BRINGING THERAPY CLOSER TO HOME.
HEALTH facilities; MEDICAL personnel; MENTAL health services; COVID-19 pandemic; TELEMEDICINE; CLINICAL psychologists; HEALTH transition; PSYCHIATRIC emergencies
Rose AF; Derrig Coda CJ; George EL; Gilbertson A
APS Observer
2021
2021-08-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Guillain-Barré syndrome in a patient previously diagnosed with COVID-19
As the COVID-19 pandemic continues to progress, the medical community is rapidly trying to identify complications and patterns of disease to improve patient outcomes. In a recent systematic review, it has been reported that isolated cases of Guillain-Barre Syndrome (GBS) have occurred secondary to COVID-19 infection. GBS is defined as a rare, but potentially fatal, immune mediated disease of peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. While several cases of GBS secondary to COVID-19 infection have been reported in Italy, only one case has been reported in the United States (US). The reported case in the US was a 54- year old male. We present a case of GBS secondary to a COVID-19 infection and believe this to be the first documented female case in the US and the second documented case in the US overall. The presented case aims to supplement the existing body of knowledge and to assist clinicians in managing complications of COVID-19.
Defabio AC; Scott TR; Stenberg RT; Simon EL
American Journal Of Emergency Medicine
2021
2021-07-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ajem.2020.07.074" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2020.07.074</a>
Procedural frequency: Results from 18 academic, community and freestanding emergency departments
emergency medicine; ACQUISITION; DELIBERATE PRACTICE; EXPERT PERFORMANCE; MEDICINE; procedural skills; skills maintenance
BackgroundEmergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP). MethodsThis was a retrospective study evaluating emergency physician procedural performance over a 12-month period. We collected data from the electronic records of 18 EDs in one healthcare system. The study EDs included higher and lower volume, academic, community and freestanding, and trauma and non-trauma centers. The main outcome measures were median number of procedures performed. We examined differences in procedural performance by physician years in practice, facility type, and trauma status. ResultsOver 12 months, 182 emergency physicians performed 1582 of 2805 procedures (56%) and supervised (resident, nurse practitioner or physician assistant) an additional 1223 of the procedures they did not perform (43%). Median (interquartile range) physician performance for each procedure was CVC 0 [0, 2], tube thoracostomy 0 [0, 0], tracheal intubation 3 [0.25, 8], and LP 0 [0, 2]. The percentage of emergency physicians who did not perform at least one of each procedure during the 1-year time frame ranged from 25.3% (tracheal intubation) to 76.4% (tube thoracostomy). Physicians who work at high-volume EDs (>50,000 visits per year) performed nearly twice as many tracheal intubations, CVCs, and LPs than those at low-volume EDs or freestanding EDs when normalized per 1000 visits. Years out of training were inversely related to total number of procedures performed. Emergency physicians at trauma centers performed almost 3 times as many tracheal intubations and almost 4 times as many CVCs compared to non-trauma centers. ConclusionIn a large healthcare system, regardless of ED type, emergency physicians infrequently performed the 4 procedures studied. Physicians in high-volume EDs, trauma centers, and recent graduates performed more procedures. Our study adds to a growing body of research that suggests clinical frequency alone may be insufficient for all emergency physicians to maintain competency.
Do ELS; Smalley CM; Meldon SW; Borden BL; Briskin I; Muir MR; Suchan A; Delgado F; Fertel BS
Journal Of The American College Of Emergency Physicians Open
2020
2020-12
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journalArticle
<a href="http://doi.org/10.1002/emp2.12238" target="_blank" rel="noreferrer noopener">10.1002/emp2.12238</a>
Adverse Events Related to Excimer Laser Coronary Atherectomy: Analysis of the FDA MAUDE Database
Bansal A; Gupta S; Jain V; Tsutsui R; Reed GW; Puri R; Hedrick DP; Kanaa'N A; Khatri JJ; Kapadia SR; Kalra A
Cardiovascular Revascularization Medicine
2021
2021-06
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journalArticle
<a href="http://doi.org/10.1016/j.carrev.2020.12.024" target="_blank" rel="noreferrer noopener">10.1016/j.carrev.2020.12.024</a>
Emergency department patients who leave before treatment is complete
HEALTH facilities; CONFIDENCE intervals; DESCRIPTIVE statistics; MEDICAL cooperation; METROPOLITAN areas; RESEARCH; RETROSPECTIVE studies; PATIENTS; EMERGENCY medical services; LONGITUDINAL method; MEDICAL screening; MEDICAL appointments
Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system. Methods: This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit. Results: During the study period 626,548 ED visits occurred; 20,158 (3.2%) LBTC index encounters occurred, and 6745 (33.5%) returned within 30 days. The majority (41.7%) returned in <24 hours with 76.1% returning in 10 days and 66.4% returning to index ED. Median return time was 43.3 hours, and 23.2% were admitted. Urban community EDs had the highest 30-day return rate (37.8%, 95% confidence interval, 36.41-39.1). Patients categorized as LSBS had longer median return hours (66.0) and higher admission rates (29.8%) than the LWBS cohort. There was a net potential realization rate of $9.5 million to the healthcare system. Conclusion: In our system, LSBS patients had longer return times and higher admission rates than LWBS patients. There was significant potential financial impact for the system. Further studies should examine how healthcare systems can reduce risk and financial impacts of LBTC patients.
Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS
Western Journal Of Emergency Medicine
2021
2021-03
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journalArticle
<a href="http://doi.org/10.5811/westjem.2020.11.48427" target="_blank" rel="noreferrer noopener">10.5811/westjem.2020.11.48427</a>
Acute kidney injury in COVID-19 pediatric patients: Analysis of the virtual pediatric systems data
Mawby I; Chakraborty R; Pandya A; Mahajan S;Rupesh R
American Journal Of Kidney Diseases
2021
2021-04
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<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Coronavirus disease-19 (COVID-19) related acute stroke causing transient global amnesia.
Coronavirus disease-2019 (COVID-19); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Stroke; TGA (transient global amnesia)
Ramanathan RS; Wachsman A
Journal Of Stroke And Cerebrovascular Diseases
2021
2021-05
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journalArticle
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105738" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2021.105738</a>
Prior admissions as a risk factor for readmission in patients surgically treated for femur fractures: Implications for a potential hip fracture bundle.
bundled payments; hip fracture; prior admission; readmission; SHFFT
INTRODUCTION: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. METHODS: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. RESULTS: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). DISCUSSION: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. CONCLUSIONS: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.
Erlichman R; Kolodychuk N; Gabra JN; Dudipala H; Maxhimer B; DiNicola N; Elias JJ
Geriatric Orthopaedic Surgery & Rehabilitation
2021
1905-07
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journalArticle
<a href="http://doi.org/10.1177/2151459321996169" target="_blank" rel="noreferrer noopener">10.1177/2151459321996169</a>
How Should Native Crotalid Envenomation Be Managed in the Emergency Department?
toxicology; ANAVIP; copperheads; cottonmouths; CroFab; crotalid; envenomation; rattlesnakes; snakebite
BACKGROUND: Pit vipers, also known as crotalids, are a group of snakes including rattlesnakes, copperheads, and cottonmouths (water moccasins). Crotalids have a broad geographic distribution across the United States, and bites from these snakes can carry significant morbidity. Their envenomations are characterized by local tissue effects, hematologic effects, and systemic effects. Envenomations are generally treated with 1 of 2 antivenoms available in the United States. OBJECTIVE: We developed a series of clinical questions to assist and guide the emergency physician in the acute management of a patient envenomated by a crotalid. METHODS: We conducted a PubMed literature review from January 1970 to May 2020 in English for articles with the keywords "bite" and "crotalidae." RESULTS: Our literature search resulted in 177 articles. A total of 33 articles met criteria for rigorous review and citation in the development of these consensus guidelines. CONCLUSIONS: Patients should be initially evaluated, stabilized, and assessed for local effects, hematologic effects, and systemic toxicity suggestive of envenomation. Antivenom should be given if toxic effects are present. Surgical intervention including debridement and fasciotomy should be avoided. Prophylactic antibiotics are not necessary.
Greene S; Cheng D; Vilke GM; Winkler G
The Journal Of Emergency Medicine
2021
2021-02-20
journalArticle
<a href="http://doi.org/10.1016/j.jemermed.2021.01.020" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2021.01.020</a>
International Federation for Emergency Medicine global research primer.
Simon EL
African Journal Of Emergency Medicine : Revue Africaine De La Medecine D'urgence
2021
2021-03
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.11.001" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.11.001</a>
Approach to the Patient with a Skin and Soft Tissue Infection.
Diagnosis; Differential diagnosis; Environmental exposures; Laboratory testing; Skin and soft tissue infection
The diagnosis of a skin and soft tissue infection (SSTI) requires careful attention to a patient's history, physical examination, and diagnostic test results. We review for many bacterial, viral, fungal, and parasitic pathogens that cause SSTIs the clues for reaching a diagnosis, including reported past medical history, hobbies and behaviors, travel, insect bites, exposure to other people and to animals, environmental exposures to water, soil, or sand, as well as the anatomic site of skin lesions, their morphology on examination, and their evolution over time. Laboratory and radiographic tests are discussed that may be used to confirm a specific diagnosis.
Watkins RR; David MZ
Infectious Disease Clinics Of North America
2021
2021-03
journalArticle
<a href="http://doi.org/10.1016/j.idc.2020.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2020.10.011</a>
Neuropsychiatric Symptoms of Multiple Sclerosis.
MENTAL depression; DISEASE complications; PSYCHOSES; COGNITION disorders; BIPOLAR disorder; ANXIETY; CENTRAL nervous system; CONTINUING education units; GENOMES; MULTIPLE sclerosis; MULTIPLE sclerosis risk factors
Tampi RR;Tampi DJ;Pittinger L
Psychiatric Times
2021
2021-02
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
The Case Files: A serious condition hiding behind nonspecific symptoms.
Diagnosis Differential; Female; Radiography Thoracic; Tomography X-Ray Computed; Middle Age; Ultrasonography; Electrocardiography; Physical Examination; Hematologic Tests; Heparin Low-Molecular-Weight; Platelet Aggregation Inhibitors -- Therapeutic Use; Takayasu Arteritis -- Diagnosis; Takayasu Arteritis -- Drug Therapy
Drogell K; Sitzlar B; Weber L; Campbell J; Simon EL
Emergency Medicine News
2020
2020-12-22
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journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
What every emergency physician should know about research: Introduction to a research primer for low- and middle-income countries
Emergency medicine research; Introduction; Low budget; Overview
Research is the search for new, generalisable knowledge (Truth in the Universe) to improve our collective ability to correctly diagnose and treat human suffering. In the formal sense, medical research implies both creating new knowledge, and also disseminating that new knowledge as well as putting it into practice. This is the first paper in this Research Primer. It briefly covers why each emergency physician should know and care about research. The paper reminds us that it does not take a physician to do research, but that it is the practicing physician who best knows what new knowledge is needed at the bedside. It introduces the scope of the other papers included in this special issue. The paper reviews the definitions of research and the scope of research practice in emergency medicine; overviews the hows and whys of research, as well as discusses the research question, study justification, literature search and touching on research design.
Totten V; Simon EL; Stassen W
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.009" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.009</a>
Research skills and the data spreadsheet: a research primer for low- and middle-income countries
Research; Data; Spreadsheet
The specialty of Emergency Medicine continues to expand and mature worldwide. As a relatively new specialty, the body of research that underpins patient management in the emergency department (ED) setting needs to be expanded for optimum patient care. Research in the ED, however, is complicated by a number of issues including limited time and resources, urgency for some therapeutic investigations and interventions, and difficulties in obtaining truly informed patient consent. Notwithstanding these issues, many of the fundamental principles of medical research apply equally to ED research. In all medical disciplines, data needs to be collected, collated and stored for analysis and a data spreadsheet is employed for this purpose. Like other aspects of clinical research, the use of the data spreadsheet needs to be exacting and appropriate. This research primer explores the choice of available spreadsheets and a range of principles for their best-practice use. It is deliberately, not an exhaustive review of the subject. However, we aim to explore basic principles and some of the most accessible and widely used data spreadsheets.
Taylor DM; Hodkinson PW; Khan AS; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.05.003" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.05.003</a>
Getting accepted - successful writing for scientific publication: A research primer for low- and middle-income countries
Publishing; Evidence-based medicine; Scientific writing
Clear and precise writing is a vital skill for healthcare providers and those involved in global emergency care research. It allows one to publish in scientific literature and present oral and written summaries of their work. However, writing skills for publishing are rarely part of the curriculum in the healthcare education system. This review gives you a step-by-step guide on how to successfully write for scientific publication following the IMRaD principle (Introduction, Methods, Results, and Discussion) with every part supporting the key message. There are specific benefits of writing for publication that justify the extra work involved. Any lessons learned about improving global emergency care delivery can be useful to emergency clinicians. The end result can lead to changing others' practice and pave the way for further research.
Simon EL; Osei-Ampofo M; Wachira BW; Kwan J
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.06.006" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.06.006</a>
Conference presentations: A research primer for low- and middle-income countries
Research methods; Conference presentation; Conference proceedings
Presenting research at a conference is an opportunity to disseminate the findings, network with other researchers, and to develop your academic track record. Although every conference will have some local differences, there are common approaches to presenting your research in the best manner. This will differ depending on whether it is an oral or a poster presentation. This research primer aims to support researchers in the early stages of their careers to undertake the best possible presentation.
Knott JC; Taylor DM; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.05.002" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.05.002</a>
Collaboration with non-emergency care specialists and other emergency care providers: A research primer for low- and middle-income countries
Collaboration; Best practice consensus; Emergency medicine research; Research networks; Systems development
As emergency and acute care systems develop, the ability to broadly engage key stakeholders becomes paramount for success. Collaborating with emergency medicine clinicians as well as other providers who have already developed their specialties, administrative leadership, as well as networking locally and regionally would maximise the success of developing a sustainable emergency care system.
Gutierrez CE; Simon EL
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.006" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.006</a>
Study design: A research primer for low- and middle-income countries
Emergency medicine; Research methods; Study design
Study design is critical to ensure that research questions are answered in an appropriate and rational manner for all aspects of health, but particularly in emergency care. Appropriate study design selection is one of the most critical decisions to make at the earliest stage of a research project; once this is clear, much of the methodology and sample size estimations should be straightforward. Selection of an appropriate study design is fundamental to good research and deserves careful consideration at the outset of any research project. The classic gold standard for study design is the double-blind randomised clinical trial, but it is often not possible to achieve this ideal in the busy clinical emergency environment or with the resources available. Descriptive studies are common in emergency care; they include retrospective clinical records reviews, prospective cohort studies and case-control studies. Case reports and surveys can be a useful introduction to research for novice researchers. When sufficient empirical evidence on a topic exists, results of similar studies can be combined in systematic reviews and/or meta-analyses to pool the results from multiple studies to determine stronger evidence for or against an intervention or treatment, but these techniques require specialist expertise and statistical skills.
Graham CA; Simon EL; Knott J
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.10.007" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.10.007</a>
Mentorship and how to conduct research: A research primer for low- and middle-income countries
Emergency medicine; Research; Mentorship; Low income countries
Development of a successful research program can seem daunting when looked at from the starting line. It will take years if not decades to succeed and become sustainable. It requires local partnerships and mentoring; it mandates the establishment of review boards; it requires national health policies to allow for protected time for research in salaries and for fund granting agencies to be set up; it requires training of researchers and support staff as well as a change in the mindset of clinical staff on the floor. It will almost inevitably require international support of some kind for low- and middle-income country researchers, be it university programs or other academic or private institutions. Success can occur; most likely it will occur by partnering with local research experts outside of emergency medicine in some combination with international networks and mentoring. Perhaps the most critical elements to success are intellectual curiosity and a burning flame of passion - and neither of those carry a financial cost.
Ducharme J; Simon EL; Jouriles N; Kole T; Maharjan RK
African Journal Of Emergency Medicine
2020
1905-7
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.09.005" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.09.005</a>
Funding sources for research: A research primer for low- and middle-income countries
Emergency medicine; Research; Mentorship; Low income countries
Research is a fundamental component of the development of quality emergency care systems. Developing qualified professionals and programs to conduct emergency care research is essential to understanding epidemiology in low resource settings. This leads to evaluating research outcomes, developing clinical practice guidelines and program implementation. This paper aims to introduce the reader to opportunities for research funding at various stages of one's career. We will discuss concepts necessary to obtain funding for research, a crucial step towards initiating a research program. The chapter further describes competitive funding mechanisms including governmental agencies, foundations and private industry along with organisations that offer funding for global health and emergency care research. We describe categories of grants specific to a stage of an investigator's career, developing a team for a proposal and the grant application process.
DeVos E; Simon EL; Aluisio A
African Journal Of Emergency Medicine
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.09.012" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.09.012</a>
Analysing the literature: A research primer for low- and middle-income countries
Social media; Evidence-based medicine; Librarian search strategies; Patient safety/QI
Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.
Carpenter CR; Hollong B; Simon EL; Graham CA
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.04.003" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.04.003</a>
Operational metrics, patient demographics, acuity, and treatment times at privately owned freestanding emergency departments
Simon EL; Dayton JR; Jouriles NJ; Augustine JJ; Hallas O; Shakya S; Marburger N; Schmitz G
American Journal Of Emergency Medicine
2020
2020-11-01
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journalArticle
<a href="http://doi.org/10.1016/j.ajem.2020.02.039" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2020.02.039</a>
The Case Files: A Serious Condition Hiding Behind Nonspecific Symptoms
Drogell K; Sitzlar B; Weber L; Campbell J; Simon EL
Emergency Medicine News
2020
2020-12-22
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journalArticle
<a href="http://doi.org/10.1097/01.EEM.0000724484.46935.8c" target="_blank" rel="noreferrer noopener">10.1097/01.EEM.0000724484.46935.8c</a>
The impact of hospital boarding on the emergency department waiting room.
length of stay; crowding; emergency department boarding; emergency department wait times; hospital occupancy; waiting room
BACKGROUND: Patient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system. METHODS: This was a retrospective multicenter study that included all ED encounters between January 1, 2018, and September 30, 2019. Encounters with missing Emergency Severity Index (ESI) level were excluded. ESI levels were defined as high (ESI 1,2), middle (ESI 3), and low (ESI 4,5). Spearman correlation coefficients measured the relationship between boarded patients and number of patients in ED waiting room. A multivariable mixed effects model identified drivers of this relationship. RESULTS: A total of 1,134,178 encounters were included. Spearman correlation coefficient was significant between number of patients in the ED waiting room and patient boarding (0.54). For every additional patient boarded/hour, the number of patients waiting/hour in the waiting room increased by 8% (95% confidence interval [CI] = 1.08-1.09). The number of patients waiting for a room/hour was 2.28 times higher for middle than for high acuity. The number of patients in waiting room slightly decreased as hospital occupancy increased (95% CI = 0.997-0.997). CONCLUSION: Number of patients in ED waiting room are directly related to boarding times and hospital occupancy. ED waiting room times should be considered as not just an ED operational issue, but an aspect of hospital throughput.
Smalley CM; Simon EL; Meldon SW; Muir McKinsey R; Briskin I; Crane S; Delgado F; Borden BL; Fertel BS
Journal Of The American College Of Emergency Physicians Open
2020
2020-10
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journalArticle
<a href="http://doi.org/10.1002/emp2.12100" target="_blank" rel="noreferrer noopener">10.1002/emp2.12100</a>
An unusual presentation and treatment of a hemorrhaging plexiform neurofibroma.
Yocum AD; Bacharach D; Simon EL
The American Journal Of Emergency Medicine
2020
2020-11-05
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journalArticle
<a href="http://doi.org/10.1016/j.ajem.2020.10.080" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2020.10.080</a>
Critical low catastrophe: a case report of treatment-refractory hypoglycemia following overdose of long-acting insulin.
BLOOD sugar; DEXTROSE; HYPOGLYCEMIA; INSULIN; INSULINOMA; PARENTERAL infusions
Overdose of long-acting insulin can cause unpredictable hypoglycemia for prolonged periods of time. The initial treatment of hypoglycemia includes oral carbohydrate intake as able and/or parenteral dextrose infusion. Refractory hypoglycemia following these interventions presents a clinical challenge in the absence of clear guidelines for management. Octreotide has sometimes been used, but its use is generally limited to sulfonylurea overdose. In this case report, we present a case of refractory hypoglycemia following an overdose of 900 units of long-acting insulin glargine that failed to respond to usual modes of therapy mentioned above. Stress-dose corticosteroids were then initiated, followed by subsequent improvement in IV dextrose and glucagon requirements and blood glucose levels. Hence, corticosteroids may serve as an adjunctive therapy in managing hypoglycemia and can be considered earlier in the course of treatment in patients with refractory hypoglycemia to prevent volume overload, especially when large volumes of dextrose infusions are required.
Sandooja R;Moorman JM;Priyadarshini KM;Detoya K
Case Reports in Endocrinology
2020
1905-07
journalArticle
<a href="http://doi.org/10.1155/2020/8856022" target="_blank" rel="noreferrer noopener">10.1155/2020/8856022</a>
Overview: The ongoing threat of antimicrobial resistance.
Antibiotics; Antimicrobial resistance; Public health
The effectiveness of antibiotics continues to erode because of the relentless spread of antimicrobial resistance (AMR). Public and private foundations, professional organizations, and international health agencies recognize the threat posed by AMR and have issued calls for action. One of the main drivers of AMR is overprescription of antibiotics, both in human and in veterinary medicine. The One Health concept is a response from a broad group of stakeholders to counter the global health threat posed by AMR. In this article, we discuss current trends in AMR and suggest strategies to mitigate its ongoing dissemination. (Copyright © 2020 Elsevier Inc. All rights reserved.)
Watkins RR;Bonomo RA
Infectious Disease Clinics Of North America
2020
2020-09-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.idc.2020.04.002" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2020.04.002</a>
Addressing behavioral health concerns in trauma: Using lean six sigma to implement a depression screening protocol in a level I trauma center
Background: Patients with physical injuries or chronic conditions may be impacted by mental health conditions, which significantly affect their participation and progress in treatment. The Patient Health Questionnaire-2 (PHQ-2) depression screening can identify patients who are at greatest risk for depression to provide better whole-person care.; Objective: The quality improvement project objective was to identify and design a process that would result in the PHQ-2 depression screening for admitted trauma patients with a minimum 75% completion rate.; Methods: Lean Six Sigma (LSS) process design methodology, DMADV (define, measure, analyze, design, and verify), drove process improvement. Medical records from before (December 2018 through February 2019) and after (March 2019 through May 2019) the intervention were evaluated using frequencies, percentages, χ, and multivariable logistic regression to determine the effectiveness of the intervention.; Results: PHQ-2 document location was imperative to successful compliance, which increased from 60.74% (78 of 128) to 80.56% (87 of 108). Specifically, weekend compliance increased from 42.9% (18 of 42) to 82.8% (24 of 29).; Conclusion: LSS DMADV methodology helped health care professionals design a process to facilitate compliance with the PHQ-2 depression screening protocol in trauma patients. Adherence with this screening can help increase the number of behavioral health consultations, which in turn improves the treatment of traumatic injury survivors.
Moran ME;Sedorovich A;Kish J;Gothard A;George RL
Quality Management In Health Care
2020
2020-12-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/qmh.0000000000000266" target="_blank" rel="noreferrer noopener">10.1097/qmh.0000000000000266</a>
Renal manifestations of tuberous sclerosis complex.
angiomyolipoma; autosomal polycystic kidney disease; renal cystic disease; tuberous sclerosis; Von Hippel–Lindau disease
Tuberous sclerosis complex (TSC) is a genetic condition caused by a mutation in either the TSC1 or TSC2 gene. Disruption of either of these genes leads to impaired production of hamartin or tuberin proteins, leading to the manifestation of skin lesions, tumors, and seizures. TSC can manifest in multiple organ systems with the cutaneous and renal systems being the most commonly affected. These manifestations can secondarily lead to the development of hypertension, chronic kidney disease, and neurocognitive declines. The renal pathologies most commonly seen in TSC are angiomyolipoma, renal cysts, and less commonly, oncocytomas. In this review, we highlight the current understanding on the renal manifestations of TSC along with current diagnosis and treatment guidelines. (Copyright: Nair N et al.)
Nair N;Chakraborty R;Mahajan Z;Sharma A;Sethi SK;Raina R
Journal Of Kidney Cancer And VHL
2020
2020-08-27
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.15586/jkcvhl.2020.131" target="_blank" rel="noreferrer noopener">10.15586/jkcvhl.2020.131</a>
Principles of research ethics: A research primer for low- and middle-income countries.
justice; autonomy; beneficence; consent; Ethics committees
Ethical oversight in the form of review boards and research ethics committees provide protection for research subjects as well as guidance for safe conduct of studies. As the number of collaborative emergency care research studies carried out in low- and middle-income countries increases, it is crucial to have a shared understanding of how ethics should inform choice of study topic, study design, methods of obtaining consent, data management, and access to treatment after closure of the study. This paper describes the basic principles of Western research ethics - respect for persons, beneficence, and justice - and how the principles may be contextualized in different settings, by researchers of various backgrounds with different funding streams. Examples of lapses in ethical practice of research are used to highlight best practices.
Bitter Cindy C; Ngabirano AA; Simon E; Taylor D
African Journal of Emergency Medicine : Revue Africaine de la Medecine d'urgence
2020
2020-08-13
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.07.006" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.07.006</a>
Fixation principles in minimal incision hallux valgus surgery
system; head; moderate; surgical-treatment; angle; 1st metatarsal; chevron osteotomy; Corrective bunion surgery; distal metatarsal osteotomy; Hallus valgus surgery; Minimal incision surgery; plane rotation; scarf osteotomy; Corrective bunion surgery
Minimal incision surgical principals rely on the soft tissue envelope to maintain stability that is supplemented by a variety of clinically recommended fixation methods. The extended distal first metatarsal osteotomy has renewed interest because of the ability to laterally translate, angulate, and rotate the metatarsal head in proper alignment with the sesamoids to a neutral alignment. The soft tissue envelope of capsule, ligaments, and tendons will re-align once the bone deformity is corrected. The periosteum is maintained to provide a biologic scaffold for new bone formation and must be minimally disrupted during the intervention.
Kay DB
Foot and Ankle Clinics
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.fcl.2020.05.011" target="_blank" rel="noreferrer noopener">10.1016/j.fcl.2020.05.011</a>
Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis.
Female; Humans; Male; Aged; Middle Aged; Treatment Outcome; Risk Factors; Aged 80 and over; Risk Assessment; Prosthesis Design; Recovery of Function; Heart Valve Prosthesis; Aortic Valve/diagnostic imaging/physiopathology/surgery; aortic valve insufficiency; heart diseases; heart valve prosthesis; Transcatheter Aortic Valve Replacement/adverse effects/instrumentation/mortality; Aortic Valve Insufficiency/diagnostic imaging/mortality/physiopathology/surgery
OBJECTIVE: The objective of this study was to analyze the available literature on using transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR). BACKGROUND: Surgical aortic valve replacement is the gold standard therapy for native AR. TAVR has emerged as an alternative approach in high-risk patients. METHODS: MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at least 5 patients undergoing TAVR for native AR. Outcomes included 30-day mortality, myocardial infarction, stroke, major bleeding, postprocedural moderate to severe AR, and device success. Pooled estimates were calculated using a random-effects model. Subgroup analysis and a meta-regression were performed to study the effects of study level covariates on outcomes. RESULTS: Nineteen studies (n =998 patients) were included. The rate of procedural success per Valve Academic Research Consortium - 2 (VARC-2) criteria was 86.2% (78.8%-92.2%]. Thirty-day mortality was 11.9% (9.4%-14.7%). Subgroup analysis showed the use of new generation valves was associated with lower 30-day mortality (P = 0.02) and higher device success (P = 0.009) compared with early generation valves. There was no significant difference (P = 0.13) in the rate of 30-day mortality between patients receiving purpose-specific [8.2% (4.3%-13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%-18.6%); I2 = 25%]. However, device success was higher (P = 0.02) in patients who received purpose-specific valves [96.3% (92.2%-98.9%); I2 = 0%] compared with nonpurpose specific valves [84.4% (75%-91.9%); I2 =46%]. CONCLUSION: TAVR for native AR is associated with acceptable procedural success but increased early mortality. However, the safety and the efficacy of the procedure increased with newer valves.
Rawasia WF; Khan MS; Usman MS; Siddiqi TJ; Mujeeb FA; Chundrigar M; Kalra A; Alkhouli M; Kavinsky CJ; Bhatt DL
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-02-01
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27840" target="_blank" rel="noreferrer noopener">10.1002/ccd.27840</a>
PMID: 30269437
Impact of residual coronary atherosclerosis on transfemoral transcatheter aortic valve replacement.
Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Risk Factors; Time Factors; Aged 80 and over; Patient Readmission; Risk Assessment; Cause of Death; Coronary Artery Disease/diagnostic imaging/mortality/therapy; AVD - aortic valve disease; CAD - coronary artery disease; Catheterization Peripheral/adverse effects/mortality; Femoral Artery; PCI - percutaneous coronary intervention (PCI); Percutaneous Coronary Intervention/adverse effects/mortality; percutaneous intervention; Transcatheter Aortic Valve Replacement/adverse effects/mortality; Aortic Valve Stenosis/diagnostic imaging/mortality/physiopathology/surgery; Aortic Valve/diagnostic imaging/physiopathology/surgery; Punctures
OBJECTIVES: This study reports on the clinical effects of complete vs incompletely revascularized coronary artery disease on transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a high prevalence of active coronary artery disease (CAD) in patients undergoing TAVR but preemptive revascularization remains controversial. METHODS: Patients were categorized into three cohorts: complete revascularization (CR), incomplete revascularization of a major epicardial artery (IR Major), and incomplete revascularization of a minor epicardial artery only (IR Minor). When feasible, SYNTAX scoring was performed for exploratory analysis. Analyses were performed using Cox proportional hazard models and Kaplan-Meier method. RESULTS: A total of 323 patients with active CAD were included. Adjusted outcomes showed that patients with IR Major had increased incidence of acute myocardial infarction (AMI) or revascularization compared with those in the CR cohort (HR 3.72, P = 0.048). No difference was noted in all-cause mortality or all-cause readmission rates. Exploratory secondary analysis with residual SYNTAX scores showed a significant interaction between disease burden and AMI/revascularization, as well as all-cause readmission. All-cause mortality remained unaffected based on residual SYNTAX scores. CONCLUSIONS: This is a retrospective single-center study reporting on pre-TAVR revascularization outcomes in patients with active CAD. In this analysis, we found that patients undergoing TAVR benefited from achieving complete revascularization to abate future incidence of AMI/revascularization. Despite this finding, all-cause mortality remained unaffected. Future efforts should focus on the role of functional assessment of the coronaries, as well as the long-term effects of complete revascularization in a larger patient cohort.
Li Jun; Patel SM; Nadeem F; Thakker P; Al-Kindi SG; Thomas R; Makani A; Hornick JM; Patel T; Lipinski J; Ichibori Y; Davis A; Markowitz AH; Bezerra HG; Simon DI; Costa MA; Kalra A; Attizzani GF
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-02-15
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27894" target="_blank" rel="noreferrer noopener">10.1002/ccd.27894</a>
PMID: 30312990
Meta-analysis comparing culprit vessel only versus multivessel percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock.
Humans; Recurrence; Retreatment; Percutaneous Coronary Intervention/methods; Coronary Artery Disease/therapy; Myocardial Infarction/mortality/therapy; Renal Insufficiency/epidemiology; Shock Cardiogenic/mortality
Cardiogenic shock (CS) after a myocardial infarction continues to be associated with high mortality. Whether percutaneous coronary intervention (PCI) of noninfarct coronary arteries (multivessel intervention [MVI]) improves outcomes in CS after acute myocardial infarction (AMI) remains controversial. MEDLINE, Cochrane CENTRAL, and Scopus databases were searched for original studies comparing MVI with culprit-vessel intervention (CVI) in AMI patients with multivessel disease and CS. Risk ratios (RRs) and 95% confidence intervals were calculated and pooled using a random effects model. Thirteen studies, consisting of 7,906 patients (n(MVI) = 1,937; n(CVI) = 5,969), were included in this meta-analysis. Overall, the MVI and CVI groups did not differ significantly in the risk of short-term mortality (RR: 1.06 [0.91, 1.23]; p = 0.45; I(2) = 75.82%), long-term mortality (RR: 0.93 [0.78, 1.11]; p = 0.37; I(2) = 67.92%), reinfarction (RR: 1.16 [0.75, 1.79]; p = 0.50; I(2) = 0%), revascularization (RR: 0.84 [0.48, 1.47]; p = 0.54; I(2) = 83.01%), bleeding (RR: 1.15 [0.96, 1.38]; p = 0.09, I(2) = 0%), or stroke (RR: 1.29 [0.86, 1.94]; p = 0.80, I(2) = 0%). However, significantly increased risk of renal failure was seen in the MVI group (RR: 1.35 [1.10, 1.66]; p = 0.004; I(2) = 0%). On subgroup analysis, it was seen that results from retrospective studies showed higher short-term mortality in the MVI group in comparison with prospective studies (p = 0.003). The certainty in estimates is low due to the largely observational nature of the evidence. In conclusion, MVI provides no additional reduction in short- or long-term mortality in AMI patients with multivessel disease and CS. Additionally, the risk of renal failure may be higher with the use of MVI.
Khan MS; Siddiqi TJ; Usman MS; Riaz H; Khan AR; Murad MH; Kalra A; Figueredo VM; Bhatt DL
The American journal of cardiology
2019
2019-01-15
Copyright © 2018. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2018.09.039" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2018.09.039</a>
PMID: 30420183
Outcomes with drug-coated balloons in small-vessel coronary artery disease.
Female; Humans; Male; Aged; Middle Aged; Treatment Outcome; Risk Factors; Risk Assessment; Randomized Controlled Trials as Topic; Cardiac Catheters; Coated Materials Biocompatible; drug-coated balloons; drug-eluting balloons; Drug-Eluting Stents; small-vessel disease coronary disease; Angioplasty Balloon Coronary/adverse effects/instrumentation/mortality; Cardiovascular Agents/administration & dosage/adverse effects; Coronary Artery Disease/diagnostic imaging/mortality/therapy; Coronary Restenosis/epidemiology; Observational Studies as Topic
BACKGROUND: Percutaneous coronary intervention (PCI) of small-vessel coronary artery disease (SVD) is associated with increased risk of restenosis. The use of drug-coated balloons (DCBs) in SVD has received limited study. OBJECTIVES: To assess the outcomes of DCB in the treatment of SVD compared with the standard of care. METHODS: We performed a meta-analysis of all studies published between January 2000 and September 2018 reporting the outcomes of DCB versus other modalities in the treatment of de novo SVD. RESULTS: Seven studies with 1,824 patients (1,938 lesions) were included (four randomized controlled trials and three observational studies). During a mean follow-up of 14.5 ± 10 months, DCBs were associated with a similar risk of target lesion revascularization (TLR) (OR: 0.99, 95% CI: 0.54, 1.84, P = 97) and major adverse cardiovascular events (MACE) (OR: 0.86, 95% CI: 0.51, 1.45, P = 0.57) compared with drug-eluting stents (DES). During a mean follow-up of 7 ± 1.5 months, DCBs were associated with a significantly lower risk of TLR (OR: 0.19, 95% CI 0.04-0.88, P = 0.03) and binary restenosis (OR: 0.17, 95% CI 0.08-0.37, P = <0.00001) compared with noncoated balloon angioplasty. CONCLUSION: The use of DCBs in SVD is associated with comparable outcomes when compared with DES and favorable outcomes when compared with balloon angioplasty.
Megaly M; Rofael M; Saad M; Rezq A; Kohl LP; Kalra A; Shishehbor M; Soukas P; Abbott JD; Brilakis ES
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-04-01
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27996" target="_blank" rel="noreferrer noopener">10.1002/ccd.27996</a>
PMID: 30489687
Outcomes among patients with heart failure with reduced ejection fraction undergoing transcatheter aortic valve replacement: Minimally invasive strategy versus conventional strategy.
Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Prognosis; Cohort Studies; Severity of Illness Index; Aged 80 and over; Logistic Models; Survival Rate; Length of Stay; Multivariate Analysis; Risk Assessment; Reference Values; Hospital Mortality; aortic stenosis; transcatheter aortic valve replacement; heart failure; Transcatheter Aortic Valve Replacement/methods/mortality; anesthesia; conscious sedation; Aortic Valve Stenosis/diagnostic imaging/epidemiology/therapy; Cardiac Catheterization/methods; Cardiac Output Low/diagnostic imaging; Conscious Sedation/methods; Echocardiography Transesophageal/methods; Heart Failure/diagnosis/epidemiology/therapy; Minimally Invasive Surgical Procedures/methods; Surgery Computer-Assisted/methods
OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50%, while 154 patients had EF ≤35%. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5% vs CS 8.8%; odds ratio for MIS, 0.60; 95% confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.
Panhwar MS; Li J; Zidar DA; Clevenger J; Lipinski J; Patel TR; Karim A; Saric P; Patel SM; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-03
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30555054
Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Short-term and long-term outcomes of patients undergoing urgent transcatheter aortic valve replacement under a minimalist strategy.
Female; Humans; Male; Retrospective Studies; Treatment Outcome; Risk Factors; United States/epidemiology; Follow-Up Studies; Severity of Illness Index; Time Factors; Aged 80 and over; Length of Stay; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement/methods; minimalist approach; Hospital Mortality/trends; severe aortic stenosis; urgent procedure; Aortic Valve Stenosis/diagnosis/mortality/surgery; Aortic Valve/diagnostic imaging/surgery; Cardiac Catheterization/methods; Echocardiography Transesophageal; Elective Surgical Procedures/methods; Femoral Artery
OBJECTIVES: Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral [TF] approach with conscious sedation and no transesophageal echocardiography guidance). METHODS: After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent
Ichibori Y; Li J; Patel T; Lipinski J; Ladas T; Saric P; Kobe D; Tsushima T; Peters M; Patel S; Davis A; Markowitz AH; Bezerra HG; Costa MA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30700628
Level of scientific evidence underlying the current American College of Cardiology/American Heart Association clinical practice guidelines.
Humans; United States; Data Accuracy; Cardiology/standards; consensus; standard of care; Practice Guidelines as Topic/standards; Evidence-Based Medicine/standards; American Heart Association; cardiology; malpractice
Bevan GH; Kalra A; Josephson RA; Al-Kindi SG
Circulation. Cardiovascular quality and outcomes
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1161/CIRCOUTCOMES.118.005293" target="_blank" rel="noreferrer noopener">10.1161/CIRCOUTCOMES.118.005293</a>
PMID: 30755028