Journal articles on the topic '200199 Clinical health not elsewhere classified'
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1
Fountoulakis, Konstantinos N. "The Contemporary Face of Bipolar Illness: Complex Diagnostic and Therapeutic Challenges." CNS Spectrums 13, no. 9 (September 2008): 763–79. http://dx.doi.org/10.1017/s1092852900013894.
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AbstractManic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the “classic” bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.
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Ridgway, Jessica P., Jessica Schmitt, Ellen Almirol, Monique Millington, Erika Harding, and David Pitrak. "Electronic data sharing between public health department and clinical providers improves accuracy of HIV retention data." Open Forum Infectious Diseases 4, suppl_1 (2017): S421—S422. http://dx.doi.org/10.1093/ofid/ofx163.1059.
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Abstract Background Retention in care is critical for treatment and prevention of HIV. Many HIV care clinics measure retention rate, but data are often incomplete for patients who are classified as lost to follow-up but may be actually in care elsewhere, moved, or died. The Data to Care (D2C) initiative supports data sharing between health departments and HIV providers to confirm patient care status and facilitate reengagement efforts for out of care HIV patients. Methods The University of Chicago Medicine (UCM) provided an electronic list to the Chicago Department of Public Health (CDPH) of adult HIV-positive patients whose retention status was not certain. Retention in care was defined as at least 2 visits >90 days apart within the prior 12 months. CDPH matched this list of patients with data from the Chicago electronic HIV surveillance database. Matches were based on patient name, including alternative spellings and phonetics, and birth date. CDPH also cross-checked patient names with the CDC’s national enhanced HIV-AIDS Reporting System (eHARS) database. CDPH provided UCM with patient current care status, i.e., patient was in care elsewhere (as verified by lab data), moved out of state, or deceased. Results 780 HIV-positive patients received care in the UCM adult HIV clinic from January 1, 2013 to March 31, 2017. Of these, 360 were retained in care as of March 2017. We shared data with CDPH for 492 patients. Of these, 294 (59.8%) were matched, and 168 (34.1%) had a date of last medical care provided. See Table 1 for patient dispositions, before and after data sharing. 24 (13.4%) of patients believed to be lost to follow up according to UCM records were confirmed either transferred care or deceased according to health department data. Conclusion Data sharing between the health department and HIV providers can improve data accuracy regarding retention in care among people living with HIV. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient
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Matthews, Peter C. "Pathological Habit Disorder?" Canadian Journal of Psychiatry 33, no. 9 (December 1988): 826–29. http://dx.doi.org/10.1177/070674378803300908.
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This paper outlines a diagnostic entity called ‘Pathological Habit Disorder’ which is suggested for inclusion in the DSM as an Axis II option. Specific areas of concern, either mental (Axis I) or physical (Axis III), would delineate the syndrome. Pathological Habit Disorder (PHD) points to treatment options where the syndrome is wholly or partly habit-driven. Whether the syndrome is habit-driven or not will remain a clinical judgement even though many conditions, previously thought immutable except by medication, are proving accessible to behavioural engineering. In the ICD system, PHD seems to fit in “Special Symptoms or Syndromes not elsewhere Classified”. It is demonstrably useful to have a diagnosis such as PHD and to incorporate it into the body of medical classification, recognizing current practices for dealing with unwelcome or damaging habits.
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Pogorzelczyk, Katarzyna, Joanna Synoweć, Andrzej Basiński, Daniel Ślęzak, Marlena Robakowska, Przemysław Żuratyński, and Wioletta Mędrzycka-Dąbrowska. "Cost analysis of treating pain patients on the example of the Clinical accident ward Of university Clinical Centre in Gdańsk." BÓL 20, no. 2 / Zjazd PTBB (September 17, 2019): 1–6. http://dx.doi.org/10.5604/01.3001.0013.4614.
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The cost analysis of pain treatment is not a topic often taken up by the health economists community. The subjective dimension and pain assessment by the patient is one of the main determinants of the lack of interest in this topic. Work carried out on this topic currently includes analysis accompanying the process of pharmacotherapy treatment, care provided by medical personnel as well as costs resulting from administrative services. The aim of the work is to present the cost analysis of care for a „pain” patient and to indicate the most optimal financial package of these activities. The study was performed on the basis of financial data of the Clinical Emergency Department of the University Clinical Center in Gdańsk for the last year. We analyzed the cases of patients complaining of pain who received pharmacotherapy. Results The total cost for 2017 amounted to 1.128.668 PLN. The largest amount of money was allocated to the group of patients qualified to the group R: „Symptoms, disease features and abnormal results of clinical trials not classified elsewhere” – 327.313.72 PLN. The symptom of pain is one of the most frequently indicated symptoms among patients who receive medical help at the Clinical Emergency Department of the University Clinical Center in Gdańsk, which should be associated with a greater degree of involvement in analgesic therapy in patients who require it.
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DeVivo, Renée, Lauren Zajac, Asim Mian, Anna Cervantes-Arslanian, Eric Steinberg, Michael L. Alosco, Jesse Mez, Robert Stern, and Ronald Killany. "Differentiating Between Healthy Control Participants and Those with Mild Cognitive Impairment Using Volumetric MRI Data." Journal of the International Neuropsychological Society 25, no. 08 (May 27, 2019): 800–810. http://dx.doi.org/10.1017/s135561771900047x.
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AbstractObjective:To determine whether volumetric measures of the hippocampus, entorhinal cortex, and other cortical measures can differentiate between cognitively normal individuals and subjects with mild cognitive impairment (MCI).Method:Magnetic resonance imaging (MRI) data from 46 cognitively normal subjects and 50 subjects with MCI as part of the Boston University Alzheimer’s Disease Center research registry and the Alzheimer’s Disease Neuroimaging Initiative were used in this cross-sectional study. Cortical, subcortical, and hippocampal subfield volumes were generated from each subject’s MRI data using FreeSurfer v6.0. Nominal logistic regression models containing these variables were used to identify subjects as control or MCI.Results:A model containing regions of interest (superior temporal cortex, caudal anterior cingulate, pars opercularis, subiculum, precentral cortex, caudal middle frontal cortex, rostral middle frontal cortex, pars orbitalis, middle temporal cortex, insula, banks of the superior temporal sulcus, parasubiculum, paracentral lobule) fit the data best (R2= .7310, whole model test chi-square = 97.16,p< .0001).Conclusions:MRI data correctly classified most subjects using measures of selected medial temporal lobe structures in combination with those from other cortical areas, yielding an overall classification accuracy of 93.75%. These findings support the notion that, while volumes of medial temporal lobe regions differ between cognitively normal and MCI subjects, differences that can be used to distinguish between these two populations are present elsewhere in the brain.
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Patten, Scott B., and Joel Paris. "The Bipolar Spectrum—A Bridge Too Far?" Canadian Journal of Psychiatry 53, no. 11 (November 2008): 762–68. http://dx.doi.org/10.1177/070674370805301108.
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Objectives: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. Methods: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. Results: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. Conclusions: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.
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Telemi, Edvin, Nikolay L. Martirosyan, Mauricio J. Avila, Ashley L. Lukefahr, Christopher Le, and G. Michael Lemole. "Suprasellar pleomorphic xanthoastrocytoma: A case report." Surgical Neurology International 10 (April 24, 2019): 72. http://dx.doi.org/10.25259/sni-83-2019.
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Background: Pleomorphic xanthoastrocytoma (PXA) is a rare form of astrocytic neoplasm most commonly found in children and young adults. This neoplasm, which is classified as a Grade II tumor by the World Health Organization classification of tumors of the central nervous system, carries a relatively favorable outcome. It is usually found supratentorially in cortical regions of the cerebral hemispheres, and as such, presenting symptoms are similar to other supratentorial cortical neoplasms; with seizures being a common initial symptom. Due to the rarity of this type of neoplasm, PXA arising elsewhere in the brain is often not included in the initial differential diagnosis. Case Description: This report presents an extremely rare patient with PXA arising in the suprasellar region who presented with progressive peripheral vision loss. Magnetic resonance imaging of the brain demonstrated a heterogeneous suprasellar mass with cystic and enhancing components initially; the most likely differential diagnosis was craniopharyngioma. The patient underwent endoscopic endonasal resection of the tumor. Microscopically, the tumor was consistent with a glial neoplasm with variable morphology. Based on these findings along with further immunohistochemical workup, the patient was diagnosed with a PXA arising in the suprasellar region. At the 1-year follow-up, the patient remained free of recurrence. Although rare PXA originating in other uncommon locations, such as the spinal cord, cerebellum, the ventricular system, and the pineal region have been previously described. Conclusion: Although rare, PXA should be included in the differential diagnosis for solid-cystic tumors arising in the suprasellar region in young adults.
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Ovadia, Yaniv S., Dov Gefel, Dorit Aharoni, Svetlana Turkot, Shlomo Fytlovich, and Aron M. Troen. "Can desalinated seawater contribute to iodine-deficiency disorders? An observation and hypothesis." Public Health Nutrition 19, no. 15 (May 6, 2016): 2808–17. http://dx.doi.org/10.1017/s1368980016000951.
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AbstractObjectiveOver 300 million people rely on desalinated seawater and the numbers are growing. Desalination removes iodine from water and could increase the risk of iodine-deficiency disorders (IDD). The present study assessed the relationship between iodine intake and thyroid function in an area reliant on desalination.DesignA case–control study was performed between March 2012 and March 2014. Thyroid function was rigorously assessed by clinical examination, ultrasound and blood tests, including serum thyroglobulin (Tg) and autoimmune antibodies. Iodine intake and the contribution made by unfiltered tap water were estimated by FFQ. The contribution of drinking-water to iodine intake was modelled using three iodine concentrations: likely, worst-case and best-case scenario.SettingThe setting for the study was a hospital located on the southern Israeli Mediterranean coast.SubjectsAdult volunteers (n102), 21–80 years old, prospectively recruited.ResultsAfter screening, seventy-four participants met the inclusion criteria. Thirty-seven were euthyroid controls. Among those with thyroid dysfunction, twenty-nine were classified with non-autoimmune thyroid disease (NATD) after excluding eight cases with autoimmunity. Seventy per cent of all participants had iodine intake below the Estimated Average Requirement (EAR) of 95 µg/d. Participants with NATD were significantly more likely to have probable IDD with intake below the EAR (OR=5·2; 95 % CI 1·8, 15·2) and abnormal serum Tg>40 ng/ml (OR=5·8; 95 % CI 1·6, 20·8).ConclusionsEvidence of prevalent probable IDD in a population reliant on desalinated seawater supports the urgent need to probe the impact of desalinated water on thyroid health in Israel and elsewhere.
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Asah, Cresta, Rune Frandsen, Rikke Ibsen, Jakob Kjellberg, and Poul Jennum. "Morbidity, Mortality, and Conversion to Neurodegenerative Diseases in Patients with REM Sleep Behavior Disorder and REM Sleep without Atonia." Neuroepidemiology 55, no. 2 (2021): 141–53. http://dx.doi.org/10.1159/000514175.
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<b><i>Introduction:</i></b> The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. <b><i>Methods:</i></b> All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson’s disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer’s, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. <b><i>Results:</i></b> In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. <b><i>Conclusions:</i></b> A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.
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Söderström, Lisa, Andreas Rosenblad, Eva Thors Adolfsson, and Leif Bergkvist. "Malnutrition is associated with increased mortality in older adults regardless of the cause of death." British Journal of Nutrition 117, no. 4 (February 28, 2017): 532–40. http://dx.doi.org/10.1017/s0007114517000435.
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AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
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Waller, Michael, Rachel F. Buckley, Colin L. Masters, Francis R. Nona, Sandra J. Eades, and Annette J. Dobson. "Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study." Journal of Alzheimer's Disease 81, no. 4 (June 15, 2021): 1589–99. http://dx.doi.org/10.3233/jad-201175.
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Background: The prevalence of dementia is generally reported to be higher among Indigenous peoples. Objective: The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. Methods: De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer’s Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as ‘unspecified’ type in Indigenous Australians. Results: The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as ‘unspecified’ on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group. Conclusion: This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.
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Holst, Søren, Dorte Lystrup, and John L. Taylor. "Firesetters with intellectual disabilities in Denmark." Journal of Intellectual Disabilities and Offending Behaviour 10, no. 4 (November 28, 2019): 72–81. http://dx.doi.org/10.1108/jidob-10-2019-0021.
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Purpose The purpose of this paper is to gather epidemiologicalinformation concerning firesetters with intellectual disabilities (ID) in Denmark to identify the assessment and treatment needs of this population and inform further research in this area. Design/methodology/approach The records held by the Danish Ministry of Justice concerning all firesetters with ID convicted of deliberate firesetting were reviewed for the period January 2001 to December 2010 inclusive. File information was extracted for 83 offenders concerning: demographic and personal characteristics; mental health characteristics; offending behaviour; offence-specific factors; and motives for offending. A sub-group of seven offenders were interviewed to explore some of the themes that emerged from the file review. Findings The majority of study participants were male and were classified as having mild ID and around 50 per cent had additional mental health problems. Many came from disturbed and deprived backgrounds. Two-thirds had set more than one fire and over 60 per cent had convictions for offences other than firesetting. Alcohol was involved in the firesetting behaviour in a significant proportion of cases (25 per cent). The motives for setting fires were – in descending order – communication (of anger, frustration and distress), fire fascination and vandalism. Interviews with participants indicated the important communicative function of firesetting, the difficulties people had in talking about and acknowledging their firesetting behaviour, and lack of access to targeted interventions. Research limitations/implications Interventions for Danish firesetters with ID, as for firesetters with ID elsewhere, need to target the communicative function of this behaviour, along with offenders’ lack of insight and initial reluctance to accept responsibility for their behaviour and associated risks. Adjunctive treatment is required to address the psychiatric comorbidity experienced by many of these offenders, along with the alcohol use/misuse that is associated with many of these offences. Originality/value This is the first study concerning nature and needs of firesetters with ID in Denmark.
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Lindskou, Tim Alex, Laura Pilgaard, Morten Breinholt Søvsø, Torben Anders Kløjgård, Thomas Mulvad Larsen, Flemming Bøgh Jensen, Ulla Møller Weinrich, and Erika Frischknecht Christensen. "Prehospital dyspnoea patients in the North Denmark Region." Dansk Tidsskrift for Akutmedicin 2, no. 3 (April 30, 2019): 41. http://dx.doi.org/10.7146/akut.v2i3.112947.
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Background: Prehospital dyspnoea patients are a frequent group with a high mortality. However, there is limited knowledge about their characteristics. We aimed to investigate causes for dispatched ambulances to patients diagnosed with dyspnoea, and diagnoses given to patients to whom an ambulance was dispatched due to dyspnoea.
Method: Retrospective cohort study in the North Denmark region in the period 2012-2015. We included all emergency ambulance patients where the main cause for a dispatched ambulance was “Breathing difficulty”, and all emergency ambulance patients who were diagnosed within the ICD-10 chapter “Diseases of the respiratory system” at hospital.
Results: 4933 patients had an ambulance dispatched due to “Breathing difficulty”. Their most frequent diagnoses at hospital were ICD-10 chapter “Diseases of the respiratory system” (49.45%), “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” (18.56%), “Diseases of the circulatory system” (9.20%), and “Factors influencing health status and contact with health services” (5.71%). Contrariwise, 5163 emergency ambulance patients received a diagnosis within ICD-10 chapter “Diseases of the respiratory system” at hospital. The most frequent causes for dispatched ambulances to these patients were “Breathing difficulty” (49.45%), “Unclarified problem” (11.16%), and “Chest pain - heart disease” (9.55%). 16.00% of dispatches were without cause.
Conclusion: Only half of the patients had both ambulance dispatch and hospital diagnose related to breathing difficulties. The variation and distribution of causes for ambulance dispatch and diagnoses given at hospital, suggests that dyspnoea is a symptom present in many conditions and the patient group is complex.
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Rajeshreddy V., S. G. S., and Lokesh V. Patil. "Causality assessment and the severity of the adverse drug reactions in tertiary care hospital: a pharmacovigilance study." International Journal of Basic & Clinical Pharmacology 6, no. 12 (November 23, 2017): 2800. http://dx.doi.org/10.18203/2319-2003.ijbcp20175073.
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Background: Adverse drug reactions (ADRs) constitute a major clinical problem in terms of human suffering and increased health care costs. To study the adverse drug reactions reported in a tertiary care hospital and study of causality assessment and severity of adverse drug reaction (ADR) cases reported.Methods: A prospective observational study was conducted as part of pharmacovigilance program over 12months between September 2015 and August 2016. Adverse drug reactions reported from hospital were filled into Suspected ADR - CDSCO forms and submitted to pharmacovigilance unit. Causal relationship was assessed and categorized by Naranjo’s algorithm and WHO - UMC causality scale. The severity of each ADR was assessed using Modified Hartwig and Siegel scale.Results: Total 120 cases were reported over 12 months. Among them, 66% were in males and 55% were in females. The majority of ADRs were due to antimicrobial agents (40.78%) followed by haematinics (12%) and anti-epileptics (10%). Maximum number of patients (30.25%) reported with dermatological manifestations. Highest number of ADRs was reported from the department of medicine (45%). As per Naranjo’s scale, 54% reports were assessed as probable and 46% classified as possible. Majority of cases were mild to moderate in severity.Conclusions: The pattern of ADRs reported in our hospital is similar with the pattern of studies conducted in other hospitals elsewhere. This study provides a database of ADRs due to commonly used drugs in our hospital, which will help clinicians for their optimum and safe use. Hence effective pharmacovigilance is required for the use of these drugs and their safety assessment.
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Rosić, Nataša. "Unknown and ill-defined causes of death in the mortality of the populations of Serbia, Croatia, North Macedonia, and Slovenia, in the period between 2007 and 2016." Srpski medicinski casopis Lekarske komore 2, no. 2 (2021): 23–32. http://dx.doi.org/10.5937/smclk2-32461.
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Introduction: Data on the cause of death form the cornerstone for analyzing the health situation and disease in countries, and they make a major contribution to building evidence for health policies. Aim: The aim of this study was to determine the extent to which diagnoses from the group - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), International Classification of Diseases (ICD - Revision X) were used as the main cause of death in Serbia, Croatia, North Macedonia, and Slovenia in the ten-year period, 2007 - 2016. Materials and methods: Methods of descriptive and analytical statistics were used in this research. An analysis of data on the causes of death (R00-R99 ICD - Revision X), by gender, during the ten-year period (2007 - 2016) was performed. Linear regression was also used as an analytical method to analyze the trend. Results: During the ten-year period, in Serbia, the R00-R99 diagnoses were among the five most common groups of diagnoses of death, i.e., in each year they took third place, with a percentage of 4.7%. In the observed period, in the surrounding countries, there was an increase in the death rate in Slovenia, with the highest rate in 2016 (19.9), while in Croatia there was a decrease in the death rate related to the diagnoses from group XVIII ICD - X (R00-R99). In Macedonia, the rate had a linear trend, with a slight decline in 2012 (52.3) and 2013 (58.7). In the observed period, an increase in the death rate of the population of Serbia with an unknown cause of death was observed, with particularly high rates in 2009 and 2016. Comparative analysis has shown that R00-R99 diagnoses are represented more in the mortality statistics of Serbia than in Slovenia and Croatia, and less than in Northern Macedonia. Conclusion: Urgent interventions are needed to improve the quality of mortality statistics and data on the causes of death in the described countries.
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Duron, Rebecca, Michael Mugavero, and Andrew Westfall. "2497." Journal of Clinical and Translational Science 1, S1 (September 2017): 81. http://dx.doi.org/10.1017/cts.2017.286.
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OBJECTIVES/SPECIFIC AIMS: Approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. This has substantial implications for both individual and public health outcomes. On an individual level, being retained in care is necessary for continuous receipt of antiretroviral therapy and sustained viral suppression. The public health implications of poor retention in HIV care are also serious, as it is estimated that people with HIV who are not retained in medical care are responsible for a majority of HIV transmissions, even more than the number of transmissions attributable to those who are HIV infected but undiagnosed. State departments of health routinely collect surveillance data including positive HIV test results, CD4 counts and viral load measures for monitoring trends in HIV infection. A shift in the use of these surveillance measures, guided by the CDC, has brought forth the opportunity to use these data for direct patient services and, more specifically, to direct re-engagement and retention in care efforts. Although the risk factors for poor retention in HIV care have been characterized using information from individual or multiple clinics, this study seeks to incorporate state surveillance data into the retention measures. METHODS/STUDY POPULATION: This retrospective cohort study was performed at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic among patients with at least one attended HIV primary care visit during the calendar year of 2015. Retention during the calendar year of 2016 was then measured as whether or not a patient had 2 or more completed clinic visits which were separated by more than 90 days (in accordance with the Health Resources and Services Administration or HRSA guidelines, a National HIV Quality Indicator). For patients who did not have any primary care visit in 2016, the Alabama Department of Public Health will provide a status of care (out of care, in care elsewhere, died, moved out of state, and cannot locate) based on HIV laboratory results reported from all clinics and labs across the state and/or mortality information. A multinominal regression model of the status of care will be fitted to demographic, clinical, laboratory, and behavioral patient reported outcomes captured during an index visit in 2015. RESULTS/ANTICIPATED RESULTS: Data were recently obtained and is currently being analyzed on 3107 patients included in this study. We anticipate that there will be differences in the factors significantly associated with patients classified as out of care, poorly retained (patients who have only one completed clinic visit), and retained in care by the HRSA measure during calendar year 2016. DISCUSSION/SIGNIFICANCE OF IMPACT: By incorporating state surveillance data into our analysis, we expect to obtain a more precise picture of the risk factors for poor retention among HIV patients. For the first time, we will be able to determine if patients lost to our HIV clinic (~10% annually) are entirely lost to medical care or are seeking care elsewhere as indicated by HIV lab data reported to public health via surveillance. Identified risk factors will then be able to better inform the efforts to proactively improve the efficiency for HIV patient retention and re-engagement, and therefore lead to better individual outcomes for HIV patients and reduce the incidence of new HIV cases.
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Komori, Takashi. "S4-KL-1 UPDATE OF WHO2016 CLASSIFICATION OF ADULT DIFFUSE GLIOMAS." Neuro-Oncology Advances 1, Supplement_2 (December 2019): ii3—ii4. http://dx.doi.org/10.1093/noajnl/vdz039.014.
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Abstract The World Health Organization (WHO) central nervous system (CNS) tumor classification has represented the primary source of diagnosis and grading criteria of brain tumors. Nonetheless, recent advances of studies on their molecular alterations require more rapid update of recommendations for clinical practice. To accomplish this, cIMPACT-NOW (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy) was established in 2016 and has published four updates. For adult gliomas, update 1 clarified the use of the term NOS (Not Otherwise Specified) and proposed a new term NEC (Not Elsewhere Classified); update 2 revised clarifications regarding diffuse astrocytoma/anaplastic astrocytoma, IDH-mutant; update 3 proposed molecular criteria for an IDH-wildtype diffuse or anaplastic astrocytic glioma without histological features of glioblastoma, which would behave similarly to a grade IV glioblastoma. Nonetheless, no consensus on pathologic or molecular markers that could be incorporated into a more clinically relevant grading scheme for IDH-mutant gliomas has been reached. The molecular alterations previously studied using relatively large cohorts include CDKN2A/B homozygous deletion, CDK4 amplification, RB1 mutation/homozygous deletion, PIK3CA or PIK3R1 mutations, PDGFRA amplification, NMYC amplification, global hypomethylation, genomic instability and chromosome 14 loss. The proliferative activity, based on the mitotic count or Ki67 indices, and other morphologic features typical of a high grade that might stratify the risk better than the current criteria have also been evaluated. Despite the discordance among the results of previous studies, CDKN2A/2B homozygous deletions have been shown prognostic significance in high-grade IDH-mutant astrocytomas and microvascular proliferation stratifies IDH-mutant gliomas lacking a CDKN2A homozygous deletion, suggesting that the integration of molecular information and traditional histological findings is still essential for achieving maximum risk stratification of adult cases of IDH-mutant diffuse gliomas. The grading scheme for adult IDH-mutant as well as wild-type gliomas should therefore be revised in the next WHO update.
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Christensen, Karoline Bjerg. "Diagnoses and mortality for patients with unclear problems calling for an ambulance." Dansk Tidsskrift for Akutmedicin 5, no. 1 (March 27, 2022): 9. http://dx.doi.org/10.7146/akut.v5i1.132151.
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Danish patients calling the Emergency Medical Services (EMS) with unclear problems are assigned a Danish Index for Emergency Care (DI) criteria called ‘unclear problem’. Previous Danish studies found ‘unclear problem’ in 17% and 19% of all emergency calls. In the Emergency Departments, unclear problems identified as non-specific symptoms are well documented. We investigated EMS patients given an ‘unclear problem’ DI-criteria prehospitally, their hospital discharge diagnoses and 1-day and 30-day mortality rates.
Population-based observational cohort study investigating 7,935 EMS patients who received the DI-criteria ‘unclear problem’ upon an emergency call and who were brought to hospital in the North Denmark Region during January 1st, 2016 – December 31st, 2018. Outcome variables were; number of emergency ambulances dispatched, ‘unclear problem’ DI-criteria, and vital status (dead or alive) 30 days after hospital contact. We evaluated the association between ICD-10 diagnosis chapters and mortality adjusted for age, gender, and comorbidity. ICD-10 chapters 18: “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” and 21: “Factors influencing health status and contact with health services” were defined as ‘non-specific diagnoses’.All ICD-10 chapters were represented in the discharge diagnoses. The majority (40.4%) were non-specific diagnoses. Common discharge diagnoses were circulatory (9.6%), injuries and poisoning (9.4%), and respiratory diseases (6.9%). Overall mortality rates were for 1-day and 30-day 2.3% (n=181) and 7.1% (n=566), respectively. Day 1 mortality rates were highest for circulatory diseases (8.6%), infections (5.4%), and respiratory diseases (4.0%). Mortality on day 30 was 2.6% and 4.1% for non-specific diagnoses, whereas circulatory, respiratory diagnoses and infections exhibted highest mortality rates. Risk of mortality was associated with age and comorbidities and when adjusted for these confounders, mortality rates decreased for all diagnoses.
EMS patients assigned ‘unclear problem’ and brought to the hospital received diagnoses from all ICD-10 chapters, the majority with non-specific diagnoses, followed by injuries and poisoning, circulatory and respiratory diseases. The latter two groups exhibited the highest crude mortality rates, decreasing substantially when adjusted for age and comorbidity. Mortality rates among patients with unclear problems were associated with age and comorbidities rather than the unclear emergency medical call and following discharge diagnoses.
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Gulati, Bal Kishan, Anil Kumar, and Arvind Pandey. "Cause of death by verbal autopsy among women of reproductive age in Rajasthan, India." International Journal of Scientific Reports 1, no. 1 (May 2, 2015): 56. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20150202.
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<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Reliable data on mortality and morbidity among women of reproductive age are scarce in India. The present study is the Rajasthan component of a large multi-centric study on cause of death by verbal autopsy conducted in five states of India. The data pertaining to deaths among women of reproductive age are presented. </p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>House-to-house surveys of a representative population from rural and urban areas in six districts of Rajasthan were undertaken by Probability of Proportion to Size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared for the purpose. International Classification of Diseases - ICD-10 was used to code the assigned cause of death. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 231 deaths of women of reproductive age were investigated, of which 36 (16%) were maternal deaths while 195 (84%) were non-maternal deaths. Nine out of ten maternal deaths were in rural area.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Certain infectious and parasitic diseases; pregnancy, childbirth and the puerpurium; injury, poisoning and other consequences of external causes; and symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified were found to be the major killers among the women of reproductive age. A comprehensive approach that includes in addition to reproductive health interventions, interventions addressing underlying illiteracy among women and social reforms needs to be undertaken. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>Maternal deaths, Non-maternal deaths, Women of reproductive age, Verbal autopsy</p>
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Ho, Gwendolyn, Ted Wun, Qian Li, Ann M. Brunson, Aaron S. Rosenberg, Brian Jonas, and Theresa Keegan. "Decreased Early Mortality Associated with Treatment of Acute Myeloid Leukemia (AML) at NCI-Designated Cancer Centers in California." Blood 128, no. 22 (December 2, 2016): 391. http://dx.doi.org/10.1182/blood.v128.22.391.391.
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Abstract Background Patients with solid tumors treated at a National Cancer Institute designated cancer center (NCI-CC) have been found to have improved survival when compared to those treated elsewhere. Few population-based studies have evaluated the association between location of care, complications associated with intensive therapy and early mortality (defined here as death ² 60 days from diagnosis) in patients with AML. Methods Using linked data from the California Cancer Registry and Patient Discharge Dataset from 1999 to 2012, we identified patients ³15 years of age diagnosed with AML who received inpatient treatment. Hospitals where patients received their care were classified as either NCI-CC or non-NCI designated facilities (non-NCI-CC). Logistic regression was used to estimate associations between patient characteristics (age, sex, race/ethnicity, year of diagnosis, marital status, neighborhood socioeconomic status, health insurance, and medical comorbidities) and location of care (NCI-CC vs non-NCI-CC facilities), and then to build a propensity score. Inverse probability weighted logistic regression models were used to determine associations between location of care and complications with early mortality. Interactions of complications and location of care with early mortality were also considered. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results Of the 5613 patients with AML identified, 1406 (25%) were treated at an NCI-CC. Compared to patients treated elsewhere, AML patients treated at an NCI-CC were more likely to be <65 years of age, Hispanic (versus non-Hispanic white), live in higher socioeconomic status neighborhoods, have fewer comorbidities and have Medicare or public (versus private) health insurance. Patients treated at NCI-CCs had higher rates of renal failure (21% vs 18%, P=0.03) and lower rates of respiratory failure (11% vs 14%, P=0.002) and sepsis (33% vs 36%, P=0.04) than those treated at non-NCI-CCs. Rates of bleeding, thrombosis, liver failure and cardiac arrest did not differ by location of care. After propensity-score weighting, baseline characteristics were balanced between patients treated at NCI-CCs versus non-NCI-CCs (all standardized mean differences <2.3%). In multivariable, inverse probability weighted models, treatment at an NCI-CC (versus non-NCI-CC) was associated with lower early mortality (OR 0.50, CI 0.42-0.59) (Table). Complications associated with higher early mortality, regardless of treatment location, included: bleeding (OR 1.91, CI 1.54-2.37), liver (OR 3.41, CI 1.91-6.09), renal (OR 2.39, CI 1.97-2.90) and respiratory (OR 6.08, CI 4.88-7.57) failure and cardiac arrest (OR 15.28, CI 8.11-27.78) (Table). The impact of complications on early mortality did not differ by location of care with the exception of respiratory failure (P for interaction=0.001); AML patients with respiratory failure had a higher odds of early mortality when treated at non-NCI-CCs (OR 8.59, CI 6.66-11.07) versus NCI-CCs (OR 4.43, CI 2.68-7.33). Other factors significantly associated with early mortality included younger age, treatment after 2002, non-Hispanic White race/ethnicity (versus African Americans, Hispanics and Asians), single marital status (versus married), residence in low socioeconomic status neighborhoods (versus high) and presence of any comorbidities (versus none). Conclusions In patients with AML, initial treatment at a NCI-CC is associated with 50% reduction in early mortality than treatment at a non-NCI-CC, adjusted for baseline socio-demographic variables, comorbidities and complications within 60 days. Lower early mortality may result from differences in supportive care practices, hospital or provider experience and access to clinical trials at NCI-CCs. Future studies should evaluate the specific differences in care at NCI-CCs to inform strategies to improve early mortality outcomes for all AML patients. Table. Table. Disclosures No relevant conflicts of interest to declare.
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Rotulo, Gioacchino Andrea, Blandine Beaupain, and Jean Donadieu. "ELANE Neutropenia Beyond the Classification into Cyclic Neutropenia and Severe Congenital Neutropenia: The Inconstant Time Clock." Blood 138, Supplement 1 (November 5, 2021): 986. http://dx.doi.org/10.1182/blood-2021-149759.
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Abstract Introduction: ELANE neutropenia represents the cause of 25-30% of the cases of congenital neutropenia. Classically, its appears in the literature as in OMIM, under two distinct entities: Severe congenital neutropenia (SCN) and cyclic neutropenia (CyN). The delineation between the 2 entities is the "cyclicity" i.e. the periodic variation of the absolute neutrophils count (ANC), also called a 21-day time clock 1. However, it is extremely difficult to obtain enough sequential complete blood counts (CBC) at the onset of the disease, during an enough length period, while the patient is not experiencing a severe infection or receiving GCSF therapy. The purpose of our study is to analyze the ANC periodicity at the onset of the disease, prior to the initiation of GCSF in a cohort of patients with ELANE neutropenia. Methods : Available data from the patients, with ELANE class 4 and 5 variants, enrolled in the French Severe Chronic Neutropenia Registry, were analysed. The final diagnostic of CyN and SCN was performed considering all the follow up period (median 16.7 years) and based on the presence of recurrent periodic variation of ANC in the absence of GCSF therapy. CyN was defined as multiple documented ANCs >500 cells/mm 3 , with intermittent ANC variation (n=49), while SCN is defined as ANC persistently <500 cells/mm 3 (n=94). In case of irregularity (i.e. not a regular periodic pattern during all the follow up), the classification takes in consideration the majority of the follow up. A comprehensive analysis of the infectious profile is available elsewhere 2. We were focused here on the diagnostic period (roughly the 2 first months since the diagnosis). We have analysed the initial blood count of the patients and cast the patients by categories if at least 4 ANCs can be evaluated. ANC oscillations defined 4 groups: Group 1: oscillation of ANC values above and below 500 ANC/mm 3 for at least 2 cycles lead to consider the patient as Cyclic; Group 2: clear oscillation of ANC values above and below 200 ANC/mm 3 (but ever<500 ANC/mm 3) for at least 2 cycles; Group 3: no oscillation of ANC values whose level are ever below 500 ANC/mm 3; Group 4: Early GCSF treatment. Results : Among the 143 patients enrolled in this study (Table 1), 137 have at least 4 CBC evaluable during the diagnosis period, including 30 who have been treated almost front line after diagnosis of neutropenia by GCSF hampering evaluation of periodicity. Such patients were all initially considered as SCN. Among the 67 finally classified as SCN, 28 (27.38%) showed an oscillation pattern (group 1), 14 (15.48%) showed minor oscillations (group 2), while 25 (30.95%) had a persistent and severe neutropenia (group 3). Among the 40 CyN, 1 have showed minor oscillations (group 2) below 500/mm 3, while 3 had a persistent and severe neutropenia (group 3). Globally, 32 /107 patients were miss- classified at diagnosis compare to the final diagnosis. Additional data shows that many health indicators could not be deducted from the initial classification like the infections rate, the use of GCSF, the death rate, the sequels rate. Conclusions: Periodic variation of ANC despite being the criteria to define the sub type of ELANE neutropenia is difficult to evaluate at the initial presentation of the disease. In addition, cyclicity is not a permanent feature in ELANE neutropenia, some patients being cyclic only for a certain time in their life span. It results a high rate of miss classification if we compare the initial diagnostic period and all the medical history of the patients. Noteworthy, the rate of several severe complications is not so clearly different between diagnosis sub categories. We propose to consider ELANE neutropenia as a unique disease characterized by a clinical spectrum ranging from more severe forms (corresponding to SCN) to milder forms, the latter often characterized at onset by ANC fluctuations. In addition, some intermediate severity forms could be characterized by minor oscillations. References 1 Horwitz M, Benson KF, Person RE, Aprikyan AG, Dale DC. Mutations in ELA2, encoding neutrophil elastase, define a 21-day biological clock in cyclic haematopoiesis. Nat.Genet. 1999;23:433-436. 2 Rotulo GA, Plat G, Beaupain B et al. Recurrent bacterial infections, but not fungal infections, characterise patients with ELANE-related neutropenia: a French Severe Chronic Neutropenia Registry study. Br J Haematol. 2021 doi: 10.1111/bjh.17695 Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Girnius, Saulius K., Habte A. Yimer, Stephen J. Noga, Sudhir Manda, Roger M. Lyons, Kimberly Bogard, Presley Whidden, et al. "In-Class Transition (iCT) from Parenteral Bortezomib to Oral Ixazomib Proteasome Inhibitor (PI) Therapy Increases the Feasibility of Long-Term PI Treatment and Benefit for Newly Diagnosed Multiple Myeloma (NDMM) Patients in an Outpatient Setting: Updated Real-World Results from the Community-Based United States (US) MM-6 Study." Blood 136, Supplement 1 (November 5, 2020): 2–4. http://dx.doi.org/10.1182/blood-2020-140482.
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Background Long-term PI-based treatment is associated with improved outcomes in MM. Nonetheless, prolonged therapy with parenteral PIs (e.g. bortezomib) can be challenging in the real world, with median duration of therapy (DOT) of 4-7 months. Barriers to this long-term approach may include the burden of repeated intravenous/subcutaneous administration, difficulty travelling to/accessing treatment centers (e.g. due to environmental factors, travel restrictions, social/family situations), patient preference for treatment outside of a hospital or clinic setting, comorbidities, and toxicity. The US MM-6 study (NCT03173092) is investigating in-class transition (iCT) from parenteral bortezomib-based induction to all-oral ixazomib-based therapy (ixazomib-lenalidomide-dexamethasone; IRd) in the diverse US community population with the aim of increasing PI-based treatment duration while maintaining quality of life and improving outcomes. We report updated efficacy and safety for the first 101 patients. Methods Transplant-ineligible/delayed-transplant (>24 months) NDMM patients with stable disease or better after 3 cycles of bortezomib-based induction are being enrolled at US community sites (including Veterans Affairs hospitals) to receive IRd (ixazomib 4 mg, days 1, 8, 15; lenalidomide 25 mg, days 1-21; dexamethasone 40 mg, days 1, 8, 15, 22) for up to 39 x 28-day cycles or until progression/toxicity. The primary endpoint is progression-free survival (PFS); key secondary endpoints include rates of partial (PR), very good PR (VGPR), and complete response (CR), and DOT. Results As of June 1 2020, 101 patients had been treated at 21 sites. Median age was 73 years (range 48-90), with 46% aged ≥75 years; 16% and 10% were of African American and Hispanic ethnicity, respectively. Table 1 summarizes the key characteristics of these real-world patients. A total of 95% of patients had ≥1 comorbidity at the start of IRd therapy including renal and urinary disorders (38%), cardiac disorders (29%), peripheral neuropathy (PN; 14%), and diabetes mellitus (13%) (Table 2). With 53 (52%) patients remaining on therapy and enrollment ongoing, mean duration of PI therapy from the start of bortezomib-based induction was 12.4 months, and mean duration of IRd therapy after iCT was 9.2 months (Table 3). Patients have received up to 29.4 months (31 cycles) of IRd to date. The overall response rate (ORR) after bortezomib-based induction was 62% (7% CR, 32% ≥VGPR). After iCT to IRd, the ORR increased to 71%, with the CR and ≥VGPR rates increasing to 29% and 53%, respectively (Figure); of 33 patients with stable disease following bortezomib-based induction, 14 (42%) achieved CR (n=10) or VGPR (n=4) after iCT. With a median follow-up of 12 months and enrollment ongoing, 13 patients had progressed and two had died during PFS analysis. The 12-month PFS rate was 84% (95% CI, 73-91) from the start of bortezomib-based induction and 80% (95% CI, 69-88) from the start of IRd. During IRd treatment to date, 91% of patients have had treatment-emergent adverse events (TEAEs) (54% grade ≥3). Grade 3 TEAEs (≥5% of patients) were diarrhea (8%), pneumonia (7%), and syncope (5%). TEAEs led to study drug modification in 52% of patients and discontinuation in 7% of patients; 37% had serious TEAEs. Diarrhea, nausea, and vomiting occurred in 43%, 23%, and 14% of patients (8%, 2%, 2% grade 3), and led to dose modification in 11%, 5%, and 2%. PN (not elsewhere classified; high-level term) occurred in 32% of patients (2% grade 3) and led to dose modification in 9%. There were three on-study deaths (i.e. occurring <30 days after last dose). Conclusions US MM-6 patients reflect the heterogeneous real-world US MM population; the population for this study includes patients from the community who may not be eligible for traditional clinical trials. These updated data in mostly elderly, comorbid, NDMM patients treated in the community setting demonstrate the feasibility and tolerability of iCT to IRd after 3 cycles of bortezomib-based induction; approximately half of patients remain on treatment, and enrollment is ongoing. iCT to IRd resulted in improved responses, with increased rates of ≥VGPR, and prolonged DOT and may thereby improve outcomes for real-world patients. iCT to an all oral regimen could also prevent treatment interruptions for patients who are unable to or prefer not to travel in the context of travel restrictions or other factors. Disclosures Girnius: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Yimer:TG Therapeutics: Consultancy; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Sanofi: Speakers Bureau; Texas Oncology: Current Employment; BeiGene: Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Janssen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Celgene, a Bristol-Myers Squibb Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Karyopharm: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Epizyme: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months. Noga:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Manda:AbbVie: Other: Investigator in AbbVie-sponsored clinical trials. Lyons:Texas Oncology/US Oncology: Current Employment; Novartis: Honoraria. Bogard:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Whidden:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Cherepanov:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Lu:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Aiello:Takeda: Honoraria; Travera: Honoraria; Celgene: Honoraria; Karyopharm: Honoraria. Richter:Celgene: Consultancy, Speakers Bureau; Adaptive Biotechnologies: Consultancy, Speakers Bureau; Janssen: Speakers Bureau; Sanofi: Consultancy; Karyopharm: Consultancy; Takeda: Consultancy; AstraZeneca: Consultancy; Secura Bio: Consultancy; Bristol Myers Squibb: Consultancy; X4 Pharmaceuticals: Consultancy; Oncopeptides: Consultancy; Antengene: Consultancy. Rifkin:McKesson: Current equity holder in publicly-traded company, Ended employment in the past 24 months, Other: Stock ownership; Takeda, Amgen, Celgene, BMS, Mylan, Coherus BioSciences, Fresenius: Consultancy; AbbVie: Other: Investigator in AbbVie sponsored clinical trials; Takeda, Amgen, BMS (Celgene): Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: Real-world evaluation of long-term proteasome inhibition with ixazomib in combination with lenalidomide and dexamethasone for the treatment of newly diagnosed multiple myeloma in non-transplant patients with stable disease after 3 cycles of a bortezomib-based induction.
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Rosenthal, Richard. "The categorization of pathological gambling and the Impulse-Control Disorders Not Elsewhere Classified." Journal of Gambling Issues, no. 15 (December 1, 2005). http://dx.doi.org/10.4309/jgi.2005.15.15.
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Nucci, L. B., C. C. Enes, F. R. Ferraz, I. V. da Silva, A. E. M. Rinaldi, and W. L. Conde. "Excess mortality associated with COVID-19 in Brazil: 2020–2021." Journal of Public Health, December 31, 2021. http://dx.doi.org/10.1093/pubmed/fdab398.
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Abstract Objective To evaluate excess mortality in Brazil from January 2020 to April 2021, according to the primary causes of death registered in the Brazilian Mortality Information System (MIS). Methods Cross-sectional study with data extracted from the MIS. Excess deaths were examined by the primary cause of death according to 11 grouped causes. Autoregressive models used mortality data from 2015 to 2019 to predict expected deaths from January 2020 to April 2021. Excess deaths were calculated as the difference between the observed and the expected number of deaths. Results Total excess deaths of 370 055 were observed in the studied period, corresponding to a ratio of observed to expected of 1.14 in 2020 and 1.40 in 2021. Excess deaths were seen in three groups: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; other diseases of the respiratory system and coronavirus infection, unspecified site. Conclusions The excess mortality in Brazil in these 16 months was 1.20 times greater than the previous year. The increase in not elsewhere classified causes and causes of death associated to COVID-19 indicate caution about the negative balance for some causes. Furthermore, the inequalities of mortality reporting systems in low- and middle-income countries in relation to underestimation of mortality still need to be addressed.
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Baugh, Laura, Noah Brown, Joo Y. Song, Shreyash Pandya, Vernon Montoya, and Anamarija M. Perry. "Fibrin-Associated, EBV-Negative Diffuse Large B-Cell Lymphoma Arising in Atrial Myxoma: Expanding the Spectrum of the Entity." International Journal of Surgical Pathology, April 29, 2021, 106689692110149. http://dx.doi.org/10.1177/10668969211014959.
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Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is a provisional entity in the 2017 Revision of the World Health Organization Classification. This indolent entity, which is frequently discovered incidentally, is currently classified under the category of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), an aggressive lymphoma with poor survival. Several authors have proposed that it be classified separately since, in contrast to DLBCL-CI, transformation to aggressive lymphoma has rarely been reported and this entity has distinct clinical and histological features. We describe a rare case of a 62-year-old male with FA-DLBCL associated with atrial myxoma, which was incidentally discovered. In contrast to typically described immunophenotypic features of this entity, that is, activated B-cell phenotype (ABC) and Epstein-Barr virus (EBV) positivity, our case showed germinal center B-cell (GCB) phenotype and was EBV negative. Clinical staging revealed no evidence of lymphoma elsewhere in the body, and the patient did not receive adjuvant chemotherapy after surgical excision and remains in remission. This case illustrates that occasionally FA-DLBCL can show GCB phenotype, as opposed to the typical ABC phenotype. Moreover, we propose that the definition of the entity be expanded to include EBV-negative cases.
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Valerio, L., S. Roure, M. Sabrià, X. Balanzó, X. Vallès, and L. Serés. "Clinical, electrocardiographic and echocardiographic abnormalities in Latin American migrants with newly diagnosed Chagas disease 2005-2009, Barcelona, Spain." Eurosurveillance 16, no. 38 (September 22, 2011). http://dx.doi.org/10.2807/ese.16.38.19971-en.
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Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countries in Europe and elsewhere. New policies are necessary to prevent transmission in those countries but the long, often undetected chronic period of the early stages of the disease also renders epidemiological studies important. The main objective of our study was to determine the presence of clinical, electrocardiogram (ECG) and echocardiographic abnormalities in a population of Latin American migrants infected with Trypanosoma cruzi at the moment of diagnosis. We performed a hospital-based observational study of 100 adult patients with newly diagnosed Chagas infection between January 2005 and December 2009. Thirty-seven patients were classified within the Brazilian Consensus on Chagas cardiomyopathy early cardiac stages (A or B1) and 49 presented pathological findings (stage B2) according to the Panamerican Health Organization Classification. Overall, 49 patients showed ECG and/or echocardiographic alterations. The presence of ECG and ecocardiographic alterations were significantly associated (p=0.038). The most frequent ECG and echocardiographic findings were right bundle branch block (12 cases) and impaired left ventricular wall relaxation (24 cases), respectively. In conclusion, ECG and echocardiographic alterations coherent with Chagas cardiomyopathy were found in a large proportion of newly diagnosed Latin American migrants infected with T. cruzi. In the mid-term, Chagas disease might become an important cause of chronic cadiomyopathy in our attendance area.
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Kyprianidou, Maria, Demosthenes Panagiotakos, Antigoni Faka, Maria Kambanaros, Konstantinos C. Makris, and Costas A. Christophi. "Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study." Public Health Nutrition, October 27, 2020, 1–10. http://dx.doi.org/10.1017/s1368980020004267.
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Abstract Objective: To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity. Design: A representative sample of the adult population of Cyprus was selected in 2018–2019 using stratified sampling. Demographics, Mediterranean diet, smoking and physical activity, as well as the presence of chronic, clinical and mental conditions, were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision. Setting: The five government-controlled municipalities of the Republic of Cyprus. Participants: A total of 1140 Cypriot men and women over 18 years. Results: The average Mediterranean diet score was 15·5 ± 4·0 with males and residents of rural regions being more adherent to the Mediterranean diet compared with females and residents of urban regions (P < 0·05). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity compared with the lower tertile, and this result was statistically significant even after adjusting for age, gender, smoking habits and physical activity (OR = 0·68, 95 % CI 0·46, 0·99). Conclusions: The study provides evidence of the adherence to the Mediterranean diet in Cypriot population and its association with multi-morbidity. Adherence to the Mediterranean diet was associated with lower risk of multi-morbidity. Future research would attempt to replicate such results that could add solid pieces of evidence towards meeting some criteria of causality and severity tests; hence, prevention programmes and practice guidelines in Cyprus and elsewhere should take into account those beneficial effects.
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Dahl, Viktor, Karin T. Wisell, Christian G. Giske, Anders Tegnell, and Anders Wallensten. "Lyme neuroborreliosis epidemiology in Sweden 2010 to 2014: clinical microbiology laboratories are a better data source than the hospital discharge diagnosis register." Eurosurveillance 24, no. 20 (May 16, 2019). http://dx.doi.org/10.2807/1560-7917.es.2019.24.20.1800453.
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Background In a study from 2013 that prioritised communicable diseases for surveillance in Sweden, we identified Lyme borreliosis as one of the diseases with highest priority. In 2014, when the present study was designed, there were also plans to make neuroborreliosis notifiable within the European Union. Aim We compared possibilities of surveillance of neuroborreliosis in Sweden through two different sources: the hospital discharge register and reporting from the clinical microbiology laboratories. Methods We examined the validity of ICD-10 codes in the hospital discharge register by extracting personal identification numbers for all cases of neuroborreliosis, defined by a positive cerebrospinal fluid–serum anti-Borrelia antibody index, who were diagnosed at the largest clinical microbiology laboratory in Sweden during 2014. We conducted a retrospective observational study with a questionnaire sent to all clinical microbiology laboratories in Sweden requesting information on yearly number of cases, age group and sex for the period 2010 to 2014. Results Among 150 neuroborreliosis cases, 67 (45%) had received the ICD-10 code A69.2 (Lyme borreliosis) in combination with G01.9 (meningitis in bacterial diseases classified elsewhere), the combination that the Swedish National Board of Health and Welfare recommends for neuroborreliosis. All 22 clinical laboratories replied to our questionnaire. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014. Conclusion The hospital discharge register was unsuitable for surveillance of neuroborreliosis, whereas laboratory-based reporting was a feasible alternative. In 2018, the European Commission included Lyme neuroborreliosis on the list of diseases under epidemiological surveillance.
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Ibsen, Stine, Karoline Bjerg Dam-Huus, Christian H. Nickel, Erika Frischknecht Christensen, and Morten Breinholt Søvsø. "Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark." Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 30, no. 1 (December 12, 2022). http://dx.doi.org/10.1186/s13049-022-01052-y.
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Abstract Background Patients calling for an emergency ambulance and assessed as presenting with ‘unclear problem’ account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1- and 30-day mortality. Methods A historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R (‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)’ and Z (‘factors influencing health status and contact with health services”) were combined and designated “non-specific diagnoses”. Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities. Results Diagnoses were widespread among the ICD-10 chapters, and the most were ‘non-specific diagnoses’ (40.4%), ‘circulatory diseases’ (9.6%), ‘injuries and poisonings’ (9.4%) and ‘respiratory diseases’ (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were ‘circulatory diseases’ (n = 148, 26%) followed by ‘non-specific diagnoses’ (n = 88, 16%) ‘respiratory diseases’ (n = 85, 15%), ‘infections’ (n = 54, 10%) and ‘digestive disease’ (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age. Conclusion This study found that almost half of the patients brought to the hospital after calling 112 with an ‘unclear problem’ were discharged with a ‘non-specific diagnosis’ which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by ‘circulatory diseases’.
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Lam, Daniel, Fidelity Dominguez, Jan Leonard, Alexandria Wiersma, and Joseph A. Grubenhoff. "Use of e-triggers to identify diagnostic errors in the paediatric ED." BMJ Quality & Safety, March 22, 2022, bmjqs—2021–013683. http://dx.doi.org/10.1136/bmjqs-2021-013683.
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BackgroundDiagnostic errors (DxEs) are an understudied source of patient harm in children rarely captured in current adverse event reporting systems. Applying electronic triggers (e-triggers) to electronic health records shows promise in identifying DxEs but has not been used in the emergency department (ED) setting.ObjectivesTo assess the performance of an e-trigger and subsequent manual screening for identifying probable DxEs among children with unplanned admission following a prior ED visit and to compare performance to existing incident reporting systems.Design/methodsRetrospective single-centre cohort study of children ages 0–22 admitted within 14 days of a previous ED visit between 1 January 2018 and 31 December 2019. Subjects were identified by e-trigger, screened to identify cases where index visit and hospital discharge diagnoses were potentially related but pathophysiologically distinct, and then these screened-in cases were reviewed for DxE using the SaferDx Instrument. Cases of DxE identified by e-trigger were cross-referenced against existing institutional incident reporting systems.ResultsAn e-trigger identified 1915 unplanned admissions (7.7% of 24 849 total admissions) with a preceding index visit. 453 (23.7%) were screened in and underwent review using SaferDx. 92 cases were classified as likely DxEs, representing 0.4% of all hospital admissions, 4.8% among those selected by e-trigger and 20.3% among those screened in for review. Half of cases were reviewed by two reviewers using SaferDx with substantial inter-rater reliability (Cohen’s κ=0.65 (95% CI 0.54 to 0.75)). Six (6.5%) cases had been reported elsewhere: two to the hospital’s incident reporting system and five to the ED case review team (one reported to both).ConclusionAn e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs.
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Teixeira, Renato Azeredo, Mohsen Naghavi, Mark Drew Crosland Guimarães, Lenice Harumi Ishitani, and Elizabeth Barboza França. "Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015." Revista Brasileira de Epidemiologia 22, suppl 3 (2019). http://dx.doi.org/10.1590/1980-549720190002.supl.3.
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ABSTRACT Introduction: reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10”) to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. Methods: death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. Results: an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. Conclusion: the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.
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Sansome, Sam, and Iain Turnbull. "Validation and Vindication: Enhancing the quality of Electronic Health Record (EHR) outcomes in a large prospective study biobank." International Journal of Population Data Science 1, no. 1 (April 19, 2017). http://dx.doi.org/10.23889/ijpds.v1i1.365.
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ABSTRACT
ObjectivesTo date we have derived and linked over 1.5 million electronic health records (EHR) to over 280,000 of our biobank participants (across 10 diverse urban and rural geographical regions of China) through established morbidity and mortality registries, and by linkage to the China national Health Insurance (HI) system to identify disease outcomes.
To ensure accuracy, completeness and consistency of these outcomes we have developed data handling, processing, and validation procedures.
ApproachOn a disease-by-disease basis we have developed multiple strategies varying from simple standardisation of disease description to ICD10, to a more comprehensive system of retrieval and examination of medical notes.For those diseases chosen for more precise phenotyping, such as stroke, we send trained research technicians to hospitals where they retrieve clinical documents that correspond to the disease outcomes as reported by registries and HI agencies.
A Portable Validation Device (PVD) tablet has been developed to guide the medical notes gathering process and ‘validate’ chosen disease events, by photographing key documents and ascertaining disease subtypes. For diseases selected for further adjudication, medical specialists in China are given access to an internet based Case Adjudication System for clinical Events (i-CASE). The information captured by PVD is presented in i-CASE according to pre-specified clinical and procedural criteria.
At least 5% of all of data undergoes quality control assessments at both validation and adjudication stages in the UK.
ResultsDiseases causing the greatest burden in China (Cancer, Diabetes, COPD, Stroke and IHD) have all been standardised and subsequently validated using the PVD where appropriate. To date, we have retrieved over 45,000 hospital records through the PVD and, more recently, over 32,000 IHD and Stroke cases have been adjudicated through the i-CASE system.
Outcomes are categorised as ‘confirmed’, ‘re-classified’, ‘sub-typed’ or ‘refuted’ and are integrated back into the study dataset for future analysis, along with additional data gathered from the notes.
ConclusionThe study provides a uniquely rich and powerful resource for investigating environmental and genetic determinants of chronic disease in the Chinese population. By treating disease types on a case-by-case basis we can both confirm their accuracy, and to link more precise clinical phenotypes to emerging data types, such as genetic and omics data. These innovations in disease validation and adjudication will enable the study to reach new insights into the aetiology of chronic disease to improve the health of the population in China and elsewhere.
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Melcher, Carolin. "Lumbar spinal stenosis – surgical outcome and the odds of revision-surgery: Is it all due to the surgeon?" Technology and Health Care, June 16, 2022, 1–12. http://dx.doi.org/10.3233/thc-223389.
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BACKGROUND: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE: The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS: Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS: Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS: While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren’t obious within the intial index group of late revisions.
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Paterson-Brown, Lucy, Alexandra Jones, and Nick Wilkinson. "P36 A case of refractory IBD-related scleritis." Rheumatology Advances in Practice 5, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/rap/rkab068.035.
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Abstract Case report - Introduction Scleritis is severe vision-threatening scleral inflammation, commonly presenting with a red, painful eye and can be classified using the Watson system. Posterior scleritis may present with associated anterior uveitis in many cases. Steroid therapy is often successful initially; however, further immunomodulation is usually required to control subsequent episodes which can be challenging. We present an 18-year-old, Caucasian girl with a left eye, sight-threatening, steroid-dependent posterior uveitis who required escalation of treatment to tocilizumab before inflammation could be suppressed. Case report - Case description Our patient was diagnosed elsewhere with ulcerative colitis at the age of 12 and subsequently developed recurrent episodes of uveitis and scleritis which could be controlled with topical steroids. At the age of 16 she presented with an inflammatory arthritis and was treated with intravenous methylprednisolone before commencing sulfasalazine therapy. Due to persistent systemic and ophthalmic inflammation she was changed to adalimumab; however, this was also unsuccessful and methotrexate was added. By the age of 18 she had been steroid-dependent for 2 years and could not reduce daily prednisolone below 15mg without a deterioration in her left eye posterior scleritis with visual acuity compromise including episodes of complete visual loss causing high levels of anxiety. Due to the pain and deterioration in vision she struggled with her studies and school attendance, and withdrew from her passion for competitive sailing. With ongoing sight-threatening inflammatory changes she was referred for further tertiary assessment in 2019. During the following 4 months treatment was escalated rapidly. Methotrexate dose was increased, and adalimumab frequency reduced to weekly. There was a limited response, with further episodes of sight deterioration as a result of flares in inflammation. Response to tocilizumab treatment was seen after only two doses with good control of scleritis by 3 months of treatment when steroids were successfully weaned and stopped. Over 18 months of tocilizumab therapy the patient has only required one course of topical steroids for mild ocular inflammation which resolved without any other treatment required. She has successfully completed her degree, can complete daily gym training sessions and participate in regular sailing competitions. Case report - Discussion Posterior scleritis is the most common scleritis in children and can be associated with anterior uveitis, concurrent anterior scleritis, disc swelling or retinal striae. Posterior scleritis has a higher rate of complications therefore is treated aggressively. Refractory cases such as this require biologic therapy and rituximab is often used. Despite the preference of two adult eye units for treatment with rituximab the rationale for tocilizumab included; recent high quality studies showing successful treatment of inflammatory bowel disease, its known benefit for anterior uveitis and case studies in adults with posterior scleritis. Tocilizumab is a recombinant monoclonal antibody that causes a blockade of interleukin-6 receptors. It is currently only approved by the Food and Drug Administration (FDA) for use in children with polyarticular or systemic onset Juvenile Idiopathic Arthritis (JIA). Our patient had a very positive experience with this drug, no side effects and rapid clinical improvement seen. As a result her quality of life and mental health improved quickly. Case report - Key learning points This is a case of refractory, sight-threatening, steroid-dependent posterior scleritis on a background of inflammatory bowel disease and arthritis. As a result of this case our team reviewed current literature from other paediatric populations and adults with scleritis, informing the clinical decision to proceed with tocilizumab after control was unsuccessful with previous agents. The remarkable response demonstrated for our patient highlights the value tocilizumab can offer to the treatment options for similar refractory cases. This adds to the growing positive data published surrounding tocilizumab in children but further studies in paediatric populations are required to evaluate this in greater detail.
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Albert, Stefanie P., Rosa Ergas, Sita Smith, Gillian Haney, and Monina Klevens. "Syndrome Development to Assess IDU, HIV, and Homelessness in MA Emergency Departments." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9895.
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ObjectiveWe sought to measure the burden of emergency department (ED) visits associated with injection drug use (IDU), HIV infection, and homelessness; and the intersection of homelessness with IDU and HIV infection in Massachusetts via syndromic surveillance data.IntroductionIn Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance.Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3. Injection of illicitly consumed opioids is associated with an increased risk of infectious diseases, including HIV infection. An investigation of an HIV outbreak among persons reporting IDU identified homelessness as a social determinant for increased risk for HIV infection.MethodsTo accomplish our objectives staff used an existing MDPH SyS IDU syndrome definition4, developed a novel syndrome definition for HIV-related visits, and adapted Maricopa County's homelessness syndrome definition. Syndromes were applied to Massachusetts ED data through the CDC’s BioSense Platform. Visits meeting the HIV and homelessness syndromes were randomly selected and reviewed to assess accuracy; inclusion and exclusion criteria were then revised to increase specificity. The final versions of all three syndrome definitions incorporate free-text elements from the chief complaint and triage notes, as well as International Statistical Classification of Diseases and Related Health Problems, 9th (ICD-9) and 10th Revision (ICD-10) diagnostic codes. Syndrome categories were not mutually exclusive, and all reported visits occurring at Massachusetts EDs were included in the analysis.Syndromes CreatedFor the HIV infection syndrome definition, we incorporated the free-text term “HIV” in both the chief complaint and triage notes. Visit level review demonstrated that the following exclusions were needed to reduce misspellings, inclusion of partial words, and documentation of HIV testing results: “negative for HIV”, “HIV neg”, “negative test for HIV”, “hive”, “hivies”, and “vehivcle”. Additionally, the following diagnostic codes were incorporated: V65.44 (Human immunodeficiency virus [HIV] counseling), V08 (asymptomatic HIV infection status), V01.79 (contact with or exposure to other viral diseases), 795.71 (nonspecific serologic evidence of HIV), V73.89 (special screening examination for other specified viral diseases), 079.53 (HIV, type 2 [HIV-2]), Z20.6 (contact with and (suspected) exposure to HIV), Z71.7 (HIV counseling), B20 (HIV disease), Z21 (asymptomatic HIV infection status), R75 (inconclusive laboratory evidence of HIV), Z11.4 (encounter for screening for HIV), and B97.35 (HIV-2 as the cause of diseases classified elsewhere).Building on the Maricopa County homeless syndrome definition, we incorporated a variety of free-text inclusion and exclusion terms. To meet this definition visits had to mention: “homeless”, or “no housing”, or, “lack of housing”, or “without housing”, or “shelter” but not animal and domestic violence shelters. We also selected the following ICD-10 codes for homelessness and inadequate housing respectively, Z59.0 and Z59.1.We analyzed MDPH SyS data for visits occurring from January 1, 2016 through June 30, 2018. Rates per 10,000 ED visits categorized as IDU, HIV, or homeless were calculated. Subsequently, visits categorized as IDU, HIV, and meeting both IDU and HIV syndrome definitions (IDU+HIV) were stratified by homelessness.ResultsSyndrome Burden on EDThe MDPH SyS dataset contains 6,767,137 ED visits occurring during the study period. Of these, 82,819 (1.2%) were IDU-related, 13,017 (0.2%) were HIV-related, 580 (<0.01%) were related to IDU + HIV, and 42,255 visits (0.6%) were associated with homelessness.The annual rate of IDU-related visits increased 15% from 2016 through June of 2018 (from 113.63 to 130.57 per 10,000 visits); while rates of HIV-related and IDU + HIV-related visits remained relatively stable. The overall rate of visits associated with homelessness increased 47% (from 49.99 to 73.26 per 10,000 visits).Rates of IDU, HIV, and IDU + HIV were significantly higher among visits associated with homelessness. Among visits that met the homeless syndrome definition compared to those that did not: the rate of IDU-related visits was 816.0 versus 118.03 per 10,000 ED visits (X2= 547.12, p<0. 0001); the rate of visits matching the HIV syndrome definition was 145.54 versus 18.44 per 10,000 ED visits (X2= 99.33, p<0.0001); and the rate of visits meeting the IDU+HIV syndrome definition was 15.86 versus 0.76 per 10,000 visits (X2= 13.72, p= 0.0002).ConclusionsMassachusetts is experiencing an increasing burden of ED visits associated with both IDU and homelessness that parallels increases in opioid overdoses. Higher rates of both IDU and HIV-related visits were associated with homelessness. An understanding of the intersection between opioid overdoses, IDU, HIV, and homelessness can inform expanded prevention efforts, introduction of alternatives to ED care, and increase consideration of housing status during ED care.Continued surveillance for these syndromes, including collection and analysis of demographic and clinical characteristics, and geographic variations, is warranted. These data can be useful to providers and public health authorities for planning healthcare services.References1. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017. MMWR Morbidity and Mortality Weekly Report 2018; 67(9);279–285 DOI: http://dx.doi.org/10.15585/mmwr.mm6709e12. Massachusetts Department of Public Health. Chapter 55 Data Brief: An assessment of opioid-related deaths in Massachusetts, 2011-15. 2017 August. Available from: https://www.mass.gov/files/documents/2017/08/31/data-brief-chapter-55-aug-2017.pdf3. Massachusetts Department of Public Health. MA Opioid-Related EMS Incidents 2013-September 2017. 2018 Feb. Available from: https://www.mass.gov/files/documents/2018/02/14/emergency-medical-services-data-february-2018.pdf4. Bova, M. Using emergency department (ED) syndromic surveillance to measure injection-drug use as an indicator for hepatitis C risk. Powerpoint presented at: 2017 Northeast Epidemiology Conference. 2017 Oct 18 – 20; Northampton, Massachusetts, USA.