Classification of ADRs: a proposal for harmonization and differentiation based on the experience of the Comprehensive Hospital Drug Monitoring Bern/St. Gallen, 1974-1993

The present paper deals with the classification of adverse drug reactions (ADRs) according to today's largely accepted pathomechanisms. The classification system applied, relies primarily on the proposals of Rawlins and Thomson with type A ('augmented') and B ('bizarre') reactions. In the database of the Comprehensive Hospital Drug Monitoring (CHDM) Bern/St. Gallen on 48,005 consecutively hospitalized patients, ADRs had been attributed to 10 different pathomechanisms. These permit a versatile new system, easily adaptable to expanding knowledge. If we look at the 12,785 ADRs registered in the CHDM Bern/St. Gallen from 1974 to 1993, 76% were of type A, 13% of type B, and 11% of a pathomechanism not yet defined (type X). The main subgroups were A1 'not specified' in type A, Ba allergic/immunological and Bpa pseudoallergic/anaphylactoid in type B. Dose-related (A2) and drug-related reactions (A4, intolerance in a restricted sense), drug-to-drug interactions (A5), rebound/withdrawal effects (A6) and secondary reactions (A7) represented smaller subgroups. Patient-related reactions (A3, 'idiosyncrasy' in the strict sense) were not assessed. Today's algorithms for ADRs mainly rely on pharmacological, i.e. type A reactions. For most of the type B reactions adaptations including the experience of allergists, clinical immunologists and infectious disease specialists should be respected.     

肺炎支原体肺炎T细胞亚群免疫球蛋白水平变化的研究

目的：为了正确认识肺炎支原体肺炎(MPP)患儿免疫状态,该研究检测了MPP患儿外周血T细胞亚群、免疫球蛋白的变化,旨在探讨MPP患儿免疫功能的特点。方法：采用流式细胞仪技术(FCM)检测了32例支原体肺炎患儿外周血T细胞亚群及免疫球蛋白,并与28例正常儿童进行比较。结果：MPP患儿急性期外周血CD3,CD4,CD8,CD4/CD8分别为57.30±6.21个/μL,32.70±6.52个/μL,24.9±2.41个/μL,1.31±0.33,恢复期外周血CD3,CD4,CD8,CD4/CD8分别为58.20±6.10个/μL,34.92±5.93个/μL,25.87±4.72个/μL,1.39±0.42,CD4,CD4/CD8较对照组低,P<0.05。MPP患儿外周血急性期IgG,IgA,IgM分别为9.93±2.67g/L,1.63±0.69g/L,1.73±0.83g/L,恢复期分别为11.45±2.97g/L,1.94±0.84g/L,2.17±1.23g/L,IgG,IgM较对照组高,P<0.01。IgA与对照组比较无明显差异。结论：肺炎支原体肺炎时患儿存在细胞免疫和体液免疫失调,该研究为临床应用免疫调节剂提供了理论依据。     

哮喘儿童IgE T细胞亚群细胞因子的动态观察及临床意义

目的：探讨哮喘儿童血IgE和T细胞亚群、细胞因子的动态变化及临床意义。方法：应用免疫萤光法及双抗夹心酶联免疫吸附试验(ELISA)分析方法对45例哮喘儿童发作期和缓解期分别测定IgE,T细胞亚群和细胞因子。对照组为20例健康儿童。结果：哮喘发作期、缓解期CD_3~+,CD_4~+ T细胞及CD_4~+/CD_8~+高于对照组,差异有显著性(P<0.05或0.01),CD_8~+ T细胞与对照组比差异无显著性(P>0.05)。发作期CD_4~+ T细胞及CD_4~+/CD_8~+高于缓解期(P<0.05)。发作期IL-2,EFN-γ低于对照组(P<0.01或0.05),IL-4,IL-6,IL-8和IgE高于对照组(P<0.01或0.05);缓解期IL-2,IFN-γ低于对照组(P<0.01),IL-4,IL-8,IgE高于对照组(P<0.05或0.01),缓解期IL-6与对照组比较差异无显著性(P>0.05)。结论：儿童哮喘在发作期和缓解期均存在着免疫功能紊乱,提示儿童哮喘应长期抗变应性炎症治疗。 [中国当代儿科杂志,2003,5(1):23-26]     

Short interpregnancy intervals and associated risk of preterm birth in Asians and Pacific Islanders

Purpose: The prevalence of short interpregnancy intervals (IPIs) and associated rates of preterm birth has been understudied in Asian and Pacific Islander populations. We sought to estimate rates of short IPI among Asian subgroups and Pacific Islanders and associated risk of preterm birth.

Materials and methods: For this retrospective cohort study, we linked records of women in California with a first birth in 1999–2000 and a second birth before 2005 with hospital discharge data. We used multivariate modeling to determine whether specific Asian ethnicities and Pacific Islanders were at greater risk of short IPI (<6 months, 6–18 months) and if a short IPI increased risk for preterm birth in these groups.

Results: Our sample included 189,931 women. In multivariable analyses, Asian subgroups and Pacific Islanders were more likely to have an IPI?<6 months than were White women (Pacific Islanders: OR 3.31 (95%CI [2.7, 4.1]); Filipinas: OR 1.51 (95%CI [1.33, 1.71]); Southeast Asians: OR 1.93 (95%CI [1.73, 2.1]); East Asians: OR 1.65 (95%CI [1.48, 1.84]); other Asians: OR 2.04 (95%CI [1.70, 2.4])).

Conclusions: Asian and Pacific Islander women have higher rates of IPI?<6 months, but this did not significantly increase their risk of preterm birth.     

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.     

Memory Tests in Subgroups of Adult Attention Deficit Hyperactivity Disorder Reveals Simultaneous Capacity Deficit

Neuropsychological tests were used to evaluate different memory systems in the three subgroups of adult Attention Deficit Hyperactivity Disorder (ADHD) (n = 105) using analysis of means, factor analysis, and GLM analysis with covariance of gender, estimated IQ, and level of anxiety and depression measured with the Hospital anxiety and depression scale. A higher IQ level was found in the neuropsychological background tests for the predominantly inattentive subtype (ADD). In the memory tests the dual-task memory/simultaneous capacity tests “Brown-Peterson” Consonant Trigram and Benton Visual Retention Test (BVRT) were the most sensitive and were severely reduced in all three subgroups, but only the BVRT revealed a difference between the three ADHD groups. In learning and delayed recall measured with Rey Auditory Verbal learning test and modified Diagnosticum für Cerebralschädigung (mDCS), the Attention Deficit Disorder subgroup had the best learning and delayed capacity of the three groups. A good agreement was found between the interviewed DSM-IV-TR criteria, Conners CAARS S:S scale, and Wender WURS 25-item scales. Despite the difference in number of ADHD criteria for the three ADHD subgroups, the results in the neuropsychological memory tests indicate a severe reduction in all three subgroups of adult ADHD in simultaneous capacity.     

How an Online Intervention to Prevent Excessive Gestational Weight Gain Is Used and by Whom: A Randomized Controlled Process Evaluation

Background

Online interventions have emerged as a popular strategy to promote healthy behaviors. Currently, there is little agreement about how to capture online intervention engagement. It is also uncertain who engages with weight-related online interventions and how engagement differs by demographic and weight characteristics.

Objective

The objectives of this study were to (1) characterize how pregnant women engaged with features of an online intervention to prevent excessive gestational weight gain, (2) identify demographic and weight status subgroups of women within the sample, and (3) examine differences in use of intervention features across the demographic and weight status subgroups.

Methods

A sample of racially and socioeconomically diverse pregnant women from a northeastern US city was assigned to the intervention group in a randomized controlled trial to prevent excessive gestational weight gain (n=1014). The intervention website included these features: weight-gain tracker, health-related articles, blogs, physical activity and diet goal-setting tools, and local resources. Engagement variables were created to capture the amount, consistency, and patterns of feature use across pregnancy using latent class analysis. Demographic/weight status subgroups were also created using latent class analysis. Differences in engagement across the demographic/weight status subgroups were examined using chi-square analysis.

Results

Six engagement patterns emerged: “super-users” (13.02%, 132/1014), “medium-users” (14.00%, 142/1014), “consistent weight-tracker users” (14.99%, 152/1014); “almost consistent weight-tracker users” (21.99%, 223/1014), “inconsistent weight-tracker users” (15.98%, 162/1014), and “non-users” (20.02%, 203/1014). Four demographic/weight status subgroups emerged: three minority and one white. There were different engagement patterns by demographic/weight status subgroups. Super-users were more likely to be in the white subgroup, while non-users were more likely to be in the minority subgroups. However, around a third of women in minority subgroups were consistently or almost consistently engaging with the weight-tracker (black, young women, 32.2%, 67/208; black, heavier women, 37.9%, 50/132; Hispanic women, 27.4%, 32/117).

Conclusions

While white and higher income women had higher engagement in general, depending on the measure, there was still considerable engagement by the minority and low-income women.

Trial Registration

Clinicaltrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01331564","term_id":"NCT01331564"}}NCT01331564; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01331564","term_id":"NCT01331564"}}NCT01331564 (Archived by WebCite at http://www.webcitation.org/6Rw4yKxI5).     

Serological typing scheme for BK-like isolates of human polyomavirus

Human polyomavirus BK-like isolates were subjected to restriction endonuclease analysis with the enzymes EcoRI and Hind III. End-point dilution was used to obtain homogeneous virus pools for DNA analysis and to remove JC virus from a mixed stock. The results of Hind III digestion suggested that two subgroups could be distinguished. Several BK-like isolates were purified and rabbit antisera raised. The isolates were compared with each other and with BK and JC viruses by haemagglutination-inhibition (HI) and by neutralisation. JC virus was serologically distinct, but all the other isolates showed some cross-reactivity. Two subgroups were again evident: GS and PG were with prototype BK in subgroup 1, and MG and IV were in subgroup 2. Two isolates, AS and SB, reacted with isolates of both subgroups 1 and 2 but were distinct from one another: their genome was similar to subgroup 1 isolates. Typing by HI or by neutralisation may form a basis for grouping BK-like polyomavirus isolates.