Physician Queries Research Articles

Interoperability approach for Hospital Information Systems based on the composition of web services

Nowadays, many health centers use Hospital Information Systems (HIS) for the daily management of center activities such as patient data management. In Burkina Faso, many HIS are used for patient data management but these systems cannot cooperate because the data sources are often heterogeneous. In order to guarantee a better diagnosis in patient management, physicians need to access these data sources in a unique way through queries. For better analysis of a patient's situation, the health worker may want to access multiple data sources that do not belong to the same health center. This is only possible if the HIS involved interoperate. In a previous work, we proposed an interoperability architecture based on semantic web services. This solution has the advantage of not modifying the current organization of health centers. Indeed, for a complex query, a composition of web services is a solution to satisfy different needs. In this paper, we detail our approach for composing semantic web services. In our approach, the functionalities of each HIS application will be implemented by a web service semantically annotated by an ontology. An ontology-based mediation service is used to enrich the physician query and the MiniCon algorithm to create a composite web service. The composite web service is executed to return the requested data.

Safety and Efficacy of Kartigen® in Treating Cartilage Defects: A Randomized, Controlled, Phase I Trial.

Here, we aimed to investigate the safety and preliminary efficacy of Kartigen®, a matrix with autologous bone marrow mesenchymal stem cell-derived chondrocyte precursors embedded in atelocollagen. As a surgical graft, Kartigen® was implanted onto the cartilage defects at the weight-bearing site of the medial femoral condyle of the knee. Fifteen patients were enrolled and stratified into two groups, undergoing either Kartigen® implantation (n = 10) or microfracture (control group, n = 5). The primary endpoint was to evaluate the safety of Kartigen® by monitoring the occurrence of adverse events through physician queries, physical examinations, laboratory tests, and radiological analyses for 2 years. There were no infections, inflammations, adhesions, loose body, or tumor formations in the Kartigen®-implanted knees. The preliminary efficacy was assessed using the International Knee Documentation Committee (IKDC) score, visual analog scale, and second-look arthroscopy. The postoperative IKDC scores of the Kartigen® group significantly improved in the 16th week (IKDC = 62.1 ± 12.8, p = 0.025), kept increasing in the first year (IKDC = 78.2 ± 15.4, p < 0.005), and remained satisfactory in the second year (IKDC = 73.6 ± 13.8, p < 0.005), compared to the preoperative condition (IKDC = 47.1 ± 17.0), while the postoperative IKDC scores of the control group also achieved significant improvement in the 28th week (IKDC = 68.5 ± 6.1, p = 0.032) versus preoperative state (IKDC = 54.0 ± 9.1). However, the IKDC scores decreased in the first year (IKDC = 63.5 ± 11.6) as well as in the second year (IKDC = 52.6 ± 16.4). Thirteen patients underwent second-look arthroscopy and biopsy one year after the operation. The Kartigen® group exhibited integration between Kartigen® and host tissue with a smooth appearance at the recipient site, whereas the microfracture group showed fibrillated surfaces. The histological and immunohistochemical analyses of biopsy specimens demonstrated the columnar structure of articular cartilage and existence of collagen type II and glycosaminoglycan mimic hyaline cartilage. This study indicates that Kartigen® is safe and effective in treating cartilage defects.

OU Medicine Chooses American Health Information Management Association's Compliant Template Library Within Artifact Health's Mobile Physician Query Platform

Journal of Clinical Engineering: 10/12 2020 - Volume 45 - Issue 4 - p 189 doi: 10.1097/JCE.0000000000000432

Information Needs and Information-Seeking Behavior of Italian Neurologists: Exploratory Mixed Methods Study.

BackgroundCurrent medical professions involve an extensive knowledge of the latest validated scientific data to implement disease diagnosis, therapeutic strategies, and patient care. Although clinicians can refer to a growing number and type of information sources to keep current with new scientific achievements, there are still various concerns about medical information validity, quality, and applicability into clinical practice. Novel strategies are required to identify physicians’ real-life needs with the final aim to improve modern medical information delivery.ObjectiveOur research used an innovative tool to collect real-time physician queries in order to investigate information needs and seeking behavior of Italian neurologists treating patients with multiple sclerosis (MS) and migraine.MethodsThe study was designed as an exploratory mixed methods (ie, qualitative and quantitative) study involving 15 consecutive days of observation. A total of 50 neurologists (n=25 MS and n=25 migraine specialists) were recruited. Data were collected using an instant messaging mobile app designed for this research. At each information-seeking event, moderators triggered a computer-assisted personal interview including both semistructured interview and close-ended questions. Interactions and physician queries collected using the mobile app were coded into emerging themes by content analysis.ResultsNeurologist queries were relevant to the following major themes: therapy management (36/50, 71%) and drug-related information (34/50, 67%), followed by diagnostic strategies and procedures (21/50, 42%). Quantitative analysis indicated online resources were preferentially used by clinicians (48/50, 96%) compared with offline sources (24/50, 47%). A multichannel approach, in which both online and offline sources were consulted to meet the same need, was adopted in 33% (65/198) of information-seeking events. Neurologists more likely retrieved information from online relative to offline channels (F=1.7; P=.01). MS specialists were 53% more likely to engage in one information-seeking event compared with migraine neurologists (risk ratio 1.54; 95% CI 1.16-2.05). MS specialists tended to be more interested in patient-related content than migraine clinicians (28% [7/25] vs 10% [2/25], P=.06), who conversely more likely sought information concerning therapy management (85% [21/25] vs 60% [15/25], P=.05). Compared with MS clinicians, migraine specialists had a harder time finding the required information, either looking at online or offline channels (F=12.5; P=.01) and less frequently used offline channels (30% [8/25] vs 60% [15/25] of information-seeking events, P=.02). When multiple sources needed to be consulted to retrieve an information item, a reduced satisfaction rate was observed both among migraine and MS specialists (single source vs multiple sources P=.003).ConclusionsThis study provides a detailed description of real-life seeking behavior, educational needs, and information sources adopted by Italian MS and migraine neurologists. Neurologist information needs and seeking behavior reflect the specific characteristics of the specialty area in which they operate. These findings suggest identification of time- and context-specific needs of clinicians is required to design an effective medical information strategy.

The Impact of ICD-10 on Obstetric Coding [5Q

INTRODUCTION: We aimed to review the accuracy of current International Classification of Diseases and Related Health Problems (ICD) coding practices at our institution which affect the delivery complication rate. METHODS: A retrospective review of vaginal and cesarean delivery complications with respective ICD-10 codes was performed (September 2017 to June 2018) at Robert Wood Johnson Barnabas Health. After review of 3 months of data, codes used erroneously were identified. Re-education of both coders and providers was performed. Subsequent coding rates were tracked for the remainder of the study period. RESULTS: Based on the Joint Commissions list of reportable complications, 67 cesarean and 177 vaginal delivery complications were identified over a 10-month period. Ten cesarean and 26 vaginal delivery complications were found to be coded erroneously; recoding decreased complications by 14% for both. Between September and January, recoding rates for cesarean and vaginal delivery complications were 26% and 15% respectively. After re-education in January, rates dropped to 3% (cesarean) and 14% (vaginal). Interim review in April identified codes persistently being used inappropriately with respect to vaginal delivery complications, despite re-education. Restrictions requiring supervisory review and physician query were placed on codes in question, further decreasing vaginal delivery complications. We decreased our complication recoding percentage from 26% to 3% and 15% to 11% for cesarean and vaginal deliveries respectively. CONCLUSION: Our findings suggest detailed chart review by medical providers in addition to re-education of coding staff and providers can improve accuracy rates for obstetrics coding.

Physicians, Patients, and Firearms.

Letters20 December 2016Physicians, Patients, and FirearmsRobert B. Sklaroff, MDRobert B. Sklaroff, MDFrom Nazareth Hospital, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0545 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Inasmuch as litigation on gun control pends before the Supreme Court of the United States, the focus is properly trained on slippery-slope rhetoric subtly embedded in (and omitted from) discussion of what is portrayed as inherent in the patient–physician relationship. Wintemute and colleagues suggest that an initial physician query “might simply be, ‘Are there any firearms kept in or around your home?'” (1). No. The topic should be gently introduced the same as other concerns, such as tobacco use, namely by asking, “Would you like to discuss … ?” Nonpejorative phrasing is welcoming without being intrusive; the ...

The value of Retrospective and Concurrent Think Aloud in formative usability testing of a physician data query tool

ObjectiveTo compare the performance of the Concurrent (CTA) and Retrospective (RTA) Think Aloud method and to assess their value in a formative usability evaluation of an Intensive Care Registry-physician data query tool designed to support ICU quality improvement processes. MethodsSixteen representative intensive care physicians participated in the usability evaluation study. Subjects were allocated to either the CTA or RTA method by a matched randomized design. Each subject performed six usability-testing tasks of varying complexity in the query tool in a real-working context. Methods were compared with regard to number and type of problems detected. Verbal protocols of CTA and RTA were analyzed in depth to assess differences in verbal output. Standardized measures were applied to assess thoroughness in usability problem detection weighted per problem severity level and method overall effectiveness in detecting usability problems with regard to the time subjects spent per method. ResultsThe usability evaluation of the data query tool revealed a total of 43 unique usability problems that the intensive care physicians encountered. CTA detected unique usability problems with regard to graphics/symbols, navigation issues, error messages, and the organization of information on the query tool’s screens. RTA detected unique issues concerning system match with subjects’ language and applied terminology. The in-depth verbal protocol analysis of CTA provided information on intensive care physicians’ query design strategies. Overall, CTA performed significantly better than RTA in detecting usability problems. CTA usability problem detection effectiveness was 0.80 vs. 0.62 (p<0.05) respectively, with an average difference of 42% less time spent per subject compared to RTA. In addition, CTA was more thorough in detecting usability problems of a moderate (0.85 vs. 0.7) and severe nature (0.71 vs. 0.57). ConclusionIn this study, the CTA is more effective in usability-problem detection and provided clarification of intensive care physician query design strategies to inform redesign of the query tool. However, CTA does not outperform RTA. The RTA additionally elucidated unique usability problems and new user requirements. Based on the results of this study, we recommend the use of CTA in formative usability evaluation studies of health information technology. However, we recommend further research on the application of RTA in usability studies with regard to user expertise and experience when focusing on user profile customized (re)design.

Results from the First Decade of Research Conducted by the Research on Adverse Drug Events and Reports (RADAR) Project

In 1998, a multidisciplinary team of investigators initiated the Research on Adverse Drug events And Reports (RADAR) project, a post-marketing surveillance effort that systematically investigates and disseminates information describing serious and previously unrecognized serious adverse drug and device reactions (sADRs). Herein, we describe the findings, dissemination efforts, and lessons learned from the first decade of the RADAR project. After identifying serious and unexpected clinical events suitable for further investigation, RADAR collaborators derived case information from physician queries, published and unpublished clinical trials, case reports, US FDA databases and manufacturer sales figures. All major RADAR publications from 1998 to the present are included in this analysis. For each RADAR publication, data were abstracted on data source, correlative basic science findings, dissemination and resultant safety information. RADAR investigators reported 43 serious ADRs. Data sources included case reports (17 sADRs), registries (5 sADRs), referral centers (8 sADRs) and clinical trial reports (13 sADRs). Correlative basic science findings were reported for ten sADRs. Thirty-seven sADRS were described as published case reports (5 sADRs) or published case-series (32 sADRs). Related safety information was disseminated as warnings or boxed warnings in the package insert (17 sADRs) and/or 'Dear Healthcare Professional' letters (14 sADRs). An independent National Institutes of Health-funded post-marketing surveillance programme can supplement existing regulatory and pharmaceutical manufacturer-supported drug safety initiatives.

Validity of The Health Improvement Network (THIN) for the study of psoriasis.

Psoriasis is a common disease frequently studied in large databases. To date the validity of psoriasis information has not been established in The Health Improvement Network (THIN). To investigate the validity of THIN for identifying patients with psoriasis and to determine if the database can be used to determine the natural history of the disease. First, we conducted a cross-sectional study to determine if psoriasis prevalence in THIN is similar to expected. Second, we created a cohort of 4900 patients, aged 45-64 years, with a psoriasis diagnostic Read Code and surveyed their general practitioners (GPs) to confirm the diagnosis clinically. Third, we created models to determine if psoriasis descriptors (extent, severity, duration and dermatologist confirmation) could be accurately captured from database records. Psoriasis prevalence was 1·9%, and showed the characteristic age distribution expected. GP questionnaires were received for 4634 of 4900 cohort patients (95% response rate), and psoriasis diagnoses were confirmed in 90% of patients. Duration of disease in the database showed substantial agreement with physician query (κ = 0·69). GPs confirmed that the psoriasis diagnosis was corroborated by a dermatologist in 91% of patients whose database records contained a dermatology referral code associated with a psoriasis code. We achieved good discrimination between patients with and without extensive disease based on the number of psoriasis codes received per year (area under curve = 0·8). THIN is a valid data resource for studying psoriasis and can be used to identify characteristics of the disease such as duration and confirmation by a dermatologist.

Innovative quality initiative measurement using Web-based drug dispensing technology with interactive physician queries to evaluate bisphosphonate use across community oncology practices nationwide.

9070 Background: Published data suggest suboptimal compliance rates with Quality Oncology Practice Initiative (QOPI) criteria for use of intravenous bisphosphonates in breast cancer patients with bone metastasis. We implemented a quality initiative across our nationwide community oncology practice membership to measure intravenous bisphosphonate compliance and provide clinical education using Web-based drug dispensing technology, with interactive physician queries. Methods: Patients within participating oncology practices using our Web-based drug dispensing technology receiving treatment for breast, lung, or prostate cancers with newly diagnosed bone metastases, or newly diagnosed multiple myeloma were identified between 6/21/2009 and 8/31/2009 and categorized as not receiving (arm A) or receiving (arm B) intravenous bisphosphonate therapy. Intravenous bisphosphonate use for the total population was evaluated. Physicians were queried regarding reason for declining to initiate therapy for each specific patient in arm A. Through the query process clinical education regarding use of intravenous bisphosphonate therapy was provided. Results: A total of 182 patients from 56 practices in 27 states were evaluated; arm A included 25 (14%) patients and arm B included 157 (86%) patients. For reasons identified by physicians for not initiating therapy, see Table. Conclusions: Practices demonstrated high rates of compliance with use of intravenous bisphosphonate therapy in patients with breast, lung, or prostate cancers with bone metastases, or multiple myeloma. In most patients for whom intravenous bisphosphonates were not prescribed, acceptable contraindications to therapy were present. Using Web-based drug dispensing technology supported with interactive queries is a viable method of measuring adherence to quality criteria. Number of patients (%) Severe renal insufficiency or renal failure 7 (28%) Indolent multiple myeloma 6 (24%) Patient deceased 3 (12%) Other 3 (12%) Side effect profile 2 (8%) Cost to patient 1 (4%) Poor performance status/frailty 1 (4%) No response to question 2 (8%) Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration McKesson, Novartis Amgen, McKesson, Novartis

A text message-based intervention to bridge the healthcare communication gap in the rural developing world

Healthcare delivery in the rural developing world is limited by a severe shortage of health workers as well as profound communicative and geographic barriers. Understaffed hospitals are forced to provide care for patients that reside at a great distance from the institutions themselves, sometimes more than 100 miles away. Community health workers (CHWs), volunteers from local villages, have been integral in bridging this patient-physician gap, but still lose enormous of amounts of time in transit between hospital and village. We report the results of a retrospective mobile health (mHealth) pilot at St. Gabriel's Hospital in Malawi designed to eliminate many of these trips in favor of communication via text messages. A group of 75 CHWs were supplied with cell phones and trained to utilize the network for a variety of usage cases, including patient adherence reporting, appointment reminders, and physician queries. At the end of the pilot, the hospital saved approximately 2,048 hours of worker time, $2,750 on net ($3,000 in fuel savings minus $250 in operational costs), and doubled the capacity of the tuberculosis treatment program (up to 200 patients). We conclude that mHealth interventions can provide cost-effective solutions to communication barriers in the setting of rural hospitals in the developing world.

Patient and Physician Perceptions as Risk Factors for Oligoanalgesia: A Prospective Observational Study of the Relief of Pain in the Emergency Department

Previous studies have reported that pain is undertreated in the emergency department (ED), but few physician-dependent risk factors have been identified. In this study, the authors determine whether pain treatment and relief in ED patients are negatively associated with the physician's perception of whether the patient was exaggerating symptoms, and with the patient and physician's perceptions of the interaction between them, as well as whether demographic characteristics were associated with these perceptions. This was a prospective observational study of patients who were undergoing treatment for painful disorders in the ED. Before treatment for pain, patients were asked to complete a 100-mm visual analog scale (VAS) describing their pain. Demographic information and pain treatments administered were recorded. Patients completed a second pain VAS before discharge from the ED. Patients were then asked to complete three queries describing their perception of their interaction with the physician. After the patient had left the department, the patient's physician was asked to complete a query describing his or her perception of the interaction and to complete a VAS describing how likely it was that the patient was exaggerating symptoms to obtain pain medicines for nonmedical purposes. There were 1,695 patients enrolled in the study; 32 patients were excluded because of missing or incomplete data, leaving 1,663 for analysis. Of these patients, 71.9% received a pain medication while in the ED. There was no association between the physician's VAS for perceived exaggeration of symptoms, the queries describing physician-patient interactions, and patient ethnicity and whether patients received pain treatment in the ED. There was a negative correlation between the physician's VAS for perceived exaggeration of symptoms and the change in the patient's pre- and posttreatment pain VAS scores. The physician's VAS score for perceived exaggeration of symptoms was higher among Native American patients than among other ethnic groups (p < or = 0.001). The patient and physician queries rating their interaction show a decreased absolute reduction of VAS pain scores (p > or = 0.001) and a reduction in the number of patients having at least a 50% reduction in their pain VAS score when interactions were rated "bad" and "very bad" (p < or = 0.001). The physician's perception of whether a patient was exaggerating symptoms was associated with the patient's ethnic background and with both the physician's and patient's perception of their interaction. These perceptions were negatively associated with the achievement of pain relief and the change in the patient's pain VAS scores, but not with whether a patient was treated with a pain medication.

Patient and Physician Perceptions as Risk Factors for Oligoanalgesia: A Prospective Observational Study of the Relief of Pain in the Emergency Department

Objectives: Previous studies have reported that pain is undertreated in the emergency department (ED), but few physician-dependent risk factors have been identified. In this study, the authors determine whether pain treatment and relief in ED patients are negatively associated with the physician's perception of whether the patient was exaggerating symptoms, and with the patient and physician's perceptions of the interaction between them, as well as whether demographic characteristics were associated with these perceptions. Methods: This was a prospective observational study of patients who were undergoing treatment for painful disorders in the ED. Before treatment for pain, patients were asked to complete a 100-mm visual analog scale (VAS) describing their pain. Demographic information and pain treatments administered were recorded. Patients completed a second pain VAS before discharge from the ED. Patients were then asked to complete three queries describing their perception of their interaction with the physician. After the patient had left the department, the patient's physician was asked to complete a query describing his or her perception of the interaction and to complete a VAS describing how likely it was that the patient was exaggerating symptoms to obtain pain medicines for nonmedical purposes. Results: There were 1,695 patients enrolled in the study; 32 patients were excluded because of missing or incomplete data, leaving 1,663 for analysis. Of these patients, 71.9% received a pain medication while in the ED. There was no association between the physician's VAS for perceived exaggeration of symptoms, the queries describing physician–patient interactions, and patient ethnicity and whether patients received pain treatment in the ED. There was a negative correlation between the physician's VAS for perceived exaggeration of symptoms and the change in the patient's pre- and posttreatment pain VAS scores. The physician's VAS score for perceived exaggeration of symptoms was higher among Native American patients than among other ethnic groups (p ≤ 0.001). The patient and physician queries rating their interaction show a decreased absolute reduction of VAS pain scores (p ≥ 0.001) and a reduction in the number of patients having at least a 50% reduction in their pain VAS score when interactions were rated “bad” and “very bad” (p ≤ 0.001). Conclusions: The physician's perception of whether a patient was exaggerating symptoms was associated with the patient's ethnic background and with both the physician's and patient's perception of their interaction. These perceptions were negatively associated with the achievement of pain relief and the change in the patient's pain VAS scores, but not with whether a patient was treated with a pain medication.

The Research on Adverse Drug Events and Reports (RADAR) Project

In 1998, a multidisciplinary team of investigators initiated RADAR (Research on Adverse Drug events And Reports), a clinically based postmarketing surveillance program that systematically investigates and disseminates information describing serious and previously unrecognized adverse drug and device reactions (ADRs). To describe the structure, operations, and preliminary findings from the RADAR project and related dissemination efforts by pharmaceutical suppliers and the US Food and Drug Administration (FDA). After identifying a serious and unexpected clinical event suitable for further investigation, RADAR collaborators postulated clinical hypotheses and derived case series and incidence estimates from physician queries, published and unpublished clinical trials, published case reports, FDA databases, and manufacturer sales figures. RADAR investigators identified 16 types of serious ADRs among 1699 patients, of whom 169 (10%) died as a result of the reaction. Initial cases were identified by 7 RADAR investigators, 4 collaborating physicians, 2 attorneys, and by reviewing 3 published reports. Additional sources included queries of occupational health programs and medical directors of interventional cardiology laboratories (3 types of ADRs), published manuscripts and clinical trials (11 types of ADRs), review of medical records at a RADAR site (2 types of ADRs), unpublished clinical trial reports (3 types of ADRs), and reports from attorneys, family members, or patients (4 types of ADRs). Incidence estimates, ranging from 0.4% to 33%, were derived from 5 clinical trial reports, 2 physician queries, and 2 observational databases. Laboratory support for hypotheses included identification of 3 neutralizing antibodies and 3 histopathological findings. ADR reports were disseminated as 8 revised package inserts, 7 "dear doctor" letters, and 9 peer-reviewed articles. A new, clinically based, hypothesis-driven approach to postmarketing surveillance may supplement existing regulatory surveillance systems and improve patient safety.

Effects of neural network feedback to physicians on admit/discharge decision for emergency department patients with chest pain

Study objectiveNeural networks can risk-stratify emergency department (ED) patients with potential acute coronary syndromes with a high specificity, potentially facilitating ED discharge of patients to home. We hypothesized that the use of “real-time” neural networks would decrease the admission rate for ED chest pain patients. MethodsWe conducted a before-and-after trial. Consecutive ED patients with chest pain were evaluated before and after implementation of a neural network in an urban university ED. Data included 40 variables used in neural networks for acute myocardial infarction and acute coronary syndrome. Data were obtained in real time, and neural network outputs were provided to the treating physician while patients were in the ED. On hospital discharge, attending physicians received feedback, including neural network output, their initial clinical impression, cardiac test results, and final diagnosis. The main outcome was the actual admit/discharge decision made before versus after the implementation of the neural network. ResultsBefore implementation, 4,492 patients were enrolled; after implementation, 432 patients were enrolled. Implementation of the neural network did not decrease the hospital admission rate (before: 62.7% [95% confidence interval (CI) 61.3% to 64.1%] versus after: 66.6% [95% CI 62.2% to 71.0%]). Additionally, the ICU admission rates were not different (11.4% [95% CI 10.5% to 12.3%] versus 9.3% [95% CI 6.6% to 12.0%]). Physician query found that the neural network changed management in only 2 cases (<1%). ConclusionThe use of real-time neural network feedback did not influence the admission decision for ED patients with chest pain, most likely because the neural network output was delayed until the return of cardiac markers, and the disposition decision had already been made by that time.

Sarcomatoid carcinoma of the cervix

Objectives To characterize clinical and pathologic characteristics of sarcomatoid carcinoma of the cervix. Methods We retrospectively reviewed the charts of women with sarcomatoid carcinoma of the cervix identified by query of the Snomed pathologic diagnostic retrieval system and by direct physician query. Data were extracted from available charts, and pathology review was performed on all cases. SPSS was used for statistical analysis. Results Nine of 12 identified patients had complete clinical information and pathologic material available. The mean age at diagnosis was 48 (range, 29–76) years. Stage at diagnosis was I (4 patients), II (2 patients), and IV (3 patients). Patients younger than 40 years of age presented with stage I disease. All patients had visible tumor; 8 of 9 had vaginal bleeding or discharge at presentation. Microscopic evaluation revealed areas of spindle-cell sarcomatous tumor confluent with areas of poorly differentiated squamous cell carcinoma. Immunohistochemistry demonstrated coexpression of cytokeratin and vimentin in tumor cells. Tumors with a prominent spindle-cell component also expressed smooth muscle actin. Initial treatment varied, but all patients had a complete response to initial treatment. Five patients recurred with a median disease-free interval of 4.9 (range, 2–9.5) months, and none responded to second-line therapy. Four patients remained disease-free at 5, 18, 30, and 40 months, respectively, after completing initial therapy. Conclusions Sarcomatoid carcinoma of the cervix is an aggressive neoplasm. Primary treatment offers the best chance for cure in women with early-stage disease. Patients with advanced disease at presentation or recurrence succumb to their disease.

Hypersensitivity Reactions and the Utility of Oral and Intravenous Desensitization in Patients with Gynecologic Malignancies

Objectives. The aims of this study were to characterize hypersensitivity reactions to chemotherapy in patients with gynecologic malignancies and to determine the utility of oral and intravenous desensitization.Methods. We retrospectively reviewed patients with hypersensitivity reactions identified by direct physician query and by review of charts with ICD9 code E933.1 (Adverse Effect Anti-Neoplastic).Results. Thirty-two patients were identified: 27 with ovarian cancer, 4 with primary peritoneal cancer, and 1 with cervical cancer. Nine patients experienced hypersensitivity reactions during the primary regimen and 23 during chemotherapy for recurrent disease. Hypersensitivity occurred following an average of nine courses. Hypersensitivity occurred secondary to paclitaxel (10) carboplatin (16), cisplatin (4), bleomycin (1), and paclitaxel/carboplatin combination therapy (1). Patients had previously received the agent in 93.8% of carboplatin reactions, in 54.5% of paclitaxel reactions, and in all other agent reactions. Hypersensitivity reactions most commonly included flushing, dyspnea/bronchospasm, back pain, chest discomfort, pruritus, erythema, and nausea and occasionally included alterations in blood pressure or pulse rate. Reactions were successfully treated in 96.9% of patients by interrupting the infusion and administering steroids, antihistamines, benzodiazepines, nebulized β-agonists, and/or pressors. Seventeen patients underwent desensitization, one to two agents, with 94% success. Nine of ten patients had successful iv desensitization, and 8/10 patients had successful oral desensitization. One failure on the oral regimen had previous successful iv desensitization.Conclusions. Hypersensitivity reactions to chemotherapeutic agents do not necessarily require exclusion of a compound from the treatment regimen. Intravenous and oral desensitization protocols are useful for successful and safe administration of paclitaxel and platinum compounds in patients with prior hypersensitivity reactions.

Nucleoside exposure in the children of HIV-infected women receiving antiretroviral drugs: absence of clear evidence for mitochondrial disease in children who died before 5 years of age in five United States cohorts.

Nucleoside reverse transcriptase inhibitors (NRTIs) have been associated with mitochondrial toxicity in individuals receiving treatment. A report of two deaths in Europe attributed to mitochondrial dysfunction in HIV-uninfected infants with perinatal NRTI exposure prompted a review of five U.S. cohorts. Deaths in HIV-exposed children <60 months of age and HIV-uninfected or indeterminate were reviewed. Review included birth history; perinatal antiretroviral drug exposure; hospital, laboratory, and clinic records; death reports; autopsy results; and local physician queries. Deaths were classified as unrelated (Class 1), unlikely related (Class 2), possibly related (Class 3), or highly suggestive or proven relationship (Class 4), to mitochondrial dysfunction; sudden infant death syndrome (SIDS) was categorized separately. Among over 20,000 children of HIV-infected women, over half of whom had been exposed to NRTIs, 223 died. In HIV-uninfected children, 26 deaths were attributed to Class 1, and 4 were attributed to SIDS. In HIV-indeterminate children, 141, 10, 3, and 0 were Classes 1, 2, 3, and 4, respectively; 33 were due to SIDS and 6 could not be classified. There was no indication that antiretroviral exposure was associated with Class 2 or 3 deaths, or deaths from SIDS. A search for mitochondrial dysfunction among living children in these cohorts is ongoing.

Postpartum assessment of maternal-fetal incompatibility. Use of a programmable calculator for interpretive reporting of laboratory data.

THE INCREASED volume and variety of clinical laboratory tests require new approaches in presenting data to the physician so that reports are clear, concise, and informative. In addition, the need for a logical series of data to answer a physician's query has induced us to assemble laboratory tests into studies geared to a specific purpose. As an example, we present a study to determine maternal candidacy for anti-Rho immune globulin serum after pregnancy to prevent Rho-sensitization, with data plus interpretation reported via a programmable calculator.1The study also checks for maternal-fetal ABO incompatibility, and, if present, for homologous antibodies in the infant's cord blood.2 Programmable Calculator Two major problems arise from this approach to laboratory testing. First, since the study is based on a variable sequence of tests from which subsequent tests are selected according to the result of a preceding test, the series must be monitored for

Postpartum Assessment of Maternal-Fetal Incompatibility

THE INCREASED volume and variety of clinical laboratory tests require new approaches in presenting data to the physician so that reports are clear, concise, and informative. In addition, the need for a logical series of data to answer a physician's query has induced us to assemble laboratory tests into studies geared to a specific purpose. As an example, we present a study to determine maternal candidacy for anti-Rho immune globulin serum after pregnancy to prevent Rho-sensitization, with data plus interpretation reported via a programmable calculator.¹The study also checks for maternal-fetal ABO incompatibility, and, if present, for homologous antibodies in the infant's cord blood.² <h3>Programmable Calculator</h3> Two major problems arise from this approach to laboratory testing. First, since the study is based on a variable sequence of tests from which subsequent tests are selected according to the result of a preceding test, the series must be monitored for