Allergic Reactions in Hospitalized Patients With a Self-Reported Penicillin Allergy Who Receive a Cephalosporin or Meropenem

2016 ◽  
Vol 30 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Danielle Joset Crotty ◽  
Xian Jie Cindy Chen ◽  
Marco R. Scipione ◽  
Yanina Dubrovskaya ◽  
Eddie Louie ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Allergic Reaction ◽  
Electronic Medical Records ◽  
Broad Spectrum ◽  
Medical Records ◽  
Odds Ratio ◽  
Hospitalized Patients ◽  
Penicillin Allergy ◽  
Allergic Reactions ◽  
Individual Study

Background: Cefepime and meropenem are used frequently in hospitalized patients for broad-spectrum empiric coverage, however, practitioners are often reluctant to prescribe these antibiotics for patients with a self-reported nonsevere, nontype I allergic reaction to penicillin. Methods: Retrospective review of electronic medical records of adults with a self-reported allergy to penicillin who received at least 1 dose of cefepime, ceftriaxone, cefoxitin, cephalexin, or meropenem to assess incidence and type of allergic reactions. Results: Of 175 patients included, 10 (6%) patients experienced an allergic reaction. The incidence for individual study drugs were cefepime 6% (6 of 96), meropenem 5% (3 of 56), cefoxitin 8% (1 of 13), ceftriaxone 0% (0 of 69), and cephalexin 0% (0 of 8). The majority of patients experienced a rash with or without pruritus and fever. Patients with a concomitant “sulfa” allergy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21, P = .02) or ≥3 other drug allergies (OR 6.4, 95% CI 1.3-32, P = .025) were more likely to have an allergic reaction. Conclusions: In one of the largest retrospective reviews of hospitalized patients who received full dose therapy with cefepime, ceftriaxone, and meropenem, the incidence of allergic reactions was low and reactions were mild. Cefepime, ceftriaxone, and meropenem can be considered for use in patients with a self-reported nontype I penicillin allergy.

scholarly journals Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients

QJM ◽  
2020 ◽  
Author(s):  
E Itelman ◽  
A Segev ◽  
L Ahmead ◽  
E Leibowitz ◽  
M Agbaria ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Cohort Analysis ◽  
Surrogate Marker ◽  
Tertiary Hospital ◽  
Big Data Analysis ◽  
Hospitalized Patients ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Overall Mortality

Summary Background Sarcopenia and frailty influence clinical patients’ outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. Aim We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. Design This was a retrospective cohort analysis. Methods We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients’ data were retrieved from their electronic medical records. Results The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT < 10 IU/l in the whole cohort (14.3% vs. 10.4%, P < 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P < 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P < 0.001 and 4.3% vs. 3.2%, P < 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels < 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13–1.29, P < 0.001). Conclusions Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.

scholarly journals Impact of a Formal Lactation Curriculum for Residents on Breastfeeding Rates Among Low-Income Women

2020 ◽  
Vol 29 (2) ◽  
pp. 83-89
Author(s):  
Emma Qureshey ◽  
Adetola F. Louis-Jacques ◽  
Yasir Abunamous ◽  
Sandra Curet ◽  
Joanne Quinones
Keyword(s):  
Retrospective Study ◽  
Confidence Interval ◽  
Low Income ◽  
Medical Records ◽  
Odds Ratio ◽  
Curriculum Implementation ◽  
Demographic Information ◽  
Before And After ◽  
Breastfeeding Rates ◽  
The Impact

Obstetrics-gynecology residents have inadequate training in lactation management and are typically unable to address basic breastfeeding needs. A retrospective study was performed to evaluate the impact of a formal lactation curriculum for obstetrics-gynecology residents on breastfeeding. Demographic information, medical history, and breastfeeding rates were derived from medical records and hospital lactation logs. Breastfeeding outcomes of women with term, singleton infants were analyzed before and after curriculum implementation. The study included 717 women, 337 prior to intervention and 380 after intervention. Women who delivered after curriculum implementation were more likely to breastfeed exclusively at 6 weeks postpartum (odds ratio [OR]: 2.01; 95% confidence interval [CI]: 1.28–3.15). A targeted breastfeeding curriculum was associated with increased exclusive breastfeeding rates at 6 weeks postpartum in a diverse, low-income population.

scholarly journals Risk Factors for Exposure of Baerveldt Glaucoma Drainage Implants: A Case-Control Study

2020 ◽  
Author(s):  
Ayaka Edo ◽  
Koji Jian ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
University Hospital ◽  
Implant Surgery ◽  
Implant Exposure ◽  
Patients With Diabetes

Abstract Background: Glaucoma drainage implant exposure is one of the serious complications after glaucoma drainage implant surgery. The purpose of this study is to evaluate the risk factors for exposure of the device after implantation of a Baerveldt glaucoma drainage implant.Methods: This is a retrospective review of the medical records of all patients who underwent Baerveldt glaucoma drainage implant surgery at the Hiroshima University Hospital between April 1, 2012 and October 31, 2016, and who were followed for at least 6 months after surgery. We examined the risk factors for implant exposure based on data obtained from the medical records, with particular focus on the differences in implant models.Results: A total of 80 eyes from 80 patients were identified; all patients were Japanese. In this study, the rate of Baerveldt glaucoma drainage implant exposure was 15.0% (12 of 80). The exposure rate of the BG 102-350 was tended to be higher than that for the BG 101-350 and BG 103-250 (p=0.092; adjusted odds ratio=3.34; 95% confidence interval, 0.82–13.58). In the patients who had diabetic mellitus, the BG 102-350 showed a significant risk of implant exposure (p=0.038; adjusted odds ratio =15.36; 95% confidence interval, 1.17–202.59).Conclusions: In Baerveldt glaucoma drainage implant surgery in patients with diabetes, using the BG 102-350 was associated with greater risk of implant exposure compared with using BG 101-350 or BG 103-250.

scholarly journals Relationship between anosmia and hospitalisation in patients with coronavirus disease 2019: an otolaryngological perspective

2020 ◽  
Vol 134 (8) ◽  
pp. 710-716 ◽  
Author(s):  
H Avcı ◽  
B Karabulut ◽  
A Farasoglu ◽  
E Boldaz ◽  
M Evman
Keyword(s):  
Confidence Interval ◽  
Patient Group ◽  
Medical Records ◽  
Odds Ratio ◽  
Clinical Presentation ◽  
Patient Treatment ◽  
Younger Age ◽  
Basic Characteristics ◽  
The Relationship

AbstractObjectiveA study was carried out to evaluate the relationship between anosmia and hospital admission in coronavirus disease 2019 patients.MethodsThe clinical data of 1534 patients with confirmed coronavirus disease 2019 virus were analysed. The study was conducted with medical records of 1197 patients (78 per cent). The basic characteristics of patients and symptoms related to otolaryngology practice were examined. The patients were divided into two groups according to their follow up: an out-patient group and an in-patient group.ResultsThe majority of patients presented with anosmia (44.2 per cent), dysgeusia (43.9 per cent) and fever (38.7 per cent). Anosmia was observed in 462 patients (47 per cent) in the out-patient group, and in only 67 patients (31.2 per cent) in the in-patient group. Younger age (odds ratio = 1.05, 95 per cent confidence interval = 1.03–1.06) and the presence of anosmia (odds ratio = 2.04, 95 per cent confidence interval = 1.39–3) were significantly related to out-patient treatment.ConclusionAnosmia could be a symptom in the clinical presentation of the coronavirus disease 2019 infection.

scholarly journals Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients

2005 ◽  
Vol 153 (6) ◽  
pp. 837-844 ◽  
Author(s):  
Iacopo Chiodini ◽  
Massimo Torlontano ◽  
Alfredo Scillitani ◽  
Maura Arosio ◽  
Simonetta Bacci ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Plasma Cortisol ◽  
Adjusted Odds Ratio ◽  
Hospitalized Patients ◽  
Diabetic Patients ◽  
Subclinical Hypercortisolism ◽  
Free Cortisol

Objective: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age- and body mass index-matched non-diabetic inpatients (none of whom dropped out). Design and methods: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression >1.8 μg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol >60.0 μg/24 h (165.6 nmol/24 h), (b) plasma ACTH <10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol >7.5 μg/dl (207 nmol/l) at 24:00 h or >1.4 μg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). Results: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6–14.1; P = 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4–10.2; P = 0.017). Conclusions: In hospitalized patients, SH is associated with T2D.

scholarly journals Higher Incidence of Hypospadias in Monochorionic Twins

2015 ◽  
Vol 18 (5) ◽  
pp. 591-594 ◽  
Author(s):  
Remco Visser ◽  
Nienke C. M. Burger ◽  
Erik W. van Zwet ◽  
Yvonne Hilhorst-Hofstee ◽  
Monique C. Haak ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Confidence Interval ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Medical Records ◽  
Odds Ratio ◽  
Age Group ◽  
Monochorionic Twins ◽  
Appropriate For Gestational Age

Background:Hypospadias is associated with twinning. The incidence of hypospadias in monochorionic and dichorionic male twins is, however, yet to be determined.Methods:All medical records of monochorionic and dichorionic twins admitted to our neonatal nursery between January 2004 and August 2013 were reviewed for the presence of hypospadias.Results:A total of 350 monochorionic and 303 dichorionic male twins were included in the study. The incidence of hypospadias in monochorionic and dichorionic groups was 4% (14/350) and 1% (3/303) (p= .016) respectively. In 11 of the 15 twin couples, hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in twin infants small-for-gestational-age group was 10% (6/60) compared with 2% (11/593) in the appropriate-for-gestational-age group (p= .002). In a multivariate analysis, both monochorionicity and small-for-gestational-age were independently associated with hypospadias, odds ratio 4.1 (95% confidence interval (CI): 1.1–14.7) and 6.1 (95% CI: 2.2–17.2) respectively.Conclusions: The incidence of hypospadias is four-fold higher in monochorionic twins compared with dichorionic twins. Hypospadias is also independently associated with small-for-gestational-age.

Gimme 3 Steps (With a Nod to an American Rock Song from the 1970s)

2016 ◽  
Vol 19 (2) ◽  
pp. 080
Author(s):  
Curt G Tribble
Keyword(s):  
Electronic Medical Records ◽  
National Survey ◽  
Medical Records ◽  
Hospitalized Patients ◽  
Physician Burnout ◽  
Recent Comment ◽  
Percent Increase ◽  
Hearts And Minds ◽  
Recent National Survey ◽  
Practicing Physicians

The message that patients are frequently dissatisfied with their interactions with their physicians is a common one. And, articles about physician burnout are plentiful [Shanafelt 2015]. Indeed, a recent national survey showed a nearly 9 percent increase in burnout rates over just the last 3 years [Peckham 2015]. Many factors contribute to this problem, not the least of which is the push to use electronic medical records systems, as evidenced by the recent comment from the acting administrator of the Centers for Medicare and Medicaid, Mr. Andy Slavitt, who said “we have to get the hearts and minds of physicians back. I think we’ve lost them” [McKnight 2016]. <br />While many of the factors contributing to physician dissatisfaction are, and will be, difficult to control, there is at least one source of satisfaction that is within the relatively easy purview of virtually all practicing physicians, and that source is the patients for whom all physicians care.  Fortunately, there are some straightforward, simple, and efficient ways to improve the view patients have of their physicians and the satisfaction that physicians can derive from caring for their patients. Three simple steps that can make both physicians and their patients more satisfied with the interactions between patients and physicians are outlined here. These suggestions are primarily oriented toward physicians in training caring for hospitalized patients, though they are most certainly applicable to all physicians. These suggestions are based on what younger physicians can say to, ask of, or do for a patient under their care, all of which can be easily and efficiently accomplished.

scholarly journals Long-term risk of hepatocellular carcinoma mortality in 23220 hospitalized patients treated with micafungin or other parenteral antifungals

2019 ◽  
Vol 75 (1) ◽  
pp. 221-228 ◽  
Author(s):  
Sebastian Schneeweiss ◽  
Peggy L Carver ◽  
Kausik Datta ◽  
Alicia Galar ◽  
Melissa D Johnson ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Liver Tumours ◽  
Event Rates ◽  
Multicentre Cohort

Abstract Background Liver tumours observed in rats exposed to micafungin led to a black box warning upon approval in Europe in 2008. Micafungin’s risk for liver carcinogenicity in humans has not been investigated. We sought to describe the risk of fatal hepatocellular carcinoma (HCC) among persons who received micafungin and other parenteral antifungals (PAFs) with up to 12 years of follow-up. Methods We assembled a US multicentre cohort of hospitalized patients who received micafungin or other PAFs between 2005 and 2012. We used propensity score (PS) matching on patient characteristics from electronic medical records to compare rates of HCC mortality identified through the National Death Index though to the end of December 2016. We computed HRs and 95% CIs. Results A total of 40110 patients who received a PAF were identified; 6903 micafungin recipients (87% of those identified) were successfully matched to 16317 comparator PAF users. Ten incident HCC deaths, one in the micafungin-exposed group and nine among comparator PAF users, occurred in 71285 person-years of follow-up. The HCC mortality rate was 0.05 per 1000 person-years in micafungin patients and 0.17 per 1000 person-years in comparator PAF patients. The PS-matched HR for micafungin versus comparator PAF was 0.29 (95% CI 0.04–2.24). Conclusions Both micafungin and comparator PAFs were associated with HCC mortality rates of &lt;0.2 per 1000 person-years. Given the very low event rates, any potential risk for HCC should not play a role in clinical decisions regarding treatment with micafungin or other PAFs investigated in this study.

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