(Press-News.org) PROVIDENCE, R.I. - Adam C. Levine, M.D., an emergency medicine physician at Rhode Island Hospital and The Miriam Hospital who treated Ebola-infected patients in Liberia last year, used his field experience to create a tool to determine the likelihood that patients presenting with Ebola symptoms will actually carry the virus. His research was published in the Annals of Emergency Medicine today.
Ebola Virus Disease (EVD) has affected 24,000 persons during the current epidemic, which is the largest recorded outbreak of EVD in history. Over 10,000 people have died in West Africa, mainly in Sierra Leone, Liberia and Guinea.
Because the initial symptoms are not specific to EVD, diagnosing EVD remains a significant challenge. This is the first time that researchers scientifically derived a clinical prediction model, the Ebola Prediction Score, for patients with suspected EVD who await laboratory confirmation.
"There is a lag time between a suspected case and a confirmation," said Levine, who volunteered in Liberia through the humanitarian organization, International Medical Corps, helping set up their first Ebola Treatment Unit (ETU) in Bong County. "The Ebola Prediction Score will help clinicians risk-stratify patients already meeting one or more suspect definitions of EVD."
Typical predictors for EVD include fever, nausea/vomiting, diarrhea, fatigue, abdominal pain, loss of appetite, muscle pain, joint pain, headache, difficulty breathing, difficulty swallowing, hiccups, unexplained bleeding, and exposure to a suspected or confirmed EVD patient within 21 days. In Levine's Ebola Prediction Score tool, six of those symptoms create the model--sick contact, diarrhea, loss of appetite, muscle pain, difficulty swallowing and absence of abdominal pain. A scoring system based on these signs may help clinicians determine who is most likely to require isolation while laboratory tests confirm diagnosis.
"Admitting a patient to an ETU in a rural setting or to a community-based isolation center who is unlikely to have EVD puts that patient at risk for exposure," said Levine. "Determining which patients to admit for definitive testing and treatment required balancing the epidemiologic imperative to break the train of transmission in the community against the ethical imperative to 'do no harm' to each individual patient, all within the context of severe resource constraints."
Patient data was collected during routine clinical care at the 52-bed Bong County ETU in Liberia during its first 16 weeks of operation. EVD testing results were available for 382 of the 395 patients admitted to the ETU during the study period. Forty-two percent, or 160 patients, tested positive for EVD.
According to Levine, while the Ebola Prediction Score can help determine who is more likely to have EVD and treat them accordingly, better testing needs to be a focus. "Given the inherent limitations of clinical prediction models...a low-cost, point-of-care test that can rapidly and definitively exclude EVD in patients should be a research priority," he said.
INFORMATION:
While funding from the USAID Office of Foreign Disaster Assistance (OFDA) supported clinical operations at the Bong County Ebola Treatment Unit, no direct financial support was provided for this research study. Levine's principal affiliation is Rhode Island Hospital and The Miriam Hospital, members of the Lifespan health system in Rhode Island. He also has an academic appointment at The Warren Alpert Medical School of Brown University, department of emergency medicine. Other researchers involved in the study are Pranav Prathap Shetty, M.D., IMC; Ryan Burbach, IMC; Sambhavi Cheemalapati, IMC; Justin Glavis-Bloom, Lifespan; Tess Wiskel, M.D., Lifespan; and J. Kota T. Kesselly, College of Allied Health Sciences, Cuttington University, Liberia.
About Rhode Island Hospital
Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Last year, Rhode Island Hospital received more than $50 million in external research funding. It is also home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care. For more information on Rhode Island Hospital, visit http://www.rhodeislandhospital.org, follow us on Twitter @RIHospital or like us on Facebook http://www.facebook.com/rhodeislandhospitalpage.
Scientists use small molecule that suppresses cancer-causing genes in glioblastoma
Nanotechnology crosses blood-brain barrier to reach tumor cells
Approach has potential to silence genes in other cancers and genetic diseases
CHICAGO --- Northwestern Medicine scientists have identified a small RNA molecule called miR-182 that can suppress cancer-causing genes in mice with glioblastoma mulitforme (GBM), a deadly and incurable type of brain tumor.
While standard chemotherapy drugs damage DNA to stop cancer cells from reproducing, the new method stops the source ...
ROCHESTER, Minn. -- Recent large-scale genomic analyses have uncovered dozens of common genetic variants that are associated with breast cancer. Each variant, however, contributes only a tiny amount to a person's overall risk of developing the disease.
A Mayo Clinic-led team of international researchers has now combined 77 of these common genetic variants into a single risk factor that can be used to improve the identification of women with an elevated risk of breast cancer. This factor, known as a polygenic risk score, was built from the genetic data of more than 67,000 ...
If a time machine was available, would it be right to kill Adolf Hitler when he was still a young Austrian artist to prevent World War II and save millions of lives? Should a police officer torture an alleged bomber to find hidden explosives that could kill many people at a local cafe? When faced with such dilemmas, men are typically more willing to accept harmful actions for the sake of the greater good than women. For example, women would be less likely to support the killing of a young Hitler or torturing a bombing suspect, even if doing so would ultimately save more ...
HOUGHTON, Mich. (April 3, 2015): Central Appalachian forests have been experiencing the effects of a changing climate for decades, and effects such as more heavy rainfall events, more drought, and more hot days are likely to continue, according to a new vulnerability assessment for the region by the U.S. Forest Service and many partners.
The assessment describes effects of climate change that have already been observed, projected changes in the climate and the landscape, and forest vulnerabilities for nine forest ecosystem types in a 29-million-acre area of Ohio, West ...
(New York, NY) April 3, 2015 - The scientific community is facing a 'pollution problem' in academic publishing, one that poses a serious threat to the "trustworthiness, utility, and value of science and medicine," according to one of the country's leading medical ethicists.
Arthur L. Caplan, PhD, director of the Division of Medical Ethics in the Department of Population Health at NYU Langone Medical Center, shares these and other observations in a commentary publishing April 3 in the journal Mayo Clinic Proceedings.
"The pollution of science and medicine by plagiarism, ...
Deaths within 30 days of children's heart surgery have almost halved in the UK over the past decade, despite a rise in the number and complexity of cases during that period, reveals an analysis of national data, published in the online journal Open Heart.
The findings prompt the researchers to suggest that it is now time to shift the focus to longer term survival and other issues that matter greatly to patients and their families, such as measures of ill health and impact on functional capacity.
Children's heart surgery in the UK has come under intense public scrutiny ...
Passive exposure to bleach in the home is linked to higher rates of childhood respiratory and other infections, suggests research published online in Occupational & Environmental Medicine.
Although modest, the results are of public health concern in light of the widespread use of bleach in the home, say the researchers, who call for further more detailed studies in this area.
The researchers looked at the potential impact of exposure to bleach in the home among more than 9000 children between the ages of 6 and 12 attending 19 schools in Utrecht, The Netherlands; 17 ...
Highlights
High parathyroid hormone levels and subsequent bone loss are major risk factors for worsening of coronary artery calcification in patients on dialysis.
Washington, DC (April 2, 2015) -- Bone loss may be a sign of poor heart health in patients on dialysis, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Monitoring bone loss in dialysis patients may therefore provide an early alert to physicians concerning cardiovascular problems.
Most patients with chronic kidney disease who are on dialysis ...
Using archival data from the Japan-led Suzaku X-ray satellite, astronomers have determined the pre-explosion mass of a white dwarf star that blew up thousands of years ago. The measurement strongly suggests the explosion involved only a single white dwarf, ruling out a well-established alternative scenario involving a pair of merging white dwarfs.
"Mounting evidence indicates both of these mechanisms produce what we call type Ia supernovae," said lead researcher Hiroya Yamaguchi, an astrophysicist at NASA's Goddard Space Flight Center in Greenbelt, Maryland. "To understand ...
Boston, MA - Harvard T.H. Chan School of Public Health researchers are calling upon police in all states to improve their reporting of crashes involving vehicles and bicycles, according to a new study being published Thursday, April 2, 2015. Currently, details on crashes are handwritten by police on paper and there are few bicycle-relevant codes. The researchers are calling for police to use electronic tablets that would include more options to gather bicycle-specific data, such as drawings of the scene and additional codes that could indicate, for example, if the bicyclist ...
