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Li Zhou - One of the best experts on this subject based on the ideXlab platform.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Yu Li, Li ZhouAbstract:Background The epidemiology of Multiple Drug Intolerance Syndrome (MDIS) and Multiple Drug Allergy Syndrome (MDAS) are poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Li ZhouAbstract:Background The epidemiology of multiple Drug Intolerance syndrome (MDIS) and multiple Drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. Methods Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had Intolerances to ≥3 Drug classes, and patients with MDAS had hypersensitivities to ≥2 Drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. Results Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). Conclusion While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
Gunther Schadow - One of the best experts on this subject based on the ideXlab platform.
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structured product labeling improves detection of Drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) Drug knowledge representation standard and its associated terminology sources for Drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE Drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of Drug-Intolerance (allergy) records, Drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of Drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct Drugs, and number of distinct Intolerances. The difference between Drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble Drug-Intolerance decision support and suggests how terminology and methods of recording Drug Intolerances could be improved.
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structured product labeling improves detection of Drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Objectives: This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) Drug knowledge representation standard and its associated terminology sources for Drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design: The Regenstrief Institute CPOE Drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of Drug-Intolerance (allergy) records, Drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements: The number of Drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct Drugs, and number of distinct Intolerances. The difference between Drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results: Although <70% of terms were mapped to SPL, the new approach detected four times as many Drug-Intolerance issues on twice as many patients. Conclusion: The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble Drug-Intolerance decision support and suggests how terminology and methods of recording Drug Intolerances could be improved.
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structured product labeling improves detection of Drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) Drug knowledge representation standard and its associated terminology sources for Drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE Drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of Drug-Intolerance (allergy) records, Drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of Drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct Drugs, and number of distinct Intolerances. The difference between Drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble Drug-Intolerance decision support and suggests how terminology and methods of recording Drug Intolerances could be improved.
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structured product labeling improves detection of Drug Intolerance issues
American Medical Informatics Association Annual Symposium, 2008Co-Authors: Gunther SchadowAbstract:The HL7 Structured Product Labeling (SPL) standard1 implemented by the FDA uses the HL7 Reference Information Model (RIM)2 to represent the chemical and physical nature of medical products and their safe and effective use. While not all of this content is available today, we enrich the 3704 available SPLs with knowledge from the SPL terminology sources, including the VA’s NDF-RT3 and MeSH. To demonstrate the value of SPL for clinical decision support, we compared the performance of Drug-Intolerance (allergy) issue detection using SPL with the Regenstrief Institute (RI) own CPOE system, Gopher4 and its knowledge base.
Kimberly G Blumenthal - One of the best experts on this subject based on the ideXlab platform.
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high cost high need patients the impact of reported penicillin allergy
The American Journal of Managed Care, 2020Co-Authors: Kimberly G Blumenthal, Christian M Mancini, Xiaoqing Fu, Nicolas M Oreskovic, Fatma M Shebl, Jennifer Maniates, Rochelle P WalenskyAbstract:OBJECTIVES: More than 90% of patients who report a penicillin allergy have the allergy disproved when tested. Unnecessary use of alternative (non-beta-lactam) antibiotics can result in more treatment failures and adverse reactions. We described the prevalence and impact of a reported penicillin allergy in high-cost, high-need (HCHN) patients. STUDY DESIGN: Retrospective cohort. METHODS: We identified HCHN patients in a care management program of an urban academic medical center (January 1, 2014, to December 31, 2016). We used multivariable logistic regression models to determine the association between a reported penicillin allergy and antibiotic use. We used multivariable Poisson regression models to determine the association between a reported penicillin allergy, with or without multiple Drug Intolerance syndrome (MDIS; ≥3 reported Drug allergies), and healthcare resource utilization (HRU). RESULTS: Of 1870 HCHN patients, 383 (20%) reported penicillin allergy, 835 (45%) had MDIS, and 290 (16%) had both. HCHN patients reporting penicillin allergy had an increased odds of beta-lactam alternative antibiotic use (adjusted odds ratio, 3.84; 95% CI, 2.17-6.80). HRU was significantly higher for patients reporting a penicillin allergy alone (adjusted relative risk [aRR], 1.13; 95% CI, 1.03-1.25) and with concurrent MDIS (aRR, 1.20; 95% CI, 1.08-1.34). CONCLUSIONS: HCHN patients had a high burden of reported Drug allergy. A reported penicillin allergy conferred a 4-fold increased odds of beta-lactam alternative antibiotic use. Reporting penicillin allergy, with and without MDIS, was associated with significantly more HRU. HCHN care management programs should consider systematic Drug allergy evaluations to optimize antibiotic use in these fragile patients.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Yu Li, Li ZhouAbstract:Background The epidemiology of Multiple Drug Intolerance Syndrome (MDIS) and Multiple Drug Allergy Syndrome (MDAS) are poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Li ZhouAbstract:Background The epidemiology of multiple Drug Intolerance syndrome (MDIS) and multiple Drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. Methods Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had Intolerances to ≥3 Drug classes, and patients with MDAS had hypersensitivities to ≥2 Drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. Results Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). Conclusion While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
Thomas R Spitzer - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized trial comparing the toxicity and safety of atovaquone with trimethoprim sulfamethoxazole as pneumocystis carinii pneumonia prophylaxis following autologous peripheral blood stem cell transplantation
Bone Marrow Transplantation, 1999Co-Authors: Christine Colby, Steven L Mcafee, Robert Sackstein, Dianne M Finkelstein, Jay A Fishman, Thomas R SpitzerAbstract:Pneumonia due to Pneumocystis carinii is an infrequent complication following autologous stem cell transplantation (ASCT) which is associated with a high mortality. Although administration of trimethoprim/sulfa- methoxazole (TMP/SMX) is an effective prophylactic strategy for Pneumocystis carinii pneumonia (PCP), treatment-associated toxicity frequently results in discontinuation of therapy. We have conducted a prospective randomized trial comparing atovaquone, a new anti-Pneumocystis agent, with TMP/SMX for PCP prophylaxis following autologous peripheral blood stem cell (PBSC) transplantation. Thirty-nine patients were studied. Twenty patients received atovaquone suspension and 19 patients received TMP/SMX. The median ages were 44 (range 20–68) and 47 (range 32–63) years, respectively. A similar number of patients with solid tumors (14 vs 15) and hematologic malignancies (five vs five) were treated in each group. Either TMP/SMX (160/800 mg) or atovaquone (1500 mg) was administered daily from transplant day −5 until day −1, discontinued from day 0 to engraftment, then resumed 3 days per week until day +100 post-transplant. The median time to engraftment (ANC >0.5 × 109/l) was similar in both groups. Eighty percent of the patients randomized to atovaquone prophylaxis completed the study. Four atovaquone-treated patients were removed from study; two patients (10%) did not receive a transplant and two patients (10%) were removed due to a protocol violation. None of the 16 patients treated with atovaquone experienced treatment-associated adverse effects. Of the 19 patients randomized to receive TMP/SMX, 55% completed the study. Nine TMP/SMX-treated patients were removed from the study; one patient (5%) did not receive a transplant and eight patients (40%) were removed due to Drug Intolerance (P < 0.003). the rate of Intolerance to tmp/smx led to the early discontinuation of this randomized trial. Intolerance of tmp/smx included elevated transaminase levels (n = 1), nausea or vomiting (n = 3), thrombocytopenia (n = 2) and neutropenia (n = 2). All episodes of TMP/SMP Intolerance occurred following transplantation after a median duration of 17.5 (range 2–48) days and a median of 7 (range 1–20) doses. Resolution of adverse side-effects occurred in all eight patients within a median of 7 (range 2–20) days following discontinuation of therapy. Neither PCP nor bacterial infections were identified in any of the patients treated. This prospective randomized study demonstrated that atovaquone is well-tolerated for anti-Pneumocystis prophylaxis in autologous PBSC transplant patients intolerant of TMP/SMX.
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a prospective randomized trial comparing the toxicity and safety of atovaquone with trimethoprim sulfamethoxazole as pneumocystis carinii pneumonia prophylaxis following autologous peripheral blood stem cell transplantation
Bone Marrow Transplantation, 1999Co-Authors: Christine Colby, Steven L Mcafee, Robert Sackstein, Dianne M Finkelstein, Jay A Fishman, Thomas R SpitzerAbstract:Pneumonia due to Pneumocystis carinii is an infrequent complication following autologous stem cell transplantation (ASCT) which is associated with a high mortality. Although administration of trimethoprim/sulfa- methoxazole (TMP/SMX) is an effective prophylactic strategy for Pneumocystis carinii pneumonia (PCP), treatment-associated toxicity frequently results in discontinuation of therapy. We have conducted a prospective randomized trial comparing atovaquone, a new anti-Pneumocystis agent, with TMP/SMX for PCP prophylaxis following autologous peripheral blood stem cell (PBSC) transplantation. Thirty-nine patients were studied. Twenty patients received atovaquone suspension and 19 patients received TMP/SMX. The median ages were 44 (range 20-68) and 47 (range 32-63) years, respectively. A similar number of patients with solid tumors (14 vs 15) and hematologic malignancies (five vs five) were treated in each group. Either TMP/SMX (160/800 mg) or atovaquone (1500 mg) was administered daily from transplant day -5 until day -1, discontinued from day 0 to engraftment, then resumed 3 days per week until day +100 post-transplant. The median time to engraftment (ANC >0.5 x 109/l) was similar in both groups. Eighty percent of the patients randomized to atovaquone prophylaxis completed the study. Four atovaquone-treated patients were removed from study; two patients (10%) did not receive a transplant and two patients (10%) were removed due to a protocol violation. None of the 16 patients treated with atovaquone experienced treatment-associated adverse effects. Of the 19 patients randomized to receive TMP/SMX, 55% completed the study. Nine TMP/SMX-treated patients were removed from the study; one patient (5%) did not receive a transplant and eight patients (40%) were removed due to Drug Intolerance (P < 0.003). The rate of Intolerance to TMP/SMX led to the early discontinuation of this randomized trial. Intolerance of TMP/SMX included elevated transaminase levels (n = 1), nausea or vomiting (n = 3), thrombocytopenia (n = 2) and neutropenia (n = 2). All episodes of TMP/SMP Intolerance occurred following transplantation after a median duration of 17.5 (range 2-48) days and a median of 7 (range 1-20) doses. Resolution of adverse side-effects occurred in all eight patients within a median of 7 (range 2-20) days following discontinuation of therapy. Neither PCP nor bacterial infections were identified in any of the patients treated. This prospective randomized study demonstrated that atovaquone is well-tolerated for anti-Pneumocystis prophylaxis in autologous PBSC transplant patients intolerant of TMP/SMX.
Warren W Acker - One of the best experts on this subject based on the ideXlab platform.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Yu Li, Li ZhouAbstract:Background The epidemiology of Multiple Drug Intolerance Syndrome (MDIS) and Multiple Drug Allergy Syndrome (MDAS) are poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression.
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multiple Drug Intolerance syndrome and multiple Drug allergy syndrome epidemiology and associations with anxiety and depression
Allergy, 2018Co-Authors: Kimberly G Blumenthal, Warren W Acker, Aleena Banerji, Yuchiao Chang, Sharmin Ghaznavi, Carlos A Camargo, Li ZhouAbstract:Background The epidemiology of multiple Drug Intolerance syndrome (MDIS) and multiple Drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. Methods Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had Intolerances to ≥3 Drug classes, and patients with MDAS had hypersensitivities to ≥2 Drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. Results Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). Conclusion While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
