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
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.amj.2019.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2019.07.012</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
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.cgh.2018.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.cgh.2018.06.018</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
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>
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
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.anai.2020.06.006" target="_blank" rel="noreferrer noopener">10.1016/j.anai.2020.06.006</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
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/aog.0000000000003682" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000003682</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
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.jstrokecerebrovasdis.2020.104692" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2020.104692</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
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/10.1093/cid/ciz090" target="_blank" rel="noreferrer noopener">10.1093/cid/ciz090</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
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.jvir.2019.08.036" target="_blank" rel="noreferrer noopener">10.1016/j.jvir.2019.08.036</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
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/mpa.0000000000001430" target="_blank" rel="noreferrer noopener">10.1097/mpa.0000000000001430</a>
Racial differences in performance-based function and potential explanatory factors among individuals with knee osteoarthritis.
Female; Humans; Male; Aged; Middle Aged; Socioeconomic Factors; Pain Measurement; African Americans; Body Mass Index; European Continental Ancestry Group; Exercise Test; Knee Joint/physiopathology; Osteoarthritis Knee/physiopathology; Physical Functional Performance
Objective: In individuals with knee osteoarthritis (OA), self-reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance-based physical function as well as potential underlying factors contributing to these racial differences.; Methods: Participants with knee OA from a randomized controlled trial completed the 2-minute step test (2MST), timed-up-and-go (TUG), and 30-second chair stand (30s-CST) at baseline. Race differences in performance-based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables.; Results: In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m 2 ), African Americans (versus whites) had greater unadjusted odds of poorer function (30s-CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65-4.72], 2MST OR 2.37 [95% CI 1.40-4.03], and TUG OR 3.71 [95% CI 2.16-6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates.; Conclusion: African American adults with knee OA had poorer unadjusted performance-based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function. (© 2019, American College of Rheumatology.)
Flowers PPE;Schwartz TA;Arbeeva L;Golightly YM;Pathak A;Cooke J;Gupta JJ;Callahan LF;Goode AP;Corsi M;Huffman KM;Allen KD
Arthritis Care & Research
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/acr.24018" target="_blank" rel="noreferrer noopener">10.1002/acr.24018</a>
Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis.
Female; Humans; Male; Aged; Middle Aged; Treatment Outcome; Risk Factors; Aged 80 and over; Risk Assessment; Prosthesis Design; Recovery of Function; Heart Valve Prosthesis; Aortic Valve/diagnostic imaging/physiopathology/surgery; aortic valve insufficiency; heart diseases; heart valve prosthesis; Transcatheter Aortic Valve Replacement/adverse effects/instrumentation/mortality; Aortic Valve Insufficiency/diagnostic imaging/mortality/physiopathology/surgery
OBJECTIVE: The objective of this study was to analyze the available literature on using transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR). BACKGROUND: Surgical aortic valve replacement is the gold standard therapy for native AR. TAVR has emerged as an alternative approach in high-risk patients. METHODS: MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at least 5 patients undergoing TAVR for native AR. Outcomes included 30-day mortality, myocardial infarction, stroke, major bleeding, postprocedural moderate to severe AR, and device success. Pooled estimates were calculated using a random-effects model. Subgroup analysis and a meta-regression were performed to study the effects of study level covariates on outcomes. RESULTS: Nineteen studies (n =998 patients) were included. The rate of procedural success per Valve Academic Research Consortium - 2 (VARC-2) criteria was 86.2% (78.8%-92.2%]. Thirty-day mortality was 11.9% (9.4%-14.7%). Subgroup analysis showed the use of new generation valves was associated with lower 30-day mortality (P = 0.02) and higher device success (P = 0.009) compared with early generation valves. There was no significant difference (P = 0.13) in the rate of 30-day mortality between patients receiving purpose-specific [8.2% (4.3%-13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%-18.6%); I2 = 25%]. However, device success was higher (P = 0.02) in patients who received purpose-specific valves [96.3% (92.2%-98.9%); I2 = 0%] compared with nonpurpose specific valves [84.4% (75%-91.9%); I2 =46%]. CONCLUSION: TAVR for native AR is associated with acceptable procedural success but increased early mortality. However, the safety and the efficacy of the procedure increased with newer valves.
Rawasia WF; Khan MS; Usman MS; Siddiqi TJ; Mujeeb FA; Chundrigar M; Kalra A; Alkhouli M; Kavinsky CJ; Bhatt DL
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-02-01
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27840" target="_blank" rel="noreferrer noopener">10.1002/ccd.27840</a>
PMID: 30269437
The development and evaluation of a brief form of the normative male alexithymia scale (NMAS-BF).
Female; Humans; Male; Adult; Aged; Middle Aged; Reproducibility of Results; Psychometrics; Factor Analysis Statistical; Socialization; Affective Symptoms/diagnosis/psychology; Brief Psychiatric Rating Scale/standards
The current study extended prior work on the Normative Male Alexithymia Scale (NMAS), a unidimensional measure of some men's limitations in expressing emotion that results from gender-based socialization informed by the masculine norm of restrictive emotionality (RE). Data (N = 505 men) were from Amazon Mechanical Turk participants. First, dimensionality was reassessed using exploratory factor analysis, which supported the unidimensional structure. Second, based on these results, three 6-item models of the NMAS-Brief Form (NMAS-BF) were developed, based on classical test theory (CTT), CTT optimized to avoid item redundancy, and item response theory (IRT). Third, the relative fits of these versions were assessed using confirmatory factor analysis on a separate part of the sample, finding that the IRT version was the best fitting model. Fourth, evidence for reliability for the
Levant RF; Parent MC
Journal of counseling psychology
2019
2019-03
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1037/cou0000312" target="_blank" rel="noreferrer noopener">10.1037/cou0000312</a>
PMID: 30284847
Outcomes with drug-coated balloons in small-vessel coronary artery disease.
Female; Humans; Male; Aged; Middle Aged; Treatment Outcome; Risk Factors; Risk Assessment; Randomized Controlled Trials as Topic; Cardiac Catheters; Coated Materials Biocompatible; drug-coated balloons; drug-eluting balloons; Drug-Eluting Stents; small-vessel disease coronary disease; Angioplasty Balloon Coronary/adverse effects/instrumentation/mortality; Cardiovascular Agents/administration & dosage/adverse effects; Coronary Artery Disease/diagnostic imaging/mortality/therapy; Coronary Restenosis/epidemiology; Observational Studies as Topic
BACKGROUND: Percutaneous coronary intervention (PCI) of small-vessel coronary artery disease (SVD) is associated with increased risk of restenosis. The use of drug-coated balloons (DCBs) in SVD has received limited study. OBJECTIVES: To assess the outcomes of DCB in the treatment of SVD compared with the standard of care. METHODS: We performed a meta-analysis of all studies published between January 2000 and September 2018 reporting the outcomes of DCB versus other modalities in the treatment of de novo SVD. RESULTS: Seven studies with 1,824 patients (1,938 lesions) were included (four randomized controlled trials and three observational studies). During a mean follow-up of 14.5 ± 10 months, DCBs were associated with a similar risk of target lesion revascularization (TLR) (OR: 0.99, 95% CI: 0.54, 1.84, P = 97) and major adverse cardiovascular events (MACE) (OR: 0.86, 95% CI: 0.51, 1.45, P = 0.57) compared with drug-eluting stents (DES). During a mean follow-up of 7 ± 1.5 months, DCBs were associated with a significantly lower risk of TLR (OR: 0.19, 95% CI 0.04-0.88, P = 0.03) and binary restenosis (OR: 0.17, 95% CI 0.08-0.37, P = <0.00001) compared with noncoated balloon angioplasty. CONCLUSION: The use of DCBs in SVD is associated with comparable outcomes when compared with DES and favorable outcomes when compared with balloon angioplasty.
Megaly M; Rofael M; Saad M; Rezq A; Kohl LP; Kalra A; Shishehbor M; Soukas P; Abbott JD; Brilakis ES
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
2019
2019-04-01
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1002/ccd.27996" target="_blank" rel="noreferrer noopener">10.1002/ccd.27996</a>
PMID: 30489687
Moderation and mediation of the relationships between masculinity ideology and health status.
Adolescent; Female; Humans; Male; Adult; Aged; Middle Aged; Young Adult; Surveys and Questionnaires; Health Status; Masculinity; Health Behavior/physiology
OBJECTIVE: The purpose of this study was to assess the direct and indirect relationships between the endorsement of traditional masculinity ideology (TMI) and self-reported health status through potential mediating variables of expectations of benefits from health risk behaviors and actual health risk behaviors. In addition, the objective was to test the moderating effect of gender identity, broadly defined (including cisgender and transgender men and women and nonbinary persons). METHOD: Participants (N = 1233; 34.3% transgender) participated in an online survey, responding to measures of TMI, expectations of benefits, health behaviors, health status, and demographics. Data were analyzed using conditional process modeling. RESULTS: TMI was positively and directly associated with general health status for self-identified men (regardless of their sex assigned at birth), and with mental health for both men and women, but was not associated with physical health for persons of any gender identity. TMI was positively and directly associated with expectations of benefits for both men and women. Expectations of benefits from engaging in health risk behaviors was positively associated with health risk behaviors, and health risk behaviors had a large negative association with health status, for people of all gender identities. CONCLUSIONS: TMI may be a general and mental health protective factor for self-identified men, and a mental health protective factor for women, regardless of assigned sex at birth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Levant RF; Jadaszewski S; Alto K; Richmond K; Pardo S; Keo-Meier C; Gerdes Z
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1037/hea0000709" target="_blank" rel="noreferrer noopener">10.1037/hea0000709</a>
PMID: 30652914
Relation of concomitant heart failure to outcomes in patients hospitalized with influenza.
Female; Humans; Male; Aged; Middle Aged; Retrospective Studies; United States/epidemiology; Incidence; Comorbidity; Follow-Up Studies; Survival Rate/trends; Hospitalization/statistics & numerical data; Inpatients; Length of Stay/trends; Heart Failure/epidemiology; Hospital Mortality/trends; Influenza Human/epidemiology
Influenza is a major public health challenge. Patients hospitalized with influenza who also have heart failure (HF) may be at risk for worse outcomes compared with patients without HF. There is a lack of large studies examining this issue. We queried the 2013 to 2014 National Inpatient Sample for all adult patients (aged ≥ 18 years) admitted with influenza with and without concomitant HF. Using propensity score matching, patients were matched across demographics, discharge weights, and comorbidities. Outcomes included in-hospital mortality, complications, length of stay, and average hospital costs. Of 218,540 influenza hospitalizations, 45,460 (20.8%) had concomitant HF. Patients with HF had higher in-hospital mortality (6.1% vs 3.8%, adjusted odds ratio [aOR] 1.66 [95% confidence interval [CI] 1.44 to 1.91]; p <0.001), acute kidney injury (29.5% vs 22.2%, aOR 1.47 [95% CI 1.37 to 1.57]; p <0.001), acute kidney injury requiring dialysis (2.0% vs 1.0%, aOR 2.08 [1.62 to 2.67], acute respiratory failure (36.2% vs 23.5%, aOR 1.85 [1.73 to 1.97]; p <0.001), and acute respiratory failure requiring mechanical ventilation (17.1% vs 9.3%, OR 2.01 [1.84 to 2.21]; p <0.001), longer length of stay (5.70 ± 0.02 days vs 4.60 ± 0.01 days, p <0.001) and higher average hospital costs ($11,609 ± $52 vs $9,003 ± $38, p <0.001). In conclusion, in patients hospitalized with influenza, HF is associated with increased risk of in-hospital mortality and complications. Our results highlight a need for early recognition and aggressive treatment of HF in these patients to try to improve outcomes.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
The American journal of cardiology
2019
2019-05-01
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2019.01.046" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.01.046</a>
PMID: 30819433
Stability after initial decline in coronary revascularization rates in the united states.
Female; Humans; Male; Aged; Middle Aged; United States; Aged 80 and over; Coronary Artery Bypass/statistics & numerical data; Percutaneous Coronary Intervention/statistics & numerical data; Procedures and Techniques Utilization/statistics & numerical data
BACKGROUND: It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States. METHODS: We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed. RESULTS: Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P < .001) but remained stable thereafter (P = .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P = .02) but remained stable thereafter (P = .60). Similar trends were seen in men and women. Both PCI and CABG rates were lower in women than men over the study period (PCI, 482 to 324/100,000 in men vs 232 to 153/100,000 in women; CABG, 172 to 118/100,000 in men vs 64 to 38/100,000 in women). Annual PCI rates were higher than CABG rates in patients of all age groups including in younger patients (age < 50) and octogenarians. The proportion of coronary revascularization procedures performed per insurance type remained relatively similar across the study period. CONCLUSIONS: Annual rates of coronary revascularization have changed significantly over time, potentially because of advances in revascularization techniques, availability of new evidence, and updated guidelines. Rates of PCI declined more steeply than CABG before plateauing but remained higher than rates of CABG across the study period.
Raza S; Deo VS; Kalra A; Zia A; Altarabsheh SE; Deo VS; Mustafa RR; Younes A; Rao SV; Markowitz AH; Park SJ; Costa MA; Simon DI; Bhatt DL; Sabik JF 3rd
The Annals of thoracic surgery
2019
2019-11
Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.athoracsur.2019.03.080" target="_blank" rel="noreferrer noopener">10.1016/j.athoracsur.2019.03.080</a>
PMID: 31039350
Olmesartan Associated Enteropathy: A Rare Underdiagnosed Cause of Diarrhea and Weight Loss.
Humans; Male; Middle Aged; Colitis; *Weight Loss; Antihypertensive Agents/*adverse effects; Diarrhea/*chemically induced; Imidazoles/*adverse effects; Tetrazoles/*adverse effects; Vomiting/*chemically induced; Lymphocytic/*chemically induced
BACKGROUND Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy. Patients typically present with diarrhea and weight loss often prompting exhaustive diagnostic workup. Discontinuation of the drug leads to dramatic recovery and hence, physicians need to be aware of olmesartan associated enteropathy (OAE) in order to avoid unnecessary testing. CASE REPORT A
Gonakoti Sripriya; Khullar Sanjiv; Rajkumar Aarthi
The American journal of case reports
2019
2019-01
<a href="http://doi.org/10.12659/AJCR.913207" target="_blank" rel="noreferrer noopener">10.12659/AJCR.913207</a>
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>
Exploring comorbid depression and physical health trajectories: A case-based computational modelling approach.
Adult; Female; Humans; Male; Middle Aged; Socioeconomic Factors; Aged; Chronic Disease; *Computer Simulation; Longitudinal Studies; Comorbidity; *Health Status; Artificial Intelligence; cluster analysis; Life Change Events; primary care; Artificial Intelligence; case-based modelling; comorbid depression and physical health; complexity theory; differential equations; longitudinal analysis; nonlinear dynamics; Systems Analysis; Adult Survivors of Child Abuse/statistics & numerical data; Depression/*epidemiology/*physiopathology; Health Services Research/*methods; Intimate Partner Violence/statistics & numerical data; Primary Health Care/organization & administration
While comorbid depression/physical health is a major clinical concern, the conventional methods of medicine make it difficult to model the complexities of this relationship. Such challenges include cataloguing multiple trends, developing multiple complex aetiological explanations, and modelling the collective large-scale dynamics of these trends. Using a case-based complexity approach, this study engaged in a richly described case study to demonstrate the utility of computational modelling for primary care research. N = 259 people were subsampled from the Diamond database, one of the largest primary care depression cohort studies worldwide. A global measure of depressive symptoms (PHQ-9) and physical health (PCS-12) were assessed at 3, 6, 9, and 12 months and then annually for a total of 7 years. Eleven trajectories and 2 large-scale collective dynamics were identified, revealing that while depression is comorbid with poor physical health, chronic illness is often low dynamic and not always linked to depression. Also, some of the cases in the unhealthy and oscillator trends remain ill without much chance of improvement. Finally, childhood abuse, partner violence, and negative life events are greater amongst unhealthy trends. Computational modelling offers a major advance for health researchers to account for the diversity of primary care patients and for developing better prognostic models for team-based interdisciplinary care.
Castellani Brian; Griffiths Frances; Rajaram Rajeev; Gunn Jane
Journal of evaluation in clinical practice
2018
2018-12
<a href="http://doi.org/10.1111/jep.13042" target="_blank" rel="noreferrer noopener">10.1111/jep.13042</a>
Exploring the role of YouTube in delivering dementia education to older Chinese.
Female; Humans; Male; Middle Aged; Aged; *Social Media; China; Internet; *Geriatric Assessment; Health Education/*methods; Dementia/*psychology
Lam Nikki H T; Woo Benjamin K P
Asian journal of psychiatry
2018
2018-01
<a href="http://doi.org/10.1016/j.ajp.2017.12.022" target="_blank" rel="noreferrer noopener">10.1016/j.ajp.2017.12.022</a>
Superficial fungal infections. Errors to avoid in diagnosis and treatment.
Adult; Female; Humans; Male; Middle Aged; Animals; Aged; Child; Cattle; Antifungal Agents/*therapeutic use; Dermatomycoses/*diagnosis/*drug therapy/pathology; Nail Diseases/diagnosis/etiology; Psoriasis/diagnosis; Tinea/*diagnosis/*drug therapy/etiology; Middle Age; Diagnosis; Differential; Tinea – Diagnosis; Tinea – Drug Therapy; Antifungal Agents – Therapeutic Use; Dermatomycoses – Diagnosis; Dermatomycoses – Drug Therapy; Dermatomycoses – Pathology; Nail Diseases – Diagnosis; Nail Diseases – Etiology; Psoriasis – Diagnosis; Tinea – Etiology
Superficial fungal infections are easily managed once the proper diagnosis is made. However, misdiagnosis is not uncommon, and many standard approaches to treatment popular just a few years ago are now out of date or in need of refinement. Through nine illustrative cases, the authors describe pitfalls in diagnosis and treatment of common fungal infections involving the skin, hair, and nails.
Brodell R T; Elewski B; Brodell R T; Elewski B
Postgraduate medicine
1997
1997-04
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/10.3810/pgm.1997.04.209" target="_blank" rel="noreferrer noopener">10.3810/pgm.1997.04.209</a>
Acid-base disorders: classification and management strategies.
Humans; Male; Middle Aged; *Acid-Base Imbalance/classification/etiology/therapy; Acidosis; Alkalosis
Acid-base disorders are common in clinical practice. Simple acid-base disturbances include metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis. Each can be clearly identified using a common clinical approach. Proper understanding of acid-base disorders requires knowledge of normal physiology. Each of the simple acid-base disorders can be diagnosed by obtaining a good history and performing a physical examination, followed by determinations of electrolyte levels, anion gap and pH. The degree and nature of compensation should then be analyzed. Finally, the ratio of the change in anion gap to the change in serum bicarbonate (delta AG/delta HCO3-) should be determined. When this diagnostic process is applied, proper identification of the disorder can be made and management can be undertaken. Mixed acid-base disorders can also be identified and managed using this method.
Williamson J C
American Family Physician
1995
1995-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Overexpression of beta-catenin and cyclinD1 predicts a poor prognosis in ovarian serous carcinomas.
Adult; Female; Humans; Middle Aged; Aged; Young Adult; Immunohistochemistry; Neoplasm Staging; Prognosis; Kaplan-Meier Estimate; Up-Regulation; Biomarkers; beta-catenin; beta Catenin/analysis/*biosynthesis; Cyclin D1/analysis/*biosynthesis; cyclinD1; Ovarian Neoplasms/*metabolism/mortality/pathology; ovarian serous carcinoma; prognosis; Cystadenocarcinoma; Serous/*metabolism/mortality/pathology; Tumor/*analysis
UNLABELLED: Ovarian serous cancer is the most common subtype of epithelial ovarian cancer, and is the leading cause of death from gynecologic cancer. There is an important need for exploration of diagnostic and prognostic markers for this disease. beta-catenin and cyclinD1 play central roles in the tumorigenesis for certain cancers. The role of beta-catenin and cyclinD1 in diagnosis and prognosis of ovarian serous carcinoma is uncertain. In the present study, the expression of beta-catenin and cyclinD1 was examined in 60 ovarian serous carcinomas patients with immunohistochemical staining. The relationship between expression of beta-catenin and cyclinD1 and FIGO stage, pathological grade was analyzed. Kaplan-Meier survival function was used to analyze the prognosis. Overexpression of beta-catenin is more often detected in patients with FIGO stage III and IV than in those with stage I, and II (P=0.003). No significant relationship was found between expression of beta-catenin and pathological grade (P=0.817). Positive expression of beta-catenin related to lower survival rate (P=0.034). The expression of cyclinD1 had no relationship with FIGO stage (P=0.829). Overexpression of cyclinD1 was positively to pathological grade (P=0.017) and survival rate (P=0.009). There is a significantly positive relationship between expression of beta-catenin and cyclinD1 (P=0.014). No statistical significance was found between expression of beta-catenin and cyclinD1 and other pathological parameters. CONCLUSIONS: Expression of beta-catenin and cyclinD1 may be used as predict markers for poor prognosis.
Wang Hai; Wang Haiyan; Makki Mohammad Shahidul; Wen Juanjuan; Dai Yingqing; Shi Qunli; Liu Qi; Zhou Xiaojun; Wang Jiandong
International journal of clinical and experimental pathology
2014
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Acute diverticulitis: diagnosis and management.
Adult; Female; Humans; Postoperative Complications; Male; Middle Aged; Acute Disease; Anti-Bacterial Agents/therapeutic use; Abscess/diagnosis/etiology/therapy; Fistula/complications; Diagnosis; Differential; Diverticulitis; Colonic/*diagnosis/drug therapy/etiology/surgery
A high index of suspicion is required for early detection of complications, most commonly diverticular abscess and colovesical fistula. Appropriate antibiotic therapy should cover a wide range of potential pathogens.
Van Ness M; Peller C
Hospital practice (Office ed.)
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).
<a href="http://doi.org/10.1080/21548331.1991.11707714" target="_blank" rel="noreferrer noopener">10.1080/21548331.1991.11707714</a>
Pruritic rash.
Female; Humans; Middle Aged; Adolescent; Treatment Outcome; Severity of Illness Index; Prognosis; Risk Assessment; Allergens; Eczema/*diagnosis; Family Practice/methods; Nickel/*adverse effects/immunology; Patch Tests; Pruritus/*diagnosis/drug therapy/etiology; Steroids/therapeutic use; Diagnosis; Differential; Administration; Topical; Dermatitis; Allergic Contact/*diagnosis/drug therapy/etiology
Uhlenhake Elizabeth; Brodell Robert T; Nedorost Susan
The Journal of Family Practice
2009
2009-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Managing psoriasis: what's best for your patient?
Humans; Male; Middle Aged; Adrenal Cortex Hormones/therapeutic use; Immunosuppressive Agents/therapeutic use; Ultraviolet Therapy; Combined Modality Therapy; *Patient Compliance; Anti-Inflammatory Agents/therapeutic use; Dermatologic Agents/therapeutic use; Photochemotherapy; Psoriasis/drug therapy/radiotherapy/*therapy; Administration; Cutaneous; ANTISEPTICS; DRUG side effects; PHOTOTHERAPY; PSORIASIS treatment; QUALITY of life; SKIN disease treatment
Whether the symptoms are mild, moderate, or severe, the optimal treatment plan is the one the patient is most likely to follow.
Uhlenhake Elizabeth E; Mehregan David A
The Journal of Family Practice
2012
2012-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Monoclonal gammopathy of undetermined significance: Using risk stratification to guide follow-up.
Humans; Male; Middle Aged; Prevalence; Disease Progression; Risk Assessment; Blood Protein Electrophoresis; Connectin/analysis; Monoclonal Gammopathy of Undetermined Significance/*diagnosis/epidemiology/therapy
Varying combinations of 3 measurable factors determine a patient's risk of progressing toward multiple myeloma and influence monitoring decisions. This review–and accompanying algorithm–can guide your approach. For monoclonal gammopathy of undetermined significance (MGUS) patients at low risk, repeat serum protein electrophoresis (SPE) in 6 months. If no significant elevation of
Uddin Zia; Maennle Diane; Russell Kimberly; Boltri John M
The Journal of Family Practice
2015
2015-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Breast cancer screening in a private women's clinic.
Adult; Female; Humans; Middle Aged; Ohio; Biopsy; Hospitals; Lymphatic Metastasis; Costs and Cost Analysis; *Mass Screening/economics; Breast Neoplasms/economics/*epidemiology; Breast/pathology; Mammography/economics; Needle/economics; Proprietary
A review of 6109 mammograms representing 4332 patients seen over 4 years is presented. The American Cancer Society guidelines for mammography screening were followed. Forty-five percent of all tumors were nonpalpable; in 12% of these the lymph nodes were positive for cancer. In the group with palpable breast cancers, 62% had positive lymph nodes. Screening mammography results in an increased number of localization biopsies. Biopsy rates were compared with several series. Costs for mammography screening programs were reviewed and related to the cost of each breast cancer detected. In our series the cost per cancer detected was $13,000. This study provides evidence to justify the American Cancer Society guidelines.
Tifft J G; Jarjoura D
American journal of obstetrics and gynecology
1988
1988-06
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/10.1016/0002-9378(88)90374-2" target="_blank" rel="noreferrer noopener">10.1016/0002-9378(88)90374-2</a>
Development of bilateral lower extremity Marjolin ulcers after childhood burns.
Humans; Male; Middle Aged; Time Factors; Burns/*complications; Skin Neoplasms/*etiology/surgery; Skin Ulcer/*etiology/surgery; Carcinoma; Squamous Cell/*etiology/surgery
Tank Jason; Scharschmidt Tom; Weiner Scott D
American journal of orthopedics (Belle Mead, N.J.)
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Malignancy in horseshoe kidney.
Female; Humans; Male; Middle Aged; Tomography; Adenocarcinoma/*diagnostic imaging/surgery; Kidney Neoplasms/*diagnostic imaging/surgery; Kidney/*abnormalities/surgery; Nephrectomy; Renal Artery/diagnostic imaging; Urography; X-Ray Computed
We have reported two cases of adenocarcinoma in a horseshoe kidney and their successful surgical treatment. Review of the literature suggests that transitional cell carcinoma and Wilms' tumor are seen more often than adenocarcinoma in horseshoe kidneys.
Smith-Behn J; Memo R
Southern medical journal
1988
1988-11
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/10.1097/00007611-198811000-00029" target="_blank" rel="noreferrer noopener">10.1097/00007611-198811000-00029</a>
Pylephlebitis: a case report and review of outcome in the antibiotic era.
Female; Humans; Middle Aged; Combined Modality Therapy; Anti-Bacterial Agents/*therapeutic use; Acute Disease; Radiography; *Portal Vein/diagnostic imaging; Liver Abscess/diagnosis/etiology/therapy; Phlebitis/complications/diagnosis/*drug therapy/etiology; Sigmoid Diseases/complications/diagnosis/therapy; Colonic/complications/diagnosis/therapy; Diverticulitis
Pylephlebitis or septic thrombophlebitis of the portal vein, a precursor of hepatic abscesses, is an extremely rare and frequently fatal complication of diverticulitis. The following report describes a patient presenting with pylephlebitis and complicated diverticulitis. Diagnosis was confirmed by computed tomography. The patient had a favorable outcome with medical and surgical therapy, prompting us to evaluate historical treatment of pylephlebitis.
Saxena R; Adolph M; Ziegler J R; Murphy W; Rutecki G W
The American journal of gastroenterology
1996
1996-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reflex sympathetic dystrophy after modified radical mastectomy: a case report.
Female; Humans; Middle Aged; Pain; Electromyography; Movement; *Postoperative Complications; Arm/physiopathology; Reflex Sympathetic Dystrophy/*etiology/physiopathology/therapy; *Mastectomy; Radical
Despite the long history of descriptions of reflex sympathetic dystrophy (RSD), much confusion remains regarding its pathogenesis, diagnosis, and treatment. It most commonly occurs after trauma and is more frequent in women, white persons, and the elderly. The first case of RSD after mastectomy is reported and the proposed pathophysiology and management of RSD are reviewed.
Saddison D K; Vanek V W
Surgery
1993
1993-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Nephrologists' subjective attitudes towards end-of-life issues and the conduct of terminal care.
Adult; Humans; Middle Aged; Pilot Projects; *Attitude of Health Personnel; Data Collection; *Attitude to Death; Empirical Approach; *Euthanasia; *Terminal Care; Advance Directive Adherence; Advance Directives; Death and Euthanasia; Nephrology; Withholding Treatment; Ethics; Medical; Active
Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy. Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible for selected aspects of terminal care independent of patient choice. To study how nephrologists' perceptions toward end-of-life issues may affect decision-making, we anonymously surveyed 125 of them. The study employed the straightforward terminology of "hastening death" rather than adopting the ambiguous term "euthanasia" or the narrow term "assisted suicide." Subjective physician profiles demonstrated that nephrologists who are less comfortable with dying patients were significantly less likely to report that they omitted life-prolonging measures (p = 0.02) and more likely to report that they would not initiate measures in order to hasten death even were it legal (p = 0.04). Ninety-eight percent of nephrologists reported omissions in terminal care with patient knowledge and 80% without patient knowledge. In contrast, forty-three percent of the nephrologists said that were it to become legal to initiate measures in order to hasten death, they would "never" do so. The ethical framework utilized for discontinuation of dialysis decisions incorporated medical benefit (cancer as criterion, 48%; multisystem complications, 84%; dementia 79%) and quality of life criteria. Twenty-five percent of nephrologists admitted difficulty with advance directives if the directives clashed with heir beliefs. ESRD end-of-life decision-making in the USA may be altered by the subjective characteristics of nephrologists. In particular, nephrologists' level of discomfort with patient mortality is linked with their reported management of terminal patients.
Rutecki G W; Cugino A; Jarjoura D; Kilner J F; Whittier F C
Clinical nephrology
1997
1997-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
[Clues to recognition of kidney disease in archaeologic record: characteristics and occurrence of leontiasis ossium].
Female; Humans; Male; Middle Aged; Aged; Radiography; *Paleopathology; Bone and Bones/diagnostic imaging/*pathology; Arthritis/diagnosis/pathology; Bone Diseases/*diagnosis/pathology; Bone Resorption/diagnosis/pathology; Cephalometry; Chronic Kidney Disease-Mineral and Bone Disorder/diagnosis/pathology; Hyperostosis Frontalis Interna/*diagnosis/pathology; Kidney Diseases/*diagnosis/pathology; Osteochondritis/diagnosis/pathology; Osteomalacia/diagnostic imaging/pathology; Skull/diagnostic imaging/*pathology; Bone Diseases; Hyperparathyroidism; Metabolic/diagnostic imaging; Secondary/diagnosis/pathology
The possible osseous effect of kidney dysfunction was evaluated in a modern skeletal population for future use in assessment of archaeologic samples. Frequency and distribution on the bones of cysts, articular surface alterations, subperiosteal resorption, porosity, osteochondritis, digital tuft alteration and periosteal reaction were recorded in 94 individuals with known kidney failure in the Hamann-Todd collection. Independent radiologic analysis was also pursued. The results were compared with a control sample. The pattern of joint surface alteration and periosteal reaction may facilitate recognition of chronic renal disease in the osseous record. Subtle manifestations of leontiasis ossium are present in the form of cranial thickening and increased cranial size and weight, but teeth spacing are rare. Pseudo osteomatous lesions are common. This study perhaps explains the apparent rarity of actual leontiasis ossium.
Rothschild C; Rothschild B; Hershkovitz I
Reumatismo
2002
2002-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antipsychotic effects of verapamil in schizophrenia.
Adult; Female; Humans; Male; Middle Aged; Random Allocation; Double-Blind Method; Clinical Trials as Topic; Haloperidol/therapeutic use; Schizophrenia/*drug therapy; Verapamil/*therapeutic use
The antipsychotic effects of verapamil were tested in a double-blind, placebo-controlled, randomized study in 18 patients who met Research Diagnostic Criteria for acute schizophrenia. The antipsychotic effect of verapamil as measured by the Bunney-Hamburg Global Rating Scale were equal to those of haloperidol. Both verapamil and haloperidol were superior to placebo in decreasing psychotic symptoms. The results indicate that verapamil may have clinical utility in the treatment of schizophrenia.
Price W A
The Hillside journal of clinical psychiatry
1987
1987
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The incarceration of individuals with severe mental disorders.
Adult; Female; Humans; Male; Middle Aged; Ohio/epidemiology; Criminal Law; Deinstitutionalization; Forensic Psychiatry/*trends; Mental Disorders/classification/*epidemiology/therapy; Mental Health Services/*statistics & numerical data; Mood Disorders/epidemiology; Prisons/*statistics & numerical data; Psychotic Disorders/epidemiology; Schizophrenia/epidemiology; Substance-Related Disorders/epidemiology/therapy; Diagnosis; Dual (Psychiatry)
This study examines the extent to which severely mentally disabled (SMD) patients in one county mental health system were incarcerated in the local jail and examines characteristics of a sample (N = 30) of such individuals. We found that in the study year, 7.9% of known SMD patients had at least one incarceration in the county jail. Diagnoses were predominantly in the schizophrenia spectrum with 70% also actively abusing substances at the time of incarceration. The majority of crimes were non-violent and substance abuse related. Half of the sample was judged to be candidates for diversion programs. Our findings are consistent with recent literature confirming that substance abusing SMD individuals are at high risk of incarceration and could benefit from integrated mental health and substance abuse treatment.
Munetz M R; Grande T P; Chambers M R
Community mental health journal
2001
2001-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cardiac computed tomographic angiography and the primary care physician.
Adult; Female; Humans; Male; Middle Aged; Aged; Risk Assessment/methods; Primary Health Care/*methods; Chest Pain/diagnosis/etiology; Coronary Artery Disease/*diagnosis/pathology; Coronary Vessels/*pathology; Stroke Volume; Tomography; *Physicians; Ventricular Function; Left; Primary Care; X-Ray Computed/*instrumentation
Through advancements in computer processing speed and storage capacity, new cardiac imaging modalities have become clinically feasible and useful. Cardiac computed tomographic angiography, a new diagnostic imaging modality, is capable of assessing coronary artery disease and left ventricular function on a par with invasive coronary arteriography in selected patients who meet appropriate use criteria. This imaging modality is of clinical value in the assessment of patients with chest pain who have an intermediate risk of coronary atherosclerosis. The purpose of the present report is to educate primary care physicians about the basic principles of advanced cardiac imaging techniques and to convey a useful strategy for their appropriate use in the current environment of medical economics.
Mikolich J Ronald
The Journal of the American Osteopathic Association
2012
2012-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Family practice residents' identification and management of obesity.
Adult; Female; Humans; Male; Middle Aged; Risk Factors; Prevalence; Body Mass Index; Motivation; Age Factors; Sex Factors; *Primary Health Care; *Family Practice; Medical Records; Self Care; Obesity/epidemiology/*therapy
This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.
McArtor R E; Iverson D C; Benken D; Dennis L K
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity
1992
1992-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Effect of digital rectal examination (and ejaculation) on serum prostate-specific antigen after twenty-four hours. A randomized, prospective study.
Adult; Humans; Male; Middle Aged; Time Factors; Aged; Prospective Studies; Rectum; *Palpation; Ejaculation; Prostate-Specific Antigen/*blood; 80 and over
The purpose of this randomized, controlled, clinical trial was to determine the effect of the digital rectal examination (DRE) on the prostate-specific antigen (PSA) serum levels in view of conflicting literature reports and screening methods and misconceptions by physicians. We showed that the DRE had no clinically important effect on PSA values twenty-four hours later. The mean PSA rose from 1.57 to 1.62 ng/mL, similar to the controls. Ejaculation had no meaningful effect on the serum PSA values.
McAleer J K; Gerson L W; McMahon D; Geller L
Urology
1993
1993-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Incorporating the Oncotype DX breast cancer assay into community practice: an expert Q&A and case study sampling.
Adult; Female; Humans; Middle Aged; Genotype; Clinical Trials as Topic; *Gene Expression Profiling; *Breast Neoplasms/diagnosis/genetics/therapy; Breast Neoplasms/classification/*drug therapy/*genetics/surgery; Gene Expression Profiling/*methods; Polymerase Chain Reaction/methods; Tamoxifen/therapeutic use; Receptors; Antineoplastic Agents; Adjuvant; Chemotherapy; Adjuvant/methods; Estrogen/analysis; Hormonal/therapeutic use
Advances in breast cancer research have confirmed that this malignancy is not a single disease, but rather a collection of genetically distinct diseases with different treatment requirements. In recent years, several studies have confirmed the clinical validity of the Oncotype DX breast cancer assay, not only as a way to predict recurrence but also as a tool for determining therapeutic benefit from adjuvant chemotherapy. Recently, Drs. Terry Mamounas, G. Thomas Budd, and Kathy Miller answered questions about the Oncotype DX assay that are particularly relevant to routine clinical practice. This expert dialog provides a useful update and essential clinical insights about how, why, and when community oncologists may want to incorporate this multi-gene assay into their care of breast cancer patients. In addition, sample case studies offer tangible examples of the practical application of Oncotype DX.
Mamounas Eleftherios P; Budd G Thomas; Miller Kathy D
Clinical advances in hematology & oncology : H&O
2008
2008-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).