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Brauer PR, Saadah M, Fritz MA, Wu SS, Lamarre ED. Analysis of antibiotic resistant infections associated with hirudotherapy. Am J Otolaryngol 2024; 45:104500. [PMID: 39208707 DOI: 10.1016/j.amjoto.2024.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Given rising concern regarding antibiotic resistance, our objective was to evaluate antibiotic-resistant infections following leech therapy and to characterize the use of prophylactic antibiotics. METHODS All reports of adverse events involving hirudotherapy (product code "NRN") were retrieved from the U.S. Food and Drug Administration MAUDE database between 2012 and 2021. Antibiotic resistance was defined by bacterial culture or infection after antibiotic administration. RESULTS Nineteen cases of antibiotic resistance involving hirudotherapy were identified. Only three cases of antibiotic resistance were discovered on routine testing and the remaining 16 cases were associated with patient injury. Positive blood cultures or fever were present in 26.3 % (n = 5) of cases. Cultures of the infection grew Aeromonas hydrophilia (n = 13; 68.4 %), Vibrio vulnificus (n = 3; 15.8 %), Pseudomonas aeruginosa (n = 2; 10.5 %), and Proteus vulgaris (n = 1; 5.3 %). There were nine (47.4 %) multi-drug resistant infections. Infection was most commonly resistant to fluoroquinolones (n = 9; 47.4 %), trimethoprim-sulfamethoxazole (n = 9; 47.4 %) and ertapenem (n = 4; 21.1 %). CONCLUSION Antibiotic-resistant infections involving hirudotherapy are frequently resistant to multiple drugs, including fluoroquinolones and trimethoprim-sulfamethoxazole. Resistance to ertapenem, a drug of last resort, was also documented. The findings presented in this study support growing literature that the trend in multi-drug resistance is more severe than previously reported.
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Affiliation(s)
- Philip R Brauer
- Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA.
| | - Malaak Saadah
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael A Fritz
- Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Shannon S Wu
- Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Lamarre
- Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA
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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Kolokolov OV, Salina EA, Lvova OI. [Sleep disorders and oncological diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:125-131. [PMID: 38934677 DOI: 10.17116/jnevro2024124052125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
The study of neurological symptoms and signs connected with neoplasms and antitumor therapy is relevant in the context of an increasing prevalence of cancer. The COVID-19 pandemic and social factors have increased the number of patients suffering from insomnia. Sleep disorders is an unfavorable prognostic factor for neoplasms. The review presents risk factors and mechanisms of sleep disturbance, their relationship with inflammation and dysfunction of the immune system in cancer. In particular, dysfunction of the melatonergic system is discussed as a risk factor for the development of insomnia and cancer. The relevance of developing measures aimed at the rehabilitation of patients in order to restore normal sleep, which plays a fundamental role in maintaining a person's mental and physical health, is emphasized.
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Affiliation(s)
- O V Kolokolov
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - E A Salina
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - O I Lvova
- Razumovsky Saratov State Medical University, Saratov, Russia
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Wang Y, Xiao Y. Potential health risks of sound abatement material in positive airway pressure devices for sleep breathing disorders: a summary of studies to date. Sleep Breath 2023; 27:1925-1927. [PMID: 36520338 DOI: 10.1007/s11325-022-02763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The potential carcinogenic and airway irritation risks of polyester-based polyurethane (PE-PUR) contained in sound-absorbing foam in positive airway pressure (PAP) devices have raised many concerns. We summarize the currently available studies to assess the potential health risks of PE-PUR. METHODS We searched Pubmed and Web of Science for studies on the safety of PAP devices containing PE-PUF and performed a systematic analysis of the cancer risk. RESULTS PE-PUR did not increase the cancer risk (OR: 1.08, 95% CI: 0.99-1.17, I2 = 0%). Patients in the group of PE-PUR devices had increased airway irritation, and they had higher rates of using short-acting beta-agonists and oral corticosteroids (SABA: 9.4% vs. 8.8%, p = 0.047; OCS: 19.7% vs. 17.3%, p < 0.001). CONCLUSION The application of PE-PUF can increase airway irritation, but there is no evidence for its potential carcinogenicity.
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Affiliation(s)
- Yuxin Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Belkora JK, Fields B, Shamim-Uzzaman QA, Stratford D, Alfandre D, Hollingshaus S, Yackel E, Geppert C, Nechanicky P, Nichols A, Williams K, Reichert J, Whooley MA, Francis J, Sarmiento KF. Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study. FRONTIERS IN SLEEP 2023; 2:10.3389/frsle.2023.1129415. [PMID: 38585370 PMCID: PMC10996451 DOI: 10.3389/frsle.2023.1129415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This case study describes, for the time frame of June 2021 through August 2022, the U.S. Veterans Health Administration (VHA) organizational response to a manufacturer's recall of positive airway pressure devices used in the treatment of sleep disordered breathing. VHA estimated it could take over a year for Veterans to receive replacement devices. Veterans awaiting a replacement faced a dilemma. They could continue using the recalled devices and bear the product safety risks that led to the recall, or they could stop using them and bear the risks of untreated sleep disordered breathing. Using a program monitoring approach, we report on the processes VHA put in place to respond to the recall. Specifically, we report on the strategic, service, and operational plans associated with VHA's response to the recall for Veterans needing replacement devices. In program monitoring, the strategic plan reflects the internal process objectives for the program. The service plan articulates how the delivery of services will intersect the customer journey. The operational plan describes how the program's resources and actions must support the service delivery plan. VHA's strategic plan featured a clinician-led, as opposed to primarily legal or administrative response to the recall. The recall response team also engaged with VHA's medical ethics service to articulate an ethical framework guiding the allocation of replacement devices under conditions of scarcity. This framework proposed allocating scarce devices to Veterans according to their clinical need. The service plan invited Veterans to schedule visits with sleep providers who could assess their clinical need and counsel them accordingly. The operational plan distributed devices according to clinical need as they became available. Monitoring our program processes in real time helped VHA launch and adapt its response to a recall affecting more than 700,000 Veterans.
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Affiliation(s)
- Jeffrey K. Belkora
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Barry Fields
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, United States
- Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
| | - Q. Afifa Shamim-Uzzaman
- Department of Internal Medicine and Neurology, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States
| | - Donna Stratford
- Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States
| | - David Alfandre
- Department of Medicine and Population Health, New York University School of Medicine, New York, NY, United States
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, United States
| | - Scott Hollingshaus
- Division of Pulmonary Medicine, Department of Medicine, Salt Lake City Veterans Affairs Medical Center, University of Utah, Salt Lake City, UT, United States
| | - Edward Yackel
- National Center for Patient Safety, Veterans Health Administration, Ann Arbor, MI, United States
| | - Cynthia Geppert
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, United States
- Department of Psychiatry and Internal Medicine, Ethics Education, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Penny Nechanicky
- Prosthetic and Sensory Aids Services, Veterans Health Administration, Washington, DC, United States
| | - Ardene Nichols
- Prosthetic and Sensory Aids Services, Veterans Health Administration, Washington, DC, United States
| | - Katherine Williams
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jill Reichert
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Mary A. Whooley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Joe Francis
- Office of Reporting Analytics, Performance, Improvement and Deployment, Veterans Health Administration, Washington, DC, United States
| | - Kathleen F. Sarmiento
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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