Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Adamski A[original query] |
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Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: The Medical Inpatients Thrombosis and Hemostasis (MITH) Study
Repp AB , Sparks AD , Wilkinson K , Roetker NS , Schaefer JK , Li A , McClure LA , Terrell DR , Ferraris A , Adamski A , Smith NL , Zakai NA . J Thromb Haemost 2024 BACKGROUND: Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown. OBJECTIVE: To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services. DESIGN: Cohort study using electronic health record data from adult patients hospitalized on medical services at four academic medical centers between 2016 and 2019. PARTICIPANTS: Among 111,550 admissions not on intermediate or full-dose anticoagulation, 48,520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. MAIN MEASURES: Candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission. KEY RESULTS: After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest two tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (1(st)) tertile (OR 0.84, 95% CI [0.81, 0.86] for 2(nd) tertile, OR 0.95, 95% CI [0.92, 0.98] for 3(rd) tertile). CONCLUSIONS: Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first two hospital days was lower in patients with higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with higher predicted risk could not be assessed. |
An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county
Peseski AM , Kapoor S , Kuchibhatla M , Adamski A , Abe K , Beckman MG , Reyes NL , Richardson LC , Saber I , Schulteis R , Singh BP , Sitlinger A , Thames EH , Ortel TL . Res Pract Thromb Haemost 2024 8 (4) Background: Cancer-associated venous thromboembolism (CA-VTE) represents a major cause of morbidity and mortality in patients with cancer. Despite poor outcomes, there is an ongoing knowledge gap in epidemiologic data related to this association. Objectives: To compare venous thromboembolism (VTE) characteristics, risk factors, and outcomes between patients with and without active cancer in a racially diverse population. Methods: Our surveillance project occurred at the 3 hospitals in Durham County, North Carolina, from April 2012 through March 2014. Electronic and manual methods were used to identify unique Durham County residents with VTE. Results: We identified 987 patients with VTE during the surveillance period. Of these, 189 patients had active cancer at the time of their VTE event. Patients with CA-VTE were older (median age: 69 years vs 60 years, P < .0001) and had a lower body mass index (median body mass index: 26.0 kg/m2 vs 28.4 kg/m2, P = .0001) than noncancer patients. The most common cancers in our cohort were gastrointestinal, breast, genitourinary, and lung. The proportion of VTE cases with pulmonary embolism (PE) was greater in the cancer cohort compared with that in the noncancer cohort (58.2% vs 44.0%, P = .0004). Overall survival was lower in the CA-VTE group than in patients without cancer (P < .0001). Black patients with CA-VTE had lower proportion of PE (52.3% vs 67.1%, P = .05) but had decreased survival (P < .0003) in comparison with White patients. Conclusion: Future studies may be needed to continue to evaluate local and national VTE data to improve VTE prevention strategies and CA-VTE outcomes. © 2024 The Authors |
The potential use of artificial intelligence for venous thromboembolism prophylaxis and management: clinician and healthcare informatician perspectives
Lam BD , Dodge LE , Zerbey S , Robertson W , Rosovsky RP , Lake L , Datta S , Elavakanar P , Adamski A , Reyes N , Abe K , Vlachos IS , Zwicker JI , Patell R . Sci Rep 2024 14 (1) 12010 ![]() ![]() Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. Artificial intelligence (AI) and machine learning (ML) can support guidelines recommending an individualized approach to risk assessment and prophylaxis. We conducted electronic surveys asking clinician and healthcare informaticians about their perspectives on AI/ML for VTE prevention and management. Of 101 respondents to the informatician survey, most were 40 years or older, male, clinicians and data scientists, and had performed research on AI/ML. Of the 607 US-based respondents to the clinician survey, most were 40 years or younger, female, physicians, and had never used AI to inform clinical practice. Most informaticians agreed that AI/ML can be used to manage VTE (56.0%). Over one-third were concerned that clinicians would not use the technology (38.9%), but the majority of clinicians believed that AI/ML probably or definitely can help with VTE prevention (70.1%). The most common concern in both groups was a perceived lack of transparency (informaticians 54.4%; clinicians 25.4%). These two surveys revealed that key stakeholders are interested in AI/ML for VTE prevention and management, and identified potential barriers to address prior to implementation. |
Machine learning natural language processing for identifying venous thromboembolism: Systematic review and meta-analysis
Lam BD , Chrysafi P , Chiasakul T , Khosla H , Karagkouni D , McNichol M , Adamski A , Reyes N , Abe K , Mantha S , Vlachos IS , Zwicker JI , Patell R . Blood Adv 2024 ![]() ![]() Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality. Monitoring VTE cases is limited by the challenges of manual chart review and diagnosis code interpretation. Natural language processing (NLP) can automate the process. Rule-based NLP methods are effective but time consuming. Machine learning (ML)-NLP methods present a promising solution. We conducted a systematic review and meta-analysis of studies published before May 2023 that use ML-NLP to identify VTE diagnoses in the electronic health records. Four reviewers screened all manuscripts, excluding studies that only used a rule-based method. A meta-analysis evaluated the pooled performance of each study's best performing model that evaluated for pulmonary embolism (PE) and/or deep vein thrombosis (DVT). Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with confidence interval (CI) were calculated by DerSimonian and Laird method using a random-effects model. Study quality was assessed using an adapted TRIPOD tool. Thirteen studies were included in the systematic review and 8 had data available for meta-analysis. Pooled sensitivity was 0.931 (95% CI 0.881-0.962), specificity 0.984 (95% CI 0.967-0.992), PPV 0.910 (95% CI 0.865-0.941) and NPV 0.985 (95% CI 0.977-0.990). All studies met at least 13 of the 21 NLP-modified TRIPOD items, demonstrating fair quality. The highest performing models used vectorization rather than bag-of-words, and deep learning techniques such as convolutional neural networks. There was significant heterogeneity in the studies and only four validated their model on an external dataset. Further standardization of ML studies can help progress this novel technology towards real-world implementation. |
Artificial intelligence for venous thromboembolism prophylaxis: Clinician perspectives
Lam BD , Zerbey S , Pinson A , Robertson W , Rosovsky RP , Lake L , Dodge LE , Adamski A , Reyes N , Abe K , Vlachos IS , Zwicker JI , Schonberg M , Patell R . Res Pract Thromb Haemost 2023 7 (8) 102272 ![]() Hospital-associated venous thromboembolism (VTE) is a major public health challenge, and while thromboprophylaxis is known to be effective, it remains misused [1]. Clinicians face enormous complexity when determining who should receive thromboprophylaxis. To better understand current practices around VTE prophylaxis in adult hospitalized patients, we previously surveyed 607 clinicians across the United States between 2021 and 2022 [2]. Overall, 48% of respondents reported patients at their institution are not on appropriate VTE prophylaxis almost all the time. The majority reported that technology such as artificial intelligence (AI) may help improve rates of appropriate prophylaxis. However, only 35% reported using existing risk assessment models (RAMs); 68% reported using their own clinical assessment instead. Therefore, we invited survey respondents to participate in focus groups to better understand how they approach VTE prophylaxis, with a focus on their perspectives regarding using AI decision support. |
Artificial intelligence in the prediction of venous thromboembolism: A systematic review and pooled analysis
Chiasakul T , Lam BD , McNichol M , Robertson W , Rosovsky RP , Lake L , Vlachos IS , Adamski A , Reyes N , Abe K , Zwicker JI , Patell R . Eur J Haematol 2023 111 (6) 951-962 ![]() ![]() BACKGROUND: Accurate diagnostic and prognostic predictions of venous thromboembolism (VTE) are crucial for VTE management. Artificial intelligence (AI) enables autonomous identification of the most predictive patterns from large complex data. Although evidence regarding its performance in VTE prediction is emerging, a comprehensive analysis of performance is lacking. AIMS: To systematically review the performance of AI in the diagnosis and prediction of VTE and compare it to clinical risk assessment models (RAMs) or logistic regression models. METHODS: A systematic literature search was performed using PubMed, MEDLINE, EMBASE, and Web of Science from inception to April 20, 2021. Search terms included "artificial intelligence" and "venous thromboembolism." Eligible criteria were original studies evaluating AI in the prediction of VTE in adults and reporting one of the following outcomes: sensitivity, specificity, positive predictive value, negative predictive value, or area under receiver operating curve (AUC). Risks of bias were assessed using the PROBAST tool. Unpaired t-test was performed to compare the mean AUC from AI versus conventional methods (RAMs or logistic regression models). RESULTS: A total of 20 studies were included. Number of participants ranged from 31 to 111 888. The AI-based models included artificial neural network (six studies), support vector machines (four studies), Bayesian methods (one study), super learner ensemble (one study), genetic programming (one study), unspecified machine learning models (two studies), and multiple machine learning models (five studies). Twelve studies (60%) had both training and testing cohorts. Among 14 studies (70%) where AUCs were reported, the mean AUC for AI versus conventional methods were 0.79 (95% CI: 0.74-0.85) versus 0.61 (95% CI: 0.54-0.68), respectively (p < .001). However, the good to excellent discriminative performance of AI methods is unlikely to be replicated when used in clinical practice, because most studies had high risk of bias due to missing data handling and outcome determination. CONCLUSION: The use of AI appears to improve the accuracy of diagnostic and prognostic prediction of VTE over conventional risk models; however, there was a high risk of bias observed across studies. Future studies should focus on transparent reporting, external validation, and clinical application of these models. |
Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices
Lam BD , Dodge LE , Datta S , Rosovsky RP , Robertson W , Lake L , Reyes N , Adamski A , Abe K , Panoff S , Pinson A , Elavalakanar P , Vlachos IS , Zwicker JI , Patell R . Res Pract Thromb Haemost 2023 7 (6) 102168 BACKGROUND: Venous thromboembolism (VTE) is a leading cause of preventable mortality among hospitalized patients, but appropriate risk assessment and thromboprophylaxis remain underutilized or misapplied. OBJECTIVES: We conducted an electronic survey of US health care providers to explore attitudes, practices, and barriers related to thromboprophylaxis in adult hospitalized patients and at discharge. RESULTS: A total of 607 US respondents completed the survey: 63.1% reported working in an academic hospital, 70.7% identified as physicians, and hospital medicine was the most frequent specialty (52.1%). The majority of respondents agreed that VTE prophylaxis is important (98.8%; 95% CI: 97.6%-99.5%) and that current measures are safe (92.6%; 95% CI: 90.2%-94.5%) and effective (93.8%; 95% CI: 91.6%-95.6%), but only half (52.0%; 95% CI: 47.9%-56.0%) believed that hospitalized patients at their institution are on appropriate VTE prophylaxis almost all the time. One-third (35.4%) reported using a risk assessment model (RAM) to determine VTE prophylaxis need; 44.9% reported unfamiliarity with RAMs. The most common recommendation for improving rates of appropriate thromboprophylaxis was to leverage technology. A majority of respondents (84.5%) do not reassess a patient's need for VTE prophylaxis at discharge, and a minority educates patients about the risk (16.2%) or symptoms (18.9%) of VTE at discharge. CONCLUSION: Despite guideline recommendations to use RAMs, the majority of providers in our survey do not use them. A majority of respondents believed that technology could help improve VTE prophylaxis rates. A majority of respondents do not reassess the risk of VTE at discharge or educate patients about this risk of VTE at discharge. |
Surveillance Indicators for Women's Preconception Care
Surveillance and Research Workgroup and Clinical Workgroup of the National Preconception Health and Health Care Initiative , Adamski Alys , Bernstein Peter S , Boulet Sheree L , Chowdhury Farah M , D’Angelo Denise V , Coonrod Dean V , Frayne Daniel J , Kroelinger Charlan , Morgan Isabel A , Okoroh Ekwutosi M , Olson Christine K , Robbins Cheryl L , Verbiest Sarah . J Womens Health (Larchmt) 2020 29 (7) 910-918 Background: Limited surveillance of preconception care (PCC) impedes states' ability to monitor access and provision of quality PCC. In response, we describe PCC indicators and the evaluation process used to identify a set of PCC indicators for state use. Materials and Methods: The Surveillance and Research Workgroup and Clinical Workgroup of the National Preconception Health and Health Care Initiative used a systematic process to identify, evaluate, and prioritize PCC indicators from nationwide public health surveillance systems that Maternal and Child Health (MCH) programs can use for state-level surveillance using the Pregnancy Risk Assessment Monitoring System (PRAMS) and Behavioral Risk Factor Surveillance System (BRFSS). For each indicator, we assessed target population, prevalence, measurement simplicity, data availability, clinical utility, and whether it was related to the 10 prioritized preconception health indicators. We also assessed relevance to clinical recommendations, Healthy People (HP)2020 objectives, and the National Quality Forum measures. Lastly, we considered input from stakeholders and subject matter experts. Results: Eighty potential PCC indicators were initially identified. After conducting evaluations, obtaining stakeholder input, and consulting with subject matter experts, the list was narrowed to 30 PCC indicators for states to consider using in their MCH programs to inform the need for new strategies and monitor programmatic activities. PRAMS is the data source for 27 of the indicators, and BRFSS is the data source for three indicators. Conclusions: The identification and evaluation of population-based PCC indicators that are available at the state level increase opportunities for state MCH programs to document, monitor, and address PCC in their locales. |
Association between thromboembolic events and COVID-19 infection within 30 days: a case-control study among a large sample of adult hospitalized patients in the United States, March 2020-June 2021.
Huang YA , Yusuf H , Adamski A , Hsu J , Baggs J , Auf R , Adjei S , Stoney R , Hooper WC , Llata E , Koumans EH , Ko JY , Romano S , Boehmer TK , Harris AM . J Thromb Thrombolysis 2022 1-6 The association between thromboembolic events (TE) and COVID-19 infection is not completely understood at the population level in the United States. We examined their association using a large US healthcare database. We analyzed data from the Premier Healthcare Database Special COVID-19 Release and conducted a case-control study. Thestudy population consisted of men and non-pregnant women aged18years with (cases) or without (controls) an inpatient ICD-10-CM diagnosis of TE between 3/1/2020 and 6/30/2021. Using multivariable logistic regression, we assessed the association between TE occurrence and COVID-19 diagnosis, adjusting for demographic factors and comorbidities. Among 227,343 cases, 15.2% had a concurrent or prior COVID-19 diagnosis within 30days of their index TE. Multivariable regression analysis showed a statistically significant association between a COVID-19 diagnosis and TE among cases when compared to controls (adjusted odds ratio [aOR]1.75, 95% CI 1.72-1.78). The association was more substantial if a COVID-19 diagnosis occurred 1-30days prior to index hospitalization (aOR3.00, 95% CI 2.88-3.13) compared to the same encounter as the index hospitalization. Our findings suggest an increased risk of TE among persons within 30days of beingdiagnosed COVID-19, highlighting the need for careful consideration of the thrombotic risk among COVID-19 patients, particularly during the first month following diagnosis. |
Exploring the Applicability of Using Natural Language Processing to Support Nationwide Venous Thromboembolism Surveillance: Model Evaluation Study
Wendelboe A , Saber I , Dvorak J , Adamski A , Feland N , Reyes N , Abe K , Ortel T , Raskob G . JMIR Bioinform Biotech 2022 3 (1) ![]() BACKGROUND: Venous thromboembolism (VTE) is a preventable, common vascular disease that has been estimated to affect up to 900,000 people per year. It has been associated with risk factors such as recent surgery, cancer, and hospitalization. VTE surveillance for patient management and safety can be improved via natural language processing (NLP). NLP tools have the ability to access electronic medical records, identify patients that meet the VTE case definition, and subsequently enter the relevant information into a database for hospital review. OBJECTIVE: We aimed to evaluate the performance of a VTE identification model of IDEAL-X (Information and Data Extraction Using Adaptive Learning; Emory University)-an NLP tool-in automatically classifying cases of VTE by "reading" unstructured text from diagnostic imaging records collected from 2012 to 2014. METHODS: After accessing imaging records from pilot surveillance systems for VTE from Duke University and the University of Oklahoma Health Sciences Center (OUHSC), we used a VTE identification model of IDEAL-X to classify cases of VTE that had previously been manually classified. Experts reviewed the technicians' comments in each record to determine if a VTE event occurred. The performance measures calculated (with 95% CIs) were accuracy, sensitivity, specificity, and positive and negative predictive values. Chi-square tests of homogeneity were conducted to evaluate differences in performance measures by site, using a significance level of .05. RESULTS: The VTE model of IDEAL-X "read" 1591 records from Duke University and 1487 records from the OUHSC, for a total of 3078 records. The combined performance measures were 93.7% accuracy (95% CI 93.7%-93.8%), 96.3% sensitivity (95% CI 96.2%-96.4%), 92% specificity (95% CI 91.9%-92%), an 89.1% positive predictive value (95% CI 89%-89.2%), and a 97.3% negative predictive value (95% CI 97.3%-97.4%). The sensitivity was higher at Duke University (97.9%, 95% CI 97.8%-98%) than at the OUHSC (93.3%, 95% CI 93.1%-93.4%; P<.001), but the specificity was higher at the OUHSC (95.9%, 95% CI 95.8%-96%) than at Duke University (86.5%, 95% CI 86.4%-86.7%; P<.001). CONCLUSIONS: The VTE model of IDEAL-X accurately classified cases of VTE from the pilot surveillance systems of two separate health systems in Durham, North Carolina, and Oklahoma City, Oklahoma. NLP is a promising tool for the design and implementation of an automated, cost-effective national surveillance system for VTE. Conducting public health surveillance at a national scale is important for measuring disease burden and the impact of prevention measures. We recommend additional studies to identify how integrating IDEAL-X in a medical record system could further automate the surveillance process. |
Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina
Saber I , Adamski A , Kuchibhatla M , Abe K , Beckman M , Reyes N , Schulteis R , Pendurthi Singh B , Sitlinger A , Thames EH , Ortel TL . Res Pract Thromb Haemost 2022 6 (5) e12769 BACKGROUND: Venous thromboembolism (VTE) affects approximately 1-2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. OBJECTIVE: To determine risk factors, incidence, treatments, and outcomes of VTE through a 2-year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). PATIENTS/METHODS: We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. RESULTS: A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital-associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were younger than White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). CONCLUSIONS: Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospital-associated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals. |
Cancer-associated venous thromboembolism: Incidence and features in a racially diverse population
Raskob GE , Wendelboe AM , Campbell J , Ford L , Ding K , Bratzler DW , McCumber M , Adamski A , Abe K , Beckman MG , Reyes NL , Richardson LC . J Thromb Haemost 2022 20 (10) 2366-2378 BACKGROUND: Data on the population-based incidence of cancer-associated venous thromboembolism (VTE) from racially diverse populations are limited. OBJECTIVE: To evaluate the incidence and burden of cancer-associated VTE, including demographic and racial subgroups in the general population of Oklahoma County-which closely mirrors the United States. DESIGN: Population-based prospective study. SETTING: We conducted surveillance of VTE at tertiary care facilities and outpatient clinics in Oklahoma County, Oklahoma from 2012-2014. Surveillance included reviewing all imaging reports used to diagnose VTE and identifying VTE events from hospital discharge data and death certificates. Cancer status was determined by linkage to the Oklahoma Central Cancer Registry. MEASUREMENTS: We used Poisson regression to calculate crude and age-adjusted incidences of cancer-associated VTE per 100,000 general population per year, with 95% confidence intervals (95% CI). RESULTS: The age-adjusted incidence (95% CI) of cancer-associated VTE among adults age 18 was 70.0 (65.1-75.3). The age-adjusted incidence rates (95% CI) were 85.9 (72.7-101.6) for non-Hispanic Black persons, 79.5 (13.2-86.5) for non-Hispanic White persons, 18.8 (8.9-39.4) for Native American persons, 15.6 (7.0-34.8) for Asian/Pacific Islander persons, and 15.2 (9.2-25.1) for Hispanic persons. Recurrent VTE up to 2years after the initial diagnosis occurred in 38 of 304 patients (12.5%) with active cancer and in 34 of 424 patients (8.0%) with a history of cancer >6 months previously. CONCLUSION: Age-adjusted incidence rates of cancer-associated VTE vary substantially by race and ethnicity. The relatively high incidences of first VTE and of recurrence warrant further assessment of strategies to prevent VTE among cancer patients. |
Epidemiology of cerebral venous sinus thrombosis and cerebral venous sinus thrombosis with thrombocytopenia in the United States, 2018 and 2019
Payne AB , Adamski A , Abe K , Reyes NL , Richardson LC , Hooper WC , Schieve LA . Res Pract Thromb Haemost 2022 6 (2) e12682 BACKGROUND: Population-based data about cerebral venous sinus thrombosis (CVST) are limited. OBJECTIVES: To investigate the epidemiology of CVST in the United States. PATIENTS/METHODS: Three administrative data systems were analyzed: the 2018 Healthcare Cost and Utilization Project National Inpatient Sample (NIS) the 2019 IBM MarketScan Commercial and Medicare Supplemental Claims Database, and the 2019 IBM MarketScan Multi-state Medicaid Database. CVST, thrombocytopenia, and numerous comorbidities were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Incidence rates of CVST and CVST with thrombocytopenia were estimated (per 100,000 total US population [NIS] and per 100,000 population aged 0 to 64 years covered by relevant contributing health plans [MarketScan samples]). Comorbidity prevalence was estimated among CVST cases versus total inpatients in the NIS sample. Recent pregnancy prevalence was estimated for the Commercial sample. RESULTS: Incidence rates of CVST in NIS, Commercial, and Medicaid samples were 2.85, 2.45, and 3.16, respectively. Incidence rates of CVST with thrombocytopenia were 0.21, 0.22, and 0.16, respectively. In all samples, CVST incidence increased with age; however, peak incidence was reached at younger ages in females than males. Compared with the general inpatient population, persons with CVST had higher prevalences of hemorrhagic stroke, ischemic stroke, other venous thromboembolism (VTE), central nervous system infection, head or neck infection, prior VTE, thrombophilia, malignancy, head injury, hemorrhagic disorder, and connective tissue disorders. Women aged 18 to 49 years with CVST had a higher pregnancy prevalence than the same-aged general population. CONCLUSIONS: Our findings provide recent and comprehensive data on the epidemiology of CVST and CVST with thrombocytopenia. |
Countries with delayed COVID-19 introduction - characteristics, drivers, gaps, and opportunities.
Li Z , Jones C , Ejigu GS , George N , Geller AL , Chang GC , Adamski A , Igboh LS , Merrill RD , Ricks P , Mirza SA , Lynch M . Global Health 2021 17 (1) 28 BACKGROUND: Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. RESULTS: Temporal spreading of COVID-19 was strongly associated with countries' globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). CONCLUSIONS: Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks. |
Update: Interim guidance for preconception counseling and prevention of sexual transmission of Zika virus for men with possible Zika virus exposure - United States, August 2018
Polen KD , Gilboa SM , Hills S , Oduyebo T , Kohl KS , Brooks JT , Adamski A , Simeone RM , Walker AT , Kissin DM , Petersen LR , Honein MA , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2018 67 (31) 868-871 Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and includes travel to or residence in an area with risk for Zika virus transmission (https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika) or sex without a condom with a partner who traveled to or lives in an area with risk for Zika virus transmission. CDC will continue to update recommendations as new information becomes available. |
Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician.
Alroy-Preis S , Daly ER , Adamski C , Dionne-Odom J , Talbot EA , Gao F , Cavallo SJ , Hansen K , Mahoney JC , Metcalf E , Loring C , Bean C , Drobeniuc J , Xia GL , Kamili S , Montero JT . Clin Infect Dis 2018 67 (6) 845-853 ![]() ![]() Background: In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. Methods: NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. Results: HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee's status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. Conclusions: This is the largest laboratory-confirmed drug diversion-associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided. |
Estimating the numbers of pregnant women infected with Zika virus and infants with congenital microcephaly in Colombia, 2015-2017
Adamski A , Bertolli J , Castaneda-Orjuela C , Devine OJ , Johansson MA , Duarte MAG , Tinker SC , Farr SL , Reyes MMM , Tong VT , Garcia OEP , Valencia D , Ortiz DAC , Honein MA , Jamieson DJ , Martinez MLO , Gilboa SM . J Infect 2018 76 (6) 529-535 BACKGROUND: Colombia experienced a Zika virus (ZIKV) outbreak in 2015-2016. To assist with planning for medical and supportive services for infants affected by prenatal ZIKV infection, we used a model to estimate the number of pregnant women infected with ZIKV and the number of infants with congenital microcephaly from August 2015- August 2017. METHODS: We used nationally-reported cases of symptomatic ZIKV disease among pregnant women and information from the literature on the percent of asymptomatic infections to estimate the number of pregnant women with ZIKV infection occurring August 2015 - December 2016. We then estimated the number of infants with congenital microcephaly expected to occur August 2015 - August 2017. To compare to the observed counts of infants with congenital microcephaly due to all causes reported through the national birth defects surveillance system, the model was time limited to produce estimates for February - November 2016. FINDINGS: We estimated 1,140-2,160 (interquartile range [IQR]) infants with congenital microcephaly in Colombia, during August 2015 - August 2017, whereas 340-540 infants with congenital microcephaly would be expected in the absence of ZIKV. Based on the time limited version of the model, for February - November 2016, we estimated 650-1,410 infants with congenital microcephaly in Colombia. The 95% uncertainty interval for the latter estimate encompasses the 476 infants with congenital microcephaly reported during that approximate time frame based on national birth defects surveillance. INTERPRETATION: Based on modeled estimates, ZIKV infection during pregnancy in Colombia could lead to 3 to 4 times as many infants with congenital microcephaly in 2015-2017 as would have been expected in the absence of the ZIKV outbreak. FUNDING: This publication was made possible through support provided by the Bureau for Global Health, U.S. Agency for International Development under the terms of an Interagency Agreement with Centers for Disease Control and Prevention. |
Preconception health indicators for public health surveillance
Robbins CL , D'Angelo D , Zapata L , Boulet SL , Sharma AJ , Adamski A , Farfalla J , Stampfel C , Verbiest S , Kroelinger C . J Womens Health (Larchmt) 2018 27 (4) 430-443 OBJECTIVES: In response to an expressed need for more focused measurement of preconception health (PCH), we identify a condensed set of PCH indicators for state and national surveillance. METHODS: We used a systematic process to evaluate, prioritize, and select 10 PCH indicators that maternal and child health programs can use for surveillance. For each indicator, we assessed prevalence, whether it was addressed by professional recommendations, Healthy People 2020 objectives, or Centers for Disease Control and Prevention winnable battles, measurement simplicity, data completeness, and stakeholders' input. RESULTS: Fifty PCH indicators were evaluated and prioritized. The condensed set includes indicators that rely on data from the Pregnancy Risk Assessment Monitoring System (n = 4) and the Behavioral Risk Factor Surveillance System (n = 6). The content encompasses heavy alcohol consumption, depression, diabetes, folic acid intake, hypertension, normal weight, recommended physical activity, current smoking, unwanted pregnancy, and use of contraception. CONCLUSIONS: Having a condensed set of PCH indicators can facilitate surveillance of reproductive-aged women's health status that supports monitoring, comparisons, and benchmarking at the state and national levels. |
Vital Signs: Update on Zika virus-associated birth defects and evaluation of all U.S. Infants with congenital Zika virus exposure - U.S. Zika Pregnancy Registry, 2016
Reynolds MR , Jones AM , Petersen EE , Lee EH , Rice ME , Bingham A , Ellington SR , Evert N , Reagan-Steiner S , Oduyebo T , Brown CM , Martin S , Ahmad N , Bhatnagar J , Macdonald J , Gould C , Fine AD , Polen KD , Lake-Burger H , Hillard CL , Hall N , Yazdy MM , Slaughter K , Sommer JN , Adamski A , Raycraft M , Fleck-Derderian S , Gupta J , Newsome K , Baez-Santiago M , Slavinski S , White JL , Moore CA , Shapiro-Mendoza CK , Petersen L , Boyle C , Jamieson DJ , Meaney-Delman D , Honein MA . MMWR Morb Mortal Wkly Rep 2017 66 (13) 366-373 BACKGROUND: In collaboration with state, tribal, local, and territorial health departments, CDC established the U.S. Zika Pregnancy Registry (USZPR) in early 2016 to monitor pregnant women with laboratory evidence of possible recent Zika virus infection and their infants. METHODS: This report includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the USZPR from January 15 to December 27, 2016. Birth defects potentially associated with Zika virus infection during pregnancy include brain abnormalities and/or microcephaly, eye abnormalities, other consequences of central nervous system dysfunction, and neural tube defects and other early brain malformations. RESULTS: During the analysis period, 1,297 pregnant women in 44 states were reported to the USZPR. Zika virus-associated birth defects were reported for 51 (5%) of the 972 fetuses/infants from completed pregnancies with laboratory evidence of possible recent Zika virus infection (95% confidence interval [CI] = 4%-7%); the proportion was higher when restricted to pregnancies with laboratory-confirmed Zika virus infection (24/250 completed pregnancies [10%, 95% CI = 7%-14%]). Birth defects were reported in 15% (95% CI = 8%-26%) of fetuses/infants of completed pregnancies with confirmed Zika virus infection in the first trimester. Among 895 liveborn infants from pregnancies with possible recent Zika virus infection, postnatal neuroimaging was reported for 221 (25%), and Zika virus testing of at least one infant specimen was reported for 585 (65%). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: These findings highlight why pregnant women should avoid Zika virus exposure. Because the full clinical spectrum of congenital Zika virus infection is not yet known, all infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy should receive postnatal neuroimaging and Zika virus testing in addition to a comprehensive newborn physical exam and hearing screen. Identification and follow-up care of infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with possible congenital Zika virus infection can ensure that appropriate clinical services are available. |
Prolonged detection of Zika virus RNA in pregnant women
Meaney-Delman D , Oduyebo T , Polen KN , White JL , Bingham AM , Slavinski SA , Heberlein-Larson L , St George K , Rakeman JL , Hills S , Olson CK , Adamski A , Culver Barlow L , Lee EH , Likos AM , Munoz JL , Petersen EE , Dufort EM , Dean AB , Cortese MM , Santiago GA , Bhatnagar J , Powers AM , Zaki S , Petersen LR , Jamieson DJ , Honein MA . Obstet Gynecol 2016 128 (4) 724-730 ![]() ![]() OBJECTIVE: Zika virus infection during pregnancy is a cause of microcephaly and other fetal brain abnormalities. Reports indicate that the duration of detectable viral RNA in serum after symptom onset is brief. In a recent case report involving a severely affected fetus, Zika virus RNA was detected in maternal serum 10 weeks after symptom onset, longer than the duration of RNA detection in serum previously reported. This report summarizes the clinical and laboratory characteristics of pregnant women with prolonged detection of Zika virus RNA in serum that were reported to the U.S. Zika Pregnancy Registry. METHODS: Data were obtained from the U.S. Zika Pregnancy Registry, an enhanced surveillance system of pregnant women with laboratory evidence of confirmed or possible Zika virus infection. For this case series, we defined prolonged detection of Zika virus RNA as Zika virus RNA detection in serum by real-time reverse transcription-polymerase chain reaction (RT-PCR) 14 or more days after symptom onset or, for women not reporting signs or symptoms consistent with Zika virus disease (asymptomatic), 21 or more days after last possible exposure to Zika virus. RESULTS: Prolonged Zika virus RNA detection in serum was identified in four symptomatic pregnant women up to 46 days after symptom onset and in one asymptomatic pregnant woman 53 days postexposure. Among the five pregnancies, one pregnancy had evidence of fetal Zika virus infection confirmed by histopathologic examination of fetal tissue, three pregnancies resulted in live births of apparently healthy neonates with no reported abnormalities, and one pregnancy is ongoing. CONCLUSION: Zika virus RNA was detected in the serum of five pregnant women beyond the previously estimated timeframe. Additional real-time RT-PCR testing of pregnant women might provide more data about prolonged detection of Zika virus RNA and the possible diagnostic, epidemiologic, and clinical implications for pregnant women. |
Behavioral Risk Factor Surveillance System state-added questions: leveraging an existing surveillance system to improve knowledge of women's reproductive health
Boulet SL , Warner L , Adamski A , Smith RA , Burley K , Grigorescu V . J Womens Health (Larchmt) 2016 25 (6) 565-70 As the prevalence of chronic conditions among women of reproductive age continues to rise, studies assessing the intersection of chronic disease and women's reproductive health status are increasingly needed. However, many data systems collect only limited information on women's reproductive health, thereby hampering the appraisal of risk and protective factors across the life span. One way to expand the study of women's health with minimal investment in time and resources is to integrate questions on reproductive health into existing surveillance systems. In 2013, previously validated questions on women's self-reported reproductive history, use of contraception, and infertility were added to the Behavioral Risk Factor Surveillance System (BRFSS) by seven states (Connecticut, Kentucky, Massachusetts, Mississippi, Ohio, Texas, and Utah); all female respondents aged 18-50 years were included in the pool of respondents for these state-added questions. Of 8691 women who completed the questions, 13.2% reported ever experiencing infertility and 59.8% of those at risk for unintended pregnancy reported using contraception at last intercourse. The information garnered from the state-added reproductive health questions can be augmented with the BRFSS core questions on health-related risk behaviors, chronic conditions, and use of preventive services. Expanding existing data collection systems with supplemental questions on women's reproductive health can provide important information on risk factors and outcomes that may not be available from other sources. |
Tracking antimicrobials dispensed during an anthrax attack: a case study from the New Hampshire anthrax exercise
Tropper J , Adamski C , Vinion C , Sapkota S . J Emerg Manag 2011 9 (1) 65-69 The Countermeasure and Response Administration (CRA) system is a Centers for Disease Control and Prevention informatics application developed to track countermeasures, including medical interventions (eg, vaccinations and pharmaceuticals) and nonmedical interventions (eg, patient isolation, quarantine, and personal protective equipment), administered during a public health response. This case study follows the use of CRA as a supplement to paper-based processes during an exercise in which antimicrobials dispensed to individual exposed persons were captured after a simulated bioterrorist attack of anthrax spores. The exercise was conducted by the New Hampshire Division of Public Health Services on April 14, 2007. Automated systems like CRA can track when medications are dispensed. The data can then be used for performance metrics, statistics, and in locating victims for follow-up study. Given that this case study was limited to a single location in a relatively rural setting, the authors concluded that more study is needed to compare the feasibility of using an automated system rather than paper-based processes for effectively managing a very large-scale urgent public health response. |
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