Evaluating definitions for maternal fever as diagnostic criteria for intraamniotic infection in low‐risk pregnancies

Birth ◽  
2021 ◽  
Author(s):  
Claire Jones ◽  
Hamer Titus ◽  
Chederli Gayle Belongilot ◽  
Selena Soviravong ◽  
Brian K. Stansfield
Keyword(s):  
Diagnostic Criteria ◽  
Low Risk ◽  
Intraamniotic Infection

Diagnosis and Treatment of Essential Thrombocythemia: Assessment of Current Clinical Practice.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1903-1903
Author(s):  
Vivian H Y Lee ◽  
Erica Peterson ◽  
Leslie Zypchen ◽  
Lynda M Foltz
Keyword(s):  
Bone Marrow ◽  
Clinical Practice ◽  
High Risk ◽  
Diagnostic Criteria ◽  
Bone Marrow Biopsy ◽  
Jak2 V617f ◽  
Low Risk ◽  
Cytoreductive Treatment ◽  
Risk Patients ◽  
History Of

Abstract Abstract 1903 Poster Board I-926 Introduction: The discovery of the JAK2 V617F gene mutation has significantly altered the clinical diagnostic approach to the myeloproliferative neoplasms, reflected in the revised 2008 WHO diagnostic criteria. Both the 2001 and 2008 diagnostic criteria for essential thrombocythemia (ET) require a bone marrow biopsy showing megakaryocytic proliferation to make a diagnosis of ET. Published expert opinion based on clinical studies suggests that ET patients > 60 years old or with history of thrombosis should be characterized as high risk and treated with hydroxyurea. It is unclear whether physicians in clinical practice utilize the WHO diagnostic criteria or follow expert treatment recommendations for ET. Methods: We conducted a retrospective chart review of all patients with a clinical diagnosis of ET made by a hematologist who were seen in clinic from 2006 to 2008 at two university teaching hospitals in Vancouver, Canada. Data collected included demographic information, thrombosis history, diagnostic tests performed and treatment administered. Testing for JAK2 V617F became locally available in 2006, so for assessment of diagnostic tests performed, patients were divided into cohorts of diagnosis pre-2006 and 2006–2008. Patients were characterized as high risk if > 60 y or history of thrombosis at the time of diagnosis. All other patients were considered low risk. Results: Diagnostic information was available for 116 patients diagnosed prior to the availability of testing for JAK2 V617F. 65% (75/116) of patients in this cohort had a bone marrow biopsy performed (table 1). 44 patients received a new diagnosis of ET from 2006–2008. Only 48% (21/44) patients in this cohort had a bone marrow biopsy performed, significantly less than in the historical cohort (p = 0.019). 41/44 had JAK2 V617F testing performed: 41% (17/41) were JAK2 V617F negative, 56% (23/41) positive and 1 equivocal. Bone marrow biopsy was performed in 59% (10/17) of JAK2 V617F negative patients and 39% (9/23) of JAK2 V617F positive patients (p = 0.055) (table 1). Bone marrow biopsy was also performed in 1 patient with equivocal JAK2 V617F testing and 1 patient not tested for JAK2 V617F. 170 patients diagnosed with ET were seen in follow up 2006–2008. 64% (109/170) were high risk due to age > 60 y or history of thrombosis. The remaining 36% (61/170) were considered low risk. Hydroxyurea was used preferentially over anagrelide for treatment of ET (table 2). Only 76% of high risk patients were receiving cytoreductive treatment. 23% of low risk patients received cytoreductive treatment. ASA was prescribed to 89% of high risk and 79% of low risk patients. Conclusion: Despite the requirement for a bone marrow biopsy to meet the WHO criteria for ET, hematologists performed a bone marrow biopsy in less than half of patients they diagnosed with ET since 2006. Hematologists performed bone marrow biopsy less frequently after JAK2 V617F testing became available, particularly in JAK2 V617F positive patients. A substantial portion of high risk patients (24%) were receiving no cytoreductive therapy, contrary to expert recommendation. Further study is required to understand the barriers to implementing treatment recommendations in clinical practice. This study highlights the challenges in translating published diagnostic criteria and treatment guidelines into changes in patient care. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Microcytosis is associated with low cognitive outcomes in healthy 2-year-olds in a high-resource setting

2017 ◽  
Vol 118 (5) ◽  
pp. 360-367 ◽  
Author(s):  
Elaine K. McCarthy ◽  
Mairead E. Kiely ◽  
Geraldine Hannon ◽  
Caroline Ahearne ◽  
Louise C. Kenny ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Effect Size ◽  
Cognitive Outcomes ◽  
Low Risk ◽  
Fe Deficiency ◽  
Longitudinal Impact ◽  
Healthy Children ◽  
Ferritin Concentration ◽  
High Resource ◽  
Composite Scores

AbstractFe deficiency in early childhood is associated with long-term consequences for cognitive, motor and behavioural development; however explorations in healthy children from low risk, high-resource settings have been limited. We aimed to explore associations between Fe status and neurodevelopmental outcomes in low risk, healthy 2-year-olds. This study was a secondary analysis of a nested case–control subgroup from the prospective, maternal-infant Cork Babies after Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact using Neurological and Nutritional Endpoints (BASELINE) Birth Cohort Study. At 2 years, serum ferritin, Hb and mean corpuscular volume (MCV) were measured and neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development (n 87). Five children had Fe deficiency (ferritin <12 µg/l) and no child had Fe deficiency anaemia (Hb<110 g/l+ferritin<12 µg/l). Children with microcytosis (MCV<74 fl, n 13) had significantly lower mean cognitive composite scores (88·5 (sd 13·3) v. 97·0 (sd 7·8), P=0·04, Cohen’s d effect size=0·8) than those without microcytosis. The ferritin concentration which best predicted microcytosis was calculated as 18·4 µg/l (AUC=0·87 (95% CI 0·75, 0·98), P<0·0001, sensitivity 92 %, specificity 75 %). Using 18·5 µg/l as a threshold, children with concentrations <18·5 µg/l had significantly lower mean cognitive composite scores (92·3 (sd 10·5) v. 97·8 (sd 8·1), P=0·012, Cohen’s d effect size=0·6) compared with those with ferritin ≥18·5 µg/l. All associations were robust after adjustment for potential confounding factors. Despite a low prevalence of Fe deficiency using current diagnostic criteria in this healthy cohort, microcytosis was associated with lower cognitive outcomes at 2 years. This exploratory study emphasises the need for re-evaluation of the diagnostic criteria for Fe deficiency in young children, with further research in adequately powered studies warranted.

scholarly journals Gestational Diabetes Mellitus: Assessing the Reliability of Risk Factor-Based Screening in a Rural Nigerian Hospital

2021 ◽  
Vol 8 ◽  
Author(s):  
Ayokunle Olumodeji ◽  
Idowu Adebara ◽  
Olumide Emmanuel Adewara ◽  
Adebayo Augustine Adeniyi ◽  
Sunday Babatunde Awoyinka ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
Challenge Test ◽  
Low Risk ◽  
High Risk Women ◽  
Significant Difference ◽  
Glucose Challenge

Implementation of the 2013WHO diagnostic criteria for Gestational Diabetes Mellitus (GDM), with lower threshold values required for the diagnosis of GDM, may be associated with further rise in the number of missed cases, especially among “low risk women”. This prospective study determined the proportions of women with GDM who were low risk. A hundred and seventeen pregnant women of gestational age 24-32weeks were screened with 50-g glucose challenge Test (GCT) and their GDM risk factor status noted. GCT positive women had 75-gOGTT, using 2013WHO GDM diagnostic criteria. The prevalence of GDM was 7.7% and about 55% of women with GDM had “low risk” status. There was no significant difference in the plasma glucose values of low risk and high risk women. With more than 50% of women with GDM being low risk, risk factor-based screening approach may be very unreliable in screening for GDM.

Clinical analysis of 33 patients with adult T-cell leukemia (ATL)-diagnostic criteria and significance of high- and low-risk ATL

1986 ◽  
Vol 37 (3) ◽  
pp. 335-341 ◽  
Author(s):  
Kazuo Tamura ◽  
Nobuhiko Nagamine ◽  
Yasuhiko Araki ◽  
Masashi Seita ◽  
Akihiko Okayama ◽  
...  
Keyword(s):  
T Cell ◽  
Diagnostic Criteria ◽  
Clinical Analysis ◽  
Low Risk ◽  
T Cell Leukemia ◽  
Cell Leukemia ◽  
Adult T Cell Leukemia

scholarly journals Sepsis score performance in women at high and low risk of intraamniotic infection: a retrospective case-control study

2020 ◽  
Author(s):  
Hen Y Sela ◽  
Vered Seri ◽  
Frederic S. Zimmerman ◽  
Philip D. Levin ◽  
Arnon Smueloff ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Low Risk ◽  
Limiting Current ◽  
Secondary Outcome ◽  
Study Group ◽  
Intraamniotic Infection ◽  
Sepsis Score ◽  
Control Study ◽  
Sirs Criteria

Abstract Background: Early infection identification may improve outcomes in obstetric patients. However, obstetric vital signs and laboratory values differ from the non-pregnant, possibly limiting current sepsis score use. Thus, we evaluated sepsis score use in peripartum infection. Methods: This case-control study evaluates sepsis criteria fulfilment in preterm premature rupture of membranes (PPROM) – at high infection risk– versus in elective caesarean delivery (CD) – at low risk. The study was perfoemd at the departement of obstetrics & gynecologt at Shaare Zedek Medical Center, a 1000-bed university-affiliated acute care hospital. We inlcuded women with PPROM undergoing CD (n=453) at gestational weeks 24-36 versus those undergoing elective term CD (n=2004). The primary and secondary outcome measures were SIRS and qSOFA criteria fullfilment and availability of the score components and clinical intraamniotic infection and positive cultures rates. Results: At admission 14.8% of the study group and 4.6% of control met SIRS criteria (p=0.001), as did 12.5% and 5.5% on post-operation day (POD) 1 (p=0.001), with no significant differences on POD 0 or 2. In the study group more cultures (29.8% versus 1.9% – cervix; 27.4% versus 1.1% – placenta; 7.5% versus 1.7% – blood; p=0.001 – all differences) and more positive cultures (5.5% versus 3.0% – urine – p=0.008; 4.2% versus 0.2% – cervix – p=0.001; 7.3% versus 0.0% – placenta – p=0.001; 0.9% versus 0.1% – blood – p=0.008) were obtained. 10.6% of the study group and 0.4% of control met criteria for intraamniotic infection (p=0.001). Conclusions: Though significant difference was noted in SIRS criteria fulfilment in the study group versus control, there was considerable between-group overlap, questioning utility of SIRS in intraamniotic infection diagnosis.

An adrenocortical oncocytoma with unusual mitochondrial inclusions and cytoplasmic crystals

1994 ◽  
Vol 52 ◽  
pp. 250-251
Author(s):  
W.T. Gunning ◽  
G.D. Haselhuhn ◽  
E.R. Phillips ◽  
S.H. Selman
Keyword(s):  
Adrenal Gland ◽  
Salivary Glands ◽  
Mitotic Activity ◽  
Diagnostic Criteria ◽  
Vascular Invasion ◽  
Benign Neoplasm ◽  
Benign Tumors ◽  
Nuclear Morphology ◽  
Case Presentation ◽  
Microscopic Evidence

Within the last few years, adrenal cortical tumors with features concordant with the diagnostic criteria attributed to oncocytomas have been reported. To date, only nine reported cases exist in the literature. This report is the tenth case presentation of a presumptively benign neoplasm of the adrenal gland with a rare differentiation. Oncocytomas are well recognized benign tumors of the thyroid, parathyroid, and salivary glands and of the kidney. Other organs also give rise to these types of tumors, however with less frequency than the former sites. The characteristics generally used to classify a tumor as an oncocytoma include the following criteria: the tumor is 1) usually a solitary circumscribed mass with no gross nor microscopic evidence of metastasis (no tissue nor vascular invasion), 2) fairly bland in terms of mitotic activity and nuclear morphology, and 3) composed of large eosinophillic cells in which the cytoplasm is packed full of mitochondria (Figure 1).

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

An Introductory Examination of Speech Disfluencies in Spanish–English Bilingual Children Who Do and Do Not Stutter During Narratives

2020 ◽  
Vol 5 (1) ◽  
pp. 131-141
Author(s):  
Cristina Rincon ◽  
Kia Noelle Johnson ◽  
Courtney Byrd
Keyword(s):  
Diagnostic Criteria ◽  
Preliminary Data ◽  
Diagnostic Information ◽  
English Speakers ◽  
Bilingual Children ◽  
English Bilingual ◽  
Developmental Stuttering ◽  
Mean Length Of Utterance

Purpose The purpose of this study is to examine the frequency and type of speech disfluencies (stuttering-like and nonstuttering-like) in bilingual Spanish–English (SE) children who stutter (CWS) to SE children who do not stutter (CWNS) during narrative samples elicited in Spanish and English to provide further diagnostic information for this population and preliminary data toward an expansion of this study. Method Participants included six bilingual SE children (three CWS, three CWNS) ranging in age from 5 years to 7;5 (years;months) and recruited from the surrounding Houston, Texas area. Participants provided a narrative sample in English and Spanish. The frequency of speech disfluencies was tabulated, and mean length of utterance was measured for each sample. Results Results indicate that both talker groups exceed the diagnostic criteria typically used for developmental stuttering. Regardless of the language being spoken, CWS participants had a frequency of stuttering-like speech disfluencies that met or exceeded the diagnostic criteria for developmental stuttering that is based on monolingual English speakers. The CWNS participants varied in meeting the criteria depending on the language being spoken, with one of the three CWNS exceeding the criteria in both languages and one exceeding the criteria for percentage of stuttering-like speech disfluencies in one language. Conclusion Findings from this study contribute to the development of more appropriate diagnostic criteria for bilingual SE-speaking children to aid in the reduction of misdiagnoses of stuttering in this population.

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