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Quantifying the Accuracy of Clinician Risk Assessment for Postpartum Hemorrhage

Maternal-Fetal Medicine 2024年第4期6卷 211-214页

作者： Ashley N.Lewis Diego Villela-Franyutti Henry J.Domenico Daniel W.Byrne michaela k.farber Holly B.Ende Department of Anesthesiology Vanderbilt University Medical CenterNashvilleTN 37232United States Department of Anesthesiology Perioperativeand Pain MedicineBrigham and Women’s HospitalBostonMA 02115United States Department of Biostatistics Vanderbilt University Medical CenterNashvilleTN 37232United States

Objective To measure the accuracy of postpartum hemorrhage(PPH)risk assessment performed by unaided individual clinicians,to inform future comparison to alternative risk assessment *** Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States(Vanderbilt University Medical Center,Brigham and Women’s Hospital)from January 2022 to January 2023,following written informed consent from the *** data included a cohort of both vaginal and cesarean deliveries(CD).For each assessment,the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100%and rated their confidence in these assessments using a 5-point Likert scale,ranging from‘not at all confident’to‘completely confident’.Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH,defined as blood loss≥1000 *** accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve(AUC).Results Of 271 patients,32(11.8%)experienced PPH,accounting for 11.4%(104/915)of *** overall AUC was 0.64(95%confidence interval(CI):0.58–0.71).Prediction accuracy was higher for CD than for vaginal deliveries,with AUCs of 0.82(95%CI:0.72–0.91)and 0.56(95%CI:0.48–0.63),*** significant differences in the accuracy of assessments were observed according to physician specialty,physician experience level,or confidence level of the *** Overall unaided clinician performance in predicting PPH was moderate,with an AUC of *** were more accurate for patients undergoing *** study is needed to understand how clinician performance compares to other modalities of risk prediction.

关键词： Postpartum hemorrhage Maternal morbidity Obstetrics Pregnancy Risk factors Risk prediction

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Quantifying Maternal Blood Loss from the Hysterotomy at Cesarean Delivery

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Open Journal of Obstetrics and Gynecology 2020年第8期10卷 969-975页

作者： Rebecca M. Reimers Daniela Carusi michaela k. farber James A. Greenberg Division of Maternal Fetal Medicine Brigham & Women’s Hospital Boston MA USA Department of Anesthesiology Perioperative and Pain Medicine Brigham & Women’s Hospital Boston MA USA Department of Obstetrics and Gynecology Brigham & Women’s Hospital Boston MA USA

Background: With newer protocols, such as delayed cord clamping, becoming routine practice, determining the potential maternal consequences is important. In particular, establishing normative values for blood loss from the hysterotomy would be helpful in addressing techniques to minimize total blood loss for cesarean deliveries. Objective: Blood loss from the hysterotomy during cesarean delivery has not been reported using quantitative methods. We aimed to quantify the rate of blood loss during cesarean delivery from the hysterotomy between creation and closure. Methods: This single center, prospective, case series was collected in 2018. Women with singleton pregnancies undergoing cesarean delivery at ≥37 0/7 weeks at Brigham and Women’s Hospital were included. Delayed cord clamping was performed which allowed for quantification of blood loss through gravimetric methods and descriptive statistics were performed. Results: Twenty patients were included. The mean hysterotomy closure delay for cord blood collection was 47 seconds (SD 10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL). Blood loss per minute was calculated with a median of 150 mL/minute (IQR 88.8 mL, 95% CI 109.2 - 190.4 mL). The mean post-operative hematocrit drop was 4.4%, and there were no blood transfusions. There was a single hysterotomy extension and a quantified blood

关键词： Cesarean Section Gravimetry Blood Loss Hysterotomy Surgery Humans Obstetrics Delivery

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Integrative and Comparative Genomic Analysis of HPV-Positive and HPV-Negative Head and Neck Squamous Cell Carcinomas

Integrative and Comparative Genomic Analysis of HPV-Positive...

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中国生物工程学会第六次全国会员代表大会暨第九届学术年会

作者： Tanguy Y.Seiwert Zhixiang Zuo michaela k.keck Arun khattri Chandra S.Pedamallu Thomas Stricker Christopher Brown Trevor J.Pugh Petar Stojanov Juok Cho Michael S.Lawrence Gad Getz Johannes Br?gelmann Rebecca DeBoer Ralph R.Weichselbaum Alexander Langerman Louis Portugal Elizabeth Blair kerstin Stenson Mark W.Lingen Ezra E.W.Cohen Everett E.Vokes kevin P.White Peter S.Hammerman Section of Hematology/Oncology Department of MedicineThe University of Chicago The University of Chicago Comprehensive Cancer Center Institute for Genomics and Systems Biology University of Chicago Broad Institute of Harvard and MIT Department of Medical Oncology Dana Farber Cancer Institute Department of Pathology Microbiologyand ImmunologyVanderbilt University Department of Genetics University of Pennsylvania Department of Radiation Oncology The University of Chicago Department of Otolaryngology/Head and Neck Surgery The University of Chicago Department of Pathology University of Chicago

Purpose:The genetic differences between human papilloma virus(HPV)–positive and –negative head and neck squamous cell carcinomas(HNSCC) remain largely *** identify differential biology and novel therapeutic targets for both entities,we determined mutations and copy-number aberrations in a large cohort of locoregionally advanced *** Design:We performed massively parallel sequencing of 617 cancer-associated genes in 120 matched tumor/normal samples(42.5% HPV-positive).Mutations and copy-number aberrations were determined and results validated with a secondary ***:The overall mutational burden in HPV-negative and HPV-positive HNSCC was similar with an average of 15.2 versus14.4 somatic exonic mutations in the targeted cancer-associated ***-negative tumors showed a mutational spectrum concordant with published lung squamous cell carcinoma analyses with enrichment for mutations in TP53,CDkN2 A,MLL2,CUL3,NSD1,PIk3 CA,and NOTCH ***-positive tumors showed unique mutations in DDX3 X,FGFR2/3 and aberrations in PIk3 CA,kRAS,MLL2/3,and NOTCH1 were enriched in HPVpositive *** targetable genomic alterations were identified in FGFR1,DDR2,EGFR,FGFR2/3,EPHA2,and PIk3 ***,CCND1,and FGFR1 amplifications occurred in HPV-negative tumors,whereas 17.6% of HPV-positive tumors harbored mutations in fibroblast growth factor receptor genes(FGFR2/3),including six recurrent FGFR3 S249 C ***-positive tumors showed a 5.8% incidence of kRAS mutations,and DNArepair gene aberrations,including 7.8% BRCA1/2 mutations,were ***:The mutational makeup of HPV-positive and HPV-negative HNSCC differs significantly,including targetable *** harbors multiple therapeutically important genetic aberrations,including frequent aberrations in the FGFR and PI3k pathway genes.

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