A Case of Nodal Anthracosis Presenting as PET-Positive Mediastinal and Hilar Lymphadenopathies.
Aged; Humans; Female; Lung; Positron-Emission Tomography; Anthracosis/complications/diagnostic imaging; Lymphadenopathy/diagnostic imaging/etiology; Mediastinum
Alzubi J; Jabri A; Hussein H; Gupta A
Mayo Clinic Proceedings
2020
2020-05
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journalArticle
<a href="http://doi.org/10.1016/j.mayocp.2020.01.040" target="_blank" rel="noreferrer noopener">10.1016/j.mayocp.2020.01.040</a>
A cost-effectiveness analysis of sentinel lymph node detection in vulvar cancer by preoperative lymphoscintigraphy versus intraoperative detection alone.
OBJECTIVE: To determine cost-effectiveness of preoperative lymphoscintigraphy (LSG) for detection of inguinofemoral sentinel lymph nodes (SLN). METHOD: We compared the use of preoperative LSG prior to SLN excision versus omission of preoperative LSG. The two outcomes were death or survival. Costs associated with the procedure were determined by CPT code and published estimates. Cost analysis was performed using Treeage software, and incremental cost-effectiveness ratios (ICERs) were calculated. The measure of effectiveness was incremental survival benefit. ICER thresholds for considering LSG to be cost-effective were based on the value of a statistical life (VSL). RESULTS: Using a baseline probability of 0.93 for finding SLN with LSG, our model estimated LSG costs were $2783.84 with 84.7% survival. Our model then estimated the cost and survival without LSG by varying the SLN detection rate. Survival was equivalent when probability of SLN detection without LSG was 0.93. If detection without LSG was >0.93, not performing LSG was the dominant strategy. Costs were equal when probability of finding SLN without LSG was 0.6. For any SLN detection without LSG below 0.6, performing LSG was the dominant strategy. Formal cost-effectiveness analysis was performed using ICERs for probabilities from 0.60 to 0.93. In this range, costs were higher with LSG, but survival was improved. As long as the incremental detection with LSG was at least 1.05% to 1.47% higher, LSG was cost-effective with ICERs below the VSL. CONCLUSION: In our model, LSG is cost-effective as long as it increases detection of SLN by at least 1.05-1.47%.
Brzezinska B N; Shepherd JP; Rath KS; Clements AE
Gynecologic Oncology
2020
2020-09-05
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journalArticle
<a href="http://doi.org/10.1016/j.ygyno.2020.08.023" target="_blank" rel="noreferrer noopener">10.1016/j.ygyno.2020.08.023</a>
A novel method for fabricating nasoalveolar molding appliances for infants with cleft lip and palate using 3-dimensional workflow and clear aligners.
Humans; Infant; India; Preoperative Care; Cleft Lip; Cleft Palate; Orthodontic Appliances Removable; Nose; Workflow
INTRODUCTION: Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices. METHODS: A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage. RESULTS: We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits. CONCLUSIONS: NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.
Bous RM; Kochenour N; Valiathan M
American Journal of Orthodontics and Dentofacial Orthopedics
2020
2020-09
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journalArticle
<a href="http://doi.org/10.1016/j.ajodo.2020.02.007" target="_blank" rel="noreferrer noopener">10.1016/j.ajodo.2020.02.007</a>
A roadmap for advancing neurostimulation approaches for bladder and bowel function after spinal cord injury.
Bourbeau D; Creasey G; French J; Grill Warren M; Howley S; Krassioukov A; Moritz C; Santacruz BG; Thor K; Wheeler T
Spinal Cord
2020
2020-09-07
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journalArticle
<a href="http://doi.org/10.1038/s41393-020-00544-x" target="_blank" rel="noreferrer noopener">10.1038/s41393-020-00544-x</a>
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
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journalArticle
<a href="http://doi.org/10.1007/s11695-020-04733-8" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-04733-8</a>
ACR Appropriateness Criteria(®) Neuroendocrine Imaging.
Diagnosis Differential; Humans; United States; Evidence-Based Medicine; Contrast Media; Societies Medical; Apoplexy; Appropriate Use Criteria; Appropriateness Criteria; AUC; Diabetes insipidus; Pituitary; Pituitary adenoma; Pituitary Diseases/diagnostic imaging; Precocious puberty; Sella turcica
Neuroendocrine dysfunction includes suspected hyper- and hypofunction of the pituitary gland. Causative lesions may include primary masses of the pituitary such as pituitary microadenomas and macroadenomas, as well as extrinsic masses, typically centered in the suprasellar cistern. Clinical syndromes related to hormonal dysfunction can be caused by excessive hormonal secretion or by inhibited secretion due to mass effect upon elements of the hypothalamic-pituitary axis. Additionally, complications such as hemorrhage may be seen in the setting of an underlying mass and can result in hormonal dysfunction. MRI with high-resolution protocols is the best first-line test to evaluate the sella turcica and parasellar region. CT provides complementary information regarding bony anatomy, and may be appropriate as a first-line test in certain instances, but it provides less detail and lesion characterization when compared to MRI. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Burns J; Policeni B; Bykowski J; Dubey P; Germano IM; Jain V; Juliano AF; Moonis G; Parsons MS; Powers WJ; Rath TJ; Schroeder JW; Subramaniam RM; Taheri MR; Whitehead MT; Zander D; Corey A
Journal of the American College of Radiology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jacr.2019.02.017" target="_blank" rel="noreferrer noopener">10.1016/j.jacr.2019.02.017</a>
Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth.
Humans; Pregnancy; Female; Risk Factors; Logistic Models; Infant Newborn; Sensitivity and Specificity; Prognosis; Gestational Age; Premature Birth; Glucocorticoids/administration & dosage; Pregnancy Trimester Third; Labor Stage First; Obstetric Labor Premature; Betamethasone/administration & dosage; Cervix Uteri; Parity; Respiratory Tract Diseases/prevention & control
OBJECTIVE: This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. STUDY DESIGN: The present study is a secondary analysis of a randomized trial of singleton pregnancies at 34(0/7) to 36(5/7) weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. RESULTS: A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68-0.75, and p-value < 0.01). CONCLUSION: Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.
Glover AV; Battarbee AN; Gyamfi-Bannerman C; Boggess KA; Sandoval G; Blackwell SC; Tita ATN; Reddy UM; Jain L; Saade GR; Rouse DJ; Iams JD; Clark EAS; Chien EK; Peaceman AM; Gibbs RS; Swamy GK; Norton ME; Casey BM; Caritis SN; Tolosa JE; Sorokin Y; Manuck TA
American Journal of Perinatology
2020
2020-03
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journalArticle
<a href="http://doi.org/10.1055/s-0039-1696641" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1696641</a>
Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization.
Medicaid; Neighborhood disadvantage; Postpartum contraception; Social determinants of health; Sterilization
BACKGROUND: Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization. METHODS: Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.4%) desired postpartum sterilization (as abstracted from the medical record at time of delivery hospitalization discharge) and for whom ADI could be calculated via geocoding their home address. We determined the association between ADI and sterilization completion, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery via logistic regression and time to sterilization via Cox proportional hazards regression. RESULTS: Of the 1332 patients included in the analysis, patients living in more disadvantaged neighborhoods were more likely to be younger, more parous, delivered vaginally, Black, unmarried, not college educated, and insured via Medicaid. Compared to patients living in less disadvantaged areas, patients living in more disadvantaged areas were less likely to obtain sterilization (44.8% vs. 53.5%, OR 0.84, 95% CI 0.75-0.93), experienced greater delays in the time to sterilization (HR 1.23, 95% CI 1.06-1.44), were less likely to attend postpartum care (58.9% vs 68.9%, OR 0.86, CI 0.79-0.93), and were more likely to have a subsequent pregnancy within a year of delivery (15.1% vs 10.4%, OR 1.56, 95% CI 1.10-1.94). In insurance-stratified analysis, for patients with Medicaid, but not private insurance, as neighborhood disadvantage increased, the rate of postpartum sterilization decreased. The rate of subsequent pregnancy was positively associated with neighborhood disadvantage for both Medicaid as well as privately insured patients. CONCLUSION: Living in an area with increased neighborhood disadvantage is associated with worse outcomes in terms of desired postpartum sterilization, especially for patients with Medicaid insurance. While revising the Medicaid sterilization policy is important, addressing social determinants of health may also play a powerful role in reducing inequities in fulfillment of postpartum sterilization.
Arora KS; Ascha M; Wilkinson B; Verbus E; Montague M; Morris J; Einstadter D
BMC Public Health
2020
2020-09-22
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journalArticle
<a href="http://doi.org/10.1186/s12889-020-09540-5" target="_blank" rel="noreferrer noopener">10.1186/s12889-020-09540-5</a>
Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.
Humans; Male; Female; Unnecessary Procedures; Infant; Adolescent; Child; Sensitivity and Specificity; Child Preschool; Retrospective Studies; Tomography X-Ray Computed; Observer Variation; Bronchoscopy; Bronchoscopy; Computed tomography; Foreign Bodies/diagnostic imaging/therapy; Foreign body aspiration; Respiratory System/diagnostic imaging
BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA
Journal of Pediatric Surgery
2020
2020-01
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journalArticle
<a href="http://doi.org/10.1016/j.jpedsurg.2019.09.045" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2019.09.045</a>
Can the electrically stimulated manual muscle test differentiate upper from lower motor neuron injury in persons with acute SCI?
spontaneous activity; EMG; lower motor neuron; SMMT; Spinal cord; upper motor neuron
OBJECTIVE: To determine if the motor response on the stimulated manual muscle test (SMMT) in muscles with a grade 0 motor score on the manual muscle test (MMT) can differentiate lower motor neuron (LMN) from upper motor neuron (UMN) injury based on the presence of spontaneous activity (SA) with needle EMG. DESIGN: Prospective Study. PARTICIPANTS/METHODS: Twenty-one subjects with acute traumatic cervical SCI. METHODS: An upper extremity International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) evaluation was completed on all subjects. A needle EMG and an electrically stimulated manual muscle test (SMMT) were completed on all key upper extremity muscles with a MMT motor score of zero. RESULTS: The MMT, SMMT and Needle EMG were done on 77 muscles. The SMMT motor score was 0 on 10 muscles and >1 on 67 muscles. The needle EMG identified spontaneous activity (SA) in 55/77 muscles. Seventy percent (7/10) of the muscles with MMT and SMMT motor score of zero demonstrated SA on EMG. Seventy-two percent (48/67) of the muscles with MMT motor score = 0 and SMMT motor score ≥1 demonstrated SA on EMG. CONCLUSION: In our study, 70% of the muscles with a SMMT motor response of zero and 72% of the muscles with a SMMT motor response greater than or equal to one demonstrated SA on EMG. The use of the SMMT as a clinical measure to differentiate LMN from UMN integrity may be limited when applied.
de Padua A; Renfro C; Grabnar M; Kilgore K; Bryden A; Roach MJ; Nemunaitis G
Neurological Research
2020
2020-09-24
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journalArticle
<a href="http://doi.org/10.1080/01616412.2020.1824417" target="_blank" rel="noreferrer noopener">10.1080/01616412.2020.1824417</a>
Carotid Artery Stenting in Asymptomatic Carotid Artery Stenosis: JACC Review Topic of the Week.
Humans; Stents; stroke; Clinical Competence; Asymptomatic Diseases; Insurance Health Reimbursement; carotid artery; endarterectomy; stenosis; stent; Carotid Stenosis/surgery; Endovascular Procedures/economics/instrumentation/standards
The advance of therapies to reduce the stroke impact of asymptomatic carotid artery stenosis has proved difficult over the last decade. Disagreement concerning the underlying randomized control trials has limited entry into the care arena of endovascular therapies. Recently, advances in percutaneous therapies for carotid artery disease have been reported and provide a substantial database supporting the further incorporation of endovascular-based therapies in patients who need revascularization and meet selection criteria. With a second randomized control trial now published, it is time for a re-evaluation of endovascular therapy as a component of carotid artery care. This review describes the advances in the field in the last 5 years, clarifying the current position of these therapies in the care of the patient with asymptomatic carotid artery disease.
Beckman JA; Ansel GM; Lyden SP; Das TS
Journal of the American College of Cardiology
2020
2020-02-18
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journalArticle
<a href="http://doi.org/10.1016/j.jacc.2019.11.054" target="_blank" rel="noreferrer noopener">10.1016/j.jacc.2019.11.054</a>
Colorectal Cancer, Age, and Obesity-Related Comorbidities: A Large Database Study.
Metabolic syndrome; Prevalence; Obesity; Average-risk; Early-onset colorectal cancer
BACKGROUND AND AIMS: The association between obesity and colorectal cancer (CRC) is well established in older individuals, but evidence is limited in the younger population. The study aims to analyze the relationship of obesity and its related comorbidities in early-onset CRC (E-CRC) and compare it to late-onset CRC (L-CRC). METHODS: A retrospective, cross-sectional study was performed on average-risk individuals ≥ 20 years who were active patients in the commercial database, IBM Watson Health Explorys in the last 5 years. Individuals with CRC were compared to those without CRC across different age groups (20-39, 40-49, and 50-74 years). Individuals with CRC diagnosed < 50 years (E-CRC) were compared to those with CRC between 50 and 74 years (L-CRC). Variables included sex, smoking, obese BMI, diabetes mellitus type 2 (DM2), hypertension (HTN), and hyperlipidemia (HLD). Since Explorys aggregates population-level, de-identified data, approval from institutional review board was not required. RESULTS: Among 37,483,140 individuals, 162,150 cases of sporadic CRC were identified. Compared to the general population, obesity and HLD were independent risk factors for CRC across all age groups; DM2, HTN, and smoking were independent risk factors for CRC in men of all age groups and women with L-CRC. Compared to L-CRC, individuals with E-CRC had lower percentages of obesity-related comorbidities. CONCLUSION: In E-CRC, obesity, DM2, HTN, HLD, and smoking are independent risk factors for CRC among men; obesity and HLD are independent risk factors for CRC in women. These subgroups may benefit from a personalized screening approach to detect early-onset CRC.
Elangovan A; Skeans J; Landsman M; Sajjadh MJA; Elangovan AG; Kaelber DC; Sandhu DS; Cooper GS
Digestive Diseases and Sciences
2020
2020-09-21
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journalArticle
<a href="http://doi.org/10.1007/s10620-020-06602-x" target="_blank" rel="noreferrer noopener">10.1007/s10620-020-06602-x</a>
Comment on: Identifying mechanisms that predict weight trajectory after bariatric surgery: rationale and design of the BioBehavioral Trial.
Daigle CR
Surgery for Obesity and Related Diseases
2020
2020-08-11
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journalArticle
<a href="http://doi.org/10.1016/j.soard.2020.07.028" target="_blank" rel="noreferrer noopener">10.1016/j.soard.2020.07.028</a>
Conceptualizations of Mental Disorder at a US Academic Medical Center.
How health care professionals conceptualize mental illness has received relatively little attention in existing literature. This survey explored how health care professionals, academic faculty, and trainees at a US academic medical center (departments of psychiatry, neurology, family medicine, and geriatric medicine, as well as medical students, nurses, and social workers) conceptualize the notion of mental disorder. Respondents (N = 209) were asked to rate their agreement or disagreement with a variety of conceptual statements. Overall, distress and impairment were seen as essential features of mental disorder, and the presence of a biological abnormality was not considered necessary. There was significant correlation between disease status and biological etiology attribution for all conditions except homosexuality. Psychology trainees and psychologists were significantly less likely to call a condition a disease compared with other groups. There was a general lack of consensus regarding conceptual issues fundamental to psychiatry. Conceptualizations of mental disorder held by respondents were complex and did not fit easily within the "biological psychiatry" paradigm.
Aftab A; Joshi Y; Sewell D
The Journal of Nervous and Mental Disease
2020
2020-09-17
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journalArticle
<a href="http://doi.org/10.1097/nmd.0000000000001227" target="_blank" rel="noreferrer noopener">10.1097/nmd.0000000000001227</a>
Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis.
Aged; Humans; Male; Adult; Female; Aged 80 and over; Middle Aged; Infant; Adolescent; Child; Emergency Medical Services; Young Adult; Child Preschool; Quality Improvement; Aircraft; Healthcare Failure Mode and Effect Analysis/methods; Triage/standards; Air Ambulances
OBJECTIVE: Overtriage (OT) of helicopter emergency medical services (HEMS) poses significant burden to multiple stakeholders. The project aims were to identify the following: 1) associated factors, 2) downstream effects, and 3) focus areas for change. METHODS: We undertook a failure mode and effects analysis (FMEA) to evaluate our HEMS interfacility transport process. Data were collected from organizational finances and 3 key stakeholder groups: 1) interfacility patients transferred by HEMS in 2017 who were discharged from the receiving facility within 24 hours (n = 149), 2) flight registered nurses (n = 19), and 3) referring emergency medicine providers (EMPs) (n = 30) from the top HEMS users of 2017. The completed FMEA identified failure modes, the frequency and severity of effects, and unique risk profile numbers (RPNs). RESULTS: Twelve failure modes were identified with 30 potential causes. Leading failure modes included inappropriate HEMS requests by EMPs (RPN = 343), inappropriate activation by EMS for interfacility transport (RPN = 343), and minimizing patient/family involvement in decision making (RPN = 315). Significant burdens to organizational finances and flight registered nurse satisfaction were identified. CONCLUSION: Associated factors for interfacility HEMS OT, downstream effects, and areas for change were identified. EMP and emergency medical services practices, HEMS processes, and shared decision making may affect regional OT rates.
Grabowski RL; McNett M; Ackerman MH; Schubert C; Mion LC
Air Medical Journal
2019
2019-12
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journalArticle
<a href="http://doi.org/10.1016/j.amj.2019.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2019.07.012</a>
Dizziness during atrial antitachycardia pacing: What is the cause.
atrial fibrillation; atrial antitachycardia therapy; permanent pacemaker
A 74-year-old with a history of sinus node dysfunction and intermittent AV block s/p permanent pacemaker implant 6 years prior, complains of one episode of dizziness.
Gianni C; Canby RC; Della Rocca DG; Natale A; Al-Ahmad A
Journal of Cardiovascular Electrophysiology
2020
2020-08-30
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journalArticle
<a href="http://doi.org/10.1111/jce.14728" target="_blank" rel="noreferrer noopener">10.1111/jce.14728</a>
Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes.
Humans; Pregnancy; Adult; Female; Blood Glucose/analysis; Surveys and Questionnaires; Follow-Up Studies; Multivariate Analysis; Insulin Resistance; Diabetes Mellitus/prevention & control; Diabetes Gestational/diagnosis/therapy; Metabolic Syndrome/prevention & control; Obesity/prevention & control
OBJECTIVE: The main purpose of this article is to evaluate whether identification and treatment of women with mild gestational diabetes mellitus (GDM) during pregnancy affects subsequent maternal body mass index (BMI), anthropometry, metabolic syndrome, and risk of diabetes. STUDY DESIGN: This is a follow-up study of women who participated in a randomized controlled treatment trial for mild GDM. Women were enrolled between 5 and 10 years after their index pregnancy. Participants underwent blood pressure, height, weight, and anthropometric measurements by trained nursing personnel using a standardized approach. A nurse-assisted questionnaire regarding screening and treatment of diabetes or hypercholesterolemia, diet, and physical activity was completed. Laboratory evaluation included fasting serum glucose, fasting insulin, oral glucose tolerance test, and a lipid panel. Subsequent diabetes, metabolic syndrome, obesity, and adiposity in those diagnosed with mild GDM and randomized to nutritional counseling and medical therapy (treated) were compared with those who underwent routine pregnancy management (untreated). Multivariable analyses were performed adjusting for race/ethnicity and years between randomization and follow-up visit. RESULTS: Four-hundred fifty-seven women with mild GDM during the index pregnancy were included in this analysis (243 treated; 214 untreated) and evaluated at a median 7 years after their index pregnancy. Baseline and follow-up characteristics were similar between treatment groups. Frequency of diabetes (9.2 vs. 8.5%, p =0.80), metabolic syndrome (32.2 vs. 34.3%, p =0.63), as well as adjusted mean values of homeostasis model assessment for insulin resistance (2.5 vs. 2.3, p =0.11) and BMI (29.4 vs. 29.1 kg/m(2), p =0.67) were also not different. CONCLUSION: Identification and treatment of women with mild GDM during pregnancy had no discernible impact on subsequent diabetes, metabolic syndrome, or obesity 7 years after delivery.
Casey BM; Rice MM; Landon MB; Varner MW; Reddy UM; Wapner RJ; Rouse DJ; Biggio JR; Thorp JM; Chien EK; Saade GR; Peaceman AM; Blackwell SC; Van Dorsten JP
American Journal of Perinatology
2020
2020-04
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journalArticle
<a href="http://doi.org/10.1055/s-0039-1681058" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1681058</a>
Efficacy and Safety of Intravenous-to-oral Lefamulin, a Pleuromutilin Antibiotic, for the Treatment of Community-acquired Bacterial Pneumonia: The Phase III Lefamulin Evaluation Against Pneumonia (LEAP 1) Trial.
Aged; Humans; Male; Adult; Female; Middle Aged; Double-Blind Method; Administration Intravenous; Microbial Sensitivity Tests; pneumonia; Randomized Controlled Trials as Topic; antibiotic; lefamulin; moxifloxacin; pleuromutilin; Anti-Bacterial Agents/administration & dosage/adverse effects/therapeutic use; Diterpenes/administration & dosage/adverse effects/therapeutic use; Linezolid/adverse effects/therapeutic use; Moxifloxacin/administration & dosage/adverse effects/therapeutic use; Pneumonia Bacterial/drug therapy/metabolism; Polycyclic Compounds/administration & dosage/adverse effects/therapeutic use; Thioglycolates/administration & dosage/adverse effects/therapeutic use
BACKGROUND: Lefamulin, a pleuromutilin antibiotic, is active against pathogens commonly causing community-acquired bacterial pneumonia (CABP). The Lefamulin Evaluation Against Pneumonia (LEAP 1) study was a global noninferiority trial to evaluate the efficacy and safety of lefamulin for the treatment of CABP. METHODS: In this double-blind study, adults with CABP of Pneumonia Outcomes Research Team risk class ≥III were randomized 1:1 to receive lefamulin at 150 mg intravenously (IV) every 12 hours or moxifloxacin at 400 mg IV every 24 hours. After 6 doses, patients could be switched to an oral study drug if prespecified improvement criteria were met. If methicillin-resistant Staphylococcus aureus was suspected, either linezolid or placebo was added to moxifloxacin or lefamulin, respectively. The US Food and Drug Administration primary endpoint was an early clinical response (ECR) 96 ± 24 hours after the first dose of the study drug in the intent-to-treat (ITT) population (noninferiority margin, 12.5%). The European Medicines Agency co-primary endpoints were an investigator assessment of clinical response (IACR) 5-10 days after the last dose of the study drug in the modified ITT (mITT) and clinically evaluable (CE) populations (noninferiority margin, 10%). RESULTS: There were 551 patients randomized (n = 276 lefamulin; n = 275 moxifloxacin). Lefamulin was noninferior to moxifloxacin for ECR (87.3% vs 90.2%, respectively; difference -2.9%, 95% confidence interval [CI] g -8.5 to 2.8) and IACR (mITT, 81.7% vs 84.2%, respectively; difference -2.6%, 95% CI -8.9 to 3.9; CE, 86.9% vs 89.4%, respectively; difference -2.5%, 95% CI -8.4 to 3.4). Rates of study drug discontinuation due to treatment-emergent adverse events were 2.9% for lefamulin and 4.4% for moxifloxacin. CONCLUSIONS: Lefamulin was noninferior to moxifloxacin for the primary efficacy endpoints and was generally safe and well tolerated. CLINICAL TRIALS REGISTRATION: NCT02559310.
File TM; Goldberg L; Das A; Sweeney C; Saviski J; Gelone SP; Seltzer E; Paukner S; Wicha WW; Talbot GH; Gasink LB
Clinical Infectious Diseases
2019
2019-11-13
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journalArticle
<a href="http://doi.org/10.1093/cid/ciz090" target="_blank" rel="noreferrer noopener">10.1093/cid/ciz090</a>
Elective Labor Induction at 39 Weeks of Gestation Compared With Expectant Management: Factors Associated With Adverse Outcomes in Low-Risk Nulliparous Women.
OBJECTIVE: To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management. METHODS: We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliveries before 39 weeks of gestation and those not adherent to study protocol or with fetal anomalies were excluded. A composite of adverse outcomes (perinatal death or severe neonatal complications), third- or fourth-degree lacerations, and postpartum hemorrhage were evaluated. Log binomial regression models estimated relative risks and 95% CIs for associations of outcomes with patient characteristics including randomly assigned treatment group. Interactions between patient characteristics and treatment group were tested. RESULTS: Of 6,096 women with outcome data, 5,007 (82.1%) met criteria for inclusion in this analysis. Frequency of the perinatal composite was 252 (5.0%), 166 (3.3%) for third- or fourth-degree perineal laceration, and 237 (4.7%) for postpartum hemorrhage. In multivariable analysis, intended labor induction at 39 weeks of gestation was associated with a reduced perinatal composite outcome (4.1% vs 6.0%; adjusted relative risk [aRR] 0.71; 95% CI 0.55-0.90), whereas increasing body mass index (BMI) was associated with an increased perinatal composite outcome (aRR 1.04/unit increase; 95% CI 1.02-1.05). Decreased risk of third- or fourth-degree perineal laceration was observed with increasing BMI (aRR 0.96/unit increase; 95% CI 0.93-0.98) and in Black women compared with White women (1.2% vs 3.9%; aRR 0.34; 95% CI 0.19-0.60). Increased risk of postpartum hemorrhage was observed in Hispanic women compared with White women (6.3% vs 4.0%; aRR 1.64; 95% CI 1.18-2.29). Patient characteristics associated with adverse outcomes were similar between treatment groups (P for interaction >.05). CONCLUSION: Compared with expectant management, intended induction at 39 weeks of gestation was associated with reduced risk of adverse perinatal outcome. Patient characteristics associated with adverse outcomes were few and similar between groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01990612.
El-Sayed YY; Rice MM; Grobman William A; Reddy UM; Tita ATN; Silver RM; Mallett Gail; Hill Kim; Thom EA; Wapner RJ; Rouse DJ; Saade GR; Thorp JM; Chauhan SP; Chien EK; Casey BM; Gibbs RS; Srinivas SK; Swamy GK; Simhan HN; Macones GA
Obstetrics and Gynecology
2020
2020-10
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journalArticle
<a href="http://doi.org/10.1097/aog.0000000000004055" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000004055</a>
Embolization of Acquired Pulmonary Arteriovenous Malformations Resulting from Metastatic Gestational Trophoblastic Neoplasia.
Ferber GA; Khoncarly S; Buchino JJ; McDaniel JD
Journal of Vascular and Interventional Radiology
2020
2020-09-16
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journalArticle
<a href="http://doi.org/10.1016/j.jvir.2020.01.021" target="_blank" rel="noreferrer noopener">10.1016/j.jvir.2020.01.021</a>
Final Two-Year Outcomes for the Sentry Bioconvertible Inferior Vena Cava Filter in Patients Requiring Temporary Protection from Pulmonary Embolism.
Aged; Humans; Male; Adult; Female; Aged 80 and over; United States; Risk Factors; Middle Aged; Treatment Outcome; Time Factors; Young Adult; Prosthesis Design; Vena Cava Filters; Phlebography; Computed Tomography Angiography; Belgium; Chile; Vena Cava Inferior/diagnostic imaging; Prosthesis Implantation/adverse effects/instrumentation; Pulmonary Embolism/diagnostic imaging/prevention & control; Venous Thrombosis/diagnostic imaging/prevention & control
PURPOSE: To report final 2-year outcomes with the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE). MATERIALS AND METHODS: In a prospective multicenter trial, the Sentry filter was implanted in 129 patients with documented deep vein thrombosis (DVT) and/or PE (67.5%) or who were at temporary risk of developing DVT/PE (32.6%). Patients were monitored and bioconversion status ascertained by radiography, computed tomography (CT), and CT venography through 2 years. RESULTS: The composite primary 6-month endpoint of clinical success was achieved in 97.4% (111/114) of patients. The rate of new symptomatic PE was 0% (n = 126) through 1 year and 2.4% (n = 85) through the second year of follow-up, with 2 new nonfatal cases at 581 and 624 days that were adjudicated as not related to the procedure or device. Two patients (1.6%) developed symptomatic caval thrombosis during the first month and underwent successful interventions without recurrence. No other filter-related symptomatic complications occurred through 2 years. There was no filter tilting, migration, embolization, fracture, or caval perforation and no filter-related deaths through 2 years. Filter bioconversion was successful for 95.7% (110/115) of patients at 6 months, 96.4% (106/110) of patients at 12 months, and 96.5% (82/85) of patients at 24 months. Through 24 months of follow-up, there was no evidence of late-stage IVC obstruction or thrombosis after filter bioconversion or of thrombogenicity associated with retracted filter arms. CONCLUSIONS: The Sentry IVC filter provided safe and effective protection against PE, with a high rate of intended bioconversion and a low rate of device-related complications, through 2 years of follow-up.
Dake MD; Murphy TP; Krämer AH; Darcy MD; Sewall LE; Curi MA; Johnson MS; Arena F; Swischuk JL; Ansel GM; Silver MJ; Saddekni S; Brower JS; Mendes R
Journal of Vascular and Interventional Radiology
2020
2020-02
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journalArticle
<a href="http://doi.org/10.1016/j.jvir.2019.08.036" target="_blank" rel="noreferrer noopener">10.1016/j.jvir.2019.08.036</a>
Fluoroscopy-Guided Transfacet Lumbar Epidural Steroid Injection for Symptomatic Synovial Cyst Treatment: A Case Report.
We report the case of a patient with a right-sided L4 synovial cyst, which had been causing significant pain, who had a successful transfacet epidural steroid injection to rupture the cyst. Using fluoroscopy, the needle was advanced through the right L4 facet joint and the cyst was ruptured using saline. The needle was then advanced into the epidural space and a transfacet epidural steroid injection was done. The patient's symptoms resolved. Repeat magnetic resonance imaging (MRI) done 2 years later showed no recurrence of the cyst. We discuss the role of transfacet epidural steroid injection in synovial cysts treatment.
Al-Saidi I; Pascoe M; Tabbaa K
A&A Practice
2020
2020-09
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journalArticle
<a href="http://doi.org/10.1213/xaa.0000000000001312" target="_blank" rel="noreferrer noopener">10.1213/xaa.0000000000001312</a>
Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice: Endorsed by the Heart Rhythm Society Board of Trustees.
Humans; Risk Factors; United States/epidemiology; Survival Rate/trends; Cardiology; Morbidity/trends; Risk Assessment/methods; Atrial fibrillation; Common data element; Data standard; Harmonization; Outcome measure; Patient outcome; Patient registry; Registries; Societies Medical; Atrial Fibrillation/complications/epidemiology; Outcome Assessment Health Care/methods; Stroke/epidemiology/etiology
BACKGROUND: Atrial fibrillation (AF) affects an estimated 33 million people worldwide, leading to increased mortality and an increased risk of heart failure and stroke. Many AF patient registries exist, but the ability to link and compare data across registries is hindered by differences in the outcome measures collected by each registry and a lack of harmonization. OBJECTIVES: The purpose of this project was to develop a minimum set of standardized outcome measures that could be collected in AF patient registries and clinical practice. METHODS: AF patient registries were identified through multiple sources and invited to join the workgroup and submit outcome measures. Additional measures were identified through literature searches and reviews of consensus statements. Outcome measures were categorized using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework (OMF). A minimum set of broadly relevant measures was identified. Measure definitions were harmonized through in-person and virtual meetings. RESULTS: One hundred twelve outcome measures, including those from thirteen registries, were curated according to the OMF and then harmonized into a minimum set of measures in the OMF categories of survival (3 measures), clinical response (3 measures), events of interest (9 measures), patient-reported outcomes (2 measures), and resource utilization (3 measures). The harmonized definitions build on existing consensus statements. CONCLUSIONS: The harmonized measures represent a minimum set of outcomes that are relevant in AF research and clinical practice. Routine and consistent collection of these measures in registries and in other systems would support creation of a research infrastructure to efficiently address new questions and improve patient outcomes.
Calkins H; Gliklich RE; Leavy MB; Piccini JP; Hsu JC; Mohanty S; Lewis W; Nazarian S; Turakhia MP
Heart Rhythm
2019
2019-01
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journalArticle
<a href="http://doi.org/10.1016/j.hrthm.2018.09.021" target="_blank" rel="noreferrer noopener">10.1016/j.hrthm.2018.09.021</a>
Impact of a Novel Post-Discharge Transitions of Care Clinic on Hospital Readmissions.
Medicaid; Medicare; 30 day readmission; 90 day mortality; African-American; Commercial health insurance; Post-discharge; Transitions of care
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) has targeted hospital readmissions, which cost $17 billion per year, as one potential solution to reduce rising health care costs. Studies have documented the ability of Transitions of care (TOC) services to reduce readmissions in high risk patients. However, the vast majority of studies have not explored TOC services for all-cause admissions nor TOC clinics led by hospitalists. The goal of this study is to provide preliminary data regarding the potential effectiveness of a hospitalist-led TOC clinic servicing all patients on hospital readmission rates. METHODS: This cross-sectional feasibility study analyzed patients on a tertiary hospital teaching service. All discharged patients from January 2016 to September 2018 were given an appointment at the TOC clinic within 14 days of discharge. The control group consisted of patients assigned to the teaching service from January 2018 to November 2018 that were not offered a TOC appointment. RESULTS: Overall, 1373 patients (n = 1373) were included in this study between January 2016 and September 2018. The control group consisted of 1000 patients who were not offered follow up in the TOC clinic while the TOC group consisted of 373 patients who did attend a follow up appointment in the TOC clinic. The study participants (n = 1373) included patients admitted to the hospital for any diagnosis and were analyzed for all cause readmission rates. The TOC group consisted of 52% African Americans, 52% Medicare patients and 8% Medicaid patients. Demographic information for the control group was not available. The TOC group had a statistically significant 42% decreased risk of being readmitted within 30 days of discharge (RR = 0.58, 95% CI: 0.40-0.83). These data showed a statistically significant difference between the TOC group and control group in relation to the incidence of 30-day readmissions (p-value = 0.002). CONCLUSION: Among Medicare and Medicaid beneficiaries and commercial health insurance patients, this hospitalist-led TOC intervention was associated with a statistically significant reduction in 30-day readmissions following discharge for all-cause hospital admissions.
Baldino M; Bonaguro AM; Burgwardt S; Lombardi A; Cristancho C; Mann C; Wright D; Jackson C; Seth A
Journal of the National Medical Association
2020
2020-09-05
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journalArticle
<a href="http://doi.org/10.1016/j.jnma.2020.07.018" target="_blank" rel="noreferrer noopener">10.1016/j.jnma.2020.07.018</a>
In-Depth Look at the Anatomical Relationship of the Lesser Occipital Nerve, Great Auricular Nerve, and Spinal Accessory Nerve and Their Implication in Safety of Operations in the Posterior Triangle of the Neck.
Humans; Female; Cadaver; Neurosurgical Procedures/methods; Accessory Nerve/anatomy & histology/surgery; Cervical Plexus/anatomy & histology/surgery; Migraine Disorders/diagnosis/surgery; Neck/innervation
BACKGROUND: Migraine surgery is an increasingly popular treatment option for migraine patients. The lesser occipital nerve is a common trigger point for headache abnormalities, but there is a paucity of research regarding the lesser occipital nerve and its intimate association with the spinal accessory nerve. METHODS: Six cadaver necks were dissected. The lesser occipital, great auricular, and spinal accessory nerves were identified and systematically measured and recorded. These landmarks included the longitudinal axis (vertical line drawn in the posterior), the horizontal axis (defined as a line between the most anterosuperior points of the external auditory canals) and the earlobe. Mean distances and standard deviations were calculated to delineate the relationship between the spinal accessory, lesser occipital, and great auricular nerves. RESULTS: The point of emergence of the spinal accessory nerve was determined to be 7.17 ± 1.15 cm lateral to the y axis and 7.77 ± 1.10 caudal to the x axis. The lesser occipital nerve emerges 7.5 ± 1.31 cm lateral to the y axis and 8.47 ± 1.11 cm caudal to the x axis. The great auricular nerve emerges 8.33 ± 1.31 cm lateral to the y axis and 9.4 ±1.07 cm caudal to the x axis. The decussation of the spinal accessory and the lesser occipital nerves was found to be 7.70 ± 1.16 cm caudal to the x axis and 7.17 ± 1.15 lateral to the y axis. CONCLUSION: Understanding the close relationship between the lesser occipital nerve and spinal accessory nerve in the posterior, lateral neck area is crucial for a safer approach to occipital migraine headaches, occipital neuralgia, and new daily persistent headaches and other reconstructive or cosmetic operations.
Amirlak B; Lu KB; Erickson CR; Sanniec K; Totonchi A; Peled ZM; Cheng JC
Plastic and Reconstructive Surgery
2020
2020-09
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journalArticle
<a href="http://doi.org/10.1097/prs.0000000000007049" target="_blank" rel="noreferrer noopener">10.1097/prs.0000000000007049</a>
Intrauterine Vacuum-Induced Hemorrhage-Control Device for Rapid Treatment of Postpartum Hemorrhage.
OBJECTIVE: To evaluate the effectiveness and safety of an intrauterine vacuum-induced hemorrhage-control device for postpartum hemorrhage treatment. METHODS: ptA multicenter, prospective, single-arm treatment study of a novel intrauterine device that uses low-level vacuum to induce uterine myometrial contraction to achieve control of abnormal postpartum uterine bleeding and postpartum hemorrhage was undertaken at 12 centers in the United States. The primary effectiveness endpoint was the proportion of participants in whom use of the intrauterine vacuum-induced hemorrhage-control device controlled abnormal bleeding without requiring escalating interventions. The primary safety endpoint was the incidence, severity, and seriousness of device-related adverse events. Secondary outcomes included time to bleeding control, rate of transfusion, and device usability scored by each investigator using the device. RESULTS: Of 107 participants enrolled with primary postpartum hemorrhage or abnormal postpartum uterine bleeding, 106 received any study treatment with the device connected to vacuum, and successful treatment was observed in 94% (100/106, 95% CI 88-98%) of these participants. In those 100 participants, definitive control of abnormal bleeding was reported in a median of 3 minutes (interquartile range 2.0-5.0) after connection to vacuum. Eight adverse events deemed possibly related to the device or procedure were reported, all of which were outlined as risks in the study and all of which resolved with treatment without serious clinical sequelae. Transfusion of 1-3 units of red blood cells was required in 35 participants, and five participants required 4 or more units of red blood cells. The majority of investigators reported the intrauterine vacuum-induced hemorrhage-control device as easy to use (98%) and would recommend it (97%). CONCLUSION: Intrauterine vacuum-induced hemorrhage control may provide a new rapid and effective treatment option for abnormal postpartum uterine bleeding or postpartum hemorrhage, with the potential to prevent severe maternal morbidity and mortality. FUNDING SOURCE: Alydia Health, Inc. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02883673.
D'Alton ME; Rood KM; Smid MC; Simhan HN; Skupski DW; Subramaniam A; Gibson KS; Rosen T; Clark SM; Dudley D; Iqbal SN; Paglia MJ; Duzyj CM; Chien EK; Gibbins KJ; Wine KD; Bentum NA; Kominiarek MA; Tuuli MG; Goffman D
Obstetrics and Gynecology
2020
2020-09-09
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journalArticle
<a href="http://doi.org/10.1097/aog.0000000000004138" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000004138</a>
Maternal Sense of Control During Childbirth and Infant Feeding Method.
Humans; Pregnancy; Adult; Female; Young Adult; Personal Autonomy; Breast Feeding/psychology; Delivery Obstetric/psychology
OBJECTIVE: To estimate whether maternal sense of control in labor is associated with breastfeeding at 4-8 weeks postpartum. METHODS: This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6-96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4-8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders. RESULTS: Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4-8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145-182). The median Labor Agentry Scale score was 169 (interquartile range 151-183) for women exclusively breastfeeding, 166 (interquartile range 142-182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142-181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant. CONCLUSION: After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4-8 weeks postpartum among nulliparous women. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01990612.
Dude A; Fette LM; Reddy UM; Tita ATN; Silver RM; El-Sayed YY; Wapner RJ; Rouse DJ; Saade GR; Thorp JM; Chauhan SP; Iams JD; Chien EK; Casey BM; Srinivas SK; Swamy GK; Simhan HN
Obstetrics and Gynecology
2020
2020-03
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journalArticle
<a href="http://doi.org/10.1097/aog.0000000000003697" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000003697</a>
Mechanical Thrombectomy for Patients with In-Hospital Ischemic Stroke: A Case-Control Study.
Aged; Humans; Male; Female; Middle Aged; Treatment Outcome; Time Factors; Feasibility Studies; Incidence; Retrospective Studies; thrombectomy; Inpatients; Thrombectomy/adverse effects; Acute ischemic stroke; Brain Ischemia/diagnostic imaging/epidemiology/physiopathology/therapy; in-hospital stroke; Intracranial Thrombosis/diagnostic imaging/epidemiology/physiopathology/therapy; large vessel occlusion; Stroke/diagnostic imaging/epidemiology/physiopathology/therapy
BACKGROUND AND AIM: Patients with in-hospital acute ischemic stroke (AIS) have, in general, worse outcomes compared to those presenting from the community, partly attributed to the numerous contraindications to intravenous thrombolysis. We aimed to identify and analyze a group of patients with in-hospital AIS who remain suitable candidates for acute endovascular therapies. METHODS: A retrospective 6-year data analysis was conducted in patients evaluated through the in-hospital stroke alert protocol in a single tertiary care university hospital to identify those with in-hospital AIS due to acute intracranial large vessel occlusion (ILVO). Feasibility and safety of mechanical thrombectomy for in-hospital AIS was assessed in a case-control study comparing inpatients to those presenting from the community. RESULTS: From 1460 in-hospital stroke alert activations, 11% had a final diagnosis of AIS (n = 167). One hundred and two patients with in-hospital AIS had emergent intracranial vessel imaging and were included in our cohort. Acute ILVO was identified in 27 patients within this cohort. Patients were younger in the ILVO group and had more severe neurologic deficit on presentation. Compared to a matched (1:2) control group of patients presenting from the community, inpatients who underwent mechanical thrombectomy achieved equivalent technical success, safety, and clinical outcomes. CONCLUSIONS: The incidence of acute ILVO in patients with in-hospital AIS who underwent emergent vessel imaging is similar to the reported incidence of ILVO in patients presenting with community-onset AIS. Among patients with in-hospital AIS secondary to ILVO, mechanical thrombectomy is a feasible and safe therapy associated with favorable outcomes.
Bulwa Z; Del Brutto VJ; Loggini A; Ammar FE; Martinez RC; Christoforidis G; Brorson JR; Ardelt AA; Goldenberg FD
Journal of Stroke and Cerebrovascular Diseases
2020
2020-05
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journalArticle
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104692" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2020.104692</a>
Meta-Analysis Comparing Angiography-Guided Versus FFR-Guided Coronary Artery Bypass Grafting.
Changal K; Patel M; Salman F; Nazir S; Gupta R
The American Journal of Cardiology
2020
2020-09-09
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journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2020.09.002" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2020.09.002</a>
Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders.
Aged; Humans; Male; Adult; Female; Prospective Studies; Middle Aged; Treatment Failure; Prognosis; Quality of Life; Follow-Up Studies; Proton Pump Inhibitors/therapeutic use; Esophagus; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Impedance Test; Proton Pump Inhibitor; Regurgitation; Electric Impedance; Endoscopy Digestive System; Esophagus/diagnostic imaging/physiopathology; Gastroesophageal Reflux/diagnosis/drug therapy/physiopathology
BACKGROUND & AIMS: As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS: Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS: Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS: We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
Abdallah J; George N; Yamasaki T; Ganocy S; Fass R
Clinical Gastroenterology and Hepatology
2019
2019-05
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journalArticle
<a href="http://doi.org/10.1016/j.cgh.2018.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.cgh.2018.06.018</a>
Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients.
Humans; Male; Female; Child; Child Preschool; Bacterial Infections/epidemiology/therapy; bloodstream infections; CLABSI; Databases Factual; hematology; mucosal barrier injury; Neoplasms/epidemiology/therapy; Neutropenia/epidemiology/therapy; oncology; pediatric; transplant; Mucous Membrane/injuries
BACKGROUND: Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS: Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS: Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P < 0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION: In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.
Hakim H; Billett AL; Xu J; Tang L; Richardson T; Winkle C; Werner EJ; Hord JD; Bundy DG; Gaur AH
Pediatric Blood & Cancer
2020
2020-08
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journalArticle
<a href="http://doi.org/10.1002/pbc.28234" target="_blank" rel="noreferrer noopener">10.1002/pbc.28234</a>
Mutations of the Transcriptional Corepressor ZMYM2 Cause Syndromic Urinary Tract Malformations.
congenital anomalies of the kidney and urinary tract; extra-renal features; FIM; genetic kidney disease; genomic analysis; syndromic CAKUT; transcription regulator; whole-exome sequencing; ZMYM2; ZNF198
Congenital anomalies of the kidney and urinary tract (CAKUT) constitute one of the most frequent birth defects and represent the most common cause of chronic kidney disease in the first three decades of life. Despite the discovery of dozens of monogenic causes of CAKUT, most pathogenic pathways remain elusive. We performed whole-exome sequencing (WES) in 551 individuals with CAKUT and identified a heterozygous de novo stop-gain variant in ZMYM2 in two different families with CAKUT. Through collaboration, we identified in total 14 different heterozygous loss-of-function mutations in ZMYM2 in 15 unrelated families. Most mutations occurred de novo, indicating possible interference with reproductive function. Human disease features are replicated in X. tropicalis larvae with morpholino knockdowns, in which expression of truncated ZMYM2 proteins, based on individual mutations, failed to rescue renal and craniofacial defects. Moreover, heterozygous Zmym2-deficient mice recapitulated features of CAKUT with high penetrance. The ZMYM2 protein is a component of a transcriptional corepressor complex recently linked to the silencing of developmentally regulated endogenous retrovirus elements. Using protein-protein interaction assays, we show that ZMYM2 interacts with additional epigenetic silencing complexes, as well as confirming that it binds to FOXP1, a transcription factor that has also been linked to CAKUT. In summary, our findings establish that loss-of-function mutations of ZMYM2, and potentially that of other proteins in its interactome, as causes of human CAKUT, offering new routes for studying the pathogenesis of the disorder.
Connaughton DM; Dai R; Owen DJ; Marquez J; Mann N; Graham-Paquin AL; Nakayama M; Coyaud E; Laurent EMN; St-Germain JR; Blok LS; Vino A; Klämbt V; Deutsch K; Wu CW; Kolvenbach CM; Kause F; Ottlewski I; Schneider R; Kitzler TM; Majmundar AJ; Buerger F; Onuchic-Whitford AC; Youying M; Kolb A; Salmanullah D; Chen E; van der Ven AT; Rao Jia; Ityel H; Seltzsam S; Rieke JM; Chen J; Vivante A; Hwang D-Y; Kohl S; Dworschak GC; Hermle T; Alders M; Bartolomaeus T; Bauer SB; Baum MA; Brilstra EH; Challman TD; Zyskind J; Costin CE; Dipple KM; Duijkers FA; Ferguson M; Fitzpatrick DR; Fick R; Glass IA; Hulick PJ; Kline AD; Krey I; Kumar S; Lu W; Marco EJ; Wentzensen IM; Mefford HC; Platzer K; Povolotskaya IS; Savatt JM; Shcherbakova NV; Senguttuvan P; Squire AE; Stein DR; Thiffault I; Voinova VY; Somers MJG; Ferguson MA; Traum AZ; Daouk GH; Daga A; Rodig NM; Terhal PA; van Binsbergen E; Eid LA; Tasic V; Rasouly HM; Lim TY; Ahram DF; Gharavi AG; Reutter HM; Rehm HL; MacArthur DG; Lek M; Laricchia KM; Lifton RP; Xu H; Mane SM; Sanna-Cherchi S; Sharrocks AD; Raught B; Fisher SE; Bouchard M; Khokha MK; Shril S; Hildebrandt F
American Journal of Human Genetics
2020
2020-10-01
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journalArticle
<a href="http://doi.org/10.1016/j.ajhg.2020.08.013" target="_blank" rel="noreferrer noopener">10.1016/j.ajhg.2020.08.013</a>
Needs, priorities, and attitudes of individuals with spinal cord injury toward nerve stimulation devices for bladder and bowel function: a survey.
STUDY DESIGN: Survey. OBJECTIVES: To investigate the needs and priorities of people with spinal cord injury for managing neurogenic bladder and bowel function and to determine their willingness to adopt neuromodulation interventions for these functions. METHODS: Anonymous online survey. It was advertised by word-of-mouth by community influencers and social media, and by advertisement in newsletters of advocacy groups. RESULTS: Responses from 370 individuals (27% female, 73% male) were included. Bladder emptying without catheters was the top priority for restoring bladder function, and maintaining fecal continence was the top priority for restoring bowel function. The biggest concerns regarding external stimulation systems were wearing a device with wires connecting to electrodes on the skin and having to don and doff the system daily as needed. The biggest concerns for implanted systems were the chances of experiencing problems with the implant that required a revision surgery or surgical removal of the whole system. Respondents were willing to accept an external (61%) or implanted (41%) device to achieve improved bladder or bowel function. CONCLUSIONS: Bladder and bowel dysfunction remain important unmet challenges for individuals living with SCI who answered our survey. These individuals are willing to accept some potential risks of nerve stimulation approaches given potential benefits. Additional consumer input is critical for guiding both research and translation to clinical use and personalized medicine.
Bourbeau D; Bolon A; Creasey G; Dai W; Fertig B; French J; Jeji T; Kaiser A; Kouznetsov R; Rabchevsky A; Santacruz BG; Sun J; Thor KB; Wheeler T; Wierbicky J
Spinal Cord
2020
2020-09-07
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<a href="http://doi.org/10.1038/s41393-020-00545-w" target="_blank" rel="noreferrer noopener">10.1038/s41393-020-00545-w</a>
Perioperative Safety of Surgery for Pelvic Organ Prolapse in Elderly and Frail Patients.
Aged; Humans; Female; Aged 80 and over; Middle Aged; Postoperative Complications/etiology; Gynecologic Surgical Procedures/adverse effects; Patient Safety; Frailty/complications; Pelvic Organ Prolapse/surgery; Perioperative Period
OBJECTIVE: To evaluate the effects of old age and frailty on complication rates after surgery for pelvic organ prolapse. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent surgery for prolapse from 2010 to 2017. We compared our control group (45-64 years, index population) to those aged 65-79 years (elderly) and 80 years and older (very elderly). Frailty was assessed using the National Surgical Quality Improvement Program Modified Frailty Index-5. The primary outcome was the composite rate of serious complications and mortality. RESULTS: We analyzed 27,403 patients in the index population, 20,567 in the elderly group, and 3,088 in the very elderly group. The composite rate of serious complications in the index population was 4.5%, compared with 4.7% in the elderly group (odds ratio [OR] 1.0, 95% CI 0.9-1.1) and 9.0% in the very elderly group (OR 2.1, 95% CI 1.8-2.4). Compared with the index group, the very elderly group had notably elevated risks of cardiac complications (OR 11.9, 95% CI 6.2-23.0), stroke (OR 26.6, 95% CI 5.4-131.8), and mortality (OR 39.9, 95% CI 8.6-184.7). On multivariate logistic regression, the only age group independently associated with serious complications was the very elderly group (adjusted odds ratio [aOR] 2.01, 95% CI 1.8-2.3). The Modified Frailty Index-5 score was independently predictive of complications (aOR 1.4, 95% CI 1.1-2.0). Stratified analysis using interaction terms revealed the Modified Frailty Index-5 score to be predictive of complications in the elderly age group (aOR 2.5, 95% CI 1.3-4.6), but not in the very elderly group. CONCLUSION: Serious complications surrounding prolapse surgery increase substantially in the cohort of patients older than 80 years of age, independent of frailty and medical or surgical risk factors.
Chapman GC; Sheyn D; Slopnick EA; Hijaz AK; Mahajan ST; Mangel J; El-Nashar SA
Obstetrics and Gynecology
2020
2020-03
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<a href="http://doi.org/10.1097/aog.0000000000003682" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000003682</a>
Peroneal Artery Adipofascial Flaps for Coverage of Distal Leg and Rearfoot.
Tibial; Wound; Adipofascial; Flap; Free flap; Peroneal; Wound care
Chronic wounds of the lower extremity can pose several obstacles for the treating physician as well as the patient. Peroneal artery adipofascial flaps have been shown to be a reliable and durable option for reconstruction of these defects for many reasons, including ease of dissection, minimized donor site mobility, reliability of take to underlying surfaces, and cosmetically more pleasing outcome. This article discusses the current literature regarding the use of peroneal artery adipofascial flaps and our surgical technique for harvest, transfer, and postoperative course for this versatile flap.
Fahim RX; AbdelFattah SR
Clinics in Podiatric Medicine and Surgery
2020
2020-10
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<a href="http://doi.org/10.1016/j.cpm.2020.07.005" target="_blank" rel="noreferrer noopener">10.1016/j.cpm.2020.07.005</a>
Pharmacotherapy for Obesity-Trends Using a Population Level National Database.
Obesity; Weight loss; Morbid obesity; Anti-obesity drugs; Bariatric surgery
BACKGROUND: Despite the growing trend of obesity, the utilization of anti-obesity therapeutic interventions is not robust in the USA. We aimed to analyze the trends of anti-obesity pharmacotherapy using a population level database. METHODS: We used an electronic health record-derived database (Explorys, IBM Watson Health) to identify adults with obesity (body mass index ≥ 30 kg/m(2)), 2010-2019. Annual rates of anti-obesity pharmacotherapy were analyzed. To assess post-bariatric utilization of these medications, the trend of adults with morbid obesity (BMI ≥ 40 kg/m (2)) who were newly started on anti-obesity medications after sleeve gastrectomy was also analyzed. RESULTS: Among 11,195,020 adults with obesity, 274,160 (2.4%) were prescribed anti-obesity medications during the study period with an increase from 1.1% in 2010 to 2.9% in 2019 (p < 0.0001). A total of 900 (3.5%) of those with morbid obesity were started on weight loss medications within 5 years of sleeve gastrectomy. Women [odds ratio (OR) 3.57, 95% confidence interval (CI) 3.51-3.58], individuals under 50 years (OR 1.59, CI 1.57-1.60), non-Hispanics (OR 1.12, 1.10-1.14, p < 0.0001), African Americans (OR 1.18, CI 1.16-1.19), Medicaid (OR 1.70, CI 1.67-1.73), and commercial insurance holders (OR 2.46, 2.43-2.49) were more likely to receive anti-obesity pharmacotherapy, p < 0.001 for all comparisons. CONCLUSION: There has been a modest increase in the prevalence of anti-obesity medications in the last 10 years, but they remain significantly underutilized. Further studies addressing the barriers to anti-obesity pharmacotherapy might help in increasing the utilization of these medications among adults with obesity.
Elangovan A; Shah R; Smith ZL
Obesity Surgery
2020
2020-09-28
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<a href="http://doi.org/10.1007/s11695-020-04987-2" target="_blank" rel="noreferrer noopener">10.1007/s11695-020-04987-2</a>
Positive outcome in a patient with coronavirus disease 2019 and common variable immunodeficiency after intravenous immunoglobulin.
Humans; Female; Middle Aged; Treatment Outcome; Pandemics; Betacoronavirus/isolation & purification; Common Variable Immunodeficiency/immunology/therapy; Coronavirus Infections/diagnosis/immunology/therapy; Immunoglobulins Intravenous/therapeutic use; Pneumonia Viral/diagnosis/immunology/therapy
Aljaberi R; Wishah K
Annals of Allergy, Asthma & Immunology
2020
2020-09
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journalArticle
<a href="http://doi.org/10.1016/j.anai.2020.06.006" target="_blank" rel="noreferrer noopener">10.1016/j.anai.2020.06.006</a>
Postoperative Critical Events Associated With Obstructive Sleep Apnea: Results From the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry.
BACKGROUND: Obstructive sleep apnea (OSA) patients are at increased risk for pulmonary and cardiovascular complications; perioperative mortality risk is unclear. This report analyzes cases submitted to the OSA Death and Near Miss Registry, focusing on factors associated with poor outcomes after an OSA-related event. We hypothesized that more severe outcomes would be associated with OSA severity, less intense monitoring, and higher cumulative opioid doses. METHODS: Inclusion criteria were age ≥18 years, OSA diagnosed or suspected, event related to OSA, and event occurrence 1992 or later and <30 days postoperatively. Factors associated with death or brain damage versus other critical events were analyzed by tests of association and odds ratios (OR; 95% confidence intervals [CIs]). RESULTS: Sixty-six cases met inclusion criteria with known OSA diagnosed in 55 (83%). Patients were middle aged (mean = 53, standard deviation [SD] = 15 years), American Society of Anesthesiologists (ASA) III (59%, n = 38), and obese (mean body mass index [BMI] = 38, SD = 9 kg/m); most had inpatient (80%, n = 51) and elective (90%, n = 56) procedures with general anesthesia (88%, n = 58). Most events occurred on the ward (56%, n = 37), and 14 (21%) occurred at home. Most events (76%, n = 50) occurred within 24 hours of anesthesia end. Ninety-seven percent (n = 64) received opioids within the 24 hours before the event, and two-thirds (41 of 62) also received sedatives. Positive airway pressure devices and/or supplemental oxygen were in use at the time of critical events in 7.5% and 52% of cases, respectively. Sixty-five percent (n = 43) of patients died or had brain damage; 35% (n = 23) experienced other critical events. Continuous central respiratory monitoring was in use for 3 of 43 (7%) of cases where death or brain damage resulted. Death or brain damage was (1) less common when the event was witnessed than unwitnessed (OR = 0.036; 95% CI, 0.007-0.181; P < .001); (2) less common with supplemental oxygen in place (OR = 0.227; 95% CI, 0.070-0.740; P = .011); (3) less common with respiratory monitoring versus no monitoring (OR = 0.109; 95% CI, 0.031-0.384; P < .001); and (4) more common in patients who received both opioids and sedatives than opioids alone (OR = 4.133; 95% CI, 1.348-12.672; P = .011). No evidence for an association was observed between outcomes and OSA severity or cumulative opioid dose. CONCLUSIONS: Death and brain damage were more likely to occur with unwitnessed events, no supplemental oxygen, lack of respiratory monitoring, and coadministration of opioids and sedatives. It is important that efforts be directed at providing more effective monitoring for OSA patients following surgery, and clinicians consider the potentially dangerous effects of opioids and sedatives-especially when combined-when managing OSA patients postoperatively.
Bolden N; Posner KL; Domino KB; Auckley D; Benumof JL; Herway ST; Hillman D; Mincer SL; Overdyk F; Samuels DJ; Warner LL; Weingarten TN; Chung F
Anesthesia and Analgesia
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/10.1213/ane.0000000000005005" target="_blank" rel="noreferrer noopener">10.1213/ane.0000000000005005</a>
Postoperative Pain Protocol in Children after Selective Dorsal Rhizotomy.
Children; Epidural catheter; Multimodal approach; Postoperative pain; Selective dorsal rhizotomy
INTRODUCTION: Selective dorsal rhizotomy (SDR) provides lasting relief of spasticity for children suffering from cerebral palsy, although controlling postoperative pain is challenging. Postoperatively, escalation of therapies to include a patient-controlled analgesia (PCA) pump and intensive care unit (ICU) admission is common. OBJECTIVES: We developed a multimodal pain management protocol that included intraoperative placement of an epidural catheter with continuous opioid administration. We present the 3-year results of protocol implementation. METHODS: With institutional review board approval, all patients who were subjected to SDR at our institution were identified for review. Hourly pain scores were recorded. Adverse effects of medication, including desaturation, nausea/vomiting, and pruritus, were also noted. Comparisons were made between patients treated with PCA and those treated with multimodal pain control using t and χ2 tests as appropriate. RESULTS: Thirty-nine patients undergoing the procedure with protocolized pain control (average age 6.8 years, 57% male) were compared to 7 PCA-treated controls (average age 6.6 years, 54% male). Pain control was satisfactory in both groups, with average pain scores of 1.5 in both groups on postoperative day 0, decreasing by postoperative day 3 to 1.1 in the PCA group and 0.5 in the protocol group. No patients under the protocol required ICU admission; all patients with PCA spent at least 1 day in the ICU. Desaturations were seen in 16 patients in the protocol group (41%), but none required ICU transfer. Treatment for pruritis was given to 57% of PCA patients and 15% of protocol patients. Treatment for nausea and vomiting was given to 100% of PCA patients and 51% of protocol patients. Medication requirements for the hospitalization were decreased from 1.1 to 0.28 doses per patient for pruritis, and from 3 to 1.1 doses per patient for nausea. CONCLUSIONS: Multimodal analgesia is an excellent alternative to PCA for postoperative pain after SDR. Actual analgesia is comparative to that of controls without the need for intensive care monitoring. Side effects of high-dose opiates were less frequent and required less medication. With the protocol, patients were safely treated outside the ICU.
Hatef J; Smith LGF; Veneziano GC; Martin DP; Bhalla T; Leonard JR
Pediatric Neurosurgery
2020
2020-09-07
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journalArticle
<a href="http://doi.org/10.1159/000509333" target="_blank" rel="noreferrer noopener">10.1159/000509333</a>
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis.
Aged; Humans; Male; Adult; Female; Hospitalization; Middle Aged; Adolescent; Young Adult; Length of Stay; Retrospective Studies; Prevalence; Health Resources; Opioid-Related Disorders/epidemiology; Pancreatitis Chronic/drug therapy
OBJECTIVES: We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients. METHODS: A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients. RESULTS: A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness. CONCLUSIONS: Opioid use disorder-related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Bilal M; Chatila A; Siddiqui MT; Al-Hanayneh M; Shah AR; Desai M; Wadhwa V; Parupudi S; Casey BW; Krishnan K; Hernandez-Barco YG
Pancreas
2019
2019-12
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journalArticle
<a href="http://doi.org/10.1097/mpa.0000000000001430" target="_blank" rel="noreferrer noopener">10.1097/mpa.0000000000001430</a>