Predictive Value of Current Imaging Modalities for the Detection of Urolithiasis during Pregnancy: A...
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pediatric neurology centers in England. Among the 245 individ- uals who were identified, 75 met criteria for narcolepsy. Among those, 11 were vaccinated before onset of narcolepsy and 4 were vaccinated after first symptoms. Using the case coverage method, children with narcolepsy were 14 times more likely to have been vaccinated compared to those who did not have narcolepsy (odds ratio = 14.4, 95% confidence interval [CI] 4.3–48.5). When analysis was restricted to cases identified from October 1, 2009 and using the self-controlled case series method, the relative incidence of narcolepsy was 1.4% (95% CI 0.2–7.5). There is increased risk of narcolepsy after receiving vaccina- tion with ASO3 adjuvanted pandemic A/H1N1 2009 vaccine. [Lauren M. Abbate, MD, PHD Denver Health Medical Center, Denver, CO] Comment: This article evaluates the association between Pandemrix and narcolepsy, a rare condition, which makes it dif- ficult to study. Nonetheless, it is unclear why the authors used cases of narcolepsy from January 2008 when the vaccine was not introduced until October of 2009. This retrospective study is potentially affected by case ascertainment bias from providers aware of current concerns of narcolepsy in relation to the vac- cine in Scandinavia or around England. In addition, there were only a small number (n = 75) of cases. Although these find- ings are in agreement with other studies from Finland, a prospec- tive study would be more helpful in elucidating a causal relationship, albeit difficult to perform at this time. , CLINICAL PHARMACY INTERVENTION IN PEDI- ATRIC ELECTRONIC PRESCRIPTIONS. Maat B, Au YS, Bollen CW, et al. Arch Dis Child 2013;98:222–7. The objective of this study was to describe the frequency and determinants of clinical pharmacy interventions in pediatric electronic prescriptions and to determine the associations be- tween the determinants and the interventions. This was a prospective cohort with nested case-control study of patients aged 0–18 years admitted to a tertiary care children’s hospital in The Netherlands from March 1, 2004 through January 1, 2008. All electronic medication prescriptions were reviewed by clinical pharmacists and types of interventions, including completion of a prescription for patient identifiers such as weight; medication name; strength; dose; route of administration; frequency and duration and correction of pre- scriptions, defined as a change in prescription to avoid adverse consequences should the drug be administered as written, were recorded. A total of 138,449 prescriptions were written over the study period, of which 1577 (1.1%) required intervention. There were 2282 interventions, 431 (18.9%) of which were completions and 1851 (81.1%) were corrections. The majority of corrections (45.4%) were for a wrong dose, and 15.9% of corrections were made on antibiotic prescriptions. Free text entries were nearly five times more likely to require intervention (odds ratio 4.71; 95% confidence interval 3.61–6.13). Prescriptions written for younger children were also more likely to require intervention. Despite electronic prescribing, errors are not uncommon in pediatric prescriptions, and additional measures such as elimination of free text should be incorporated into electronic prescribing software to minimize errors. [Lauren M. Abbate, MD, PHD Denver Health Medical Center, Denver, CO] Comment: This study provides valuable insight into the qual- ity of electronic prescribing and reveals areas for improvement in electronic programs. However, there are various types of computerized physician order entry programs, which, if evalu- ated, may provide different results. Furthermore, this study does not provide information on provider status (i.e., resident vs. attending), which may affect outcomes. , PREDICTIVE VALUE OF CURRENT IMAGING MODALITIES FOR THE DETECTION OF UROLITH- IASIS DURING PREGNANCY: A MULTICENTER, LONGITUDINAL STUDY. White WM, Johnson EB, Zite NB, et al. J Urol 2013;189:931–4. The objective of this study was to determine the most appro- priate imaging study to identify urolithiasis in pregnant women. Data were from a multicenter retrospective study designed to determine the risk of obstetric complications after ureteroscopy for this post hoc analysis and included patients who underwent ureteroscopy for suspected urolithiasis at one of five tertiary academic centers. Women were evaluated for urolithiasis with renal ultrasound (RUS) alone, RUS plus low-dose computed to- mography (CT), or RUS plus magnetic resonance (MR) urogra- phy and, when indicated, underwent ureteroscopy. Fifty-one women, mean age and mean gestational age of 27 years (range 18–42 years) and 24.4 weeks (range 9–35 weeks), respectively, underwent ureteroscopy. Of these, a stone was found in 44 (86%) cases. Before ureteroscopy, 24 (47%) had RUS alone, 22 (43%) underwent RUS plus low-dose CT, and 5 (10%) under- went RUS and MR urography. The positive predictive values (PPV) were estimated to be 77% for RUS alone, 95.8% for RUS plus low-dose CT,and 80% for RUS plus MR urography. In conclusion, RUS alone was found to have the lowest PPV for identifying urolithiasis, and the addition of other modalities such as low-dose CT may improve identification and decrease the need for unnecessary procedures. [Lauren M. Abbate, MD, PHD Denver Health Medical Center, Denver, CO] Comment: This study suggests that unnecessary procedures may be avoided in pregnancy by using low-dose CT for identi- fying urolithiasis, however, this study is retrospective study of women who received ureteroscopy at one center and the authors did not define criteria for ureteroscopy, such as size or location of stone or patient’s symptoms. In addition, only five women un- derwent MR urography, so additional studies would have to evaluate this further as MR is potentially a safer option than CT for pregnant women. , RELATION OF B-TYPE NATRIURETIC PEPTIDE LEVEL IN HEART FAILURE TO SUDDEN CARDIAC DEATH IN PATIENTS WITH AND WITHOUT QT INTERVAL PROLONGATION. Vrtovec B, Knezevic I, Poglajen G, et al. Am J Cardiol 2013;111:886–90. 1216 Abstracts
Transcript of Predictive Value of Current Imaging Modalities for the Detection of Urolithiasis during Pregnancy: A...
1216 Abstracts
pediatric neurology centers in England. Among the 245 individ-uals who were identified, 75 met criteria for narcolepsy. Amongthose, 11 were vaccinated before onset of narcolepsy and 4 werevaccinated after first symptoms. Using the case coveragemethod, children with narcolepsy were 14 times more likelyto have been vaccinated compared to those who did not havenarcolepsy (odds ratio = 14.4, 95% confidence interval [CI]4.3–48.5). When analysis was restricted to cases identifiedfrom October 1, 2009 and using the self-controlled case seriesmethod, the relative incidence of narcolepsy was 1.4% (95%CI 0.2–7.5).
There is increased risk of narcolepsy after receiving vaccina-tion with ASO3 adjuvanted pandemic A/H1N1 2009 vaccine.
[Lauren M. Abbate, MD, PHDDenver Health Medical Center, Denver, CO]
Comment: This article evaluates the association betweenPandemrix and narcolepsy, a rare condition, which makes it dif-ficult to study. Nonetheless, it is unclear why the authors usedcases of narcolepsy from January 2008 when the vaccine wasnot introduced until October of 2009. This retrospective studyis potentially affected by case ascertainment bias from providersaware of current concerns of narcolepsy in relation to the vac-cine in Scandinavia or around England. In addition, therewere only a small number (n = 75) of cases. Although these find-ings are in agreement with other studies fromFinland, a prospec-tive study would be more helpful in elucidating a causalrelationship, albeit difficult to perform at this time.
, CLINICAL PHARMACY INTERVENTION IN PEDI-ATRIC ELECTRONIC PRESCRIPTIONS.Maat B, Au YS,Bollen CW, et al. Arch Dis Child 2013;98:222–7.
The objective of this study was to describe the frequency anddeterminants of clinical pharmacy interventions in pediatricelectronic prescriptions and to determine the associations be-tween the determinants and the interventions.
This was a prospective cohort with nested case-control studyof patients aged 0–18 years admitted to a tertiary care children’shospital in The Netherlands from March 1, 2004 throughJanuary 1, 2008. All electronic medication prescriptions werereviewed by clinical pharmacists and types of interventions,including completion of a prescription for patient identifierssuch as weight; medication name; strength; dose; route ofadministration; frequency and duration and correction of pre-scriptions, defined as a change in prescription to avoid adverseconsequences should the drug be administered as written, wererecorded.
A total of 138,449 prescriptions were written over the studyperiod, of which 1577 (1.1%) required intervention. Therewere 2282 interventions, 431 (18.9%)ofwhichwere completionsand 1851 (81.1%) were corrections. The majority of corrections(45.4%) were for a wrong dose, and 15.9% of corrections weremade on antibiotic prescriptions. Free text entries were nearlyfive times more likely to require intervention (odds ratio 4.71;95% confidence interval 3.61–6.13). Prescriptions written foryounger children were also more likely to require intervention.
Despite electronic prescribing, errors are not uncommonin pediatric prescriptions, and additional measures such as
elimination of free text should be incorporated into electronicprescribing software to minimize errors.
[Lauren M. Abbate, MD, PHDDenver Health Medical Center, Denver, CO]
Comment: This study provides valuable insight into the qual-ity of electronic prescribing and reveals areas for improvementin electronic programs. However, there are various types ofcomputerized physician order entry programs, which, if evalu-ated, may provide different results. Furthermore, this studydoes not provide information on provider status (i.e., residentvs. attending), which may affect outcomes.
, PREDICTIVE VALUE OF CURRENT IMAGINGMODALITIES FOR THE DETECTION OF UROLITH-IASIS DURING PREGNANCY: A MULTICENTER,LONGITUDINAL STUDY.WhiteWM, Johnson EB, Zite NB,et al. J Urol 2013;189:931–4.
The objective of this study was to determine the most appro-priate imaging study to identify urolithiasis in pregnant women.
Data were from amulticenter retrospective study designed todetermine the risk of obstetric complications after ureteroscopyfor this post hoc analysis and included patients who underwentureteroscopy for suspected urolithiasis at one of five tertiaryacademic centers. Women were evaluated for urolithiasis withrenal ultrasound (RUS) alone, RUS plus low-dose computed to-mography (CT), or RUS plus magnetic resonance (MR) urogra-phy and, when indicated, underwent ureteroscopy. Fifty-onewomen, mean age and mean gestational age of 27 years (range18–42 years) and 24.4 weeks (range 9–35 weeks), respectively,underwent ureteroscopy. Of these, a stone was found in 44(86%) cases. Before ureteroscopy, 24 (47%) had RUS alone,22 (43%) underwent RUS plus low-dose CT, and 5 (10%) under-went RUS and MR urography. The positive predictive values(PPV) were estimated to be 77% for RUS alone, 95.8% forRUS plus low-dose CT, and 80% for RUS plus MR urography.
In conclusion, RUS alone was found to have the lowest PPVfor identifying urolithiasis, and the addition of other modalitiessuch as low-dose CT may improve identification and decreasethe need for unnecessary procedures.
[Lauren M. Abbate, MD, PHDDenver Health Medical Center, Denver, CO]
Comment: This study suggests that unnecessary proceduresmay be avoided in pregnancy by using low-dose CT for identi-fying urolithiasis, however, this study is retrospective study ofwomen who received ureteroscopy at one center and the authorsdid not define criteria for ureteroscopy, such as size or locationof stone or patient’s symptoms. In addition, only fivewomen un-derwent MR urography, so additional studies would have toevaluate this further as MR is potentially a safer option thanCT for pregnant women.
, RELATION OF B-TYPE NATRIURETIC PEPTIDELEVEL IN HEART FAILURE TO SUDDEN CARDIACDEATH IN PATIENTS WITH AND WITHOUT QTINTERVAL PROLONGATION. Vrtovec B, Knezevic I,Poglajen G, et al. Am J Cardiol 2013;111:886–90.
