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Stream S, Ashraf MS, Craft CF, German D, Hankins R, Pavlovsky LL, Tyner LKK, Cortes-Penfield N. Abundant Opportunities to Improve Infection Control Training and Assessment in Dentistry. Am J Infect Control 2022. [PMCID: PMC9215286 DOI: 10.1016/j.ajic.2022.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Infection control (IC) training and practice in dental facilities is not well studied. The Nebraska Infection Control Assessment and Promotion program (ICAP) offers free consultations to Nebraska healthcare facilities, in which infection preventionists visit the site, interview stakeholders, and provide a complete assessment of the facility's IC program using an adaptation of the Centers for Disease Control's “Basic Expectations of Safe Care” infection prevention checklist. Here, we report the ICAP team's findings during voluntary assessments of dental IC programs. Methods ICAP solicited invitations into eighteen dental facilities (nine private practice clinics, seven public health clinics, and two other facilities) across Nebraska from 2018-2021. Fourteen assessments were conducted in 2018-2019 and four from April to June 2021; assessments were suspended in the interim due to the COVID-19 pandemic. Results We found 24% of facilities provided no IC training to employees upon hire and 35% did not provide annual refresher trainings. When facilities did offer training, key subjects were frequently omitted, including safe injection practices (omitted in 60%), protective personal equipment (PPE) selection and use (50%), hand hygiene (44%), and sterilization and disinfection procedures (38%). Few facilities required employees to demonstrate competency in PPE selection (19%), safe infection practices (7%), or hand hygiene or sterilization and disinfection (0% each). Additionally, few facilities performed audits with feedback regarding adherence to proper procedures for sterilization and disinfection (19%), hand hygiene (6%), PPE selection and safe infection practices (0% each). New hire and annual IC training rates were higher in post-pandemic assessments, but other measures had not improved. Conclusions Most dental facilities offered employees IC trainings, but these were often neither routine nor comprehensive. Important gaps in dental IC programs included failures to assess employee competency regarding IC procedures and failures to engage in audit and feedback processes to ensure adherence to IC measures.
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Manley NA, Boron JB, Shade MY, Jain I, Kim J, Chirackal RS, Byers ML, Bishop KI, Ashraf MS, Tyner LK, Stream SE, Potter JF. A Robotic Device to Enhance Nursing Home Provider Telepresence During and After the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 23:311-314.e2. [PMID: 34896058 PMCID: PMC8603033 DOI: 10.1016/j.jamda.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/28/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic presented significant challenges to face-to-face communication with people residing in post-acute and long-term care (PALTC) settings. Telemedicine is an alternative, but facility staff may be overburdened with the management of the equipment. Here we introduce the use of a mobile HIPPA-compliant telepresence robot (MTR) to bridge this barrier, which may be beneficial to reimagine options for PALTC in the future.
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Affiliation(s)
- Natalie A Manley
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Julie B Boron
- Department of Gerontology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Marcia Y Shade
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
| | - Isha Jain
- University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - Jungyoon Kim
- University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - Robin S Chirackal
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mandy L Byers
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Karina I Bishop
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Muhammad S Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Laura K Tyner
- Nebraska Medicine, Nebraska Infection Control Assessment and Promotion Program, Omaha, NE, USA
| | - Sarah E Stream
- Nebraska Medicine, Nebraska Infection Control Assessment and Promotion Program, Omaha, NE, USA
| | - Jane F Potter
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Nace DA, Archbald-Pannone LR, Ashraf MS, Drinka PJ, Frentzel E, Gaur S, Mahajan D, Mehr DR, Mercer WC, Sloane PD, Jump RLP. Pneumococcal Vaccination Guidance for Post-Acute and Long-Term Care Settings: Recommendations From AMDA's Infection Advisory Committee. J Am Med Dir Assoc 2017; 18:99-104. [PMID: 28126142 DOI: 10.1016/j.jamda.2016.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022]
Abstract
Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers. Here, we discuss the importance of pneumococcal vaccination for older adults, detail AMDA-The Society for Post-Acute and Long-Term Care Medicine (The Society)'s recommendations for pneumococcal vaccination practice and procedures, and offer guidance to postacute and long-term care providers supporting the development and effective implementation of pneumococcal vaccine policies.
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Affiliation(s)
- David A Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Laurie R Archbald-Pannone
- Divisions of General, Geriatric, Palliative, and Hospital Medicine and Infectious Diseases and International Health, Department of Internal Medicine, University of Virginia, Charlottesville, VA
| | - Muhammad S Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Paul J Drinka
- Divisions of Internal Medicine and Geriatric Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Swati Gaur
- Northeast Georgia Health System, Gainesville, GA; Senior Care Advances, Gainesville, GA
| | - Dheeraj Mahajan
- Chicago Internal Medicine Practice and Research (CIMPAR), Chicago, IL; University of Illinois, Chicago, IL
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO
| | - William C Mercer
- Peterson Rehabilitation Hospital and Geriatric Center, Wheeling, WV; Wheeling Ohio County Health Department, Wheeling, WV
| | - Philip D Sloane
- Program on Aging, Disability and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center, Division of Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH
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4
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Jump RLP, Gaur S, Katz MJ, Crnich CJ, Dumyati G, Ashraf MS, Frentzel E, Schweon SJ, Sloane P, Nace D. Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings. J Am Med Dir Assoc 2017; 18:913-920. [PMID: 28935515 DOI: 10.1016/j.jamda.2017.07.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 01/22/2023]
Abstract
In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of free resources to support those efforts.
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Affiliation(s)
- Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), Specialty Care Center of Innovation and Infectious Disease Section, Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC), Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH.
| | - Swati Gaur
- New Horizons Nursing Facilities, Gainesville, GA
| | - Morgan J Katz
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher J Crnich
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI; William S. Middleton VA Hospital, Department of Medicine, Madison, WI
| | - Ghinwa Dumyati
- Infectious Diseases Division and Center for Community Health, University of Rochester Medical Center, Rochester, NY
| | - Muhammad S Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | | | - Philip Sloane
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - David Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Siraj DS, Kabchi B, Ashraf MS, Shah K, Elnabtity M. Treatment of genotype one hepatitis C virus (HCV) infection in HIV co-infected patients using telaprevir based regimen. Braz J Infect Dis 2014; 19:226-7. [PMID: 25528578 PMCID: PMC9425261 DOI: 10.1016/j.bjid.2014.11.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 11/10/2014] [Accepted: 11/16/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dawd S Siraj
- Brody School of Medicine - East Carolina University, United States.
| | - Badih Kabchi
- Brody School of Medicine - East Carolina University, United States
| | | | - Kaushal Shah
- Brody School of Medicine - East Carolina University, United States
| | - Manal Elnabtity
- Brody School of Medicine - East Carolina University, United States
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Rimawi RH, Cook PP, Gooch M, Kabchi B, Ashraf MS, Rimawi BH, Gebregziabher M, Siraj DS. The impact of penicillin skin testing on clinical practice and antimicrobial stewardship. J Hosp Med 2013; 8:341-5. [PMID: 23553999 DOI: 10.1002/jhm.2036] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Penicillin skin testing (PST) is a simple and reliable way of diagnosing penicillin allergy. After being off the market for 4 years, penicilloyl-polylysine was reintroduced in 2009 as PRE-PEN. We describe the negative predictive value (NPV) of PST and the impact on antibiotic selection in a sample of hospitalized patients with a reported history of penicillin allergy. METHODS We introduced a quality improvement process at our 861-bed tertiary care hospital that used PST to guide antibiotic usage in patients with a history consistent with an immunoglobulin E (IgE)-mediated reaction to penicillin. Subjects with a negative PST were then transitioned to a β-lactam agent for the remainder of their therapy. NPV of skin testing was established at 24-hour follow-up. We are reporting the result of 146 patients tested between March 2012 and July 2012. RESULTS A total of 146 patients with a history of penicillin allergy and negative PST were treated with β-lactam antibiotics. Of these, only 1 subject experienced an allergic reaction to the PST. The remaining 145 patients tolerated a full course of β-lactam therapy without an allergic response, giving the PST a 100% NPV. We estimated that PST-guided antibiotic alteration for these patients resulted in an estimated annual savings of $82,000. CONCLUSION Patients with a history of penicillin allergy who have a negative PST result are at a low risk of developing an immediate-type hypersensitivity reaction to β-lactam antibiotics. The increased use of PST may help improve antibiotic stewardship in the hospital setting.
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Affiliation(s)
- Ramzy H Rimawi
- Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine-East Carolina University, Greenville, NC 27834, USA.
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7
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Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, Gould CV, Juthani-Mehta M, Lautenbach E, Loeb M, Maccannell T, Malani PN, Mody L, Mylotte JM, Nicolle LE, Roghmann MC, Schweon SJ, Simor AE, Smith PW, Stevenson KB, Bradley SF. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2013; 33:965-77. [PMID: 22961014 DOI: 10.1086/667743] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
(See the commentary by Moro, on pages 978-980 .) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.
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Affiliation(s)
- Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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8
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Hussain SW, Hussain SW, S. Ashraf M, Takahashi PY. Deep Venous Thrombosis and Cyanocobalmin Deficiency in Nursing Home Resident: Is There an Association? J Am Med Dir Assoc 2011. [DOI: 10.1016/j.jamda.2010.12.033] [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: 10/18/2022]
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9
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Sharma S, Sharma S, Ashraf MS, El-Kass G, Kuniyil J, Louis B, Eichorn A, Hussain R, Cal C, Dlugacz Y, Pekmezaris R, Tommasulo B, Wolf-Klein G. Health Care Employees' Knowledge and Awareness of Pressure Ulcers in Hospitals and Long-Term Care Facilities. J Am Med Dir Assoc 2010. [DOI: 10.1016/j.jamda.2009.12.031] [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: 10/19/2022]
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10
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Ashraf MS, Ashraf MS, Hussain SW, Agarwal N, Rivera M, El-Kass G, Hussain R, Mathew N, Pekmezaris R, Cal C, Edwards B, Louis B, Wolf-Klein GP. Hand Hygiene: A Multi-Center Study on Knowledge and Compliance of Nursing Home Employees. J Am Med Dir Assoc 2009. [DOI: 10.1016/j.jamda.2008.12.025] [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: 10/21/2022]
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11
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El-Kass G, El-Kass G, Ashraf MS, Garankina O, Gory A, Louis B, Mathew N, Hussain R, Wolf-Klein GP. Is There a Correlation Between Physicians' Ethnicity and Nursing Home Placement? J Am Med Dir Assoc 2009. [DOI: 10.1016/j.jamda.2008.12.029] [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: 11/28/2022]
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12
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Ashraf MS. Prediabetes. J Indian Med Assoc 2007; 105:10. [PMID: 17802968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Abstract
Menopause is accompanied by a dramatic rise in the prevalence of hypertension in women, suggesting a protective role of endogenous estradiol on blood pressure (BP). Both animal experimental and human clinical investigations suggest that estrogen engages several mechanisms that protect against hypertension, such as activation of the vasodilator pathway mediated by nitric oxide and prostacyclin and inhibition of the vasoconstrictor pathway mediated by the sympathetic nervous system and angiotensin. However, emerging evidence from recent clinical trials indicates a small increase, rather than decrease, in systolic BP with oral estrogen administration in postmenopausal women, without any detectable effect on diastolic BP. Mechanisms underlying this selective rise in systolic BP in postmenopausal women and oral contraceptive-induced hypertension in premenopausal women remain unknown, but the rise may be related to supraphysiologic concentration of estrogen in the liver. To date, transdermal delivery of estrogen, which avoids the first-pass hepatic metabolism of estradiol, appears to have a small BP-lowering effect in postmenopausal women and may be a safer alternative in hypertensive women.
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Affiliation(s)
- Muhammad S Ashraf
- Divisions of Hypertension, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, J4 134, Dallas, TX 75390-8586, USA
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Liu K, Dyer AR, Vu TH, Pirzada A, Manheim LM, Manning WG, Ashraf MS, Garside DB, Daviglus ML. One-hour postload plasma glucose in middle age and Medicare expenditures in older age among nondiabetic men and women: the Chicago Heart Association Detection Project in Industry. Diabetes Care 2005; 28:1057-62. [PMID: 15855567 DOI: 10.2337/diacare.28.5.1057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine associations in nondiabetic individuals of 1-h postload plasma glucose measured in young adulthood and middle age with subsequent Medicare expenditures for cardiovascular disease (CVD), diabetes, cancer, and all health care at age 65 years or older using data from the Chicago Heart Association Detection Project in Industry (CHA). RESEARCH DESIGN AND METHODS Medicare data (1984-2000) were linked with CHA baseline records (1967-1973) for 8,580 men and 6,723 women ages 33-64 years who were free of coronary heart disease, diabetes, and major electrocardiogram (ECG) abnormalities and who were Medicare eligible (65+ years) for at least 2 years. Participants were classified based on 1-h postload plasma glucose levels <120, 120-199, or > or =200 mg/dl. RESULTS With adjustment for baseline age, cigarette smoking, serum cholesterol, systolic blood pressure, BMI, ethnicity, education, and minor ECG abnormalities, the average annual and cumulative Medicare, total, and diabetes- and CVD-related charges were significantly higher with higher baseline plasma glucose in women, while only diabetes-related charges were significantly higher in men. For example, in women, multivariate-adjusted CVD-related cumulative charges were, respectively, USD 14,260, 18,909, and 21,183 for the three postload plasma glucose categories (P value for trend = 0.035). CONCLUSIONS These findings suggest that maintaining low glucose levels early in life has the potential to reduce health care costs in older age.
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Affiliation(s)
- Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1102, Chicago, IL 60611, USA.
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Abstract
Although reversibility of acute ifosfamide-induced nephrotoxicity is well documented, there is a paucity of data concerning the long-term outcome of chronic renal toxicity, and full recovery from established damage has not been reported. A 4-year-old boy presented with hypophosphatemic rickets 9 months after completion of combination chemotherapy (including ifosfamide) for prostatic rhabdomyosarcoma. Further investigation confirmed glomerular and generalised tubular dysfunction with a Fanconi syndrome. However, serial investigation over the next 4 years revealed complete and sustained recovery of this chronic nephrotoxicity.
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Affiliation(s)
- M S Ashraf
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, England
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Ashraf MS, Gururangan S, Breatnach F. Benign giant cell tumour of bone in a child with pulmonary metastases at presentation. Eur J Surg Oncol 1994; 20:700-2. [PMID: 7995428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The clinical course of a 14-year-old boy who presented with a giant cell tumour of bone with pulmonary metastases is reported. There was a partial response to chemotherapy which included vincristine, adriamycin, ifosfamide, carboplatinum and etoposide. Two enlarging metastatic lung lesions were later resected because of chest pain, with symptomatic improvement. The patient is currently well almost 7 years from diagnosis despite the presence of radiological disease.
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Affiliation(s)
- M S Ashraf
- Dept of Paediatric Oncology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Abstract
Ifosfamide is an alkylating agent which has been incorporated into frontline therapy for a number of malignant paediatric tumours. Recent data appears to suggest that tubular dysfunction may result from incorporation of this drug into chemotherapy schedules and that toxicity may be dose related. A detailed investigation of renal function was performed in a group of patients, ranging in age from 8 months to 15.9 years (median 8.6 years) with rhabdomyosarcoma (n = 11) and Ewing's sarcoma (n = 9) who were currently receiving (n = 4) or had completed ifosfamide (n = 16) therapy a mean of 16 months at the time of study. All but one patient demonstrated some degree of renal dysfunction and toxicity did not necessarily appear to be dose related. Implications for incorporation of this agent into future schedules for childhood sarcomas, which can expect to cure more than 60% of such children, must be addressed. The importance of ongoing monitoring is emphasised.
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Affiliation(s)
- M S Ashraf
- Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Abstract
Oesophageal achalasia is uncommon in children and in its familial form it is a rarity. The presentation and management of two male siblings who presented with oesophageal achalasia as infants are reported. A high degree of consanguinity in the parents of the children existed, suggesting autosomal recessive transmission.
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Affiliation(s)
- T K Kaar
- Department of Paediatrics, Regional Hospital, Wilton, Cork, Republic of Ireland
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