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Hemoglobin Value (hemoglobin + value)
Selected AbstractsPatient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Jagdish S. Nachnani MD Abstract BACKGROUND: The use of acid suppressive therapy (AST) in prevention of stress ulcers has been well defined in critical care patients, though its use has become increasingly common in general medicine patients, with little to no supportive evidence. None of the previous studies has examined the patient and physician characteristics of inappropriate AST initiation and use in hospitalized patients. The aim of our study was to identify: (1) the appropriateness of AST in hospitalized patients and the cost associated with inappropriate use; and (2) patient and physician characteristics predicting inappropriate initiation and use of AST. METHODS: All discharges over a period of 8 consecutive days were selected. RESULTS: There were 207 patients discharged over a period of 8 days. AST was inappropriately initiated in 92 of 133 (69.2%) patients included in our study. On univariate analysis, higher hemoglobin value, postgraduate year 1 (PGY-1) residents, physicians with an MD degree, international medical graduates (IMGs), and internal medicine physicians were more likely to prescribe AST inappropriately. On multivariate analysis, a higher hemoglobin value, PGY-1 residents, and MD physicians were factors associated with inappropriate AST use. The total direct patient cost for this inappropriate use was $8026, with an estimated annual cost of approximately $366,000. CONCLUSIONS: AST was inappropriately initiated in 69.2% of patients with increased direct costs of $8026. Residents in their first year of training as well physicians with a MD degree are more likely to initiate AST inappropriately. Curtailing the inappropriate use of AST therapy may reduce overall costs for the patient and institution. Journal of Hospital Medicine 2009;4:E10,E14. © 2009 Society of Hospital Medicine. [source] Blast phase of essential thrombocythemia: A single center study,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Francesco Passamonti Blast phase (BP) may occur as a late event in essential thrombocythemia (ET). This study includes 19patients with post-ET BP diagnosed and followed in a single institution. At BP, 63% of patients had leukocytosis (white blood cell count >10 × 109/L), 74% had anemia (hemoglobin value <10 g/dL), 74% had thrombocytopenia (platelet count <100 × 109/L), and 84% were over 65 years of age. Cytogenetic analysis was available in 10 patients: six had karyotype aberrations. According to cytogenetic-based risk stratification of de novo acute leukemia (AL), all patients had an unfavorable profile. JAK2 (V617F) mutational status was evaluated in five patients. In two of them, the JAK2 mutation was undetectable in blast cells (one with JAK2 -positive ET), whereas in three both granulocytes and blast cells displayed the mutation. Treatment of BP was patient-based according to the performance status and co-morbidities and consisted of palliation in 14 patients, and of induction of remission in five. Median survival was 2.3 months (range 0.2,22.3), irrespective of the treatment received. In conclusion, this study indicates that AL evolved from ET has unfavorable clinical and biological features. JAK2 (V617F)-positive ET may evolve in few instances into JAK2 -negative leukemia. The outcome of patients is poor whatever the treatment used. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Spontaneous apoptosis in chronic lymphocytic leukemia and its relationship to clinical and cell kinetic parametersCYTOMETRY, Issue 6 2001Gislaine B. Oliveira Abstract Chronic lymphocytic leukemia (CLL) presents considerable variability in clinical presentation as well as in its evolution. In contrast to the inhibition of apoptosis in vivo, spontaneous apoptosis after short-term culture occurs. We studied the degree of this apoptosis in vitro, and its interactions with several clinical and laboratory parameters. Apoptosis was measured by the annexin V technique. Proliferation rate was evaluated by the AgNOR (nucleolar organizer regions) technique. There were inverse correlations between the percentage of annexin V-positive cells and peripheral lymphocyte count (r = - 0.49), Rai stage (r = - 0.40), Binet stage (r = - 0.50), TTM (total tumor mass score; r = - 0.51), and percentage of cells with one AgNOR cluster (r = - 0.45). Direct correlations were found with hemoglobin values ( r = 0.34) and platelet counts (r = 0.52). The number of CD8-positive cells showed a correlation with peripheral lymphocyte count (r = 0.49). When this variable was held constant, a correlation was detected between CD8-positive cells and staging (r = -0.47), TTM (r = - 0.42), and platelet count (r = 0.67). CD4-positive lymphocytes presented a correlation only with CD8-positive lymphocytes. In a cluster analysis, it was possible to create three groups of patients with different apoptosis rates using the TTM and AgNOR values. We conclude that, with the progression of the disease, together with the increase of tumor mass and proliferation rate, there is a decrease in the suceptibility to apoptosis. Cytometry (Comm. Clin. Cytometry) 46:329,335, 2001. © 2001 Wiley-Liss, Inc. [source] Safety of cesarean myomectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Byung-Joon Park Abstract Aim:, To examine the safety and appropriateness of uterine myomectomy during cesarean section. Methods:, We conducted a retrospective analysis of 97 patients who underwent myomectomy during cesarean section and 60 patients who had uterine myomas, but underwent cesarean section only, between January 2000 and December 2007. Based on the patients' medical records, we conducted an analysis of the characteristics of the uterine myomas, hematologic changes that occurred between the preoperative and postoperative phases, complications, and length of hospital stay. Results:, Changes in hemoglobin values between the preoperative and postoperative phases, indicating the degree of intraoperative bleeding, were evaluated. There were no significant differences between the two groups (cesarean myomectomy group [1.2 ± 1.2 g/dL] versus control group [1.1 ± 1.3 g/dL]). There were no significant differences in the frequency of blood transfusion, incidence of postoperative fever, duration of surgery, and length of hospital stay between the two groups. In patients who received a blood transfusion intraoperatively, the increased amount was added to the hemoglobin changes between the preoperative and postoperative phases (adjusted value). The difference in the adjusted value of hemoglobin change did not reach statistical significance (cesarean myomectomy group [1.3 ± 1.2 g/dL] versus control group [1.2 ± 1.1 g/dL]). When the size of the uterine myoma exceeded 6 cm, the operative time was longer in the cesarean myomectomy group. Conclusion:, Cesarean myomectomy is a safe surgical option with no significant complications if performed by an experienced practitioner. [source] | ||||||||||