Terah Koch

Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes

OBJECTIVE To investigate safety of hormonal contraception with regard to thromboembolic events in women with type 1 or 2 diabetes. RESEARCH DESIGN AND METHODS We used data from 2002–2011 in Clinformatics Data Mart to identify women in the U.S., 14–44 years of age, with an ICD-9-CM code for diabetes and a prescription for a diabetic medication or device. We examined contraceptive claims and compared time to thromboembolism (venous thrombosis, stroke, or myocardial infarction) among women with diabetes dispensed hormonal contraception using a modification of Cox regression to control for age, smoking, obesity, hypertension, hyperlipidemia, diabetic complications, and history of cancer; we excluded data for 3 months after women gave birth. RESULTS We identified 146,080 women with diabetes who experienced 3,012 thromboembolic events. Only 28% of reproductive-aged women with diabetes had any claims for hormonal contraception, with the majority receiving estrogen-containing oral contraceptives. Rates of thromboembolism were highest among women who used the contraceptive patch (16 per 1,000 woman-years) and lowest among women who used intrauterine (3.4 per 1,000 woman-years) and subdermal (0 per 163 woman-years) contraceptives. Compared with use of intrauterine contraception, progestin-only injectable contraception was associated with increased risk of thromboembolism (12.5 per 1,000 woman-years; adjusted hazard ratio 4.69 [95% CI 2.51–8.77]). CONCLUSIONS The absolute risk of thromboembolism among women with type 1 or 2 diabetes using hormonal contraception is low. Highly effective, intrauterine and subdermal contraceptives are excellent options for women with diabetes who hope to avoid the teratogenic effects of hyperglycemia by carefully planning their pregnancies.

Hydroxyurea use in Children with Sickle Cell Disease: Do Severely Affected Patients Use It and Does It Impact Hospitalization Outcomes?

Expert guidelines recommend that hydroxyurea (HU) be offered to all children with hemoglobin SS and Sβ0 sickle cell disease (SCD) and be considered for children with clinically severe hemoglobin SC or Sβ+. This study aims to determine the rate of HU use in hospitalized children, if HU is differentially used in children with clinically severe SCD, and if HU users have shorter length of stay (LOS), fewer intensive care unit (ICU) admissions, and fewer inpatient transfusions compared to nonusers.

The Effects of Hospital Length of Stay on Readmissions for Children With Newly Diagnosed Acute Lymphoblastic Leukemia.

Although regimens for induction therapy in children with acute lymphoblastic leukemia (ALL) are similar across the United States, typical practice with regard to inpatient length of stay (LOS) varies by institution. US children’s hospitals were categorized by typical induction LOS; and readmissions, pediatric intensive care unit (PICU) admissions, and average adjusted charges were compared for the first 30 days from initial admission. Using Pediatric Health Information System data, we extracted ALL induction admissions from 2007 to 2013. We categorized hospitals into 3 categories based on median LOS: short (⩽7 d), medium (8 to 15 d), or long (≥16 d). Median LOS varied from 5 to 31 days across hospitals. Thirty-day median inpatient costs per patient ranged from

The accuracy of a patient or parent-administered bleeding assessment tool administered in a paediatric haematology clinic.

32 K for short LOS,

Intravenous iron therapy in non-anemic iron-deficient menstruating adolescent females with fatigue

40 K for medium LOS, and

Patterns of Emergency Department Care for Newly Diagnosed Immune Thrombocytopenia in United States Children's Hospitals

47 K for long LOS. Compared with short LOS hospitals (n=14), medium LOS (n=8) and long LOS hospitals (n=8) had lower odds of PICU readmissions (odds ratio [OR], 0.68; P=0.0124 and OR, 0.31; P<0.001, respectively), and long LOS hospitals had lower odds of any readmission (OR, 0.44; P<0.0001). Average LOS for children with newly diagnosed ALL varies widely by institution. Children’s hospitals that typically admit new ALL patients for >7 days have fewer PICU readmissions but substantial increase in total induction inpatient costs.

Steroid-induced Hypertension During Induction Chemotherapy for Acute Lymphoblastic Leukemia in US Children’s Hospitals

Classifying and describing bleeding symptoms is essential in the diagnosis and management of patients with mild bleeding disorders (MBDs). There has been increased interest in the use of bleeding assessment tools (BATs) to more objectively quantify the presence and severity of bleeding symptoms. To date, the administration of BATs has been performed almost exclusively by clinicians; the accuracy of a parent‐proxy BAT has not been studied. Our objective was to determine the accuracy of a parent‐administered BAT by measuring the level of agreement between parent and clinician responses to the Condensed MCMDM‐1VWD Bleeding Questionnaire. Our cross‐sectional study included children 0–21 years presenting to a haematology clinic for initial evaluation of a suspected MBD or follow‐up evaluation of a previously diagnosed MBD. The parent/caregiver completed a modified version of the BAT; the clinician separately completed the BAT through interview. The mean parent‐report bleeding score (BS) was 6.09 (range: −2 to 25); the mean clinician report BS was 4.54 (range: −1 to 17). The mean percentage of agreement across all bleeding symptoms was 78% (mean κ = 0.40; Gwets AC1 = 0.74). Eighty percent of the population had an abnormal BS (defined as ≥2) when rated by parents and 76% had an abnormal score when rated by clinicians (86% agreement, κ = 0.59, Gwets AC1 = 0.79). While parents tended to over‐report bleeding as compared to clinicians, overall, BSs were similar between groups. These results lend support for further study of a modified proxy‐report BAT as a clinical and research tool.

Comorbidities associated with Sjögren's syndrome: Results from the Nationwide Inpatient Sample.

Menstruating women, with or without underlying bleeding disorders, are at increased risk for developing iron deficiency‐related fatigue, even in the absence of anemia. Oral iron therapy has limitations which include poor absorption and non‐adherence due to gastrointestinal side effects. We performed a prospective clinical trial of post‐menarchal adolescent females with iron‐deficiency with or without mild anemia and fatigue who received a standardized regimen of intravenous iron sucrose. The baseline mean (SD) hemoglobin was 11.96 g dl−1 (1.05) in 20 girls (ages 14–21 years); with a range of 10.3–14.1 g dl−1. In this cohort, intravenous iron was well tolerated and patients demonstrated a sustained increase in ferritin levels with means (SD) of 13.4 ng ml−1 (13.1) at baseline to 141.5 ng ml−1 (104.5) at 6 weeks and 85.2 ng ml−1 (128.4) at 6 months after the infusions. We used a standardized (Peds QLTM Multidimensional) fatigue scale to objectively measure fatigue and proxy scores by parents with mean screening scores (SD) of 35.2 (16.8) and 31.9 (19.6), respectively. We demonstrated a clinically significant improvement both in patient as well as parent fatigue scores (in 19 out of 20 subjects) at 6 weeks (Mean (SD) 58.3 (21.3) [P < 0.0001] and 57 (24.4) [P < 0.0001], respectively); as well as 3 and 6 months after the iron infusions. In nonanemic patients, iron administration did not significantly influence hemoglobin concentration. Therefore, the fatigue‐reducing effects of iron therapy reflect the nonhematological functions of iron. Am. J. Hematol. 91:973–977, 2016.

Effect of Intravenous Iron Therapy on Quality of Life in Non-Anemic Iron-Deficient Young Women with Fatigue

&NA; We used the Pediatric Health Information Systems database to ascertain treatment patterns of immune thrombocytopenia across the US. Despite the recently published guidelines by the American Society of Hematology, most patients are still being hospitalized for immune thrombocytopenia, even in the absence of documented bleeding symptoms.

Steroid-Induced Hypertension during Induction Chemotherapy for Acute Lymphoblastic Leukemia in US Children's Hospitals

Childhood acute lymphoblastic leukemia achieves excellent cure rates in part due to induction chemotherapy including high dose corticosteroids. Hypertension (HTN) is a known complication of corticosteroids, but incidence and risk factors for steroid-induced HTN are poorly understood. We sought to describe these using a large pediatric health database. Of the 5578 unique patients receiving induction chemotherapy, 14.7% received anti-HTN medications during their initial hospital admission. We found that age below 1 year, obesity, secondary diabetes mellitus, and abnormal glucose were associated with developing steroid-induced HTN. We also found that ICD-9 codes had poor sensitivity for detecting treatment of HTN, suggesting underreporting by physicians.