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1.
Prenat Diagn ; 39(5): 361-368, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30740743

RESUMO

OBJECTIVES: To determine the association between medications intake in early pregnancy and variation in the fetal fraction (FF) in pregnant women undergoing cell-free DNA (cfDNA) testing. METHODS: We performed a retrospective cohort study of women (n = 1051) undergoing cfDNA testing at an academic center. The exposed group included women taking medications (n = 400; 38.1%), while the nonexposed group consisted of women taking no medications (n = 651; 61.9%). Our primary outcome was FF. We performed univariate and multivariate analyses as appropriate. RESULTS: The FFs were 8.8% (6.6-12.1), 8.7% (6.3-11.6), and 7.7% (5.1-9.3) among women taking 0, 1, and two or more medications, respectively (P < 0.01). Using multivariable linear mixed effects model, the mean FF was significantly lower among those taking two or more medications compared with the nonexposed group. FF was directly correlated with gestational age at the time of cfDNA testing and inversely correlated with maternal obesity. Exposure to metformin was associated with 1.8% (0.2-3.4) lower mean FF when compared with the nonexposed group (P = 0.02). Obesity and intake of two or more medications were associated with higher hazard ratio of having a low FF less than 4%. CONCLUSIONS: Exposure to metformin or two or more medications was associated with decreased FF, and obesity is associated with delay in achieving adequate FF percentage. These findings should be considered while counseling patients on test limitations.

2.
Am J Perinatol ; 36(4): 406-421, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30130821

RESUMO

OBJECTIVE: To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening. METHODS: Databases from MEDLINE (U.S. National Library of Medicine, 1980-May 12, 2017), MEDLINE (Ovid, 1980-June 30, 2017), the Cochrane Library Controlled Trials Register, ClinicalTrials.gov, and Web of Science were queried for studies on FB cervical ripening with or without oxytocin in pregnant women. Search terms included: "balloon dilatation" OR "mechanical methods" OR "mechanical method" OR "mechanical dilation" OR "mechanical dilatation" OR "mechanical dilations" OR "mechanical dilatations" OR "balloon" OR "Foley" AND "Pitocin" OR "oxytocin." All relevant references were reviewed. Literature for inclusion and methodological quality were reviewed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. RESULTS: Out of 344 citations, six randomized clinical trials (1,133 patients) fulfilled our inclusion criteria. The pooled estimate showed that the cesarean delivery (CD) rate did not differ (relative risk [RR]: 0.91 (95% confidence interval [CI] [0.76-1.10]; p = 0.23) between patients who underwent preinduction cervical ripening with FB alone versus those who received oxytocin in addition to FB. Heterogeneity was not significant among studies (I 2 0.0%; p = 0.64). Furthermore, no differences in other outcomes such as composite and maternal outcomes were detected between these two groups. Compared with simultaneous use of oxytocin with FB, the Foley alone cervical ripening group had a longer induction to delivery time, and lower deliveries within 12 and 24 hours. Subgroup analysis showed that only multiparous women in the Foley alone group had lower rate of vaginal delivery within 24 hours (RR: 0.74, 95% CI [0.61-0.89], p = 0.002) along with a trend toward higher CD rates. CONCLUSION: Adding oxytocin to FB at the time of preinduction cervical ripening does not reduce cesarean rates nor improve maternal or neonatal outcomes. Multiparous women who received FB alone seem to have lower rates of vaginal deliveries within 24 hours, but these results should be interpreted with caution.

3.
West J Emerg Med ; 19(5): 834-841, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30202496

RESUMO

The prevalence of patients living with a left ventricular assist device (LVAD) is rapidly increasing due to improvements in pump technology, limiting the adverse event profile, and to expanding device indications. To date, over 22,000 patients have been implanted with LVADs either as destination therapy or as a bridge to transplant. It is critical for emergency physicians to be knowledgeable of current ventricular assist devices (VAD), and to be able to troubleshoot associated complications and optimally treat patients with emergent pathology. Special consideration must be taken when managing patients with VADs including device inspection, alarm interpretation, and blood pressure measurement. The emergency physician should be prepared to evaluate these patients for cerebral vascular accidents, gastrointestinal bleeds, pump failure or thrombosis, right ventricular failure, and VAD driveline infections. Early communication with the VAD team and appropriate consultants is essential for emergent care for patients with VADs.


Assuntos
Serviço Hospitalar de Emergência , Insuficiência Cardíaca/terapia , Coração Auxiliar , Disfunção Ventricular Esquerda/terapia , Insuficiência Cardíaca/complicações , Humanos
4.
Prenat Diagn ; 37(11): 1112-1119, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28873215

RESUMO

OBJECTIVE: To address the growing demand for prenatal genetic services, group genetic counseling was explored as an alternative service delivery model for women with a positive prenatal screening result. METHOD: Women were recruited from a prenatal genetic service and systematically allocated to a traditional individual appointment with a genetic counselor or a group genetic counseling session. Questionnaires were administered to assess patient psychological outcomes, knowledge, and satisfaction following individual and group genetic counseling for a positive prenatal screen. Genetic counselor time per type of patient was measured. RESULTS: Of 172 participants, 107 (62.2%) received group genetic counseling and 65 (37.8%) received individual genetic counseling. Both group and individual genetic counseling encounters significantly decreased patient anxiety, increased perceived personal control, decreased decisional conflict, and increased knowledge. Satisfaction was high following both methods. Anxiety was significantly decreased in women who received individual genetic counseling compared with group sessions (P < .001). Genetic counselors spent less time per group patient seen compared with individual patients. CONCLUSION: Group genetic counseling followed by the option of brief individual genetic counseling appears acceptable to women in a high-risk prenatal screening population. The findings support an alternative service delivery model for prenatal genetic services that could optimize the utilization of genetic counseling resources.


Assuntos
Aconselhamento Genético , Processos Grupais , Adulto , Assistência à Saúde/métodos , Feminino , Humanos , Gravidez
5.
J Genet Couns ; 25(6): 1338-1341, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27026235

RESUMO

Social Media is a powerful and emerging method of communication that is becoming increasingly popular in genetic counseling and other health care communities. Despite its multiple benefits, the Social Media revolution has been met with some resistance in the healthcare setting. Herein, we will describe the potential benefits of Social Media for the genetic counseling profession specifically and explore ways in which any risks can be mitigated and barriers overcome to ensure responsible Social Media use by the profession.


Assuntos
Comunicação , Aconselhamento Genético/métodos , Mídias Sociais , Humanos , Risco
6.
J Clin Microbiol ; 53(10): 3370-3, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26269624

RESUMO

This study compared the performance of the Carba NP assay, published by the Clinical and Laboratory Standards Institute, and the Rosco Rapid Carb Screen kit. Carba NP had superior sensitivity, but both assays required an increased inoculum to detect carbapenemase production in isolates with blaNDM, blaIMP, and blaOXA-48.


Assuntos
Proteínas de Bactérias/análise , Enterobacteriaceae/enzimologia , Técnicas Microbiológicas/métodos , Pseudomonas aeruginosa/enzimologia , beta-Lactamases/análise , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , América do Norte , Sensibilidade e Especificidade
7.
J Manag Care Spec Pharm ; 21(2): 124-31, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25615001

RESUMO

BACKGROUND: Primary medication nonadherence (PMN), defined as patients not picking up an initial prescription, can limit the effectiveness of therapy for chronic conditions. Effective interventions to reduce PMN have not been widely studied or implemented. OBJECTIVE: To evaluate the ability of an additional nurse-directed telephone intervention to reduce PMN in a cohort of patients with persistent nonadherence after repeated pharmacy-based outreach. METHODS: Patients in the Geisinger Health System receiving new (i.e., initially prescribed) prescriptions sent to CVS pharmacies for medications treating asthma, hypertension, diabetes, or hyperlipidemia were identified. As part of existing programs, all patients received 2 automated and 1 live call from CVS pharmacies encouraging them to pick up their prescriptions; those who had canceled their prescriptions or had not picked them up after the 3 pharmacy interventions were eligible for this study. Patients were then randomized, and the intervention group received telephone outreach from a nursing call center to assess reasons for PMN and encourage pickup of prescriptions, with up to 3 attempts to reach each patient. Medication pickup rates were compared across the intervention and control groups. RESULTS: Initial PMN rates in the overall population were 6%, lower than previously observed in other studies. A total of 290 patients had not picked up their prescriptions after 3 calls from the pharmacy and were enrolled in the study: 142 in the intervention group and 148 controls. The intervention did not change the rate at which patients picked up their prescriptions: 25% of intervention patients did so compared with 24% of control patients. Multivariate models adjusting for patient characteristics and medication classes did not change the results. CONCLUSIONS: In a population of patients who had not picked up new prescriptions after 3 calls from the pharmacy, additional nurse-directed outreach did not improve primary medication adherence. Re-engagement with the prescribing clinician may be needed to improve adherence in this patient population. The low rate of PMN in the overall population differed from prior studies in this setting and others and should be assessed in future research.


Assuntos
Adesão à Medicação , Telefone , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Infect Control Hosp Epidemiol ; 35(9): 1126-32, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25111920

RESUMO

BACKGROUND: Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections. Variability in reported infection rates among NICUs exists, possibly related to differences in prevention strategies. A better understanding of current prevention practices may help identify prevention gaps and areas for further research. METHODS: We surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network (NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and central line-associated bloodstream infections in NICUs. RESULTS: Staff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central line insertion and maintenance bundles, but maintenance practices varied, including agents used for antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs (51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no restrictions. CONCLUSIONS: Our survey illustrated heterogeneity of CLABSI and MRSA prevention practices and underscores the need for further research to define optimal strategies and evidence-based prevention recommendations for neonates.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Unidades de Terapia Intensiva Neonatal , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/prevenção & controle , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Controle de Infecções/estatística & dados numéricos , Estados Unidos
9.
Am J Infect Control ; 41(10): 936-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23870793

RESUMO

During the investigation of an outbreak of Escherichia coli O157:H7 in a child care center, illness logs were reviewed and parents interviewed to identify classroom and household exposures. Costs incurred by the center and the public health laboratory were estimated from self-administered questionnaires. We conclude that household transmission played a role in this outbreak and estimate the cost of investigation and intervention at over $6,000 per case.


Assuntos
Creches , Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/transmissão , Escherichia coli O157/isolamento & purificação , Características da Família , Adulto , Pré-Escolar , Infecções por Escherichia coli/microbiologia , Custos de Cuidados de Saúde , Humanos , Illinois/epidemiologia , Lactente , Controle de Infecções/economia , Controle de Infecções/métodos
10.
J Phys Chem A ; 116(36): 8925-33, 2012 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-22889439

RESUMO

In this paper, we report a study on the reactivity of the phenylium ion with acetylene, by measuring product yield as a function of pressure and temperature using mass-selected ion mobility mass spectrometry. The reactivity is dominated by a rapid sequential addition of acetylene to form covalently bonded C8H7(+) and C10H9(+) ions with an overall rate coefficient of 7-5 × 10(-10) cm(3) s(-1), indicating a reaction efficiency of nearly 50% at room temperature. The covalent bonding nature of the product ions is confirmed by high temperature studies where enhanced production of these ions is observed at temperatures as high as 660 K. DFT calculations at the UPBEPBE/6-31++G** level identify the C8H7(+) adduct as 2-phenyl-ethenylium ion, the most stable C8H7(+) isomer that maintains the phenylium ion structure. A small barrier of 1.6 kcal/mol is measured and attributed to the formation of the second adduct C10H9(+) containing a four-membered ring connected to the phenylium ion. Evidence for rearrangement of the C10H9(+) adduct to the protonated naphthalene structure at temperatures higher than 600 K is provided and suggests further reactions with acetylene with the elimination of an H atom and an H2 molecule to generate 1-naphthylacetylene or acenaphthylene cations. The high reactivity of the phenylium ion toward acetylene is in sharp contrast to the low reactivity of the benzene radical cation with a reaction efficiency of 10(-4)-10(-5), confirming that the first step in the cation ring growth mechanism is the loss of an aromatic H atom. The observed reactions can explain the formation of complex organics by gas phase ion-molecule reactions involving the phenylium ion and acetylene under a wide range of temperatures and pressures in astrochemical environments.

11.
Microb Drug Resist ; 16(2): 155-61, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20438349

RESUMO

Shigellosis is the third most common enteric bacterial infection in the United States. Although infection is typically self-limiting, empiric treatment is often prescribed. Because of increasing antimicrobial resistance to Shigella, empiric treatment options are decreasing. Identifying resistance patterns can inform empiric treatment recommendations. The goals of our study were to examine risk factors associated with antimicrobial resistance of Shigella and examine issues related to empiric treatment and antimicrobial resistance of Shigella. During June 2006-February 2009, we attempted to interview all New York City patients reported to have shigellosis. Their Shigella isolates were tested for antimicrobial susceptibility to examine the level of resistance and identify risk factors for resistance. Analysis was conducted on two groups distinguished by a large outbreak that was documented during the data collection period. Of the 477 nonoutbreak patients, 333 (70%) patients reported taking an antibiotic for shigellosis and 36 (11%) were treated with an antibiotic to which their Shigella infection was resistant. Among this group, high levels of antimicrobial resistance were detected to amoxicillin-clavulanate (66%), ampicillin (68%), and trimethoprim-sulfamethoxazole (66%). Non-travel-associated ciprofloxacin-resistant Shigella (five patients) and ciprofloxacin-resistant Shigella sonnei (four patients) were reported for the first time to our knowledge. Antimicrobial resistance is significantly higher in New York City residents compared with national data. Some patients were treated with therapies that were not effective and to which the patient's Shigella infection was resistant. Shigella infections should not be treated with antibiotics unless the patient presents with severe or underlying illness and is at risk for systemic illness. When treatment is indicated, local monitoring of Shigella for antimicrobial resistance will provide local clinicians with the best guidance for effective empiric treatments.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Disenteria Bacilar/epidemiologia , Shigella/classificação , Shigella/efeitos dos fármacos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Surtos de Doenças , Disenteria Bacilar/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Fatores de Risco , Sorotipagem , Shigella/isolamento & purificação , Shigella flexneri/classificação , Shigella flexneri/efeitos dos fármacos , Shigella flexneri/isolamento & purificação , Shigella sonnei/classificação , Shigella sonnei/efeitos dos fármacos , Shigella sonnei/isolamento & purificação , Adulto Jovem
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