Erratum to ‘Epidemiology of potentially inappropriate medication use in elderly patients in Japanese acute care hospitals’ and ‘Clinical prediction rule to identify high-risk inpatients for adverse drug events: the JADE Study’

2013 ◽  
Vol 22 (11) ◽  
pp. 1245-1245
Author(s):  
Takeshi Morimoto ◽  
Mio Sakuma ◽  
David W. Bates
Keyword(s):  
High Risk ◽  
Elderly Patients ◽  
Acute Care ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Inappropriate Medication Use

scholarly journals Epidemiology of potentially inappropriate medication use in elderly patients in Japanese acute care hospitals

2011 ◽  
Vol 20 (4) ◽  
pp. 386-392 ◽  
Author(s):  
Mio Sakuma ◽  
Takeshi Morimoto ◽  
Kunihiko Matsui ◽  
Susumu Seki ◽  
Nobuo Kuramoto ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Care ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Acute Care Hospitals ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Medication Use

The Use of a Clinical Prediction Model and D-Dimer (DD) Testing in the Diagnosis of Deep Vein Thrombosis (DVT): A Systematic Review.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1052-1052
Author(s):  
Carolyn J. Owen ◽  
Steve Doucette ◽  
Philip S. Wells
Keyword(s):  
High Risk ◽  
High Probability ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Prediction Rules ◽  
Clinical Probability ◽  
Probability Estimates ◽  
Low Probability

Abstract Background: The diagnosis of DVT can be made by determining pretest probability of disease and using this information in combination with DD testing and ultrasound imaging. A number of studies have evaluated the use of clinical probability but this literature has not been summarized. Purpose: To systematically review trials that evaluated DVT prevalence using clinical prediction rules either with or without DD for the diagnosis of DVT. Data Sources: English and French language studies were identified from a MEDLINE search from 1990 to March 2004 and were supplemented by a review of all relevant bibliographies. Study Selection: Prospective management studies of symptomatic outpatients with suspected DVT in which patients were followed for a minimum of 3 months were selected. Clinical prediction rules had to be employed prior to DD and diagnostic tests. Studies were excluded if patients with a history of prior DVT were enrolled or if insufficient information was presented to calculate the prevalence of DVT for each of the 3 clinical probability estimates (low, moderate and high risk). Data Extraction: Two reviewers assessed each study for inclusion/exclusion criteria and collected data on prevalence and on sensitivity, specificity and likelihood ratios of DD in each of the 3 clinical probability estimates (low, moderate and high risk). Data Synthesis: 14 management studies involving a clinical prediction model in the diagnosis of DVT in over 8000 patients were included, of which 11 utilized DD in the diagnostic algorithm. All studies employed the same clinical prediction rule. The inverse variance weighted average prevalence of DVT in the low, moderate and high probability subgroups were 4.9% (95% CI= 4.2% to 5.7%), 17.4% (95% CI= 16.2% to 18.8%), and 53.6% (95% CI= 51.1% to 56.2%), respectively. The overall weighted prevalence was 18.3% (95% CI= 17.4% to 19.2%). The sensitivity of DD for the diagnosis of DVT in the low, moderate and high probability subgroups were 90.4% (95% CI= 84.7% to 94.2%), 92.0 % (95% CI= 89.1% to 94.2%), 93.6% (95% CI= 91.2% to 94.3%); and the specificities were 69.9% (95% CI= 68.0% to 71.8%), 52.4% (95% CI= 49.8% to 55.0%), and 43.2% (95% CI= 38.8% to 47.6%), respectively. The Mantel-Haenszel pooled estimates for diagnostic odds ratios (DOR) were 17.4 (95%CI=10.4–29.1), 10.2 (95% CI=7.1–14.6), and 10.1 (95% CI=6.9–14.9) in low, moderate and high groups respectively. Conclusion: Accurate estimates of the prevalence of DVT can be achieved using the same clinical prediction rule. Using this rule, it is unlikely that low probability patients have a DVT probability of more than 5%. Specificity of the DD seems to have clinically relevant differences depending on pretest probability but the DORs (which incorporate sensitivity and specificity) are similar. The data suggest that DVT can be excluded if patients are low probability even when DDs of lower sensitivity are employed and that DD testing has lower utility in high probability patients since false positives are common.

Predicting Venous Thromboembolism Recurrence Risk in Patients with Cancer: A Validation Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 394-394
Author(s):  
Martha L Louzada ◽  
Gauruv Bose ◽  
Andrew Cheung ◽  
Benjamin H Chin-Yee ◽  
Simon Wells ◽  
...  
Keyword(s):  
High Risk ◽  
Low Molecular Weight Heparin ◽  
Treatment Strategies ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Recurrence Risk ◽  
Low Molecular Weight ◽  
Clinical Prediction ◽  
Unusual Site ◽  
Patients With Cancer

Abstract Abstract 394 Background: Long-term low molecular weight heparin (LMWH) is the current standard for treatment of venous thromboembolism (VTE) in cancer patients. Whether treatment strategies should vary according to individual risk of VTE recurrence remains unknown. We have derived a clinical prediction rule that stratifies VTE recurrence risk in patients with cancer-associated VTE. The derivation model includes 4 independent predictors (sex, primary tumor site, stage and prior VTE). The score sum ranges between −3 and +3 points. Patients with a score ≤ 0 had low risk (≤4.5%) for recurrence and patients with a score above 1 had a high risk (≥ 19%) for VTE recurrence. Subsequently, we applied and validated the rule in an independent set of 819 patients from 2 randomized controlled trials comparing LMWH to warfarin for VTE treatment in cancer patients. In the current study we aim to externally validate our clinical prediction rule with an independent population of patients with cancer-associated VTE followed at the Thrombosis clinics of two tertiary Canadian centres. Methods: We conducted a retrospective cohort study of patients with cancer and VTE diagnosed and/or followed at the Thrombosis Clinic of the Victoria Hospital (London, Canada) from January 2006 to December 2010; and the Thrombosis Unit of the Ottawa Hospital (Ottawa, Canada) from January 2009 to December 2011. We included data from adult patients with active malignancy and objectively diagnosed acute pulmonary embolism (PE) or deep venous thrombosis (DVT) of the lower extremity (above knee), upper extremity and neck veins, or unusual site thrombosis. The primary outcome measure was VTE recurrence during the first six months of anticoagulation. Results: 353 patients fulfilled our inclusion criteria and were included in the study. There were 149 males, and the overall population had a median age of 64 years (range: 18 – 95). One hundred and twenty-three patients had lower extremity DVT, 93 had PE and 57 had both. The remaining 80 patients had either upper extremity/neck DVT (n = 55) or unusual site thrombosis (n = 25). 77 patients had a prior history of VTE. The most common primary tumour site was gastrointestinal, followed by the lung. Of the 304 patients with solid tumours, 230 (75.7%%) had TNM greater than I. Two hundred and ninety-three (83.0%) patients were treated with longterm low molecular weight heparin (LMWH) only and 60 (17.0%) with warfarin (VKA). VTE recurrence occurred in 44 of 353 patients (12.4%). When we evaluated VTE recurrence risk per site, there was no significant difference: London 13 of 90 and Ottawa 31 of 263 [RR=1.23 (95%CI= 0.671 – 2.237; p=0. 507)]. In addition, there was no significant benefit with the use of LMWH (37 of 293) over VKA (7 of 60) in the risk of recurrence [RR=0.92 (95%CI= 0.433 – 1.973; p= 0.8379)]. When we applied our clinical prediction rule (Table 1) in the entire study population, recurrent VTE occurred in 12 of 204 (5.8%) patients stratified as low risk probability and in 32 of 149 (21.4%) patients stratified as high risk probability (Table 2). Conclusions: Our prediction rule has been adequately validated to now be used in prospective trials of treatment. Future trials evaluating novel treatment strategies for high risk patients are warranted. Disclosures: No relevant conflicts of interest to declare.

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