Browsing by Subject "morbidity"

Now showing 1 - 7 of 7
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    Antibiotics in the pipeline: a literature review (2017–2020)
    (Springer, 2021-10-04) Al-Tawfiq, Jaffar A.; Momattin, Hisham; Al-Ali, Anfal Y.; Eljaaly, Khalid; Tirupathi, Raghavendra; Haradwala, Mohamed Bilal; Areti, Swetha; Alhumaid, Saad; Rabaan, Ali A.; Al Mutair, Abbas; Schlagenhauf, Patricia; Medicine, School of Medicine
    Introduction Antimicrobial resistance (AMR) is an emerging global threat. It increases mortality and morbidity and strains healthcare systems. Health care professionals can counter the rising AMR by promoting antibiotic stewardship and facilitating new drug development. Even with the economic and scientific challenges, it is reassuring that new agents continue to be developed. Methods This review addresses new antibiotics in the pipeline. We conducted a review of the literature including Medline, Clinicaltrials.org, and relevant pharmaceutical companies for approved and in pipeline antibiotics in phase 3 or new drug application (NDA). Results We found a number of new antibiotics and reviewed their current development status, mode of action, spectra of activity, and indications for which they have been approved. The included studies from phase 3 clinical trials were mainly utilized for the treatment of acute bacterial skin and skin structure infections, community-acquired bacterial pneumonia, and pneumonia acquired in the healthcare settings. The number of these agents is limited against high priority organisms. The identified antibiotics were based mainly on previously known molecules or pre-existing antimicrobial agents. Conclusion There are a limited number of antibiotics against high priority organisms such as multi-drug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae. New antimicrobial agents directed against the top priority organisms as classified by the World Health Organization are urgently needed.
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    Comprehensive Strategy for Evaluation of Clinical Health Coaches in Chronic Disease Management
    (Office of the Vice Chancellor for Research, 2016-04-08) Randolph, Courtney; Maxey, Hannah L.; Mullen, Cody
    Purpose: As chronic disease rises to the top of morbidity and mortality causes in the United States, improving chronic disease management, particularly at healthcare administration and patient engagement levels, becomes a rising public health concern. Clinical Health Coaches (CHCs) are an innovative role in primary care settings, collaborating with patients to improve patient outcomes. There is a need for best practices guidelines of the CHC role, as there is currently no standardized training program. Iowa Chronic Care Consortium (ICCC) developed a CHC training program which is being implemented in an Indiana Rural Health Association pilot program. This study seeks to develop an evaluation tool for ICCC training and its effectiveness in chronic disease management. Methods: An extensive literature review was performed on previous evaluations of similar health coach role implementation in chronic disease management. ICCC training was completed to further understand the training program. Results: A collaboration of the chronic care model and ICCC’s proposed CHC model was determined to be the most appropriate tool for evaluation. From these models, 5 key domains were identified including: patient engagement, self-management support, patient experience, patient satisfaction, and delivery system design. This comprehensive approach will allow for both qualitative and quantitative analysis. Discussion & Implications: These survey tools will be administered to both patients and CHCs as a part of an evaluation of ICCC training and its effectiveness. As a result of this study, the CHC program could be expanded to more primary care settings to improve health outcomes in chronic disease patients. Learning objectives: Design an evaluation tool for clinical health coach training in chronic disease management. Evaluate the effectiveness of clinical health coach implementation in chronic disease management in a primary care setting.
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    Late Preterm and Early Term Birth: At-risk Populations and Targets for Reducing Such Early Births
    (AAP, 2017-05) Kardatzke, Matthew A.; Rose, Rebecca S.; Engle, William A.; Pediatrics, School of Medicine
    The risks of late preterm (LPT) and early term (ET) birth have been recognized during the last decade. Increased awareness accompanied by efforts to reduce elective delivery before 39 weeks of gestation have led to a decline in LPT/ET births. Despite this success, strategies to identify and reduce preventable LPT/ET births using traditional and novel prevention methods are still needed. Because preterm birth is a common endpoint associated with many different preventable and nonpreventable causes, the efforts for reducing such early births must be multifaceted. For neonates born LPT/ET, there is an inverse relationship between gestational age and morbidity and mortality, with a nadir at 39 to 40 weeks of gestation. Recognition of the short-term complications of LPT/ET is important for timing of delivery and the initial clinical management of these patients. In addition, the recognition of the long-term respiratory and neurocognitive complications of LPT/ET birth helps inform the evaluation, treatment, and monitoring for impairments and disabilities that benefit from early detection and intervention. In this article, we review the definition of LPT/ET birth, prevention strategies, indications for LPT/ET birth, and the short- and long-term outcomes for such infants.
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    Late Preterm Infants: Morbidities, Mortality, and Management Recommendations
    (Elsevier, 2019-04) Huff, Katie; Rose, Rebecca S.; Engle, William A.; Pediatrics, School of Medicine
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    Machine learning to predict coronary artery disease using proteomics biomarkers
    (Office of the Vice Chancellor for Research, 2010-04-09) Mahoui, Malika
    Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the United States and is greatly exacerbated by metabolic syndrome (MetS). Current techniques to diagnose CAD are invasive, expensive, and their appropriateness varies among physicians. Therefore, they cannot be used as a routine screening test to predict CAD. To assess the severity of the CAD disease, the diagnostic tests determine with various degrees of accuracy the percentage level of phenotypes such as atheroma wall coverage, stenosis, and plaque composition in the coronary arteries. These phenotypes are measured using invasive methods such as IVUS; in comparison to other phenotypes such as the insulin level that do not require such invasive methods, but at the same time, these phenotypes are less accurate for diagnosis purposes. In addition to predicting the CAD disease, there is a need to improve early screening of the disease without having to use invasive methods such as IVUS. The objective of the study described in this poster is to develop an accurate and non-invasive informatics approach to facilitate screening and monitoring of patients with CAD using a combination of plasma proteomics data and the non-invasively generated phenotypes (e.g. insulin level). This study concentrates on using machine-learning approach to predict ranges of values (e.g. low, moderate, high percentage) for the invasively generated phenotypes, with a special focus on atheroma wall coverage. The ranges of values are mapped to different stages in the CAD disease.
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    THE OUTCOME OF ATG ON THE STEM CELL TRANSPLANTS FROM MATCHED UNRELATED DONOR, A SINGLE INSTITUTE EXPERIENCE
    (Office of the Vice Chancellor for Research, 2010-04-09) Alwan, Dareen; Homsi, Yaser; Kiel, Patrick; Rosenbeck, Lindsay; Farag, Sherif S.
    BACKGROUND: Antithymocyte globulin (ATG) was found to decrease the morbidity of stem cell transplant (SCT) from matched unrelated donor (MUD) by decreasing the incidence of chronic graft vs host disease cGvHD, and at high doses, acute GvHD. We reviewed our results of MUD transplants where ATG was incorporated into the preparative regimen, and compared the results to patients prior to September 2006 where ATG was not used. The primary endpoints were the effect on GvHD and lethal infectious complications. Method: All stem cell transplants from MUD performed after 2000 at IU hospital for treatment of hematological malignancies using a myelo-ablative regimen were retrospectively reviewed. Result: between 1/2000 and 3/2009 seventy nine stem cell transplants were conducted using stem cells from MUD. 28 patients received ATG at a total dose of 7.5mg/kg vs 51 patients who did not receive ATG. Both groups were matched in term of age, sex, underline malignancies, degree of HLA-match, CMV serology, and conditioning regimens. Ninety-six percent of patient in ATG group received prophylaxis for GvHD using FK506/Sirolimus vs 14% in the no ATG group where a methotrexate based treatment was used (P<0.0001). The rate of Grade II-VI acute GVHD at day 100 was significantly lower in the ATG group compare to no ATG (14% vs 39%, P =0.011). Although however, the rate of chronic GVHD at 1 year was higher in ATG group than in the no ATG group, this was statistically not significant (43% and 23%; P=0.2). The rates of overall fungal infections and lethal fungal infections were comparable (14% and 10%) for ATG vs (17% and 11%) for no ATG (p =0.70). The rate of primary CMV infection (i.e., in patient not receiving corticosteroid treatment for GVHD) was higher in ATG group, although not statistically significant (31% vs 17%, P=0.27). Day 100 mortality was 15% and 25% in ATG and no ATG group respectively, overall survival at 1 and 2 years was 47% and 31% for ATG group vs 49% and 36% for no ATG group (P>0.05), Median time to death was 8.6 months (CI95%, 1.8-15.4) and 11.9 months (CI95%, 8-15.7) with P=0.7. The mortality from GVHD at 4 months was 0% in ATG group vs 12% in no ATG group (P =0.08).While the mortality rate from bacterial infection and sepsis were equivalent, more patients in the ATG group who did not receiving corticosteroid treatment for aGVHD died from viral and fungal infection (15% vs 0% at 8 months, P=0.013). Summary: While ATG was associated with a trend toward lower mortality rate at day 100 due to statistically significant decrease in incidence and mortality of aGVHD, it was associated with increase rate of delayed-onset acute GVHD and statistically significant high rate of lethal viral and fungal infection leading to similar overall survival at 1 and 2 years. This study demonstrates the lack of overall benefit of ATG at dose of 7.5mg/kg. Further study to investigate the outcome of using lower doses of ATG to lower the rate of lethal infections while still reducing the risk of GvHD is recommended.
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    Preoperative platelet counts and postoperative outcomes in cancer surgery: a multicenter, retrospective cohort study
    (Taylor & Francis, 2019) Rachidi, Saleh; Li, Hong; Wallace, Kristin; Li, Zihai; Balch, Charles; Lautenschlaeger, Tim; Pediatrics, School of Medicine
    Platelets play roles in malignancy, wound healing, and immunity. Nevertheless, their significance in postoperative outcomes is not established. This is a retrospective cohort study of 100,795 patients undergoing cancer surgery in 2010 and 2014 in >500 hospitals. Patients were stratified into five groups based on preoperative platelet counts. Multivariable logistic regression was used to determine the risk of 30-day mortality, morbidities, readmission, and prolonged hospitalization using the mid-normal group as a reference. We adjusted for demographic variables, comorbidities, and operation complexity. In the 2014 cohort, multivariable analysis showed that mortality was higher in patients with thrombocytopenia (OR 1.49, 95% CI [1.23–1.81]), high-normal platelets (OR 1.29, [1.06–1.55]), and thrombocytosis (OR 1.78, [1.45–2.19]). Composite postoperative morbidity followed a similar trend with thrombocytopenia (OR 1.34, [1.25–1.43]), high-normal counts (OR 1.41, [1.33–1.49]), and thrombocytosis (OR 2.20, [2.05–2.36]). Concordantly, the risks of prolonged hospitalization and 30-day readmission followed the same pattern. These results were validated in a large colon cancer cohort from the 2010 database. In conclusion, platelet count is a prognostic indicator in cancer surgeries. This could be related to the role of platelets in wound healing and immunity on one hand, and propagating malignancy on the other.