang, Lee-Ming; Chang, Yi-Cheng

    2016-02-01

    To analyze the association between use of DPP-4 inhibitors and acute pancreatitis in high-risk type 2 diabetic patients. A retrospective nationwide cohort study was conducted using the Taiwan National Health Insurance claim database. The risk associated with sitagliptin was compared to that with acarbose, a second-line antidiabetic drug prescribed for patients with similar diabetes severity and with a known neutral effect on pancreatitis. Between January 1, 2009 and December 31, 2010, a total of 8526 sitagliptin initiators and 8055 acarbose initiators who had hypertriglyceridemia or prior hospitalization history for acute pancreatitis were analyzed for the risk of hospitalization due to acute pancreatitis stratified for baseline propensity score. In the crude analysis, sitagliptin was associated with a decreased risk of acute pancreatitis (hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.62-0.88) compared to acarbose in diabetic patients with prior history of hospitalization for pancreatitis or hypertriglyceridemia. The association was abolished after stratification for propensity score quintiles (adjusted HR 0.95; 95% CI: 0.79-1.16). Similar results were found separately in both patients' histories of prior hospitalization of acute pancreatitis (adjusted HR 0.97; 95% CI: 0.76-1.24) and those with hypertriglyceridemia (adjusted HR 0.86; 95% CI: 0.65-1.13). No significant association was found for different durations or accumulative doses of sitagliptin. In the stratified analysis, no significant effect modification was found in relation to patients' characteristics. Use of sitagliptin was not associated with an increased risk of acute pancreatitis in high-risk diabetic patients with hypertriglyceridemia or with history of acute pancreatitis. PMID:26886601

  1. Stratifying diffuse large B-cell lymphoma patients treated with chemoimmunotherapy: GCB/non-GCB by immunohistochemistry is still a robust and feasible marker

    PubMed Central

    Batlle-López, Ana; de Villambrosía, Sonia González; Francisco, Mazorra; Malatxeberria, Sefora; Sáez, Anabel; Montalban, Carlos; Sánchez, Lydia; Garcia, Juan F.; González-Barca, Eva; López-Hernández, Andrés; Ruiz-Marcellan, MC; Mollejo, Manuela; Grande, Carlos; Richards, Kristy L.; Hsi, Eric D.; Tzankov, Alexandar; Visco, Carlo; Xu-Monette, Zijun Y.; Cao, Xin; Young, Ken H.; Piris, Miguel Ángel; Conde, Eulogio; Montes-Moreno, Santiago

    2016-01-01

    Diffuse large B cell lymphoma (DLBCL) is a heterogeneous group of aggressive lymphomas that can be classified into three molecular subtypes by gene expression profiling (GEP): GCB, ABC and unclassified. Immunohistochemistry-based cell of origin (COO) classification, as a surrogate for GEP, using three available immunohistochemical algorithms was evaluated in TMA-arranged tissue samples from 297 patients with de novo DLBCL treated by chemoimmunotherapy (R-CHOP and R-CHOP-like regimens). Additionally, the prognostic impacts of MYC, BCL2, IRF4 and BCL6 abnormalities detected by FISH, the relationship between the immunohistochemical COO classification and the immunohistochemical expression of MYC, BCL2 and pSTAT3 proteins and clinical data were evaluated. In our series, non-GCB DLBCL patients had significantly worse progression-free survival (PFS) and overall survival (OS), as calculated using the Choi, Visco-Young and Hans algorithms, indicating that any of these algorithms would be appropriate for identifying patients who require alternative therapies to R-CHOP. Whilst MYC abnormalities had no impact on clinical outcome in the non-GCB subtype, those patients with isolated MYC rearrangements and a GCB-DLBCL phenotype had worse PFS and therefore might benefit from novel treatment approaches. PMID:26910115

  2. Stratifying diffuse large B-cell lymphoma patients treated with chemoimmunotherapy: GCB/non-GCB by immunohistochemistry is still a robust and feasible marker.

    PubMed

    Batlle-López, Ana; González de Villambrosía, Sonia; Francisco, Mazorra; Malatxeberria, Sefora; Sáez, Anabel; Montalban, Carlos; Sánchez, Lydia; Garcia, Juan; González-Barca, Eva; López-Hernández, Andrés; Ruiz-Marcellan, M C; Mollejo, Manuela; Grande, Carlos; Richards, Kristy L; Hsi, Eric D; Tzankov, Alexandar; Visco, Carlo; Xu-Monette, Zijun Y; Cao, Xin; Young, Ken H; Piris, Miguel Ángel; Conde, Eulogio; Montes-Moreno, Santiago

    2016-04-01

    Diffuse large B cell lymphoma (DLBCL) is a heterogeneous group of aggressive lymphomas that can be classified into three molecular subtypes by gene expression profiling (GEP): GCB, ABC and unclassified. Immunohistochemistry-based cell of origin (COO) classification, as a surrogate for GEP, using three available immunohistochemical algorithms was evaluated in TMA-arranged tissue samples from 297 patients with de novo DLBCL treated by chemoimmunotherapy (R-CHOP and R-CHOP-like regimens). Additionally, the prognostic impacts of MYC, BCL2, IRF4 and BCL6 abnormalities detected by FISH, the relationship between the immunohistochemical COO classification and the immunohistochemical expression of MYC, BCL2 and pSTAT3 proteins and clinical data were evaluated. In our series, non-GCB DLBCL patients had significantly worse progression-free survival (PFS) and overall survival (OS), as calculated using the Choi, Visco-Young and Hans algorithms, indicating that any of these algorithms would be appropriate for identifying patients who require alternative therapies to R-CHOP. Whilst MYC abnormalities had no impact on clinical outcome in the non-GCB subtype, those patients with isolated MYC rearrangements and a GCB-DLBCL phenotype had worse PFS and therefore might benefit from novel treatment approaches. PMID:26910115

  3. Prognostic value of angiopoietin-2 for death risk stratification in patients with metastatic colorectal carcinoma

    PubMed Central

    Jary, Marine; Vernerey, Dewi; Lecomte, Thierry; Dobi, Erion; Ghiringhelli, François; Monnien, Franck; Godet, Yann; Kim, Stefano; Bouché, Olivier; Fratte, Serge; Gonçalves, Anthony; Leger, Julie; Queiroz, Lise; Adotevi, Olivier; Bonnetain, Franck; Borg, Christophe

    2015-01-01

    Background Baseline prognostic biomarkers stratifying treatment strategies in first-line metastatic colorectal cancer (mCRC) are lacking. Angiopoietin-2 (Ang-2) is proposed as a potential biomarker in several cancers. We therefore decided to establish the additional prognostic value of Ang-2 for overall survival (OS) in first-line mCRC patients. Methods We enrolled 177 patients treated with a bevacizumab containing chemotherapy in two prospective phase II clinical trials. Patient plasma samples were collected at baseline. Enzyme-linked immunosorbent assays were used to measure Ang-2. Results The multivariable Cox model identified increased LDH (HR=1.60, 95%CI: 1.04–2.45, p=0.03) and Ang-2 log-transformation level (HR=1.59, 95%CI: 1.14–2.21, p=0.0065) as two significant independent OS prognostic factors. It exhibited good calibration (p=0.8) and discrimination (C-index: 0.64; 95%CI: 0.58–0.68). Ang-2 parameter inclusion in the GERCOR reference model significantly and strongly improved its discriminative ability since the C-statistic increased significantly from 0.61 to 0.63 (bootstrap mean difference=0.07, 95%CI: 0.069–0.077). Interestingly, the addition of Ang-2 binary information with a 5 ng/mL cut-off value to the GERCOR model allowed the reclassification of intermediate-risk profile patients (41%) into two subsets of low and high-risks. Conclusions Our study provides robust evidence in favour of baseline Ang-2 prognostic value for OS adding to the conventional factors. Its assessment appears to be useful for the improvement in risk stratification for patients with intermediate-risk profile. Impact Ang-2 ability to predict OS at diagnosis could be of interest in the selection of patients eligible to intermittent or sequential therapeutic strategies dedicated to the optimization of patient’s quality of life and chemotherapy cost-effectiveness. PMID:25583947

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

    SciTech Connect

    Lee, Ching-Chih; Su, Yu-Chieh; Ho, Hsu-Chueh; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Chou, Pesus; Huang, Yung-Sung

    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.

  5. Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing.

    PubMed

    Vollert, Jan; Kramer, Martin; Barroso, Alejandro; Freynhagen, Rainer; Haanpää, Maija; Hansson, Per; Jensen, Troels S; Kuehler, Bianca M; Maier, Christoph; Mainka, Tina; Reimer, Maren; Segerdahl, Märta; Serra, Jordi; Solà, Romà; Tölle, Thomas R; Treede, Rolf-Detlef; Baron, Ralf

    2016-08-01

    The painDETECT Questionnaire (PDQ) is commonly used as a screening tool to discriminate between neuropathic pain (NP) and nociceptive pain, based on the self-report of symptoms, including pain qualities, numbness, and pain to touch, cold, or heat. However, there are minimal data about whether the PDQ is differentially sensitive to different sensory phenotypes in NP. The aim of the study was to analyze whether the overall PDQ score or its items reflect phenotypes of sensory loss in NP as determined by quantitative sensory testing. An exploratory analysis in the Innovative Medicines Initiative Europain and Neuropain database was performed. Data records of 336 patients identified with NP were grouped into sensory profiles characterized by (1) no loss of sensation, (2) loss of thermal sensation, (3) loss of mechanical sensation, and (4) loss of thermal and mechanical sensation. painDETECT Questionnaire profiles were analyzed in a 2-factor analysis of variance. Patients with loss of thermal sensation (2 and 4) significantly more often reported pain evoked by light touch, and patients with loss of mechanical sensation (3 and 4) significantly more often reported numbness and significantly less often burning sensations and pain evoked by light touch. Although the PDQ was not designed to assess sensory loss, single items reflect thermal and/or mechanical sensory loss at group level, but because of substantial variability, the PDQ does not allow for individual allocation of patients into sensory profiles. It will be useful to develop screening tools according to the current definition of NP. PMID:27093432

  6. 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…

  7. Risk factors for osteoporosis in inflammatory bowel disease patients

    PubMed Central

    Lima, Carla Andrade; Lyra, Andre Castro; Rocha, Raquel; Santana, Genoile Oliveira

    2015-01-01

    Inflammatory bowel disease (IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density (BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn’s disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored. PMID:26600979

  8. An exploratory retrospective assessment of a quantitative measure of diabetes risk: medical management and patient impact in a primary care setting

    PubMed Central

    Courtney, Maureen R; Moler, Edward J; Osborne, John A; Whitney, Geoff; Conard, Scott E

    2015-01-01

    Background Primary care providers with limited time and resources bear a heavy responsibility for chronic disease prevention or progression. Reliable clinical tools are needed to risk stratify patients for more targeted care. This exploratory study examined the care of patients who had been risk stratified regarding their likelihood of clinically progressing to type 2 diabetes. Methods This was a retrospective chart review pilot study conducted to assess a primary care provider’s use of a risk screening test. In this quality improvement project, the result of the risk screening was examined in relation to its influence on medical management and clinical impact on patients at risk for diabetes. All providers were board certified in family medicine and had more than 10 years clinical experience in managing diabetes and prediabetes. No specific clinical practice guidelines were mandated for patient care in this pilot study. Physicians in the practice group received an orientation to the diabetes risk measure and its availability for use in a pilot study to be conducted over a 6-month period. We identified the 696 nondiabetic adults in family practices who received a risk screening test (PreDx®, a multi-marker blood test that estimates the 5-year likelihood of conversion to type 2 diabetes) between June and November 2011 for a 6-month sample. A comparison group of 2,002 patients from a total database of 3.2 million patients who did not receive the risk test was randomly selected from the same clinical database after matching for age, sex, selected diagnoses, and metabolic risk factors. Patient groups were compared for intensity of care provided and clinical impact. Results Compared to patients with a similar demographic and diagnostic profile, patients who had the risk test received more intensive primary care and had better clinical outcome than comparison patients. Risk-tested patients were more likely to return for follow-up visits, be monitored for relevant

  9. Risk of cardiovascular disease? A qualitative study of risk interpretation among patients with high cholesterol

    PubMed Central

    2013-01-01

    Background Previous studies have shown the importance of paying attention to lay peoples’ interpretations of risk of disease, in order to explain health-related behavior. However, risk interpretations interplay with social context in complex ways. The objective was to explore how asymptomatic patients with high cholesterol interpret risk of cardiovascular disease. Methods Fourteen patients with high cholesterol and risk of cardiovascular disease were interviewed, and patterns across patient accounts were identified and analysed from an ethnographic approach. Results Information from the general practitioner about high cholesterol and risk of cardiovascular disease was reinterpreted in everyday social life. The risk associated with fatty foods was weighed against the pleasures of social and cultural events in which this type of food was common and cherished. A positive mindset was applied as a strategy to lower the risk of having high cholesterol, but knowledge about risk was viewed as a cause of anxiety and self-absorption, and this anxiety made the body susceptible to disease, hampering the chances for healthy life. Conclusion Interpretations of high cholesterol and risk of cardiovascular disease are embedded in social relations and everyday life concerns. This should be addressed in general practice in preference-sensitive cases about risk-reducing medication. Trial registration ClinicalTrials.gov: NCT01187056 PMID:24040920

  10. Initial clinical validation of Health Heritage, a patient-facing tool for personal and family history collection and cancer risk assessment.

    PubMed

    Baumgart, Leigh A; Postula, Kristen J Vogel; Knaus, William A

    2016-04-01

    Personal and family health histories remain important independent risk factors for cancer; however they are currently not being well collected or used effectively. Health Heritage was designed to address this need. The purpose of this study was to validate the ability of Health Heritage to identify patients appropriate for further genetic evaluation and to accurately stratify cancer risk. A retrospective chart review was conducted on 100 random patients seen at an adult genetics clinic presenting with concern for an inherited predisposition to cancer. Relevant personal and family history obtained from the patients' medical records was entered into Health Heritage. Recommendations by Health Heritage were compared to national guidelines of eligibility for genetic evaluation. Agreement between Health Heritage referral for genetic evaluation and guideline eligibility for genetic evaluation was 97 % (sensitivity 98 % and specificity 88 %). Risk stratification for cancer was also compared between Health Heritage and those documented by a geneticist. For patients at increased risk for breast, ovarian, or colorectal cancer as determined by the geneticist, risk stratification by Health Heritage agreed 90, 93, and 75 %, respectively. Discordances in risk stratification were attributed to both complex situations better handled by the geneticist and Health Heritage's adherence to incorporating all information into its algorithms. Health Heritage is a clinically valid tool to identify patients appropriate for further genetic evaluation and to encourage them to confirm the assessment and management recommendations with cancer genetic experts. Health Heritage also provides an estimate of cancer risk that is complementary to a genetics team. PMID:26711915

  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. Early Identification of Patients at Risk of Acute Lung Injury

    PubMed Central

    Gajic, Ognjen; Dabbagh, Ousama; Park, Pauline K.; Adesanya, Adebola; Chang, Steven Y.; Hou, Peter; Anderson, Harry; Hoth, J. Jason; Mikkelsen, Mark E.; Gentile, Nina T.; Gong, Michelle N.; Talmor, Daniel; Bajwa, Ednan; Watkins, Timothy R.; Festic, Emir; Yilmaz, Murat; Iscimen, Remzi; Kaufman, David A.; Esper, Annette M.; Sadikot, Ruxana; Douglas, Ivor; Sevransky, Jonathan

    2011-01-01

    Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk. ALI developed a median of 2 (interquartile range 1–4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80 (95% confidence interval, 0.78–0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9–5.7). Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772). PMID:20802164

  13. Increased risk of osteoporosis in patients with erectile dysfunction

    PubMed Central

    Wu, Chieh-Hsin; Lu, Ying-Yi; Chai, Chee-Yin; Su, Yu-Feng; Tsai, Tai-Hsin; Tsai, Feng-Ji; Lin, Chih-Lung

    2016-01-01

    Abstract In this study, we aimed to investigate the risk of osteoporosis in patients with erectile dysfunction (ED) by analyzing data from the Taiwan National Health Insurance Research Database (NHIRD). From the Taiwan NHIRD, we analyzed data on 4460 patients aged ≥40 years diagnosed with ED between 1996 and 2010. In total, 17,480 age-matched patients without ED in a 1:4 ratio were randomly selected as the non-ED group. The relationship between ED and the risk of osteoporosis was estimated using Cox proportional hazard regression models. During the follow-up period, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The overall incidence of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (9.74 vs 2.47 per 1000 person-years) after controlling for covariates. Compared with patients without ED, patients with psychogenic and organic ED were 3.19- and 3.03-fold more likely to develop osteoporosis. Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED. PMID:27368024

  14. Increased Risk of Ischemic Stroke in Patients with Benign Paroxysmal Positional Vertigo: A 9-Year Follow-Up Nationwide Population Study in Taiwan

    PubMed Central

    Kao, Chung-Lan; Cheng, Yuan-Yang; Leu, Hsin-Bang; Chen, Tzeng-Ji; Ma, Hsin-I; Chen, Jaw-Wen; Lin, Shing-Jong; Chan, Rai-Chi

    2014-01-01

    Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo and is characterized by episodic dizziness related to changes in head position relative to gravity. BPPV symptoms can be similar to those of central nervous system vascular diseases. The association between BPPV and ischemic stroke has not yet been investigated. The study cohort consisted of patients who were diagnosed with BPPV at least twice in the previous year as an outpatient or for whom BPPV was the primary diagnosis as an inpatient (n = 4104). An age- and gender-matched sample that excluded patients with a diagnosis of any form of vertigo was selected as the comparison cohort (n = 8397). All cases were followed up from January 1, 2000, to December 31, 2008. The demographic characteristics, medical comorbidities, and use of medications in both groups were investigated using chi-square tests. A stratified analysis of stroke risk factors was performed to determine the hazard ratios of BPPV. During the 9-year follow-up period, 185 of the 4104 (4.5%) subjects with BPPV and 240 of the 8379 (2.9%) subjects without BPPV developed ischemic strokes. The crude hazard ratio of BPPV for developing ischemic strokes was 1.708. After adjusting for stroke risk factors, the risk of developing ischemic strokes in BPPV subjects was 1.415-fold higher than the risk among those without BPPV (confidence interval: 1.162–1.732, p = 0.001). After a subgroup analysis stratified according to stroke risk factors, BPPV remained independently associated with a higher risk of developing future ischemic stroke. We conclude that BPPV is independently associated with a risk of subsequent ischemic stroke. More aggressive control of modifiable risk factors for ischemic strokes should be conducted in patients with BPPV. PMID:24917815

  15. Locoregional Recurrence Risk in Breast Cancer Patients with Estrogen Receptor Positive Tumors and Residual Nodal Disease following Neoadjuvant Chemotherapy and Mastectomy without Radiation Therapy

    PubMed Central

    Kandula, Shravan; Switchenko, Jeffrey M.; Harari, Saul; Fasola, Carolina; Mister, Donna; Yu, David S.; Zelnak, Amelia B.; Torres, Mylin A.

    2015-01-01

    Among breast cancer patients treated with neoadjuvant chemotherapy (NAC) and mastectomy, locoregional recurrence (LRR) rates are unclear in women with ER+ tumors treated with adjuvant endocrine therapy without postmastectomy radiation (PMRT). To determine if PMRT is needed in these patients, we compared LRR rates of patients with ER+ tumors (treated with adjuvant endocrine therapy) with women who have non-ER+ tumors. 85 consecutive breast cancer patients (87 breast tumors) treated with NAC and mastectomy without PMRT were reviewed. Patients were divided by residual nodal disease (ypN) status (ypN+ versus ypN0) and then stratified by receptor subtype. Among ypN+ patients (n = 35), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 5%, 33%, and 37%, respectively (p = 0.02). Among ypN+/ER+ patients, lymphovascular invasion and grade three disease increased the five-year LRR risk to 13% and 11%, respectively. Among ypN0 patients (n = 52), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 7%, 22%, and 6%, respectively (p = 0.71). In women with ER+ tumors and residual nodal disease, endocrine therapy may be sufficient adjuvant treatment, except in patients with lymphovascular invasion or grade three tumors where PMRT may still be indicated. PMID:26266050

  16. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks.

    PubMed

    Raven, Maria C; Billings, John C; Goldfrank, Lewis R; Manheimer, Eric D; Gourevitch, Marc N

    2009-03-01

    Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs. PMID:19082899

  17. Risk and experience: effects of experiential learning and patient characteristics in interpretation of dynamic risk graphics.

    PubMed

    Ancker, Jessica S; Senathirajah, Yalini; Weber, Elke U; Kukafka, Rita

    2006-01-01

    Risks can be explained to patients in narratives, numbers, or graphs. All these methods depend upon description. However, decisions from description differ systematically from decisions about risks that are experienced through activities such as drawing cards from a deck. We have developed a dynamic graphic interface that provides a virtual experience of event probabilities, with potential applications in patient education and decision support. PMID:17238464

  18. A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients

    PubMed Central

    Rajendran, Ranjith; Sherry, Leighann; Deshpande, Ashutosh; Johnson, Elizabeth M.; Hanson, Mary F.; Williams, Craig; Munro, Carol A.; Jones, Brian L.; Ramage, Gordon

    2016-01-01

    This study provide an up-to-date overview of the epidemiology and risk factors for Candida bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland. Candida isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as albicans and non-albicans cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with Candida albicans, followed by C. glabrata (35%), C. parapsilosis (11.5%), and remainder with other Candida spp. C. albicans and C. glabrata infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with C. albicans was significantly lower compared to non-C. albicans and catheter line removal in C. albicans patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with C. albicans infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among C. glabrata isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of C. glabrata isolates were resistant to anidulafungin. We have observed a shift in Candida spp. with an increasing isolation of C. glabrata. Delay and choice of antifungal treatment are associated with poor clinical outcomes. PMID:27379047

  19. Increased Risk of Dementia in Patients With Erectile Dysfunction

    PubMed Central

    Yang, Chun-Ming; Shen, Yuan-Chi; Weng, Shih-Feng; Wang, Jhi-Joung; Tien, Kai-Jen

    2015-01-01

    Abstract Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and cerebrovascular disease. However, the relationship between ED and dementia has rarely been examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer dementia in patients with ED. We collected a random sample of 1,000,000 individuals from Taiwan's National Health Insurance database. From this sample, we identified 4153 patients with newly diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765 patients without ED. All patients were tracked for 7 years from the index date to identify which of them subsequently developed dementia. During the 7-year follow-up period, the incidence rate of dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was 21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities, patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI = 1.34–2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia. Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and non-Alzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31–2.16, P < 0.0001 and 1.63, 95% CI = 1.02–2.62, P = 0.0429, respectively). Log-rank test revealed that patients with ED had significantly higher cumulative incidence rates of dementia than those without (P < 0.0001). Patients with ED are at an increased risk for dementia later in life.

  20. Increased Risk of Dementia in Patients With Erectile Dysfunction

    PubMed Central

    Yang, Chun-Ming; Shen, Yuan-Chi; Weng, Shih-Feng; Wang, Jhi-Joung; Tien, Kai-Jen

    2015-01-01

    Abstract Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and cerebrovascular disease. However, the relationship between ED and dementia has rarely been examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer dementia in patients with ED. We collected a random sample of 1,000,000 individuals from Taiwan's National Health Insurance database. From this sample, we identified 4153 patients with newly diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765 patients without ED. All patients were tracked for 7 years from the index date to identify which of them subsequently developed dementia. During the 7-year follow-up period, the incidence rate of dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was 21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities, patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI = 1.34–2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia. Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and non-Alzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31–2.16, P < 0.0001 and 1.63, 95% CI = 1.02–2.62, P = 0.0429, respectively). Log-rank test revealed that patients with ED had significantly higher cumulative incidence rates of dementia than those without (P < 0.0001). Patients with ED are at an increased risk for dementia later in life. PMID:26091478

  1. Mapping Patterns of Ipsilateral Supraclavicular Nodal Metastases in Breast Cancer: Rethinking the Clinical Target Volume for High-risk Patients

    SciTech Connect

    Jing, Hao; Wang, Shu-Lian; Li, Jing; Xue, Mei; Xiong, Zu-Kun; Jin, Jing; Wang, Wei-Hu; Song, Yong-Wen; Liu, Yue-Ping; Ren, Hua; Fang, Hui; Yu, Zi-Hao; Liu, Xin-Fan; Li, Ye-Xiong

    2015-10-01

    Purpose: To map the location of metastatic supraclavicular (SCV) lymph nodes (LNMs) in breast cancer patients with SCV node involvement and determine whether and where the radiation therapy clinical target volume (CTV) of this region could be modified in high-risk subsets. Methods and Materials: Fifty-five patients with metastatic SCV LNMs were eligible for geographic mapping and atlas coverage analysis. All LNMs and their epicenters were registered proportionally by referencing the surrounding landmarks onto simulation computed tomography images of a standard patient. CTVs based on selected SCV atlases, including the one by the Radiation Therapy Oncology Group (RTOG) were contoured. A modified SCV CTV was tried and shown to have better involved-node coverage and thus theoretically improved prophylaxis in this setting. Results: A total of 50 (91%) and 45 (81.8%) patients had LNMs in the medial and lateral SCV subregions, respectively. Also, 36 patients (65.5%) had LNMs located at the junction of the jugular-subclavian veins. All nodes were covered in only 25.5% to 41.8% of patients by different atlases. The RTOG atlas covered all nodes in 25.5% of patients. Stratified by the nodes in all the patients as a whole, 49.2% to 81.3% were covered, and the RTOG atlas covered 62.6%. The lateral and posterior borders were the most overlooked locations. Modification by extending the borders to natural anatomic barriers allowed the new CTV to cover all the nodes in 81.8% of patients and encompass 96.1% of all the nodes. Conclusions: According to the distribution of SCV LNMs, the extent of existing atlases might not be adequate for potential metastatic sites in certain groups of patients. The extension of the lateral and posterior CTV borders in high-risk or recurrent patients might be a reasonable approach for increasing coverage. However, additional data in more homogeneous populations with localized disease are needed before routine application.

  2. Fracture risk in patients with monoclonal gammopathy of undetermined significance.

    PubMed

    Gregersen, Henrik; Jensen, Paw; Gislum, Mette; Jørgensen, Birgit; Sørensen, Henrik Toft; Nørgaard, Mette

    2006-10-01

    Little information is available on the risk of fractures in patients with monoclonal gammopathy of undetermined significance (MGUS). We identified 1535 patients with MGUS between 1978 and 2003 in North Jutland County, Denmark. The population control group consisted of 15 350 persons selected from the Danish Central Population Registry, matched by age and sex. Data on fractures in the two groups were obtained from the regional Hospital Discharge Registry. In the MGUS cohort, 187 first-time fractures were identified during 9754 person-years of follow-up, corresponding to an incidence rate of 19/1000 person-years. The adjusted relative risk for fractures among MGUS patients compared with population controls was 1.4 [95% confidence interval (CI), 1.2-1.6]. After 5 years of follow-up, the risk difference was 1.8% (95% CI, 0.5-3.0). Six of the 187 MGUS patients with fractures were later diagnosed with malignant transformation. Relative risks for fractures were increased in IgG-type MGUS [1.3 (95% CI,1.1-1.6)], IgM-type MGUS [1.6 (95% CI, 1.1-2.2)] and MGUS with kappa light chain [1.4 (95% CI, 1.1-1.7)]. MGUS patients had an increased risk of fractures, which could not be explained by comorbidity, advanced age, gender or malignant transformation. PMID:16925792

  3. 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.

  4. Awareness of vitamin D deficiency among at-risk patients

    PubMed Central

    2012-01-01

    Background Vitamin D deficiency is a significant problem for a growing proportion of the UK population. Individuals with dark or covered skin are at particularly high risk due to ethno-cultural, environmental and genetic factors. We assessed the level of awareness of vitamin D deficiency among at-risk patients in order to identify groups most in need of education. Findings A cross-sectional survey using a piloted questionnaire was conducted among consecutive at-risk patients without a diagnosis of Vitamin D deficiency arriving at a large inner city general practice in the North West of England over a five day period. The survey was completed by 221 patients. The mean age was 35 years. 28% of them (n = 61) had never heard about vitamin D. Older patients (p = 0.003) were less likely to have heard about vitamin D. 54% of participants were unaware of the commonest symptoms of vitamin D deficiency. 34% did not expose their skin other than their face in the last one year, and 11% did not include vitamin D rich foods in their diet. Conclusion The majority of at-risk patients are aware of vitamin D; nevertheless, there is a significant lack of knowledge among older people, who have higher morbidity. A programme of targeted education of the at-risk population is recommended. PMID:22230819

  5. Adrenomedullin for Risk Stratification of Emergency Patients With Nonspecific Complaints

    PubMed Central

    Nickel, Christian Hans; Messmer, Anna Sarah; Ghanim, Leyla; Ilsemann-Karakoumis, Julia; Giersdorf, Sven; Hertel, Sabine; Ernst, Susanne; Geigy, Nicolas; Bingisser, Roland

    2016-01-01

    Abstract Patients with nonspecific complaints (NSC) presenting to the emergency department (ED) are at risk of life-threatening conditions. New stress biomarkers such as the midregional portion of adrenomedullin (MR-proADM) promise to support decision-making. This study tested the following hypotheses: biomarker-assisted disposition of patients with NSC will not increase mortality. Second, discharge from the ED will increase if clinical risk assessment is combined with low MR-proADM levels. Third, inappropriate disposition to a lower level of care will decrease, if clinical assessment is combined with high MR-proADM levels, and fourth that this algorithm is feasible in the ED setting. Prospective, multicenter, randomized, controlled interventional feasibility study with a 30-day follow-up, including patients with NSC. Patients were randomly assigned to either the standard group (decision-making solely based on clinical assessment) or the Novum group (biomarker-assisted). Regarding disposition, patients were assigned to 1 of 3 risk classes: high-risk (admission to hospital), intermediate risk (community geriatric hospital), and low-risk patients (discharge). In the Novum group, in addition to clinical risk assessment, the information of the MR-proADM level was used. Unless there were overruling criteria, patients were transferred or discharged according to the risk assessment. Primary endpoint was 30-day mortality. Secondary endpoints were comparisons of patient disposition and related mortality rates, ED, and hospital length of stay and readmission. The final study cohort consisted of 398 patients (210 in the Standard group and 188 in the Novum group). Overruling, that is, disposition not according to the result of the proposed algorithm occurred in 51 cases. Baseline characteristics between Standard and Novum groups were similar. The mortality rate in the Novum group was 4.3%, as compared to the Standard group mortality of 6.2%, which was not significantly

  6. Lepidic and micropapillary growth pattern and expression of Napsin A can stratify patients of stage I lung adenocarcinoma into different prognostic subgroup

    PubMed Central

    Yang, Xin; Liu, Yu; Lian, Fang; Guo, Lei; Wen, Peng; Liu, Xiu-Yun; Lin, Dong-Mei

    2014-01-01

    Histologic categories and related growth pattern proposed by IASLC/ATS/ERS classification has been reported to be prognostically important in lung adenocarcinoma. Thyroid transcription factor-1 (TTF1) and Napsin A have been investigated as potential prognostic parameters with conflicting results. A total of 211 cases with stage I lung adenocarcinoma were analyzed according to the IASLC/ATS/ERS classification with slight modifications. Expression levels of TTF1 and Napsin A were evaluated by immunohistochemistry. In univariate analyses, we found female sex (p=0.009), lepidic growth pattern (P=0.011) and lack of micropapillary pattern (P=0.048) were favorable predictor significantly associated with disease-free survival (DFS). Lack of mitosis (P=0.044) and Napsin A expression (P=0.031) were favorable predictors for overall survival (OS). Tumors with a maximum diameter ≤2 cm had both longer DFS (P=0.008) and OS (P=0.020). Negative TTF1 expression indicated increased risk of death, but failure in statistical significance (P=0.215). After multivariate analysis, histologic subtype, tumor size and gender were identified as independent predictor for DFS (RR: 0.343, 3.697, 0.494; P=0.006, 0.029, 0.019), no feature was found as an independent predictor for overall survival (P>0.05). To conclude, lepidic growth pattern, female sex and tumor size ≤2 cm are independent favorable predictors for tumor recurrence, tumors with more than 5% percentage of lepidic growth pattern will have a better prognosis than absence, in early-stage lung adenocarcinoma. PMID:24817941

  7. Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease

    PubMed Central

    Wu, Chieh-Hsin; Tung, Yi-Ching; Chai, Chee-Yin; Lu, Ying-Yi; Su, Yu-Feng; Tsai, Tai-Hsin; Kuo, Keng-Liang; Lin, Chih-Lung

    2016-01-01

    Abstract To investigate osteoporosis risk in patients with peptic ulcer disease (PUD) using a nationwide population-based dataset. This Taiwan National Health Insurance Research Database (NHIRD) analysis included 27,132 patients aged 18 years and older who had been diagnosed with PUD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 531–534) during 1996 to 2010. The control group consisted of 27,132 randomly selected (age- and gender)-matched patients without PUD. The association between PUD and the risk of developing osteoporosis was estimated using a Cox proportional hazard regression model. During the follow-up period, osteoporosis was diagnosed in 2538 (9.35 %) patients in the PUD group and in 2259 (8.33 %) participants in the non-PUD group. After adjusting for covariates, osteoporosis risk was 1.85 times greater in the PUD group compared to the non-PUD group (13.99 vs 5.80 per 1000 person-years, respectively). Osteoporosis developed 1 year after PUD diagnosis. The 1-year follow-up period exhibited the highest significance between the 2 groups (hazard ratio [HR] = 63.44, 95% confidence interval [CI] = 28.19–142.74, P < 0.001). Osteoporosis risk was significantly higher in PUD patients with proton-pump-inhibitors (PPIs) use (HR = 1.17, 95% CI = 1.03–1.34) compared to PUD patients without PPIs use. This study revealed a significant association between PUD and subsequent risk of osteoporosis. Therefore, PUD patients, especially those treated with PPIs, should be evaluated for subsequent risk of osteoporosis to minimize the occurrence of adverse events. PMID:27100415

  8. Cardiovascular risk factor management in patients with RA compared to matched non-RA patients

    PubMed Central

    Cawston, Helene; Bourhis, Francois; Al, Maiwenn; Rutten-van Mölken, Maureen P. M. H.; Liao, Katherine P.; Solomon, Daniel H.

    2016-01-01

    Objective. RA is associated with a 50–60% increase in risk of cardiovascular (CV) death. This study aimed to compare management of CV risk factors in RA and matched non-RA patients. Methods. A retrospective cohort study was conducted using UK clinical practice data. Patients presenting with an incident RA diagnosis were matched 1:4 to non-RA patients based on a propensity score for RA, entry year, CV risk category and treatment received at index date (date of RA diagnosis). Patients tested and treated for CV risk factors as well as those attaining CV risk factor management goals were evaluated in both groups. Results. Between 1987 and 2010, 24 859 RA patients were identified and matched to 87 304 non-RA patients. At index date, groups had similar baseline characteristics. Annual blood pressure, lipids and diabetes-related testing were similar in both groups, although CRP and ESR were higher in RA patients at diagnosis and decreased over time. RA patients prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0 to 20.6% for lipid-lowering treatments and from 5.1 to 6.4% for antidiabetics. Similar treatment percentages were observed in non-RA patients, although slightly lower for antihypertensives. Modest (2%) but significantly lower attainment of lipid and diabetes goals at 1 year was observed in RA patients. Conclusion. There were no differences between groups in the frequency of testing and treatment of CV risk factors. Higher CV risk in RA patients seems unlikely to be driven by differences in traditional CV risk factor management. PMID:26705329

  9. The risk of non-melanoma skin cancer in HIV-infected patients: new data and meta-analysis.

    PubMed

    Zhao, Honglei; Shu, Guobin; Wang, Songting

    2016-06-01

    The role of HIV/AIDS in non-melanoma skin cancer (NMSC) is not well defined. We sought to update the evidence of the association between HIV/AIDS and risk of NMSC by gender and antiretroviral therapy (ART). We searched MEDLINE and EMBASE on 29 February 2014. Standardised incidence ratios with corresponding 95% confidence intervals were extracted and combined using generic inverse variance methods assuming a random effects model. Six studies including 78,794 patients with HIV/AIDS fulfilled the inclusion criteria. Analysis of all studies showed that HIV/AIDS was associated with an increased risk of NMSC (standardised incidence ratio 2.76; 95% confidence interval 2.55-2.98). The standardised incidence ratios of NMSC were 3.63 (1.08-12.22) for men and 2.18 (1.24-3.83) for women with HIV/AIDS, respectively. In analysis stratified by ART, we found that individuals receiving ART had lower risk of developing NMSC than individuals who had not received ART (standardised incidence ratio, 95% confidence interval; 1.95 [1.10-3.47] versus 2.11 [1.44-3.12]). HIV/AIDS is associated with an increased risk of NMSC in both male and female patients. The use of ART appears to be beneficial in protecting against the development of NMSC. PMID:25999166

  10. 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

  11. Comparative accuracy of different risk scores in assessing cardiovascular risk in Indians: A study in patients with first myocardial infarction

    PubMed Central

    Bansal, Manish; Kasliwal, Ravi R.; Trehan, Naresh

    2014-01-01

    Background Although a number of risk assessment models are available for estimating 10-year risk of cardiovascular (CV) events in patients requiring primary prevention of CV disease, the predictive accuracy of the contemporary risk models has not been adequately evaluated in Indians. Methods 149 patients [mean age 59.4 ± 10.6 years; 123 (82.6%) males] without prior CV disease and presenting with acute myocardial infarction (MI) were included. The four clinically most relevant risk assessment models [Framingham Risk score (RiskFRS), World Health Organization risk prediction charts (RiskWHO), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA) and the 3rd Joint British Societies' risk calculator (RiskJBS)] were applied to estimate what would have been their predicted 10-year risk of CV events if they had presented just prior to suffering the acute MI. Results RiskWHO provided the lowest risk estimates with 86.6% patients estimated to be having <20% 10-year risk. In comparison, RiskFRS and RiskACC/AHA returned higher risk estimates (61.7% and 69.8% with risk <20%, respectively; p values <0.001 for comparison with RiskWHO). However, the RiskJBS identified the highest proportion of the patients as being at high-risk (only 44.1% at <20% risk, p values 0 < 0.01 for comparison with all the other 3 risk scores). Conclusions This is the first study to show that in Indian patients presenting with acute MI, RiskJBS is likely to identify the largest proportion of the patients as at ‘high-risk’ as compared to RiskWHO, RiskFRS and RiskACC/AHA. However, large-scale prospective studies are needed to confirm these findings. PMID:25634388

  12. Predicting 30- to 120-Day Readmission Risk among Medicare Fee-for-Service Patients Using Nonmedical Workers and Mobile Technology

    PubMed Central

    Ostrovsky, Andrey; O'Connor, Lori; Marshall, Olivia; Angelo, Amanda; Barrett, Kelsy; Majeski, Emily; Handrus, Maxwell; Levy, Jeffrey

    2016-01-01

    Objective Hospital readmissions are a large source of wasteful healthcare spending, and current care transition models are too expensive to be sustainable. One way to circumvent cost-prohibitive care transition programs is complement nurse-staffed care transition programs with those staffed by less expensive nonmedical workers. A major barrier to utilizing nonmedical workers is determining the appropriate time to escalate care to a clinician with a wider scope of practice. The objective of this study is to show how mobile technology can use the observations of nonmedical workers to stratify patients on the basis of their hospital readmission risk. Materials and Methods An area agency on aging in Massachusetts implemented a quality improvement project with the aim of reducing 30-day hospital readmission rates using a modified care transition intervention supported by mobile predictive analytics technology. Proprietary readmission risk prediction algorithms were used to predict 30-, 60-, 90-, and 120-day readmission risk. Results The risk score derived from the nonmedical workers' observations had a significant association with 30-day readmission rate with an odds ratio (OR) of 1.12 (95 percent confidence interval [CI], 1 .09–1.15) compared to an OR of 1.25 (95 percent CI, 1.19–1.32) for the risk score using nurse observations. Risk scores using nurse interpretation of nonmedical workers' observations show that patients in the high-risk category had significantly higher readmission rates than patients in the baseline-risk and mild-risk categories at 30, 60, 90, and 120 days after discharge. Of the 1,064 elevated-risk alerts that were triaged, 1,049 (98.6 percent) involved the nurse care manager, 804 (75.6 percent) involved the patient, 768 (72.2 percent) involved the health coach, 461 (43.3 percent) involved skilled nursing, and 235 (22.1 percent) involved the outpatient physician in the coordination of care in response to the alert. Discussion The predictive

  13. 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

  14. Making risk meaningful: developing caring relationships with AIDS patients.

    PubMed

    Reutter, L I; Northcott, H C

    1993-09-01

    A qualitative study was conducted in order to understand how nurses cope with the risk of contagion while providing care to persons with AIDS (PWAs). Data were collected through in-depth interviews with 13 nurses who had cared for PWAs in an acute-care hospital in a western Canadian city. The data were analysed using the constant comparative methodology of grounded theory. The analysis revealed that caring for PWAs involved achieving a sense of control over uncertainty. One aspect of this process, making risk meaningful, centred on efforts to justify caring for PWAs in the face of risk. The purpose of this paper is to describe how nurses make risk meaningful. A sense of meaning was found to be related to three major factors: accepting the patient as a person who needs and deserves care, finding work enjoyable and worthwhile, and professional commitment to care for all patients. Attaining a sense of meaning led to a reappraisal of the risk situation as worthy of investment and provided the motivation to care for patients in spite of risk. The paper concludes with implications for practice and suggestions for further research. PMID:8258595

  15. Risk of suicide in patients with dementia: a case study.

    PubMed

    Nicholson, Linda

    Evidence indicates that the risk of attempted suicide is a significant issue among people with dementia, however there is a lack of information to guide professional practice. This article uses a case study to reflect on the risk management strategies and ethics of suicide and assisted suicide in relation to a specific patient with dementia. It analyses recommendations aimed at improving the lived experience of people with dementia and those involved in their care, including providing patients with a formal diagnosis as early as possible. PMID:24219483

  16. Elderly patients with a hip fracture: the risk for delirium.

    PubMed

    Schuurmans, Marieke J; Duursma, Sijmen A; Shortridge-Baggett, Lillie M; Clevers, Gert-Jan; Pel-Littel, Ruth

    2003-05-01

    This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised. PMID:12764718

  17. Bevacizumab Increases Risk for Severe Proteinuria in Cancer Patients

    PubMed Central

    Kim, Christi; Baer, Lea; Zhu, Xiaolei

    2010-01-01

    Treatment with the chemotherapeutic agent bevacizumab, a humanized mAb that neutralizes vascular endothelial growth factor, can lead to proteinuria and renal damage. The risk factors and clinical outcomes of renal adverse events are not well understood. We performed a systematic review and meta-analysis of published randomized, controlled trials to assess the overall risk for severe proteinuria with bevacizumab. We analyzed data from 16 studies comprising 12,268 patients with a variety of tumors. The incidence of high-grade (grade 3 or 4) proteinuria with bevacizumab was 2.2% (95% confidence interval [CI] 1.2 to 4.3%). Compared with chemotherapy alone, bevacizumab combined with chemotherapy significantly increased the risk for high-grade proteinuria (relative risk 4.79; 95% CI 2.71 to 8.46) and nephrotic syndrome (relative risk 7.78; 95% CI 1.80 to 33.62); higher dosages of bevacizumab associated with increased risk for proteinuria. Regarding tumor type, renal cell carcinoma associated with the highest risk (cumulative incidence 10.2%). We did not detect a significant difference between platinum- and non–platinum-based concurrent chemotherapy with regard to risk for high-grade proteinuria (P = 0.39). In conclusion, the addition of bevacizumab to chemotherapy significantly increases the risk for high-grade proteinuria and nephrotic syndrome. PMID:20538785

  18. Risk of Stroke in Patients With Spontaneous Pneumothorax

    PubMed Central

    Cheng, Ching-Yuan; Yeh, Diana Yu-Wung; Lin, Cheng-Li; Kao, Chia-Hung

    2016-01-01

    Abstract The association between spontaneous pneumothorax (SP) and stroke has not been reported, and this study aimed to explore this association. We used the National Health Insurance Research Database for conducting a nationwide, population-based, retrospective cohort study of patients newly hospitalized for SP from 2000 to 2010. A total of 2541 patients with newly diagnosed SP were included and compared with patients without SP. We observed that patients with SP were at higher risk for developing stroke, with an adjusted hazard ratio (HR) of 1.56. In addition, these patients had a significantly higher risk of hemorrhagic stroke (adjusted HR = 2.22) than of ischemic stroke (adjusted HR = 1.48). The risk of stroke was the highest in the initial 4 months after hospitalization for SP (adjusted HR = 3.41, 95% confidence interval = 1.98–5.87). In conclusion, our study revealed a correlation between stroke and a history of SP, and the risk of stroke after SP was time sensitive. PMID:27100423

  19. Transcatheter versus Surgical Aortic Valve Replacement in Patients with Diabetes and Severe Aortic Stenosis at High Risk for Surgery: An Analysis of the PARTNER Trial

    PubMed Central

    Lindman, Brian R.; Pibarot, Philippe; Arnold, Suzanne V.; Suri, Rakesh; McAndrew, Thomas C.; Maniar, Hersh S.; Zajarias, Alan; Kodali, Susheel; Kirtane, Ajay J.; Thourani, Vinod H.; Tuzcu, E. Murat; Svensson, Lars G.; Waksman, Ron; Smith, Craig R.; Leon, Martin B.

    2013-01-01

    Objectives To determine whether a less invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS). Background Diabetes is associated with increased morbidity and mortality after surgical AVR for AS. Methods Among treated patients with severe symptomatic AS at high-risk for surgery in the PARTNER trial, we examined outcomes stratified by diabetes status of patients randomly assigned to transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year. Results Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p=0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (HR 0.60; 95% CI, 0.36–0.99; p=0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among non-diabetic patients, there was no significant difference in all-cause mortality at 1 year (p=0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery, p=0.88), but the rates of renal failure requiring dialysis >30 days were lower in the transcatheter group (0% vs. 6.1%, p=0.003). Conclusions Among patients with diabetes and severe symptomatic AS at high-risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter compared to surgical AVR. PMID:24291272

  20. Risk of thrombosis in patients with primary immune thrombocytopenia and antiphospholipid antibodies: A systematic review and meta-analysis.

    PubMed

    Moulis, Guillaume; Audemard-Verger, Alexandra; Arnaud, Laurent; Luxembourger, Cécile; Montastruc, François; Gaman, Amelia Maria; Svenungsson, Elisabet; Ruggeri, Marco; Mahévas, Matthieu; Gerfaud-Valentin, Mathieu; Brainsky, Andres; Michel, Marc; Godeau, Bertrand; Lapeyre-Mestre, Maryse; Sailler, Laurent

    2016-03-01

    Antiphospholipid antibodies (aPL) are common in ITP, but their role for the occurrence of ITP-related thrombosis is controversial. We performed a systematic review and a meta-analysis to investigate the risk of thrombosis associated with lupus anticoagulant (LA), anticardiolipin (aCL) and anti-β2GP-I antibodies in primary ITP. The literature search was run on Medline, Cochrane and ISI Web of Science from January 1st 1980 to December 31st 2014. Unpublished studies were searched in meeting abstracts. The main analysis assessed the risk of all thromboses (arterial or venous) associated with the presence of LA, aCL or anti-β2GP-I antibodies. Random-effect models were used to calculate odds ratios (OR) and their 95% confidence intervals (CI). Searches in electronic databases retrieved 776 citations. Twelve additional studies from unpublished literature were added. Eventually, 10 cohort studies totalizing 1574 patients were included in the analysis. The pooled OR for the risk of all thromboses associated with LA was 6.11, 95% CI [3.40-10.99]; it was 2.14, 95% CI [1.11-4.12] with aCL. The ORs were similar when stratifying on the type of thrombosis (arterial vs. venous). Only two studies assessed the risk of thrombosis associated with anti-β2GP-I antibody positivity; consequently, no pooled OR was computed for these antibodies. This meta-analysis highly suggests that LA positivity, and to a less extent aCL antibodies, are associated with an enhanced risk of thrombosis in primary ITP patients. Further prospective studies are needed to identify the factors associated with the risk of thrombosis among LA patients before assessing prevention strategies. PMID:26708169

  1. [Hyperhomocysteinemia as a vascular risk factor in chronic hemodialysis patients].

    PubMed

    Trimarchi, Hernán; Young, Pablo; Díaz, María L; Schropp, Juan; Forrester, Mariano; Freixas, Emilio

    2005-01-01

    Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l. PMID:16433478

  2. [Risk factors for therapeutic noncompliance of patients with epilepsies].

    PubMed

    Santiago-Rodríguez, Efraín; Sales-Carmona, Víctor; Ramos-Ramírez, Ricardo

    2002-01-01

    Inadequate compliance is a major contributor to unsuccessful treatment in epilepsies. To establish risk factors associated with therapeutic non-compliance in patients with epilepsy, we carried out a case-control study, nested into a cohort, with thirteen factors possibly implicated in therapeutic non-compliance. The patient's general characteristics, the illness, and patient-practitioner relationship were studied. Patients were followed during 6 months; during this time, serum levels and pill counts were registered. Of 150 patients, 66 were non-compliers and 84 were compliers. Seven of thirteen factors were statistically different with an odds ratio greater than 3 (p < 0.05). However, after log-lineal regression analysis, only the total number of pills per day and the subject's intellectual level were significant. These two factors increase 3.66 times the risk of non-compliance. We conclude that epileptic patients with a low intellectual level and more than three prescribed pills per day have a 3.66 times greater risk of non-compliance to anti epileptic treatment. PMID:12096392

  3. Suicidal ideation and risk factors in Korean migraine patients.

    PubMed

    Kim, Sun-Young; Park, Sung-Pa

    2014-10-01

    Population-based studies have reported an increased risk of suicidal ideation in patients with migraine. However, there is some controversy as to whether migraine itself is a risk factor for suicidal ideation after adjusting for psychiatric comorbidities. We calculated the frequency of suicidal ideation among patients with migraine visiting a tertiary care hospital and determined its risk factors. Patients with migraine and healthy controls completed self-report questionnaires to assess depression, anxiety, and suicidal ideation, and the frequency of suicidal ideation. Risk factors for suicidal ideation were investigated in terms of demographic, clinical, and psychiatric variables. One hundred eighty-five patients with migraine (156 females and 29 males; mean age 39.1 years) and 53 age and education-matched healthy controls participated in the study. The frequency of suicidal ideation was significantly greater in patients with migraine than healthy controls (odds ratio [OR]=5.09, 95% confidence interval [CI] 1.17-22.10, p=0.003), but this significance was not sustained after adjusting for comorbid depression and anxiety. The risk of suicidal ideation in patients with migraine was associated with lower education levels, higher frequency of migraine attacks, stronger intensity of headaches, and presence of phonophobia, chronic migraine, depression, and anxiety. The strongest predictor was depression (OR=15.36, 95% CI 5.39-43.78, p<0.001), followed by the intensity of headache while completing the questionnaire (OR=1.293, 95% CI 1.077-1.553; p=0.006). The contribution of migraine-specific variables to suicidal ideation is trivial compared to that of depression and headache intensity. PMID:24998861

  4. 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

  5. Pressure ulcer risk of patient handling sling use.

    PubMed

    Peterson, Matthew J; Kahn, Julie A; Kerrigan, Michael V; Gutmann, Joseph M; Harrow, Jeffrey J

    2015-01-01

    Patient handling slings and lifts reduce the risk of musculoskeletal injuries for healthcare providers. However, no published evidence exists of their safety with respect to pressure ulceration for vulnerable populations, specifically persons with spinal cord injury, nor do any studies compare slings for pressure distribution. High-resolution interface pressure mapping was used to describe and quantify risks associated with pressure ulceration due to normal forces and identify at-risk anatomical locations. We evaluated 23 patient handling slings with 4 nondisabled adults. Sling-participant interface pressures were recorded while participants lay supine on a hospital bed and while suspended during typical patient transfers. Sling-participant interface pressures were greatest while suspended for all seated and supine slings and exceeded 200 mm Hg for all seated slings. Interface pressures were greatest along the sling seams (edges), regardless of position or sling type. The anatomical areas most at risk while participants were suspended in seated slings were the posterior upper and lower thighs. For supine slings, the perisacral area, ischial tuberosities, and greater trochanters were most at risk. The duration of time spent in slings, especially while suspended, should be limited. PMID:26237005

  6. Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients

    PubMed Central

    Merck, Lisa H.; Ward, Laura A.; Applegate, Kimberly E.; Choo, Esther; Lowery-North, Douglas W.; Heilpern, Katherine L.

    2015-01-01

    Introduction The increasing rate of patient exposure to radiation from computerized tomography (CT) raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT). Our study assessed the relationship between informed consent and CT utilization in emergency department (ED) patients. Methods An observational multiphase before-after cohort study was completed from 4/2010–5/2011. We assessed CT utilization before and after (Time I/Time II) the implementation of an informed consent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvic pathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mental status. Data on history, exam, diagnostics, and disposition were collected via standard abstraction tool. We generated a multivariate logistic model via stepwise regression, to assess CT utilization across risk groups. Logistic models, stratified by risk, were generated to include study phase and a propensity score that controlled for potential confounders of CT utilization. Results 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10–36%]) reduction in CT utilization in the low-risk patient group (p<0.002). ICCT did not affect CT utilization in the high-risk group (p=0.16). In low-risk patients, the propensity score was significant (p<0.001). There were no adverse events reported during the study period. Conclusion The implementation of ICCT was associated with reduced CT utilization in low-risk ED patients. ICCT has the potential to increase informed, shared decision making with patients, as well as to reduce the risks and cost associated with CT. PMID:26759646

  7. Metformin use and lung cancer risk in patients with diabetes

    PubMed Central

    Sakoda, Lori C.; Ferrara, Assiamira; Achacoso, Ninah S.; Peng, Tiffany; Ehrlich, Samantha F.; Quesenberry, Charles P.; Habel, Laurel A.

    2015-01-01

    Methodologic biases may explain why observational studies examining metformin use in relation to lung cancer risk have produced inconsistent results. We conducted a cohort study to further investigate this relationship, accounting for potential biases. For 47,351 patients with diabetes aged ≥40 years, who completed a health-related survey administered between 1994 and 1996, data on prescribed diabetes medications were obtained from electronic pharmacy records. Follow-up for incident lung cancer occurred from January 1, 1997, until June 30, 2012. Using Cox regression, we estimated lung cancer risk associated with new use of metformin, along with total duration, recency, and cumulative dose (all modeled as time-dependent covariates), adjusting for potential confounding factors. During 428,557 person-years of follow-up, 747 patients were diagnosed with lung cancer. No association was found with duration, dose, or recency of metformin use and overall lung cancer risk. Among never smokers, however, ever use was inversely associated with lung cancer risk (hazard ratio (HR) 0.57; 95% confidence interval (CI), 0.33-0.99), and risk appeared to decrease monotonically with longer use (≥5 years: HR, 0.48; 95% CI, 0.21-1.09). Among current smokers, corresponding risk estimates were >1.0, although not statistically significant. Consistent with this variation in effect by smoking history, longer use was suggestively associated with lower adenocarcinoma risk (HR, 0.69; 95% CI, 0.40-1.17), but higher small cell carcinoma risk (HR, 1.82; 95% CI, 0.85-3.91). In this population, we found no evidence that metformin use affects overall lung cancer risk. The observed variation in association by smoking history and histology requires further confirmation. PMID:25644512

  8. Stratified medicine for mental disorders.

    PubMed

    Schumann, Gunter; Binder, Elisabeth B; Holte, Arne; de Kloet, E Ronald; Oedegaard, Ketil J; Robbins, Trevor W; Walker-Tilley, Tom R; Bitter, Istvan; Brown, Verity J; Buitelaar, Jan; Ciccocioppo, Roberto; Cools, Roshan; Escera, Carles; Fleischhacker, Wolfgang; Flor, Herta; Frith, Chris D; Heinz, Andreas; Johnsen, Erik; Kirschbaum, Clemens; Klingberg, Torkel; Lesch, Klaus-Peter; Lewis, Shon; Maier, Wolfgang; Mann, Karl; Martinot, Jean-Luc; Meyer-Lindenberg, Andreas; Müller, Christian P; Müller, Walter E; Nutt, David J; Persico, Antonio; Perugi, Giulio; Pessiglione, Mathias; Preuss, Ulrich W; Roiser, Jonathan P; Rossini, Paolo M; Rybakowski, Janusz K; Sandi, Carmen; Stephan, Klaas E; Undurraga, Juan; Vieta, Eduard; van der Wee, Nic; Wykes, Til; Haro, Josep Maria; Wittchen, Hans Ulrich

    2014-01-01

    There is recognition that biomedical research into the causes of mental disorders and their treatment needs to adopt new approaches to research. Novel biomedical techniques have advanced our understanding of how the brain develops and is shaped by behaviour and environment. This has led to the advent of stratified medicine, which translates advances in basic research by targeting aetiological mechanisms underlying mental disorder. The resulting increase in diagnostic precision and targeted treatments may provide a window of opportunity to address the large public health burden, and individual suffering associated with mental disorders. While mental health and mental disorders have significant representation in the "health, demographic change and wellbeing" challenge identified in Horizon 2020, the framework programme for research and innovation of the European Commission (2014-2020), and in national funding agencies, clear advice on a potential strategy for mental health research investment is needed. The development of such a strategy is supported by the EC-funded "Roadmap for Mental Health Research" (ROAMER) which will provide recommendations for a European mental health research strategy integrating the areas of biomedicine, psychology, public health well being, research integration and structuring, and stakeholder participation. Leading experts on biomedical research on mental disorders have provided an assessment of the state of the art in core psychopathological domains, including arousal and stress regulation, affect, cognition social processes, comorbidity and pharmacotherapy. They have identified major advances and promising methods and pointed out gaps to be addressed in order to achieve the promise of a stratified medicine for mental disorders. PMID:24176673

  9. Downsizing, reengineering and patient safety: numbers, newness and resultant risk.

    PubMed

    Knox, G E; Kelley, M; Hodgson, S; Simpson, K R; Carrier, L; Berry, D

    1999-01-01

    Downsizing and reengineering are facts of life in contemporary healthcare organizations. In most instances, these organizational changes are undertaken in an attempt to increase productivity or cut operational costs with results measured in these terms. Less often considered are potential detrimental effects on patient safety or strategies, which might be used to minimize these risks. PMID:10620901

  10. Therapeutic Amenorrhea in Patients at Risk for Thrombocytopenia

    PubMed Central

    Martin-Johnston, Meredith K.; Okoji, Olanma Y.; Armstrong, Alicia

    2016-01-01

    To examine the need for and evaluate the method of menses suppression in women at risk for thrombocytopenia. A systematic review of the published literature in MEDLINE using the search terms thrombocytopenia, menorrhagia, therapeutic amenorrhea, progestin intrauterine device, combination oral contraceptive—extended and cyclic, gonadotropin releasing hormone agonist, danazol, and progestins. There are an increased number of reproductive age women at risk for thrombocytopenia who would benefit from menses suppression. A number of effective medical regimens are available. In patients who fail medical therapy, endometrial ablation appears to be effective in women with thrombocytopenia. As a result of the increased number of women at risk for thrombocytopenia, there is a need for therapeutic amenorrhea. The type of regimen selected depends upon the patients need for contraception and the ability to tolerate estrogen-containing medications. For women who fail medical therapy, there are surgical options, which are associated with less morbidity than hysterectomy. PMID:18492296

  11. Dementia Risk in Irradiated Patients With Head and Neck Cancer

    PubMed Central

    Chen, Jin-Hua; Yen, Yu-Chun; Liu, Shing-Hwa; Lee, Fei-Peng; Lin, Kuan-Chou; Lai, Ming-Tang; Wu, Chia-Che; Chen, Tsung-Ming; Yuan, Sheng-Po; Chang, Chia-Lun; Wu, Szu-Yuan

    2015-01-01

    Abstract Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age <20 years. In total, 20,135 patients were included. In patient groups that underwent surgery alone, surgery and adjuvant chemoradiotherapy, and chemoradiotherapy alone, the dementia incidence per 1000 person-years was 1.44, 1.04, and 1.98, respectively. The crude hazard ratio (HR) of dementia was 1.84 (95% confidence interval [CI] 1.21–2.81) in the RT with or without CT group. After adjustment for age, sex, clinical stage, and comorbidity, the HR was 1.92 (95% CI 1.14–3.24). Examining the dementia risk in patients who received different treatment modalities according to the Cox proportional-hazard model revealed that an age >65 years and having undergone RT with or without CT were risk factors (P < 0.001 and P = 0.015; and HRs of 16.5 and 1.92, respectively). The dementia risk

  12. Dementia Risk in Irradiated Patients With Head and Neck Cancer.

    PubMed

    Chen, Jin-Hua; Yen, Yu-Chun; Liu, Shing-Hwa; Lee, Fei-Peng; Lin, Kuan-Chou; Lai, Ming-Tang; Wu, Chia-Che; Chen, Tsung-Ming; Yuan, Sheng-Po; Chang, Chia-Lun; Wu, Szu-Yuan

    2015-11-01

    Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age <20 years. In total, 20,135 patients were included. In patient groups that underwent surgery alone, surgery and adjuvant chemoradiotherapy, and chemoradiotherapy alone, the dementia incidence per 1000 person-years was 1.44, 1.04, and 1.98, respectively. The crude hazard ratio (HR) of dementia was 1.84 (95% confidence interval [CI] 1.21-2.81) in the RT with or without CT group. After adjustment for age, sex, clinical stage, and comorbidity, the HR was 1.92 (95% CI 1.14-3.24). Examining the dementia risk in patients who received different treatment modalities according to the Cox proportional-hazard model revealed that an age >65 years and having undergone RT with or without CT were risk factors (P < 0.001 and P = 0.015; and HRs of 16.5 and 1.92, respectively). The dementia risk in patients

  13. Increased Risk of Restless Legs Syndrome in Patients With Migraine

    PubMed Central

    Yang, Fu-Chi; Lin, Te-Yu; Chen, Hsuan-Ju; Lee, Jiunn-Tay; Lin, Chun-Chieh; Huang, Wen-Yen; Chen, Hsin-Hung; Kao, Chia-Hung

    2016-01-01

    Abstract Previous studies suggest that an association between restless legs syndrome (RLS) and migraine exists. However, population-based data are unavailable in Asian cohorts. Our study thus aims to evaluate the association between migraine and RLS in a nationwide, population-based cohort in Taiwan and to examine the effects of age, sex, migraine subtype, and comorbidities on RLS development. Data from the Taiwan National Health Insurance Research Database were used. Patients aged 20 years or older with newly diagnosed migraine from 2000 to 2008 were included; 23,641 patients with newly diagnosed migraine and 94,564 subjects without migraine were randomly selected and followed until RLS development, withdrawal from the National Health Insurance, or until the end of 2011. A multivariate Cox proportional hazards regression model was used to explore the risk of RLS in patients with migraine after adjustment for demographic characteristics and comorbidities. Both cohorts were followed for a mean of 7.38 years. After adjustment for covariates, the risk of RLS was 1.42-fold higher (95% confidence interval = 1.13–1.79) in the migraine cohort than in the nonmigraine cohort (7.19 versus 3.42 years per 10,000 person-years). The increased risk was more prominent in males in the migraine cohort (1.87-fold increased risk, 95% confidence interval 1.22–2.85). Neither comorbidity status nor migraine subtype influenced the RLS risk. This population-based study demonstrated that migraine is associated with an increased risk of RLS compared with those without migraine, particularly in male patients with migraine and regardless of the comorbidity status. PMID:26844484

  14. Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis

    PubMed Central

    Mallhi, Tauqeer Hussain; Khan, Amer Hayat; Adnan, Azreen Syazril; Sarriff, Azmi; Khan, Yusra Habib; Jummaat, Fauziah

    2015-01-01

    Background Dengue induced acute kidney injury (AKI) imposes heavy burden of illness in terms of morbidity and mortality. A retrospective study was conducted to investigate incidence, characteristics, risk factors and clinical outcomes of AKI among dengue patients. Methodology A total 667 dengue patients (2008–2013) were retrospectively evaluated and were stratified into AKI and non-AKI groups by using AKIN criteria. Two groups were compared by using appropriate statistical methods. Results There were 95 patients (14.2%) who had AKI, with AKIN-I, AKIN-II and AKIN-III in 76.8%, 16.8% and 6.4% patients, respectively. Significant differences (P<0.05) in demographics and clinico-laboratory characteristics were observed between patients with and without AKI. Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64–17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04–20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14–84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12–19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12–19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12–19.86), P = 0.006] were associated with AKI. Longer hospital stay (>3 days) was also observed among AKI patients (OR = 1.3, P = 0.044). Additionally, 48.4% AKI patients had renal insufficiencies at discharge that were signicantly associated with severe dengue, secondary infection and diabetes mellitus. Overall mortality was 1.2% and all fatal cases had AKI. Conclusions The incidence of AKI is high at 14.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase healthcare burden that underscores the need of clinicians’ alertness to this highly morbid and potentially fatal complication for optimal prevention and management. PMID:26421839

  15. Bladder cancer in a young patient: Undiscovered risk factors

    PubMed Central

    KHAN, RAFAY; IBRAHIM, HIYAM; TULPULE, SUNIL; IROKA, NNEKA

    2016-01-01

    Bladder cancer is one of the most common forms of malignancies involving the urinary system and multiple risk factors have been associated with its etiology. The most common of which include cigarette smoking and various occupational or chemical exposures. It is usually diagnosed in older individuals with an average age of 70. In rare cases it is observed in children as well as young adults where it usually presents as a low-grade, non-invasive disease. In the present case report a 27-year-old male patient is discussed: The patient presented with no significant risk factors and was treated for mucinous adenocarcinoma of the bladder while further investigations were performed to identify other associated factors related to this form of malignancy. Debate in the literature exists in regards to the characteristics of bladder neoplasms in younger patients compared with older patients, however there is a lack of research into the etiology or prognosis in young patients. The present case study illustrates the case of a young adult with no clear risk factors who was diagnosed with a rare case of mucinous adenocarcinoma of the bladder. PMID:27123090

  16. Environmental Risk Factors in Patients with Noninvasive Fungal Sinusitis.

    PubMed

    Mostafa, Badr Eldin; El Sharnoubi, Mohammed M K; El-Sersy, Hesham A A; Mahmoud, Mohammed S M

    2016-01-01

    Objective. The aim of our study was to try to determine the possible environmental risk factors for noninvasive fungal sinusitis in Egyptian patients. Methods. This is a prospective epidemiological case control study on the environmental risk factors of noninvasive fungal sinusitis. It included 60 patients and 100 age and sex matched controls. Results. There was a statistically significant relation between apartment floor, surface area, exposure to dust, exposure to cockroaches, poor air conditioning, and fungal sinusitis. Yet, no statistical significance was found between allergy related occupations, exposure to animals or plants, although their percentages were higher among cases, smoking, and urban or rural residence. Conclusion. We suggest that for patients with noninvasive fungal sinusitis a change in their living environment must be implied with better exposure to sunlight, larger well ventilated homes, proper cleaning of dust and cockroach extermination, and if possible the judicious use of air conditioners. PMID:27274885

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

    PubMed Central

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

    2015-01-01

    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

  18. 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

  19. Environmental Risk Factors in Patients with Noninvasive Fungal Sinusitis

    PubMed Central

    Mostafa, Badr Eldin; El Sharnoubi, Mohammed M. K.; El-Sersy, Hesham A. A.; Mahmoud, Mohammed S. M.

    2016-01-01

    Objective. The aim of our study was to try to determine the possible environmental risk factors for noninvasive fungal sinusitis in Egyptian patients. Methods. This is a prospective epidemiological case control study on the environmental risk factors of noninvasive fungal sinusitis. It included 60 patients and 100 age and sex matched controls. Results. There was a statistically significant relation between apartment floor, surface area, exposure to dust, exposure to cockroaches, poor air conditioning, and fungal sinusitis. Yet, no statistical significance was found between allergy related occupations, exposure to animals or plants, although their percentages were higher among cases, smoking, and urban or rural residence. Conclusion. We suggest that for patients with noninvasive fungal sinusitis a change in their living environment must be implied with better exposure to sunlight, larger well ventilated homes, proper cleaning of dust and cockroach extermination, and if possible the judicious use of air conditioners. PMID:27274885

  20. General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

    PubMed Central

    Karstens, Sven; Joos, Stefanie; Hill, Jonathan C.; Krug, Katja; Szecsenyi, Joachim; Steinhäuser, Jost

    2015-01-01

    Background and Objective The STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP). Methods A 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach. Results For the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues. Conclusions The attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk

  1. Association of Patient Care with Ventilator-Associated Conditions in Critically Ill Patients: Risk Factor Analysis

    PubMed Central

    Yamada, Tomomi; Ogura, Toru; Nakajima, Ken; Suzuki, Kei

    2016-01-01

    Background Ventilator-associated conditions (VACs), for which new surveillance definitions and methods were issued by the Center for Disease Control and Prevention (CDC), are respiratory complications occurring in conjunction with the use of invasive mechanical ventilation and are related to adverse outcomes in critically ill patients. However, to date, risk factors for VACs have not been adequately established, leading to a need for developing a better understanding of the risks. The objective of this study was to explore care-related risk factors as a process indicator and provide valuable information pertaining to VAC preventive measures. Methods This retrospective, single-center, cohort study was conducted in the intensive-care unit (ICU) of a university hospital in Japan. Patient data were automatically sampled using a computerized medical records system and retrospectively analyzed. Management and care-related, but not host-related, factors were exhaustively analyzed using multivariate analysis for risks of VACs. VAC correlation to mortality was also investigated. Results Of the 3122 patients admitted in the ICU, 303 ventilated patients meeting CDC-specified eligibility criteria were included in the analysis. Thirty-seven VACs (12.2%) were found with a corresponding rate of 12.1 per 1000 ventilator days. Multivariate analysis revealed four variables related to patient care as risk factors for VACs: absence of intensivist participation in management of ventilated patients [adjusted HR (AHR): 7.325, P < 0.001)], using relatively higher driving pressure (AHR: 1.216, P < 0.001), development of edema (AHR: 2.145, P = 0.037), and a larger body weight increase (AHR: 0.058, P = 0.005). Furthermore, this research confirmed mortality differences in patients with VACs and statistically derived risks compared with those without VACs (HR: 2.623, P = 0.008). Conclusion Four risk factors related to patient care were clearly identified to be the key factors for VAC

  2. [Secondary prevention of osteoporosis and identification of high risk patients].

    PubMed

    Lehmann, R; Pfeifer, M; Minne, H; Allolio, B

    2000-08-01

    Low bone mass is a major determinant of bone fragility. With respect to hip fracture risk however, there is limited contribution of BMD to the exponential age-related increase in hip fracture incidence. Large prospective studies have identified a number of additional risk factors for hip fractures independent of bone density. These can be classified as skeletal factors and fall-related factors. Body height and hip axis length are positively correlated with fracture risk. Neuromuscular impairment with low gait speed, difficulty in doing a tandem walk, lower limb dysfunction, body sway or inability to rise from a chair without using one's arms predict future fracture risk. According to the concept of evidence-based medicine (EBM) preventive strategies are now available. Supplementation with calcium and vitamin D restores bone quality through suppression of secondary hyperparathyroidism and decreases the risk of falling through improvement of neuromuscular co-ordination and body sway. Treatment with the bisphosphonates alendronate and risedronate increase bone strength and result in a significant reduction of vertebral as well as non-vertebral fractures. Hip protectors absorb energy during a fall and reduce hip fracture risk by 56%. Risk factor based patient selection may improve the cost-effectiveness of therapy. PMID:10996933

  3. Inhibition of Gastric Acid Secretion by H2 Receptor Antagonists Associates a Definite Risk of Enteric Peritonitis and Infectious Mortality in Patients Treated with Peritoneal Dialysis

    PubMed Central

    Pérez-Fontan, Miguel; Machado Lopes, Daniela; García Enríquez, Alba; López-Calviño, Beatriz; López-Muñiz, Andrés; García Falcón, Teresa; Rodríguez-Carmona, Ana

    2016-01-01

    Background Evidences linking treatment with inhibitors of gastric acid secretion (IGAS) and an increased risk of serious infections are inconclusive, both in the population at large and in the particular case of patients with chronic kidney disease. We have undertaken an investigation to disclose associations between treatment with IGAS and infectious outcomes, in patients undergoing chronic Peritoneal Dialysis (PD). Method Observational, historic cohort, single center design. Six hundred and ninety-one patients incident on PD were scrutinized for an association among treatment with IGAS (H2 antagonists H2A or proton pump inhibitors PPI) (main study variable), on one side, and the risks of enteric peritoneal infection (main outcome), overall peritoneal infection, and general and infectious mortality (secondary outcomes). We applied a three-step multivariate approach, based on classic Cox models (baseline variables), time-dependent analyses and, when appropriate, competing risk analyses. Main results The clinical characteristics of patients treated with H2A, PPI or none of these were significantly different. Multivariate analyses disclosed a consistently increased risk of enteric peritonitis in patients treated with IGAS (RR 1.65, 95% CI 1.08–2.55, p = 0.018, Cox). Stratified analysis indicated that patients treated with H2A, rather than those on PPI, supported the burden of this risk. Similar findings applied for the risk of infectious mortality. On the contrary, we were not able to detect any association among the study variables, on one side, and the general risks of peritonitis or mortality, on the other. Conclusions Treatment with IGAS associates increased incidences of enteric peritonitis and infectious mortality, among patients on chronic PD. The association is clear in the case of H2A but less consistent in the case of PPI. Our results support the convenience of preferring PPI to H2A, for gastric acid inhibition in PD patients. PMID:26872254

  4. Does albuminuria predict renal risk and/or cardiovascular risk in obese type 2 diabetic patients?

    PubMed

    Bentata, Yassamine; Abouqal, Redouane

    2014-01-01

    Increased urinary albumin excretion (UAE) is a marker of renal and cardiovascular risk in patients with type 2 diabetes (DT2). What about the obese patient with DT2? Does albuminuria predict the progression of renal disease and/or cardiovascular disease? The objective of this study is to determine the link between albuminuria, renal risk and cardiovascular risk in a cohort of obese DT2 patients. This is a prospective study begun in September 2006. It included DT2 patients presenting obesity defined by a body mass index (BMI)>30 Kg/m(2). Three groups of patients were defined: normo-albuminuria (Urinary Albumin Excretion UAE<30 mg/day or Albumin Creatinine Ratio ACR<30 mg/g), micro-albuminuria (UAE=30-300 mg/day or ACR=30-300 mg/g) and macro-albuminuria (UAE>300 mg/day or ACR>300 mg/g). Data on 144 obese DT2 patients were compiled: The mean age of our patients was 59 ± 9 years and the sex ratio 0.26. The incidence of ESRD was higher in the macro-albuminuria group than in the two other groups (26.5% vs. 1.2%, p<0.001). The incidence of cardiovascular events was 15.4%, 14.3% and 23.5% in the normo, micro and macro-albuminuria groups (p=0.48). A history of cardiovascular comorbidities was the main cardiovascular risk in multivariate analysis (0R=15.07; 95% CI=5.30-42.82; p<0.001) and the low admission GFR (0R=5.67; 95% CI=1.23-9.77; p=0.008) was the main factor for progression of kidney disease in multivariate analysis. Albuminuria may be a better marker of kidney disease progression than of cardiovascular risk in the obese DT2 patient, according to our results. However, to accurately demonstrate the link albuminuria - renal risk and albuminuria - cardiovascular risk in the obese DT2 patient, additional studies using very strict criteria of selection and judgment are needed. PMID:24551483

  5. Factors associated with risk of suicide in patients with hemodialysis.

    PubMed

    Martiny, Camila; de Oliveira e Silva, Adriana Cardoso; Neto, José Pedro Simões; Nardi, Antonio Egidio

    2011-01-01

    Suicide risk (SR) has been associated to several factors; one of them is the presence of psychiatric disorders. This study has the objective of investigating the relationship between the risk factors for suicidal behavior in patient bearers of chronic renal illness who are undertaking hemodialysis treatment. Sixty-nine undertook a short, structured diagnostic interview. The prevalence of some psychiatric disorders showed itself greater in the sample than that in the population in general. A significant positive correlation was found between SR, major depressive episode, and agoraphobia without panic disorder. The religiosity of the patient was also evaluated as an influencing factor of SR. Nonreligious patients had 8 times more chance to have SR compared to religious patients. However, the referred effect only occurred in nondepressed religious patients. The latter indicated that religiosity had its effect annulled in depressed patients. This study shows the importance of measures of intervention in mental health, mainly in relation to prevention and treatment of major depressive episode with a view to reducing SR. PMID:21193182

  6. Risk factors for mortality in patients with septic pulmonary embolism.

    PubMed

    Oh, Hong Geun; Cha, Seung-Ick; Shin, Kyung-Min; Lim, Jae-Kwang; Kim, Hyun Jung; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong

    2016-08-01

    Data regarding prognostic factors for patients with septic pulmonary embolism (SPE) are lacking. The purpose of the present study was to investigate the clinical features of SPE and to ascertain the risk factors for mortality in patients with this condition. Patients with SPE, whose data were retrospectively collected from a tertiary referral center in Korea, were categorized by the presence or absence of in-hospital death into two groups: death and survival groups. The two groups were compared for clinical and radiologic parameters. SPE was community-acquired in most patients (78%). The most common focus of primary infection was that of bone, joint, or soft tissue (33%), followed by liver abscess (17%). The in-hospital mortality was 12%. Multivariate analysis showed that tachypnea (odds ratio [OR] 4.73, 95% confidence interval [CI] 1.09-20.53, p = 0.038) and segmental or lobar consolidation on computed tomography (CT) scan (OR 10.79, 95% CI 2.51-46.43, p = 0.001) were independent predictors of in-hospital death in SPE patients. Taken together, the primary infectious foci of SPE in Korea are different from those reported in Western countries. Tachypnea and segmental or lobar consolidation on CT scan may be independent risk factors for in-hospital death in these patients. PMID:27346380

  7. Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients

    PubMed Central

    Puckett, Yana

    2016-01-01

    Purpose Our objective was to determine the risk factors for inpatient admission of pediatric burn patients. Materials & methods This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included. Results A total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse.  Conclusions Pediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July. PMID:27335714

  8. [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

  9. 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

  10. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Introduction Although intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis. Methods We searched electronic bibliographic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Database from 1950 until January 21, 2013) and reference lists of included articles for observational studies reporting risk factors for IAH or ACS among adult ICU patients. Identified risk factors were summarized using formal narrative synthesis techniques alongside a random effects meta-analysis. Results Among 1,224 citations identified, 14 studies enrolling 2,500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into three themes and eight subthemes. Large volume crystalloid resuscitation, the respiratory status of the patient, and shock/hypotension were common risk factors for IAH and ACS that transcended across presenting patient populations. Risk factors with pooled evidence supporting an increased risk for IAH among mixed ICU patients included obesity (four studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58), sepsis (two studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (four studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (two studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (two studies; OR 2.17; 95% CI, 1.30 to 3.63). Among trauma and surgical patients, large volume crystalloid resuscitation and markers of shock/hypotension and metabolic derangement/organ failure were risk factors for IAH and ACS while increased disease severity scores and elevated creatinine were

  11. Risk of rupture of unruptured cerebral aneurysms in elderly patients

    PubMed Central

    Date, Isao; Tokunaga, Koji; Tominari, Shinjiro; Nozaki, Kazuhiko; Shiokawa, Yoshiaki; Houkin, Kiyohiro; Murayama, Yuichi; Ishibashi, Toshihiro; Takao, Hiroyuki; Kimura, Toshikazu; Nakayama, Takeo; Morita, Akio

    2015-01-01

    Objectives: The aim of this study was to identify risk factors for rupture of unruptured cerebral aneurysms (UCAs) in elderly Japanese patients aged 70 years or older. Methods: The participants included all patients 70 years of age or older in 3 prospective studies in Japan (the Unruptured Cerebral Aneurysm Study of Japan [UCAS Japan], UCAS II, and the prospective study at the Jikei University School of Medicine). A total of 1,896 patients aged 70 years or older with 2,227 UCAs were investigated. The median and mean follow-up periods were 990 and 802.7 days, respectively. Results: The mean aneurysm size was 6.2 ± 3.9 mm. Sixty-eight patients (3.6%) experienced subarachnoid hemorrhage during the follow-up period. Multivariable analysis per patient revealed that in patients aged 80 years or older (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.16–3.49, p = 0.012), aneurysms 7 mm or larger (HR, 3.08; 95% CI, 1.35–7.03, p = 0.007 for 7–9 mm; HR, 7.82; 95% CI, 3.60–16.98, p < 0.001 for 10–24 mm; and HR, 43.31; 95% CI, 12.55–149.42, p < 0.001 for ≥25 mm) and internal carotid–posterior communicating artery aneurysms (HR, 2.45; 95% CI, 1.23–4.88, p = 0.011) were independent predictors for UCA rupture in elderly patients. Conclusions: In our pooled analysis of prospective cohorts in Japan, patient age and aneurysm size and location were significant risk factors for UCA rupture in elderly patients. PMID:26511450

  12. Complications of coeliac disease: are all patients at risk?

    PubMed

    Goddard, C J R; Gillett, H R

    2006-11-01

    Coeliac disease is a common condition that is increasingly being recognised as a result of the development of sensitive and specific serology. The diagnosis of coeliac disease and its subsequent treatment with a gluten-free diet have implications for the patient, not just for symptom control but also for the possible effect on quality of life and risk of complications. Whether the mode of presentation of coeliac disease has an effect on survival or risk of complication is yet unclear. This article reviews the available evidence regarding these issues. PMID:17099088

  13. [Medical high-risk patient in the dental practice].

    PubMed

    Esser, E

    1992-01-01

    Cardiovaskular and pulmonary diseases, terminal renal failure, hepatitis B and C as well as the acquired immune deficiency syndrome, hemorrhagic diatheses, diabetes mellitus and hyperthyreosis are the major systemic diseases related to the practice of dentistry and require a modified treatment plan. Dental treatment during pregnancy may involve a risk for the woman and the fetus. The article outlines the most important aspects of interdisciplinary care for medial high-risk patients in the dental practice, refers to further readings and emphasizes the necessity of active continued education in the field of general medicine and specific emergency care. PMID:1535310

  14. 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

  15. Management of dyslipidemia in the high-risk patient.

    PubMed

    Stein, Evan A

    2002-12-01

    Lipid-lowering agents have been shown to reduce morbidity and mortality associated with coronary heart disease (CHD), particularly in high-risk patients. The identification and treatment of these patients should therefore be a high priority for clinicians. Guidelines from medical organizations, such as the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) and the American Diabetes Association (ADA), suggest that patients with low-density lipoprotein cholesterol (LDL-C) levels > or =130 mg/dL, and perhaps even those with levels > or =100 mg/dL, should receive drug therapy. Optimal LDL-C levels have been set at <100 mg/dL and <115 mg/dL for high-risk patients by US and European guidelines, respectively. However, a recent survey shows that only about 20% of high-risk patients currently meet these goals. In order to achieve therapeutic targets for LDL-C, the statins are the foundation of treatment, as they are the most effective and best-tolerated form of lipid-lowering therapy. Other therapeutic options include bile acid sequestrants, niacin, and plant stanols, although seldom as monotherapy. Combination therapy with a statin and one of these other lipid-lowering agents can be useful in patients who are unable to achieve target lipid levels through monotherapy. There remains, however, a need for additional agents. Some of the new options for reducing LDL-C levels that may be available in the near future include 2 new statins, pitavastatin and rosuvastatin. In patients with heterozygous familial hypercholesterolemia, rosuvastatin, which is currently under review by the Food and Drug Administration (FDA), has been shown to produce significantly greater reductions in LDL-C than atorvastatin over its full dose range. In comparative clinical trials, it has also enabled more patients with primary hypercholesterolemia to meet lipid goals than atorvastatin, simvastatin, and pravastatin. Inhibitors of bile acid transport or cholesterol absorption may also

  16. Risk factors for malignancy in systemic sclerosis patients.

    PubMed

    Kaşifoğlu, T; Yaşar Bilge, Ş; Yıldız, F; Özen, G; Pehlivan, Y; Yılmaz, N; Tarhan, F; Yılmaz, S; Küçük, A; Emmungil, H; Koca, S S; Çınar, M; Direskeneli, H; Erken, E; Can, G; Özmen, M; Gönüllü, E; Kisacik, B; Aksu, K; Karadağ, O; Kasifoglu, N; Arslantas, D; Sahin, F; Keser, G; Yavuz, S; Birlik, M; Onat, A M

    2016-06-01

    Systemic sclerosis (SSc) is an autoimmune connective tissue disease with multisystem involvement. An increased incidence of cancer in SSc patients compared with the general population has been reported in several reports. Our aims in this study were to determine the most common malignancies and to investigate the possible risk factors for the development of malignancy in patients with SSc. Three hundred forty SSc patients from 13 centers were included to the study. Data of the patients were obtained by evaluating their medical records retrospectively. A total of 340 patients with SSc were evaluated. Twenty-five of the patients had 19 different types of malignancy. Bladder cancer was the most common type of cancer with four patients and was followed by breast cancer with three patients, and cervix cancer and ovarian cancer with two patients each. Other types of cancers such as squamous cell skin cancer, adenocancer with an unknown origin, multiple myeloma, chronic myeloid leukemia, papillary thyroid cancer, larynx cancer, non-small cell lung cancer, follicular type non-Hodgkin lymphoma (NHL), endometrium cancer, colon cancer, uterus cancer, neuroendocrine tumor, glioblastoma multiforme, and soft tissue sarcoma were diagnosed in one patient each. The only cancer type that showed an association with cyclophosphamide dose was bladder carcinoma. Other malignancies did not show a correlation with age, sex, smoking, type and duration of the disease, autoantibodies, organ involvement, and dose and duration of cyclophosphamide therapy. Cancer may develop in any organ in patients with SSc. Continuous screening of the patients during a follow-up period is necessary for the early detection of the tumor development. PMID:27118199

  17. Identification of Risk Factors Affecting Impaired Fasting Glucose and Diabetes in Adult Patients from Northeast China

    PubMed Central

    Yin, Yutian; Han, Weiqing; Wang, Yuhan; Zhang, Yue; Wu, Shili; Zhang, Huiping; Jiang, Lingling; Wang, Rui; Zhang, Peng; Yu, Yaqin; Li, Bo

    2015-01-01

    Background: Besides genetic factors, the occurrence of diabetes is influenced by lifestyles and environmental factors as well as trace elements in diet materials. Subjects with impaired fasting glucose (IFG) have an increased risk of developing diabetes mellitus (DM). This study aimed to explore risk factors affecting IFG and diabetes in patients from Northeast China. Methods: A population-based, cross-sectional survey of chronic diseases and related risk factors was conducted in Jilin Province of Northeast China. All adult residents, aged 18–79, were invited to participate in this survey using the method of multistage stratified random cluster sampling. One hundred thirty-four patients with IFG or DM and 391 healthy control subjects were recruited. We compared demographic factors, body size measurements, healthy-related behaviors, and hair metallic element contents between IFG/diabetes patients and healthy individuals. Results: IFG/diabetes patients had a greater weight, waist, hip, and body mass index (BMI) than control subjects. Significant differences in the content of zinc (Zn), potassium (K), copper (Ca), and sodium (Na) as well as Cu/Zn ratios between IFG or DM patients and control subjects (p < 0.05) were also observed. Hair Cu, selenium (Se), and Na contents were positively correlated with blood glucose levels (Cu: rs = 0.135, p = 0.002; Se: rs = 0.110, p = 0.012; Na: rs = 0.091, p = 0.038). Polytomous logistic regression adjusting for age, sex, family history of diabetes and BMI, showed that subjects with high BMI were more likely to develop IFG and DM (IFG: OR = 1.15, OR 95% CI = 1.02–1.29; DM: OR = 1.15, OR 95% CI = 1.01–1.33). Moreover, rarely or never eating fruits was a risk factor for DM (OR = 5.46, OR 95% CI = 1.87–15.98) but not for IFG (OR = 1.70, OR 95% CI = 0.72–4.02). Subjects with abdominal obesity or DM history were more susceptible to DM (abdominal obesity: OR = 2.99, OR 95% CI = 1.07–8.37; DM history: OR = 2.69, OR 95% CI = 1

  18. Effects of hypertension and type 2 diabetes mellitus on the risk of total cardiovascular events in Japanese patients with hypercholesterolemia: implications from the Japan Lipid Intervention Trial (J-LIT).

    PubMed

    Shimamoto, Kazuaki; Kita, Toru; Mabuchi, Hiroshi; Matsuzaki, Masunori; Matsuzawa, Yuji; Nakaya, Noriaki; Oikawa, Shinichi; Saito, Yasushi; Sasaki, Jun; Itakura, Hiroshige

    2007-02-01

    Hyperlipidemia, hypertension, and diabetes mellitus (DM) are well-established risk factors for cardiovascular disease. We analyzed the cardiovascular events in hyperlipidemic patients with or without DM who were administered open-labeled simvastatin in groups stratified by blood pressure level using data from the Japan Lipid Intervention Trial (J-LIT). Hyperlipidemic patients with DM (n=6,288) had significantly more cardiovascular events than those without DM (n=33,933). The incidence rates of total cardiovascular events in the Non-DM and DM groups were 15.40 and 25.76 per 1,000 patients for the 6-year period, respectively. The relative risk of total cardiovascular events in the DM vs. the Non-DM group was 1.68, and the relative risk was significantly higher in the DM than in the Non-DM group. The relative risks of total cardiovascular events were significantly higher in DM and Non-DM patients whose systolic blood pressure (SBP) was greater than or equal to 130 mmHg compared to that of Non-DM patients whose SBP was less than 130 mmHg, and in DM and Non-DM patients whose diastolic blood pressure (DBP) was greater than or equal to 80 mmHg compared to that of Non-DM patients whose DBP was less than 80 mmHg. In all groups stratified by SBP and DBP, relative risks of total cardiovascular events were higher in DM patients than in Non-DM patients. For patients with hypercholesterolemia and DM, blood pressure should be strictly controlled in order to prevent both coronary events and stroke. These results are in good agreement with the JNC 7 and the ESH/ESC guidelines for DM patients, which recommended that the SBP and DBP be less than 130 and 80 mmHg, respectively. PMID:17460381

  19. 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

  20. Using Simulated Patients to Train Physicians in Sexual Risk Assessment and Risk Reduction.

    ERIC Educational Resources Information Center

    Gonzalez-Willis, Angela; And Others

    1990-01-01

    The objectives of this preliminary study were to evaluate the feasibility and acceptability of using trained simulated patient instructors (N=6) as an office-based continuing medical education method and to assess the current sexually transmitted diseases/human immunodeficiency virus risk assessment and counseling practices of primary care…

  1. Patterns and Risk Factors of Locoregional Recurrence in T1-T2 Node Negative Breast Cancer Patients Treated With Mastectomy: Implications for Postmastectomy Radiotherapy

    SciTech Connect

    Abi-Raad, Rita; Boutrus, Rimoun; Wang Rui; Niemierko, Andrzej; Macdonald, Shannon; Smith, Barbara; Taghian, Alphonse G.

    2011-11-01

    Purpose: Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN-) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN- who might benefit from PMRT. Methods and Materials: We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors. Results: Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9-6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5-5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2-28.6%). Conclusion: It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size {>=}2 cm, close or positive margin, age {<=}50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT.

  2. Tumor profiling and the incidentalome: patient decisions and risks.

    PubMed

    Hofstatter, Erin; Mehra, Karishma; Yushak, Melinda; Pusztai, Lajos

    2015-01-01

    In recent years, the field of oncology has witnessed rapid advancements in genetic sequencing simultaneously with steeply declining costs of sequencing technology. As a result, genomics-driven cancer medicine and the use of tumor profiling are quickly becoming mainstays of cancer therapy. Oncology patients can benefit from tumor profiling by allowing the selection of targeted therapies tailored to their disease. However, it is increasingly recognized that the process of determining a tumor DNA sequence may lead to incidental discovery of underlying germline mutations which can impact other aspects of a patient's health, and that of their family. How to handle the 'incidentalome' has been the subject of recent public debate, yet patient education about the potential risks of tumor profiling remains sparse. Patient perspectives and clinical implications of the tumor incidentalome must be specifically addressed by the oncology community as tumor profiling expands to become a new standard of care. PMID:26562094

  3. Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

    SciTech Connect

    Li Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Toncheva, Greta; Yoshizumi, Terry T.; Frush, Donald P.

    2011-01-15

    Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients (a 5-week-old female patient and a 12-year-old male patient), who underwent 64-slice CT examinations (LightSpeed VCT, GE Healthcare) of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine (NURBS) based full-body computer model was created based on the patient's clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index (CTDI{sub vol}) and the effective dose derived from the dose-length product (DLP). Results: The effective dose for the CT examination of the newborn patient (5.7 mSv) was higher but comparable to that for the CT examination of the teenager patient (4.9 mSv) due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller

  4. Does Pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients?

    PubMed Central

    2014-01-01

    Background Atherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality among hemodialysis (HD) patients. It has been attributed, among other causes, to hypertension and dyslipidemia. The aim of the present study was to investigate the effect of a year-long consumption of Pomegranate juice (PJ), on two traditional cardiovascular (CV) risk factors: hypertension and lipid profile, as well as on cardiovascular events. Methods 101 HD patients were randomized to receive 100 cc of PJ (0.7 mM polyphenols) or matching placebo juice, three times a week for one year. The primary endpoints were traditional CV risk factors; blood pressure and lipid profile. Systolic, diastolic and pulse pressure, plasma levels of triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol were monitored quarterly during the study year. Secondary endpoint was incidence of cardiovascular events. Results PJ consumption yielded a significant time response improvement in systolic blood pressure, pulse pressure, triglycerides and HDL level; an improvement that was not observed in the placebo intake group. These beneficial outcomes were more pronounced among patients with hypertension, high level of triglycerides and low levels of HDL. Conclusion Regular PJ consumption by HD patients reduced systolic blood pressure and improved lipid profile. These favorable changes may reduce the accelerated atherosclerosis and high incidence of CVD among HD patients. Trial registration ClinicalTrials.gov registry, Identifier number: NCT00727519 PMID:24593225

  5. Germline RECQL mutations in high risk Chinese breast cancer patients.

    PubMed

    Kwong, Ava; Shin, Vivian Y; Cheuk, Isabella W Y; Chen, Jiawei; Au, Chun H; Ho, Dona N; Chan, Tsun L; Ma, Edmond S K; Akbari, Mohammad R; Narod, Steven A

    2016-06-01

    Recently, RECQL was reported as a new breast cancer susceptibility gene. RECQL belongs to the RECQ DNA helicase family which unwinds double strand DNA and involved in the DNA replication stress response, telomere maintenance and DNA repair. RECQL deficient mice cells are prone to spontaneous chromosomal instability and aneuploidy, suggesting a tumor-suppressive role of RECQL in cancer. In this study, RECQL gene mutation screening was performed on 1110 breast cancer patients who were negative for BRCA1, BRCA2, TP53 and PTEN gene mutations and recruited from March 2007 to June 2015 in the Hong Kong Hereditary and High Risk Breast Cancer Program. Four different RECQL pathogenic mutations were identified in six of the 1110 (0.54 %) tested breast cancer patients. The identified mutations include one frame-shift deletion (c.974_977delAAGA), two splicing site mutations (c.394+1G>A, c.867+1G>T) and one nonsense mutation (c.796C>T, p.Gln266Ter). Two of the mutations (c.867+1G>T and p.Gln266Ter) were seen in more than one patients. This study provides the basis for existing of pathogenic RECQL mutations in Southern Chinese breast cancer patients. The significance of rare variants in RECQL gene in the estimation of breast cancer risk warranted further investigation in larger cohort of patients and in other ethnic groups. PMID:27125668

  6. Left ventricular assist device patient selection: do risk scores help?

    PubMed Central

    Cowger, Jennifer

    2015-01-01

    Mechanical circulatory support (MCS) and left ventricular assist device (LVAD) implantation is becoming increasingly utilized in the advanced heart failure (HF) population. Until further developments are made in this continually evolving field, the need for appropriate patient selection is fueled by our knowledge that the less sick do better. Due to the evolution of MCS technology, and the importance of patient selection to outcomes, risk scores and classification schemes have been developed to provide a structure for medical decision making. As clinical experience grows, technology improves, and further favorable clinical characteristics are identified, it is incumbent upon the HF community to continually hone these instruments. The magnitude of such tools cannot be understated when it comes to aiding in the informed consent and shared-decision making process for patients, families, and the healthcare team. Many risk models that have attempted to address which groups of patients will be successful focus on short term mortality and not long term survival or quality of life. The benefits and pitfalls of these models and their potential implications for patient selection and MCS therapy will be reviewed here. PMID:26793327

  7. Risk factors for death in patients with severe asthma*

    PubMed Central

    Fernandes, Andréia Guedes Oliva; Souza-Machado, Carolina; Coelho, Renata Conceição Pereira; Franco, Priscila Abreu; Esquivel, Renata Miranda; Souza-Machado, Adelmir; Cruz, Álvaro Augusto

    2014-01-01

    OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality. PMID:25210958

  8. 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, Şebnem; 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

  9. Cardiac Implantable Electronic Device Infection in Patients at Risk

    PubMed Central

    Tarakji, Khaldoun G; Ellis, Christopher R; Defaye, Pascal; Kennergren, Charles

    2016-01-01

    The incidence of infection following implantation of cardiac implantable electronic devices (CIEDs) is increasing at a faster rate than that of device implantation. Patients with a CIED infection usually require hospitalisation and complete device and lead removal. A significant proportion die from their infection. Transvenous lead extraction (TLE) is associated with rare but serious complications including major vascular injury or cardiac perforation. Operator experience and advances in lead extraction methods, including laser technology and rotational sheaths, have resulted in procedures having a low risk of complication and mortality. Strategies for preventing CIED infections include intravenous antibiotics and aseptic surgical techniques. An additional method to reduce CIED infection may be the use of antibacterial TYRX™ envelope. Data from non-randomised cohort studies have indicated that antibacterial envelope use can reduce the incidence of CIED infection by more than 80 % in high-risk patients and a randomised clinical trial is ongoing. PMID:27403296

  10. Risk factors for complications in patients with ulcerative colitis

    PubMed Central

    Borovicka, Jan; Seibold, Frank; Vavricka, Stephan R; Lakatos, Peter L; Fried, Michael; Rogler, Gerhard

    2016-01-01

    Background Patients with ulcerative colitis may develop extraintestinal manifestations like erythema nodosum or primary sclerosing cholangitis or extraintestinal complications like anaemia, malabsorption or they may have to undergo surgery. Objective The aim of this study was to investigate potential risk factors for complications like anaemia, malabsorption or surgery in ulcerative colitis. Methods Data on 179 patients with ulcerative colitis were retrieved from our cross-sectional and prospective Swiss Inflammatory Bowel Disease Cohort Study data base for a median observational time of 4.2 years. Data were compared between patients with (n = 140) or without (n = 39) complications. Gender, age at diagnosis, smoking status, disease extent, delay of diagnosis or therapy, mesalamine (5-ASA) systemic and topical therapy, as well as other medication were analysed as potential impact factors. Results In the multivariate regression analysis a delay of 5-ASA treatment by at least two months (odds ratio (OR) 6.21 (95% confidence interval (CI) 2.13–18.14), p = 0.001) as well as a delay with other medication with thiopurines (OR 6.48 (95% CI 2.01–20.91), p = 0.002) were associated with a higher risk for complications. This significant impact of a delay of 5-ASA therapy was demonstrated for extraintestinal manifestations (EIMs) as well as extraintestinal complications (EICs). Extensive disease as well as therapy with methotrexate showed a significantly increased risk for surgery (extensive disease: OR 2.62 (1.02–6.73), p = 0.05, methotrexate: OR 5.36 (1.64–17.58), p = 0.006). Conclusions A delay of 5-ASA therapy of more than two months in the early stage of ulcerative colitis (UC) constitutes a risk for complications during disease course. Extensive disease is associated with a higher risk for surgery. PMID:27087958

  11. Managing patients at genetic risk of breast cancer.

    PubMed

    Pederson, Holly J; Padia, Shilpa A; May, Maureen; Grobmyer, Stephen

    2016-03-01

    Hereditary syndromes that increase the risk of breast cancer are not common, but it is critical to recognize and manage them appropriately. This paper reviews the management of patients with the most common hereditary breast cancer syndromes, ie, hereditary breast and ovarian cancer syndrome, hereditary diffuse gastric cancer, Cowden syndrome (PTEN hamartoma tumor syndrome), Peutz-Jeghers syndrome, and Li-Fraumeni syndrome. PMID:26974991

  12. HSPB1 polymorphisms might be associated with radiation-induced damage risk in lung cancer patients treated with radiotherapy.

    PubMed

    Li, Xiaofeng; Xu, Sheng; Cheng, Yu; Shu, Jun

    2016-05-01

    Several studies investigating the association between heat shock protein beta-1 (HSPB1) polymorphisms and radiation-induced damage in lung cancer patients administrated with radiotherapy have derived conflicting results. This meta-analysis aimed to assess the association between the HSPB1 genes' (rs2868370 and rs2868371) polymorphisms and the risk of radiation-induced damage in lung cancer patients. After an electronic literature search, four articles including six studies were found to be eligible for this meta-analysis. No association was observed between rs2868370 genotypes and radiation-induced damage risk. However, rs2868371 showed a statistically increased risk of radiation-induced damage under CC vs. CG/GG model (OR = 1.59, 95 % CI = 1.10-2.29). Subgroup analysis by ethnicity showed that the genotypes of rs2868371 were also associated with a significantly increased risk of radiation-induced damage in CC vs. CG/GG model (OR = 1.86, 95 % CI = 1.21-2.83) among mixed ethnicities which are mainly comprised of white people. When the data was stratified by organ-damaged, a significant association was only observed in the esophagus group (OR = 2.94, 95 % CI = 1.35-6.37, for CC vs. CG/GG model). In conclusion, the present study demonstrated that the rs2868371 genotypes of HSPB1 might be associated with radiation-induced esophagus damage risk, especially in Caucasians but not in the Asian population. PMID:26874728

  13. Janus Kinase 2 Polymorphisms Are Associated with Risk in Patients with Gastric Cancer in a Chinese Population

    PubMed Central

    Guo, Renhua; Zhang, Zhihong; Xu, Hao; Yang, Chao; Zhu, Yi

    2013-01-01

    Aim To evaluate the impact of the Janus kinase 2 single nucleotide polymorphisms (SNPs) on gastric cancer risk. Methods In this hospital-based, case–control study, the genotypes were identified by polymerase chain reaction–restriction fragment length polymorphism protocols in 661 individuals (359 gastric cancer patients and 302 age and sex matched cancer-free controls). Results Both the frequency of A allele in rs2230724 and G allele in rs1887427 were more frequent in patients with gastric cancer (P = 0.013 and 0.001, respectively). Compared with the common genotype, subjects with the (AG+AA) genotypes of rs2230724 and the (AG+GG) genotypes of rs1887427 had a 59% and 98% increased risk of developing gastric cancer, respectively (P = 0.010, adjusted OR = 1.59, 95% CI = 1.12–2.27; P<0.001, adjusted OR = 1.98, 95% CI = 1.39–2.81, respectively). Further stratified analysis showed that the association between the risk of gastric cancer and the rare genotypes of rs2230724 were more profound in the subgroups of elder individuals (>56 years), males, nonsmokers and urban subjects, while the association between the risk and the rare genotypes of rs1887427 persisted in subgroups of younger individuals (≤56 years), males, nonsmokers and both of rural and urban subjects. Conclusion The JAK2 gene rs2230724 and rs1887427 polymorphisms are associated with an increased risk of gastric cancer in a Chinese Han population. PMID:23717640

  14. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

    PubMed Central

    Gallagher, Tom K; McErlean, Sarah; O'Farrell, Aimee; Hoti, Emir; Maguire, Donal; Traynor, Oscar J; Conlon, Kevin C; Geoghegan, Justin G

    2014-01-01

    Background Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development. Methods From a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed. Results Seven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification). Conclusion This study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium. PMID:24750484

  15. Pulsatile roller pump perfusion is safe in high risk patients.

    PubMed

    Kocakulak, M; Küçükaksu, S; Pişkin, E

    2004-05-01

    In this study, controllability, safety, blood cell depletion, and hemolysis of a pulsatile roller pump in high-risk patients was evaluated. Sarns 8000 roller pump (Sams, Terumo CVS, Ann Arbor, MI, USA) with a pulsatile control module was used as arterial pump in a clinical setting. Forty patients undergoing elective open heart surgery with high-risk either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be operated on using pulsatile perfusion or non-pulsatile perfusion. Blood samples were withdrawn at induction of anesthesia, at the time of aortic clamping and de-clamping and at 1 hour and 24 hours following cessation of the bypass. Hematocrit and plasma free hemoglobin values were measured. We observed that the pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study is safe in high-risk patients undergoing cardiopulmonary bypass. We did not face any emboli, hemolysis, or technical problems. Pulsatile roller pump perfusion with Sarns 8000 heart-lung machine is a simple and reliable technique and can be easily applied during open heart surgery. PMID:15202823

  16. Risk factors in selected patients undergoing femoral embolectomy.

    PubMed Central

    Scott, D. J.; Davies, A. H.; Horrocks, M.

    1989-01-01

    Mortality rates after femoral embolectomy (FE) in patients with an acutely ischaemic leg vary from 20-40%. In the last 3 years we have adopted a policy of proceeding directly to femoral embolectomy in those patients with a strong clinical suspicion of an embolus. Where doubt exists about the diagnosis, arteriography is performed in combination with local streptokinase, balloon dilatation and/or reconstruction. In a prospective study between September 1984 and March 1987, 43 patients underwent femoral embolectomy with a limb salvage rate of 87%. The early mortality (within 30 days) was 16%, the late mortality was 26%, with a mean follow-up of 22 months. Of the seven patients who died within 30 days, one had a successful embolectomy but died from a cerebrovascular accident. The remaining six failed to improve clinically, all had poor backbleeding and no return of the peripheral pulses. None of these patients had an amputation. We recommend that femoral embolectomy be performed in those patients with a short history of ischaemia (less than 72 h), a risk factor suggesting an embolic source and no past history of intermittent claudication. If all three criteria are not met, arteriography should be performed with a view to fibrinolytic therapy or vascular reconstruction. In those patients who have had a failed embolectomy or where the circulation cannot be restored promptly, despite fibrinolytic therapy and/or distal reconstruction, early major amputation may be life-saving. PMID:2774451

  17. Prediction of the Risk of Hepatocellular Carcinoma in Chronic Hepatitis C Patients after Sustained Virological Response by Aspartate Aminotransferase to Platelet Ratio Index

    PubMed Central

    Lee, Keol; Sinn, Dong Hyun; Gwak, Geum-Youn; Cho, Hyun Chin; Jung, Sin-Ho; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

    2016-01-01

    Background/Aims Following sustained virological response (SVR) for chronic hepatitis C (CHC) infection, patients with advanced fibrosis require regular monitoring for hepatocellular carcinoma (HCC). The aspartate aminotransferase to platelet ratio index (APRI) is a simple noninvasive surrogate marker known to reflect fibrosis. Methods We retrospectively analyzed 598 patients who achieved SVR with interferon-based therapy for CHC. Results Over a median of 5.1 years of follow-up, there were eight patients diagnosed with HCC and a 5-year cumulative incidence rate of 1.3%. The median pretreatment APRI was 0.83, which decreased to 0.29 after achieving SVR (p<0.001). Both the pre- and posttreatment indices were associated with HCC development. The 5-year cumulative HCC incidence rates were 0% and 2.8% for patients with pretreatment APRI <1.0 and ≥1.0, respectively (p=0.001) and 0.8% and 12.8% for patients with posttreatment APRI <1.0 and ≥1.0, respectively (p<0.001). Pretreatment APRI at a cutoff of 1.0 had a 100% negative predictive value until 10 years after SVR. Conclusions HCC development was observed among CHC patients who achieved SVR. The pre- and post-treatment APRI could stratify HCC risk, indicating that the APRI could be a useful marker to classify HCC risk in CHC patients who achieved SVR. However, given the small number of HCC patients, this finding warrants further validation. PMID:27114418

  18. Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction.

    PubMed

    Liu, Yuan-Hui; Liu, Yong; Zhou, Ying-Ling; He, Peng-Cheng; Yu, Dan-Qing; Li, Li-Wen; Xie, Nian-Jin; Guo, Wei; Tan, Ning; Chen, Ji-Yan

    2016-06-15

    Accurate risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We aimed to compare the prognostic value of validated risk scores for CIN. We prospectively enrolled 422 consecutive patients with STEMI undergoing PPCI. Mehran; Gao; Chen; age, serum creatinine (SCr), or glomerular filtration rate, and ejection fraction (ACEF or AGEF); and Global Registry for Acute Coronary Events risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (increase in SCr ≥0.5 mg/dl) or CIN broad (≥0.5 mg/dl and/or a ≥25% increase in baseline SCr). All risk scores had relatively high predictive values for CIN-narrow (c-statistic: 0.746 to 0.873) and performed well for prediction of in-hospital death (0.784 to 0.936), MACEs (0.685 to 0.763), and 3-year all-cause mortality (0.655 to 0.871). The ACEF and AGEF risk scores had better discrimination and calibration for CIN-narrow and in-hospital outcomes. However, all risk score exhibited low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). In conclusion, risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in patients with STEMI undergoing PPCI. The ACEF and AGEF risk scores appear to have greater prognostic value. PMID:27161818

  19. Cumulative genetic risk and prefrontal activity in patients with schizophrenia.

    PubMed

    Walton, Esther; Turner, Jessica; Gollub, Randy L; Manoach, Dara S; Yendiki, Anastasia; Ho, Beng-Choon; Sponheim, Scott R; Calhoun, Vince D; Ehrlich, Stefan

    2013-05-01

    The lack of consistency of genetic associations in highly heritable mental illnesses, such as schizophrenia, remains a challenge in molecular psychiatry. Because clinical phenotypes for psychiatric disorders are often ill defined, considerable effort has been made to relate genetic polymorphisms to underlying physiological aspects of schizophrenia (so called intermediate phenotypes), that may be more reliable. Given the polygenic etiology of schizophrenia, the aim of this work was to form a measure of cumulative genetic risk and study its effect on neural activity during working memory (WM) using functional magnetic resonance imaging. Neural activity during the Sternberg Item Recognition Paradigm was measured in 79 schizophrenia patients and 99 healthy controls. Participants were genotyped, and a genetic risk score (GRS), which combined the additive effects of 41 single-nucleotide polymorphisms (SNPs) from 34 risk genes for schizophrenia, was calculated. These risk SNPs were chosen according to the continuously updated meta-analysis of genetic studies on schizophrenia available at www.schizophreniaresearchforum.org. We found a positive relationship between GRS and left dorsolateral prefrontal cortex inefficiency during WM processing. GRS was not correlated with age, performance, intelligence, or medication effects and did not differ between acquisition sites, gender, or diagnostic groups. Our study suggests that cumulative genetic risk, combining the impact of many genes with small effects, is associated with a known brain-based intermediate phenotype for schizophrenia. The GRS approach could provide an advantage over studying single genes in studies focusing on the genetic basis of polygenic conditions such as neuropsychiatric disorders. PMID:22267534

  20. Renal outcomes in hypertensive Black patients at high cardiovascular risk.

    PubMed

    Weir, Matthew R; Bakris, George L; Weber, Michael A; Dahlof, Bjorn; Devereux, Richard B; Kjeldsen, Sverre E; Pitt, Bertram; Wright, Jackson T; Kelly, Roxzana Y; Hua, Tsushung A; Hester, R Allen; Velazquez, Eric; Jamerson, Kenneth A

    2012-03-01

    The ACCOMPLISH trial (Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension) was a 3-year multicenter, event-driven trial involving patients with high cardiovascular risk who were randomized in a double-blinded manner to benazepril plus either hydrochlorothiazide or amlodipine and titrated in parallel to reach recommended blood pressure goals. Of the 8125 participants in the United States, 1414 were of self-described Black ethnicity. The composite kidney disease end point, defined as a doubling in serum creatinine, end-stage renal disease, or death was not different between Black and non-Black patients, although the Blacks were significantly more likely to develop a greater than 50% increase in serum creatinine to a level above 2.6 mg/dl. We found important early differences in the estimated glomerular filtration rate (eGFR) due to acute hemodynamic effects, indicating that benazepril plus amlodipine was more effective in stabilizing eGFR compared to benazepril plus hydrochlorothiazide in non-Blacks. There was no difference in the mean eGFR loss in Blacks between therapies. Thus, benazepril coupled to amlodipine was a more effective antihypertensive treatment than when coupled to hydrochlorothiazide in non-Black patients to reduced kidney disease progression. Blacks have a modestly higher increased risk for more advanced increases in serum creatinine than non-Blacks. PMID:22189843

  1. PHOTOSPHERIC EMISSION FROM STRATIFIED JETS

    SciTech Connect

    Ito, Hirotaka; Nagataki, Shigehiro; Ono, Masaomi; Lee, Shiu-Hang; Mao, Jirong; Yamada, Shoichi; Pe'er, Asaf; Mizuta, Akira; Harikae, Seiji

    2013-11-01

    We explore photospheric emissions from stratified two-component jets, wherein a highly relativistic spine outflow is surrounded by a wider and less relativistic sheath outflow. Thermal photons are injected in regions of high optical depth and propagated until the photons escape at the photosphere. Because of the presence of shear in velocity (Lorentz factor) at the boundary of the spine and sheath region, a fraction of the injected photons are accelerated using a Fermi-like acceleration mechanism such that a high-energy power-law tail is formed in the resultant spectrum. We show, in particular, that if a velocity shear with a considerable variance in the bulk Lorentz factor is present, the high-energy part of observed gamma-ray bursts (GRBs) photon spectrum can be explained by this photon acceleration mechanism. We also show that the accelerated photons might also account for the origin of the extra-hard power-law component above the bump of the thermal-like peak seen in some peculiar bursts (e.g., GRB 090510, 090902B, 090926A). We demonstrate that time-integrated spectra can also reproduce the low-energy spectrum of GRBs consistently using a multi-temperature effect when time evolution of the outflow is considered. Last, we show that the empirical E{sub p}-L{sub p} relation can be explained by differences in the outflow properties of individual sources.

  2. Photospheric Emission from Stratified Jets

    NASA Astrophysics Data System (ADS)

    Ito, Hirotaka; Nagataki, Shigehiro; Ono, Masaomi; Lee, Shiu-Hang; Mao, Jirong; Yamada, Shoichi; Pe'er, Asaf; Mizuta, Akira; Harikae, Seiji

    2013-11-01

    We explore photospheric emissions from stratified two-component jets, wherein a highly relativistic spine outflow is surrounded by a wider and less relativistic sheath outflow. Thermal photons are injected in regions of high optical depth and propagated until the photons escape at the photosphere. Because of the presence of shear in velocity (Lorentz factor) at the boundary of the spine and sheath region, a fraction of the injected photons are accelerated using a Fermi-like acceleration mechanism such that a high-energy power-law tail is formed in the resultant spectrum. We show, in particular, that if a velocity shear with a considerable variance in the bulk Lorentz factor is present, the high-energy part of observed gamma-ray bursts (GRBs) photon spectrum can be explained by this photon acceleration mechanism. We also show that the accelerated photons might also account for the origin of the extra-hard power-law component above the bump of the thermal-like peak seen in some peculiar bursts (e.g., GRB 090510, 090902B, 090926A). We demonstrate that time-integrated spectra can also reproduce the low-energy spectrum of GRBs consistently using a multi-temperature effect when time evolution of the outflow is considered. Last, we show that the empirical E p-L p relation can be explained by differences in the outflow properties of individual sources.

  3. Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity.

    PubMed

    Daniel Guerron, A; Portenier, Dana D

    2016-08-01

    Bariatric surgery is the most effective way to improve comorbidities related to obesity. Since the introduction of minimally invasive laparoscopic surgery in the bariatric surgery techniques, the number of procedures has increased substantially; advances in techniques and the transition from open to minimally invasive procedures have decreased morbidity and mortality. Multidisciplinary teams in charge of the operative planning, surgical act, and postoperative recovery are determinant in the success of the management of high-risk bariatric patients; careful identification and preoperative management of these higher-risk patients is crucial in decreasing complications after weight loss surgery. PMID:27473799

  4. 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

  5. Gun safety management with patients at risk for suicide.

    PubMed

    Simon, Robert I

    2007-10-01

    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 responsible for removing guns from the home. A call-back to the clinician from the designated person is required confirming that guns have been removed and secured according to plan. The principle of gun safety management applies to outpatients, inpatients, and emergency patients, although its implementation varies according to the clinical setting. PMID:17967118

  6. [Need of risk reevaluation in morphine dependence in pain patients].

    PubMed

    Boureau, F; Luu, M; Koskas-Sergent, A S; Doubrere, J F

    1992-11-01

    It is commonly recognized than opioids analgesics have an major place in the treatment of pain. In spite of guidelines, opioids drugs remain underutilized in chronic cancer pain and acute severe pain. Among the possible factors, involved in the insufficient use of opioids drugs, is the fear (opiophoby) of physicians, nurses, patients and family to induce or to maintain an addiction. This review examines the potential of iatrogenic addiction. We will examined the place of morphine-like drugs in the treatment of severe acute pain and chronic cancer pain, the definition of dependency in pain patients, the assessment of the dependency potential in patients treated for pain. Available studies indicate that iatrogenic addiction is quite scarce and that the risk for a major tolerance is very small. Further studies will be necessary, since opioids analgesics may also be useful in some non-cancer chronic pain. PMID:1363796

  7. Bariatric surgery: three surgical techniques, patient care, risks, and outcomes.

    PubMed

    McGraw, Carrie A; Wool, Daniel B

    2015-08-01

    The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a recognized and accepted approach for addressing weight loss and health conditions that occur as a result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires the use of interventions that differ from those used for nonobese patients, including bariatric-specific equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory compromise. This articles outlines the risks and typical outcomes associated with three common bariatric procedures-laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass-to help perioperative nurses and other health care providers successfully advise patients and monitor their care for optimal outcomes. PMID:26227518

  8. Identifying Causal Risk Factors for Violence among Discharged Patients

    PubMed Central

    Coid, Jeremy W.; Kallis, Constantinos; Doyle, Mike; Shaw, Jenny; Ullrich, Simone

    2015-01-01

    Background Structured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments. Methods We carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer. Results In a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85–12.65, P<0.001), instability (OR 5.41, 95% CI 3.44–8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21–16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08–0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence. Conclusions Using two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors

  9. Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia

    PubMed Central

    Jeon, Yong Duk; Jeong, Woo Yong; Kim, Moo Hyun; Jung, In Young; Ahn, Mi Young; Ann, Hea Won; Ahn, Jin Young; Han, Sang Hoon; Choi, Jun Yong; Song, Young Goo; Kim, June Myung; Ku, Nam Su

    2016-01-01

    Abstract Stenotrophomonas maltophilia is a nosocomial pathogen associated with high morbidity and mortality, particularly in immunocompromised or critically ill patients. In this study, we investigated the risk factors for mortality in patients with S. maltophilia bacteremia. Retrospectively, medical records from all patients with S. maltophilia bacteremia between December 2005 and 2014 at Severance Hospital, a 2000-bed tertiary care hospital in Seoul, Korea, were reviewed. Analysis was performed to identify factors associated with 28-day mortality. In total, 142 bacteremia patients were enrolled in this study. The overall 28-day mortality rate was 36.6%. Based on the univariate analysis, hematologic malignancy (P = 0.015), Sepsis-related Organ Failure Assessment (SOFA) score (P < 0.001) and the removal of a central venous catheter (CVC) (P = 0.040) were significantly related to mortality. In the intensive care unit patients, the Acute Physiology and Chronic Health Evaluation II score (P = 0.001) also had significance. Based on the multivariate analysis, the SOFA score (odds ratio [OR] = 1.323; 95% confidence interval [CI]: 1.159, 1.509; P < 0.001) and removal of the CVC (OR = 0.330; 95% CI: 0.109, 0.996; P = 0.049) were independent factors associated with mortality. Our results suggest that removing a CVC may considerably reduce mortality in patients with S. maltophilia bacteremia. PMID:27495046

  10. Infection risk in Rheumatoid Arthritis and Spondyloarthropathy patients under treatment with DMARDs, Corticosteroids and TNF-α antagonists

    PubMed Central

    2014-01-01

    Background Infections which complicate rheumatic diseases such as Rheumatoid Arthritis (RA) and Spondyloarthropathy (SpA) (Psoriatic Arthritis [PA] and Ankylosing Spondylitis [AS]), may cause significant morbidity and mortality. However, among the studies on the incidence rate (IR) of infections in such patients, very few have involved controls and the results have been controversial, probably due to methodological difficulties. To estimate infection rates in RA and SpA patients under disease-modifying anti-rheumatic drugs (DMARDs), corticosteroids (CS) and tumor necrosis factor (TNF)α antagonists, alone or combined, a single-centre retrospective observational cohort study has been performed. Patients and methods Incidence rates/100 patient-years of any infections were evaluated in RA and SpA outpatients observed in the period November 1, 2003 through December 31, 2009 and stratified according to therapy. Infection incidence rate ratios (IRR) were calculated using Poisson regression models which adjusted for demographic/clinical characteristics of the patients. Results Three hundred and thirtyone infections [318 (96.1%) non-serious and 13 (3.9%) serious] have been registered among 176 of the 341 patients (52%). The IR/100 patient-years of all infections was 36.3 ranging from 12.4 (DMARDs + CS) to 62.7 (anti-TNFα + CS). The most frequent infection site was respiratory tract, and bacteria were responsible for three quarters of all infections. In the multivariate analysis, adding anti-TNFα to DMARDs doubled the IRR compared to DMARDs alone, anti-TNFα + CS significantly tripled it, whereas anti-TNFα + CS + DMARDs only increased the risk 2.5 times. The degree of disease activity was strongly and significantly associated with the infection risk (severe or moderate versus mild, IRR = 4). Female sex was significantly associated with increased infection risk, while duration of disease and anti-influenza vaccination were protective, the latter even for

  11. Artificial neural network modeling enhances risk stratification and can reduce downstream testing for patients with suspected acute coronary syndromes, negative cardiac biomarkers, and normal ECGs.

    PubMed

    Isma'eel, Hussain A; Cremer, Paul C; Khalaf, Shaden; Almedawar, Mohamad M; Elhajj, Imad H; Sakr, George E; Jaber, Wael A

    2016-04-01

    Despite uncertain yield, guidelines endorse routine stress myocardial perfusion imaging (MPI) for patients with suspected acute coronary syndromes, unremarkable serial electrocardiograms, and negative troponin measurements. In these patients, outcome prediction and risk stratification models could spare unnecessary testing. This study therefore investigated the use of artificial neural networks (ANN) to improve risk stratification and prediction of MPI and angiographic results. We retrospectively identified 5354 consecutive patients referred from the emergency department for rest-stress MPI after serial negative troponins and normal ECGs. Patients were risk stratified according to thrombolysis in myocardial infarction (TIMI) scores, ischemia was defined as >5 % reversible perfusion defect, and obstructive coronary artery disease was defined as >50 % angiographic obstruction. For ANN, the network architecture employed a systematic method where the number of neurons is changed incrementally, and bootstrapping was performed to evaluate the accuracy of the models. Compared to TIMI scores, ANN models provided improved discriminatory power. With regards to MPI, an ANN model could reduce testing by 59 % and maintain a 96 % negative predictive value (NPV) for ruling out ischemia. Application of an ANN model could also avoid 73 % of invasive coronary angiograms while maintaining a 98 % NPV for detecting obstructive CAD. An online calculator for clinical use was created using these models. The ANN models improved risk stratification when compared to the TIMI score. Our calculator could also reduce downstream testing while maintaining an excellent NPV, though further study is needed before the calculator can be used clinically. PMID:26626458

  12. [Global treatment of cardiovascular risk in the hypertensive patient].

    PubMed

    Mazón-Ramos, Pilar; Bertomeu-Martínez, Vicente; Palma-Gámiz, José L; Quiles-Granado, Juan; Guindo-Soldevilla, José; González-Juanatey, José R

    2007-02-01

    During 2006, new evidence supporting the need to adopt a global approach to the treatment of cardiovascular risk in hypertensive patients has been reported. It is increasingly clear that it is not sufficient to aim for optimum blood pressure control, which in any case is not easy to achieve, and that it is essential to treat all cardiovascular risk factors by using drugs with proven benefits, even when those benefits are supplementary to the drug's principal effects. In addition, drugs that could have a detrimental effect or that are, merely, less beneficial should be avoided or kept as a last resort. This appears to have happened with atenolol, and with beta-blockers in general, which have been withdrawn as first-line treatment in the recommendations of some professional societies. To lower cardiovascular risk, it is essential to prevent the development of conditions like diabetes, which are known to have drastic effect on the patient's prognosis. Recently, the results of the DREAM study, which are discussed in detail in this article, have been reported. They could lead to a change in therapeutic strategy in patients who are expected to develop diabetes. In addition, this year has seen the publication of substantial data on a new antihypertensive agent, aliskiren, the first oral renin inhibitor. It is awaiting approval by the international medicine agencies (i.e., the FDA and the EMEA), but should provide a very promising tool in the difficult area of high blood pressure management. Despite numerous advances in the pharmacologic treatment of high blood pressure, control is very difficult to achieve, principally in the elderly, in whom the prevalence of hypertension is high. In these patients, social factors and difficulties with treatment compliance also have an influence and must be dealt with by public health measures aimed at improving blood pressure control. PMID:17352858

  13. Low serum testosterone increases mortality risk among male dialysis patients.

    PubMed

    Carrero, Juan Jesús; Qureshi, Abdul Rashid; Parini, Paolo; Arver, Stefan; Lindholm, Bengt; Bárány, Peter; Heimbürger, Olof; Stenvinkel, Peter

    2009-03-01

    Men treated with hemodialysis (HD) have a very poor prognosis and an elevated risk of premature cardiovascular disease (CVD). In the general population, associations between low testosterone concentrations and cardiovascular risk have been suggested. We performed a prospective observational study involving a well characterized cohort of 126 men treated with HD to examine the relationship between testosterone concentration and subsequent mortality during a mean follow-up period of 41 mo. Independent of age, serum creatinine, and sexual hormone binding globulin (SHBG), testosterone levels inversely and strongly associated with the inflammatory markers IL-6 and CRP. Patients with a clinical history of CVD had significantly lower testosterone levels. During follow up, 65 deaths occurred, 58% of which were a result of CVD. Men with testosterone values in the lowest tertile had increased all-cause and CVD mortality (crude hazard ratios [HRs] 2.03 [95% CI 1.24 to 3.31] and 3.19 [1.49 to 6.83], respectively), which persisted after adjustment for age, SHBG, previous CVD, diabetes, ACEi/ARB treatment, albumin, and inflammatory markers, but was lost after adjustment for creatinine. In summary, among men treated with HD, testosterone concentrations inversely correlate with all-cause and CVD-related mortality, as well as with markers of inflammation. Hypogonadism may be an additional treatable risk factor for patients with chronic kidney disease. PMID:19144759

  14. Kidney transplantation in immunologically high-risk patients.

    PubMed

    Keven, K; Sengul, S; Celebi, Z K; Tuzuner, A; Yalcin, F; Duman, T; Tutkak, H

    2013-04-01

    An increased number of sensitized patients await kidney transplantation (KTx). Sensitization has a major impact on patient mortality and morbidity due to prolonged waiting time and may preclude live donor transplantation. However, recent reports have shown that KTx can be performed successfully using novel immunosuppressive protocols. This study presents our experience with patients displaying donor-specific antibody (DSA) (+). We enrolled 5 lymphocyte cross-match (LCM) negative (complement-dependent cytotoxicity) and panel-reactive antibody (PRA) plus DSA-positive patients mean fluorescein intensity [MFI] > 1000) who underwent living kidney donor procedures. All subjects were females and their mean age was 36.7 years. In our protocol, we started mycophenolate mofetil (2 g/d), tacrolimus (0.01 mg/kg) and prednisolone (0.5 mg/kg) on day -6. We performed 2 sessions of total plasma exchange (TPE) with albumin replacement and administered 2 doses of IVIG (5 g/d). On day -1, we added rituximab (200 mg). On the operation day and on day +4, the patients received doses of basiliximab. Serum samples were taken on days -6, 0, and 30 as well as at 1 year after transplantation. All patients displayed immediate graft function. Mean basal DSA titer was 5624 MFI. After desensitization, the MFI titers decreased at the time of transplantation to 2753 MFI, and were 2564 MFI at the 1st month and 802 MFI at 1st year. Three patients experienced acute rejection episodes (60%). After treatment for rejection, the average follow-up was 17 months and last creatinine levels were 0.6-0.8 mg/dL (minimum-maximum). In conclusion, KTx can be succesfully performed in sensitized patients displaying DSA. However, there seems to be a greater acute rejection risk. There is no consensus regarding adequate doses of IVIG or plasmapheresis treatments; furthermore, more studies are needed to clarify the safe MFI titer of the DSA. PMID:23622587

  15. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  16. Assessment of Risk Factors in Patients With Myocardial Infarction

    PubMed Central

    Kiani, Fatemeh; Hesabi, Nasrin; Arbabisarjou, Azizollah

    2016-01-01

    Background: Coronary artery diseases (CAD) are one of the important health problems in the world, although considerable progresses have been made to decrease the mortality, they are still the first cause of death in many countries. Hence, the necessity of examining effective factors and risk factors on CAD can be one of the most important health priorities in many countries like Iran. Objective: This study was performed to assess the risk factors in patients with myocardial infarction (MI) in Zahedan. Materials and Methods: This is a cross sectional study in which 213 patients were examined. They had been diagnosed to have heart failure. Data gathering took 18 months. Data gathering tool was a designed checklist which was filled up by an experienced nurse during interview. Obtained results were recorded in files and analyzed in SPSS 21. Results: Results showed that 70% of patients were women and only 30% were men. 48% of them were illiterate and patients mean age was 58.3. SD had been 12.6. The mean of pain onset time till referring to hospital was 11 hours with SD of 2.1. 17% of patients (coronary artery diseases history), 25.5% (hypertension history), 26% (diabetes history), 15.5% (cholesterol history), 13% (smoking) and 3% have reported CABG history. The majority of people who referred had inferior MI (40.4%). 67.1% normal rhythm, 2.8% atrial fibrillation and 16% had ventricular tachycardia. Statistical tests showed a significant correlation between sex and the mean of referring time (p<0.05) but the relation between age and referring time was not significant. Conclusion: Effective risk factors on MI were recognized in this study. Some of them such as age, sex and education cannot be modified but many are controllable such as hypertension, diabetes, cholesterol, and smoking and on time referring after pain onset. Having considered the results of this study health promotion for society and especially vulnerable people can be provided by omitting or reducing risk

  17. [Special considerations for the regulation of biological medicinal products in individualised medicine. More than stratified medicine].

    PubMed

    Müller-Berghaus, J; Volkers, P; Scherer, J; Cichutek, K

    2013-11-01

    . The development of biomarkers accelerates the process towards stratified or individualised therapies. Increased requirements for companion diagnostics are a possible consequence. Progress in analytical processes and in biotechnology make a higher degree of individualization likely, possibly to the degree that medicinal products will be individually manufactured for each patient. Current principles of medicinal product testing and market authorization may be applicable only with limitations, because the individual medicinal products are not uniform and are not repeatedly manufactured. The assessment of the process, performed on several different medicinal products manufactured by the same process could potentially serve as a basis for the assessment. For the evaluation of risk for the patient in clinical trials new concepts must be considered, which can be facilitated by interaction of regulatory authorities and developers. PMID:24170083

  18. Blood transfusion risks and alternative strategies in pediatric patients.

    PubMed

    Lavoie, Josée

    2011-01-01

    Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review. PMID:21155923

  19. Potential Risk Factors of Death in Multiple Trauma Patients

    PubMed Central

    Jelodar, Sina; Jafari, Peyman; Yadollahi, Mahnaz; Sabetian Jahromi, Golnar; Khalili, Hoseynali; Abbasi, Hamidreza; Bolandparvaz, Shahram; Paydar, Shahram

    2014-01-01

    Introduction: rauma has been recognized as one of the leading causes of death in many countries for decades. Reduction in mortality and morbidity rate of trauma cases is one of the most important attitudes in this field. Evaluation of different risk factors have been considered as the main goal of some studies. The purpose of this study was determining potential risk factors of death in trauma patients. Method: In a retrograde study, data of 740 patients admitted during three years (2009-2011) were studied. Demographic data (sex and age), clinical factors (blood pressure, pulse rate, respiratory rate, Glasgow coma scale (GCS)), trauma characteristics (location, type of injury, etc.), as well as outcome of patients were evaluated. Data analyses was done using SPSS 18.0. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of death in multiple trauma patients. Results: Of those admitted, majority of patients were male (81.4%), 68% between 18 to 60 years, and 11.2% of them died during the course of treatment. Age; type of trauma; abnormal respiration rate, pulse rate, blood pressure; total GCS ≤8; abnormal pupil size; and head and neck; vertebral, and extremities fractures were obtained as significant predictive factor of death. GCS≤8, head and neck fracture, and abnormal pulse rate were independent death predictors. Conclusion: We identified GCS≤8, head and neck fracture, and abnormal pulse rate as predictive factors of mortality after trauma, which remained independent in the presence of all other factors and potentially treatable. PMID:26495375

  20. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients.

    PubMed

    Liu, Xinhui; Huang, Rong; Wu, Haishan; Wu, Juan; Wang, Juan; Yu, Xueqing; Yang, Xiao

    2016-01-01

    This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival. PMID:27576771

  1. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients

    PubMed Central

    Liu, Xinhui; Huang, Rong; Wu, Haishan; Wu, Juan; Wang, Juan; Yu, Xueqing; Yang, Xiao

    2016-01-01

    This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival. PMID:27576771

  2. A US Claims-Based Analysis of Real-World Lipid-Lowering Treatment Patterns in Patients With High Cardiovascular Disease Risk or a Previous Coronary Event.

    PubMed

    Quek, Ruben G W; Fox, Kathleen M; Wang, Li; Li, Lu; Gandra, Shravanthi R; Wong, Nathan D

    2016-02-15

    The objective was to examine real-world treatment patterns of lipid-lowering therapies and their possible associated intolerance and/or ineffectiveness in patients with high cardiovascular disease (CVD) risk initiating statins and/or ezetimibe. Patients aged ≥18 years who initiated statins and/or ezetimibe from January 01, 2007, to June 30, 2011, were retrospectively identified from the IMS LifeLink PharMetrics Plus commercial claims database. Patients were further classified into 2 cohorts: (1) history of cardiovascular event (CVE) and (2) history of coronary heart disease risk equivalent (CHD RE). Patients had continuous health plan enrollment ≥1 year pre- and post-index date (statin and/or ezetimibe initiation date). Primary outcomes were index statin intensity, treatment modifications, possible associated statin/nonstatin intolerance and/or ineffectiveness issues (based on treatment modification), and time-to-treatment modifications. Analyses for each cohort were stratified by age group (<65 and ≥65 years). A total of 41,934 (history of CVE) and 170,344 patients (history of CHD RE) were included. On the index date, 8.8% to 25.1% of patients were initiated on high-intensity statin. Among patients aged <65, 79.2% and 48.8% of those with history of CVE and 78.6% and 47.3% of those with a history of CHD RE had ≥1 and 2 treatment modifications, respectively. Among all patients, 24.6% to 25.6% had possible statin intolerance and/or ineffectiveness issues after accounting for second treatment modification (if any). In conclusion, in patients with high CVD risk, index statin treatment modifications that imply possible statin intolerance and/or ineffectiveness were frequent; low use of high-intensity statins indicates unmet need in the management of hyperlipidemia and possible remaining unaccounted CVD residual risk. PMID:26742468

  3. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E.; Cahenzly, Martin; Binder, Ronald K.; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F.

    2015-01-01

    Background Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. Objectives We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. Methods We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. Results During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0–26.0, P < 0.01), whereas patients with EuroSCORE II scores above the 75th percentile (> 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8–5.6, P = 0.13). The Harrell’s C-statistic was 0.58 (95% CI 0.45–0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71–0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1–31.3), P <0.01) and improved the model’s net reclassification index (0.89, 95% CI (0.28–1.59). These results were confirmed in the independent validation cohort. Conclusions Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis. PMID

  4. Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study

    PubMed Central

    George, Steven Z.

    2015-01-01

    Background The effectiveness of risk stratification for low back pain (LBP) management has not been demonstrated in outpatient physical therapy settings. Objective The purposes of this study were: (1) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and (2) to determine feasibility of conducting a larger-scale study. Design This was a 2-phase, preliminary study. Methods In phase 1, clinicians were randomly assigned to receive standard (n=6) or stratified care (n=6) training. Stratified care training included 8 hours of content focusing on psychologically informed practice. Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). In phase 2, clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale (NPRS), and the Oswestry Disability Index (ODI). Study feasibility was assessed to identify potential barriers for completion of a larger-scale study. Results In phase 1, minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians (Cohen d=0.00–0.28). Decreased biomedical (−4.5±2.5 points, d=1.08) and increased biopsychosocial (+5.5±2.0 points, d=2.86) treatment orientations were observed for stratified care clinicians, with these changes sustained 6 months later on the PABS-PT. In phase 2, patients receiving stratified care (n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1, 13.6; d=0.76) scores compared with patients receiving standard physical therapy care (n=33). Limitations In phase 2, treatment was not randomly assigned, and therapist adherence to treatment recommendations was

  5. Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function

    PubMed Central

    Aleong, Ryan G; Mulvahill, Matthew J; Halder, Indrani; Carlson, Nichole E; Singh, Madhurmeet; Bloom, Heather L; Dudley, Samuel C; Ellinor, Patrick T; Shalaby, Alaa; Weiss, Raul; Gutmann, Rebecca; Sauer, William H; Narayanan, Kumar; Chugh, Sumeet S; Saba, Samir; London, Barry

    2015-01-01

    Background Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N =930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P =0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P =0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P =0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P =0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P =0.0009). Conclusions LV dilatation may complement

  6. Effectiveness of the fixed-dose combination of olmesartan/amlodipine/hydrochlorothiazide for the treatment of hypertension in patients stratified by age, race and diabetes, CKD and chronic CVD.

    PubMed

    Chrysant, Steven G

    2013-09-01

    The prevalence of hypertension is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and chronic cardiovascular disease (CVD), as well as in black and elderly subjects. In addition, these subjects have the lowest control of blood pressure (BP) among the hypertensive population, and also the risk of having a morbid or fatal cardiovascular event >20% in 10 years. For these reasons, aggressive control of BP to <130/80 mm Hg for these subjects is strongly recommended by National and International guidelines. To accomplish this goal, combination therapy with two or more antihypertensive drugs with a complementary mechanism of action is necessary. Drugs that block the renin-angiotensin system (RAS) in combination with a calcium channel blocker (CCB) and a diuretic have been shown to be the most effective combinations to accomplish this goal. However, this will require the administration of multiple drugs given separately, which will decrease the patient compliance and adherence to treatment. Poor patient compliance and adherence to treatment is a major factor for poor BP control. Several studies have shown that patient compliance is inversely related to the number of drugs being administered. To overcome this problem, several dual and triple-drug, fixed-dose combinations with a RAS blocker, a CCB and a diuretic have been developed and marketed, which are easier to administer, and have been shown to increase patient compliance and adherence to treatment. In this concise review, the effectiveness and safety of the fixed-dose, triple-combination of the RAS blocker olmesartan medoxomil, the CCB amlodipine besylate and the diuretic hydrochlorothiazide, as well as other similar combinations for the treatment of hypertension, will be discussed. These drug combinations have been shown to be effective, safe and well tolerated by most patients. PMID:24073676

  7. Economic effects of aspergillosis management in high-risk patients.

    PubMed

    Leather, Helen

    2005-04-01

    Aspergillosis mortality has risen exponentially over the last 2 decades, related primarily to the availability of medical treatments and procedures that prolong the survival of patients with other disorders who are at high risk because of immunologic compromise. In addition to excess mortality, aspergillosis results in increased costs for hospitalization and treatment, including management of adverse events associated with conventional amphotericin B treatment. Compared with amphotericin B, the triazole antifungal voriconazole has excellent efficacy and a favorable side-effect profile. Reliable oral bioavailability of voriconazole may permit switching to an oral formulation in the inpatient setting and offers the possibility of earlier hospital discharge and potentially substantial cost savings. PMID:15889762

  8. Evaluation of Periodontal Risk in Adult Patients using Two Different Risk Assessment Models – A Pilot Study

    PubMed Central

    Bade, Shruthi; Bollepalli, Appaiah Chowdary; Katuri, Kishore Kumar; Devulapalli, Narasimha Swamy; Swarna, Chakrapani

    2015-01-01

    Objective: The aim of the present study was to evaluate the periodontal risk of individuals using periodontal risk assessment (PRA) model and modified PRA model. Materials and Methods: A total of 50 patients with chronic periodontitis, age 30-60 years were selected randomly and charting of the periodontal status was performed and those who met the inclusion criteria were enrolled in the study. Parameters recorded were- percentage of sites with bleeding on probing (BOP), number of sites with pocket depths (PD) ≥ 5mm, number of the teeth lost, bone loss (BL)/age ratio, Clinical attachment loss(CAL)/age ratio, diabetic and smoking status, dental status, systemic factors like diabetes were assessed. All the risk factors were plotted on the radar chart in (PRA) and (mPRA) models, using Microsoft excel and periodontal risk were categorized as low, moderate and high risk. Results: Among 50 patients 31 were in low risk, 9 in moderate risk, and 10 in high risk identified by modified (PRA) model, whereas 28 patients were in low risk, 13 in moderate risk and 9 in high risk identified by (PRA). Statistical analysis demonstrated that there was no significant difference between the risk scores (X2 = 0.932 with degree of freedom = 2, P = 0.627). Conclusion: Both the periodontal risk models are effective in evaluating the risk factors and can be useful tool for predicting proper diagnosis, disease progression and therapeutic strategies during the supportive periodontal therapy. PMID:25859520

  9. Is drug discontinuation risk of adalimumab compared with etanercept affected by concomitant methotrexate dose in patients with rheumatoid arthritis?

    PubMed Central

    Chen, Hsin-Hua; Chen, Der-Yuan; Chen, Yi-Ming; Tang, Chao-Hsiun

    2016-01-01

    Objective To compare drug discontinuation risk between adalimumab (ADA) and etanercept (ETN) treatment among anti-tumor necrosis factor (anti-TNF)-naïve rheumatoid arthritis (RA) patients, in particular the influence of concomitant dose of methotrexate (MTX). Methods This retrospective nationwide population-based cohort study identified 4,592 anti-TNF-naïve RA patients in whom ETN (n=2,609) or ADA (n=1,983) was initiated using National Health Insurance claims data. After adjustment for prior medication, concomitant medication, and baseline demographic data, the relative risk of drug discontinuation in ADA users compared with ETN users was quantified by calculating adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox proportional hazard regression analyses, stratified by the follow-up time (≤1 year, >1 year) and/or concomitant MTX dose (≤10 mg/wk, >10 mg/wk). Results ADA users had a higher risk of drug discontinuation compared with ETN users during the first year of follow-up (aHR, 1.13; 95% CI, 1.01–1.27), but not during all treatment periods (aHR, 1.06; 95% CI, 0.98–1.16) or after 1 year (aHR, 0.99; 95% CI, 0.87–1.13). However, ADA users had a significantly higher risk of drug discontinuation compared with ETN users among patients on concomitant MTX >10 mg/wk during all treatment periods (aHR, 1.27; 95% CI, 1.10–1.47), during the first year of follow-up (aHR, 1.48; 95% CI, 1.22–1.78), or after 1 year (aHR, 1.42; 95% CI, 1.06–1.90), but not among patients on concomitant MTX 0–10 mg/wk. Conclusion This population-based cohort study demonstrated a modification effect of concomitant MTX dose on the relative risk of anti-TNF discontinuation for ADA compared with ETN among anti-TNF-naïve RA patients. However, the lack of exact cause of anti-TNF discontinuation limited causal inference of such a concomitant MTX dose-related modification effect. PMID:26917952

  10. Waves in Turbulent Stably Stratified Shear Flow

    NASA Technical Reports Server (NTRS)

    Jacobitz, F. G.; Rogers, M. M.; Ferziger, J. H.; Parks, John W. (Technical Monitor)

    2002-01-01

    Two approaches for the identification of internal gravity waves in sheared and unsheared homogeneous stratified turbulence are investigated. First, the phase angle between the vertical velocity and density fluctuations is considered. It was found, however, that a continuous distribution of the phase angle is present in weakly and strongly stratified flow. Second, a projection onto the solution of the linearized inviscid equations of motion of unsheared stratified flow is investigated. It was found that a solution of the fully nonlinear viscous Navier-Stokes equations can be represented by the linearized inviscid solution. The projection yields a decomposition into vertical wave modes and horizontal vortical modes.

  11. Photoinduced spinodal decomposition in stratifying solutions

    NASA Astrophysics Data System (ADS)

    Bunkin, F. V.; Podgaetskii, V. I.; Semin, V. N.

    1988-01-01

    The effect of photoinduced spinodal decomposition in stratifying solutions is examined with particular reference to experimental results obtained for an aqueous solution of butyl Cellosolve of critical concentration (30.14 percent by mass). At the late stages of spinodal decomposition, the coalescence of similar microheterophase inhomogeneities leads to the formation of small-scale (up to 5 microns) grains of each of the phases, which are then grouped into larger-scale (up to 100 microns) segregations. Such multilevel self-organization of the stratifying phases leads to the formation of a granular-cellular structure. This effect can be used for the quick interruption of chemical reactions in a stratifying solution.

  12. Kidney transplantation in older patients: benefits and risks.

    PubMed

    Rao, Venkateswara K

    2002-01-01

    The proportion of older patients accepted for dialysis is increasing every year both in the US and abroad. Of the two treatment modalities for end-stage renal disease, i.e. dialysis and transplantation, the latter offers more freedom and is associated with better clinical outcome. Most elderly patients seem to have excellent functional rehabilitation after a kidney transplant. However, in view of the wide gap between the availability of cadaver organs and the people in need, giving the precious organ to the elderly who have a shorter expected lifespan may present an ethical problem. Therefore, it has become increasingly important to offer the kidney to only those who have no significant comorbid conditions or other high risk factors, so as to improve the odds of success after renal transplantation. PMID:11950375

  13. Exercise and cardiovascular risk in patients with hypertension.

    PubMed

    Sharman, James E; La Gerche, Andre; Coombes, Jeff S

    2015-02-01

    Evidence for the benefits of regular exercise is irrefutable and increasing physical activity levels should be a major goal at all levels of health care. People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure-lowering ability of regular exercise, especially in hypertensive individuals. This narrative review discusses evidence relating to exercise and cardiovascular (CV) risk in people with hypertension. Comparisons between aerobic, dynamic resistance, and static resistance exercise have been made along with the merit of different exercise volumes. High-intensity interval training and isometric resistance training appear to have strong CV protective effects, but with limited data in hypertensive people, more work is needed in this area. Screening recommendations, exercise prescriptions, and special considerations are provided as a guide to decrease CV risk among hypertensive people who exercise or wish to begin. It is recommended that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2-3 days/week. Professionals with expertise in exercise prescription may provide additional benefit to patients with high CV risk or in whom more intense exercise training is planned. Despite lay and media perceptions, CV events associated with exercise are rare and the benefits of regular exercise far outweigh the risks. In summary, current evidence supports the assertion of exercise being a cornerstone therapy in reducing CV risk and in the prevention, treatment, and control of hypertension. PMID:25305061

  14. Identifying patients at risk of perinatal mood disorders.

    PubMed

    Topiwala, Anya; Hothi, Gurjiven; Ebmeier, Klaus P

    2012-05-01

    Perinatal mental illness influences obstetric outcomes, mother-baby interactions and longer term emotional and cognitive development of the child. Psychiatric disorders have consistently been found to be one of the leading causes of maternal deaths, often through suicide. Postnatal depression and puerperal psychosis are two disorders most commonly associated with the perinatal period. The most efficient strategy to identify patients at risk relies on focussing on clinically vulnerable subgroups: enquiries about depressive symptoms should be made at the usual screening visits. Attention should be paid to any sign of poor self-care, avoidance of eye contact, overactivity or underactivity, or abnormalities in the rate of speech. Particular care should be taken to ask about suicidal ideation and thoughts of harming others, including the baby. One of the most important risk factors is a previous history of depression. The degree of risk is directly correlated with severity of past episodes. Both antenatal and postnatal depression are being increasingly recognised in men. Puerperal psychosis is rare (1 to 2 per 1,000). Sixty per cent of women with puerperal psychosis already have a diagnosis of bipolar disorder or schizoaffective disorder. Women with a personal history of postpartum psychosis or bipolar affective disorder should be considered as high risk for postpartum psychosis. All pregnant women who are identified as being at high risk should have a shared care plan for their late pregnancy and early postnatal psychiatric management. Women with current mood disorder of mild or moderate severity who have a first-degree relative with a history of bipolar disorder or postpartum psychosis should be referred for psychiatric assessment. PMID:22774377

  15. Achilles tendon ruptures stratified by age, race, and cause of injury among active duty U.S. Military members.

    PubMed

    Davis, J J; Mason, K T; Clark, D A

    1999-12-01

    A total of 865 members of the U.S. military underwent repair of Achilles tendon ruptures at U.S. military hospitals during calendar years 1994, 1995, and 1996. The discharge summaries of these patients were analyzed for patient demographic information, including age, race, and causative activity. Patients were then stratified by age, race, and cause of injury. Blacks were at increased risk for undergoing repair of the Achilles tendon compared with nonblacks (overall relative risk = 4.15, 95% confidence interval [CI] = 3.63, 4.74; summary odds ratio controlling for age = 3.69, CI = 3.25, 4.19). Participation in the game of basketball accounted for 64.9% of all injuries in black patients and 34.0% of all injuries in nonblack patients. Among those injured, blacks had a significantly increased risk for injury related to playing basketball than nonblacks (relative risk = 1.82, CI = 1.58, 2.10). This finding suggests that there may be other predisposing factor(s) that result in a higher risk of Achilles tendon ruptures in black individuals. PMID:10628159

  16. How stratified is mantle convection?

    NASA Astrophysics Data System (ADS)

    Puster, Peter; Jordan, Thomas H.

    1997-04-01

    due to slabs alone. A stratification index, Sƒ≲0.2, is sufficient to exclude many stratified convection models still under active consideration, including most forms of chemical layering between the upper and lower mantle, as well as the more extreme versions of avalanching convection governed by a strong endothermic phase change.

  17. [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

  18. Atrial fibrillation and risk of stroke in dialysis patients

    PubMed Central

    Wetmore, James B.; Ellerbeck, Edward F.; Mahnken, Jonathan D.; Phadnis, Milind; Rigler, Sally K.; Mukhopadhyay, Purna; Spertus, John A.; Zhou, Xinhua; Hou, Qingjiang; Shireman, Theresa I.

    2013-01-01

    Purpose Both stroke and chronic atrial fibrillation (AF) are common in dialysis patients, but uncertainty exists in the incidence of new strokes and the risk conferred by chronic AF. Methods A cohort of dually-eligible (Medicare & Medicaid) incident dialysis patients was constructed. Medicare claims were used to determine the onset of chronic AF, which was specifically treated as a time-dependent covariate. Cox proportional hazards models were used to model time to stroke. Results Of 56,734 patients studied, 5629 (9.9%) developed chronic AF. There were 22.8 ischemic and 5.0 hemorrhagic strokes per 1000 patient-years, a ratio of approximately 4.5:1. Chronic AF was independently associated with time to ischemic (HR 1.26, 99% CI’s 1.06 – 1.49, P = 0.0005), but not hemorrhagic, stroke. Race was strongly associated with hemorrhagic stroke: African-Americans (HR 1.46, 99% CI’s 1.08 – 1.96), Hispanics (HR 1.64, 99% CI’s 1.16 – 2.31), and others (HR 1.76, 99% CI’s 1.16 – 2.78) had higher rates than did Caucasians (P < 0.001 for all). Conclusions Chronic AF has a significant, but modest, association with ischemic stroke. Race/ethnicity is strongly associated with hemorrhagic strokes. The proportion of strokes due to hemorrhage is much higher than in the general population. PMID:23332588

  19. [Tele-medicine system for high-risk asthmatic patients].

    PubMed

    Kokubu, F; Suzuki, H; Sano, Y; Kihara, N; Adachi, M

    1999-07-01

    We have developed a tele-medicine system to monitor the airway status at home for patients with poorly controlled asthma, whereby a nurse provides instructions to individuals via the telephone to help them manage exacerbation under the supervision of their physicians. We examined the effectiveness of this system with a randomized control study. Patients with high hospitalization risk were enrolled in the study by screening patients for those with multiple previous emergency room visits and randomly assigned to either the tele-medicine or control group. After six months of participation in the program, the number of emergency room visits decreased significantly and the activities of daily living were improved in the tele-medicine group. Most of the patients in the tele-medicine group were able to continue measuring and transmitting peak expiratory flow (PEF) value successfully, and at six months had noticed an improvement in PEF. We therefore conclude that the system effectively contributes to the management of poorly controlled asthma. In addition, further consideration suggests that the reduction of emergency room visits may lead to reduction in hospitalization since we found a good correlation between number of emergency room visits and hospitalization from the studies published previously. PMID:10481354

  20. Risk of skin cancer in patients with diabetes mellitus

    PubMed Central

    Tseng, Hui-Wen; Shiue, Yow-Ling; Tsai, Kuo-Wang; Huang, Wei-Chun; Tang, Pei-Ling; Lam, Hing-Chung

    2016-01-01

    Abstract Increasing evidence suggests that certain types of cancers are more common in people with diabetes mellitus (DM). This study aimed to investigate the risk of skin cancer in patients with DM in Taiwan. In this retrospective cohort study using data from the Taiwan Longitudinal Health Insurance Research Database, the risk of developing overall skin cancer, including nonmelanoma skin cancer (NMSC) and melanoma, was compared by Poisson regression analysis and Cox regression analysis between the DM and non-DM cohorts. The DM cohort with newly diagnosed DM (n = 41,898) and a non-DM cohort were one-to-one matched by age, sex, index date, and comorbidities (coronary artery disease, hyperlipidemia, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and obesity). Compared with non-DM cohort statistically, for the people with DM aged ≥60 years, the incidence rates of overall skin cancer and NMSC were significantly higher (overall: DM/non-DM: number [n] = 99/76, incidence rate ratio [IRR] = 1.44, P = 0.02; NMSC: DM/non-DM: n = 94/66, IRR = 1.57, P = 0.005). By Cox regression analysis, the risk of developing overall skin cancer or NMSC was significantly higher after adjusting for sex, comorbidities, and overall diseases with immunosuppression status (overall: adjusted hazard ratio [AHR] = 1.46, P = 0.01; NMSC: AHR = 1.6, P = 0.003). Other significant risk factors were older males for skin cancer (overall: AHR = 1.68, P = 0.001; NMSC: AHR = 1.59, P = 0.004; melanoma: AHR = 3.25, P = 0.04), chronic obstructive pulmonary disease for NMSC (AHR = 1.44, P = 0.04), and coronary artery disease for melanoma (AHR = 4.22, P = 0.01). The risk of developing melanoma was lower in the DM cohort than in the non-DM cohort, but without significance (AHR = 0.56, P = 0.28; DM/non-DM: n = 5/10). The incidence rate and risk of developing overall skin cancer, including NMSC, was significantly higher in older adults with DM. Other significant risk factors for older

  1. Proactive Risk Assessment for Ebola-Infected Patients: A Systematic Approach to Identifying and Minimizing Risk to Healthcare Personnel.

    PubMed

    Fernandez, Rosemarie; Mitchell, Steven; Ehrmantraut, Ross; Meschke, John Scott; Simcox, Nancy J; Wolz, Sarah A; Parker, Sarah Henrickson

    2016-07-01

    Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks. Infect Control Hosp Epidemiol 2016;37:867-871. PMID:27226216

  2. Effects of Cardiovascular Disease Risk Communication for Patients With Type 2 Diabetes on Risk Perception in a Randomized Controlled Trial

    PubMed Central

    Welschen, Laura M.C.; Bot, Sandra D.M.; Kostense, Piet J.; Dekker, Jacqueline M.; Timmermans, Daniëlle R.M.; van der Weijden, Trudy; Nijpels, Giel

    2012-01-01

    OBJECTIVE Patients with type 2 diabetes mellitus (T2DM) underestimate their risk of developing severe complications, and they do not always understand the risk communication by their caregivers. The aim of this study was to investigate the effects of an intervention focused on the communication of the absolute 10-year risk of developing cardiovascular disease (CVD) in patients with T2DM. RESEARCH DESIGN AND METHODS A randomized controlled trial was performed in T2DM patients newly referred to the Diabetes Care System (DCS) West-Friesland, a managed-care system in the Netherlands. The intervention group (n = 131) received a six-step CVD risk communication. Control subjects (n = 130) received standard managed care. The primary outcome measure was appropriateness of risk perception (difference between actual CVD risk calculated by the UK Prospective Diabetes Study risk engine and risk perception). Secondary outcome measures were illness perceptions, attitude and intention to change behavior, satisfaction with the communication, and anxiety and worry about CVD risk. Patients completed questionnaires at baseline, at 2 weeks (immediately after the intervention), and at 12 weeks. RESULTS Appropriateness of risk perception improved between the intervention and control groups at 2 weeks. This effect disappeared at 12 weeks. No effects were found on illness perceptions, attitude and intention to change behavior, or anxiety and worry about CVD risk. Patients in the intervention group were significantly more satisfied with the communication. CONCLUSIONS This risk communication method improved patients’ risk perception at 2 weeks but not at 12 weeks. Negative effects were not found, as patients did not become anxious or worried after the CVD risk communication. PMID:22923669

  3. Cysteinyl Leukotriene Receptor Antagonists Decrease Cancer Risk in Asthma Patients

    PubMed Central

    Tsai, Ming-Ju; Wu, Ping-Hsun; Sheu, Chau-Chyun; Hsu, Ya-Ling; Chang, Wei-An; Hung, Jen-Yu; Yang, Chih-Jen; Yang, Yi-Hsin; Kuo, Po-Lin; Huang, Ming-Shyan

    2016-01-01

    Previous in vitro and in vivo studies have demonstrated the potential of using cysteinyl leukotriene receptor antagonists (LTRAs) for chemoprevention, but this has not been investigated in any clinical setting. We therefore investigated the chemopreventive effect of LTRAs in a nationwide population-based study. From the Taiwan National Health Insurance Research Database, we enrolled adults with newly-diagnosed asthma between 2001 and 2011. Among these patients, each LTRA user was matched with five randomly-selected LTRA non-users by sex, age, asthma diagnostic year and modified Charlson Comorbidity Index score. We considered the development of cancer as the outcome. Totally, 4185 LTRA users and 20925 LTRA non-users were identified. LTRA users had a significantly lower cancer incidence rate than LTRA non-users did. Multivariable Cox regression analyses adjusting for baseline characteristics and comorbidities showed LTRA use was an independent protecting factor (hazard ratio = 0.31 [95% CI: 0.24–0.39]), and cancer risk decreased progressively with higher cumulative dose of LTRAs. In conclusion, this study revealed that the LTRA use decreased cancer risk in a dose-dependent manner in asthma patients. The chemopreventive effect of LTRAs deserves further study. PMID:27052782

  4. Cysteinyl Leukotriene Receptor Antagonists Decrease Cancer Risk in Asthma Patients.

    PubMed

    Tsai, Ming-Ju; Wu, Ping-Hsun; Sheu, Chau-Chyun; Hsu, Ya-Ling; Chang, Wei-An; Hung, Jen-Yu; Yang, Chih-Jen; Yang, Yi-Hsin; Kuo, Po-Lin; Huang, Ming-Shyan

    2016-01-01

    Previous in vitro and in vivo studies have demonstrated the potential of using cysteinyl leukotriene receptor antagonists (LTRAs) for chemoprevention, but this has not been investigated in any clinical setting. We therefore investigated the chemopreventive effect of LTRAs in a nationwide population-based study. From the Taiwan National Health Insurance Research Database, we enrolled adults with newly-diagnosed asthma between 2001 and 2011. Among these patients, each LTRA user was matched with five randomly-selected LTRA non-users by sex, age, asthma diagnostic year and modified Charlson Comorbidity Index score. We considered the development of cancer as the outcome. Totally, 4185 LTRA users and 20925 LTRA non-users were identified. LTRA users had a significantly lower cancer incidence rate than LTRA non-users did. Multivariable Cox regression analyses adjusting for baseline characteristics and comorbidities showed LTRA use was an independent protecting factor (hazard ratio = 0.31 [95% CI: 0.24-0.39]), and cancer risk decreased progressively with higher cumulative dose of LTRAs. In conclusion, this study revealed that the LTRA use decreased cancer risk in a dose-dependent manner in asthma patients. The chemopreventive effect of LTRAs deserves further study. PMID:27052782

  5. UPSTREAM MOTIONS IN STRATIFIED FLOW (JOURNAL VERSION)

    EPA Science Inventory

    In the paper experimental measurements of the time-dependent velocity and density perturbations upstream of obstacles in linearly stratified flow are presented. Attention is concentrated on obstacles which generate turbulent separated wakes at Froude numbers, based on velocity an...

  6. Impact of Continuous Positive Airway Pressure on Cardiovascular Risk Factors in High-Risk Patients.

    PubMed

    Zhao, Ying Y; Redline, Susan

    2015-11-01

    Cardiovascular disease remains the leading cause of morbidity and mortality in developed countries. Obstructive sleep apnea is a highly prevalent condition characterized by repetitive upper airway collapse during sleep. A large body of evidence suggests that obstructive sleep apnea is associated with the development of cardiovascular disease and increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the current gold standard for the treatment of obstructive sleep apnea. CPAP devices maintain upper airway patency using a pneumatic splint, thereby ameliorating the repetitive deoxygenation and reoxygenation characteristic of sleep in obstructive sleep apnea patients. Accumulating evidence suggests that CPAP treatment may lead to a reduction in blood pressure. Limited evidence also suggests that CPAP therapy may modulate glucose metabolism, serum cholesterol levels, and inflammatory biomarkers. Thus, CPAP treatment may be associated with cardiovascular risk factor modification in patients with obstructive sleep apnea, who are often obese and at an increased risk of developing cardiovascular disease. This review updates the knowledge on the effects of CPAP on cardiovascular risk factors from recently published randomized trials. PMID:26370408

  7. Magnetized stratified rotating shear waves

    NASA Astrophysics Data System (ADS)

    Salhi, A.; Lehner, T.; Godeferd, F.; Cambon, C.

    2012-02-01

    solution at infinite vertical wavelength (k3=0): There is an oscillatory behavior for τ>1+|K2/k1|, where τ=St is a dimensionless time and K2 is the radial component of the wave vector at τ=0. The model is suitable to describe instabilities leading to turbulence by the bypass mechanism that can be relevant for the analysis of magnetized stratified Keplerian disks with a purely azimuthal field. For initial isotropic conditions, the time evolution of the spectral density of total energy (kinetic + magnetic + potential) is considered. At k3=0, the vertical motion is purely oscillatory, and the sum of the vertical (kinetic + magnetic) energy plus the potential energy does not evolve with time and remains equal to its initial value. The horizontal motion can induce a rapid transient growth provided K2/k1≫1. This rapid growth is due to the aperiodic velocity vortex mode that behaves like Kh/kh where kh(τ)=[k12+(K2-k1τ)2]1/2 and Kh=kh(0). After the leading phase (τ>K2/k1≫1), the horizontal magnetic energy and the horizontal kinetic energy exhibit a similar (oscillatory) behavior yielding a high level of total energy. The contribution to energies coming from the modes k1=0 and k3=0 is addressed by investigating the one-dimensional spectra for an initial Gaussian dense spectrum. For a magnetized Keplerian disk with a purely vertical field, it is found that an important contribution to magnetic and kinetic energies comes from the region near k1=0. The limit at k1=0 of the streamwise one-dimensional spectra of energies, or equivalently, the streamwise two-dimensional (2D) energy, is then computed. The comparison of the ratios of these 2D quantities with their three-dimensional counterparts provided by previous direct numerical simulations shows a quantitative agreement.

  8. Magnetized stratified rotating shear waves.

    PubMed

    Salhi, A; Lehner, T; Godeferd, F; Cambon, C

    2012-02-01

    stability of the solution at infinite vertical wavelength (k(3) = 0): There is an oscillatory behavior for τ > 1+|K(2)/k(1)|, where τ = St is a dimensionless time and K(2) is the radial component of the wave vector at τ = 0. The model is suitable to describe instabilities leading to turbulence by the bypass mechanism that can be relevant for the analysis of magnetized stratified Keplerian disks with a purely azimuthal field. For initial isotropic conditions, the time evolution of the spectral density of total energy (kinetic + magnetic + potential) is considered. At k(3) = 0, the vertical motion is purely oscillatory, and the sum of the vertical (kinetic + magnetic) energy plus the potential energy does not evolve with time and remains equal to its initial value. The horizontal motion can induce a rapid transient growth provided K(2)/k(1)>1. This rapid growth is due to the aperiodic velocity vortex mode that behaves like K(h)/k(h) where k(h)(τ)=[k(1)(2) + (K(2) - k(1)τ)(2)](1/2) and K(h) =k(h)(0). After the leading phase (τ > K(2)/k(1)>1), the horizontal magnetic energy and the horizontal kinetic energy exhibit a similar (oscillatory) behavior yielding a high level of total energy. The contribution to energies coming from the modes k(1) = 0 and k(3) = 0 is addressed by investigating the one-dimensional spectra for an initial Gaussian dense spectrum. For a magnetized Keplerian disk with a purely vertical field, it is found that an important contribution to magnetic and kinetic energies comes from the region near k(1) = 0. The limit at k(1) = 0 of the streamwise one-dimensional spectra of energies, or equivalently, the streamwise two-dimensional (2D) energy, is then computed. The comparison of the ratios of these 2D quantities with their three-dimensional counterparts provided by previous direct numerical simulations shows a quantitative agreement. PMID:22463311

  9. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes

    PubMed Central

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47–0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46–0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37–0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46–2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes

  10. Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed

    PubMed Central

    Crivera, Concetta; Nelson, Winnie W; Schein, Jeff R; Witt, Edward A

    2016-01-01

    Background Atrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulant (AC) therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment. Method Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4%) were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens. Results The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8%) and other medical concerns (26.6%), whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%). In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist) and ease of use, respectively. Conclusion Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of patients by physicians on the risks and benefits may be a simple strategy to improve outcomes. PMID:27274206

  11. Lack of health maintenance examinations and risk in myeloma patients.

    PubMed

    Tariman, Joseph D; Gleason, Charise; Faiman, Beth; Doss, Deborah; Catamero, Donna; Bishop-Royse, Jessica; Katz, Mike; Kurtin, Sandra; Moran, Diane; Lonial, Sagar

    2016-07-01

    Health maintenance (HM) practices are essential to prevent illness, promote well-being, and maximize health. Patients with multiple myeloma (MM) are at increased risk for cardiovascular disease and cancers, yet, research on HM practices and preventative care of MM survivors has limited report. The study comprised a descriptive, correlational, and cross-sectional online survey design. Survey of patients with MM was carried out through the International Myeloma Foundation (IMF) and the Association of Cancer Online Resources (ACOR) e-mail list services. The members of the IMF and ACOR e-mail list services were surveyed, of which 237 patients responded. The modified Medical Expenditure Preventive Survey-Preventive Care questionnaire was used; it included items that ask patients regarding their healthcare practices that relate to dental care, cancer prevention, addiction, lifestyles, sensory screening, immunizations, cardiovascular, endocrine, psychosocial, and bone health. Descriptive statistics, Pearson's chi-square, and Spearman's rho correlation coefficient were obtained. In this study, men had statistically significant inferior global health maintenance scores than women (P = 0.002). Being employed (P = 0.054) and married or partnered (P = 0.017) were significantly correlated with better health maintenance patterns among male respondents. In contrast, no statistically significant correlations between sociodemographic factors and health maintenance patterns were found in women. Patients with MM, particularly men, require continued education and close monitoring of health maintenance practices. These findings are consistent with publications looking at gender disparities in healthcare utilization in the United States. Studies show that men, in general, are less likely to seek preventative healthcare screenings. Healthcare providers must incorporate health maintenance promotion during clinic visits. PMID:27119422

  12. Risk Factors for Gallstone Formation in Resected Gastric Cancer Patients.

    PubMed

    Paik, Kyu-hyun; Lee, Jong-Chan; Kim, Hyoung Woo; Kang, Jingu; Lee, Yoon Suk; Hwang, Jin-Hyeok; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung-Ho; Kim, Jaihwan

    2016-04-01

    Previous studies reported increased incidence of gallstone formation after gastrectomy. However, there were few reports about factors other than surgical technique. The purpose of this study is to investigate the spectrum of risk factors of gallstone formation after gastrectomy. From June 2003 to December 2008, 1480 patients who underwent gastrectomy due to gastric cancer but had no gallstones before surgery were identified. Electronic medical records were retrospectively reviewed. Gallstones were assessed by computerized tomography or ultrasound performed as surveillance for recurrence. There were 987 men (66.7%) and the median age was 59.0 years. The median follow-up period was 47.0 months. According to the surgical technique, 754 (50.9%), 459 (31.1%), and 267 (18.0%) underwent subtotal gastrectomy with Billroth I (STG B-I) and Billroth II (STG B-II) anastomosis, and total gastrectomy (TG). Within the follow-up period, gallstone formation occurred in 106 of 1480 patients (7.2%), the only 9 patients (0.6%) experienced symptomatic cholecystitis. By multivariate Cox regression analysis, age (HR 1.02, 95% CI 1.00-1.04), male (1.65, 1.02-2.67), diabetes mellitus (2.15, 1.43-3.24), ≥4% decrease of body mass index after surgery (1.66, 1.02-2.70), STG B-II (1.63, 1.03-2.57), and TG (2.35, 1.43-3.24) compared with STG B-I were associated with gallstone formation. Common bile duct stone formation occurred in 20 of 1480 patients (1.4%) and was only associated with gallstones. After gastrectomy, there were considerable numbers of patients with newly developed gallstones; however, prophylactic cholecystectomy should not be routinely recommended. Gastrectomy (STG B-II or TG), old age, male sex, diabetes mellitus, and decreased body mass index were associated with gallstones. PMID:27082555

  13. Risk of thromboembolic events in patients with prolactinomas compared with patients with nonfunctional pituitary adenomas.

    PubMed

    Mon, Sann Yu; Alkabbani, Abdulrahman; Hamrahian, Amir; Thorton, Julie N; Kennedy, Lawrence; Weil, Robert; Olansky, Leann; Doshi, Krupa; Makin, Vinne; Hatipoglu, Betul

    2013-12-01

    Prolactin has been proposed as a potent coactivator of platelet aggregation, possibly contributing to thromboembolic events. The objective of the study was to evaluate the relationship between prolactinoma and deep vein thrombosis (DVT), pulmonary embolism (PE), and cerebrovascular accident (CVA). Subjects were identified from a prospectively maintained pituitary database at the Cleveland Clinic. We retrospectively reviewed the charts of 544 subjects: 347 patients with prolactinomas (prolactinoma group) and 197 patients with nonfunctional pituitary adenomas (control group). Main outcome measures were DVT, PE and CVA. We found that 19 (5.5%) patients in the prolactinoma group and five (2.5%) patients in the control group had documented DVT, PE, or CVA, but this difference was not significant (p = 0.109). However, the mean initial prolactin level was higher at the time of diagnosis among prolactinoma patients than among controls (815.23 ng/ml vs. 15.90 ng/ml; p < 0.001). Among prolactinoma patients, 15 (5.5%) of 275 patients who underwent medical treatment (with cabergoline, bromocriptine, pergolide and/or other drug) and 4 (5.6%) of 72 patients who underwent transsphenoidal surgery had documented DVT, PE, or CVA, which suggests that dopaminergic therapy did not influence the risk of thromboembolic events. Hyperprolactinemia per se does not appear to predispose to a hypercoagulable state. PMID:23203499

  14. The Incremental Diagnostic Performance of Coronary Computed Tomography Angiography Added to Myocardial Perfusion Imaging in Patients with Intermediate-to-High Cardiovascular Risk

    PubMed Central

    Hsu, Pei-Ying; Lee, Wen-Jeng; Cheng, Mei-Fang; Yen, Ruoh-Fang; Tzen, Kai-Yuan; Wu, Yen-Wen

    2016-01-01

    Purpose Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. Methods A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and 201Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. Results Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. Conclusions CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk. PMID:27122945

  15. Association between Cardiorespiratory Fitness and Health-Related Quality of Life among Patients at Risk for Cardiovascular Disease in Uruguay

    PubMed Central

    Payne, Jonathan P. W.; Rienzi, Edgardo G.; Lavie, Carl J.; Blair, Steven N.; Pate, Russell R.

    2015-01-01

    To date, few studies have examined the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) in populations at high risk for developing cardiovascular disease (CVD). Purpose To examine the association between objectively measured CRF and physical and mental components of HRQoL in a Uruguayan cohort at risk for developing CVD. Methods Patient data records from 2002–2012 at the Calidad de Vida Center were examined. To assess CRF, participants performed a submaximal exercise test. During the evaluation, participants also completed the SF-36, a HRQoL measure comprised of eight dimensions that are summarized by physical and mental component scores (PCS and MCS, respectively). ANCOVA was used to examine the relationship between HRQoL dimensions and CRF. Logistic regression was then used to compare the odds of having a HRQoL component score above the norm across CRF. All analyses were performed separately for males and females with additional stratified analyses across age and BMI conducted among significant trends. Results A total of 2,302 subjects were included in the analysis. Among females, a significant relationship was observed between CRF and vitality, physical functioning, physical role, bodily pain, and general health dimensions. However, for males the only dimension found to be significantly associated with CRF was physical health. After adjusting for potential confounders, a significant linear trend (p<0.001) for PCS scores above the norm across CRF levels was observed for females only. Conclusion Among females with one or more risk factors for developing CVD, higher levels of CRF were positively associated with the vitality and physical dimensions of HRQoL, as well as the overall PCS. However, among males the only dimension associated with CRF was physical functioning. Future studies should examine this relationship among populations at risk for developing CVD in more detail and over time. PMID:25901358

  16. Potential for Early Fracture Risk Assessment in Patients with Metastatic Bone Disease using Parametric Response Mapping of CT Images

    PubMed Central

    Hoff, Benjamin A.; Toole, Michael; Yablon, Corrie; Ross, Brian D.; Luker, Gary D.; VanPoznak, Catherine; Galbán, Craig J.

    2016-01-01

    Pathologic vertebral compression fractures (PVCF) cause significant morbidity in patients with bone metastases from breast cancer and other malignancies. Due to limitations of existing biochemical and imaging biomarkers, clinicians currently have no reliable metrics to identify patients with impending PVCF, impeding efforts to prevent this severe complication. To establish the feasibility of a new method for defining risk of PVCF, we retrospectively analyzed serial CT scans from five breast cancer patients using parametric response mapping (PRM) to quantify dynamic bone density changes that preceded an event. Vertebrae segmented from each scan were registered to vertebrae at the earliest time point (i.e. furthest from PVCF) and voxel classification accomplished using a predetermined threshold of change in HU values, resulting in relative volumes of increased (PRMHU+), decreased (PRMHU−), or unchanged (PRMHU0) attenuation. A total of seven PVCF were compared to un-diseased vertebrae in each patient serving as controls. Receiver operator curve (ROC) analysis identified optimal image acquisition and analysis times for group stratification. Bone density changes were visualized by an increasing trend in PRMHU+ as early as one year before fracture. PRMHU− demonstrated negligible changes over the course of the study. These observations were consistent with ROC results, showing poor performance of PRMHU− in stratifying PVCF versus control. As early as 6 months prior to PVCF, PRMHU+ was significantly larger (12.9 ± 11.6%) compared to control vertebrae (2.3 ± 2.5%), with an AUC of 0.918 from a receiver operator curve analysis. Mean HU changes were also significant between PVCF (+26.8 ± 26.9%) and control (−2.2 ± 22.0%) over the same period. PRM analysis of bone density changes using standard CT imaging was sensitive for spatially resolving bone remodeling which preceded structural failure in patients with breast cancer vertebral metastases. PMID:26771006

  17. Non-invasive evaluation of arrhythmic risk in dilated cardiomyopathy: From imaging to electrocardiographic measures

    PubMed Central

    Iacoviello, Massimo; Monitillo, Francesco

    2014-01-01

    Malignant ventricular arrhythmias are a major adverse event and worsen the prognosis of patients affected by ischemic and non-ischemic dilated cardiomyopathy. The main parameter currently used to stratify arrhythmic risk and guide decision making towards the implantation of a cardioverter defibrillator is the evaluation of the left ventricular ejection fraction. However, this strategy is characterized by several limitations and consequently additional parameters have been suggested in order to improve arrhythmic risk stratification. The aim of this review is to critically revise the prognostic significance of non-invasive diagnostic tools in order to better stratify the arrhythmic risk prognosis of dilated cardiomyopathy patients. PMID:25068017

  18. Impact on Life Expectancy of Withdrawing Thiopurines in Patients with Crohn’s Disease in Sustained Clinical Remission: A Lifetime Risk-Benefit Analysis

    PubMed Central

    Kirchgesner, Julien; Beaugerie, Laurent; Carrat, Fabrice; Sokol, Harry; Cosnes, Jacques; Schwarzinger, Michaël

    2016-01-01

    Objective Long-term treatment with thiopurines is associated with a decreased risk of Crohn’s disease (CD) flare but an increased risk of various cancers depending on gender, age, and presence of extensive colitis. We evaluated risks and benefits of withdrawing thiopurines in patients with CD in prolonged remission. Methods We developed a Markov model assessing risks and benefits of withdrawing thiopurines compared to continuing thiopurines in a lifetime horizon. The model was stratified by age (35 and 65 years old at thiopurine withdrawal), gender and presence of extensive colitis. Parameter estimates were taken from French cohorts and hospital databases, cancer and death national registries and published literature. Life expectancy, rates of relapse, serious adverse events, and causes-of-death were evaluated. Results In patients without extensive colitis, continuing thiopurines increased life expectancy up to 0.03 years for 35 year-old men and women but decreased life expectancy down to 0.07 years for 65 year-old men and women. Withdrawal strategy became the preferred strategy at 40.6 years for men, and 45.7 years for women without extensive colitis. In patients with extensive colitis, continuation strategy was the preferred strategy regardless of age. Risk-benefit analysis was not modified by duration of CD activity. Conclusions Factors determining life expectancy associated with withdrawal or continuation of thiopurines in patients with CD and in sustained clinical remission vary substantially according to gender, age and presence of extensive colitis. Individual decisions to continue or withdraw thiopurines in patients with CD in sustained remission should take into account these parameters. PMID:27271176

  19. Obesity and type 2 diabetes: which patients are at risk?

    PubMed

    Garber, A J

    2012-05-01

    An estimated 72.5 million American adults are obese, and the growing US obesity epidemic is responsible for substantial increase in morbidity and mortality, as well as increased health care costs. Obesity results from a combination of personal and societal factors, but is often viewed as a character flaw rather than a medical condition. This leads to stigma and discrimination towards obese individuals and decreases the likelihood of effective intervention. Conditions related to obesity are increasingly common, such as metabolic syndrome, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), all of which indicate high risk for type 2 diabetes (T2DM). This paper reviews the progression from obesity to diabetes, identifying physiological changes that occur along this path as well as opportunities for patient identification and disease prevention. Patients with prediabetes (defined as having IFG, IGT or both) and/or metabolic syndrome require interventions designed to preserve insulin sensitivity and β-cell function, both of which start to deteriorate prior to T2DM diagnosis. Lifestyle modification, including both healthy eating choices and increased physical activity, is essential for weight management and diabetes prevention. Although sustained weight loss is often considered by patients and physicians as being impossible to achieve, effective interventions do exist. Specifically, the Diabetes Prevention Program (DPP) and programs modelled along its parameters have shown repeated successes, even with long-term maintenance. Recent setbacks in the development of medications for weight loss further stress the importance of lifestyle management. By viewing obesity as a metabolic disorder rather than a personal weakness, we can work with patients to address this increasingly prevalent condition and improve long-term health outcomes. PMID:22074144

  20. RISK OF DEMENTIA IN PERITONEAL DIALYSIS PATIENTS COMPARED WITH HEMODIALYSIS PATIENTS

    PubMed Central

    Wolfgram, Dawn F.; Szabo, Aniko; Murray, Anne M.; Whittle, Jeff

    2016-01-01

    Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) versus peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated on PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% versus 2.7%, 2.5% versus 5.3%, and 3.9% versus 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms. PMID:25742686

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

    PubMed Central

    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

    2015-01-01

    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

  2. Cancer Risk in Patients With Inflammatory Systemic Autoimmune Rheumatic Diseases

    PubMed Central

    Yu, Kuang-Hui; Kuo, Chang-Fu; Huang, Lu Hsiang; Huang, Wen-Kuan; See, Lai-Chu

    2016-01-01

    Abstract The aim of this study was to determine whether inflammation is related to cancer development, and whether the incidence of cancer is increased and occurs in a site-specific manner in patients with systemic autoimmune rheumatic diseases (SARDs). This study included a nationwide dynamic cohort of patients with various newly diagnosed SARDs from 1997 to 2010 with follow-up until 2012. This study included 75,123 patients with SARDs. During 562,870 person-years of follow-up, 2844 patients developed cancer. Between 1997 and 2010, the highest number of newly diagnosed SARDs cases were rheumatoid arthritis (n = 35,182), followed by systemic lupus erythematosus (SLE, n = 15,623), Sjögren syndrome (n = 11,998), Kawasaki disease (n = 3469), inflammatory bowel disease (n = 2853), scleroderma (n = 1814), Behçet disease (n = 1620), dermatomyositis (n = 1119), polymyositis (n = 811), and vasculitis other than Kawasaki disease (n = 644). A significant standardized incidence ratio (SIR) of overall cancer was observed for patients with SLE (1.41; 95% confidence interval [CI], 1.28–1.56), Sjögren syndrome (1.19; 95% CI, 1.08–1.30), scleroderma (1.27; 95% CI, 1.02–1.59), dermatomyositis (4.79; 95% CI, 4.01–5.73), polymyositis (1.47; 95% CI, 1.05–2.06), vasculitis excluding Kawasaki disease (1.75; 95% CI, 1.20–2.55), and Kawasaki disease (2.88; 95% CI, 1.60–5.20). Overall, patients with most SARDs had a significantly higher risk of inflammation-associated site-specific cancers and hematologic malignancies. This study confirms that autoimmunity is associated with site-specific and hematological malignancies and provides clinical evidence of an association between inflammation and subsequent site-specific cancer development. These findings support the importance of inflammation in site-specific organ system carcinogenesis. PMID:27149461

  3. Genetic risk factors of cisplatin induced ototoxicity in adult patients.

    PubMed

    Talach, T; Rottenberg, J; Gal, B; Kostrica, R; Jurajda, M; Kocak, I; Lakomy, R; Vogazianos, E

    2016-01-01

    Ototoxicity is an important adverse effect of using Cisplatin (cis-diamminedichloroplatinum) (CDDP) as a form of chemotherapy. The clinical picture of CDDP induced ototoxicity includes perceptive hearing impairment (reversible or permanent) and tinnitus. Ototoxicity manifests with considerable variability between patients. The objective of this prospective study was to investigate a possible genetic background to this variability. We assessed ototoxicity induced by therapeutic doses of CDDP in adult patients with germinative testicular tumors, or other tumors treated with an identical CDDP dosage scheme. Audiological examination before, during and after the treatment has shown deterioration in hearing; first in the high-frequencies and with increased CDDP cumulative doses, impairment in other frequencies as well. Occurrence of tinnitus was not dependent on the administered dose of CDDP, or the other risk factors examined in this study. The association of CDDP induced ototoxicity with genetic polymorphisms in candidate genes was examined. Our study has demonstrated an association of early onset of CDDP induced ototoxicity with the presence of two copies of GSTT1 gene (p=0,009) and with T allele of rs9332377 polymorphism in COMT gene (p=0,001). PMID:26774148

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

    MedlinePlus

    ... News Releases News 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 ...

  5. Effects of brief intervention on subgroups of injured patients who drink at risk levels.

    PubMed

    Cochran, Gerald; Field, Craig; Foreman, Michael; Ylioja, Thomas; Brown, Carlos V R

    2016-06-01

    Alcohol-related injuries are a major source of admission for trauma care. Screening and brief intervention (SBI) for injured patients can result in decreased drinking and risk behaviors. It is not clear SBI is equally beneficial for all injured patients. A secondary data analysis of 553 patients admitted to two Level-1 trauma centers was conducted. Latent class analysis was used to identify patient subgroups based on injury-related risks and consequences of alcohol use. Intervention effects on drinking were examined among subgroups. Five subgroups were identified. Drinking improved in patients reporting multiple risks and injuries/accidents and drinking and driving. Patients that reported drinking and driving and taking foolish risks or fighting while drinking and taking foolish risks did not show improvements. Trauma centers may benefit from targeting interventions based on injury-related risks and consequences of alcohol use. Further research is needed to test bedside approaches for tailored interventions. PMID:26124071

  6. Risk of Hand Syndromes in Patients With Diabetes Mellitus

    PubMed Central

    Chen, Lu-Hsuan; Li, Chung-Yi; Kuo, Li-Chieh; Wang, Liang-Yi; Kuo, Ken N.; Jou, I-Ming; Hou, Wen-Hsuan

    2015-01-01

    Abstract The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications. The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders. Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48–1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15–3.24 and 2.99, 95% CI = 2.55–3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86–1.95) and DD (HR = 1.83, 95% CI = 1.39–2.39) than with CTS (HR = 1.31, 95% CI = 1.28–1.34) and LJM (HR = 1.24, 95% CI = 1.13–1.35). Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians. PMID:26469895

  7. Risk Factors for Gallstone Formation in Resected Gastric Cancer Patients

    PubMed Central

    Paik, Kyu-hyun; Lee, Jong-Chan; Kim, Hyoung Woo; Kang, Jingu; Lee, Yoon Suk; Hwang, Jin-Hyeok; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung-Ho; Kim, Jaihwan

    2016-01-01

    Abstract Previous studies reported increased incidence of gallstone formation after gastrectomy. However, there were few reports about factors other than surgical technique. The purpose of this study is to investigate the spectrum of risk factors of gallstone formation after gastrectomy. From June 2003 to December 2008, 1480 patients who underwent gastrectomy due to gastric cancer but had no gallstones before surgery were identified. Electronic medical records were retrospectively reviewed. Gallstones were assessed by computerized tomography or ultrasound performed as surveillance for recurrence. There were 987 men (66.7%) and the median age was 59.0 years. The median follow-up period was 47.0 months. According to the surgical technique, 754 (50.9%), 459 (31.1%), and 267 (18.0%) underwent subtotal gastrectomy with Billroth I (STG B-I) and Billroth II (STG B-II) anastomosis, and total gastrectomy (TG). Within the follow-up period, gallstone formation occurred in 106 of 1480 patients (7.2%), the only 9 patients (0.6%) experienced symptomatic cholecystitis. By multivariate Cox regression analysis, age (HR 1.02, 95% CI 1.00–1.04), male (1.65, 1.02–2.67), diabetes mellitus (2.15, 1.43–3.24), ≥4% decrease of body mass index after surgery (1.66, 1.02–2.70), STG B-II (1.63, 1.03–2.57), and TG (2.35, 1.43–3.24) compared with STG B-I were associated with gallstone formation. Common bile duct stone formation occurred in 20 of 1480 patients (1.4%) and was only associated with gallstones. After gastrectomy, there were considerable numbers of patients with newly developed gallstones; however, prophylactic cholecystectomy should not be routinely recommended. Gastrectomy (STG B-II or TG), old age, male sex, diabetes mellitus, and decreased body mass index were associated with gallstones. PMID:27082555

  8. Risk Factors for Anxiety in Major Depressive Disorder Patients

    PubMed Central

    Xin, Li-Min; Chen, Lin; Ji, Zhen-Peng; Zhang, Suo-Yuan; Wang, Jun; Liu, Yan-Hong; Chen, Da-Fang; Yang, Fu-De; Wang, Gang; Fang, Yi-Ru; Lu, Zheng; Yang, Hai-Chen; Hu, Jian; Chen, Zhi-Yu; Huang, Yi; Sun, Jing; Wang, Xiao-Ping; Li, Hui-Chun; Zhang, Jin-Bei; Si, Tian-Mei

    2015-01-01

    Objective To analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD). Methods This study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively. Results Compared with the non-anxious group, the anxious-depression group had an older age at onset (t=−4.39, p<0.001), were older (t=−4.69, p<0.001), reported more lifetime depressive episodes (z=−3.24, p=0.001), were more likely to experience seasonal depressive episodes (χ2=6.896, p=0.009) and depressive episodes following stressful life events (χ2=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (χ2=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression. Conclusion These findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD. PMID:26598584

  9. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    PubMed Central

    Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

    2015-01-01

    Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux

  10. 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

  11. Coronary revascularization in "high" versus "low-risk" patients: The role of myocardial protection.

    PubMed Central

    Olinger, G N; Po, J; Maloney, J V; Mulder, D G; Buckberg, G D

    1975-01-01

    Postoperative mortality, infarction, and need for inotropic support are reportedly increased following myocardial revascularization in "high-risk" patients. We believe these complications result from inadequate protection of the compromised myocardium and should not occur with greater frequency in "high-risk" than "Low-risk" patients if the heart is optimally protected during the entire course of the operative procedure. Results following revascularization in 50 consecutive "low-risk" and 50 consecutive "high-risk" patients were analyzed. One or more of the followin factors were present in the "high-risk" group: ventricular dysfunction--ejection fraction less than 0.4, preinfarction angina, evolving infarction, recent infarction (less than 2 weeks), and refractory ventricular tachyarrhythmia. The following principles were used in all patients to minimize ischemic injury: 1) avoidance of pre-bypass hypo- or hypertension, 2) limitation of ischemic arrest to less than 12 minutes, 3) avoidance of ventricular fibrillation, and 4) prolongation of total bypass as necessary to repay the myocardial oxygen debt. Postoperative inotropic support was required in 10% of "high" and 10% of "low-risk" patients, new postoperative infarction developed in 10% of "high" vs. 10% "low-risk" patients; death occurred in 2% of "high" vs. 4% "low-risk" patients. These results are comparable and indicate that optimum myocardial protection allows safe revascularization in the "high-risk" patient. PMID:1164057

  12. Stratified charge rotary engine for general aviation

    NASA Technical Reports Server (NTRS)

    Mount, R. E.; Parente, A. M.; Hady, W. F.

    1986-01-01

    A development history, a current development status assessment, and a design feature and performance capabilities account are given for stratified-charge rotary engines applicable to aircraft propulsion. Such engines are capable of operating on Jet-A fuel with substantial cost savings, improved altitude capability, and lower fuel consumption by comparison with gas turbine powerplants. Attention is given to the current development program of a 400-hp engine scheduled for initial operations in early 1990. Stratified charge rotary engines are also applicable to ground power units, airborne APUs, shipboard generators, and vehicular engines.

  13. Thermal laminarization of a stratified pipe flow

    SciTech Connect

    Oras, J.J.; Kasza, K.E.

    1984-01-01

    The present work constitutes a new program that grew out of a scoping assessment by ANL to determine the propensity for pipe stratification to occur in the reactor outlet nozzles and hot-leg piping of a generic LMFBR during events producing reverse pipe flow. This paper focuses on the role that thermal buoyancy plays relative to being able to laminarize a turbulent stratified shear zone in a horizontal pipe. The preceeding can influence the behavior of a pipe stratified-backflow-recirculation zone (cold plenum water down into the hot pipe flow) which developes as the result of a temperature difference between the pipe flow and the plenum.

  14. Mixing in thermally stratified energy stores

    SciTech Connect

    Berkle, J. van

    1996-10-01

    Two important aspects of short-term thermally stratified energy storage, thermocline mixing and thermocline thickness, are studied analytically, experimentally and numerically. The storage detrimental aspects are investigated for a simplified configuration, i.e., an adiabatic box containing a quasi-stationary thermocline. Numerical finite difference/volume simulations agree well with experiments. The dissipation-free 1D analytical model shows a large discrepancy. It appears that mixing inside thermally stratified stores is a two-state process. First fluid is withdrawn from the thermocline by viscous drag. Subsequent mixing takes place by stretching and folding of fluid particles, thereby enabling diffusion to become active. 17 refs., 10 figs., 2 tabs.

  15. Clinical decision making regarding suicide risk: Effect of patient and clinician age.

    PubMed

    Berman, Noah Chase; Tung, Esther S; Matheny, Natalie; Cohen, I Glenn; Wilhelm, Sabine

    2016-05-27

    To ascertain how patient age influences suicide risk assessment, clinicians (N = 262) read an ambiguous vignette about Bill (aged either 39 or 79 years old) and subsequently rated Bill's suicide risk and hospitalization needs. Suicide-risk ratings varied greatly and young clinicians rated Bill's suicide risk and hospitalization needs higher when he was elderly (79 years old); whereas, older clinicians rated Bill's suicide risk and need for hospitalization higher when he was younger (39 years old). The interaction between patient and clinician age may reflect a "similarity" bias, such that clinicians perceive those who are different (i.e., younger or older) to be at elevated risk. PMID:26677913

  16. Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction

    PubMed Central

    Shore, Supriya; Jones, Philip G.; Maddox, Thomas M.; Bradley, Steven M.; Stolker, Joshua M.; Arnold, Suzanne V.; Parashar, Susmita; Peterson, Pamela; Bhatt, Deepak L.; Spertus, John; Ho, P. Michael

    2016-01-01

    Background Prior studies have demonstrated that high-risk AMI patients are less likely to receive guideline-directed medications during hospitalization. It is unknown if this paradox persists following discharge. We aimed to assess if persistence with guideline-directed medications post-discharge varies by patients’ risk following acute myocardial infarction (AMI). Methods Data were analyzed from two prospective, multicenter U.S. AMI registries. The primary outcome was persistence with all prescribed guideline-directed medications (aspirin, beta-blockers, statins, angiotensin-antagonists) at 1, 6, and 12-months post-discharge. The association between risk and medication persistence post-discharge was assessed using multivariable mixed-effect models. Results Among 6434 AMI patients discharged home, 2824 were considered low-risk, 2014 intermediate-risk and 1596 high-risk for death based upon their GRACE 6-month risk score. High-risk was associated with a lower likelihood of receiving all appropriate therapies at discharge compared with low-risk patients (RR 0.90; 95% CI 0.87–0.94). At 12-months, the rate of persistence with all prescribed therapies was 61.5%, 57.9% and 45.9% among low-, intermediate- and high-risk patients respectively. After multivariable adjustment, high-risk was associated with lower persistence with all prescribed medications (RR 0.87; 95% CI 0.82–0.92) over follow-up. Similar associations were seen for individual medications. Over the 5 years of the study, persistence with prescribed therapies post-discharge improved modestly among high-risk patients (RR 1.05; 95% CI 1.03–1.08 per year). Conclusion High-risk AMI patients have a lower likelihood of persistently taking prescribed medications post-discharge as compared with low-risk patients. Continued efforts are needed to improve the use of guideline-directed medications in high-risk patients. PMID:25801001

  17. Antipsychotic Drugs Tied to Risk of Early Death in Parkinson's Patients

    MedlinePlus

    ... Drugs Tied to Risk of Early Death in Parkinson's Patients But it's unclear whether the medications or ... 22, 2016 (HealthDay News) -- New research suggests that Parkinson's patients who are given antipsychotics to treat dementia ...

  18. Risk factors for Clostridium difficile infection in hemato-oncological patients: A case control study in 144 patients

    PubMed Central

    Fuereder, Thorsten; Koni, Danjel; Gleiss, Andreas; Kundi, Michael; Makristathis, Athanasios; Zielinski, Christoph; Steininger, Christoph

    2016-01-01

    Evidence on risk factors for Clostridium difficile infection (CDI) in hemato-oncologic patients is conflicting. We studied risk factors for CDI in a large, well-characterized cohort of hemato-oncological patients. 144 hemato-oncological patients were identified in this retrospective, single center study with a microbiologically confirmed CDI-associated diarrhea. Patients were compared with 144 age and sex matched hemato-oncologic patients with CDI negative diarrhea. Risk factors such as prior antimicrobial therapy, type of disease, chemotherapy and survival were evaluated. CDI-positive patients received more frequently any antimicrobial agent and antimicrobial combination therapy than CDI-negative patients (79% vs. 67%; OR = 2.26, p = 0.038 and OR = 2.62, p = 0.003, respectively). CDI positive patients were treated more frequently with antimicrobial agents active against C. difficile than CDI negative ones (25% vs. 13%; OR = 2.2, p = 0.039). The interval between last chemotherapy and onset of diarrhea was significantly shorter in patients without CDI (median, 17 days vs 36 days; p < 0.001). Our study demonstrates that chemotherapy is not a significant risk factor for CDI but for early onset CDI negative diarrhea. The predominant modifiable risk factor for CDI is in hemato-oncological patients antimicrobial treatment. These findings should be taken into account in the daily clinical practice to avoid CDI associated complications and excess health care costs. PMID:27510591

  19. Risk factors for Clostridium difficile infection in hemato-oncological patients: A case control study in 144 patients.

    PubMed

    Fuereder, Thorsten; Koni, Danjel; Gleiss, Andreas; Kundi, Michael; Makristathis, Athanasios; Zielinski, Christoph; Steininger, Christoph

    2016-01-01

    Evidence on risk factors for Clostridium difficile infection (CDI) in hemato-oncologic patients is conflicting. We studied risk factors for CDI in a large, well-characterized cohort of hemato-oncological patients. 144 hemato-oncological patients were identified in this retrospective, single center study with a microbiologically confirmed CDI-associated diarrhea. Patients were compared with 144 age and sex matched hemato-oncologic patients with CDI negative diarrhea. Risk factors such as prior antimicrobial therapy, type of disease, chemotherapy and survival were evaluated. CDI-positive patients received more frequently any antimicrobial agent and antimicrobial combination therapy than CDI-negative patients (79% vs. 67%; OR = 2.26, p = 0.038 and OR = 2.62, p = 0.003, respectively). CDI positive patients were treated more frequently with antimicrobial agents active against C. difficile than CDI negative ones (25% vs. 13%; OR = 2.2, p = 0.039). The interval between last chemotherapy and onset of diarrhea was significantly shorter in patients without CDI (median, 17 days vs 36 days; p < 0.001). Our study demonstrates that chemotherapy is not a significant risk factor for CDI but for early onset CDI negative diarrhea. The predominant modifiable risk factor for CDI is in hemato-oncological patients antimicrobial treatment. These findings should be taken into account in the daily clinical practice to avoid CDI associated complications and excess health care costs. PMID:27510591

  20. 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

  1. 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.

  2. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients*

    PubMed Central

    Stanzani, Fabiana; Paisani, Denise de Moraes; de Oliveira, Anderson; de Souza, Rodrigo Caetano; Perfeito, João Aléssio Juliano; Faresin, Sonia Maria

    2014-01-01

    OBJECTIVE: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies. PMID:24626266

  3. Risk for Mycobacterial Disease among Patients with Rheumatoid Arthritis, Taiwan, 2001–2011

    PubMed Central

    Liao, Tsai-Ling; Lin, Ching-Heng; Shen, Gwan-Han; Chang, Chia-Li; Lin, Chin-Fu

    2015-01-01

    Increasing evidence indicates that the risk of acquiring tuberculosis (TB) and nontuberculous mycobacterial disease is elevated among patients with rheumatoid arthritis (RA). To determine the epidemiology of mycobacterial diseases among RA patients in Asia, we conducted a retrospective cohort study. We used a nationwide database to investigate the association of RA with mycobacterial diseases. The risk for development of TB or nontuberculous mycobacterial disease was 2.28-fold and 6.24-fold higher among RA patients than among the general population, respectively. Among RA patients, risk for development of mycobacterial disease was higher among those who were older, male, or both. Furthermore, among RA patients with mycobacterial infections, the risk for death was increased. Therefore, RA patients, especially those with other risk factors, should be closely monitored for development of mycobacterial disease. PMID:26196158

  4. DOC-2/DAB2 Interacting Protein Status in High-Risk Prostate Cancer Correlates With Outcome for Patients Treated With Radiation Therapy

    SciTech Connect

    Jacobs, Corbin; Tumati, Vasu; Kapur, Payal; Yan, Jingsheng; Hong, David; Bhuiyan, Manzerul; Xie, Xian-Jin; Pistenmaa, David; Yu, Lan; Hsieh, Jer-Tsong; Saha, Debabrata; Kim, D. W. Nathan

    2014-07-15

    Purpose: This pilot study investigates the role of DOC-2/DAB2 Interacting Protein (DAB2IP) and enhancer of zeste homolog 2 (EZH2) as prognostic biomarkers in high-risk prostate cancer patients receiving definitive radiation therapy. Methods and Materials: Immunohistochemistry was performed and scored by an expert genitourinary pathologist. Clinical endpoints evaluated were freedom from biochemical failure (FFBF), castration resistance–free survival (CRFS), and distant metastasis–free survival (DMFS). Log-rank test and Cox regression were used to determine significance of biomarker levels with clinical outcome. Results: Fifty-four patients with high-risk prostate cancer (stage ≥T3a, or Gleason score ≥8, or prostate-specific antigen level ≥20 ng/mL) treated with radiation therapy from 2005 to 2012 at our institution were evaluated. Nearly all patients expressed EZH2 (98%), whereas 28% of patients revealed DAB2IP reduction and 72% retained DAB2IP. Median follow-up was 34.0 months for DAB2IP-reduced patients, 29.9 months for DAB2IP-retained patients, and 32.6 months in the EZH2 study. Reduction in DAB2IP portended worse outcome compared with DAB2IP-retained patients, including FFBF (4-year: 37% vs 89%, P=.04), CRFS (4-year: 50% vs 90%, P=.02), and DMFS (4-year: 36% vs 97%, P=.05). Stratified EZH2 expression trended toward significance for worse FFBF and CRFS (P=.07). Patients with reduced DAB2IP or highest-intensity EZH2 expression exhibited worse FFBF (4-year: 32% vs 95%, P=.02), CRFS (4-year: 28% vs 100%, P<.01), and DMFS (4-year: 39% vs 100%, P=.04) compared with the control group. Conclusion: Loss of DAB2IP is a potent biomarker that portends worse outcome despite definitive radiation therapy for patients with high-risk prostate cancer. Enhancer of zeste homolog 2 is expressed in most high-risk tumors and is a less potent discriminator of outcome in this study. The DAB2IP status in combination with degree of EZH2 expression may be useful for

  5. Characteristics of Stratified Bedded Pack Dairy Manure

    Technology Transfer Automated Retrieval System (TEKTRAN)

    "Compost" dairy barns are a relatively new housing system that generates a deep (0.9 to 1.5 m), stratified bedded pack (SBP) manure source. Bedding composed of sawdust, wood chips, or crop residues accumulates as additions are made to maintain a dry surface. Surface drying is promoted by a combinati...

  6. A chemically stratified lake in alaska.

    PubMed

    Likens, G E; Johnson, P L

    1966-08-19

    A meromictic (chemically stratified) lake occupies a thawed depression in a pingo in interior Alaska, near Circle City. Increased salt concentration and anaerobic conditions characterize the zone extending from a maximum depth of 3 to 8.8 meters. The concentration of strontium and lithium is unusually high for lake water. PMID:17780648

  7. MERGING BUOYANT JETS IN A STRATIFIED CROSSFLOW

    EPA Science Inventory

    Some of the results of an extensive series of experiments to study the characteristics of merging, horizontally discharged buoyant jets in a linearly density stratified current are summarized. The experiments were conducted in a towing tank to simulate conditions typical of ocean...

  8. Oscillations in a Linearly Stratified Salt Solution

    ERIC Educational Resources Information Center

    Heavers, Richard M.

    2007-01-01

    Our physics students like to watch a ball bouncing underwater. They do this by dropping a weighted plastic ball into a 1000-ml cylinder filled with a linearly stratified salt-water solution at room temperature. The ball oscillates and comes to rest at about mid-depth. Its motion is analogous to the damped vertical oscillations of a mass hanging…

  9. Broadband acoustic quantification of stratified turbulence.

    PubMed

    Lavery, Andone C; Geyer, W Rockwell; Scully, Malcolm E

    2013-07-01

    High-frequency broadband acoustic scattering techniques have enabled the remote, high-resolution imaging and quantification of highly salt-stratified turbulence in an estuary. Turbulent salinity spectra in the stratified shear layer have been measured acoustically and by in situ turbulence sensors. The acoustic frequencies used span 120-600 kHz, which, for the highly stratified and dynamic estuarine environment, correspond to wavenumbers in the viscous-convective subrange (500-2500 m(-1)). The acoustically measured spectral levels are in close agreement with spectral levels measured with closely co-located micro-conductivity probes. The acoustically measured spectral shapes allow discrimination between scattering dominated by turbulent salinity microstructure and suspended sediments or swim-bladdered fish, the two primary sources of scattering observed in the estuary in addition to turbulent salinity microstructure. The direct comparison of salinity spectra inferred acoustically and by the in situ turbulence sensors provides a test of both the acoustic scattering model and the quantitative skill of acoustical remote sensing of turbulence dissipation in a strongly sheared and salt-stratified estuary. PMID:23862783

  10. First Detection of Mycobacteria in African Rodents and Insectivores, Using Stratified Pool Screening▿ †

    PubMed Central

    Durnez, Lies; Eddyani, Miriam; Mgode, Georgies F.; Katakweba, Abdul; Katholi, Charles R.; Machang'u, Robert R.; Kazwala, Rudovik R.; Portaels, Françoise; Leirs, Herwig

    2008-01-01

    With the rising number of patients with human immunodeficiency virus (HIV)/AIDS in developing countries, the control of mycobacteria is of growing importance. Previous studies have shown that rodents and insectivores are carriers of mycobacteria. However, it is not clear how widespread mycobacteria are in these animals and what their role is in spreading them. Therefore, the prevalence of mycobacteria in rodents and insectivores was studied in and around Morogoro, Tanzania. Live rodents were trapped, with three types of live traps, in three habitats. Pieces of organs were pooled per habitat, species, and organ type (stratified pooling); these sample pools were examined for the presence of mycobacteria by PCR, microscopy, and culture methods. The mycobacterial isolates were identified using phenotypic techniques and sequencing. In total, 708 small mammals were collected, 31 of which were shrews. By pool prevalence estimation, 2.65% of the animals were carriers of mycobacteria, with a higher prevalence in the urban areas and in Cricetomys gambianus and the insectivore Crocidura hirta. Nontuberculous mycobacteria (Mycobacterium chimaera, M. intracellulare, M. arupense, M. parascrofulaceum, and Mycobacterium spp.) were isolated from C. gambianus, Mastomys natalensis, and C. hirta. This study is the first to report findings of mycobacteria in African rodents and insectivores and the first in mycobacterial ecology to estimate the prevalence of mycobacteria after stratified pool screening. The fact that small mammals in urban areas carry more mycobacteria than those in the fields and that potentially pathogenic mycobacteria were isolated identifies a risk for other animals and humans, especially HIV/AIDS patients, that have a weakened immune system. PMID:18065608

  11. First detection of mycobacteria in African rodents and insectivores, using stratified pool screening.

    PubMed

    Durnez, Lies; Eddyani, Miriam; Mgode, Georgies F; Katakweba, Abdul; Katholi, Charles R; Machang'u, Robert R; Kazwala, Rudovik R; Portaels, Françoise; Leirs, Herwig

    2008-02-01

    With the rising number of patients with human immunodeficiency virus (HIV)/AIDS in developing countries, the control of mycobacteria is of growing importance. Previous studies have shown that rodents and insectivores are carriers of mycobacteria. However, it is not clear how widespread mycobacteria are in these animals and what their role is in spreading them. Therefore, the prevalence of mycobacteria in rodents and insectivores was studied in and around Morogoro, Tanzania. Live rodents were trapped, with three types of live traps, in three habitats. Pieces of organs were pooled per habitat, species, and organ type (stratified pooling); these sample pools were examined for the presence of mycobacteria by PCR, microscopy, and culture methods. The mycobacterial isolates were identified using phenotypic techniques and sequencing. In total, 708 small mammals were collected, 31 of which were shrews. By pool prevalence estimation, 2.65% of the animals were carriers of mycobacteria, with a higher prevalence in the urban areas and in Cricetomys gambianus and the insectivore Crocidura hirta. Nontuberculous mycobacteria (Mycobacterium chimaera, M. intracellulare, M. arupense, M. parascrofulaceum, and Mycobacterium spp.) were isolated from C. gambianus, Mastomys natalensis, and C. hirta. This study is the first to report findings of mycobacteria in African rodents and insectivores and the first in mycobacterial ecology to estimate the prevalence of mycobacteria after stratified pool screening. The fact that small mammals in urban areas carry more mycobacteria than those in the fields and that potentially pathogenic mycobacteria were isolated identifies a risk for other animals and humans, especially HIV/AIDS patients, that have a weakened immune system. PMID:18065608

  12. 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

  13. Old age, high risk medication, polypharmacy: a ‘trilogy’ of risks in older patients with atrial fibrillation

    PubMed Central

    2015-01-01

    Background: The safety of pharmacotherapy in atrial fibrillation (AF) is compounded by a trilogy of risks old age, high-risk medications (e.g., antithrombotics, antiarrhythmics), polypharmacy due to multiple patient comorbidities. However, to date, scarce study has investigated the use of polypharmacy (including potentially inappropriate medication (PIM)) in AF patients, and how this may contribute to their overall risk of medication misadventure. Objectives: To review the extent of polypharmacy and PIM use in older patients (65 years or older) with AF. Methods: Information was extracted from a database characterising a cohort of older AF patients treated in general practice in New South Wales, Australia. Patient characteristics, number and types of drugs, the degree of PIM use were recorded. The predictors for the use of polypharmacy in older AF patients were identified. Results: Overall, 367 patients (mean age 77.8 years) were reviewed, among which 94.8% used 5 medications or more and over half used 10 medications or more. Cardiovascular agents were most commonly used (98.9%), followed by antithrombotics (90.7%). Among agents deemed PIMs, digoxin (30.2%) was the most frequently used, followed by benzodiazepines (19.6%), and sotalol (9.8%). AF patients using polypharmacy were more likely to have low bleeding risk (OR=10.97), representing those patients in whom high-risk antithrombotics are mostly indicated. Patients with major-polypharmacy (5-9 medications) are more likely to have obstructive pulmonary diseases (OR=2.32), upper gastrointestinal diseases (OR=2.02) and poor physical function (OR=1.04), but less likely to have cognitive impairment (OR=0.27). Conclusion: Polypharmacy affects oldest AF patients, comprising medications that are indicated for AF, yet regarded as PIMs. Patients with lower risk of bleeding, obstructive pulmonary diseases, upper gastrointestinal diseases and poor physical function are also at higher risk of using higher number of

  14. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk.

    PubMed

    Schopp, Jennifer G; Iyer, Ramesh S; Wang, Carolyn L; Petscavage, Jonelle M; Paladin, Angelisa M; Bush, William H; Dighe, Manjiri K

    2013-08-01

    The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction. PMID:23430296

  15. Dapagliflozin’s Effects on Glycemia and Cardiovascular Risk Factors in High-Risk Patients With Type 2 Diabetes: A 24-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study With a 28-Week Extension

    PubMed Central

    Leiter, Lawrence A.; de Bruin, Tjerk W.A.; Gause-Nilsson, Ingrid; Sugg, Jennifer; Parikh, Shamik J.

    2015-01-01

    OBJECTIVE To assess the efficacy and safety of dapagliflozin, a selective sodium-glucose cotransporter 2 inhibitor, compared with placebo in patients with type 2 diabetes (T2D), documented pre-existing cardiovascular disease (CVD), and a history of hypertension. RESEARCH DESIGN AND METHODS Patients (N = 922) were randomized to receive 10 mg dapagliflozin or placebo in a double-blind trial for 24 weeks, followed by a 28-week extension period. In patients receiving insulin, the insulin dose was reduced by 25% at randomization. Patients were stratified by age, insulin use, and time from the most recent qualifying cardiovascular (CV) event. Co-primary end points were a change from baseline in hemoglobin A1c (HbA1c) and the proportion of patients achieving a combined reduction in HbA1c of ≥0.5% (5.5 mmol/mol), body weight (BW) of ≥3%, and systolic blood pressure (SBP) of ≥3 mmHg. RESULTS At 24 weeks, dapagliflozin significantly reduced HbA1c (−0.38% [−4.2 mmol/mol]) from baseline (8.18%) compared with a slight increase with placebo from baseline (8.08%) (0.08% [0.9 mmol/mol]). Significantly more patients met the three-item end point with treatment with dapagliflozin than with placebo (11.7% vs. 0.9%, respectively). Changes were maintained over 52 weeks. Although ∼42% of patients were ≥65 years old, similar results were observed in both age-stratified groups. Serious adverse events, hypoglycemia, urinary tract infections, and cardiac disorders were similar between groups. Adverse events of hypotension, dehydration, hypovolemia, genital infection, and renal failure or impairment occurred more often with dapagliflozin treatment. CONCLUSIONS In this study that evaluated T2D patients who were at high risk for future CVD events, dapagliflozin administration had significantly greater effects in reducing HbA1c, BW, and SBP, without adversely impacting CV safety when compared with placebo treatment. PMID:25852208

  16. Tailored information increases patient/physician discussion of colon cancer risk and testing: The Cancer Risk Intake System trial.

    PubMed

    Skinner, Celette Sugg; Gupta, Samir; Bishop, Wendy Pechero; Ahn, Chul; Tiro, Jasmin A; Halm, Ethan A; Farrell, David; Marks, Emily; Morrow, Jay; Julka, Manjula; McCallister, Katharine; Sanders, Joanne M; Rawl, Susan M

    2016-12-01

    Assess whether receipt of tailored printouts generated by the Cancer Risk Intake System (CRIS) - a touch-screen computer program that collects data from patients and generates printouts for patients and physicians - results in more reported patient-provider discussions about colorectal cancer (CRC) risk and screening than receipt of non-tailored information. Cluster-randomized trial, randomized by physician, with data collected via CRIS prior to visit and 2-week follow-up telephone survey among 623 patients. Patients aged 25-75 with upcoming primary-care visits and eligible for, but currently non-adherent to CRC screening guidelines. Patient-reported discussions with providers about CRC risk and testing. Tailored recipients were more likely to report patient-physician discussions about personal and familial risk, stool testing, and colonoscopy (all p < 0.05). Tailored recipients were more likely to report discussions of: chances of getting cancer (+ 10%); family history (+ 15%); stool testing (+ 9%); and colonoscopy (+ 8%) (all p < 0.05). CRIS is a promising strategy for facilitating discussions about testing in primary-care settings. PMID:27413654

  17. 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

  18. The challenge of individualised risk assessment and therapy planning in elderly high-risk myelodysplastic syndromes (MDS) patients.

    PubMed

    Stauder, Reinhard

    2012-09-01

    Myelodysplastic syndromes (MDS) represent one of the most frequent and serious haematologic diseases of the elderly. Effective therapies exist ranging from best supportive care to haematologic stem cell transplantation (HSCT). Decision making, however, is rather complex in this group of patients because ageing is a multidimensional process involving not only physiological changes but also changes in functional, social, emotional and cognitive capacities. All these factors can have a significant impact on the efficacy and tolerability of a potential therapy and therefore have to be thoroughly assessed before deciding on individual treatment regimens. Risk assessment tools are available both to classify the stage and prognosis of MDS and to meet the needs of elderly patients. A tool explicitly focussing on elderly MDS patients, however, is still missing. The current report approached this issue by combining the well established MDS-risk score 'International Prognostic Scoring System' (IPSS) with the 'Multidimensional Geriatric Assessment' (MGA). As decision making is most complex in high-risk MDS patients, the new algorithm is presented exemplarily for this group of patients. In a first step, MDS-related risk is identified using IPSS, in a second step, patients are assigned to one of three risk categories of the MGA (go-go/fit, slow-go/vulnerable, no-go/frail). While go-go patients might be subjected to therapies comparable to those given to younger patients, in no-go patients, a palliative therapy combined with best supportive care will probably be most appropriate. In slow-go patients, age-related life expectancy taken from public age statistics should be compared to the MDS-related life expectancy. Based on this combined assessment procedure and also on treatment tolerance in terms of the expectations/wishes of the patient and his/her family, an individualised therapeutic approach should be developed. Specific treatment recommendations for these three groups of

  19. [Incidence and Risk Assessment of Tumor Lysis Syndrome in Patients with Advanced Germ Cell Cancer].

    PubMed

    Kurobe, Masahiro; Kawai, Koji; Tanaka, Ken; Ichioka, Daishi; Yoshino, Takayuki; Kandori, Shuya; Kawahara, Takashi; Waku, Natsui; Takaoka, Ei-Ichirou; Kojima, Takahiro; Joraku, Akira; Suetomi, Takahiro; Miyazaki, Jun; Nishiyama, Hiroyuki

    2016-05-01

    Tumor lysis syndrome (TLS) is a major oncological emergency. TLS is common in patients with hematological malignancies, but it can occur across a spectrum of cancer types. Germ cell tumors (GCT) have rapid cancer cell turnover and often present with bulky metastasis. The international TLS expert consensus panel has recommended guidelines for a medical decision tree to assign low, intermediate and high risk to patients with cancer at risk for TLS. GCT is classified as intermediate risk for TLS, and the patients who have other TLS risks factors are classified to be at high risk for TLS. In this study, we retrospectively analyzed 67 patients with metastatic GCT who were treated with induction chemotherapy at Tsukuba University Hospital between 2000 and 2013. Thirty-one, 15 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Twelve patients (18%) were classified to be at high risk for TLS, and two patients were treated with allopurinol or rasburicase as prophylaxes for TLS. They did not show progression to laboratory TLS (L-TLS). In the remaining 10 TLS high-risk patients, three (30%) patients developed L-TLS after chemotherapy and started receiving oral allopurinol. As a result, no patients developed clinical TLS (C-TLS). In this study, 30% of TLS-high risk patients developed L-TLS without prophylactic treatment. Therefore, it is important to conduct TLS-risk stratification and consider prophylaxis such as rasburicase for advanced GCT patients at induction chemotherapy. PMID:27320114

  20. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee

    PubMed Central

    Eka, Aleeson

    2015-01-01

    Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA). Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors. Medical risk factors, such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), preoperative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery. Treating patients to get laboratory values under a specified threshold or cessation of certain modifiable risk factors can decrease the risk of PJI. Although significant advances have been made in past decades to identify these risk factors, there remains some uncertainty regarding the risk factors predisposing TJA patients to PJI. Through a review of the current literature, this paper aims to comprehensively evaluate and provide a better understanding of known medical risk factors for PJI after TJA. PMID:26539450

  1. Patients' perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy.

    PubMed

    Kendel, Friederike; Helbig, Lukas; Neumann, Konrad; Herden, Jan; Stephan, Carsten; Schrader, Mark; Gaissmaier, Wolfgang

    2016-08-15

    Treatment choice for localized prostate cancer (PCa) is a controversial issue, and mortality risk is probably the most decisive factor in this regard. The study aimed to compare prostate-cancer-specific mortality risk estimates for different treatment options assigned by patients managed with active surveillance (AS), radical prostatectomy (RP) and patients who had discontinued AS (DAS). Patients initially managed with AS or RP (N = 370) were matched according to length of therapy. All patients completed mailed questionnaires assessing their mortality risk estimates (in %) and prostate-cancer-specific anxiety. Differences in risk estimates among the three treatment groups were analyzed using ANOVA, relationships of clinical and psychosocial variables with risk estimates using standard multiple regression. In all treatment groups, the prostate- cancer-specific mortality risk was overestimated. This applied whether it was the patient's own treatment or the alternative treatment option. RP patients assigned a mortality risk to AS that was almost three times higher than that assigned to RP (50.9 ± 25.0 vs. 17.8 ± 19.7, d = 1.48; p < 0.001). Anxiety was significantly associated with risk estimates for AS (p = 0.008) and RP (p = 0.001). Compared with clinical data that suggest that the prostate-cancer-specific mortality risk for AS is low and does not significantly differ from that for RP, patients strongly overestimated the mortality risk. This was most markedly so in RP patients, who drastically overestimated the benefits of RP compared to the risk of AS. This overestimation could increase overtreatment and should therefore be corrected by better patient education. PMID:27038059

  2. HDL Cholesterol, Apolipoproteins, and Cardiovascular Risk in Hemodialysis Patients

    PubMed Central

    Genser, Bernd; Drechsler, Christiane; Scharnagl, Hubert; Grammer, Tanja B.; Stojakovic, Tatjana; Krane, Vera; Ritz, Eberhard; Wanner, Christoph; März, Winfried

    2015-01-01

    High concentrations of HDL cholesterol are considered to indicate efficient reverse cholesterol transport and to protect from atherosclerosis. However, HDL has been suggested to be dysfunctional in ESRD. Hence, our main objective was to investigate the effect of HDL cholesterol on outcomes in maintenance hemodialysis patients with diabetes. Moreover, we investigated the associations between the major protein components of HDL (apoA1, apoA2, and apoC3) and end points. We performed an exploratory, post hoc analysis with 1255 participants (677 men and 578 women) of the German Diabetes Dialysis study. The mean age was 66.3 years and the mean body mass index was 28.0 kg/m2. The primary end point was a composite of cardiac death, myocardial infarction, and stroke. The secondary end point included all-cause mortality. The mean duration of follow-up was 3.9 years. A total of 31.3% of the study participants reached the primary end point and 49.1% died from any cause. HDL cholesterol and apoA1 and apoC3 quartiles were not related to end points. However, there was a trend toward an inverse association between apoA2 and all-cause mortality. The hazard ratio for death from any cause in the fourth quartile compared with the first quartile of apoA2 was 0.63 (95% confidence interval, 0.40 to 0.89). The lack of an association between HDL cholesterol and cardiovascular risk may support the concept of dysfunctional HDL in hemodialysis. The possible beneficial effect of apoA2 on survival requires confirmation in future studies. PMID:25012163

  3. Wakes of Maneuvering Bodies in Stratified Fluids

    NASA Astrophysics Data System (ADS)

    Voropayev, S. I.; Fernando, H. J.

    2007-05-01

    We present the results of experimental/theoretical studies on large momentum eddies generated in late wakes of unsteady moving self-propelled bodies in stratified fluids. The experiments were conducted with scaled submarine model at high Reynolds numbers (50,000), corresponding to the fully turbulent flow regime. Dye visualization and PIV were used for flow diagnostics. When a self-propelled body makes a maneuver, e.g. accelerates, it imparts net momentum on the surrounding fluid. We show that in a stratified fluid this leads to impulsive momentum wakes with large, long-lived coherent vortices in the late flows, which may be used as a signature for identification of submarine wakes in oceanic thermocline. First, we consider dynamics and properties of such wakes in a linearly stratified fluid and present a model that permits to predict the main flow characteristics. Second, we consider wakes in a two layer stratified fluid (analog of the upper ocean) and show that such wakes may penetrate to the water surface; we present a model for this phenomenon and propose criteria for the penetration of wake signatures to the water surface in terms of main governing parameters (signature contrast versus confinement number). Finally, we consider the evolution of such momentum wake eddies in the field of decaying background turbulence, which mimics the oceanic thermocline, and show that for the flow configuration studied the contrast number remains sufficiently large and detectable wake imprints survive for a long period of time. Some pertinent estimates for submarines cruising in the upper ocean are also given. For more details see [1-3]. This study was supported by grant from the Office of Naval Research. 1. Voropayev S.I., Fernando H.J.S., Smirnov S.A. & Morrison R.J. 2006. On surface signatures generated by submersed momentum sources. Phys. Fluids, under revision. 2. Voropayev S.I., Fernando H.J.S. & Morrison R.J. 2006. Dipolar eddies in a stratified turbulent flow. J. Fluid

  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. RISK OF SEVERE AND REFRACTORY POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING DIEP FLAP BREAST RECONSTRUCTION

    PubMed Central

    MANAHAN, MICHELE A.; BASDAG, BASAK; KALMAR, CHRISTOPHER L.; SHRIDHARANI, SACHIN M.; MAGARAKIS, MICHAEL; JACOBS, LISA K.; THOMSEN, ROBERT W.; ROSSON, GEDGE D.

    2014-01-01

    Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients. PMID:24038427

  6. Improved Clinical Risk Stratification in Patients with Long QT Syndrome? Novel Insights from Multi-Channel ECGs

    PubMed Central

    Samol, Alexander; Gönes, Mehmet; Zumhagen, Sven; Bruns, Hans-Jürgen; Paul, Matthias; Vahlhaus, Christian; Waltenberger, Johannes; Schulze-Bahr, Eric; Eckardt, Lars; Mönnig, Gerold

    2016-01-01

    Background We investigated whether multichannel ECG-recordings are useful to risk-stratify patients with congenital long-QT syndrome (LQTS) for risk of sudden cardiac death under optimized medical treatment. Methods In 34 LQTS-patients (11 male; age 31±13 years, QTc 478±51ms; LQT1 n = 8, LQT2 n = 15) we performed a standard 12-channel ECG and a 120-channel body surface potential mapping. The occurrence of clinical events (CE; syncope, torsade de pointes (TdP), sudden cardiac arrest (SCA)) was documented and correlated with different ECG-parameters in all lead positions. Results Seven patients developed TdP, four survived SCA and 12 experienced syncope. 12/34 had at least one CE. CE was associated with a longer QTc-interval (519±43ms vs. 458±42ms; p = 0.001), a lower T-wave integral (TWI) on the left upper chest (-1.2±74.4mV*ms vs. 63.0±29.7mV*ms; p = 0.001), a lower range of T-wave amplitude (TWA) in the region of chest lead V8 (0.10±0.08mV vs. 0.18±0.07mV; p = 0.008) and a longer T-peak-T-end time (TpTe) in lead V1 (98±23ms vs. 78±26ms; p = 0.04). Receiver-operating-characteristic (ROC) analyses revealed a sensitivity of 96% and a specificity of 75% (area under curve (AUC) 0.89±0.06, p = 0.001) at a cut-off value of 26.8mV*ms for prediction of CE by TWI, a sensitivity of 86% and a specificity of 83% at a cut-off value of 0.11mV (AUC 0.83±0.09, p = 0.002) for prediction of CE by TWA and a sensitivity of 83% and a specificity of 73% at a cut-off value of 87ms (AUC 0.80±0.07, p = 0.005) for prediction of CE by TpTe. Conclusions Occurrence of CE in LQTS-patients seems to be associated with a prolonged, low-amplitude T-wave. PMID:27379800

  7. The increasing influence of risk assessment on forensic patient review board decisions.

    PubMed

    Hilton, N Zoe; Simpson, Alexander I; Ham, Elke

    2016-08-01

    Previous studies of decisions about forensic patients' placement in secure hospitals indicate some changes over time in the use of empirically supported risk factors. Our aim was to investigate whether, in more recent cases, risk assessment instruments were cited by a forensic patient review board or by the clinicians who made recommendations to the board and whether there was evidence of an association between risk assessment results and either dispositions or recommendations. Among review board hearings held in 2009-2012 pertaining to 63 different maximum security patients found not criminally responsible on account of mental disorder in Ontario, Canada, dispositions were most strongly associated with psychiatrists' testimony, consistent with previous studies. However, dispositions were associated with the scores on the Violence Risk Appraisal Guide (VRAG), such that transferred patients had a lower risk of violent recidivism than detained patients. An association between clinical opinions and risk assessment results was also evident and significantly larger than in previous research. There was no evidence that risk assessment was cited selectively in higher risk cases or when scores were concordant with the review board decision. This research may provide a baseline for studies of the effect of 2014 legislation introducing a high-risk designation for forensic patients in Canada. We recommend further efforts to measure the effect of nonpharmacological treatment participation and in-hospital security decisions on forensic decision-making. (PsycINFO Database Record PMID:27504642

  8. Patient- and cohort-specific dose and risk estimation for abdominopelvic CT: a study based on 100 patients

    NASA Astrophysics Data System (ADS)

    Tian, Xiaoyu; Li, Xiang; Segars, W. Paul; Frush, Donald P.; Samei, Ehsan

    2012-03-01

    The purpose of this work was twofold: (a) to estimate patient- and cohort-specific radiation dose and cancer risk index for abdominopelvic computer tomography (CT) scans; (b) to evaluate the effects of patient anatomical characteristics (size, age, and gender) and CT scanner model on dose and risk conversion coefficients. The study included 100 patient models (42 pediatric models, 58 adult models) and multi-detector array CT scanners from two commercial manufacturers (LightSpeed VCT, GE Healthcare; SOMATOM Definition Flash, Siemens Healthcare). A previously-validated Monte Carlo program was used to simulate organ dose for each patient model and each scanner, from which DLP-normalized-effective dose (k factor) and DLP-normalized-risk index values (q factor) were derived. The k factor showed exponential decrease with increasing patient size. For a given gender, q factor showed exponential decrease with both increasing patient size and patient age. The discrepancies in k and q factors across scanners were on average 8% and 15%, respectively. This study demonstrates the feasibility of estimating patient-specific organ dose and cohort-specific effective dose and risk index in abdominopelvic CT requiring only the knowledge of patient size, gender, and age.

  9. Lack of benefit of pelvic radiation in prostate cancer patients with a high risk of positive pelvic lymph nodes treated with high-dose radiation

    SciTech Connect

    Vargas, Carlos Enrique; Galalae, Razavan; Demanes, Jeffrey; Harsolia, Asif; Meldolesi, Elisa; Nuernberg, Nils; Schour, Lionel; Martinez, Alvaro . E-mail: amartinez@beaumont.edu

    2005-12-01

    ), no benefit was seen in the 5-year rates of clinical failure, cause-specific survival, or overall survival with pelvic radiation. In the Cox multivariate analysis for cause-specific survival, Gleason score (p = 0.009, hazard ratio [HR] 3.1), T stage (p = 0.03, HR 1.8), and year of treatment (p = 0.05, HR 1.1) were significant. A log-rank test for cause-specific survival for all patients (n = 577) by the use of pelvic radiation was not significant (p = 0.99) accounting for high-dose-rate brachytherapy dose, neoadjuvant hormones, Gleason score, prostate-specific antigen, T stage, and year of treatment as covariates. Conclusions: The use of the Roach formula to stratify patients for clinical and biochemical outcomes is excellent. Pelvic radiation added to high prostate radiation doses did not show a clinical benefit for patients at a high risk of pelvic LN disease (>15%) selected using the Roach formula.

  10. A case management approach to immunizing patients at high risk for influenza.

    PubMed

    Kreager, A M; Cicerone, J; Hella, S; Johnson, A N; Matthews, L; Richards, N L; Sinishtaj, L; Tobin, A; Veltigian, S

    2001-01-01

    The influenza season affects not only the people afflicted with influenza, but the healthcare system as a whole. An estimated dollar 12 billion is the annual cost to care for these patients. An existing problem is that although there is an immunization for influenza, many patients at high risk are not immunized. This article will describe an innovative program of a large Midwest suburban hospital to immunize patients at high risk. PMID:16398063

  11. A new frontier in healthcare risk management: Working to reduce avoidable patient suffering.

    PubMed

    Card, Alan J; Klein, Victor R

    2016-01-01

    This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system. PMID:26789746

  12. 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

  13. Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma

    PubMed Central

    Fonseca, Rafael; Siegel, David; Dimopoulos, Meletios A.; Špička, Ivan; Masszi, Tamás; Hájek, Roman; Rosiñol, Laura; Goranova-Marinova, Vesselina; Mihaylov, Georgi; Maisnar, Vladimír; Mateos, Maria-Victoria; Wang, Michael; Niesvizky, Ruben; Oriol, Albert; Jakubowiak, Andrzej; Minarik, Jiri; Palumbo, Antonio; Bensinger, William; Kukreti, Vishal; Ben-Yehuda, Dina; Stewart, A. Keith; Obreja, Mihaela; Moreau, Philippe

    2016-01-01

    The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391. PMID:27439911

  14. Stably Stratified Flow in a Shallow Valley

    NASA Astrophysics Data System (ADS)

    Mahrt, L.

    2016-07-01

    Stratified nocturnal flow above and within a small valley of approximately 12-m depth and a few hundred metres width is examined as a case study, based on a network of 20 sonic anemometers and a central 20-m tower with eight levels of sonic anemometers. Several regimes of stratified flow over gentle topography are conceptually defined for organizing the data analysis and comparing with the existing literature. In our case study, a marginal cold pool forms within the shallow valley in the early evening but yields to larger ambient wind speeds after a few hours, corresponding to stratified terrain-following flow where the flow outside the valley descends to the valley floor. The terrain-following flow lasts about 10 h and then undergoes transition to an intermittent marginal cold pool towards the end of the night when the larger-scale flow collapses. During this 10-h period, the stratified terrain-following flow is characterized by a three-layer structure, consisting of a thin surface boundary layer of a few metres depth on the valley floor, a deeper boundary layer corresponding to the larger-scale flow, and an intermediate transition layer with significant wind-directional shear and possible advection of lee turbulence that is generated even for the gentle topography of our study. The flow in the valley is often modulated by oscillations with a typical period of 10 min. Cold events with smaller turbulent intensity and duration of tens of minutes move through the observational domain throughout the terrain-following period. One of these events is examined in detail.

  15. Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation

    PubMed Central

    Barrett, Tyler W.; Storrow, Alan B.; Jenkins, Cathy A.; Harrell, Frank E.; Amdahl, John; Russ, Stephan; Slovis, Corey M.; Darbar, Dawood

    2010-01-01

    Study Objective Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all ED visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF. Methods We systematically reviewed the electronic medical records of ED patients with newly diagnosed AF between August 2005 and July 2008. We measured the frequency of the Framingham Heart Study predictors and calculated each patient's risk score. Results During the 3-year study period, 914 patients had 1228 ED visits. New AF was diagnosed in 296 (32%) patients. Among these patients, 107 (36%) were female, 127 (43%) had prior ED visits since 2003, 189 (64%) were taking hypertension medications and 170 (57.4%) had previous electrocardiograms with measurable PR intervals. The median PR interval was 166 ms (151 to 180) and 60% of available PR intervals were ≥160 ms. The median (Interquartile range) age, body mass index, and systolic blood pressure were 66 years (53 to 77), 27 (23 to 31), and 134 mm Hg (118 to 151), respectively. Median risk score was 7 (3 to 9) indicating high predicted risk. Heart failure and cardiac murmurs were previously diagnosed in 45 (15%) and 32 (11%) of these patients, respectively. Conclusions The Framingham risk factors for AF are commonly encountered among ED patients with newly diagnosed AF. The ED might provide an opportunity to identify patients at high risk for AF and refer them for primary prevention interventions. PMID:21208770

  16. Safety of IVF under anticoagulant therapy in patients at risk for thrombo-embolic events.

    PubMed

    Yinon, Yoav; Pauzner, Rachel; Dulitzky, Mordechai; Elizur, Shai E; Dor, Jehoshua; Shulman, Adrian

    2006-03-01

    The objective of this study was to assess the safety of induction of ovulation and oocyte retrieval in patients at risk of thrombosis, necessitating treatment with anticoagulants. Twenty-four patients considered as high risk for a thromboembolic event underwent 73 IVF cycles and 68 oocyte retrieval procedures, and were treated concomitantly with anticoagulation therapy (low molecular weight heparin; LMWH). A subgroup of five patients considered at especially high risk for thrombosis was isolated. These patients were prepared for oocyte retrieval using a controlled spontaneous cycle. All these patients were programmed exclusively for surrogacy. Nineteen women underwent 49 cycles of ovulation induction with gonadotrophins. The average peak oestradiol concentration was 1791 +/- 1420 pg/ml with an average of 13.5 +/- 8.4 oocytes retrieved in each cycle. The five patients from the very high risk group underwent 24 cycles: the average peak oestradiol concentration was 163 +/- 98 pg/ml. In 18, an egg was retrieved and in 14, fertilization was achieved. No bleeding or thromboembolic complications were noted during treatment of both groups of patients. It is concluded that during induction of ovulation in patients at risk for thrombosis, the introduction of LMWH as a cycle protective treatment was not associated with any medical complication. The use of a controlled spontaneous cycle with LMWH is suggested in very high risk patients. PMID:16578908

  17. The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy

    PubMed Central

    Wang, Kunlun; Liu, Yang; You, Jie; Cui, Han; Zhu, Yiwei; Yuan, Ling

    2016-01-01

    The impact of nutritional status on survival among elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy is unclear. In this study, we aimed at validating the performance of the geriatric nutritional risk index (GNRI) in predicting overall survival time in elderly ESCC patients with radiotherapy. A retrospective cohort study was conducted on 239 ESCC patients aged 60 and over admitted consecutively from January 2008 to November 2014 in the Department of Radiotherapy, Henan Tumor Hospital (Affiliated Tumor Hospital of Zhengzhou University), Zhengzhou, Henan, China. All patients were subjected to nutritional screening using GNRI, and were followed for the occurrence of lymphatic node metastasis, radiation complication and mortality. The Kaplan–Meier method with Log-rank test was used to estimate survival curves. Univariable Cox regression analysis was used to identify variables associated with overall survival time. Among the 239 patients, 184 patients (76.9%) took no nutritional risk, 32 patients (13.4%) took moderate risk of malnutrition, and 23 patients (9.7%) took a high risk of malnutrition. Univariable Cox regression showed that both high nutritional risk group and moderate nutritional risk group were significantly less likely to survive than no nutritional risk patients (hazard ratio (HR) = 1.688, 95% confidence interval (CI) = 1.019–2.798 for moderate risk group, and HR = 2.699, 95% CI = 1.512–4.819 for high risk group, respectively). The GNRI is an independent prognostic factor for overall survival time in elderly ESCC patients with radiotherapy. A GNRI ≤98 can be suggested as an indicator of surviving less. PMID:27196126

  18. Evolution of a forced stratified mixing layer

    NASA Astrophysics Data System (ADS)

    Rotter, J.; Fernando, H. J. S.; Kit, E.

    2007-06-01

    Laboratory measurements were carried out in a spatially developing stably stratified shear layer generated downstream of a splitter plate. The instabilities were controlled using a flapper spanning the entire shear layer, with the flapper forced at the fastest growing frequency of the primary [Kelvin-Helmholtz (KH)] instability. The measurements were taken as the KH instabilities roll up, break down, and degenerate into stratified turbulence. Both stratified and homogeneous shear layers were considered, the latter acting as the "baseline" case. The measurements included the streamwise and vertical velocities (made using X-wire hot film probes), which allowed calculation of the mean and rms velocities, turbulent kinetic energy (TKE) dissipation, and TKE production. The density and its gradients were measured using miniature conductivity probes. The measurements and flow visualization elicited interesting features of KH evolution, namely that KH billows may be turbulent from the onset, the TKE dissipation is largest at early stages of evolution, the production of TKE is a maximum at the breakdown of billows, the decay of turbulence to fossilized motions and concomitant formation of fine (layered) structure occur rapidly after the breakdown of billows, and episodic rebirth of (zombie) turbulence develops before a final permanently fossilized state is achieved.

  19. Do ultrasound-guided regional blocks signify a new paradigm in high-risk patients?

    PubMed

    Bendtsen, Thomas F; Haskins, Stephen; Kølsen Petersen, Jens Aage; Børglum, Jens

    2016-06-01

    It has been suggested for many years that regional anaesthesia is advantageous in high-risk patients, either as the sole anaesthetic or in combination with general anaesthesia. Regional techniques are safe and even more so when guided by ultrasound. In the high-risk patient population, ultrasound-guided regional anaesthesia (UGRA) can help decrease risk of perioperative morbidity and improve short-term as well as long-term outcomes, particularly in the orthopaedic, vascular, oncologic and chronic pain patient populations. Nevertheless, complications do still occur and benefits of a specific regional nerve blockade need to be weighed against potential risks on an individual basis. The emergence of reasonably priced, easy-to-use ultrasound machines facilitates regional anaesthesia, and this kind of anaesthesia may become the standard of care in high-risk patients. PMID:27396806

  20. Communicating radiation risk to patients and referring physicians in the emergency department setting.

    PubMed

    Shyu, Jeffrey Y; Sodickson, Aaron D

    2016-05-01

    Heightened awareness about the radiation risks associated with CT imaging has increased patients' wishes to be informed of these risks, and has motivated efforts to reduce radiation dose and eliminate unnecessary imaging. However, many ordering providers, including emergency physicians, are ill prepared to have an informed discussion with patients about the cancer risks related to medical imaging. Radiologists, who generally have greater training in radiation biology and the risks of radiation, often do not have a face-to-face relationship with the patients who are being imaged. A collaborative approach between emergency physicians and radiologists is suggested to help explain these risks to patients who may have concerns about getting medical imaging. PMID:26647958

  1. Increased pulmonary alveolar-capillary permeability in patients at risk for adult respiratory distress syndrome

    SciTech Connect

    Tennenberg, S.D.; Jacobs, M.P.; Solomkin, J.S.; Ehlers, N.A.; Hurst, J.M.

    1987-04-01

    Two methods for predicting adult respiratory distress syndrome (ARDS) were evaluated prospectively in a group of 81 multitrauma and sepsis patients considered at clinical high risk. A popular ARDS risk-scoring method, employing discriminant analysis equations (weighted risk criteria and oxygenation characteristics), yielded a predictive accuracy of 59% and a false-negative rate of 22%. Pulmonary alveolar-capillary permeability (PACP) was determined with a radioaerosol lung-scan technique in 23 of these 81 patients, representing a statistically similar subgroup. Lung scanning achieved a predictive accuracy of 71% (after excluding patients with unilateral pulmonary contusion) and gave no false-negatives. We propose a combination of clinical risk identification and functional determination of PACP to assess a patient's risk of developing ARDS.

  2. Dry Eye Syndrome Risks in Patients With Fibromyalgia: A National Retrospective Cohort Study.

    PubMed

    Chen, Chao-Hsien; Yang, Tse-Yen; Lin, Cheng-Li; Chen, Chih-Sheng; Lin, Wei-Ming; Kuo, Chia-Nan; Lin, Ming-Chia; Kao, Chia-Hung

    2016-01-01

    The coexistence of fibromyalgia (FM) and dry eye syndrome (DES) has been previously reported. However, there are few studies on how patients with FM may develop concomitant DES. Patients with chronic widespread pain, like FM, chronic fatigue syndrome, and irritable bowel syndrome (IBS), was concerned for the rheumatic or psychosomatic disorders which might adequately reflect the long-term risk of DES. We retrieved data on FM patients from the National Health Insurance Research Database of Taiwan covering the years 2000 to 2011. Our FM population consisted of 25,777 patients versus 103,108 patients in the non-FM group: the overall incidence of DES in these populations was 7.37/10,000 and 4.81/10,000, respectively. Male FM patients had a higher incidence of DES, with a 1.39-fold DES risk for males and a 1.45-fold for females after adjustment for confounding factor. Notably, FM patients aged ≤49 years had an elevated 80% risk of DES compared with the non-FM group. Without comorbidities, FM patients had an approximately 1.40-fold risk of DES than those without FM. The additive effects of FM and IBS or FM and sleep disturbance were pointed out that the risk for DES would be elevated when the FM patients with IBS or sleep disturbance. FM patients have a higher incidence of DES than that of non-FM patients. They carry long-term DES risks from a relatively young age, particularly those with psychiatric problems. Risk stratification for a timely psychiatric medication intervention and risk modifications are not intended. PMID:26825913

  3. External validation of risk classification in patients with docetaxel-treated castration-resistant prostate cancer

    PubMed Central

    2014-01-01

    Background Castration-resistant prostate cancer (CRPC) patients have poor prognoses, and docetaxel (DTX) is among the few treatment options. An accurate risk classification to identify CRPC patient groups for which DTX would be effective is urgently warranted. The Armstrong risk classification (ARC), which classifies CRPC patients into 3 groups, is superior; however, its usefulness remains unclear, and further external validation is required before clinical use. This study aimed to examine the clinical significance of the ARC through external validation in DTX-treated Japanese CRPC patients. Methods CRPC patients who received 2 or more DTX cycles were selected for this study. Patients were classified into good-, intermediate-, and poor-risk groups according to the ARC. Prostate-specific antigen (PSA) responses and overall survival (OS) were calculated and compared between the risk groups. A multivariate analysis was performed to clarify the relationship between the ARC and major patient characteristics. Results Seventy-eight CRPC patients met the inclusion criteria. Median PSA levels at DTX initiation was 20 ng/mL. Good-, intermediate-, and poor-risk groups comprised 51 (65%), 17 (22%), and 10 (13%) patients, respectively. PSA response rates ≥30% and ≥50% were 33%, 41%, and 30%, and 18%, 41%, and 20% in the good-, intermediate-, and poor-risk groups, respectivcixely, with no significant differences (p = 0.133 and 0.797, respectively). The median OS in the good-, intermediate-, and poor-risk groups were statistically significant (p < 0.001) at 30.1, 14.2, and 5.7 months, respectively. A multivariate analysis revealed that the ARC and PSA doubling time were independent prognostic factors. Conclusions Most of CRPC patients were classified into good-risk group according to the ARC and the ARC could predict prognosis in DTX-treated CRPC patients. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) number

  4. Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection

    PubMed Central

    2013-01-01

    Background Clostridium difficile infection poses a significant healthcare burden. However, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described. This study aimed to identify such a prediction rule to stratify hospital inpatients according to risk of all-cause mortality, at initial diagnosis of infection. Method Univariate, multivariate and decision tree procedures were used to deduce a prediction rule from over 186 variables; retrospectively collated from clinical data for 213 patients. The resulting prediction rule was validated on independent data from a cohort of 158 patients described by Bhangu et al. (Colorectal Disease, 12(3):241-246, 2010). Results Serum albumin levels (g/L) (P = 0.001), respiratory rate (resps /min) (P = 0.002), C-reactive protein (mg/L) (P = 0.034) and white cell count (mcL) (P = 0.049) were predictors of all-cause mortality. Threshold levels of serum albumin ≤ 24.5 g/L, C- reactive protein >228 mg/L, respiratory rate >17 resps/min and white cell count >12 × 103 mcL were associated with an increased risk of all-cause mortality. A simple four variable prediction rule was devised based on these threshold levels and when tested on the initial data, yield an area under the curve score of 0.754 (P < 0.001) using receiver operating characteristics. The prediction rule was then evaluated using independent data, and yield an area under the curve score of 0.653 (P = 0.001). Conclusions Four easily measurable clinical variables can be used to assess the risk of mortality of patients with Clostridium difficile infection and remains robust with respect to independent data. PMID:23849267

  5. Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

    PubMed Central

    Edwards, Robert R.; Wasan, Ajay D.; Michna, Ed; Greenbaum, Seth; Ross, Ed; Jamison, Robert N.

    2011-01-01

    This study employed quantitative sensory testing (QST) to evaluate pain responses in chronic spinal pain patients at low risk and high risk for opioid misuse, with risk classification based on scores on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Patients were further sub-grouped according to current use of prescription opioids. Of the 276 chronic pain patients tested, approximately 65% were taking opioids; a median split was used to further categorize these patients as being on lower or higher doses of opioids. The highrisk group (n= 161) reported higher levels of clinical pain, had lower pressure and thermal pain thresholds at multiple body sites, had lower heat pain tolerance, and rated repetitive mechanical stimuli as more painful relative to the low-risk group (n= 115; p’s< .01). In contrast, QST measures did not differ across opioid groups. Multiple linear regression analysis suggested that indices of pain-related distress (i.e., anxiety and catastrophizing about pain) were also predictive of hyperalgesia, particularly in patients taking opioids. Collectively, regardless of opioid status, the high-risk group was hyperalgesic relative to the low-risk group; future opioid treatment studies may benefit from the classification of opioid risk, and the examination of pain sensitivity and other factors that differentiate high- and low-risk groups. PMID:21680252

  6. The value of quantitative patient preferences in regulatory benefit-risk assessment

    PubMed Central

    Egbrink, Mart oude; IJzerman, Maarten

    2014-01-01

    Quantitative patient preferences are a method to involve patients in regulatory benefit-risk assessment. Assuming preferences can be elicited, there might be multiple advantages to their use. Legal, methodological and procedural issues do however imply that preferences are currently at most part of the solution on how to best involve patients in regulatory decision making. Progress is recently made on these issues.

  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. How do dental students determine patients' caries risk level using the Caries Management By Risk Assessment (CAMBRA) system?

    PubMed

    Doméjean, Sophie; Léger, Stéphanie; Rechmann, Peter; White, Joel M; Featherstone, John D B

    2015-03-01

    Research has demonstrated the validation of specific caries risk assessment (CRA) systems, but little is known about how dental practitioners assign a caries risk level to their patients. The aim of this study was to explore dental students' decision making in caries risk assignment when using the Caries Management By Risk Assessment (CAMBRA) system. Multiple correspondence analysis and chi-squared automated interaction detector analysis were performed on data collected retrospectively for a period of six years (2003-09) at the University of California, San Francisco predoctoral dental clinic. The study population consisted of 12,952 patients from six years of age through adult who received a baseline CRA during the period, were new to CAMBRA, and had not received any prior CAMBRA recommendations. The results showed variation in decision making and risk level assignment, illustrated by the range of percentages for the three scores (low, moderate, and high/extreme caries risk) when CRA was assigned for the first time. For those first-time CRAs, decision making was mainly based on four factors: cavities or caries lesions into dentin on radiograph, restorations during the last three years due to caries, visible heavy plaque, and interproximal lesions into enamel (by radiographs). This study's findings provide important data regarding one group of CAMBRA users and thus contribute to the development of knowledge about the implementation of caries risk assessment in contemporary dental practice. PMID:25729021

  9. Gravity-driven intrusions in stratified fluids

    NASA Astrophysics Data System (ADS)

    Maurer, Benjamin Dudley

    All natural fluids stratify. Stable stratifications, in which isobars and isopycnals are parallel, are capable of supporting internal wave motion. Unstable stratification, in which density and pressure gradients are not aligned, results in gravity-driven flow. Gravity currents are a subset of these flows in which horizontal density gradients sharpen and propagate horizontally, transporting mass, momentum, and energy. If the density of the gravity current is within the density extrema of the stably stratified ambient fluid, it propagates as an intrusion at an intermediate height. Through laboratory experiments and numerical simulations, this dissertation explores the influence of stratification on the dynamics of gravity-driven intrusions. Intrusions require stable stratification in the ambient fluid, which is capable of transporting momentum and energy away from the current in the form of internal waves. We investigate the constant velocity propagation of well-mixed intrusions propagating into a linearly stratified ambient fluid. Varying the level of neutral buoyancy, we quantify the corresponding variation in structure, momentum, and energy of the upstream wave field. Adjacent stable stratifications of differing vertical density structure necessarily entail horizontal density gradients. These gradients determine the hydrostatic pressure differences driving the ensuing gravity current. We examine the mid-depth, constant velocity propagation of one linearly stratified fluid into another more strongly linearly stratified fluid. Working from the available potential energy of the system and measurements of the intrusion thickness, we develop an energy model to describe the speed of the intrusion in terms of the ratio of the two buoyancy frequencies. Distinct from adjacent linear stratifications, adjacent discrete stratifications may create flow consisting of interleaving intrusions. Single intrusions into a two-layer ambient fluid are well understood. Limiting our

  10. A 6 gene signature identifies the risk of developing cirrhosis in patients with chronic hepatitis B.

    PubMed

    Xu, Ming-Yi; Qu, Ying; Li, Zhenghong; Li, Fei; Xiao, Chun-Yang; Lu, Lun-Gen

    2016-01-01

    Clinical factors and liver biopsy cannot accurately predict the risk of developing cirrhosis in chronic hepatitis B (CHB).This study was to develop a predictive gene signature for cirrhosis in CHB patients. A total of 183 untreated CHB patients were enrolled. GeneChip, significant analysis of microarray (SAM) and prediction analysis of microarray (PAM) were used to select predictor genes (PGs) in liver tissues. The Cirrhosis Risk Score (CRS) was calculated based on 6 PG variables and the predictive value of CRS was evaluated. Firstly differentially expressed genes were filtered from a genome scan and SAM, and 87 significant genes were selected for the signature building. Secondly a signature consisting of 6 PGs (CD24, CXCL6, EHF, ITGBL1, LUM and SOX9) most predictive for cirrhosis risk in CHB patients was developed in the selection set (n=40) by use of PAM and PCR approach. Finally the CRS was calculated to estimate the risk of developing cirrhosis and then tested in validation cohort (n=143). The area under the ROC curves (AUROC) of the CRS was 0.944 and exceeded to 6 PGs and clinical factors. A low CRS cutoff of 6.43 to identify low-risk patients would misclassify only 8.16% of high-risk patients, while a high cutoff of 8.32 to identify high-risk patients would misclassify 0% of low-risk patients. So CRS is a better predictor than clinical factors in differentiating high-risk versus low-risk for cirrhosis and application of CRS in clinical practice could help to reduce the rate of liver biopsy in patients with CHB. PMID:26709788

  11. Aggression and risk of future violence in forensic psychiatric patients with and without dyslexia.

    PubMed

    Selenius, Heidi; Hellström, Ake; Belfrage, Henrik

    2011-05-01

    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 the Aggression Questionnaire, and trained assessors performed the risk assessments using HCR-20 version 2. Patients with dyslexia self-reported more aggressive behaviour compared with those without dyslexia. There was only a nearly significant tendency (p = 0.06) for the patients with dyslexia to receive higher scores in the HCR-20 compared with the patients without dyslexia, and phonological processing skills did not significantly predict aggression or risk of future violence. However, regression analyses demonstrated that poor phonological processing skills are a significant predictor of anger, which in turn significantly predicts risk of future violence. PMID:21268184

  12. Perforated Duodenal Ulcer in High Risk Patients: Is Percutaneous Drainage Justified?

    PubMed Central

    Saber, Aly; Gad, Mohammad A; Ellabban, Gouda M

    2012-01-01

    Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate. PMID:22393546

  13. [Assessment of surgical risk in patients with lower limb chronic critical ischaemia].

    PubMed

    Kazakov, Iu I; Lukin, I B; Sokolova, N Iu; Strakhov, M A

    2016-01-01

    Analysed herein are both immediate and remote results of surgical treatment of 93 patients presenting with chronic atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The patients were subjected to autovenous femoropopliteal bypass grafting to the isolated arterial segment or balloon angioplasty with stenting of the superficial femoral artery. While choosing the method of arterial reconstruction we assessed concomitant diseases, primarily lesions of the coronary and cerebral circulation. In order to objectively evaluate the patient state, we worked out a scale for assessing surgical risk. Survival rate without amputation after three years in patients with low risk amounted to 71.4%, in those with moderate risk to 60.0%, and in high-risk patients to 43.3%. Patients with initially high risk were found to have a high incidence rate of cardiac and cerebrovascular complications, exceeding 40%. It was shown that the worked out system of assessing the level of surgical risk objectively reflects the prognosis of patient survival following a reconstructive operation. This system of assessment may be appropriate while choosing an optimal method of arterial reconstruction (bypassing operation or endovascular intervention) in patients with atherosclerotic lesions of arteries of the femoropopliteal-tibial segment and critical ischaemia accompanied by severe concomitant pathology. Patients with high surgical risk should preferably be subjected to endovascular reconstruction, while those with low surgical risk should better undergo open shunting bypassing operation, and for those with moderate risk it is acceptable to perform both methods of arterial reconstruction. PMID:27626262

  14. Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis

    PubMed Central

    Chiang, Yi-Ting; Tsai, Yi-Wen; Huang, Weng-Foung; Li, Cheng-Yuan; Wang, Ting-Shun; Tsai, Tsen-Fang

    2016-01-01

    Background The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. Results Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22–1.28) and stroke (aHR, 1.24; 95% CI, 1.16–1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. Conclusions The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis. PMID:26745869

  15. Cerebrovascular Disease Risk in Older Head and Neck Cancer Patients After Radiotherapy

    PubMed Central

    Smith, Grace L.; Smith, Benjamin D.; Buchholz, Thomas A.; Giordano, Sharon H.; Garden, Adam S.; Woodward, Wendy A.; Krumholz, Harlan M.; Weber, Randal S.; Ang, K.-Kian; Rosenthal, David I.

    2008-01-01

    Purpose Cerebrovascular disease is common in head and neck cancer patients, but it is unknown whether radiotherapy increases the cerebrovascular disease risk in this population. Patients and Methods We identified 6,862 patients (age > 65 years) from the Surveillance, Epidemiology, and End Results (SEER) –Medicare cohort diagnosed with nonmetastatic head and neck cancer between 1992 and 2002. Using proportional hazards regression, we compared risk of cerebrovascular events (stroke, carotid revascularization, or stroke death) after treatment with radiotherapy alone, surgery plus radiotherapy, or surgery alone. To further validate whether treatment groups had equivalent baseline risk of vascular disease, we compared the risks of developing a control diagnosis, cardiac events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or cardiac death). Unlike cerebrovascular risk, no difference in cardiac risk was hypothesized. Results Mean age was 76 ± 7 years. Ten-year incidence of cerebrovascular events was 34% in patients treated with radiotherapy alone compared with 25% in patients treated with surgery plus radiotherapy and 26% in patients treated with surgery alone (P < .001). After adjusting for covariates, patients treated with radiotherapy alone had increased cerebrovascular risk compared with surgery plus radiotherapy (hazard ratio [HR] = 1.42; 95% CI, 1.14 to 1.77) and surgery alone (HR = 1.50; 95% CI, 1.18 to 1.90). However, no difference was found for surgery plus radiotherapy versus surgery alone (P = .60). As expected, patients treated with radiotherapy alone had no increased cardiac risk compared with the other treatment groups (P = .63 and P = .81). Conclusion Definitive radiotherapy for head and neck cancer, but not postoperative radiotherapy, was associated with excess cerebrovascular disease risk in older patients. PMID:18725647

  16. 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

  17. [Individualized, personalized and stratified medicine: a challenge for allergology in ENT?].

    PubMed

    Chaker, Adam M; Klimek, L

    2015-05-01

    Individualized, personalized or stratified medicine approaches offer emerging opportunities in the field of allergy and ENT. Avoidance of side effects, targeted therapy approaches and stratified prevention promise better outcomes and optimal results for patients. Conceptual incongruencies remain with regard to definitions and perceptions of "personalized medicine". Serious ethical considerations have to be taken into account. The development of pharmacogenomics, molecular phenotyping, genomic sequencing and other -omics opens the door to unique mechanistic therapeutic advances. The molecular allergology and recombinant diagnostics available are tools that offer substantial improved diagnostics for the benefit of allergic patients, e. g. in anaphylaxis and food allergy. For stratified therapeutic approaches, however, regulatory affairs will have to keep pace with medical and scientific discovery. PMID:25940007

  18. Cardiovascular risk factor control is insufficient in young patients with coronary artery disease

    PubMed Central

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Brøndberg, Anders Krogh; Bøtker, Hans Erik; Jensen, Henrik Kjærulf

    2016-01-01

    Background Control of cardiovascular risk factor is important in secondary prevention of coronary artery disease (CAD) but it is unknown whether treatment targets are achieved in young patients. We aimed to examine the prevalence and control of risk factors in this subset of patients. Methods We performed a cross-sectional, single-center study on patients with documented CAD before age 40. All patients treated between 2002 and 2014 were invited to participate at least 6 months after the last coronary intervention. We included 143 patients and recorded the family history of cardiovascular disease, physical activity level, smoking status, body mass index, waist circumference, blood pressure, cholesterol levels, metabolic status, and current medical therapy. Risk factor control and treatment targets were evaluated according to the shared guidelines from the European Society of Cardiology. Results The most common insufficiently controlled risk factors were overweight (113 [79.0%]), low-density lipoprotein cholesterol above target (77 [57.9%]), low physical activity level (78 [54.6%]), hypertriglyceridemia (67 [46.9%]), and current smoking (53 [37.1%]). Almost one-half of the patients fulfilled the criteria of metabolic syndrome. The median (interquartile range) number of uncontrolled modifiable risk factors was 2 (2;4) and only seven (4.9%) patients fulfilled all modifiable health measure targets. Conclusion Among the youngest patients with CAD, there remains a potential to improve the cardiovascular risk profile. PMID:27307744

  19. Aspirin as a risk factor for hemorrhage in patients with head injuries.

    PubMed

    Reymond, M A; Marbet, G; Radü, E W; Gratzl, O

    1992-01-01

    The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. Aspirin should not be prescribed to patients with post-traumatic headaches. PMID:1584433

  20. Risk factors for progression of visual field defects in medically treated patients with glaucoma.

    PubMed

    Richler, M; Werner, E B; Thomas, D

    1982-12-01

    A multivariate discriminant analysis of potential risk factors for the progression of visual field defects was performed in 70 patients with chronic open-angle or low-tension glaucoma. Male sex, low diastolic blood pressure and diabetes mellitus were found to be significant risk factors. When the patients with low-tension glaucoma were excluded, a high mean intraocular pressure was identified as a risk factor. It was concluded that there is no reliable way to predict future visual field loss in patients with glaucoma. PMID:7165838

  1. Injury Risk Spikes While Cancer Patients Seek Diagnosis

    MedlinePlus

    ... medical and drug therapy complications, accidents and self-harm To use the sharing features on this page, ... 8,300 injuries from accidents or intentional self-harm, the study findings showed. The risk for medical- ...

  2. 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

  3. [Corruption risks in relations between doctor and patient ].

    PubMed

    Kolwitz, Marcin; Gąsiorowski, Jakub

    2014-01-01

    The article describes the problem of corruption occurring in the relationship between doctor and patient. The doctor-patient relationship, including the provision of health services, is one of several potential areas of corruption in the health care system. Among the reasons for the existence of corruption in these relationships are the need to obtain better healthcare for the patient, and higher earnings in the case of a doctor. Indications of corruption are utilitarian (action for personal advantage without ethical aspects), but may also be (actually or in the patient's opinion) the only way to obtain services and save health and even life. Corruption between the doctor and the patient can be limited by better organization of the health care system, including the financing of benefits and education of medical personnel and patients, as well as traditional legal measures, such as prevention or the application of criminal sanctions. PMID:25518104

  4. Omission of adjuvant therapy after gastric cancer resection: development of a validated risk model.

    PubMed

    Datta, Jashodeep; McMillan, Matthew T; Shang, Eric K; Mamtani, Ronac; Lewis, Russell S; Kelz, Rachel R; Teitelbaum, Ursina; Plastaras, John P; Drebin, Jeffrey A; Fraker, Douglas L; Karakousis, Giorgos C; Roses, Robert E

    2015-05-01

    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer recommend adjuvant chemotherapy with or without radiotherapy following after resection of gastric adenocarcinoma (GA) for patients who have not received neoadjuvant therapy. Despite frequent noncompliance with NCCN Guidelines nationally, risk factors underlying adjuvant therapy omission (ATom) have not been well characterized. We developed an internally validated preoperative instrument stratifying patients by incremental risk of ATom. The National Cancer Data Base was queried for patients with stage IB-III GA undergoing gastrectomy; those receiving neoadjuvant therapy were excluded. Multivariable models identified factors associated with ATom between 2006 and 2011. Internal validation was performed using bootstrap analysis; model discrimination and calibration were assessed using k-fold cross-validation and Hosmer-Lemeshow procedures, respectively. Using weighted β-coefficients, a simplified Omission Risk Score (ORS) was created to stratify ATom risk. The impact of ATom on overall survival (OS) was examined in ORS risk-stratified cohorts. In 4,728 patients (median age, 70 years; 64.8% male), 53.7% had ATom. The bootstrap-validated model identified advancing age, comorbidity, underinsured/uninsured status, proximal tumor location, and clinical T1/2 and N0 tumors as independent ATom predictors, demonstrating good discrimination. The simplified ORS, stratifying patients into low-, moderate-, and high-risk categories, predicted incremental risk of ATom (30% vs 53% vs 80%, respectively) and progressive delay to adjuvant therapy initiation (median time, 51 vs 55 vs 61 days, respectively). Patients at moderate/high-risk of ATom demonstrated worsening risk-adjusted mortality compared with low-risk patients (median OS, 26.4 vs 29.2 months). This ORS may aid in rational selection of multimodality treatment sequence in GA. PMID:25964639

  5. Substance misuse treatment for high-risk chronic pain patients on opioid therapy: a randomized trial.

    PubMed

    Jamison, Robert N; Ross, Edgar L; Michna, Edward; Chen, Li Q; Holcomb, Caroline; Wasan, Ajay D

    2010-09-01

    Chronic pain patients who show aberrant drug-related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain. The purpose of this study was to conduct a randomized trial in patients who were prescribed opioids for noncancer back pain and who showed risk potential for or demonstration of opioid misuse to see if close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance with opioids. Forty-two patients meeting criteria for high-risk for opioid misuse were randomized to either standard control (High-Risk Control; N=21) or experimental compliance treatment consisting of monthly urine screens, compliance checklists, and individual and group motivational counseling (High-Risk Experimental; N=21). Twenty patients who met criteria indicating low potential for misuse were recruited to a low-risk control group (Low-Risk Control). Patients were followed for 6 months and completed pre- and post-study questionnaires and monthly electronic diaries. Outcomes consisted of the percent with a positive Drug Misuse Index (DMI), which was a composite score of self-reported drug misuse (Prescription Drug Use Questionnaire), physician-reported abuse behavior (Addiction Behavior Checklist), and abnormal urine toxicology results. Significant differences were found between groups with 73.7% of the High-Risk Control patients demonstrating positive scores on the DMI compared with 26.3% from the High-Risk Experimental group and 25.0% from the Low-Risk Controls (p<0.05). The results of this study demonstrate support for the benefits of a brief behavioral intervention in the management of opioid compliance among chronic back pain patient at high-risk for prescription opioid misuse. PMID:20334973

  6. Substance Misuse Treatment for High Risk Chronic Pain Patients on Opioid Therapy: A Randomized Trial

    PubMed Central

    Jamison, Robert N.; Ross, Edgar L.; Michna, Edward; Chen, Li Q.; Holcomb, Caroline; Wasan, Ajay D.

    2010-01-01

    Chronic pain patients who show aberrant drug-related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain. The purpose of this study was to conduct a randomized trial in patients prescribed opioids for noncancer back pain who showed risk potential for or demonstration of opioid misuse to see if close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance with opioids. Forty two patients meeting criteria for high risk for opioid misuse were randomized to either standard control (High-Risk Control; N=21) or experimental compliance treatment consisting of monthly urine screens, compliance checklists, and individual and group motivational counseling (High-Risk Experimental; N=21). Twenty patients who met criteria indicating low potential for misuse were recruited to a low-risk control group (Low-Risk Control). Patients were followed for 6 months and completed pre- and post-study questionnaires and monthly electronic diaries. Outcomes consisted of the percent with a positive Drug Misuse Index (DMI), which was a composite score of self-reported drug misuse (Prescription Drug Use Questionnaire), physician-reported abuse behavior (Addiction Behavior Checklist), and abnormal urine toxicology results. Significant differences were found between groups with 73.7 % of the High-Risk Control patients demonstrating positive scores on the DMI compared with 26.3% from the High-Risk Experimental group and 25.0% from the Low-Risk Controls (p<0.05). The results of this study demonstrate support for the benefits of a brief behavioral intervention in the management of opioid compliance among chronic back pain patient at high-risk for prescription opioid misuse. PMID:20334973

  7. Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

    PubMed Central

    Misenheimer, Jacob A.; Jones, Wesley; Bahekar, Amol; Caughey, Melissa; Ramm, Cassandra J.; Caranasos, Thomas G.; Yeung, Michael; Vavalle, John P.

    2016-01-01

    Background Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons. Methods A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). Results Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)]. Conclusions We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR. PMID:27280087

  8. Patients with primary membranous nephropathy are at high risk of cardiovascular events.

    PubMed

    Lee, Taewoo; Derebail, Vimal K; Kshirsagar, Abhijit V; Chung, Yunro; Fine, Jason P; Mahoney, Shannon; Poulton, Caroline J; Lionaki, Sophia; Hogan, Susan L; Falk, Ronald J; Cattran, Daniel C; Hladunewich, Michelle; Reich, Heather N; Nachman, Patrick H

    2016-05-01

    Here we conducted a retrospective study to examine the risk of cardiovascular events (CVEs) relative to that of end-stage renal disease (ESRD) in patients with primary membranous nephropathy, in a discovery cohort of 404 patients. The cumulative incidence of CVEs was estimated in the setting of the competing risk of ESRD with risk factors for CVEs assessed by multivariable survival analysis. The observed cumulative incidences of CVEs were 4.4%, 5.4%, 8.2%, and 8.8% at 1, 2, 3, and 5 years respectively in the primary membranous nephropathy cohort. In the first 2 years after diagnosis, the risk for CVEs was similar to that of ESRD in the entire cohort, but exceeded it among patients with preserved renal function. Accounting for traditional risk factors and renal function, the severity of nephrosis at the time of the event (hazard ratio 2.1, 95% confidence interval 1.1 to 4.3) was a significant independent risk factor of CVEs. The incidence and risk factors of CVEs were affirmed in an external validation cohort of 557 patients with primary membranous nephropathy. Thus early in the course of disease, patients with primary membranous nephropathy have an increased risk of CVEs commensurate to, or exceeding that of ESRD. Hence, reduction of CVEs should be considered as a therapeutic outcome measure and focus of intervention in primary membranous nephropathy. PMID:26924046

  9. 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

  10. Atomic force microscopy as a tool to evaluate the risk of cardiovascular diseases in patients

    NASA Astrophysics Data System (ADS)

    Guedes, Ana Filipa; Carvalho, Filomena A.; Malho, Inês; Lousada, Nuno; Sargento, Luís; Santos, Nuno C.

    2016-08-01

    The availability of biomarkers to evaluate the risk of cardiovascular diseases is limited. High fibrinogen levels have been identified as a relevant cardiovascular risk factor, but the biological mechanisms remain unclear. Increased aggregation of erythrocytes (red blood cells) has been linked to high plasma fibrinogen concentration. Here, we show, using atomic force microscopy, that the interaction between fibrinogen and erythrocytes is modified in chronic heart failure patients. Ischaemic patients showed increased fibrinogen–erythrocyte binding forces compared with non-ischaemic patients. Cell stiffness in both patient groups was also altered. A 12-month follow-up shows that patients with higher fibrinogen–erythrocyte binding forces initially were subsequently hospitalized more frequently. Our results show that atomic force microscopy can be a promising tool to identify patients with increased risk for cardiovascular diseases.

  11. IMPROVING THE RISK-BENEFIT RELATIONSHIP AND INFORMED CONSENT FOR PATIENTS TREATED WITH HYDROXYCHLOROQUINE

    PubMed Central

    Flach, Allan J.

    2007-01-01

    Purpose To determine the prevalence of high-risk factors for hydroxychloroquine (HCQ) retinopathy and compliance with the American Academy of Ophthalmology (AAO) screening guidelines at the San Francisco Veterans Affairs Medical Center (VASF) and to develop an approach to improve the risk-benefit relationship and informed consent during HCQ treatment. Methods All medical records of patients receiving HCQ were reviewed, with special attention to high-risk factors for retinopathy. The results were used to develop a method of enhancing the risk-benefit relationship and improving informed consent at the VASF. Results Of the 109 patients taking HCQ at the VASF, 87% had at least one high-risk factor for retinal toxicity and 47% had two or more risk factors. Thirty-four percent had no evidence of an eye examination having been performed. An approach has been developed to improve the risk-benefit and informed consent for patients using HCQ at the VASF. Conclusions A significant number of veterans taking HCQ may be at an increased risk for retinal toxicity. More than one-third of these patients may not be managed as recommended by the AAO. Methods to minimize these risks and improve informed consent are outlined. PMID:18427609

  12. Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification

    PubMed Central

    Solomon, Ahmed; Tsang, Linda; Woodiwiss, Angela J.; Millen, Aletta M. E.; Norton, Gavin R.; Dessein, Patrick H.

    2014-01-01

    Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients. PMID:25157371

  13. [The PROMET study: Prophylaxis for venous thromboembolic disease in at-risk patients hospitalized in Algeria].

    PubMed

    Guermaz, R; Belhamidi, S; Amarni, A

    2015-07-01

    PROMET is an observational study aimed to assess the management of patients at venous thromboembolism risk in the Algerian hospitals and to evaluate the proportion of at-risk patients treated with an adequate prophylaxis. Following the ENDORSE study achieved five years before with a similar protocol, PROMET included 435hospitalized patients (229 in medical units and 206 in surgical units). Compared to the ENDORSE results, the PROMET data reflect progress in the management of venous thromboembolism: 73.3% of at-risk patients received prophylaxis (57.6% of medical patients and 90.8% of surgical patients). In 93.1% of cases, this prophylaxis was provided by a low molecular weight heparin, mainly at the dose of one injection per day. In medical population, the prescription was triggered by long-term immobilization (P=0.01; OR=5.8 95%CI [1.5-23.0]), associated risk factors (P=0.025; OR=4.13 [1.2-14.2]) and the cause of hospitalization (P=0.056). In surgical departments, the therapeutic decision depended on the nature of the surgical intervention and was influenced by the presence of a contraindication for prophylaxis (P<0.001; OR=0.02 [0.00-0.14]) or a high hemorrhagic risk (P<0.001; OR=0.02). The assessment and management of thromboembolic risk were in accordance with ACCP recommendations for surgical patients. However efforts are needed for medical patients for whom the risk is underestimated and insufficiently supported. Unlike surgery where procedures are well established, there are real difficulties in medicine to define the at-risk patients who will benefit from thromboprophylaxis. The process of preventive treatment (particularly the optimal duration) needs to be clarified. PMID:26051861

  14. Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy.

    PubMed

    Kimmell, Kristopher T; Jahromi, Babak S

    2015-05-01

    OBJECT Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. METHODS The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. RESULTS Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. CONCLUSIONS Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0. PMID:25495743

  15. Imbalance in treatment assignments in stratified blocked randomization.

    PubMed

    Hallstrom, A; Davis, K

    1988-12-01

    Blocking and stratification are used in preparing randomization assignments to ensure that there will be nearly equal numbers of patients in each treatment group and that the groups will be similar with respect to important covariates. Stratified blocked randomization will create near balance within strata, but imbalance for the total trial may still occur. The variance for the total trial imbalance D is derived and examples from clinical trials are given. Under reasonable assumptions, if the blocking factor is size B in each of K strata, then max D = KB/2 and var D = K(B + 1)/6. These results may be used in planning a trial to estimate the overall imbalance expected for various choices of B and K. A conditional variance is given that allows the probability of an observed imbalance at the completion of a trial to be evaluated. Overall imbalance is about as likely with stratified blocked randomization as with simple randomization unless the total sample size N is appreciably larger than K X B. So long as the blinding is maintained, the block sizes should be chosen to be as small as possible. PMID:3203527

  16. Social networks of health care providers and patients in cardiovascular risk management: a study protocol

    PubMed Central

    2014-01-01

    Background In recent years, preventive and clinical interventions for cardiovascular risk management have been implemented widely in primary care in the Netherlands. Although this has enhanced quality and outcomes of cardiovascular risk management, further improvement remains possible. In the planned observational study, we aim to examine the role of social networks of healthcare providers and patients in quality and outcomes of cardiovascular risk management. Methods/Design In a longitudinal observational study, data on social networks of approximately 300 primary care providers from 30 general practices and 900 cardiovascular patients will be collected twice, with a six month interval, using a mix of measures. Social networks are documented with specifically designed questionnaires for patients, relatives, and healthcare professionals. For each included patient, we will extract from medical records to gather data on clinical processes and cardiovascular risk predictors. Data on self-management and psychosocial outcomes of patients will be collected using questionnaires for patients. The analysis focuses on identifying network characteristics, which are associated with (changes in) cardiovascular risk management or self-management. Discussion This research will provide insight into the role of social networks of patients and providers in cardiovascular risk management in primary practice. Trial registration Nederlands Trial Register NTR4069. PMID:24942555

  17. Assessment of caries risk in elderly patients using the Cariogram model.

    PubMed

    Alian, Anna Y; McNally, Mary E; Fure, Solveig; Birkhed, Dowen

    2006-06-01

    For several decades, Swedish researchers, clinicians and educators have recognized risk assessment as an important part of routine management of dental caries. Innovative caries risk assessment models, such as the Cariogram software program, have been developed to systematize the evaluation of various risk factors for caries and to develop targeted prevention interventions based on caries risk. The benefits derived from these models in terms of improving the health of high-risk groups such as older adults have not been well studied. The purpose of this article is to demonstrate the application of the Cariogram software in the management of dental care for 3 elderly patients. PMID:16772072

  18. Psychiatric Symptoms and Community Violence among High-Risk Patients: A Test of the Relationship at the Weekly Level

    ERIC Educational Resources Information Center

    Skeem, Jennifer L.; Schubert, Carol; Odgers, Candice; Mulvey, Edward P.; Gardner, William; Lidz, Charles

    2006-01-01

    Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of…

  19. Exercise for Asthma Patients. Little Risk, Big Rewards.

    ERIC Educational Resources Information Center

    Disabella, Vincent; Sherman, Carl

    1998-01-01

    Asthma patients can benefit from 20 to 30 minutes of exercise at 60 to 85% of maximum heart rate several times a week. Improved fitness can reduce airway reactivity and medication use. The capacity to exercise requires good general control of asthma. Patients must learn to prevent exercise-induced bronchoconstriction by using inhaled medications…

  20. Is Adjuvant Chemoradiotherapy Overtreatment in Cervical Cancer Patients With Intermediate Risk Factors?

    SciTech Connect

    Ryu, Sang-Young; Park, Sang-Il; Nam, Byung-Ho; Cho, Chul-Koo; Kim, Kidong; Kim, Beob-Jong; Kim, Moon-Hong; Choi, Seok-Cheol; Lee, Eui-Don; Lee, Kyoung-Hee

    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.

  1. Risk factors for hip fracture among elderly patients with Alzheimer's disease.

    PubMed

    Sato, Yoshihiro; Kanoko, Tomohiro; Satoh, Kei; Iwamoto, Jun

    2004-08-30

    Incidence of hip fracture among patients with Alzheimer's disease (AD), especially in elderly patients, is high. To analyze risk factors of hip fracture, we prospectively studied a cohort of elderly female patients with AD. Subjects studied were 225 female patients with AD, and the average age was 76 years old. At baseline, we recorded body mass index (BMI), a score of Mini-Mental State Examination (MMSE) and bone mineral density (BMD), and measured serum concentrations of ionized calcium, intact parathyroid hormone (PTH), pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), intact bone Gla protein (BGP), 25-hydroxyvitamin (25-OHD) and 1, 25-dihydroxyvitamin D (1, 25-[OH]2D). The patients were followed for 2 years. During the 2-year study, hip fractures occurred in 29 patients. We compared baseline variables between the 29 patients with and 176 patients without hip fracture. AD patients with lower BMD, low concentrations of serum ionized calcium and 25-OHD (mean 3.0 ng/ml) with compensatory hyperparathyroidism were found to have an increased risk of hip fracture. Also, concentrations of serum ICTP and BGP were higher in the fracture group than in the nonfracture group. Elderly female AD patients with low BMD and serum 25-OHD concentrations <5 ng/ml with secondary hyperparathyroidism have a high risk of hip fracture, and the risk may be reduced by vitamin D supplementation. PMID:15337610

  2. Restless Legs Syndrome: Associated Risk Factors in Hemodialysis Patients

    PubMed Central

    Beladi-Mousavi, Seyed Seifollah; Jafarizade, Mehrian; Shayanpour, Shokouh; Bahadoram, Mohammad; Moosavian, Seyed Mostafa; Houshmand, Gholamreza

    2015-01-01

    Background: Restless legs syndrome (RLS) may be associated with increased morbidity and mortality among end-stage renal disease (ESRD) patients; however, it is a disorder that is neglected in dialysis centers. Objectives: The goal of this study was to investigate the clinical factors associated with RLS among ESRD patients. Patients and Methods: This cross-sectional study was conducted on ESRD patients undergoing maintenance hemodialysis (HD) in three HD centers in Ahvaz city in Southwest Iran. Blood samples were obtained prior to a dialysis session to check the routine laboratory test results and assess the adequacy of dialysis. The presence of RLS was assessed by using the international RLS study group (IRLSSG) diagnostic criteria. The IRLSSG rating scale was also used to evaluate the severity of the RLS symptoms. Results: Of the 139 HD patients enrolled in this study, 60 were female (43.2%) and 79 were male (56.8%), with a mean age of 51.82 ± 13.31 years. The prevalence of RLS was 15.8% (22 patients), with 50% of them (11 patients) having severe or very severe symptoms. There was a significant relationship between RLS and longer durations of dialysis (P < 0.001). The mean level of serum ferritin was lower in patients without RLS, but it was not significant (P = 0.065). No significant differences were found according to age, gender, dialysis shifts, and hemoglobin (Hb) level among patients with and without RLS. Conclusions: We conclude that a significant percentage of ESRD patients undergoing maintenance HD have severe or very severe RLS symptoms. The presence of RLS is associated to longer durations of dialysis. PMID:26866010

  3. [Inhaled corticosteroid treatment increases the risk of pneumonia in patients with CPOD.

    PubMed

    Lumholdt, Mads; Steenholt, Janni Vagner; Vestbo, Jørgen

    2014-09-01

    Clinical studies have suggested that inhaled corticosteroid (ICS) increases the frequency of pneumonia in patients with chronic obstructive pulmonary disease (COPD). This article summarizes the risk of pneumonia by reviewing the largest clinical studies addressing pneumonia as an adverse effect of ICS treatment. The collected data show that treatment of COPD patients with ICS increases the rate of pneumonia compared with b2-agonists or placebo. Physicians are recommended to follow guidelines and solely treat COPD patients with ICS if the patients are at high risk of exacerbations. PMID:25293857

  4. [Risk assessment and management of exodontia perioperative patients with cardiovascular diseases].

    PubMed

    Wang, W Y

    2016-07-01

    The number of tooth extraction patients with cardiovascular disease in our country is increasing year by year. Safety is essential for those patients and there is no uniform standard of risk assessment and management for tooth extraction patients with cardiovascular disease during perioperative period. By referring to literatures and with the clinical experience, the author summarized the risk assessment methods for tooth extraction patients with cardiovascular disease during perioperative period. Blood pressure control, cardiac function determination, arrhythmia recognition, blood glucose management, oral antiplatelet or anticoagulant medicine use, etc, were proposed in this article. PMID:27480428

  5. Waves in stratified geomaterials with sliding layers

    NASA Astrophysics Data System (ADS)

    Pasternak, Elena; Dyskin, Arcady

    2016-04-01

    Wave propagation in stratified geomaterials with sliding layers is strongly anisotropic. The simplest representation of this behaviour is an elastic transverse-isotropic (orthotropic in 2D) continuum. Such a model is however only applicable when loading that is sufficiently uniform or when the wavelength is much larger than the layer thickness. In this case the stress non-uniformity over the layer thickness and the associated layer bending can be neglected. In an intermediate case when the wavelength is still higher than the layer thickness but not as high to neglect the stress non-uniformity at least bending moments and layer bending need to be taken into account. This is equivalent to retaining only the linear term of the normal stress variation over the layer thickness. The layer bending creates additional, rotational degrees of freedom. In 2D only one rotational degree of freedom exists, which considerably simplifies the modelling. The corresponding rotation is represented by the average gradient of layer deflection. The presence of rotations makes the stress tensor non-symmetrical. On top of that the rotation gradient creates moment stresses, which represent bending moments over the unit area in the layer cross-section. This requires the use of a 2D orthotropic Cosserat continuum to model the dynamics of such a stratified geomaterial. We show that in the stratified geomaterial shear-bending waves propagate. We determine the wave velocities and demonstrate that as the resistance to sliding reduces, the waves tend to localise over a line normal to the layering.

  6. Stably stratified canopy flow in complex terrain

    NASA Astrophysics Data System (ADS)

    Xu, X.; Yi, C.; Kutter, E.

    2015-07-01

    Stably stratified canopy flow in complex terrain has been considered a difficult condition for measuring net ecosystem-atmosphere exchanges of carbon, water vapor, and energy. A long-standing advection error in eddy-flux measurements is caused by stably stratified canopy flow. Such a condition with strong thermal gradient and less turbulent air is also difficult for modeling. To understand the challenging atmospheric condition for eddy-flux measurements, we use the renormalized group (RNG) k-ϵ turbulence model to investigate the main characteristics of stably stratified canopy flows in complex terrain. In this two-dimensional simulation, we imposed persistent constant heat flux at ground surface and linearly increasing cooling rate in the upper-canopy layer, vertically varying dissipative force from canopy drag elements, buoyancy forcing induced from thermal stratification and the hill terrain. These strong boundary effects keep nonlinearity in the two-dimensional Navier-Stokes equations high enough to generate turbulent behavior. The fundamental characteristics of nighttime canopy flow over complex terrain measured by the small number of available multi-tower advection experiments can be rep