In acute PE, triage for home treatment using the Hestia rule vs. sPESI was noninferior for 30-d clinical outcomes

2022 ◽  
Author(s):  
Bethany Samuelson Bannow
Keyword(s):  
Clinical Outcomes ◽  
Home Treatment ◽  
Acute Pe

scholarly journals Progrostic impact of a pre-existing heart failure with preserved ejection fraction in patients with acute pulmonary embolism or paroxysmal atrial fibrillation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Tufano
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Older Age ◽  
Lower Percentage ◽  
Preserved Ejection Fraction ◽  
Acute Pe

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf none Introduction heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Its prevalence among heart failure patients increases over time, accounting for at least 50 % of all hospital admissions for HF.  Nevertheless, no single guideline exists for diagnosis or treatment for HFpEF, and older age or comorbidities are additional factors that confuse etiology and complicate prognosis. Moreover, there are few data regarding the consequences of HFpEF on other recurrent pathologies. Aims to assess the prognostic impact of a pre-existing HFpEF on patients ospidalized for intercurrent episodes of atrial fibrillation (AF) or acute pulmonary embolism (PE) Methods We performed a retrospective evaluation of 194 patients, consecutively hospitalized in our unit of Cardiology with a diagnosis of paroxysmal AF or acute PE, from April 2017 to October 2020. We recruited exclusively patients with normal cardiac function and HFpEF patients.  Heart failure with reduced FEVS patients were excluded from the study. We have described for each patient the demographic and clinical characteristics, comorbidities, instrumental test results and clinical outcomes.  In order to assess, for each group, the relationship between patient characteristics and clinical outcomes, the Chi-square test or alternatively the Pearson-Spearman correlation coefficients were calculated. Results the 194 patients studied had an average age of 73,7 years (min. 27, max 94). 59 AF patients had  pre-existing HFpEF, whereas AF patients  without HF were 67.  Patients with pre-existing HFpEF and newly-onset AF had a more advanced age (76,7 y vs 72,9 y), and greater comorbidity (meanly 4 vs 3) rather than AF patients without HFpEF. Moreover, percentage of converting arrhythmia were significantly higher in AF patients without HFpEF.  . Patients with acute PE and pre-existing HFpEF were 38, whereas PE patients without HF were 30. Acute PE patients with pre-existing HFpEF had older age, a prevalence for femal sex, more comorbidities, an average longer hospitalizations,  but no significantly different rates of severe complications (ictus, hemorrhagies, needs for ventilation, pulmonary infarction or deaths) rather than PE patients without HFpEF. Conclusions the patients with AF or PE and concomitant HFpEF that were hospitalized from April 2017 to October 2020, showed an average longer hospitalization, a lower percentage of converting arrhythmia, probably due to the older age and the greater comorbidity.

scholarly journals Clozapine discontinuation in early schizophrenia: a retrospective case note review of patients under an early intervention service

2017 ◽  
Vol 8 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Andrew Shaker ◽  
Rowena Jones
Keyword(s):  
Early Intervention ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Case Note ◽  
Home Treatment ◽  
Early Intervention Service ◽  
Treatment Resistant ◽  
Intervention Service ◽  
The Impact ◽  
Case Note Review

Aim: Research in patients with treatment-resistant schizophrenia has demonstrated that clozapine discontinuation is associated with poor outcomes. There is, however, a paucity of research investigating the impact of clozapine discontinuation specifically in younger patients with more recent onset schizophrenia. A case note review was therefore conducted to ascertain medium-term prognoses in patients with treatment-resistant schizophrenia under an early intervention service (EIS) following clozapine discontinuation. Methods: The case notes of 25 patients under the care of Birmingham EIS who discontinued clozapine were examined retrospectively. Reasons for discontinuation were recorded. Clinical outcomes including total duration of inpatient or home treatment admission, antipsychotic dose, number of alternative antipsychotics prescribed and adverse events were recorded for both the year before and the year after stopping clozapine. Statistical comparisons of pre- and post-discontinuation clinical outcomes determined whether discontinuation had negative effects. Results: There was no significant difference between the pre- and post-discontinuation clinical status following clozapine discontinuation. More than half (56%) of patients remained stable after stopping clozapine. Mean inpatient or home treatment stay rose from 29.7 to 62.6 days ( p = 0.155), total antipsychotic dose from 50.1% of British National Formulary (BNF) limits to 60.5% ( p = 0.627), number of alternative antipsychotics prescribed from 1.28 to 1.80 ( p = 0.186), number of hospital/home treatment episodes from 0.20 to 0.44 ( p = 0.083) and number of adverse events from 0 to 0.20 ( p = 0.059). Non-compliance was the main reason for discontinuation (44%, n = 11). Conclusions: This is the first clozapine discontinuation study specifically considering EIS patients. Discontinuation did not lead to significant effects on 1 year outcomes, though the study is underpowered. These findings may be used to inform future prospective cohort discontinuation studies.

scholarly journals 8 Acute pulmonary embolism or paroxysmal atrial fibrillation in patients with heart failure and preserved ejection fraction: prognostic implications

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Nicola Tufano ◽  
Salvatore De Turris
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Older Age ◽  
Lower Percentage ◽  
Preserved Ejection Fraction ◽  
Acute Pe

Abstract Aims Heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Its prevalence among heart failure patients increases over time, accounting for at least 50% of all hospital admissions for HF. Nevertheless, no single guideline exists for diagnosis or treatment for HFpEF, and older age or comorbidities are additional factors that confuse etiology and complicate prognosis. Moreover, there are few data regarding the consequences of HFpEF on other recurrent pathologies. To assess the prognostic impact of a pre-existing HFpEF on patients ospidalized for intercurrent episodes of atrial fibrillation (AF) or acute pulmonary embolism (PE). Methods and results We performed a retrospective evaluation of 222 patients, consecutively hospitalized in our unit of Cardiology with a diagnosis of paroxysmal AF or acute PE, from January 2017 to December 2020. We recruited exclusively patients with normal cardiac function and HFpEF patients. Heart failure with reduced FEVS patients were excluded from the study. We have described for each patient the demographic and clinical characteristics, comorbidities, instrumental test results, and clinical outcomes. In order to assess, for each group, the relationship between patient characteristics and clinical outcomes, the Chi-square test or alternatively the Pearson–Spearman correlation coefficients were calculated. The 222 patients studied had an average age of 73.7 years (min. 27, max: 94). 68 AF patients had pre-existing HFpEF, whereas AF patients without HF were 77. Patients with pre-existing HFpEF and newly-onset AF had a more advanced age (76.7 y vs. 72.9 y), and greater comorbidity (meanly 4 vs. 3) rather than AF patients without HFpEF. Moreover, percentage of converting arrhythmia were significantly higher in AF patients without HFpEF. Patients with acute PE and pre-existing HFpEF were 44, whereas PE patients without HF were 33. Acute PE patients with pre-existing HFpEF had older age, a prevalence for female sex, more comorbidities, an average longer hospitalizations, but no significantly different rates of severe complications (ictus, haemorrhagies, needs for ventilation, pulmonary infarction or deaths) rather than PE patients without HFpEF. Conclusions The patients with AF or PE and concomitant HFpEF that were hospitalized from January 2017 to December 2020, showed an average longer hospitalization, a lower percentage of converting arrhythmia, probably due to the older age and the greater comorbidity.

Incidence and Clinical Outcomes of Occult Malignancies Detected by Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2983-2983
Author(s):  
Yi-Hao Shen ◽  
Phil Wells ◽  
Carole Dennie ◽  
Marc Carrier
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Conflicts Of Interest ◽  
Filling Defect ◽  
Pulmonary Angiography ◽  
Advanced Stage ◽  
Ottawa Hospital ◽  
Computed Tomographic ◽  
Occult Malignancy ◽  
Acute Pe

Abstract Abstract 2983 Poster Board II-959 Introduction: Venous thromboembolism (VTE) can be the earliest sign of malignancy. Approximately 10% of patients with unprovoked VTE will be diagnosed with cancer within the next 12 months. Diagnosis of pulmonary embolism (PE) using computed tomographic pulmonary angiograhy (CTPA) allows the visualization of anatomy in addition to thoracic vasculature. Hence, CTPA might be useful for detecting occult cancers in patients with PE. Objective: To evaluate the incidence and clinical outcomes of occult cancers detected by CTPA in patients with acute PE. Methods: This is a retrospective cohort study of consecutive patients with suspected PE undergoing CTPA at the Ottawa Hospital from Jan 1, 2007 to Dec 31, 2008. PE was defined as a subsegmental or larger pulmonary artery filling defect on CTPA. Occult malignancy was defined as any new cancer first detected by CTPA with index PE diagnosis in patients with no known history of malignancy. All patients were followed for a minimum of 6 months after the index PE. Results: A total of 4410 CTPA were reviewed and 748 (17%) were positive for acute PE. Of these, 57 (7.6%; 95% CI: 5.7 to 9.5) revealed abnormalities suggestive of possible occult cancers. Twenty-two (2.9%; 95% CI: 1.7 to 4.2) patients were diagnosed with occult cancers. Among these 22 patients with occult cancers, 20 (91%) had unprovoked PE. Thirteen (59%) patients had occult lung cancer and 16 (73%) had advanced stage (stage 3 or 4) cancers. Sixteen (73%) patients have died following the diagnosis of occult cancer, and their median survival following the diagnosis of PE was 51 days. Conclusion: CTPA detected occult cancers in approximately 3% of patients with acute PE. Most of these cancers were detected at an advanced stage and were associated with high mortality and short survival. Disclosures: No relevant conflicts of interest to declare.

Home treatment of fragile patients with acute pulmonary embolism: a subgroup analysis of the multinational home treatment of pulmonary embolism (HoT-PE) trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Hobohm ◽  
T Anusic ◽  
S.V Konstantinides ◽  
S Barco
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
Early Discharge ◽  
Home Treatment ◽  
Funding Source ◽  
Primary Efficacy ◽  
Primary Efficacy Outcome ◽  
Efficacy Outcome ◽  
Acute Pe

Abstract Background and aims Subgroup analyses of randomized trials and cohort studies on direct oral anticoagulants (DOACs) suggested that single direct drug treatment may be effective and safe in elderly and “fragile” patients with acute pulmonary embolism (PE). In a post-hoc analysis of HoT-PE, a prospective multicenter management trial, we studied whether early discharge and home treatment of acute PE is effective and safe in these patients. Methods HoT-PE enrolled patients with acute PE classified as being at low risk based on the modified Hestia criteria and the absence of right ventricular dysfunction. The primary efficacy outcome was symptomatic recurrent VTE, or PE-related death within 3 months of enrolment. The safety outcome included major bleeding. Fragility was defined as age >75 years, a creatinine clearance level <50 ml/min, or a body mass index <18.5 kg/cm2. Results A total of 524 patients were included; of these, 112 (21.4%) were fragile. Mean age was 77 (range 74–80) years. A total of 104 (92.9%) fragile and 372 (90.3%) non-fragile patients spent two nights or less in hospital corresponding to a median hospital stay of 42 (Q1-Q3: 25–47) and 32 (Q1-Q3: 23–46) hours, respectively. The primary efficacy outcome occurred in one (0.9%) fragile and one (0.5%) non-fragile patient (absolute risk difference [ARD] +0.4%; 95% CI: −1.1%; +4.4%). Major bleeding occurred in three (2.7%) fragile and three (0.7%) non-fragile patients; ARD +2.0% (+0.3%; +6.9%). All-cause 3-month mortality was low in both groups (0.9% vs. 0.2%; ARD +0.7%, −0.7%; +4.7%). Conclusion Early discharge and home treatment of fragile patients with acute PE appears to be feasible and acceptably safe. The HoT-PE trial supports the notion that these patients should not be a priori excluded from early discharge, but caution is warranted due to a possibly higher risk of major bleeding on DOAC treatment. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

scholarly journals Outcomes of acute pulmonary embolism in hospitalized patients with cancer

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Khalid Shalaby ◽  
Adriana Kahn ◽  
Elizabeth S. Silver ◽  
Min Jung Kim ◽  
Kathir Balakumaran ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Health Services ◽  
Clinical Outcomes ◽  
Cancer Diagnosis ◽  
Home Health ◽  
Total Charge ◽  
Patients With Cancer ◽  
Home Health Services ◽  
Acute Pe

Abstract Background Cancer-associated pulmonary embolism (PE) places a significant burden on patients and health care systems. Methods A retrospective cross-sectional analysis of the National Inpatient Sample (NIS) database was performed in patients with acute PE from 2002 to 2014. Among patients hospitalized with PE, we investigated the differences in clinical outcomes and healthcare utilization in patients with and without cancer. A multivariate logistic regression model was applied to calculate adjusted odds ratios (OR) to estimate the impact of cancer on clinical outcomes. Wilcoxon rank sum tests were used to determine the differences in healthcare utilization between the two cohorts. Results Among 3,313,044 patients who were discharged with a diagnosis of acute PE, 84.2% did not have cancer, while 15.8% had cancer as a comorbidity (56% metastatic cancer, 35% solid tumor without metastasis, and 9% lymphoma). Patients with cancer had a higher mean age but lower rates of common comorbidities except for coagulation deficiency than patients without a cancer diagnosis. In patients with cancer, the rate of IVC filter placement was higher (21.7% vs. 13.11%, OR 1.76 (95% CI 1.73–1.79); p < 0.0001) and thrombolytic use lower (1.34% vs. 2.15%, OR 0.68 (95% CI 0.64–0.72); p < 0.0001). Patients with cancer hospitalized for PE had a higher all-cause in-hospital mortality (11.8% vs. 6.6%, OR 1.79 (95% CI 1.75–1.83); p < 0.0001), longer length of stay (6 vs. 5 days; p < 0.0001), higher total charge per hospitalization ($30,885 vs. $27,273; p < 0.0001), and higher rates of home health services upon discharge (35.8% vs. 23.2%; p < 0.0001) compared with those without cancer. Conclusion Concurrent cancer diagnosis in patients hospitalized for acute PE was associated with a 90% increase in all-cause mortality, longer length of stay, higher total charge per hospitalization, and higher rates of home health services upon discharge. The majority (56%) of patients with cancer had metastatic disease. Furthermore, there were identifiable differences in the intervention for acute PE between the two groups.

Selecting Skills To Teach Communication Partners: Where Do I Start?

2012 ◽  
Vol 21 (4) ◽  
pp. 127-135 ◽  
Author(s):  
Cathy Binger ◽  
Jennifer Kent-Walsh
Keyword(s):  
Clinical Outcomes ◽  
Intervention Program ◽  
Communication Partners ◽  
Multiple Challenges

Abstract Clinicians and researchers long have recognized that teaching communication partners how to provide AAC supports is essential to AAC success. One way to improve clinical outcomes is to select appropriate skills to teach communication partners. Although this sometimes seems like it should be a straightforward component of any intervention program, deciding which skills to teach partners can present multiple challenges. In this article, we will troubleshoot common issues and discuss how to select skills systematically, resulting in the desired effects for both communication partners and clients.

Linguistic Interactions: A Therapeutic Consideration for Adults With Aphasia

2008 ◽  
Vol 17 (3) ◽  
pp. 93-98
Author(s):  
Lynn E. Fox
Keyword(s):  
Clinical Outcomes ◽  
Social Contexts ◽  
Interaction Models ◽  
Social Communities ◽  
Wernicke's Aphasia ◽  
Communication Challenges ◽  
Therapeutic Consideration ◽  
Patterns Of Interaction ◽  
Structural Language

Abstract Linguistic interaction models suggest that interrelationships arise between structural language components and between structural and pragmatic components when language is used in social contexts. The linguist, David Crystal (1986, 1987), has proposed that these relationships are central, not peripheral, to achieving desired clinical outcomes. For individuals with severe communication challenges, erratic or unpredictable relationships between structural and pragmatic components can result in atypical patterns of interaction between them and members of their social communities, which may create a perception of disablement. This paper presents a case study of a woman with fluent, Wernicke's aphasia that illustrates how attention to patterns of linguistic interaction may enhance AAC intervention for adults with aphasia.

The Complexity of Health Disparities: More Than Just Black–White Differences

2021 ◽  
pp. 1-10
Author(s):  
Charles Ellis ◽  
Molly Jacobs
Keyword(s):  
Health Disparities ◽  
Clinical Outcomes ◽  
The United States ◽  
Careful Examination ◽  
White Americans ◽  
Speech Language Pathology ◽  
Death Rates ◽  
The Social ◽  
Health Related ◽  
Language Pathology

Health disparities have once again moved to the forefront of America's consciousness with the recent significant observation of dramatically higher death rates among African Americans with COVID-19 when compared to White Americans. Health disparities have a long history in the United States, yet little consideration has been given to their impact on the clinical outcomes in the rehabilitative health professions such as speech-language pathology/audiology (SLP/A). Consequently, it is unclear how the absence of a careful examination of health disparities in fields like SLP/A impacts the clinical outcomes desired or achieved. The purpose of this tutorial is to examine the issue of health disparities in relationship to SLP/A. This tutorial includes operational definitions related to health disparities and a review of the social determinants of health that are the underlying cause of such disparities. The tutorial concludes with a discussion of potential directions for the study of health disparities in SLP/A to identify strategies to close the disparity gap in health-related outcomes that currently exists.

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