A Structured Approach for Safely Reintroducing Bariatric Surgery in a COVID-19 Environment.
Humans; Male; Adult; Female; Risk Factors; Cohort Studies; Middle Aged; Clinical Protocols; Patient Selection; Bariatric Surgery; Pneumonia; Safety; Complications; COVID-19; Bariatric surgery; Betacoronavirus; Coronavirus; Coronavirus Infections/epidemiology/prevention & control; Infection Control/organization & administration; Obesity Morbid/complications/surgery; Pandemics/prevention & control; Pneumonia Viral/epidemiology/prevention & control
Due to the profound effect of novel coronavirus disease 2019 (COVID-19) on healthcare systems, surgical programs across the country have paused surgical operations and have been utilizing virtual visits to help maintain public safety. For those who treat obesity, the importance of bariatric surgery has never been more clear. Emerging studies continue to identify obesity and several other obesity-related comorbid conditions as major risk factors for a more severe COVID-19 disease course. However, this also suggests that patients seeking bariatric surgery are inherently at risk of suffering severe complications if they were to contract COVID-19 in the perioperative period. The aim of this protocol is to utilize careful analysis of existing risk stratification for bariatric patients, novel COVID-19-related data, and consensus opinion from multiple academic bariatric centers within our organization to help guide the reanimation of our programs when appropriate and to use this template to prospectively study this risk-stratified population in real time. The core principles of this protocol can be applied to any surgical specialty.
Daigle CR; Augustin T; Wilson R; Schulz K; Fathalizadeh A; Laktash A; Bauman M; Bencsath KP; Cha W; Rodriguez J; Aminian A
Obesity Surgery
2020
2020-10
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/10.1007/s11695-020-04733-8" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-04733-8</a>
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
Feasibility and safety of adopting next-day discharge as first-line option after transfemoral transcatheter aortic valve replacement.
Female; Humans; Male; Aged; Retrospective Studies; Cohort Studies; Follow-Up Studies; Severity of Illness Index; Time Factors; United States; Aged 80 and over; Survival Analysis; Patient Readmission/statistics & numerical data; Propensity Score; Ohio; Academic Medical Centers; Risk Assessment; Feasibility Studies; Patient Discharge; aortic stenosis; transcatheter aortic valve replacement; Length of Stay; early discharge; minimalist approach; next-day discharge; Patient Safety; Aortic Valve Stenosis/diagnosis/surgery; Transcatheter Aortic Valve Replacement/methods/mortality
OBJECTIVES: Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR. METHODS: We reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization. RESULTS: Sixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08). CONCLUSIONS: Utilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.
Ichibori Y; Li J; Davis A; Patel TM; Lipinski J; Panhwar M; Saric P; Qureshi G; Patel SM; Sareyyupoglu B; Markowitz AH; Bezerra HG; Costa MA; Zidar DA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-03
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30819977
Contributions of symptomatic osteoarthritis and physical function to incident cardiovascular disease.
Female; Humans; Male; Middle Aged; Cardiovascular disease; Function; *Osteoarthritis; Aged; Incidence; Cohort Studies; Risk Factors; Exercise/*physiology; Cardiovascular Diseases/diagnosis/*epidemiology/physiopathology; Health Surveys/methods/trends; Independent Living/trends; North Carolina/epidemiology; Walk Test/methods/trends; Knee/diagnosis/*epidemiology/physiopathology
BACKGROUND: Osteoarthritis (OA) is associated with worsening physical function and a high prevalence of comorbid health conditions. In particular, cardiovascular disease (CVD) risk is higher in individuals with OA than the general population. Limitations in physical function may be one pathway to the development of CVD among individuals with OA. This study evaluated associations of symptomatic knee OA (sxKOA), baseline physical function and worsening of function over time with self-reported incident CVD in a community-based cohort. METHODS: Our sample consisted of individuals from the Johnston County Osteoarthritis Project who did not report having CVD at baseline. Variables used to evaluate physical function were the Health Assessment Questionnaire (HAQ), time to complete 5 chair stands, and the 8-ft walk. Worsening function for these variables was defined based on previous literature and cutoffs from our sample. Logistic regression analyses examined associations of sxKOA, baseline function and worsening of function over time with self-reported incident CVD, unadjusted and adjusted for relevant demographic and clinical characteristics. RESULTS: Among 1709 participants included in these analyses, the mean age was 59.5 +/- 9.5 years, 63.6% were women, 15% had sxKOA, and the follow up time was 5.9 +/- 1.2 years. About a third of participants reported worsening HAQ score, about two-fifths had worsened chair stand time, half had worsened walking speed during the 8-ft walk, and 16% self-reported incident CVD. In unadjusted analyses, sxKOA, baseline function, and worsening function were all associated with self-reported incident CVD. In multivariable models including all of these variables, sxKOA was not associated with incident CVD, but worsening function was significantly associated with increased CVD risk, for all three functional measures: HAQ odds ratio (OR) = 2.49 (95% confidence interval (CI) 1.90-3.25), chair stands OR = 1.58 (95% CI 1.20-2.08), 8-ft walk OR = 1.53 (95%CI 1.15-2.04). These associations for worsening function remained in models additionally adjusted for demographic and clinical characteristics related to CVD risk. CONCLUSIONS: The association between symptomatic knee osteoarthritis and cardiovascular disease risk was explained by measures of physical function. This highlights the importance of physical activity and other strategies to prevent functional loss among individuals with symptomatic knee osteoarthritis.
Corsi Michela; Alvarez Carolina; Callahan Leigh F; Cleveland Rebecca J; Golightly Yvonne M; Jordan Joanne M; Nelson Amanda E; Renner Jordan; Tsai Allen; Allen Kelli D
BMC musculoskeletal disorders
2018
2018-11
<a href="http://doi.org/10.1186/s12891-018-2311-4" target="_blank" rel="noreferrer noopener">10.1186/s12891-018-2311-4</a>
Recognition and management of obesity in a family practice setting.
Adult; Female; Humans; Male; Middle Aged; Regression Analysis; Aged; Cohort Studies; Risk Factors; Body Mass Index; Diet; Exercise; Patient Education as Topic; Family Practice; Obesity/*diagnosis/therapy
BACKGROUND: Research on the diagnosis and management of obesity in primary care is limited. Our study goals were to describe the rate of obesity in a primary care setting, to identify factors associated with clinically recognized obesity, and to ascertain the level of diet and exercise counseling for obesity. METHODS: Medical records from a private group practice were used for a historical cohort study of 276 patients (aged 40 years and older) who were provided care for a maximum 4.5-year follow-up period. RESULTS: Forty-six percent of the study patients (95 percent confidence interval = 0.43, 0.49) received an obesity diagnosis according to medical record notations. The diagnosis of obesity, in turn, was predicted by body mass index (BMI) quartile (P \textless 0.001) and a positive family history of cardiovascular disease (P \textless 0.01). Those patients with a diagnosis of obesity had a higher mean level of subsequent weight and diet counseling (P = 0.0001) but the same level (P = 0.11) of exercise counseling as nonobese patients. Weight and diet counseling was also predicted by diabetes (P = 0.0001) and hypercholesterolemia (P = 0.0003). CONCLUSIONS: The clinical recognition of obesity was not determined by BMI alone. Although weight and diet counseling was initiated for those individuals described as obese, there was a relatively low level of exercise counseling among these patients. Additional research could provide ways of reducing both physician and patient barriers to exercise counseling.
Logue EE; Gilchrist V; Bourguet C C; Bartos P
The Journal of the American Board of Family Practice
1993
1993-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Elapsed time from symptom onset and acute myocardial infarction in a community hospital.
Humans; Middle Aged; Time Factors; Aged; Cohort Studies; Prognosis; Hospitals; Thrombolytic Therapy; Electrocardiography; Risk; Heart Arrest/etiology; Heart Ventricles; *Myocardial Infarction/diagnosis/therapy; *Patient Admission; Angina Pectoris/complications; Chest Pain/etiology; Coronary Artery Bypass; Tachycardia/etiology; Community; Angioplasty; Balloon; Coronary
STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change.
Logue EE; Ognibene A; Marquinez C; Jarjoura D
Annals of emergency medicine
1991
1991-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)81650-6" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)81650-6</a>
The prevalence of osteoporosis risk factors and physician intervention.
Adult; Female; Humans; Middle Aged; Aged; Retrospective Studies; Cohort Studies; Risk Factors; Patient Education as Topic; Osteoporosis; Counseling; Family; *Physicians; Estrogen Replacement Therapy; Osteoporosis/*prevention & control; Postmenopausal/prevention & control
To determine the prevalence of osteoporosis risk factors and the probability of physician risk recognition and intervention, the medical records of a cohort of 243 women aged 40 to 65 years were reviewed retrospectively. A historical cohort design was used. Risk factors present before the start of the study were identified. Osteoporosis risk recognition (discussion, problem list), osteoporosis specific intervention (counseling about risk, or estrogen or calcium supplementation), or nonspecific intervention (dietary, exercise, smoking, or alcohol counseling) were recorded over a 3-year follow-up period. Seventy-four percent of the women had two or more risk factors. The most common were perimenopausal or postmenopausal status (73%) and absence of estrogen supplementation (ever) (65%). During the period of the study, 46 women (19%) had received an osteoporosis-specific intervention. One hundred eleven women (46%) had received one of the above or a less specific intervention. The medical records of only 25 women (10%) documented an assessment of osteoporosis risk. Only menopausal status predicted osteoporosis intervention, and the probability of intervention decreased as the total number of risk factors increased. The data identify three groups of women who could benefit from increased risk-reduction strategies: premenopausal women, perimenopausal or postmenopausal women who have never previously taken supplemental estrogens, and women with multiple risk factors.
Bourguet C C; Hamrick G A; Gilchrist V J
The Journal of Family Practice
1991
1991-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Temporal artery temperature measurements in healthy infants, children, and adolescents.
Adolescent; Body Temperature/*physiology; Child; Cohort Studies; Confidence Intervals; Female; Humans; Infant; Male; Newborn; Preschool; Reference Values; Sensitivity and Specificity; Skin Temperature/physiology; Temporal Arteries; Thermometers/*standards
A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1 degrees C (38.1 degrees C) for 383 infants 0 to 2 months; 36.9 degrees C (37.9 degrees C) for 860 children 3 to 47 months; 36.8 degrees C (37.8 degrees C) for 680 children 4 to 9 years; and 36.7 degrees C (37.8 degrees C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.
Roy Sumita; Powell Keith; Gerson Lowell W
Clinical pediatrics
2003
2003-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992280304200508" target="_blank" rel="noreferrer noopener">10.1177/000992280304200508</a>
An open-label dose escalation study to evaluate the safety of administration of nonviral stromal cell-derived factor-1 plasmid to treat symptomatic ischemic heart failure.
*Plasmids; Aged; Brain/blood; Chemokine CXCL12/*genetics/metabolism; Cohort Studies; Dose-Response Relationship; Drug; Echocardiography; Exercise Tolerance; Female; Follow-Up Studies; Genetic Therapy/*adverse effects/*methods; Heart Failure/metabolism/pathology/*therapy; Humans; Male; Middle Aged; Myocardium/metabolism/pathology; Natriuretic Peptide; Peptide Fragments/blood; Positron-Emission Tomography; Quality of Life; Treatment Outcome
RATIONALE: Preclinical studies indicate that adult stem cells induce tissue repair by activating endogenous stem cells through the stromal cell-derived factor-1:chemokine receptor type 4 axis. JVS-100 is a DNA plasmid encoding human stromal cell-derived factor-1. OBJECTIVE: We tested in a phase 1, open-label, dose-escalation study with 12 months of follow-up in subjects with ischemic cardiomyopathy to see if JVS-100 improves clinical parameters. METHODS AND RESULTS: Seventeen subjects with ischemic cardiomyopathy, New York Heart Association class III heart failure, with an ejection fraction
Penn Marc S; Mendelsohn Farrell O; Schaer Gary L; Sherman Warren; Farr Maryjane; Pastore Joseph; Rouy Didier; Clemens Ruth; Aras Rahul; Losordo Douglas W
Circulation research
2013
2013-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1161/CIRCRESAHA.111.300440" target="_blank" rel="noreferrer noopener">10.1161/CIRCRESAHA.111.300440</a>
A Review of Treatment for Breast Cancer-Related Lymphedema: Paradigms for Clinical Practice.
*Bandages; Adult; Aged; Breast Neoplasms/*complications/pathology/*surgery; Cohort Studies; Combined Modality Therapy; Drainage/methods; Female; Humans; Lymphedema/etiology/physiopathology/*therapy; Massage/methods; Mastectomy/*adverse effects/methods; Middle Aged; Prognosis; Quality of Life; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survivors; Treatment Outcome
OBJECTIVES: Breast cancer-related lymphedema (BCRL) represents a major complication of breast cancer treatment, impacting the quality of life for breast cancer survivors that develop it. The purpose of this review is to evaluate the literature surrounding BCRL treatment modalities to guide clinicians regarding risk-stratified treatment options. METHODS: A review of studies over a 10-year period (January 2006 to February 2016) was performed. Noninvasive strategies evaluated included compression therapy, manual lymphatic drainage, and complex decongestive therapy (CDT). Invasive modalities evaluated included liposuction and lymphatic bypass/lymph node transfer (LNT). Our search yielded 149 initial results with 45 studies included. RESULTS: A number of prospective studies have found that CDT is associated with volume reduction in the affected limb as well as improved quality of life, particularly in patients with early stage BCRL. With regards to invasive treatment options, data support that lymphatic bypass and LNT are associated with symptomatic and physiologic improvements, particularly in patients with more advanced BCRL. In addition, a small number of studies suggest that liposuction may be an efficacious and safe treatment for moderate to severe BCRL. CONCLUSIONS: CDT is an effective treatment modality for early stage BCRL. For more advanced BCRL, LNT has demonstrated efficacy. Further study is required with respect to comparing BCRL treatment modalities.
Smile Timothy D; Tendulkar Rahul; Schwarz Graham; Arthur Douglas; Grobmyer Stephen; Valente Stephanie; Vicini Frank; Shah Chirag
American journal of clinical oncology
2018
2018-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/COC.0000000000000355" target="_blank" rel="noreferrer noopener">10.1097/COC.0000000000000355</a>
Lumbar spine fractures within a complete American cohort: epidemiology and risk factors among military service members.
*Warfare; Adolescent; Adult; Age Distribution; Aged; Cohort Studies; Comorbidity; Female; Humans; Lumbar Vertebrae/*injuries; Male; Middle Aged; Military Personnel/*statistics & numerical data; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Spinal Cord Injuries/*epidemiology; Spinal Fractures/*epidemiology; United States/epidemiology; Young Adult
STUDY DESIGN: Retrospective database review. OBJECTIVE: To describe the incidence of, and risk factors for, lumbar spine fractures within the population of the US military. SUMMARYOF BACKGROUND DATA: Fractures of the lumbar region are an important health concern; however, the epidemiology of this injury has not been extensively studied in the United States. METHODS: International Classification of Diseases, Clinical Modification, Ninth Revision codes for lumbar spine fractures were used in a search of the Defense Medical Epidemiology Database, identifying all individuals who sustained such injuries between 2001 and 2010. The database was also used to obtain the complete number of individuals serving in the Armed Forces over the same time period. Information regarding race, rank, branch of service, sex, and age was obtained for all individuals identified as having lumbar spine fractures as well as for the whole military population. The incidence of lumbar spine fractures was determined for the cohort. Unadjusted incidence rates were derived for risk factors and multivariate Poisson regression analysis, controlling for all other risks, was used to obtain adjusted incidence rate ratios and identify statistically significant risks for lumbar fractures. RESULTS: Between 2001 and 2010, the overall incidence of lumbar fractures was 0.38 per 1000 person-years. Male sex, white race, enlisted ranks, service in the Army and Marines, and age were found to be significant predictors of lumbar spine fracture. Service in the Army demonstrated the highest rate of lumbar fractures (0.48 per 1000 person-years). CONCLUSIONS: This investigation is the first to document the incidence and postulate risk factors for lumbar spine fracture in an American population. In this study, males, whites, enlisted personnel, those serving in the Army and Marines, and individuals aged 20-24 or greater than 40 were found to be at an increased risk of lumbar fracture.
Schoenfeld Andrew J; Romano David; Bader Julia O; Walker John J
Journal of spinal disorders & techniques
2013
2013-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e31823f3237" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31823f3237</a>
Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009.
*Military Personnel/statistics & numerical data; Adult; Age Factors; Cohort Studies; Databases; Factual; Female; Humans; Incidence; Male; Prospective Studies; Radiculopathy/diagnosis/*epidemiology; Risk Factors; Sex Factors; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological review of a prospectively collected military database. OBJECTIVE: This investigation sought to determine the incidence of cervical radiculopathy and risk factors for its development within the population of the United States military from 2000 to 2009. SUMMARY OF BACKGROUND DATA: Currently, the epidemiology of cervical radiculopathy remains poorly understood and risk factors for its development have not been reliably defined. METHODS: The military's Defense Medical Epidemiological Database was used to identify all servicemembers diagnosed with cervical radiculopathy (International Classification of Diseases code 723.4) between 2000 and 2009. Demographic data was obtained for all identified individuals including age group, sex, race, military rank, and branch of service. Like data was recorded for all servicemembers within the Armed Forces during the time period under study. The incidence of cervical radiculopathy was calculated and unadjusted incidence rate ratios were determined. Risk factors were analyzed by performing multivariate Poisson regression analysis, controlling for all other factors within the model. RESULTS: Between 2000 and 2009, about 24,742 individuals were diagnosed with cervical radiculopathy among a population-at-risk of 13,813,333, for an incidence of 1.79 per 1000 person-years. Statistically significant differences (P\textless0.001) in adjusted incidence rate ratios were identified for each successive age group with mutually exclusive 95% confidence intervals. Those age 40 years and above were found to have the greatest risk of cervical radiculopathy. Female sex (P\textless0.001), White race (P\textless0.001), senior positions within the rank structure (P\textless0.001), and service in the Army (P\textless0.001) or Air Force (P=0.01) were also identified as significant risk factors for cervical radiculopathy. CONCLUSIONS: This study is the first to attempt to define the incidence of cervical radiculopathy and characterize risk factors for its development within an American population. Findings presented here indicate that age is most likely the greatest risk factor for cervical radiculopathy, with female sex, White race, senior military positions, and Army or Air Force service also influencing risk to varying degrees.
Schoenfeld Andrew J; George Alan A; Bader Julia O; Caram Pedro M Jr
Journal of spinal disorders & techniques
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e31820d77ea" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31820d77ea</a>
Long-term results of percutaneous lumbar decompression for LSS: two-year outcomes.
80 and over; 80 and Over; Aged; Cohort Studies; Decompression; Disability Evaluation; Female; Human; Humans; Intermittent Claudication – Complications; Intermittent Claudication – Surgery; Intermittent Claudication/complications/surgery; Lumbar Vertebrae; Male; Middle Age; Middle Aged; Prospective Studies; Questionnaires; Spinal Stenosis – Complications; Spinal Stenosis – Surgery; Spinal Stenosis/complications/*surgery; Surgical – Methods; Surgical/*methods; Surveys and Questionnaires; Time Factors; Treatment Outcome; Treatment Outcomes; Visual Analog Scale; Visual Analog Scaling
OBJECTIVE: The aim of this report was to evaluate the long-term effectiveness and safety of mild lumbar decompression for the treatment of neurogenic claudication associated with lumbar spinal stenosis. This technique uses a percutaneous dorsal approach to remove small portions of ligament and lamina, thereby restoring space and decompressing the spinal canal. MATERIALS AND METHODS: Two-year data are reported for 45 patients treated with mild decompression at 11 US sites. Outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index, and Zurich Claudication Questionnaire. Safety was monitored throughout the procedural and follow-up period for all patients. Interim data are included for these patients at 1 week, 6 months, and 1-year follow-up. RESULTS: Seventy-one percent of patients reported improvement in VAS at the end of the reporting period. At 2 years, patients demonstrated a statistically significant reduction of pain as measured by VAS, and improvement in physical function and mobility was significant as measured by Zurich Claudication Questionnaire and Oswestry Disability Index. Tukey honestly significant different test found significant improvement in all outcome measures from baseline to each follow-up interval. Further, major improvement occurred by 1-week follow-up and showed no difference between each subsequent follow-up, signifying considerable stability and durability of the initial result over time. No major device or intraprocedural adverse events were reported. DISCUSSION: In this report of 2-year follow-up on 45 patients treated with mild percutaneous lumbar decompression, patients experienced statistically significant pain relief and improved functionality.
Chopko Bohdan W
The Clinical journal of pain
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/AJP.0b013e31827fb803" target="_blank" rel="noreferrer noopener">10.1097/AJP.0b013e31827fb803</a>
Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.
*Cardiovascular; *Cortisol; *Epinephrine; *Post-operative Pain; *Severity of Illness Index; *Stress; *Surgery; 80 and over; 80 and Over; Aged; Arthroplasty; Catecholamines – Urine; Center for Epidemiological Studies Depression Scale; Cohort Studies; Data Analysis Software; Descriptive Statistics; Effect Size; Female; Human; Humans; Hydrocortisone – Urine; Knee; Knee/*adverse effects/psychology; Male; Middle Age; Middle Aged; Nonexperimental Studies; Ohio; Pain; Pain Measurement/methods; Physiological; Postoperative Pain – Risk Factors; Postoperative/*diagnosis/etiology/*psychology; Predictive Value of Tests; Prospective Studies; Psychological/complications/*diagnosis/*psychology; Regression; Replacement; Scales; Stress; Summated Rating Scaling; Treatment Outcome
OBJECTIVE: The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS: Participants included 110 patients undergoing total knee arthroplasty. METHODS: Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a
Cremeans-Smith Julie K; Greene Kenneth; Delahanty Douglas L
Pain medicine (Malden, Mass.)
2016
2016-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/pm/pnv043" target="_blank" rel="noreferrer noopener">10.1093/pm/pnv043</a>
Parathyroid Hormone and Subclinical Cerebrovascular Disease: The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study.
*Magnetic Resonance Imaging; Brain; Brain Diseases; Brain Diseases – Complications; brain MRI; Brain/*diagnostic imaging; cerebrovascular disease; Cerebrovascular Disorders; Cerebrovascular Disorders – Blood; Cerebrovascular Disorders/*blood/*diagnostic imaging; Cohort Studies; Computer Assisted; Computer-Assisted; Cross Sectional Studies; Cross-Sectional Studies; Female; Funding Source; Human; Humans; Image Processing; Leukoencephalopathies/complications/diagnostic imaging; Magnetic Resonance Imaging; Male; Middle Age; Middle Aged; Parathyroid hormone; Parathyroid Hormone/*blood; Parathyroid Hormones – Blood; Prospective Studies; subclinical brain infarcts; white matter hyperintensities
BACKGROUND: Elevated parathyroid hormone (PTH) levels have been associated with cardiovascular disease risk factors and events. We hypothesized that elevated PTH levels would also be associated with subclinical cerebrovascular disease. We examined the relationship between elevated PTH level and white matter hyperintensities (WMHs) and subclinical infarcts measured on brain magnetic resonance imaging (MRI). METHODS: PTH was measured at baseline (1993-1994) among participants free of prior clinical stroke who underwent a brain MRI at baseline (n = 1703) and a second brain MRI 10 years later (n = 948). PTH levels of 65 pg/mL or higher were considered elevated (n = 204). Participants who did not return for a follow-up MRI had, at baseline, higher PTH and a greater prevalence of cardiovascular risk factors (P \textless .05 for all); therefore, multiple imputation was used. The cross-sectional and prospective associations of PTH levels with WMH and MRI-defined infarcts (and their progression) were investigated using multivariable regression models. RESULTS: At baseline, the participants had a mean age of 62 years and were 60% female and 49% black. Cross-sectionally, after adjusting for demographic and lifestyle factors, elevated PTH level was associated with higher WMH score (beta = .19, 95% confidence interval [CI] .04-.35) and increased odds of prevalent infarcts (odds ratio 1.56, 95% CI 1.02-2.36). Results were attenuated after adjustment for potential mediators of this association (i.e., hypertension). No prospective associations were found between PTH and incident infarcts or change in estimated WMH volume, although estimates were imprecise. CONCLUSIONS: Although associated cross-sectionally, we did not confirm any association between elevated PTH level and progression of cerebrovascular changes on brain MRIs obtained 10 years apart. The relationship of PTH with subclinical brain disease warrants further study.
Korada Sai Krishna C; Zhao Di; Gottesman Rebecca F; Guallar Eliseo; Lutsey Pamela L; Alonso Alvaro; Sharrett A Richey; Post Wendy S; Reis Jared P; Mosley Thomas H; Michos Erin D
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2016
2016-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.029" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2015.12.029</a>
Hemipelvic amputations for recalcitrant pelvic osteomyelitis.
80 and over; Adult; Aged; Anti-Bacterial Agents/*therapeutic use; Cohort Studies; Female; Hemipelvectomy/*methods/psychology; Humans; Male; Middle Aged; Osteomyelitis/drug therapy/microbiology/*surgery; Palliative Care/methods; Paraplegia/psychology; Pelvic Bones/*surgery; Retrospective Studies; Secondary Prevention; Treatment Outcome; Wound Infection/*drug therapy/microbiology
OBJECTIVE: To evaluate the outcome of recalcitrant deep pelvic infection that required a hemipelvic amputation. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral centre; Level I trauma. PATIENTS: There were 20 patients with an infection of the pelvic girdle who developed life-threatening sepsis or had an intolerable existence due to putrefied tissues that prevented end of life care. All patients failed other more conservative treatments such as limited debridement and local wound care. The indication for amputation was life-threatening sepsis (eight patients), intolerable state with putrid tissue (four patients), and both sepsis/putrefaction (eight patients). INTERVENTION: A hemipelvic amputation, multidrug antibiotic treatment, and long-term suppression. Ten internal hemipelvectomies, eight external hemipelvectomies, and two hemicorporectomies were performed. MAIN OUTCOME MEASURE: Survival and recurrence of infection. RESULTS: Six patients died within 6 months (mean time 17 weeks, range 2-24). The 14 surviving patients had a mean follow-up time of 28 weeks (9-48). Of these, 10 patients survived with no evidence of ongoing infection, and four patients had ongoing infection requiring suppressive antibiotics. All of the six deaths were in C-hosts with an average of six comorbidities each; mean age was 62 years old. Aetiologies of the infection were vasculopathy (5), spinal cord injury (4), post fracture (3), post abdominal surgery (2), gunshot wound (2), seeding from bacteraemia (4). Cierny-Mader host class was C (11) and B systemic/local (9) with an average of four (4) comorbidities each. Mean estimated blood loss=3100 cc and operative time=157 min. There were 11 cases of minor wound problems and no flap loss. Pathogens were polymicrobial (16 total pathogens) with mean of three per patient (most common was MRSA). Multi-agent antibiotic and suppression were used in all patients. In cases with putrefied tissues, appropriate nursing care was possible. CONCLUSION: Patients requiring hemipelvectomies usually present with sepsis or an intolerable state. Despite expected complications, we found that hemipelvectomy is an effective palliative tool in selected cases. Age and vascular disease seemed to be associated with worse outcomes.
Ziran Bruce H; Smith Wade R; Rao Nalini
Injury
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.injury.2007.12.002" target="_blank" rel="noreferrer noopener">10.1016/j.injury.2007.12.002</a>
Overcoming missed opportunities in diabetes management to improve outcomes for hospitalized patients with diabetes.
Aged; Blood Glucose/*metabolism; Cohort Studies; Diabetes Mellitus; Female; Glycated Hemoglobin A/*metabolism; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Type 2/*drug therapy
AIMS: The purpose of this study is to assess the impact of hospitalization on
Oravec Michael; Salem James; Kunz Jason; Cudnik Michelle L; Clough Lynn; Woods Robert; Elavsky Megan
Diabetes research and clinical practice
2018
2018-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.diabres.2018.04.020" target="_blank" rel="noreferrer noopener">10.1016/j.diabres.2018.04.020</a>
Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
*Emergency Service; *Practice Guidelines as Topic; Adolescent; Adult; Anti-Bacterial Agents/*therapeutic use; Child; Cohort Studies; Dose-Response Relationship; Drug; Drug Administration Schedule; Evidence-Based Medicine; Female; Follow-Up Studies; Hospital; Hospitals; Humans; Male; Pediatric; Pharyngitis/*drug therapy/*microbiology; Preschool; Streptococcal Infections/*drug therapy/microbiology; Treatment Outcome
BACKGROUND: Pharyngitis is a common complaint in pediatric patients. If clinical parameters are used alone, bacterial pathogens will be wrongly implicated in many cases. A nonstandardized approach to the treatment of children with pharyngitis in an emergency department setting may lead to inappropriate empirical therapy, contribute to increased bacterial resistance, and result in adverse events related to the treatment provided. OBJECTIVE: To implement evidence-based guidelines for the diagnosis and treatment of children with pharyngitis in an emergency department setting and thereby influence practices of prescribing antibiotics. DESIGN AND METHODS: An evidence-based guideline for the evaluation and treatment of patients with pharyngitis was developed and implemented in our emergency department. Preintervention and postintervention patient cohorts were identified by a search of the emergency department's clinical repository. A medical record review was performed using a standardized data abstraction form (history and examination data, diagnostic testing, and therapy provided). Treatment decisions were judged as appropriate if the diagnosis of pharyngitis caused by group A beta-hemolytic streptococci was based on confirmatory microbiological testing rather than on the history and physical examination findings alone. RESULTS: We included 443 patients for study (219 preintervention and 224 postintervention). In the preintervention group, 97 (44%) of 214 received appropriate treatment. In the postintervention group, 204 (91%) of 224 received appropriate treatment. CONCLUSION: An evidence-based clinical guideline can influence and improve practices of prescribing antibiotics by pediatric emergency physicians in a teaching hospital setting.
Diaz Maria Carmen G; Symons Nadine; Ramundo Maria L; Christopher Norman C
Archives of Pediatrics & Adolescent Medicine
2004
2004-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archpedi.158.10.977" target="_blank" rel="noreferrer noopener">10.1001/archpedi.158.10.977</a>