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Shannon KL, Osula VO, Shaw-Saliba K, Hardick J, McBryde B, Dugas A, Hsieh YH, Hansoti B, Rothman RE. Viral co-infections are associated with increased rates of hospitalization in those with influenza. Influenza Other Respir Viruses 2022; 16:780-788. [PMID: 35302283 PMCID: PMC9178061 DOI: 10.1111/irv.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co‐infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co‐infections. The objective of this study was to determine rates of viral co‐infections in emergency department (ED) patients with confirmed influenza and association of co‐infection with disease severity. Methods Secondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014–2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza‐positive patients were tested for viral co‐infections (ePlex, Genmark Diagnostics). Patterns of viral co‐infections were evaluated using chi‐square analysis. The association of viral co‐infection with hospital admission was assessed using univariate and multivariate regression. Results The overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co‐infections was 7.9% (79/999). The most common viral co‐infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01–5.34) increased significantly for those with viral co‐infections (other than RhV/EV) versus those with influenza A infection only. Conclusion Presence of viral co‐infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.
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Affiliation(s)
- Kerry L Shannon
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valerie O Osula
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hardick
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Breana McBryde
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of International Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Shaw-Saliba K, Hansoti B, Burkom H, Martinez D, DuVal A, Lee B, Chau P, McBride B, Hsieh YH, Sathananthan V, Persing D, Turnlund M, Shively R, Dugas A, Rothman R. Cloud-Based Influenza Surveillance System in Emergency Departments Using Molecular-Based Testing: Advances and Challenges. West J Emerg Med 2022; 23:115-123. [PMID: 35302441 PMCID: PMC8967469 DOI: 10.5811/westjem.2021.9.52741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/18/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Electronic influenza surveillance systems aid in health surveillance and clinical decisionmaking within the emergency department (ED). While major advances have been made in integrating clinical decision-making tools within the electronic health record (EHR), tools for sharing surveillance data are often piecemeal, with the need for data downloads and manual uploads to shared servers, delaying time from data acquisition to end-user. Real-time surveillance can help both clinicians and public health professionals recognize circulating influenza earlier in the season and provide ongoing situational awareness.
Methods: We created a prototype, cloud-based, real-time reporting system in two large, academically affiliated EDs that streamed continuous data on a web-based dashboard within hours of specimen collection during the influenza season. Data included influenza test results (positive or negative) coupled with test date, test instrument geolocation, and basic patient demographics. The system provided immediate reporting to frontline clinicians and to local, state, and federal health department partners.
Results: We describe the process, infrastructure requirements, and challenges of developing and implementing the prototype system. Key process-related requirements for system development included merging data from the molecular test (GeneXpert) with the hospitals’ EHRs, securing data, authorizing/ authenticating users, and providing permissions for data access refining visualizations for end-users.
Conclusion: In this case study, we effectively integrated multiple data systems at four distinct hospital EDs, relaying data in near real time to hospital-based staff and local and national public health entities, to provide laboratory-confirmed influenza test results during the 2014-2015 influenza season. Future innovations need to focus on integrating the dashboard within the EHR and clinical decision tools.
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Affiliation(s)
- Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard Burkom
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Diego Martinez
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Anna DuVal
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian Lee
- Office of the Chief Information Officer, Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Engineering and Software, Cepheid, Sunnyvale, California
| | - Phong Chau
- Biomedical Advanced Research and Development Authority, US Department of Health and Human Services, Washington, District of Columbia
| | - Breanna McBride
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vidiya Sathananthan
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - David Persing
- Biomedical Advanced Research and Development Authority, US Department of Health and Human Services, Washington, District of Columbia
| | - Michael Turnlund
- Biomedical Advanced Research and Development Authority, US Department of Health and Human Services, Washington, District of Columbia
| | - Roxanne Shively
- National Emergency Department Influenza Consortium Site Leads: Greg Moran, David Talan (UCLA Olive View, Sylmar California), Frank Lovecchio (Maricopa Medical Center, Phoenix, Arizona), Mark Steele (Truman Medical Center, Kansas City, Missouri)
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Zapf AJ, Hardick J, McBryde B, Sauer LM, Fenstermacher KZJ, Ricketts EP, Lin YC, Chen KF, Hsieh YH, Dugas A, Shaw-Saliba K, Pekosz A, Gaydos CA, Rothman RE. Impact of coinfection status and comorbidity on disease severity in adult emergency department patients with influenza B. Influenza Other Respir Viruses 2021; 16:236-246. [PMID: 34533270 PMCID: PMC8818819 DOI: 10.1111/irv.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Influenza B accounts for approximately one fourth of the seasonal influenza burden. However, research on the importance of influenza B has received less attention compared to influenza A. We sought to describe the association of both coinfections and comorbidities with disease severity among adults presenting to emergency departments (ED) with influenza B. Methods Nasopharyngeal samples from patients found to be influenza B positive in four US and three Taiwanese ED over four consecutive influenza seasons (2014–2018) were tested for coinfections with the ePlex RP RUO panel. Multivariable logistic regressions were fitted to model adjusted odds ratios (aOR) for two severity outcomes separately: hospitalization and pneumonia diagnosis. Adjusting for demographic factors, underlying health conditions, and the National Early Warning Score (NEWS), we estimated the association of upper respiratory coinfections and comorbidity with disease severity (including hospitalization or pneumonia). Results Amongst all influenza B positive individuals (n = 446), presence of another upper respiratory pathogen was associated with an increased likelihood of hospitalization (aOR = 2.99 [95% confidence interval (95% CI): 1.14–7.85, p = 0.026]) and pneumonia (aOR = 2.27 [95% CI: 1.25–4.09, p = 0.007]). Chronic lung diseases (CLD) were the strongest predictor for hospitalization (aOR = 3.43 [95% CI: 2.98–3.95, p < 0.001]), but not for pneumonia (aOR = 1.73 [95% CI: 0.80–3.78, p = 0.166]). Conclusion Amongst ED patients infected with influenza B, the presence of other upper respiratory pathogens was independently associated with both hospitalization and pneumonia; presence of CLD was also associated with hospitalization. These findings may be informative for ED clinician's in managing patients infected with influenza B.
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Affiliation(s)
- Alexander J Zapf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin Hardick
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Breana McBryde
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin P Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yi-Chin Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Maurice P, Guilbaud L, Garel J, Mine M, Dugas A, Friszer S, Maisonneuve E, Moutard ML, Coste T, Héron D, Tournier-Lasserve E, Garel C, Jouannic JM. Prevalence of COL4A1 and COL4A2 mutations in severe fetal multifocal hemorrhagic and/or ischemic cerebral lesions. Ultrasound Obstet Gynecol 2021; 57:783-789. [PMID: 32515830 DOI: 10.1002/uog.22106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To establish the prevalence of COL4A1 and COL4A2 gene mutations in fetuses presenting with a phenotype suggestive of cerebral injury. METHODS This was a single-center retrospective analysis of all cases of fetal cerebral anomalies suggestive of COL4A1 or COL4A2 gene mutation over the period 2009-2018. Inclusion criteria were: (1) severe and/or multifocal hemorrhagic cerebral lesions; (2) multifocal ischemic-hemorrhagic cerebral lesions. These anomalies could be of different ages and associated with schizencephaly or porencephaly. Between fetuses with and those without a mutation, we compared gestational age at the time of diagnosis, parity and fetal gender. RESULTS Among the 956 cases of cerebral anomaly diagnosed in our center during the 10-year study period, 18 fetuses were identified for inclusion. A pathogenic COL4A1 gene mutation was found in five of these cases, among which four were de-novo mutations. A variant of unknown significance was found in four fetuses: in the COL4A1 gene in one case and in the COL4A2 gene in three cases. No COL4A1 or COL4A2 mutation was found in the remaining nine fetuses. The median (interquartile range) gestational age at diagnosis was significantly lower in cases with a mutation (24 (22-26) weeks) than in cases without a mutation (32 (29.5-34.5) weeks) (P = 0.03). CONCLUSIONS A phenotype suggestive of cerebral injury was found in 18 of the 956 (1.9%) cases in our population, in 28% of which there was an associated COL4A1 or COL4A2 mutation. COL4A1 and COL4A2 gene mutations should be sought systematically in cases of severe and/or multifocal hemorrhagic or ischemic-hemorrhagic cerebral lesions, with or without schizencephaly or porencephaly. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Maurice
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - L Guilbaud
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - J Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - M Mine
- Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis, APHP, Paris, France
| | - A Dugas
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - S Friszer
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - E Maisonneuve
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - M-L Moutard
- Service de Neuropédiatrie, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - T Coste
- Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis, APHP, Paris, France
| | - D Héron
- Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Hôpital Armand Trousseau APHP, Paris, France
| | - E Tournier-Lasserve
- Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis, APHP, Paris, France
| | - C Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
| | - J-M Jouannic
- Service de Médecine Fœtale, Hôpital Armand Trousseau APHP, Sorbonne Université, Paris, France
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5
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Blumenkrantz DR, Mehoke T, Shaw-Saliba K, Powell H, Wohlgemuth N, Liu H, Macias E, Evans J, Lewis M, Medina R, Hardick J, Sauer LM, Dugas A, DuVal A, Lane AP, Gaydos C, Rothman R, Thielen P, Pekosz A. Identification of H3N2 NA and PB1-F2 genetic variants and their association with disease symptoms during the 2014-15 influenza season. Virus Evol 2021; 7:veab047. [PMID: 34131512 PMCID: PMC8197029 DOI: 10.1093/ve/veab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The 2014-15 influenza season saw the emergence of an H3N2 antigenic drift variant that formed the 3C.2a HA clade. Whole viral genomes were sequenced from nasopharyngeal swabs of ninety-four patients with confirmed influenza A virus infection and primary human nasal epithelial cell cultures used to efficiently isolate H3N2 viruses. The isolates were classified by HA clade and the presence of a new set of co-selected mutations in NA (a glycosylation site, NAg+) and PB1-F2 (H75P). The NA and PB1-F2 mutations were present in a subset of clade 3C.2a viruses (NAg+F2P), which dominated during the subsequent influenza seasons. In human nasal epithelial cell cultures, a virus with the novel NAg+F2P genotype replicated less well compared with a virus with the parental genotype. Retrospective analyses of clinical data showed that NAg+F2P genotype viruses were associated with increased cough and shortness of breath in infected patients.
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Affiliation(s)
- Deena R Blumenkrantz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Thomas Mehoke
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Kathryn Shaw-Saliba
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harrison Powell
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Nicholas Wohlgemuth
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Hsuan Liu
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
| | - Elizabeth Macias
- Epidemiology Laboratory Service, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA
| | - Jared Evans
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Mitra Lewis
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Medina
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hardick
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna DuVal
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew P Lane
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Rothman
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Thielen
- Research and Exploratory Development Department, Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health,Laurel, MD, USA
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6
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Mouna B, Hitier M, Babin E, Dugas A. An anomalous form of dyspnoea. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:515-516. [PMID: 32646747 DOI: 10.1016/j.anorl.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B Mouna
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France.
| | - M Hitier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - E Babin
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - A Dugas
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
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7
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Carsuzaa F, Thariat J, Gorphe P, Atallah I, Cosmidis A, Thureau S, de Mones E, Servagi-Vernat S, Tonnerre D, Morinière S, Dugas A, Malard O, Pasquier F, Ashley B, Vergez S, Dufour X. Stratégies de prise en charge des tumeurs des voies aérodigestives supérieures de stade T1-T2 N3. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Powers JH, Bacci ED, Leidy NK, Poon JL, Stringer S, Memoli MJ, Han A, Fairchok MP, Coles C, Owens J, Chen WJ, Arnold JC, Danaher PJ, Lalani T, Burgess TH, Millar EV, Ridore M, Hernández A, Rodríguez-Zulueta P, Ortega-Gallegos H, Galindo-Fraga A, Ruiz-Palacios GM, Pett S, Fischer W, Gillor D, Moreno Macias L, DuVal A, Rothman R, Dugas A, Guerrero ML. Performance of the inFLUenza Patient-Reported Outcome (FLU-PRO) diary in patients with influenza-like illness (ILI). PLoS One 2018; 13:e0194180. [PMID: 29566007 PMCID: PMC5863969 DOI: 10.1371/journal.pone.0194180] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/26/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The inFLUenza Patient Reported Outcome (FLU-PRO) measure is a daily diary assessing signs/symptoms of influenza across six body systems: Nose, Throat, Eyes, Chest/Respiratory, Gastrointestinal, Body/Systemic, developed and tested in adults with influenza. OBJECTIVES This study tested the reliability, validity, and responsiveness of FLU-PRO scores in adults with influenza-like illness (ILI). METHODS Data from the prospective, observational study used to develop and test the FLU-PRO in influenza virus positive patients were analyzed. Adults (≥18 years) presenting with influenza symptoms in outpatient settings in the US, UK, Mexico, and South America were enrolled, tested for influenza virus, and asked to complete the 37-item draft FLU-PRO daily for up to 14-days. Analyses were performed on data from patients testing negative. Reliability of the final, 32-item FLU-PRO was estimated using Cronbach's alpha (α; Day 1) and intraclass correlation coefficients (ICC; 2-day reproducibility). Convergent and known-groups validity were assessed using patient global assessments of influenza severity (PGA). Patient report of return to usual health was used to assess responsiveness (Day 1-7). RESULTS The analytical sample included 220 ILI patients (mean age = 39.3, 64.1% female, 88.6% white). Sixty-one (28%) were hospitalized at some point in their illness. Internal consistency reliability (α) of FLU-PRO Total score was 0.90 and ranged from 0.72-0.86 for domain scores. Reproducibility (Day 1-2) was 0.64 for Total, ranging from 0.46-0.78 for domain scores. Day 1 FLU-PRO scores correlated (≥0.30) with the PGA (except Gastrointestinal) and were significantly different across PGA severity groups (Total: F = 81.7, p<0.001; subscales: F = 6.9-62.2; p<0.01). Mean score improvements Day 1-7 were significantly greater in patients reporting return to usual health compared with those who did not (p<0.05, Total and subscales, except Gastrointestinal and Eyes). CONCLUSIONS Results suggest FLU-PRO scores are reliable, valid, and responsive in adults with influenza-like illness.
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Affiliation(s)
- John H. Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, United States of America
| | - Elizabeth D. Bacci
- Evidera Evidence, Value & Access by PPD, Seattle, WA, United States of America
| | - Nancy K. Leidy
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Jiat-Ling Poon
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Sonja Stringer
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Matthew J. Memoli
- National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Alison Han
- National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Mary P. Fairchok
- Madigan Army Medical Center, Fort Lewis, WA, United States of America
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Christian Coles
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Jackie Owens
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - John C. Arnold
- Naval Medical Center, San Diego, CA, United States of America
| | - Patrick J. Danaher
- Defense Institute for Medical Operations, San Antonio, TX, United States of America
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
- Naval Medical Center, Portsmouth, VA, United States of America
| | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Eugene V. Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Michelande Ridore
- Children’s National Medical Center, Washington, DC, United States of America
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Infecciosas, Mexico City, Mexico
| | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Sarah Pett
- UCL, London, United Kingdom
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- Institute of Clinical Trials and Methodology, University College, London, United Kingdom
- Institute for Global Health, University College, London, United Kingdom
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - William Fischer
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel Gillor
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- University of Cologne, Cologne, Germany
| | - Laura Moreno Macias
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
| | - Anna DuVal
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - M. Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Powers JH, Bacci ED, Guerrero ML, Leidy NK, Stringer S, Kim K, Memoli MJ, Han A, Fairchok MP, Chen WJ, Arnold JC, Danaher PJ, Lalani T, Ridoré M, Burgess TH, Millar EV, Hernández A, Rodríguez-Zulueta P, Smolskis MC, Ortega-Gallegos H, Pett S, Fischer W, Gillor D, Macias LM, DuVal A, Rothman R, Dugas A, Ruiz-Palacios GM. Reliability, Validity, and Responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) Scores in Influenza-Positive Patients. Value Health 2018; 21:210-218. [PMID: 29477403 PMCID: PMC5831548 DOI: 10.1016/j.jval.2017.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the reliability, validity, and responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) scores for quantifying the presence and severity of influenza symptoms. METHODS An observational prospective cohort study of adults (≥18 years) with influenza-like illness in the United States, the United Kingdom, Mexico, and South America was conducted. Participants completed the 37-item draft FLU-PRO daily for up to 14 days. Item-level and factor analyses were used to remove items and determine factor structure. Reliability of the final tool was estimated using Cronbach α and intraclass correlation coefficients (2-day reliability). Convergent and known-groups validity and responsiveness were assessed using global assessments of influenza severity and return to usual health. RESULTS Of the 536 patients enrolled, 221 influenza-positive subjects comprised the analytical sample. The mean age of the patients was 40.7 years, 60.2% were women, and 59.7% were white. The final 32-item measure has six factors/domains (nose, throat, eyes, chest/respiratory, gastrointestinal, and body/systemic), with a higher order factor representing symptom severity overall (comparative fit index = 0.92; root mean square error of approximation = 0.06). Cronbach α was high (total = 0.92; domain range = 0.71-0.87); test-retest reliability (intraclass correlation coefficient, day 1-day 2) was 0.83 for total scores and 0.57 to 0.79 for domains. Day 1 FLU-PRO domain and total scores were moderately to highly correlated (≥0.30) with Patient Global Rating of Flu Severity (except nose and throat). Consistent with known-groups validity, scores differentiated severity groups on the basis of global rating (total: F = 57.2, P < 0.001; domains: F = 8.9-67.5, P < 0.001). Subjects reporting return to usual health showed significantly greater (P < 0.05) FLU-PRO score improvement by day 7 than did those who did not, suggesting score responsiveness. CONCLUSIONS Results suggest that FLU-PRO scores are reliable, valid, and responsive to change in influenza-positive adults.
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Affiliation(s)
- John H Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, USA.
| | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Matthew J Memoli
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Alison Han
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mary P Fairchok
- Madigan Army Medical Center, Fort Lewis, WA, USA; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | | | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; Naval Medical Center, Portsmouth, VA, USA
| | | | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sarah Pett
- University College London, London, UK; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Anna DuVal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
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Klein EY, Monteforte B, Gupta A, Jiang W, May L, Hsieh YH, Dugas A. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses 2016; 10:394-403. [PMID: 27232677 PMCID: PMC4947938 DOI: 10.1111/irv.12398] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 12/19/2022] Open
Abstract
Aim Coinfecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of coinfection in influenza patients. Method A systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria. Results Twenty‐seven studies including 3215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I2 = 95%), with reported coinfection rates ranging from 2% to 65%. Although only a subset of papers were responsible for observed heterogeneity, subanalyses and meta‐regression analysis found no study characteristic that was significantly associated with coinfection. The most common coinfecting species were Streptococcus pneumoniae and Staphylococcus aureus, which accounted for 35% (95% CI, 14%–56%) and 28% (95% CI, 16%–40%) of infections, respectively; a wide range of other pathogens caused the remaining infections. An assessment of bias suggested that lack of small‐study publications may have biased the results. Conclusions The frequency of coinfection in the published studies included in this review suggests that although providers should consider possible bacterial coinfection in all patients hospitalized with influenza, they should not assume all patients are coinfected and be sure to properly treat underlying viral processes. Further, high heterogeneity suggests additional large‐scale studies are needed to better understand the etiology of influenza bacterial coinfection.
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Affiliation(s)
- Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.,Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | | | | | - Wendi Jiang
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Larissa May
- Department of Emergency Medicine, The George Washington University, Washington, DC, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
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Dugas A, Rothman R. Clinical Decision Guideline for Influenza Testing in the Emergency Department. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Broniatowski DA, Dredze M, Paul MJ, Dugas A. Using Social Media to Perform Local Influenza Surveillance in an Inner-City Hospital: A Retrospective Observational Study. JMIR Public Health Surveill 2015; 1:e5. [PMID: 27014744 PMCID: PMC4803078 DOI: 10.2196/publichealth.4472] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Public health officials and policy makers in the United States expend significant resources at the national, state, county, and city levels to measure the rate of influenza infection. These individuals rely on influenza infection rate information to make important decisions during the course of an influenza season driving vaccination campaigns, clinical guidelines, and medical staffing. Web and social media data sources have emerged as attractive alternatives to supplement existing practices. While traditional surveillance methods take 1-2 weeks, and significant labor, to produce an infection estimate in each locale, web and social media data are available in near real-time for a broad range of locations. Objective The objective of this study was to analyze the efficacy of flu surveillance from combining data from the websites Google Flu Trends and HealthTweets at the local level. We considered both emergency department influenza-like illness cases and laboratory-confirmed influenza cases for a single hospital in the City of Baltimore. Methods This was a retrospective observational study comparing estimates of influenza activity of Google Flu Trends and Twitter to actual counts of individuals with laboratory-confirmed influenza, and counts of individuals presenting to the emergency department with influenza-like illness cases. Data were collected from November 20, 2011 through March 16, 2014. Each parameter was evaluated on the municipal, regional, and national scale. We examined the utility of social media data for tracking actual influenza infection at the municipal, state, and national levels. Specifically, we compared the efficacy of Twitter and Google Flu Trends data. Results We found that municipal-level Twitter data was more effective than regional and national data when tracking actual influenza infection rates in a Baltimore inner-city hospital. When combined, national-level Twitter and Google Flu Trends data outperformed each data source individually. In addition, influenza-like illness data at all levels of geographic granularity were best predicted by national Google Flu Trends data. Conclusions In order to overcome sensitivity to transient events, such as the news cycle, the best-fitting Google Flu Trends model relies on a 4-week moving average, suggesting that it may also be sacrificing sensitivity to transient fluctuations in influenza infection to achieve predictive power. Implications for influenza forecasting are discussed in this report.
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Affiliation(s)
- David Andre Broniatowski
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC, United States
| | - Mark Dredze
- Human Language Technology Center of Excellence, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Paul
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - Andrea Dugas
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, United States
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Hardick J, Dugas A, Goheen J, Rothman R, Gaydos C. Prospective comparison of RT-PCR/ESI-MS to Prodesse ProFlu Plus and Cepheid GenXpert for the detection of Influenza A and B viruses. J Virol Methods 2015; 214:43-5. [PMID: 25681525 PMCID: PMC4560249 DOI: 10.1016/j.jviromet.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 11/16/2022]
Abstract
RT-PCR/ESI-MS was compared to two gold standards, Prodesse ProFlu Plus and Cepheid ExpertFlu.
RT-PCR/ESI-MS has previously demonstrated the capability to detect and identify respiratory viral pathogens in nasopharyngeal swabs. This study expands on previous research by performing a prospective evaluation of RT-PCR/ESI-MS to detect and identify Influenza A and B viruses compared to Prodesse ProFlu Plus and combined ProFlu Plus and Cepheid Xpert Flu. ProFlu Plus was also used as a gold standard for comparison for respiratory syncytial virus detection. Using ProFlu Plus as a gold standard, RT-PCR/ESI-MS had sensitivity and specificity of 82.1% (23/28) and 100% (258/258), respectively, for Influenza A, 100% (16/16) and 99.6% (269/270), respectively for Influenza B, and 88.6% (39/44) and 99.6% (241/242) for any Influenza virus. Using matching results from ProFlu Plus and Xpert Flu as a gold standard, RT-PCR/ESI-MS had 85.2% (23/27) and 100% (259/259) sensitivity and specificity respectively for Influenza A, 100% (14/14) and 99.6% (270/272), respectively for Influenza B virus. Overall, RT-PCR/ESI-MS was not as sensitive as the combined gold standard of ProFlu Plus and Xpert Flu, although it has the capability of detecting other respiratory viruses.
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Affiliation(s)
- Justin Hardick
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, United States.
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, United States
| | - Joshua Goheen
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, United States
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, United States
| | - Charlotte Gaydos
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, United States
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Dugas A, Hsieh YH, Levin S, Pines J, Mareiniss D, Mohareb A, Gaydos C, Perl T, Rothman R. Google flu trends: correlation with emergency department influenza rates and crowding metrics. Emerging Health Threats Journal 2011. [DOI: 10.3402/ehtj.v4i0.11187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Flaherty S, Weber R, Dugas A, Cocchi M, Salciccioli J, Donnino M. 133 Sepsis and Empiric Antibiotics: Should We Consider “Health Care Associated” Urinary Tract Infections? Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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