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  1. Article ; Online: Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults.

    Hughes, Kailey / Middleton, Donald B / Nowalk, Mary Patricia / Balasubramani, Goundappa K / Martin, Emily T / Gaglani, Manjusha / Talbot, H Keipp / Patel, Manish M / Ferdinands, Jill M / Zimmerman, Richard K / Silveira, Fernanda P

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2021  Volume 73, Issue 11, Page(s) e4353–e4360

    Abstract: Background: Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the nonimmunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE ... ...

    Abstract Background: Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the nonimmunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults.
    Methods: We analyzed data from adults ≥ 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using prespecified case definitions using electronic medical record data. VE was evaluated with a test-negative case-control design using multivariable logistic regression with polymerase chain reaction-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations.
    Results: Of 3524 adults hospitalized with ARI, 1210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%) and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years of age). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% confidence interval [CI], 21-44). VE among IC vs non-IC adults was lower at 5% (95% CI, -29% to 31%) vs 41% (95% CI, 27-52) (P < .05 for interaction term).
    Conclusions: VE in 1 influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.
    MeSH term(s) Adult ; Case-Control Studies ; Hospitalization ; Humans ; Influenza Vaccines ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Laboratories ; Middle Aged ; Seasons ; United States/epidemiology ; Vaccination
    Chemical Substances Influenza Vaccines
    Language English
    Publishing date 2021-01-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciaa1927
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  2. Article ; Online: A learning health system approach to the COVID-19 pandemic: System-wide changes in clinical practice and 30-day mortality among hospitalized patients.

    McCreary, Erin K / Kip, Kevin E / Bariola, J Ryan / Schmidhofer, Mark / Minnier, Tami / Mayak, Katelyn / Albin, Debbie / Daley, Jessica / Linstrum, Kelsey / Hernandez, Erik / Sackrowitz, Rachel / Hughes, Kailey / Horvat, Christopher / Snyder, Graham M / McVerry, Bryan J / Yealy, Donald M / Huang, David T / Angus, Derek C / Marroquin, Oscar C

    Learning health systems

    2022  Volume 6, Issue 3, Page(s) e10304

    Abstract: Introduction: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID-19) pandemic created a new threat to this common "slow to learn ... ...

    Abstract Introduction: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID-19) pandemic created a new threat to this common "slow to learn and adapt" model in healthcare. We describe how the University of Pittsburgh Medical Center (UPMC) committed to a rapid learning health system (LHS) model to respond to the COVID-19 pandemic.
    Methods: A treatment cohort study was conducted among 11 429 hospitalized patients (pediatric/adult) from 22 hospitals (PA, NY) with a primary diagnosis of COVID-19 infection (March 19, 2020 - June 6, 2021). Sociodemographic and clinical data were captured from UPMC electronic medical record (EMR) systems. Patients were grouped into four time-defined patient "waves" based on nadir of daily hospital admissions, with wave 3 (September 20, 2020 - March 10, 2021) split at its zenith due to high volume with steep acceleration and deceleration. Outcomes included changes in clinical practice (eg, use of corticosteroids, antivirals, and other therapies) in relation to timing of internal system analyses, scientific publications, and regulatory approvals, along with 30-day rate of mortality over time.
    Results: The mean (SD) daily number of admissions across hospitals was 26 (29) with a maximum 7-day moving average of 107 patients. System-wide implementation of the use of dexamethasone, remdesivir, and tocilizumab occurred within days of release of corresponding seminal publications and regulatory actions. After adjustment for differences in patient clinical profiles over time, each month of hospital admission was associated with an estimated 5% lower odds of 30-day mortality (adjusted odds ratio [OR] = 0.95, 95% confidence interval: 0.93-0.97,
    Conclusions: In our large LHS, near real-time changes in clinical management of COVID-19 patients happened promptly as scientific publications and regulatory approvals occurred throughout the pandemic. Alongside these changes, patients with COVID-19 experienced lower adjusted 30-day mortality following hospital admission over time.
    Language English
    Publishing date 2022-01-27
    Publishing country United States
    Document type Journal Article
    ISSN 2379-6146
    ISSN (online) 2379-6146
    DOI 10.1002/lrh2.10304
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  3. Article ; Online: A Learning Health System Approach to the COVID-19 Pandemic: System-Wide Changes in Clinical Practice and 30-Day Mortality Among Hospitalized Patients

    McCreary, Erin J. / Kip, Kevin E / Bariola, J. Ryan / Schmidhofer, Mark / Minnier, Tami / Mayak, Katelyn / Albin, Debbie / Daley, Jessica / Linstrum, Kelsey / Hernandez, Erik / Sackrowitz, Rachel / Hughes, Kailey / Horvat, Christopher / Snyder, Graham M / McVerry, Bryan J / Yealy, Donald M / Huang, David T / Angus, Derek C / Marroquin, Oscar C

    medRxiv

    Abstract: Introduction: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The COVID 19 pandemic created a new threat to this common 9slow to learn and adapt9 model in ... ...

    Abstract Introduction: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The COVID 19 pandemic created a new threat to this common 9slow to learn and adapt9 model in healthcare. We describe how UPMC committed to a rapid learning health system (LHS) model to respond to the COVID 19 pandemic. Methods: An observational cohort study was conducted among 11,429 hospitalized patients from 22 hospitals (PA, NY) with a primary diagnosis of COVID 19 infection (March 19, 2020 to June 6, 2021). Sociodemographic and clinical data were captured from UPMC electronic medical record (EMR) systems. Patients were grouped into four time-defined patient 9waves9 based on nadir of daily hospital admissions, with wave 3 (September 20, 2020 to March 10, 2021) split at its zenith due to high volume with steep acceleration and deceleration. Outcomes included changes in clinical practice (e.g., use of corticosteroids, antivirals, and other therapies) in relation to timing of internal system analyses, scientific publications, and regulatory approvals, along with 30-day rate of mortality over time. Results: Mean (SD) daily number of hospital admissions was 26 (28) with a maximum 7 day moving average of 107 patients. System wide implementation of the use of dexamethasone, remdesivir, and tocilizumab occurred within days of release of corresponding seminal publications and regulatory actions. After adjustment for differences in patient clinical profiles over time, each month of hospital admission was associated with an estimated 5% lower odds of 30 day mortality (adjusted OR = 0.95, 95% confidence interval: 0.92 to 0.97, p < .001). Conclusions: In our large LHS, near real-time changes in clinical management of COVID 19 patients happened promptly as scientific publications and regulatory approvals occurred throughout the pandemic. Alongside these changes, patients with COVID 19 experienced lower adjusted 30 day mortality following hospital admission over time.
    Keywords covid19
    Language English
    Publishing date 2021-08-28
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.08.26.21262661
    Database COVID19

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  4. Article ; Online: Brief Report: Willingness to Accept HIV-Infected and Increased Infectious Risk Donor Organs Among Transplant Candidates Living With HIV.

    Seaman, Shanti M / Van Pilsum Rasmussen, Sarah E / Nguyen, Anh Q / Halpern, Samantha E / You, Susan / Waldram, Madeleine M / Anjum, Saad K / Bowring, Mary Grace / Muzaale, Abimereki D / Ostrander, Darin B / Brown, Diane / Massie, Allan B / Tobian, Aaron A R / Henderson, Macey L / Fletcher, Faith E / Smith, Burke / Chao, Ada / Gorupati, Nishita / Prakash, Katya /
    Aslam, Saima / Lee, Dong H / Kirchner, Varvara / Pruett, Timothy L / Haidar, Ghady / Hughes, Kailey / Malinis, Maricar / Trinh, Sonya / Segev, Dorry L / Sugarman, Jeremy / Durand, Christine M

    Journal of acquired immune deficiency syndromes (1999)

    2020  Volume 85, Issue 1, Page(s) 88–92

    Abstract: Background: HIV-infected (HIV+) donor to HIV+ recipient (HIV D+/R+) transplantation might improve access to transplantation for people living with HIV. However, it remains unknown whether transplant candidates living with HIV will accept the currently ... ...

    Abstract Background: HIV-infected (HIV+) donor to HIV+ recipient (HIV D+/R+) transplantation might improve access to transplantation for people living with HIV. However, it remains unknown whether transplant candidates living with HIV will accept the currently unknown risks of HIV D+/R+ transplantation.
    Methods: We surveyed transplant candidates living with HIV from 9 US transplant centers regarding willingness to accept HIV+ donor organs.
    Results: Among 116 participants, the median age was 55 years, 68% were men, and 78% were African American. Most were willing to accept HIV+ living donor organs (87%), HIV+ deceased donor organs (84%), and increased infectious risk donor organs (70%). Some (30%) were concerned about HIV superinfection; even among these respondents, 71% were willing to accept an HIV D+ organ. Respondents from centers that had already performed a transplant under an HIV D+/R+ transplantation research protocol were more willing to accept HIV+ deceased donor organs (89% vs. 71%, P = 0.04). Respondents who chose not to enroll in an HIV D+/R+ transplantation research protocol were less likely to believe that HIV D+/R+ transplantation was safe (45% vs. 77%, P = 0.02), and that HIV D+ organs would work similar to HIV D- organs (55% vs. 77%, P = 0.04), but more likely to believe they would receive an infection other than HIV from an HIV D+ organ (64% vs. 13%, P < 0.01).
    Conclusions: Willingness to accept HIV D+ organs among transplant candidates living with HIV does not seem to be a major barrier to HIV D+/R+ transplantation and may increase with growing HIV D+/R+ transplantation experience.
    MeSH term(s) Female ; HIV Infections/virology ; HIV-1 ; Humans ; Male ; Middle Aged ; Organ Transplantation ; Risk Factors ; Tissue Donors ; Transplant Recipients ; Transplants/microbiology ; Transplants/virology
    Language English
    Publishing date 2020-05-19
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 645053-2
    ISSN 1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
    ISSN (online) 1944-7884 ; 1077-9450
    ISSN 0897-5965 ; 0894-9255 ; 1525-4135
    DOI 10.1097/QAI.0000000000002405
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    Zs.A 2442: Show issues Location:
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  5. Article ; Online: COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study.

    Heldman, Madeleine R / Kates, Olivia S / Safa, Kassem / Kotton, Camille N / Georgia, Sarah J / Steinbrink, Julie M / Alexander, Barbara D / Hemmersbach-Miller, Marion / Blumberg, Emily A / Crespo, Maria M / Multani, Ashrit / Lewis, Angelica V / Eugene Beaird, Omer / Haydel, Brandy / La Hoz, Ricardo M / Moni, Lisset / Condor, Yesabeli / Flores, Sandra / Munoz, Carlos G /
    Guitierrez, Juan / Diaz, Esther I / Diaz, Daniela / Vianna, Rodrigo / Guerra, Giselle / Loebe, Matthias / Rakita, Robert M / Malinis, Maricar / Azar, Marwan M / Hemmige, Vagish / McCort, Margaret E / Chaudhry, Zohra S / Singh, Pooja / Hughes, Kailey / Velioglu, Arzu / Yabu, Julie M / Morillis, Jose A / Mehta, Sapna A / Tanna, Sajal D / Ison, Michael G / Tomic, Rade / Candace Derenge, Ariella / van Duin, David / Maximin, Adrienne / Gilbert, Carlene / Goldman, Jason D / Sehgal, Sameep / Weisshaar, Dana / Girgis, Reda E / Nelson, Joanna / Lease, Erika D / Limaye, Ajit P / Fisher, Cynthia E

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

    2021  Volume 21, Issue 8, Page(s) 2774–2784

    Abstract: Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been ... ...

    Abstract Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.
    MeSH term(s) Adult ; Aged ; COVID-19 ; Cohort Studies ; Humans ; Lung ; Organ Transplantation/adverse effects ; SARS-CoV-2 ; Transplant Recipients
    Language English
    Publishing date 2021-07-24
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
    ZDB-ID 2060594-8
    ISSN 1600-6143 ; 1600-6135
    ISSN (online) 1600-6143
    ISSN 1600-6135
    DOI 10.1111/ajt.16692
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  6. Article ; Online: Coronavirus Disease 2019 in Solid Organ Transplant

    Kates, Olivia S / Haydel, Brandy M / Florman, Sander S / Rana, Meenakshi M / Chaudhry, Zohra S / Ramesh, Mayur S / Safa, Kassem / Kotton, Camille Nelson / Blumberg, Emily A / Besharatian, Behdad D / Tanna, Sajal D / Ison, Michael G / Malinis, Maricar / Azar, Marwan M / Rakita, Robert M / Morilla, Jose A / Majeed, Aneela / Sait, Afrah S / Spaggiari, Mario /
    Hemmige, Vagish / Mehta, Sapna A / Neumann, Henry / Badami, Abbasali / Goldman, Jason D / Lala, Anuradha / Hemmersbach-Miller, Marion / McCort, Margaret E / Bajrovic, Valida / Ortiz-Bautista, Carlos / Friedman-Moraco, Rachel / Sehgal, Sameep / Lease, Erika D / Fisher, Cynthia E / Limaye, Ajit P / Arya, Akanksha / Jeng, Amy / Kuo, Alexander / Luk, Alfred / Puing, Alfredo G / Rossi, Ana P / Brueckner, Andrew J / Multani, Ashrit / Keller, Brian C / Derringer, Darby / Florescu, Diana F / Dominguez, Edward A / Sandoval, Elena / Bilgili, Erin P / Hashim, Faris / Silveira, Fernanda P / Haidar, Ghady / Joharji, Hala G / Murad, Haris F / Gani, Imran Yaseen / el-amm, Jose-Marie / Kahwaji, Joseph / Popoola, Joyce / Yabu, Julie M / Hughes, Kailey / Saharia, Kapil K / Gajurel, Kiran / Bowman, Lyndsey J / Veroux, Massimiliano / Morales, Megan K / Fung, Monica / Theodoropoulos, Nicole M / de la Cruz, Oveimar / Kapoor, Rajan / La Hoz, Ricardo M / Allam, Sridhar R / Vora, Surabhi B / McCarty, Todd P / Anderson-Haag, Tracy / Malhotra, Uma / Kelly, Ursula M / Bhandaram, Vidya / Bennett, William M / Lominadze, Zurabi

    Clinical Infectious Diseases ; ISSN 1058-4838 1537-6591

    A Multicenter Cohort Study

    2020  

    Abstract: Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, ... ...

    Abstract Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described. Methods We performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46–57), median time post-transplant was 5 years (IQR 2–10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7–5.5, P < .001], congestive heart failure [aOR 3.2, 95% CI 1.4–7.0, P = .004], chronic lung disease [aOR 2.5, 95% CI 1.2–5.2, P = .018], obesity [aOR 1.9, 95% CI 1.0–3.4, P = .039]) and presenting findings (lymphopenia [aOR 1.9, 95% CI 1.1–3.5, P = .033], abnormal chest imaging [aOR 2.9, 95% CI 1.1–7.5, P = .027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
    Keywords Microbiology (medical) ; Infectious Diseases ; covid19
    Language English
    Publisher Oxford University Press (OUP)
    Publishing country uk
    Document type Article ; Online
    DOI 10.1093/cid/ciaa1097
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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