1908. Development of an Electronic Health Record Generated Alert for Prophylaxis Against Pneumocystis Jirovecii Pneumonia in the Setting of High-Dose Steroids
Noopur GoyalEric GaskillStephanie A. SandersKencee GravesRussell J BenefieldDavid ElHaltaNicholas C LinkP. Cariello
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Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection associated with high dose steroid use in non-HIV patients. Many patients on high dose steroids (>20 mg prednisone equivalents for 28 days or longer), developed PJP within a month of steroid use. This study aims to develop an electronic alert for providers to consider PJP prophylaxis for patients discharged on high-dose steroids. Cases were obtained from the University of Utah Enterprise Data Warehouse between October 2014 and September 2017. A retrospective, manual chart review evaluated adults 18 years of age or older, with an inpatient PJP diagnosis made via direct fluorescent antibody or PCR. Patients with PJP due to HIV were excluded. Steroid dose and duration one month prior to diagnosis of PJP were evaluated. After retrospective analysis, via a multidisciplinary team, a best practice advisory (BPA) alert was created to flag providers to consider PJP prophylaxis at discharge, with consideration of creatinine levels and allergy profile to guide drug choices. The alert was trailed in a silent mode from January to April 2018 without provider notification so it could be modified to prevent inappropriate firing. The alert was approved for live use by the Clinical Decision Support Committee and is now active in the University of Utah Epic system as of April 10, 2018. In retrospective analysis, of 94 non-HIV patients diagnosed with PJP, 31/94 (33%) cases were in the setting of high dose steroids. 7/31 (23%) cases were exclusively with high dose steroids, while 24/31 (77%) cases were in combination with chemotherapy or other immune modulating agents. Data from the silent BPA from February to April 2018 demonstrated 23 cases triggered the alert, all of which were determined to be appropriate by chart review. Since live use, the BPA has fired 15 times, of which 14 cases met criteria for prophylaxis and 4/14 (29%) resulted in prophylaxis on discharge. Chart review identified high dose steroids as a target for a quality improvement intervention, which led to development of a BPA. Data indicates room for improvement on discharge with prophylaxis. Goals include reducing morbidity, mortality and cost associated with PJP, as well as educating providers regarding the need for prophylaxis. All authors: No reported disclosures.Keywords:
Medical record
Prednisolone
Liver disease
Chronic liver disease
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• A randomized, controlled trial of daily prednisone was conducted in 99 boys (aged 5 to 15 years) with Duchenne dystrophy to define the time course of improvement and the dose response to treatment. Prednisone at 0.3 mg/kg (n=33), prednisone at 0.75 mg/kg (n = 34), and placebo (n = 32) were administered for 6 months. Patients were examined using manual muscle and myometry testing, timed functional testing, pulmonary function testing, and laboratory measurements at 10 days, 1 month, 2 months, 3 months, and 6 months of treatment. Boys treated with prednisone had stronger average muscle strength scores, than did boys treated with placebo as early as 10 days after starting therapy. At the 3-month visit, the boys in the group given 0.75 mg/kg of prednisone were significantly stronger than those in the group given 0.3 mg/kg of prednisone, indicating a dose response. At 6 months, significant side effects occurred in the group treated with 0.75 mg/kg of prednisone, including weight gain, cushingoid appearance, and excessive hair growth. Only weight gain was observed in the group taking prednisone at a dose of 0.3 mg/kg. Importantly, no side effects were evident at 10 days or 1 month of treatment, despite improvement in muscle strength and function. We conclude that prednisone produces a rapid increase in muscle strength in patients with Duchenne dystrophy and that this improvement is maximal at a prednisone dosage of 0.75 mg/kg or less.
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The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP).Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone.Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group (p < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8-195 days), whereas that in the combination group was 14 days (range, 6-85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone.These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.
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THE AIM: to compare the parameters of physical development (PD) in children with idiopathic nephrotic syndrome (INS), depending on the treatment with prednisone. PATIENTS AND METHODS. The effect of treatment with prednisone on PD was analyzed in 60 children with INS aged from 2 to 17 years. The children were divided into 2 groups: 30 children who did not receive prednisone, and 30 children who received it during the last 6 months before the study (1st and 2nd group, respectively). The groups compared the anamnestic parameters and the risk factors of children in terms of length, weight, and body mass index. RESULTS. When comparing the characteristics of the risk factors of children of the above 2 groups, differences in body mass and BMI were established. In children who received prednisone for the last 6 months, body weight and BMI were significantly exceeded compared to WHO standards and similar patients who did not receive prednisone for the last 6 months. We have established a reliable association of the Z-BMI criterion with the cumulative dose of prednisone in the last 6 months: r = 0.49, p <0.05. At the same time, no reliable association of body weight with a cumulative dose of prednisone, which the child received before 6 months, has been identified. When analyzing the effectiveness of different doses of prednisone therapy for stopping relapses in children with steroid-sensitive INS, it was found that the onset and duration of remission did not significantly differ when taking standard (60mg/m 2 /day or 2 mg/kg/day) and half as much (1mg/kg/day) doses of prednisone. CONCLUSION. The relationship of the body mass of children with INS and the cumulative dose of prednisone in the last 6 months has been established. When treating a recurrent steroid-sensitive non-relapsing INS, a decrease in the daily dose of prednisone from 2 mg/kg/day to 1 mg/kg/day is possible in adolescents who are afraid of steroid obesity or who have had severe complications during previous courses of prednisone therapy.
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Objective:To analyze the effect of Cyclosporine A and prednisone in treatment of nephrotic syndrome.Methods:48 cases of nephrotic syndrome patients were divided into two groups randomly.The treatment group were given cyclosporine A and prednisone,the control group were given prednisone only.Compared the biochemical improvement and efficacy.Results:The control group improved 87.5%,the treatment group was 95.83%,it was significantly different (P 0.05).Conclusion:Cyclosporine A and prednisone in treatment of nephrotic syndrome,the effect is significant and safety,and has little adverse reaction.It is worthy of further using.
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SYNOPSIS Prednisone in peak doses of 10‐80 mg/day was employed for therapy in 19 patients with cluster headache. Overall, 14 of the 19 patients (73%) had greater than 50% relief and 11 (58%) had 100% relief from headache. The remaining 5 patients had less than 50% improvement. Of the subjects who were greater than 50% improved, 12 received peak doses of prednisone of 40 mg. or more, one received 30 mg. and one received 10 mg. The subjects with less than 50% improvement received peak prednisone doses of 10, 30, 40, 60 and 80 mg. Recurrence of cluster headache was noted in 79% of patients when the prednisone dose was tapered below 10–20 mg./d. Prednisone appears effective in relief of cluster headache but recurrence can be expected as the dose is reduced.
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Erythrocyte sedimentation rate
Tocilizumab
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Published outcome reports in neurosurgical literature frequently rely on data from retrospective review of hospital records at discharge, but the sensitivity and specificity of retrospective assessments of surgical morbidity is not known. The aim of this study was to elucidate the sensitivity and specificity of retrospective assessment of morbidity after intracranial tumor surgery by comparing it to patient-reported outcomes at 30 days.In 191 patients who underwent surgery for the treatment of intracranial tumors, we evaluated newly acquired neurological deficits within the motor, language, and cognitive domains. Traditional retrospective discharge data were collected by review of hospital records. Patient-reported data were obtained by structured phone interviews at 30 days after surgery. Data on perioperative medical and surgical complications were obtained from both hospital records and patient interviews conducted 30 days postoperatively.Sensitivity values for retrospective review of hospital records as compared with patient-reported outcomes were 0.52 for motor deficits, 0.4 for language deficits, and 0.07 for cognitive deficits. According to medical records, 158 patients were discharged with no new or worsened deficits, but only 117 (74%) of these patients confirmed this at 30 days after surgery. Specificity values were high (0.97-0.99), indicating that new deficits were unlikely to be found by retrospective review of hospital records at discharge when the patients did not report any at 30 days. Major perioperative complications were all identified through retrospective review of hospital records.Retrospective assessment of medical records at discharge from hospital may greatly underestimate the incidence of new neurological deficits after brain tumor surgery when compared with patient-reported outcomes after 30 days.
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