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"Newman, Michael G."
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Antibiotic Treatment of Suspected and Confirmed Neonatal Sepsis Within 28 Days of Birth: A Retrospective Analysis
Neonatal sepsis causes significant mortality and morbidity worldwide. Diagnosis is usually confirmed via blood culture results. Blood culture sepsis confirmation can take days and suffer from contamination and false negatives. Empiric therapy with antibiotics is common. This study aims to retrospectively describe and compare treatments of blood culture-confirmed and unconfirmed, but suspected, sepsis within the University of Utah Hospital system. Electronic health records were obtained from 1,248 neonates from January 1, 2006, to December 31, 2017. Sepsis was categorized into early-onset (≤3 days of birth, EOS) and late-onset (>3 and ≤28 days of birth, LOS) and categorized as culture-confirmed sepsis if a pathogen was cultured from the blood and unconfirmed if all blood cultures were negative with no potentially contaminated blood cultures. Of 1,010 neonates in the EOS cohort, 23 (2.3%) were culture-confirmed, most with Escherichia coli (42%). Treatment for unconfirmed EOS lasted an average of 6.1 days with primarily gentamicin and ampicillin while confirmed patients were treated for an average of 12.3 days with increased administration of cefotaxime. Of 311 neonates in the LOS cohort, 62 (20%) were culture-confirmed, most culturing coagulase negative staphylococci (46%). Treatment courses for unconfirmed LOS lasted an average of 7.8 days while confirmed patients were treated for an average of 11.4 days, these patients were primarily treated with vancomycin and gentamicin. The use of cefotaxime for unconfirmed EOS and LOS increased throughout the study period. Cefotaxime administration was associated with an increase in neonatal mortality, even when potential confounding factors were added to the logistic regression model (adjusted odds ratio 2.8, 95%CI [1.21, 6.88], p = 0.02). These results may not be generalized to all hospitals and the use of cefotaxime may be a surrogate for other factors. Given the low rate of blood culture positive diagnosis and the high exposure rate of empiric antibiotics, this patient population might benefit from improved diagnostics with reevaluation of antibiotic use guidelines.
Journal Article
Risk of Type II Diabetes Mellitus Among B‐Cell Non‐Hodgkin's Lymphoma Survivors
Purpose Advancing therapies have increased B‐cell Non‐Hodgkin's Lymphoma (B‐NHL) patient survival. However, data are limited on the risk of type II diabetes mellitus (type II DM) in adult survivors following treatment. This study examines the risk of type II DM among a Utah population of B‐NHL survivors, compared to the general population. Methods A cohort of 3529 adult survivors diagnosed with B‐NHL in Utah between 1997 and 2013 in the Utah Cancer Registry and 13,339 individuals from the general population were identified using the Utah Population Database (UPDB). Multivariate Cox Proportional Hazard models were used to estimate adjusted hazard ratios (aHR) for developing type II DM, stratified for time post‐diagnosis. Results Compared to the cancer‐free population, B‐NHL survivors had an overall increased risk of developing type II DM (HR: 1.49; 95% CI: 1.32, 1.69), largely within the first year (HR: 4.41; 95% CI: 3.52, 5.52) following diagnosis. Older B‐NHL survivors were more likely to develop type II DM at any time compared to survivors < 40 years [40–65 years (HR: 2.66; 95% CI 1.48–4.79); ≥ 65 years (HR: 3.77; 95% CI 2.09–6.78)]. Obese (BMI > 30 kg/m2) survivors had a 4.06‐fold increase in the risk of type II DM compared to normal BMI (18–24.9 kg/m2) cancer survivors. Cancer treatment did not increase the risk of type II DM compared to no treatment. Conclusions Adult B‐NHL cancer survivors were at an overall increased risk of developing type II DM compared to the general population, within the first year and overall, following a cancer diagnosis. This study provides evidence suggesting the importance of obesity prevention and improvement in care management oversight for B‐NHL survivorship and DM outcomes.
Journal Article
Capturing Chemotherapy and Radiotherapy Dose Among Breast Cancer Patients With the Utah All‐Payer Claims Database Compared With Gold‐Standard Abstraction
Objective To evaluate the validity of the Utah statewide All‐Payer Claims Database (APCD), we compared breast cancer‐specific treatments and dosages with gold‐standard ion of medical records. Study Design In this pilot study, breast cancer treatments were ed by a certified tumor registrar at the Utah Cancer Registry (UCR) for patients diagnosed in 2013 with breast cancer. The ion of medical records was the gold standard for comparison with treatments identified in the APCD. The reliability and agreement between the treatment identified in the APCD and ion data were measured with sensitivity and specificity. Dose consistency was measured with the intraclass correlation coefficients (ICC). Results Compared with the 186 ions, the sensitivity of the APCD to identify chemotherapy agents was high: 89% for any agent, 91% for carboplatin, 83% for docetaxel, 82% for doxorubicin, or 94.7% for biologic therapy. The consistency between the chemotherapy dosage identified in the claims and the ion varied from 63% to 76%. For radiotherapy, the sensitivity of the claims to identify the completed radiotherapy regimen was 66%. The ICC between radiotherapy doses identified in the claims and the ion was 54% (95% confidence interval [CI], 48%, 67%). Conclusions Employing these novel methods, the claims were highly reliable in identifying cancer treatment agents overall, namely carboplatin, docetaxel, and trastuzumab. The claims were of moderate utility in capturing the treatment dose information. In addition to the APCD, the use of multiple data sources improved the completeness of cancer treatment information.
Journal Article
Cumulative Incidence of All-Cause Knee Injury, Concussion, and Stress Fracture among Transgender Patients on Gender-Affirming Hormone Therapy: An Exploratory Retrospective Cohort Study
Previous research has shown a discrepancy in incidences of knee injuries, stress fractures, and concussions between cisgender men and women. Little is known regarding the incidence of musculoskeletal injuries among patients on gender-affirming hormone therapy (GAHT). This retrospective cohort study examines cumulative incidence of knee injuries, concussions, and stress fracture injuries among transgender patients on GAHT at one health system from 2011–2020. Using relevant ICD-9 and 10 codes, incidences of knee injury, concussion, and stress fracture were calculated. Cohorts included 1971 transgender and 3964 cisgender patients. Transgender patients had significantly higher incidence of all-cause knee injuries over the study period, 109 (5.5%) versus 175 (4.4%) (p < 0.001; OR: 2.14, 95% CI [1.17–3.92]). Subgroup analysis showed significantly higher incidence of knee injuries among cisgender men (5.6%) versus cisgender women (4.1%) (p = 0.042) and among transgender women (6.6%) versus cisgender women (4.1%) (p = 0.005). There were no significant differences between incidences of concussion and stress fracture between groups. This sample showed that patients on GAHT had increased cumulative incidences of all-cause knee injury compared to controls but similar cumulative incidences of concussion and bone-stress injuries. Transgender women on exogenous estrogen had significantly higher cumulative incidences of all-cause knee injuries compared to cisgender women.
Journal Article
Generating Older Adult Multimorbidity Trajectories Using Various Comorbidity Indices and Calculation Methods
Abstract
Background and Objectives
Older adult multimorbidity trajectories are helpful for understanding the current and future health patterns of aging populations. The construction of multimorbidity trajectories from comorbidity index scores will help inform public health and clinical interventions targeting those individuals that are on unhealthy trajectories. Investigators have used many different techniques when creating multimorbidity trajectories in prior literature, and no standard way has emerged. This study compares and contrasts multimorbidity trajectories constructed from various methods.
Research Design and Methods
We describe the difference between aging trajectories constructed with the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). We also explore the differences between acute (single-year) and chronic (cumulative) derivations of CCI and ECI scores. Social determinants of health can affect disease burden over time; thus, our models include income, race/ethnicity, and sex differences.
Results
We use group-based trajectory modeling (GBTM) to estimate multimorbidity trajectories for 86,909 individuals aged 66–75 in 1992 using Medicare claims data collected over the following 21 years. We identify low-chronic disease and high-chronic disease trajectories in all 8 generated trajectory models. Additionally, all 8 models satisfied prior established statistical diagnostic criteria for well-performing GBTM models.
Discussion and Implications
Clinicians may use these trajectories to identify patients on an unhealthy path and prompt a possible intervention that may shift the patient to a healthier trajectory.
Journal Article